Employment exit and entry among U.S. adults with and without arthritis during the Great Recession. A longitudinal study: 2007-2009, NHIS/MEPS
Theis KA , Roblin D , Helmick CG , Luo R . Work 2018 60 (2) 303-318 BACKGROUND: Negative employment consequences of arthritis are known but not fully understood. Examining transitions in and out of work can provide valuable information. OBJECTIVE: To examine associations of arthritis with employment during the Great Recession and predictors of employment transitions. METHODS: Data were for 3,277 adults ages 30-62 years with and without arthritis from the 2007 National Health Interview Survey followed in the Medical Expenditure Panel Survey 2008-2009. Employment (working vs. not working) was ascertained at baseline and five follow-ups. We estimated Kaplan Meier survival curves with 95% confidence intervals (CI) separately for time to stopping work (working at baseline) and starting work (not working at baseline) using Cox proportional hazards regression models with hazard ratios (HR). RESULTS: Arthritis was significantly associated with greater risk of stopping work (HR = 1.7, 95% CI = 1.3-2.2; adjusted HR= 1.5, 95% CI = 1.1-2.0) and significantly associated with 40% lower chance of starting work (HR = 0.6, 95% CI = 0.4-0.8); which reversed on adjustment (HR = 1.5, 95% CI = 1.0-2.2). Employment predictors were mixed by outcome. CONCLUSIONS: During the Great Recession, adults with arthritis stopped work at higher rates and started work at lower rates than those without arthritis. |
Where is tuberculosis transmission happening? Insights from the literature, new tools to study transmission and implications for the elimination of tuberculosis.
Auld SC , Shah NS , Cohen T , Martinson NA , Gandhi NR . Respirology 2018 More than 10 million new cases of tuberculosis (TB) are diagnosed worldwide each year. The majority of these cases occur in low- and middle-income countries where the TB epidemic is predominantly driven by transmission. Efforts to 'end TB' will depend upon our ability to halt ongoing transmission. However, recent studies of new approaches to interrupt transmission have demonstrated inconsistent effects on reducing population-level TB incidence. TB transmission occurs across a wide range of settings, that include households and hospitals, but also community-based settings. While home-based contact investigations and infection control programmes in hospitals and clinics have a successful track record as TB control activities, there is a gap in our knowledge of where, and between whom, community-based transmission of TB occurs. Novel tools, including molecular epidemiology, geospatial analyses and ventilation studies, provide hope for improving our understanding of transmission in countries where the burden of TB is greatest. By integrating these diverse and innovative tools, we can enhance our ability to identify transmission events by documenting the opportunity for transmission-through either an epidemiologic or geospatial connection-alongside genomic evidence for transmission, based upon genetically similar TB strains. A greater understanding of locations and patterns of transmission will translate into meaningful improvements in our current TB control activities by informing targeted, evidence-based public health interventions. |
Update: Influenza Activity in the United States During the 2017-18 Season and Composition of the 2018-19 Influenza Vaccine.
Garten R , Blanton L , Elal AIA , Alabi N , Barnes J , Biggerstaff M , Brammer L , Budd AP , Burns E , Cummings CN , Davis T , Garg S , Gubareva L , Jang Y , Kniss K , Kramer N , Lindstrom S , Mustaquim D , O'Halloran A , Sessions W , Taylor C , Xu X , Dugan VG , Fry AM , Wentworth DE , Katz J , Jernigan D . MMWR Morb Mortal Wkly Rep 2018 67 (22) 634-642 The United States 2017-18 influenza season (October 1, 2017-May 19, 2018) was a high severity season with high levels of outpatient clinic and emergency department visits for influenza-like illness (ILI), high influenza-related hospitalization rates, and elevated and geographically widespread influenza activity across the country for an extended period. Nationally, ILI activity began increasing in November, reaching an extended period of high activity during January-February, and remaining elevated through March. Influenza A(H3N2) viruses predominated through February and were predominant overall for the season; influenza B viruses predominated from March onward. This report summarizes U.S. influenza activity* during October 1, 2017-May 19, 2018.(dagger). |
Burden of severe norovirus disease in Taiwan, 2003-2013
Burke RM , Shih SM , Yen C , Huang YC , Parashar UD , Lopman BA , Wu FT , Hsiung CA , Hall AJ . Clin Infect Dis 2018 67 (9) 1373-1378 Background: Despite the increasingly recognized role of norovirus in global acute gastroenteritis (AGE), specific estimates of the associated disease burden remain sparse, primarily due to limited availability of sensitive norovirus diagnostics in the clinical setting. We sought to estimate the incidence of norovirus-associated hospitalizations by age group in Taiwan using a previously developed indirect regression method. Methods: AGE-related hospitalizations in Taiwan were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes abstracted from a national database; population data were provided from the Department of Household Registration Affairs. Population and hospitalizations were aggregated by month and year (July 2003-June 2013) and grouped by age: <5 years, 5-19 years, 20-64 years, and >/=65 years. Monthly counts of cause-unspecified AGE hospitalizations were modeled as a function of counts of known causes, and the residuals were then analyzed to estimate norovirus-associated hospitalizations. Results: Over the study period, an annual mean of 101400 gastroenteritis-associated hospitalizations occurred in Taiwan (44 per 10000 person-years), most of which (83%) had no specified cause. The overall estimated rate of norovirus-associated hospitalizations was 6.7 per 10000 person-years, with the highest rates in children aged <5 years (63.7/10000 person-years). Predicted norovirus peaked in 2006-2007 and 2012-2013. Conclusions: Our study is one of the first to generate a population-based estimate of severe norovirus disease incidence in Asia, and highlights the large burden of norovirus in Taiwan, particularly in children. Predicted peak norovirus seasons coincided with the emergence of new strains and resulting pandemics, supporting the validity of the estimates. |
The contributions and future direction of Program Science in HIV/STI prevention
Becker M , Mishra S , Aral S , Bhattacharjee P , Lorway R , Green K , Anthony J , Isac S , Emmanuel F , Musyoki H , Lazarus L , Thompson LH , Cheuk E , Blanchard JF . Emerg Themes Epidemiol 2018 15 7 Background: Program Science is an iterative, multi-phase research and program framework where programs drive the scientific inquiry, and both program and science are aligned towards a collective goal of improving population health. Discussion: To achieve this, Program Science involves the systematic application of theoretical and empirical knowledge to optimize the scale, quality and impact of public health programs. Program Science tools and approaches developed for strategic planning, program implementation, and program management and evaluation have been incorporated into HIV and sexually transmitted infection prevention programs in Kenya, Nigeria, India, and the United States. Conclusion: In this paper, we highlight key scientific contributions that emerged from the growing application of Program Science in the field of HIV and STI prevention, and conclude by proposing future directions for Program Science. |
Evaluation of the impact of the ARC program on national nursing and midwifery regulations, leadership, and organizational capacity in East, Central, and Southern Africa
Gross JM , McCarthy CF , Verani AR , Iliffe J , Kelley MA , Hepburn KW , Higgins MK , Kalula AT , Waudo AN , Riley PL . BMC Health Serv Res 2018 18 (1) 406 BACKGROUND: The African Health Professions Regulatory Collaborative (ARC) was launched in 2011 to support countries in East, Central, and Southern Africa to safely and sustainably expand HIV service delivery by nurses and midwives. While the World Health Organization recommended nurse initiated and managed antiretroviral therapy, many countries in this region had not updated their national regulations to ensure nurses and midwives were authorized and trained to provide essential HIV services. For four years, ARC awarded annual grants, convened regional meetings, and provided technical assistance to country teams of nursing and midwifery leaders to improve national regulations related to safe HIV service delivery. We examined the impact of the program on national regulations and the leadership and organizational capacity of country teams. METHODS: Data was collected to quantify the level of participation in ARC by each country (number of grants received, number of regional meetings attended, and amount of technical assistance received). The level of participation was analyzed according to two primary outcome measures: 1) changes in national regulations and 2) improvements in leadership and organizational capacity of country teams. Changes in national regulations were defined as advancement of one "stage" on a capability maturity model; nursing and midwifery leadership and organizational capacity was measured by a group survey at the end of the program. RESULTS: Seventeen countries participated in ARC between 2012 and 2016. Thirty-three grants were awarded; the majority addressed continuing professional development (20; 61%) and scopes of practice (6; 18%). Fourteen countries (representing approximately two-thirds of grants) progressed at least one stage on the capability maturity model. There were significant increases in all five domains of leadership and organizational capacity (p < 0.01). The number of grants (Kendall's tau = 0.56, p = 0.02), duration of technical assistance (Kendall's tau = 0.50, p = 0.03), and number of learning sessions attended (Kendall's tau = 0.46, p = 0.04) were significantly associated with improvements in in-country collaboration between nursing and midwifery organizations. CONCLUSIONS: The ARC program improved national nursing regulations in participating countries and increased reported leadership, organizational capacity, and collaboration among national nursing and midwifery organizations. These changes help ensure national policies and professional regulations underpin nurse initiated and managed treatment for people living with HIV. |
The finding of casual sex partners on the internet, methamphetamine use for sexual pleasure, and incidence of HIV infection among men who have sex with men in Bangkok, Thailand: an observational cohort study
Piyaraj P , van Griensven F , Holtz TH , Mock PA , Varangrat A , Wimonsate W , Thienkrua W , Tongtoyai J , McNamara A , Chonwattana W , Nelson KE . Lancet HIV 2018 5 (7) e379-e389 BACKGROUND: The finding of casual sex partners on the internet and methamphetamine use have been described as risk factors for HIV infection in men who have sex with men (MSM). However, the interplay between these factors has not been studied prospectively in one design. This study aims to determine the associations between finding casual sex partners on the internet and incident methamphetamine use and HIV infection. METHODS: In this observational cohort study of Thai MSM, we recruited Bangkok residents aged 18 years or older with a history of penetrative male-to-male sex in the past 6 months. Baseline and follow-up visits were done at a dedicated study clinic in central Bangkok. Men were tested for HIV infection at every study visit and for sexually transmitted infections at baseline. Baseline demographics and HIV risk behaviour information were collected at every visit by audio computer-assisted self-interview. We used a descriptive model using bivariate odds ratios to elucidate the order of risk factors in the causal pathway to HIV incidence and methamphetamine use. We used Cox proportional hazard regression analysis to evaluate covariates for incident methamphetamine use and HIV infection. FINDINGS: From April 6, 2006, to Dec 31, 2010, 1977 men were screened and 1764 were found eligible. 1744 men were enrolled, of whom 1372 tested negative for HIV and were followed up until March 20, 2012. Per 100 person-years of follow-up, incidence of methamphetamine use was 3.8 (128 events in 3371 person-years) and incidence of HIV infection was 6.0 (212 events in 3554 person-years). In our descriptive model, methamphetamine use, anal sex, and various other behaviours cluster together but their effect on HIV incidence was mediated by the occurrence of ulcerative sexually transmitted infections. Dual risk factors for both incident methamphetamine use and HIV infection were younger age and finding casual sex partners on the internet. Having ever received money for sex was predictive for incident methamphetamine use; living alone or with a housemate, recent anal sex, and ulcerative sexually transmitted infections at baseline were predictive for incident HIV infection. INTERPRETATION: In MSM in Bangkok, casual sex partner recruitment on the internet, methamphetamine use, and sexually transmitted infections have important roles in sustaining the HIV epidemic. Virtual HIV prevention education, drug use harm reduction, and biomedical HIV prevention methods, such as pre-exposure prophylaxis, could help to reduce or revert the HIV epidemic among MSM in Bangkok. FUNDING: US Centers for Disease Control and Prevention. |
In-hospital deaths among adults with community-acquired pneumonia
Waterer GW , Self WH , Courtney DM , Grijalva CG , Balk RA , Girard TD , Fakhran SS , Trabue C , McNabb P , Anderson EJ , Williams DJ , Bramley AM , Jain S , Edwards KM , Wunderink RG . Chest 2018 154 (3) 628-635 INTRODUCTION: Adults hospitalized with community-acquired pneumonia are at high risk for short-term mortality. However, it is unclear whether improvements in in-hospital pneumonia care could substantially lower this risk. We extensively reviewed all in-hospital deaths in a large prospective CAP study to assess the cause of each death and assess the extent of potentially preventable mortality. METHODS: We enrolled adults hospitalized with CAP at five tertiary-care hospitals in the United States. Five physician investigators reviewed the medical record and study database for each patient who died to identify the cause of death, the contribution of CAP to death, and any preventable factors potentially contributing to death. RESULTS: Among 2,320 enrolled patients, 52 (2.2%) died during initial hospitalization. Among these 52 patients, 33 (63.4%) were >/=65 years old, and 32 (61.5%) had >/=2 chronic comorbidities. CAP was judged to be the direct cause of death in 27 (51.9%) patients. Ten (19.2%) patients had do-not-resuscitate orders prior to admission. Four patients were identified in whom a lapse in quality of care potentially contributed to death; pre-existing end-of-life limitations were present in two of these patients. Two patients seeking full medical care experienced a lapse in in-hospital quality of pneumonia care that potentially contributed to death. CONCLUSION: In this study of adults with CAP at tertiary-care hospitals with a low mortality rate, most in-hospital deaths did not appear to be preventable with improvements in in-hospital pneumonia care. Pre-existing end-of-life limitations in care, advanced age, and high comorbidity burden were common among those who died. |
Intelligent Network DisRuption Analysis (INDRA): A targeted strategy for efficient interruption of hepatitis C transmissions
Campo DS , Khudyakov Y . Infect Genet Evol 2018 63 204-215 Hepatitis C virus (HCV) infection is a global public health problem. The implementation of public health interventions (PHI) to control HCV infection could effectively interrupt HCV transmission. PHI targeting high-risk populations, e.g., people who inject drugs (PWID), are the most efficient but there is a lack of tools for prioritizing individuals within a high-risk community. Here, we present Intelligent Network DisRuption Analysis (INDRA), a targeted strategy for efficient interruption of hepatitis C transmissions.Using a large HCV transmission network among PWID in Indiana as an example, we compare effectiveness of random and targeted strategies in reducing the rate of HCV transmission in two settings: (1) long-established and (2) rapidly spreading infections (outbreak). Identification of high centrality for the network nodes co-infected with HIV or>1 HCV subtype indicates that the network structure properly represents the underlying contacts among PWID relevant to the transmission of these infections. Changes in the network's global efficiency (GE) were used as a measure of the PHI effects. In setting 1, simulation experiments showed that a 50% GE reduction can be achieved by removing 11.2 times less nodes using targeted vs random strategies. A greater effect of targeted strategies on GE was consistently observed when networks were simulated: (1) with a varying degree of errors in node sampling and link assignment, and (2) at different levels of transmission reduction at affected nodes. In simulations considering a 10% removal of infected nodes, targeted strategies were ~2.8 times more effective than random in reducing incidence. Peer-education intervention (PEI) was modeled as a probabilistic distribution of actionable knowledge of safe injection practices from the affected node to adjacent nodes in the network. Addition of PEI to the models resulted in a 2-3 times greater reduction in incidence than from direct PHI alone. In setting 2, however, random direct PHI were ~3.2 times more effective in reducing incidence at the simulated conditions. Nevertheless, addition of PEI resulted in a ~1.7-fold greater efficiency of targeted PHI. In conclusion, targeted PHI facilitated by INDRA outperforms random strategies in decreasing circulation of long-established infections. Network-based PEI may amplify effects of PHI on incidence reduction in both settings. |
Invasive methicillin-resistant staphylococcus aureus infections among persons who inject drugs - six sites, 2005-2016
Jackson KA , Bohm MK , Brooks JT , Asher A , Nadle J , Bamberg WM , Petit S , Ray SM , Harrison LH , Lynfield R , Dumyati G , Schaffner W , Townes JM , See I . MMWR Morb Mortal Wkly Rep 2018 67 (22) 625-628 In the United States, age-adjusted opioid overdose death rates increased by >200% during 1999-2015, and heroin overdose death rates increased nearly 300% during 2011-2015 (1). During 2011-2013, the rate of heroin use within the past year among U.S. residents aged >/=12 years increased 62.5% overall and 114.3% among non-Hispanic whites, compared with 2002-2004 (2). Increases in human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections related to increases in injection drug use have been recently highlighted (3,4); likewise, invasive bacterial infections, including endocarditis, osteomyelitis, and skin and soft tissue infections, have increased in areas where the opioid epidemic is expanding (5-7). To assess the effects of the opioid epidemic on invasive methicillin-resistant Staphylococcus aureus (MRSA) infections during 2005-2016, surveillance data from CDC's Emerging Infections Program (EIP) were analyzed (8). Persons who inject drugs were estimated to be 16.3 times more likely to develop invasive MRSA infections than others. The proportion of invasive MRSA cases that occurred among persons who inject drugs increased from 4.1% in 2011 to 9.2% in 2016. Infection types were frequently those associated with nonsterile injection drug use. Continued increases in nonsterile injection drug use are likely to result in increases in invasive MRSA infections, underscoring the importance of public health measures to curb the opioid epidemic. |
Mass chemoprophylaxis for control of outbreaks of meningococcal disease
McNamara LA , MacNeil JR , Cohn AC , Stephens DS . Lancet Infect Dis 2018 18 (9) e272-e281 Although vaccination is the main strategy used to control meningococcal disease outbreaks, mass chemoprophylaxis has also been used as an immediate response to outbreaks, either to supplement vaccination or when vaccination is not possible. However, public health guidelines regarding the use of mass chemoprophylaxis for outbreak control vary by country, partly because the impact of mass chemoprophylaxis on the course of an individual outbreak is difficult to assess. We have reviewed data for the use of mass chemoprophylaxis during 33 outbreaks that occurred both in military populations and in communities and non-military organisations. In most outbreaks, no additional cases of meningococcal disease occurred after mass chemoprophylaxis, or cases occurred only in individuals who had not received prophylaxis. A delay of several weeks was common before cases occurred among prophylaxis recipients. Overall, the outbreak reports that we reviewed suggest that mass chemoprophylaxis might provide temporary protection to chemoprophylaxis recipients during outbreaks. |
Using search engine data as a tool to predict syphilis
Young SD , Torrone EA , Urata J , Aral SO . Epidemiology 2018 29 (4) 574-578 BACKGROUND: Researchers have suggested that social media and online search data might be used to monitor and predict syphilis and other sexually transmitted diseases. Because people at risk for syphilis might seek sexual health and risk-related information on the internet, we investigated associations between internet state-level search query data (e.g., Google Trends) and reported weekly syphilis cases. METHODS: We obtained weekly counts of reported primary and secondary syphilis for 50 states from 2012 to 2014 from the US Centers for Disease Control and Prevention. We collected weekly internet search query data regarding 25 risk-related keywords from 2012 to 2014 for 50 states using Google Trends. We joined 155 weeks of Google Trends data with 1-week lag to weekly syphilis data for a total of 7750 data points. Using the least absolute shrinkage and selection operator, we trained three linear mixed models on the first 10 weeks of each year. We validated models for 2012 and 2014 for the following 52 weeks and the 2014 model for the following 42 weeks. RESULTS: The models, consisting of different sets of keyword predictors for each year, accurately predicted 144 weeks of primary and secondary syphilis counts for each state, with an overall average R of 0.9 and overall average root mean squared error of 4.9. CONCLUSIONS: We used Google Trends search data from the prior week to predict cases of syphilis in the following weeks for each state. Further research could explore how search data could be integrated into public health monitoring systems. |
The prevalence of Middle East respiratory syndrome coronavirus (MERS-CoV) antibodies in dromedary camels in Israel
Harcourt JL , Rudoler N , Tamin A , Leshem E , Rasis M , Giladi M , Haynes LM . Zoonoses Public Health 2018 65 (6) 749-754 Middle East respiratory syndrome coronavirus, MERS-CoV, was identified in Saudi Arabia in 2012, and as of January 29, 2018, there were 2,123 laboratory-confirmed MERS-CoV cases reported to WHO (WHO, 2018, https://www.who.int/emergencies/mers-cov/en/). Multiple studies suggest that dromedary camels are a source for human MERS-CoV infection. MERS-CoV-specific antibodies have been detected in the serum of dromedary camels across Northern Africa and across the Arabian Peninsula. Israel's geographic location places Israel at risk for MERS-CoV infection. To date, MERS-CoV-related illness has not been reported and the burden of MERS-CoV infection in the Israeli population is unknown. The seroprevalence of MERS-CoV-specific antibodies in Israeli dromedary camels is unknown. The objective of this study was to determine the prevalence of MERS-CoV seropositivity in dromedary camels in Israel. The prevalence of MERS-CoV antibodies in Israeli camels was examined in 71 camel sera collected from four farms across Israel by MERS-CoV-specific microneutralization (Mnt) assay and confirmed by MERS-CoV-specific immunofluorescence assay (IFA). Although this study cannot rule out potential antibody cross-reactivity by IFA, the presence of bovine coronavirus-specific antibodies do not appear to impact detection of MERS-CoV antibodies by Mnt. MERS-CoV neutralizing antibodies were detectable in 51 (71.8%) camel sera, and no association was observed between the presence of neutralizing antibodies and camel age or gender. These findings extend the known range of MERS-CoV circulation in Middle Eastern camels. The high rate of MERS-CoV-specific antibody seropositivity in dromedary camels in the absence of any reported human MERS cases suggests that there is still much to be learned about the dynamics of camel-to-human transmission of MERS-CoV. |
Innovative safe water program improvement e-learning for environmental health professionals
Sabogal R , Kalis M , Hubbard B , Oeffinger J , Baddour LJ , Tate C , Shorter C . J Environ Health 2018 80 (10) 38-40 The Centers for Disease Control and Prevention’s (CDC) National Center for Environmental Health (NCEH) released a free e-learning curriculum in January 2018 titled “Safe Water Program Improvement (SWPI).” With approximately 34 million American residents served by privately owned wells (NGWA, 2016), there is a need for training on how health departments can improve their services to homeowners. CDC developed the curriculum for state, local, tribal and territorial health departments as a resource to improve safe drinking water programs focused on private wells and other federally unregulated drinking water. CDC designed the SWPI curriculum using the 10 Essential Environmental Public Health Services (EEPHSs) (Figure 1) and the Environmental Public Health Performance Standards (CDC, 2014) as frameworks. |
Measuring community vulnerability to natural and anthropogenic hazards: The Centers for Disease Control and Prevention's social vulnerability index
Flanagan BE , Hallisey EJ , Adams E , Lavery A . J Environ Health 2018 80 (10) 34-36 Until recent decades, the focus of disaster management remained largely on attributes of the physical world, primarily risk assessments of the threat of natural and anthropogenic hazards to the built environment. The concept of social vulnerability within a disaster management context received increasing attention when researchers recognized that a more complete assessment of risk must also include the socioeconomic and demographic factors that affect community resilience (Flanagan, Gregory, Hallisey, Heitgerd, & Lewis, 2011; Juntunen, 2005). |
Private drinking water systems: Creating a public health network for partnerships, resources, and training: Part 1: The private water network
Hubbard B , Tate C . J Environ Health 2018 80 (9) 42-43 Introduction | In late 2017, the Centers for Disease | Control and Prevention’s Water, Food, | and Environmental Health Services Branch | (WFEHSB) partnered with the National Environmental Health Association (NEHA) to | establish a network focused on private drinking water systems. WFEHSB and NEHA are | creating the Private Water Network to support | the estimated 50 state and 2,800 local environmental public health programs (National | Association of County and City Health Officials, 2017) and the diverse partners working | with them to ensure safe drinking water from | federally unregulated drinking water systems | (e.g., private wells, springs, trucked water). | WFEHSB and NEHA are bringing together | the varied skill sets, experience, and capacity needed to assure safe drinking water for | approximately 34 million U.S. residents relying on private wells and for others depending | on drinking water sources not protected by the | Safe Drinking Water Act (National Ground | Water Association, 2016). Initial members of | the Private Water Network include representatives from state and local health departments, | universities, federal agencies, and national | associations. Members facilitating the network | are working with stakeholders throughout the | private drinking water spectrum to define the | vision, mission, structure, and g |
Cost analysis of tuberculosis diagnosis in cambodia with and without Xpert((R)) MTB/RIF for People living with HIV/AIDS and people with presumptive multidrug-resistant tuberculosis
Pallas SW , Courey M , Hy C , Killam WP , Warren D , Moore B . Appl Health Econ Health Policy 2018 16 (4) 537-548 BACKGROUND: The Xpert((R)) MTB/RIF (Xpert) test has been shown to be effective and cost-effective for diagnosing tuberculosis (TB) under conditions with high HIV prevalence and HIV-TB co-infection but less is known about Xpert's cost in low HIV prevalence settings. Cambodia, a country with low HIV prevalence (0.7%), high TB burden, and low multidrug-resistant (MDR) TB burden (1.4% of new TB cases, 11% of retreatment cases) introduced Xpert into its TB diagnostic algorithms for people living with HIV (PLHIV) and people with presumptive MDR TB in 2012. The study objective was to estimate these algorithms' costs pre- and post-Xpert introduction in four provinces of Cambodia. METHODS: Using a retrospective, ingredients-based microcosting approach, primary cost data on personnel, equipment, maintenance, supplies, and specimen transport were collected at four sites through observation, records review, and key informant consultations. RESULTS: Across the sample facilities, the cost per Xpert test was US$33.88-US$37.11, clinical exam cost US$1.22-US$1.84, chest X-ray cost US$2.02-US$2.14, fluorescent microscopy (FM) smear cost US$1.56-US$1.93, Ziehl-Neelsen (ZN) smear cost US$1.26, liquid culture test cost US$11.63-US$22.83, follow-on work-up for positive culture results and Mycobacterium tuberculosis complex (MTB) identification cost US$11.50-US$14.72, and drug susceptibility testing (DST) cost US$44.26. Specimen transport added US$1.39-US$5.21 per sample. Assuming clinician adherence to the algorithms and perfect test accuracy, the normative cost per patient correctly diagnosed under the post-Xpert algorithms would be US$25-US$29 more per PLHIV and US$34-US$37 more per person with presumptive MDR TB (US$41 more per PLHIV when accounting for variable test sensitivity and specificity). CONCLUSIONS: Xpert test unit costs could be reduced through lower cartridge prices, longer usable life of GeneXpert((R)) (Cepheid, USA) instruments, and increased test volumes; however, epidemiological and test eligibility conditions in Cambodia limit the number of specimens received at laboratories, leading to sub-optimal utilization of current instruments. Improvements to patient referral and specimen transport could increase test volumes and reduce Xpert test unit costs in this setting. |
Systematic review of health care costs related to mental health conditions among cancer survivors
Khushalani JS , Qin J , Cyrus J , Buchanan Lunsford N , Rim SH , Han X , Yabroff KR , Ekwueme DU . Expert Rev Pharmacoecon Outcomes Res 2018 18 (5) 505-517 INTRODUCTION: This systematic review examines healthcare costs associated with mental health conditions among cancer survivors in the United States. Areas covered: Ten published studies were identified. Studies varied substantially in terms of population, mental health conditions examined, data collection methods, and type of cost reported. Cancer survivors with mental health conditions incurred significantly higher total medical costs and costs of most service types compared to cancer survivors without a mental health condition. Additionally, the total healthcare expenditure related to mental health was higher among cancer survivors compared with people without history of cancer. Expert commentary: Mental health conditions are associated with increased healthcare costs among cancer survivors. Future examination of other components of economic burden, including patient out-of-pocket costs, non-medical costs, such as transportation, childcare, and productivity losses for patients and their caregivers, will be important. Additionally, evaluation of economic burden by cancer site, stage at diagnosis, duration of survivorship, and treatment(s) will increase understanding of the overall impact of mental health conditions on cancer survivors and on the healthcare system. |
Safety Surveillance of Diphtheria and Tetanus Toxoids and Acellular Pertussis (DTaP) Vaccines.
Moro PL , Perez-Vilar S , Lewis P , Bryant-Genevier M , Kamiya H , Cano M . Pediatrics 2018 142 (1) OBJECTIVE: To assess the safety of currently licensed diphtheria-tetanus-acellular pertussis (DTaP) vaccines in the United States by using data from the Vaccine Adverse Event Reporting System (VAERS), a spontaneous reporting surveillance system. METHODS: We searched VAERS for US reports of DTaP vaccinations occurring from January 1, 1991, through December 31, 2016, and received by March 17, 2017. We reviewed available medical records for all death reports and a random sample of reports classified as nondeath serious. We used Empirical Bayesian data mining to identify adverse events that were disproportionally reported after DTaP vaccination. RESULTS: VAERS received 50 157 reports after DTaP vaccination; 43 984 (87.7%) of them reported concomitant administration of other vaccines, and 5627 (11.2%) were serious. Median age at vaccination was 19 months (interquartile range 35 months). The most frequently reported events were injection site erythema (12 695; 25.3%), pyrexia (9913; 19.8%), injection site swelling (7542; 15.0%), erythema (5599; 11.2%), and injection site warmth (4793; 9.6%). For 3 of the DTaP vaccines, we identified elevated values for vaccination errors using Empirical Bayesian data mining. CONCLUSIONS: No new or unexpected adverse events were detected. The observed disproportionate reporting for some nonserious vaccination errors calls for better education of vaccine providers on the specific indications for each of the DTaP vaccines. |
Hepatitis B vaccination and screening among foreign-born women of reproductive age in the United States: 2013-2015
Kilmer GA , Barker LK , Ly KN , Jiles RB . Clin Infect Dis 2018 68 (2) 256-265 Background: Mother-to-child transmission of hepatitis B can be prevented with vaccination and screening. Foreign-born women living in the United States may have lower vaccination coverage and greater lifetime exposure to hepatitis B virus than US-born women. Objective: To determine if self-reported hepatitis B vaccination and screening differ between US-born and foreign-born women of reproductive age and examine predictors. Methods: National Health Interview Survey data from 2013-2015 were pooled to estimate prevalence of lifetime history of hepatitis B vaccination and screening self-reported by women aged 18-44 years who were born in the United States or elsewhere (foreign-born). Significance of world region of birth, birth cohort, and immigration-related characteristics were considered. Results: Among women of reproductive age (n= 24,216), reported hepatitis B vaccination was 33% lower for foreign-born (27.3%) than US-born (40.9%) women (t-test P < .05). Vaccination coverage was low for women who were born in Mexico and other parts of Central America, including the Caribbean islands (18.4%), South America (25.3%), and the Indian subcontinent (31.7%). Factors associated with vaccination in both groups included education, income, and health insurance coverage. Screening was reported by 28.5% of foreign-born vs. 31.9% of US-born women (t-test P < .05). The lowest reported screening prevalence occurred among foreign-born Hispanic or Latina Mexican (21.0%) and Puerto Rican (21.9%) women. Factors associated with screening prevalence among foreign-born women included English fluency, recent US residency, and citizenship. Conclusions: Foreign-born women of reproductive age had lower hepatitis B vaccination and screening coverage compared to US-born women of reproductive age. |
Safety of repeated doses of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine in adults and adolescents
Jackson ML , Yu O , Nelson JC , Nordin JD , Tartof SY , Klein NP , Donahue JG , Irving SA , Glanz JM , McNeil MM , Jackson LA . Pharmacoepidemiol Drug Saf 2018 27 (8) 921-925 In light of waning immunity to pertussis following receipt of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine, maintaining protection may require repeated Tdap vaccination. We evaluated the safety of repeated doses of tetanus-containing vaccine in 68 915 nonpregnant adolescents and adults in the Vaccine Safety Datalink population who had received an initial dose of Tdap. Compared with 7521 subjects who received a subsequent dose of tetanus toxoid, reduced diphtheria (Td) vaccine, the 61 394 subjects who received a subsequent dose of Tdap did not have significantly elevated risk of medical visits for seizure, cranial nerve disorders, limb swelling, pain in limb, cellulitis, paralytic syndromes, or encephalopathy/encephalitis/meningitis. These results suggest that repeated Tdap vaccination has acceptable safety relative to Tdap vaccination followed by Td vaccination. |
Update: ACIP Recommendations for the use of quadrivalent live attenuated influenza vaccine (LAIV4) - United States, 2018-19 influenza season
Grohskopf LA , Sokolow LZ , Fry AM , Walter EB , Jernigan DB . MMWR Morb Mortal Wkly Rep 2018 67 (22) 643-645 Intranasally administered live attenuated influenza vaccine (LAIV) was initially licensed in the United States in 2003 as a trivalent formulation (LAIV3) (FluMist, MedImmune, LLC). Quadrivalent live attenuated influenza vaccine (LAIV4) (FluMist Quadrivalent, MedImmune) has been licensed in the United States since 2012 and was first available during the 2013-14 influenza season, replacing LAIV3. During the 2016-17 and 2017-18 influenza seasons, the Advisory Committee on Immunization Practices (ACIP) recommended that LAIV4 not be used because of concerns about low effectiveness against influenza A(H1N1)pdm09-like viruses circulating in the United States during the 2013-14 and 2015-16 seasons (1,2). On February 21, 2018, ACIP recommended that LAIV4 be an option for influenza vaccination of persons for whom it is appropriate for the 2018-19 season (3). This document provides an overview of the information discussed in the decision-making process leading to this recommendation. A description of methodology and data reviewed will be included in the background materials that will supplement the 2018-19 ACIP Influenza Recommendations, which will replace the 2017-18 ACIP influenza statement (2), and which will also contain guidance for the use of LAIV4. |
Preventing intimate partner violence through paid parental leave policies
D'Inverno AS , Reidy DE , Kearns MC . Prev Med 2018 114 18-23 Paid parental leave policies have the potential to strengthen economic supports, reduce family discord, and provide opportunities to empower women (Basile et al., 2016; Niolon et al., 2017). In this article, we present a theory of change and evidence to suggest how paid parental leave may impact intimate partner violence (IPV). In doing so, we present three mechanisms of change (i.e., reduction in financial stress, increase in egalitarian parenting practices, and promotion of child/parent bonding) through which paid parental leave could reduce rates of IPV. We also describe limitations of the current state of knowledge in this area, as well as opportunities for future research. Ultimately, our goal is to facilitate the identification and implementation of approaches that have the potential to reduce violence at the population level. Paid parental leave embodies the potential of policies to change societal-level factors and serve as an important prevention strategy for IPV. |
Vital Signs: Trends in state suicide rates - United States, 1999-2016 and circumstances contributing to suicide - 27 states, 2015
Stone DM , Simon TR , Fowler KA , Kegler SR , Yuan K , Holland KM , Ivey-Stephenson AZ , Crosby AE . MMWR Morb Mortal Wkly Rep 2018 67 (22) 617-624 INTRODUCTION: Suicide rates in the United States have risen nearly 30% since 1999, and mental health conditions are one of several factors contributing to suicide. Examining state-level trends in suicide and the multiple circumstances contributing to it can inform comprehensive state suicide prevention planning. METHODS: Trends in age-adjusted suicide rates among persons aged >/=10 years, by state and sex, across six consecutive 3-year periods (1999-2016), were assessed using data from the National Vital Statistics System for 50 states and the District of Columbia. Data from the National Violent Death Reporting System, covering 27 states in 2015, were used to examine contributing circumstances among decedents with and without known mental health conditions. RESULTS: During 1999-2016, suicide rates increased significantly in 44 states, with 25 states experiencing increases >30%. Rates increased significantly among males and females in 34 and 43 states, respectively. Fifty-four percent of decedents in 27 states in 2015 did not have a known mental health condition. Among decedents with available information, several circumstances were significantly more likely among those without known mental health conditions than among those with mental health conditions, including relationship problems/loss (45.1% versus 39.6%), life stressors (50.5% versus 47.2%), and recent/impending crises (32.9% versus 26.0%), but these circumstances were common across groups. CONCLUSIONS: Suicide rates increased significantly across most states during 1999-2016. Various circumstances contributed to suicides among persons with and without known mental health conditions. IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: States can use a comprehensive evidence-based public health approach to prevent suicide risk before it occurs, identify and support persons at risk, prevent reattempts, and help friends and family members in the aftermath of a suicide. |
PET-PCR for Detection of Plasmodium falciparum Plasmepsin 2 G ene copy number.
Santos Souza S , L'Episcopia M , Severini C , Udhayakumar V , Lucchi NW . Antimicrob Agents Chemother 2018 62 (8) Piperaquine is an important partner drug used in artemisinin-based combination therapies (ACTs). An increase in the plasmepsin 2 and 3 gene copy number has been associated with decreased susceptibility of Plasmodium falciparum to piperaquine in Cambodia. Here, we developed a photo- induced electron transfer real-time PCR (PET-PCR) assay to quantify the copy number of plasmepsin 2 (PfPM2) that can be used in endemic countries to enhance molecular surveillance. |
Characterization of real-time microarrays for simultaneous detection of HIV-1, HIV-2, and hepatitis viruses.
Granade TC , Kodani M , Wells SK , Youngpairoj AS , Masciotra S , Curtis KM , Kamili S , Owen SM . J Virol Methods 2018 259 60-65 Real-time PCR assays for nucleic acid testing (NAT) of hepatitis viruses A-E and for HIV-1 and HIV-2 have been developed; however, a multiplex assay that can simultaneously detect all of these agents is not yet available. Standardized TaqMan assays for detection of hepatitis viruses A-E have been described and applied to TaqMan Array Cards (TAC) which are capable of multiple pathogen detection using a single set of optimized PCR conditions. Assays for three gene regions of HIV-1 (long-terminal repeat (LTR), gag, and polymerase) and HIV-2 (overlap of LTR and gag, protease and integrase) were designed using the hepatitis assay conditions. Nucleic acid extracts of HIV-1-infected samples (44 plasma, 41 whole blood, 20 HIV-1 viral stocks) were tested on the TAC cards; 98 were reactive (92%) with 70 in multiple gene regions. Twenty-four of the 27 (89%) HIV-2 specimens (10 plasma, 1 PBMC lysate, 6 whole blood and 10 plasmids containing HIV-2 polymerase) were detected on TAC. No HIV or hepatitis virus sequences were detected in 30 HIV-negative samples (specificity 100%). Three HBV and 18 HCV co-infections were identified in the HIV-1-infected specimens. Multi-pathogen detection using TAC could provide a rapid, sensitive and more efficient method of surveying for a variety of infectious disease nucleic acids. |
Antigenic characterization of highly pathogenic avian influenza A(H5N1) viruses with chicken and ferret antisera reveals clade-dependent variation in hemagglutination inhibition profiles
Thi Nguyen D , Shepard SS , Burke DF , Jones J , Thor S , Nguyen LV , Nguyen TD , Balish A , Hoang DN , To TL , Iqbal M , Wentworth DE , Spackman E , van Doorn HR , Davis CT , Bryant JE . Emerg Microbes Infect 2018 7 (1) 100 Highly pathogenic avian influenza (HPAI) A(H5N1) viruses pose a significant economic burden to the poultry industry worldwide and have pandemic potential. Poultry vaccination against HPAI A(H5N1) viruses has been an important component of HPAI control measures and has been performed in Vietnam since 2005. To systematically assess antigenic matching of current vaccines to circulating field variants, we produced a panel of chicken and ferret antisera raised against historical and contemporary Vietnamese reference viruses representing clade variants that were detected between 2001 and 2014. The antisera were used for hemagglutination inhibition (HI) assays to generate data sets for analysis by antigenic cartography, allowing for a direct comparison of results from chicken or ferret antisera. HI antigenic maps, developed with antisera from both hosts, revealed varying patterns of antigenic relationships and clustering of viruses that were dependent on the clade of viruses analyzed. Antigenic relationships between existing poultry vaccines and circulating field viruses were also aligned with in vivo protection profiles determined by previously reported vaccine challenge studies. Our results establish the feasibility and utility of HPAI A(H5N1) antigenic characterization using chicken antisera and support further experimental and modeling studies to investigate quantitative relationships between genetic variation, antigenic drift and correlates of poultry vaccine protection in vivo. |
Collaborative method performance study of the measurement of nicotine, its metabolites, and total nicotine equivalents in human urine
Wang L , Bernert JT , Benowitz NL , Feng J , Jacob P , McGahee E , Caudill SP , Scherer G , Scherer M , Pluym N , Doig MV , Newland K , Murphy SE , Caron NJ , Sander LC , Shimizu M , Yamazaki H , Kim S , Langman LJ , Pritchett JS , Sniegoski LT , Li Y , Blount B , Pirkle JL . Cancer Epidemiol Biomarkers Prev 2018 27 (9) 1083-1090 BACKGROUND: Biomarkers of tobacco exposure have a central role in studies of tobacco use and nicotine intake. The most significant exposure markers are nicotine itself and its metabolites in urine. Therefore, it is important to evaluate the performance of laboratories conducting these biomarker measurements. METHODS: This report presents the results from a method performance study involving 11 laboratories from 6 countries which are currently active in this area. Each laboratory assayed blind replicates of 7 human urine pools at various concentrations on 3 separate days. The samples included 5 pools blended from smoker and nonsmoker urine sources, and 2 additional blank urine samples fortified with pure nicotine, cotinine and hydroxycotinine standards. All laboratories used their own methods, and all were based on some form of liquid chromatography / tandem mass spectrometry. RESULTS: Overall, good agreement was found among the laboratories in this study. Intralaboratory precision was good, and in the fortified pools the mean bias observed was < + 3.5% for nicotine, approximately 1.2% for hydroxycotinine, and less than 1% for cotinine (1 outlier excluded in each case). Both indirect and direct methods for analyzing the glucuronides gave comparable results. CONCLUSIONS: This evaluation indicates that the experienced laboratories participating in this study can produce reliable and comparable human urinary nicotine metabolic profiles in samples from people with significant recent exposure to nicotine. IMPACT: This work supports the reliability and agreement of an international group of established laboratories measuring nicotine and its metabolites in urine in support of nicotine exposure studies. |
Malaria diagnostic practices in United States laboratories, 2017
Prestel C , Tan KR , Abanyie F , Jerris R , Gutman JR . J Clin Microbiol 2018 56 (8) Background: In the United States (US), the gold standard for malaria diagnosis is microscopic blood smear examination. Because malaria is not endemic in the US, diagnostic capabilities may be limited, causing delays in diagnosis and increased morbidity and mortality.Methods: A survey of US laboratories was conducted from June to July, 2017 of their malaria diagnostic practices; members of the American Society for Microbiology's listserv received a questionnaire inquiring about malaria diagnostic test availability, techniques, and reporting. Results were assessed using the Clinical and Laboratory Standards Institute (CLSI) guidelines for malaria diagnostics.Results: After excluding incomplete and duplicate responses, responses representing 175 laboratories were included. Most (99%) labs received at least one specimen for malaria diagnosis annually and 31% reported receiving only 1-10 specimens. The majority (74%) diagnosed five or fewer cases of malaria per year. Most (90%) performed blood smears on-site. Two-thirds (70%) provided initial blood smear results within 4 hours. Although diagnostic testing for malaria was available 24/7 at 74% (141) of responding laboratories, only 12% (17) met criteria for analysis and reporting of malaria testing, significantly higher than reported in a similar survey in 2010 (3%; p<0.05).Conclusion: The majority of laboratories surveyed had the capability for timely diagnosis of malaria; few comply with CLSI guidelines. Inexperience may factor into this non-compliance; many laboratories see few to no cases of malaria per year. Although reported adherence to CLSI guidelines was higher than in 2010, there is a need to further improve laboratory compliance with recommendations. |
Quantitative HPLC-MS/MS analysis of toxins in soapberry seeds: Methylenecyclopropylglycine and hypoglycin A
Sanford AA , Isenberg SL , Carter MD , Mojica MA , Mathews TP , Harden LA , Takeoka GR , Thomas JD , Pirkle JL , Johnson RC . Food Chem 2018 264 449-454 Methylenecyclcopropylglycine (MCPG) and hypoglycin A (HGA) are naturally occurring amino acids found in various soapberry (Sapindaceae) fruits. These toxins have been linked to illnesses worldwide and were recently implicated in Asian outbreaks of acute hypoglycemic encephalopathy. In a previous joint agricultural and public health investigation, we developed an analytical method capable of evaluating MCPG and HGA concentrations in soapberry fruit arils as well as a clinical method for the urinary metabolites of the toxins. Since the initial soapberry method only analyzed the aril portion of the fruit, we present here the extension of the method to include the fruit seed matrix. This work is the first method to quantitate both MCPG and HGA concentrations in the seeds of soapberry fruit, including those collected during a public health investigation. Further, this is the first quantitation of HGA in litchi seeds as well as both toxins in mamoncillo and longan seeds. |
Type 2 immune mechanisms in carbon nanotube-induced lung fibrosis
Dong J , Ma Q . Front Immunol 2018 9 1120 T helper (Th) 2-dependent type 2 immune pathways have been recognized as an important driver for the development of fibrosis. Upon stimulation, activated Th2 immune cells and type 2 cytokines interact with inflammatory and tissue repair functions to stimulate an overzealous reparative response to tissue damage, leading to organ fibrosis and destruction. In this connection, type 2 pathways are activated by a variety of insults and pathological conditions to modulate the response. Carbon nanotubes (CNTs) are nanomaterials with a wide range of applications. However, pulmonary exposure to CNTs causes a number of pathologic outcomes in animal lungs, dominated by inflammation and fibrosis. These findings, alongside the rapidly expanding production and commercialization of CNTs and CNT-containing materials in recent years, have raised concerns on the health risk of CNT exposure in humans. The CNT-induced pulmonary fibrotic lesions resemble those of human fibrotic lung diseases, such as idiopathic pulmonary fibrosis and pneumoconiosis, to a certain extent with regard to disease development and pathological features. In fibrotic scenarios, immune cells are activated including varying immune pathways, ranging from innate immune cell activation to autoimmune disease. These events often precede and/or accompany the occurrence of fibrosis. Upon CNT exposure, significant induction and activation of Th2 cells and type 2 cytokines in the lungs are observed. Moreover, type 2 pathways are shown to play important roles in promoting CNT-induced lung fibrosis by producing type 2 pro-fibrotic factors and inducing the reparative phenotypes of macrophages in response to CNTs. In light of the vastly increased demand for nanosafety and the apparent induction and multiple roles of type 2 immune pathways in lung fibrosis, we review the current literature on CNT-induced lung fibrosis, with a focus on the induction and activation of type 2 responses by CNTs and the stimulating function of type 2 signaling on pulmonary fibrosis development. These analyses provide new insights into the mechanistic understanding of CNT-induced lung fibrosis, as well as the potential of using type 2 responses as a monitoring target and therapeutic strategy for human fibrotic lung disease. |
Case definitions for conditions identified by newborn screening public health surveillance
Sontag MK , Sarkar D , Comeau AM , Hassell K , Botto LD , Parad R , Rose SR , Wintergerst KA , Smith-Whitley K , Singh S , Yusuf C , Ojodu J , Copeland S , Hinton CF . Int J Neonatal Screen 2018 4 (2) 16 Newborn screening (NBS) identifies infants with rare conditions to prevent death or the onset of irreversible morbidities. Conditions on the Health and Human Services Secretary's Recommended Uniform Screening Panel have been adopted by most state NBS programs, providing a consistent approach for identification of affected newborns across the United States. Screen-positive newborns are identified and referred for confirmatory diagnosis and follow-up. The designation of a clinically significant phenotype precursor to a clinical diagnosis may vary between clinical specialists, resulting in diagnostic variation. Determination of disease burden and birth prevalence of the screened conditions by public health tracking is made challenging by these variations. This report describes the development of a core group of new case definitions, along with implications, plans for their use, and links to the definitions that were developed by panels of clinical experts. These definitions have been developed through an iterative process and are piloted in NBS programs. Consensus public health surveillance case definitions for newborn screened disorders will allow for consistent categorization and tracking of short- and long-term follow-up of identified newborns at the local, regional, and national levels. |
Leveraging resources to establish equitable breastfeeding support across Alabama
Barrera CM , Whatley G , Stratton A , Kahin S , Roberts Ayers D , Grossniklaus D , MacGowan C . J Hum Lact 2018 34 (3) 890334418775631 Breastfeeding is the best source of nutrition for infants, and research emphasizes the benefits of breastfeeding for both mother and infant (American Academy of Pediatrics, 2012; Ip et al., 2007). The American Academy of Pediatrics (2012) recommends exclusive breastfeeding for about the first 6 months of life, and continued breastfeeding for 1 year or longer. In the United States, only 24.9% of infants are exclusively breastfed for 6 months and 33.7% receive any human milk at 12 months (Centers for Disease Control and Prevention [CDC], 2017a). Furthermore, there are disparities among rates of initiation and duration: Rates are lowest for infants who are non-Hispanic Black, living in rural areas, or living in the southeastern United States (CDC, 2017a). |
Association of iodine deficiency with hearing impairment in US adolescents aged 12 to 19 years: Analysis of NHANES 2007-2010 data
Scinicariello F , Buser MC . JAMA Otolaryngol Head Neck Surg 2018 144 (7) 644-645 This analysis of data from NHANES 2007-2010 evaluates associations between urinary iodine concentrations and hearing impairment among US adolescents. |
Biomarkers of Nutrition for Development (BOND) - Iron review
Lynch S , Pfeiffer CM , Georgieff MK , Brittenham G , Fairweather-Tait S , Hurrell RF , McArdle HJ , Raiten DJ . J Nutr 2018 148 1001s-1067s This is the fifth in the series of reviews developed as part of the Biomarkers of Nutrition for Development (BOND) program. The BOND Iron Expert Panel (I-EP) reviewed the extant knowledge regarding iron biology, public health implications, and the relative usefulness of currently available biomarkers of iron status from deficiency to overload. Approaches to assessing intake, including bioavailability, are also covered. The report also covers technical and laboratory considerations for the use of available biomarkers of iron status, and concludes with a description of research priorities along with a brief discussion of new biomarkers with potential for use across the spectrum of activities related to the study of iron in human health.The I-EP concluded that current iron biomarkers are reliable for accurately assessing many aspects of iron nutrition. However, a clear distinction is made between the relative strengths of biomarkers to assess hematological consequences of iron deficiency versus other putative functional outcomes, particularly the relationship between maternal and fetal iron status during pregnancy, birth outcomes, and infant cognitive, motor and emotional development. The I-EP also highlighted the importance of considering the confounding effects of inflammation and infection on the interpretation of iron biomarker results, as well as the impact of life stage. Finally, alternative approaches to the evaluation of the risk for nutritional iron overload at the population level are presented, because the currently designated upper limits for the biomarker generally employed (serum ferritin) may not differentiate between true iron overload and the effects of subclinical inflammation. |
Re-emergence of thiamine deficiency disease in the Pacific islands (2014-15): A case-control study
Nilles EJ , Manaia A , Ruaia B , Huppatz C , Ward C , George P , Sies C , Cangiano A , Sejvar J , Reiffer A , Tira T . PLoS One 2018 13 (6) e0198590 BACKGROUND: From late 2014 multiple atolls in Kiribati reported an unusual and sometimes fatal illness. We conducted an investigation to identify the etiology of the outbreak on the most severely affected atoll, Kuria, and identified thiamine deficiency disease as the cause. Thiamine deficiency disease has not been reported in the Pacific islands for >5 decades. We present the epidemiological, clinical, and laboratory findings of the investigation. METHODOLOGY/PRINCIPAL FINDINGS: We initially conducted detailed interviews and examinations on previously identified cases to characterize the unknown illness and develop a case definition. Active and passive surveillance was then conducted to identify additional cases. A questionnaire to identify potential risk factors and blood samples to assay biochemical indices were collected from cases and asymptomatic controls. Thiamine hydrochloride treatment was implemented and the response to treatment was systematically monitored using a five-point visual analogue scale and by assessing resolution of previously abnormal neurological examination findings. Risk factors and biochemical results were assessed by univariate and multivariate analyses. 69 cases were identified on Kuria (7% attack rate) including 34 confirmed and 35 unconfirmed. Most were adults (median age 28 years [range 0-62]) and 83% were male. Seven adult males and two infants died (13% case fatality rate). Resolution of objective clinical signs (78%) or symptoms (94%) were identified within one week of starting treatment. Risk factors included having a friend with thiamine deficiency disease and drinking kava; drinking yeast alcohol reduced the risk of disease. Higher chromium (p<0.001) but not thiamine deficiency (p = 0.66) or other biochemical indices were associated with disease by univariate analyses. Chromium (p<0.001) and thiamine deficiency (p = 0.02) were associated with disease by multivariate analysis. CONCLUSIONS/SIGNIFICANCE: An outbreak of thiamine deficiency disease (beriberi) in Kiribati signals the re-emergence of a classic nutritional disease in the Pacific islands after five decades. Although treatment is safe and effective, the underlying reason for the re-emergence remains unknown. Chromium was highly and positively correlated with disease in this study raising questions about the potential role of factors other than thiamine in the biochemistry and pathophysiology of clinical disease. |
Carpal tunnel syndrome prevalence: an evaluation of workers at a raw poultry processing plant
Musolin KM , Ramsey JG . Int J Occup Environ Health 2018 23 (4) 1-9 OBJECTIVES: Evaluate the prevalence of carpal tunnel syndrome (CTS) among workers at a raw poultry processing plant and categorize jobs on the basis of hand activity and force. METHODS: A cross-sectional survey among 191 workers assessed CTS defined by self-reported CTS symptoms, a hand symptom diagram, and measurements of nerve conduction parameters. We categorized jobs based on American Conference of Governmental Industrial Hygienists' (ACGIH(R)) limits for hand activity and force, and examined the relationships with CTS occurrence. RESULTS: A total of 64 workers (34%) had CTS after adjusting for non-occupational factors. Overall, 81% of jobs were above the ACGIH action limit; 59% were above the ACGIH threshold limit value(R). CTS prevalence did not differ significantly between exposure groups (PR = 0.82, p = 0.35). CONCLUSIONS: These findings suggest that poultry processing jobs continue to be hazardous with workers at risk for CTS. Recommendations for the study population were provided to reduce exposure and CTS risk among workers. |
Sleep quality and the cortisol awakening response (CAR) among law enforcement officers: The moderating role of leisure time physical activity
Fekedulegn D , Innes K , Andrew ME , Tinney-Zara C , Charles LE , Allison P , Violanti JM , Knox SS . Psychoneuroendocrinology 2018 95 158-169 OBJECTIVE: The goal of this study was to investigate the role of leisure time physical activity (LTPA) on the association between sleep quality and the cortisol awakening response (CAR) in people with an occupation that exposes them to high levels of stress. METHODS: Participants were 275 police officers (age=42 years +/- 8.3, 27% women) enrolled in the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study (conducted between 2004 and 2009). Officers provided four salivary cortisol samples (on awakening and 15, 30, and 45min after awakening). Hours of leisure time physical activity were assessed using the Seven-Day Physical Activity Recall questionnaire. Sleep quality (good/poor) was evaluated using the Pittsburgh Sleep Quality Index (PSQI) scale. Analysis of covariance and repeated measures models were used to examine the association of sleep quality to the two aspects of CAR: cortisol levels (total area under the curve (AUCG), mean, and peak cortisol) and cortisol profiles (the overall pattern in cortisol level during the 45min period following awakening, the increase in cortisol from baseline to average of post awakening values (mean increase), and area under the curve with respect to increase (AUCI)). Analyses were stratified by participant level of reported LTPA (sufficiently vs. insufficiently active, defined as >/= 150 vs.<150min/week of moderate intensity activity, respectively). Since cortisol activity is known to be influenced by gender, we conducted additional analyses also stratified by gender. RESULTS: Overall, results demonstrated that LTPA significantly moderated the association of sleep quality with CAR. Among participants who were sufficiently active, CAR did not differ by sleep quality. However, in those who were insufficiently active during their leisure time, poor sleep quality was associated with a significantly reduced level of total awakening cortisol secretion (AUCG (a.u.)=777.4+/-56 vs. 606.5+/-45, p=0.02; mean cortisol (nmol/l)=16.7+/-1.2 vs. 13.3+/-0.9, p=0.03; peak cortisol (nmol/l)=24.0+/-1.8 vs. 18.9+/-1.5, p=0.03 for good vs. poor sleep quality, respectively). The normal rise in cortisol after awakening was also significantly lower in inactive officers with poor sleep quality than in those with good sleep quality (mean increase (nmol/l)=6.7+/-1.5 vs. 2.3+/-1.2, p=0.03; AUCI (a.u.)=249.3+/-55 vs. 83.3+/-44, p=0.02 for those with good vs. poor sleep quality, respectively). While findings for male officers were consistent with the overall results, CAR did not differ by sleep quality in female officers regardless of LTPA level. CONCLUSION: Findings of this study suggest that poor sleep quality is associated with diminished awakening cortisol levels and dysregulated cortisol patterns over time, but only among officers who were inactive or insufficiently active during their leisure time. In contrast, sleep quality was not associated with any measures of CAR in officers who reported sufficient activity, suggesting a potential protective effect of LTPA. In analyses stratified by gender, findings for male officers were similar to those in the pooled sample, although we found no evidence for a modifying effect of LTPA in women. Future longitudinal studies in a larger population are needed to confirm these findings and further elucidate the relationships between LTPA, sleep quality, and cortisol response. |
Use of nanomaterials in animals
Howard J , Murashov V . Appl Biosaf 2018 23 (3) 162-167 Nanotechnology is predicted to be a transformative technology and lead to improvements in many aspects of human life. Accumulating scientific evidence from experimental animal studies indicates that exposure to some engineered nanomaterials may cause adverse health effects. Despite efforts to move away from using animals for toxicity and biological testing, the use of animals in nanomaterial testing raises the potential for harmful occupational exposure to researchers, laboratory technicians, and custodial personnel. The risks to workers from such unintentional exposures can be reduced or eliminated through identification of the hazards arising from the use nanomaterials in animals, assessment of all potential worker exposures, and implementation of effective exposure control measures. Proactive guidelines for safe handling of nanomaterials in laboratories are available from both public and private sector bodies and should be consulted regularly to ensure awareness of the newest, actionable nanomaterial risk prevention information. |
Applying the precaution adoption process model to the acceptance of mine safety and health technologies
Haas EJ . Occup Health Sci 2018 2 (1) 43-66 Mineworkers are continually introduced to protective technologies on the job. Yet, their perceptions toward the technologies are often not addressed until they are actively trying to use them, which may halt safe technology adoption and associated work practices. This study explored management and worker perspectives toward three technologies to forecast adoption and behavioral intention on the job. Interviews and focus groups were conducted with 21 mineworkers and 19 mine managers to determine the adoption process stage algorithm for workers and managers, including perceived barriers to using new safety and health technologies. Differences between workers and managers were revealed in terms of readiness, perceptions, and initial trust in using technologies. Workers, whether they had or had not used a particular technology, still had negative perceptions toward its use in the initial introduction and integration at their mine site, indicating a lengthy time period needed for full adoption. The key finding from these results is that a carefully considered and extended introduction of technology for workers in Stage 3 (undecided to act) is most important to promote progression to Stage 5 (decided to act) and to avoid Stage 4 (decided not to act). In response, organizational management may need to account for workers' particular stage algorithm, using the Precaution Adoption Process Model, to understand how to tailor messages about protective technologies, administer skill-based trainings and interventions that raise awareness and knowledge, and ultimately encourage safe adoption of associated work practices. |
Mineworker fatigue: A review of what we know and future decisions
Bauerle T , Dugdale Z , Poplin G . Min Eng 2018 70 (3) 33 Fatigue presents several challenges for the mining industry. Depending on the specific occupation, daily work or operational setup on any given mine site, mining jobs can have a fair amount of labor-intensive tasks mixed with monotonous and repetitive duties. Combined with the long working hours and shift-work schedules of mining work, the prevalence of fatigue in mine workers may seem rather unsurprising. |
A Case of Prototheca zopfii Genotype 1 Infection in a Dog (Canis lupus familiaris).
Silveira CS , Cesar D , Keating MK , DeLeon-Carnes M , Armien AG , Luhers M , Riet-Correa F , Giannitti F . Mycopathologia 2018 183 (5) 853-858 Protothecosis is a rare disease caused by environmental algae of the genus Prototheca. These are saprophytic, non-photosynthetic, aerobic, colorless algae that belong to the Chlorellaceae family. Seven different species have been described. Prototheca zopfii genotype 2 and P. wickerhamii are most commonly involved in pathogenic infections in humans and animals. The objective of this work is to describe, for the first time, a case of protothecosis caused by P. zopfii genotype 1 in a dog. The dog, a 4-year-old mix bred male, was presented to a veterinary clinic in Montevideo, Uruguay, with multiple skin nodules, one of which was excised by surgical biopsy. The sample was examined histologically and processed by PCR, DNA sequencing, and restriction fragments length polymorphisms for the detection and genotyping of P. zopfii. In addition, transmission electron microscopy and scanning electron microscopy were performed. Histology showed severe ulcerative granulomatous dermatitis and panniculitis with myriads of pleomorphic algae. Algal cells were 4-17 microm in size, with an amphophilic, 2-4-microm-thick wall frequently surrounded by a clear halo, contained flocculant material and a deeply basophilic nucleus, and internal septae with daughter cells (endospores) consistent with endosporulation. Ultrastructurally, algal cells/endospores at different stages of development were found within parasitophorous vacuoles in macrophages. Prototheca zopfii genotype 1 was identified by molecular testing, confirming the etiologic diagnosis of protothecosis. |
Design, implementation, and evaluation of a school insecticide-treated net distribution program in Cross River State, Nigeria
Acosta A , Obi E , Ato Selby R , Ugot I , Lynch M , Maire M , Belay K , Okechukwu A , Inyang U , Kafuko J , Greer G , Gerberg L , Fotheringham M , Koenker H , Kilian A . Glob Health Sci Pract 2018 6 (2) 272-287 BACKGROUND: In 2013, the World Health Organization recommended distribution through schools, health facilities, community health workers, and mass campaigns to maintain coverage with insecticide-treated nets (ITNs). We piloted school distribution in 3 local government areas (LGAs) of Cross River State, Nigeria. METHODS: From January to March 2011, all 3 study sites participated in a mass ITN campaign. Baseline data were collected in June 2012 (N=753 households) and school distribution began afterward. One ITN per student was distributed to 4 grades once a year in public schools. Obubra LGA distributed ITNs in 2012, 2013, and 2014 and Ogoja LGA in 2013 and 2014 while Ikom LGA served as a comparison site. Pregnant women in all sites were eligible to receive ITNs through standard antenatal care (ANC). Endline survey data (N=1,450 households) were collected in March 2014. Data on ITN ownership, population access to an ITN, and ITN use were gathered and analyzed. Statistical analysis used contingency tables and chi-squared tests for univariate analysis, and a concentration index was calculated to assess equity in ITN ownership. RESULTS: Between baseline and endline, household ownership of at least 1 ITN increased in the intervention sites, from 50% (95% confidence interval [CI]: 44.7, 54.3) to 76% (95% CI: 71.2, 81.0) in Ogoja and from 51% (95% CI: 35.3, 66.7) to 78% (95% CI: 71.5, 83.1) in Obubra, as did population access to ITN, from 36% (95% CI: 32.0, 39.5) to 53% (95% CI: 48.0, 58.0) in Ogoja and from 34% (95% CI: 23.2, 45.6) to 55% in Obubra (95% CI: 48.4, 60.9). In contrast, ITN ownership declined in the comparison site, from 64% (95% CI: 56.4, 70.8) to 43% (95% CI: 37.4, 49.4), as did population ITN access, from 47% (95% CI: 40.0, 53.7) to 26% (95% CI: 21.9, 29.9). Ownership of school ITNs was nearly as equitable (concentration index 0.06 [95% CI: 0.02, 0.11]) as for campaign ITNs (-0.03 [95% CI: -0.08, 0.02]), and there was no significant oversupply or undersupply among households with ITNs. Schools were the most common source of ITNs at endline and very few households (<2%) had nets from both school and ANC. CONCLUSION: ITN distribution through schools and ANC provide complementary reach and can play an effective role in achieving and maintaining universal coverage. More research is needed to evaluate the cost-effectiveness of such continuous distribution channels in combination with, or as a potential replacement for, subsequent mass campaigns. |
Dracunculiasis eradication: Are we there yet
Hopkins DR , Ruiz-Tiben E , Eberhard ML , Weiss A , Withers PC , Roy SL , Sienko DG . Am J Trop Med Hyg 2018 99 (2) 388-395 This report summarizes the status of the global Dracunculiasis Eradication Program as of the end of 2017. Dracunculiasis (guinea worm disease) has been eliminated from 19 of 21 countries where it was endemic in 1986, when an estimated 3.5 million cases occurred worldwide. Only Chad and Ethiopia reported cases in humans, 15 each, in 2017. Infections of animals, mostly domestic dogs, with Dracunculus medinensis were reported in those two countries and also in Mali. Insecurity and infections in animals are the two main obstacles remaining to interrupting dracunculiasis transmission completely. |
Laboratory diagnosis of neurocysticercosis/Taenia solium
Garcia HH , O'Neal SE , Noh J , Handali S . J Clin Microbiol 2018 56 (9) Neurocysticercosis accounts for approximately 30% of all epilepsy cases in most developing countries. Immunodiagnosis of cysticercosis is complex and strongly influenced by the course of infection, the disease burden and cyst location, and the immune response of the host. The main approach to immunodiagnosis should thus be to evaluate whether the serological results are consistent with the diagnosis suggested by imaging. Antibody detection is performed using lentil-lectin purified parasite antigens in an enzyme-linked immunoelectrotransfer blot format while antigen detection uses a monoclonal antibody-based ELISA. Promising new assay configurations have been developed for detection of both antibody and antigen, including assays based on synthetic or recombinant antigens that may reduce costs and improve assay reproducibility, and multiplex bead based assays that may provide simultaneous quantitative results for several target antigens or antibodies. |
Supporting active living through community plans: The association of planning documents with design standards and features
Peterson EL , Carlson SA , Schmid TL , Brown DR , Galuska DA . Am J Health Promot 2018 33 (2) 890117118779011 PURPOSE: The purpose of this study was to examine the association between the presence of supportive community planning documents in US municipalities with design standards and requirements supportive of active living. DESIGN: Cross-sectional study using data from the 2014 National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living. SETTING: Nationally representative sample of US municipalities. PARTICIPANTS: Respondents are 2005 local officials. MEASURES: Assessed: (1) The presence of design standards and feature requirements and (2) the association between planning documents and design standards and feature requirements supportive of active living in policies for development. ANALYSIS: Using logistic regression, significant trends were identified in the presence of design standards and feature requirements by plan and number of supportive objectives present. RESULTS: Prevalence of design standards ranged from 19% (developer dedicated right-of-way for bicycle infrastructure development) to 50% (traffic-calming features in areas with high pedestrian and bicycle volume). Features required in policies for development ranged from 14% (short/medium pedestrian-scale block sizes) to 44% (minimum sidewalk widths of 5 feet) of municipalities. As the number of objectives in municipal plans increased, there was a significant and positive trend ( P < .05) in the prevalence of each design standard and requirement. CONCLUSIONS: Municipal planning documents containing objectives supportive of physical activity are associated with design standards and feature requirements supportive of activity-friendly communities. |
Impact of the Tips From Former Smokers Campaign on population-level smoking cessation, 2012-2015
Murphy-Hoefer R , Davis KC , Beistle D , King BA , Duke J , Rodes R , Graffunder C . Prev Chronic Dis 2018 15 E71 This study provides estimates of the long-term cumulative impact of the Centers for Disease Control and Prevention's national tobacco education campaign, Tips From Former Smokers (Tips), on population-level smoking cessation. We used recently published estimates of the association between increased Tips campaign media doses and quit attempts to calculate campaign-attributable population sustained (6-month) quits during 2012-2015. Tips led to approximately 522,000 sustained quits during 2012-2015. These findings indicate that the Tips campaign's comprehensive approach to combining evidence-based messages with the promotion of cessation resources was successful in achieving substantial long-term cigarette cessation at the population level over multiple years. |
Rules to prohibit the use of electronic vapor products inside homes and personal vehicles among adults in the U.S., 2017
Gentzke AS , Homa DM , Kenemer JB , Gomez Y , King BA . Prev Med 2018 114 47-53 Most U.S. adults have voluntary rules prohibiting the use of smoked tobacco products in their homes and vehicles. However, the prevalence of similar rules for electronic vapor products (EVPs) is uncertain. This study assessed the prevalence and correlates of rules prohibiting EVP use inside homes and vehicles. Data from a 2017 Internet-based panel survey of U.S. adults aged >/=18years (n=4107) were analyzed. For homes and vehicles, prevalence of reporting that EVP use was not allowed, partially allowed, fully allowed, or unknown was assessed overall and by covariates. Correlates of prohibiting EVP use was assessed by multivariable logistic regression. In homes, 58.6% of adults did not allow EVP use, 7.7% partially allowed use, 10.1% fully allowed use, and 23.6% were unsure of the rules. In vehicles, 63.8% of respondents did not allow EVP use, 6.0% partially allowed use, 8.9% fully allowed use, and 21.4% were unsure of the rules. Following multivariable adjustment, prohibiting EVP use inside homes and vehicles was more likely among respondents with higher income and education, and with a child aged <18years. Users of EVPs and other tobacco products, and respondents living with users of EVPs and other tobacco products, were less likely to prohibit EVP use in these locations. These findings show that about 6 in 10U.S. adults have rules prohibiting EVP use inside homes and vehicles, but variations exist by population subgroups. Voluntary smoke-free rules in homes and vehicles that include EVPs can help protect children and non-users from secondhand EVP aerosol exposure. |
Systemic absorption of nicotine following acute secondhand exposure to electronic cigarette aerosol in a realistic social setting
Melstrom P , Sosnoff C , Koszowski B , King BA , Bunnell R , Le G , Wang L , Thanner MH , Kenemer B , Cox S , DeCastro BR , McAfee T . Int J Hyg Environ Health 2018 221 (5) 816-822 Evidence suggests exposure of nicotine-containing e-cigarette aerosol to nonusers leads to systemic absorption of nicotine. However, no studies have examined acute secondhand exposures that occur in public settings. Here, we measured the serum, saliva and urine of nonusers pre- and post-exposure to nicotine via e-cigarette aerosol. Secondarily, we recorded factors affecting the exposure. Six nonusers of nicotine-containing products were exposed to secondhand aerosol from ad libitum e-cigarette use by three e-cigarette users for 2h during two separate sessions (disposables, tank-style). Pre-exposure (baseline) and post-exposure peak levels (Cmax) of cotinine were measured in nonusers' serum, saliva, and urine over a 6-hour follow-up, plus a saliva sample the following morning. We also measured solution consumption, nicotine concentration, and pH, along with use behavior. Baseline cotinine levels were higher than typical for the US population (median serum session one=0.089ng/ml; session two=0.052ng/ml). Systemic absorption of nicotine occurred in nonusers with baselines indicative of no/low tobacco exposure, but not in nonusers with elevated baselines. Median changes in cotinine for disposable exposure were 0.007ng/ml serum, 0.033ng/ml saliva, and 0.316ng/mg creatinine in urine. For tank-style exposure they were 0.041ng/ml serum, 0.060ng/ml saliva, and 0.948ng/mg creatinine in urine. Finally, we measured substantial differences in solution nicotine concentrations, pH, use behavior and consumption. Our data show that although exposures may vary considerably, nonusers can systemically absorb nicotine following acute exposure to secondhand e-cigarette aerosol. This can particularly affect sensitive subpopulations, such as children and women of reproductive age. |
Tobacco product use among middle and high school students - United States, 2011-2017
Wang TW , Gentzke A , Sharapova S , Cullen KA , Ambrose BK , Jamal A . MMWR Morb Mortal Wkly Rep 2018 67 (22) 629-633 Tobacco use is the leading cause of preventable disease and death in the United States, and nearly all tobacco use begins during youth and young adulthood (1,2). CDC and the Food and Drug Administration (FDA) analyzed data from the 2011-2017 National Youth Tobacco Surveys (NYTS)* to determine patterns of current (past 30-day) use of seven tobacco product types among U.S. middle school (grades 6-8) and high school (grades 9-12) students and estimate use nationwide. Among high school students, current use of any tobacco product decreased from 24.2% (estimated 3.69 million users) in 2011 to 19.6% (2.95 million) in 2017. Among middle school students, current use of any tobacco product decreased from 7.5% (0.87 million) in 2011 to 5.6% (0.67 million) in 2017. In 2017, electronic cigarettes (e-cigarettes) were the most commonly used tobacco product among high (11.7%; 1.73 million) and middle (3.3%; 0.39 million) school students. During 2016-2017, decreases in current use of hookah and pipe tobacco occurred among high school students, while decreases in current use of any tobacco product, e-cigarettes, and hookah occurred among middle school students. Current use of any combustible tobacco product, >/=2 tobacco products, cigarettes, cigars, smokeless tobacco, and bidis did not change among middle or high school students during 2016-2017. Comprehensive and sustained strategies can help prevent and reduce the use of all forms of tobacco products among U.S. youths (1,2). |
Acquisition of Bartonella elizabethae by experimentally exposed oriental rat fleas (Xenopsylla cheopis; Siphonaptera, Pulicidae) and excretion of Bartonella DNA in flea feces
McKee CD , Osikowicz LM , Schwedhelm TR , Maes SE , Enscore RE , Gage KL , Kosoy MY . J Med Entomol 2018 55 (5) 1292-1298 Few studies have been able to provide experimental evidence of the ability of fleas to maintain rodent-associated Bartonella infections and excrete these bacteria. These data are important for understanding the transmission cycles and prevalence of these bacteria in hosts and vectors. We used an artificial feeding approach to expose groups of the oriental rat flea (Xenopsylla cheopis Rothschild; Siphonaptera, Pulicidae) to rat blood inoculated with varying concentrations of Bartonella elizabethae Daly (Bartonellaceae: Rhizobiales). Flea populations were maintained by membrane feeding on pathogen-free bloodmeals for up to 13 d post infection. Individual fleas and pools of flea feces were tested for the presence of Bartonella DNA using molecular methods (quantitative and conventional polymerase chain reaction [PCR]). The threshold number of Bartonellae required in the infectious bloodmeal for fleas to be detected as positive was 106 colony-forming units per milliliter (CFU/ml). Individual fleas were capable of harboring infections for at least 13 d post infection and continuously excreted Bartonella DNA in their feces over the same period. This experiment demonstrated that X. cheopis are capable of acquiring and excreting B. elizabethae over several days. These results will guide future work to model and understand the role of X. cheopis in the natural transmission cycle of rodent-borne Bartonella species. Future experiments using this artificial feeding approach will be useful for examining the horizontal transmission of B. elizabethae or other rodent-associated Bartonella species to naive hosts and for determining the viability of excreted bacteria. |
Arboviral surveillance among pediatric patients with acute febrile illness in Houston, Texas
Sahni LC , Fischer RSB , Gorchakov R , Berry RM , Payne DC , Murray KO , Boom JA . Am J Trop Med Hyg 2018 99 (2) 413-416 We instituted active surveillance among febrile patients presenting to the largest Houston-area pediatric emergency department to identify acute infections of dengue virus (DENV), West Nile virus (WNV), and chikungunya virus (CHIKV). In 2014, 1,063 children were enrolled, and 1,015 (95%) had blood and/or cerebrospinal fluid specimens available for DENV, WNV, and CHIKV testing. Almost half (49%) reported recent mosquito bites, and 6% (N = 60) reported either recent international travel or contact with an international traveler. None were positive for acute WNV; three had false-positive CHIKV results; and two had evidence of DENV. One DENV-positive case was an acute infection associated with international travel, whereas the other was identified as a potential secondary acute infection, also likely travel-associated. Neither of the DENV-positive cases were clinically recognized, highlighting the need for education and awareness. Health-care professionals should consider the possibility of arboviral disease among children who have traveled to or from endemic areas. |
Incidence of human brucellosis in the Kilimanjaro Region of Tanzania in the periods 2007-2008 and 2012-2014
Carugati M , Biggs HM , Maze MJ , Stoddard RA , Cash-Goldwasser S , Hertz JT , Halliday JEB , Saganda W , Lwezaula BF , Kazwala RR , Cleaveland S , Maro VP , Rubach MP , Crump JA . Trans R Soc Trop Med Hyg 2018 112 (3) 136-143 Background: Brucellosis causes substantial morbidity among humans and their livestock. There are few robust estimates of the incidence of brucellosis in sub-Saharan Africa. Using cases identified through sentinel hospital surveillance and health care utilization data, we estimated the incidence of brucellosis in Moshi Urban and Moshi Rural Districts, Kilimanjaro Region, Tanzania, for the periods 2007-2008 and 2012-2014. Methods: Cases were identified among febrile patients at two sentinel hospitals and were defined as having either a 4-fold increase in Brucella microscopic agglutination test titres between acute and convalescent serum or a blood culture positive for Brucella spp. Findings from a health care utilization survey were used to estimate multipliers to account for cases not seen at sentinel hospitals. Results: Of 585 patients enrolled in the period 2007-2008, 13 (2.2%) had brucellosis. Among 1095 patients enrolled in the period 2012-2014, 32 (2.9%) had brucellosis. We estimated an incidence (range based on sensitivity analysis) of brucellosis of 35 (range 32-93) cases per 100 000 persons annually in the period 2007-2008 and 33 (range 30-89) cases per 100 000 persons annually in the period 2012-2014. Conclusions: We found a moderate incidence of brucellosis in northern Tanzania, suggesting that the disease is endemic and an important human health problem in this area. |
Notes from the Field: Crimean-Congo hemorrhagic fever outbreak - Central Uganda, August-September 2017
Kizito S , Okello PE , Kwesiga B , Nyakarahuka L , Balinandi S , Mulei S , Kyondo J , Tumusiime A , Lutwama J , Ario AR , Ojwang J , Zhu BP . MMWR Morb Mortal Wkly Rep 2018 67 (22) 646-647 On August 20, 2017, physicians in two noncontiguous districts in central Uganda (Kyankwanzi and Nakaseke) reported two unrelated cases of Crimean-Congo hemorrhagic fever (CCHF). CCHF is the most widespread tickborne viral hemorrhagic fever in the world and represents a global health security threat (1–3); a single case of CCHF constitutes an outbreak. Humans are infected through tick bites or contact with the blood or body fluids of infected persons or animals. Treatment of infected patients is supportive, and the case-fatality rate ranges from 3%–40% (2,3). No licensed vaccine is available (2). Although CCHF cases were first reported in Uganda between 1958 and 1977, no subsequent cases were reported until 2013, when enhanced viral hemorrhagic fever surveillance capacity began to identify CCHF outbreaks (3–5). |
Risk factors for human acute leptospirosis in northern Tanzania
Maze MJ , Cash-Goldwasser S , Rubach MP , Biggs HM , Galloway RL , Sharples KJ , Allan KJ , Halliday JEB , Cleaveland S , Shand MC , Muiruri C , Kazwala RR , Saganda W , Lwezaula BF , Mmbaga BT , Maro VP , Crump JA . PLoS Negl Trop Dis 2018 12 (6) e0006372 INTRODUCTION: Leptospirosis is a major cause of febrile illness in Africa but little is known about risk factors for human infection. We conducted a cross-sectional study to investigate risk factors for acute leptospirosis and Leptospira seropositivity among patients with fever attending referral hospitals in northern Tanzania. METHODS: We enrolled patients with fever from two referral hospitals in Moshi, Tanzania, 2012-2014, and performed Leptospira microscopic agglutination testing on acute and convalescent serum. Cases of acute leptospirosis were participants with a four-fold rise in antibody titers, or a single reciprocal titer >/=800. Seropositive participants required a single titer >/=100, and controls had titers <100 in both acute and convalescent samples. We administered a questionnaire to assess risk behaviors over the preceding 30 days. We created cumulative scales of exposure to livestock urine, rodents, and surface water, and calculated odds ratios (OR) for individual behaviors and for cumulative exposure variables. RESULTS: We identified 24 acute cases, 252 seropositive participants, and 592 controls. Rice farming (OR 14.6), cleaning cattle waste (OR 4.3), feeding cattle (OR 3.9), farm work (OR 3.3), and an increasing cattle urine exposure score (OR 1.2 per point) were associated with acute leptospirosis. CONCLUSIONS: In our population, exposure to cattle and rice farming were risk factors for acute leptospirosis. Although further data is needed, these results suggest that cattle may be an important source of human leptospirosis. Further investigation is needed to explore the potential for control of livestock Leptospira infection to reduce human disease. |
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