Smoking and visual impairment among older adults with age-related eye diseases
Zhang X , Kahende J , Fan AZ , Barker L , Thompson TJ , Mokdad AH , Li Y , Saaddine JB . Prev Chronic Dis 2011 8 (4) A84 INTRODUCTION: Tobacco use is the leading preventable cause of death in the United States. Visual impairment, a common cause of disability in the United States, is associated with shorter life expectancy and lower quality of life. The relationship between smoking and visual impairment is not clearly understood. We assessed the association between smoking and visual impairment among older adults with age-related eye diseases. METHODS: We analyzed Behavioral Risk Factor Surveillance System data from 2005 through 2008 on older adults with age-related eye diseases (cataract, glaucoma, age-related macular degeneration, and diabetic retinopathy; age ≥50 y, N = 36,522). Visual impairment was defined by self-reported difficulty in recognizing a friend across the street or difficulty in reading print or numbers. Current smokers were respondents who reported having smoked at least 100 cigarettes ever and still smoked at the time of interview. Former smokers were respondents who reported having ever smoked at least 100 cigarettes but currently did not smoke. We used multivariate logistic regressions to examine the association and to adjust for potential confounders. RESULTS: Among respondents with age-related eye diseases, the estimated prevalence of visual impairment was higher among current smokers (48%) than among former smokers (41%, P < .05) and respondents who had never smoked (42%, P < .05). After adjustment for age, sex, race/ethnicity, education, and general health status, current smokers with age-related eye diseases were more likely to have visual impairment than respondents with age-related eye diseases who had never smoked (odds ratio, 1.16, P < .05). Furthermore, respondents with cataract who were current smokers were more likely to have visual impairment than respondents with cataract who had never smoked (predictive margin, 44% vs 40%, P = .03), and the same was true for respondents with age-related macular degeneration (65% of current smokers vs 57% of never smokers, P = .02). This association did not hold true among respondents with glaucoma or diabetic retinopathy. CONCLUSION: Smoking is linked to self-reported visual impairment among older adults with age-related eye diseases, particularly cataract and age-related macular degeneration. Longitudinal evaluation is needed to assess smoking cessation's effect on vision preservation. |
Metabolic syndrome, testosterone, and cardiovascular mortality in men
Lin JW , Lee JK , Wu CK , Caffrey JL , Chang MH , Hwang JJ , Dowling N , Lin YS . J Sex Med 2011 8 (8) 2350-60 INTRODUCTION: Interactions among testosterone, metabolic syndrome (MetS), and mortality risk in men remain to be elucidated. AIM: To examine relationships among testosterone, MetS, and cardiovascular mortality risk in U.S. men, middle-aged and older. METHODS: The analysis included the men aged 40 years and above in Phase 1 (1988-1991) of the Third National Health and Nutrition Examination Survey (NHANES III). Serum testosterone and sex hormone binding globulin were measured, and free testosterone and bioavailable testosterone were calculated. MetS was determined according to the Adult Treatment Panel III (ATP-III) criteria. MAIN OUTCOME MEASURES: Cardiovascular and other causes of mortality were obtained from the NHANES III-linked follow-up file through December 31, 2006. Multivariate Cox regression models were applied to assess associations of interest. RESULTS: Of 596 men included in the analysis, 187 men were found to have MetS. During a median follow-up of 15.6 years, 97 men died of cardiovascular causes (cardiovascular mortality rate: 9.84 and 5.77 per 1,000 person-years for those with and without MetS, respectively). Higher calculated bioavailable testosterone (CBT) was associated with a lower odds of MetS (odds ratio: 0.80 for each ng/mL, 95% confidence interval [CI]: 0.76-0.84, P < 0.001) and lower risk of cardiovascular mortality (hazard ratios [HRs]: 0.72 for each log ng/mL, 95% CI: 0.54-0.96, P = 0.03) in subjects with MetS. The influence of CBT was not observed in those without MetS (HR: 0.84 for each log ng/mL, 95% CI: 0.68-1.04, P = 0.10). CONCLUSIONS: The combination of lower bioavailable testosterone and ATP-III-defined MetS is associated with an increased cardiovascular mortality in the men aged 40 years and above. |
Reflections on 30 years of AIDS
De Cock KM , Jaffe HW , Curran JW . Emerg Infect Dis 2011 17 (6) 1044-1048 June 2011 marks the 30th anniversary of the first description of what became known as HIV/AIDS, now one of history's worst pandemics. The basic public health tools of surveillance and epidemiologic investigation helped define the epidemic and led to initial prevention recommendations. Features of the epidemic, including the zoonotic origin of HIV and its spread through global travel, are central to the concept of emerging infectious diseases. As the epidemic expanded into developing countries, new models of global health and new global partnerships developed. Advocacy groups played a major role in mobilizing the response to the epidemic, having human rights as a central theme. Through the commitments of governments and private donors, modern HIV treatment has become available throughout the developing world. Although the end of the epidemic is not yet in sight and many challenges remain, the response has been remarkable and global health has changed for the better. |
Review of cytomegalovirus shedding in bodily fluids and relevance to congenital cytomegalovirus infection
Cannon MJ , Hyde TB , Schmid DS . Rev Med Virol 2011 21 (4) 240-55 Congenital cytomegalovirus (CMV) infections are a leading cause of sensorineural hearing loss (SNHL) and neurological impairment. Congenital transmission of CMV can occur with maternal primary infection, reactivation, or reinfection during pregnancy. We reviewed studies of CMV shedding in bodily fluids (defined as CMV detected by culture or CMV DNA detected by polymerase chain reaction). Following diagnosis at birth, children with congenital CMV infection exhibited the highest prevalences of CMV shedding (median = 80%, number of sample population prevalences [N] = 6) and duration of shedding, with a steep decline by age five. Healthy children attending day care shed more frequently (median = 23%, N = 24) than healthy children not attending day care (median = 12%, N = 11). Peak shedding prevalences in children occurred at 1-2 years of age, confirming that young children are the key transmission risk for pregnant women. CMV shedding among children was more prevalent in urine specimens than in oral secretions (median prevalence difference = 11.5%, N = 12). Adults with risk factors such as STD clinic attendance had higher shedding prevalences (median = 22%, N = 20) than adults without risk factors (median = 7%, N = 44). In adults with risk factors, CMV was shed more frequently in urine; in adults without risk factors genital shedding was most common. The prevalence of CMV shedding in nine sample populations of pregnant women increased with advancing gestation. In seven sample populations of children with congenital CMV infection, higher viral load at birth was consistently associated with an elevated risk of SNHL. Higher CMV viral load at birth also consistently correlated with the presence of symptoms of congenital CMV at birth. |
Stability of the age distribution of measles cases over time during outbreaks in Bangladesh, 2004-2006
Wiesen E , Wannemuehler K , Goodson JL , Anand A , Mach O , Thapa A , O'Connor P , Linayage J , Diorditsa S , Hasan AS , Uzzaman S , Jalil Mondal MD . J Infect Dis 2011 204 Suppl 1 S414-20 Despite recommendations from WHO to conduct measles outbreak response vaccination campaigns based on the age distribution of cases at the beginning of an outbreak, few data exist to specifically examine whether the age distribution of cases remains constant over time in a measles outbreak. This analysis explores this question with use of measles outbreak surveillance data from Bangladesh from the period 2004-2006. Pearson chi(2) tests were conducted of age distributions over 2 periods during 41 large laboratory-confirmed measles outbreaks. Statistically significant changes in age distribution over time were observed in 24% of the outbreaks. No single pattern was detected in the shifts in age distribution; however, an increase in the proportion of cases occurring among infants <9 months of age was evident in 6 outbreaks. These findings suggest a need to consider the possibility of a shift in the age distribution over time when planning an outbreak response vaccination campaign. |
Status of rubella and congenital rubella syndrome surveillance, 2005-2009, the World Health Organization European Region
Zimmerman LA , Muscat M , Jankovic D , Goel A , Bang H , Khetsuriani N , Martin R . J Infect Dis 2011 204 Suppl 1 S381-8 BACKGROUND: The World Health Organization European Region has a goal for rubella elimination and congenital rubella syndrome (CRS) prevention. Although all Member States recommend a rubella-containing vaccine in their national immunization programs, rubella and CRS continue to occur, and surveillance quality varies throughout the region. METHODS: To describe the status of regional rubella and CRS surveillance and assess progress toward elimination, we reviewed surveillance practices by surveying all 53 Member States and analyzed rubella and CRS surveillance data during 2005-2009. RESULTS: Overall, 41 (91%) of 45 responding Member States have nationwide rubella surveillance, and 39 (87%) have nationwide CRS surveillance. During 2005-2009, rubella cases reported in the region decreased by 94% from 206,359 cases to 11,623 cases. The greatest decrease (99%) was observed in newly independent states of the former Soviet Union. In the rest of the region, high rubella incidence was observed in Poland, Romania, Italy, and San Marino during 2005-2008 and in Poland, Bosnia and Herzegovina, and Austria in 2009. A total of 68 CRS cases were reported during 2005-2009. CONCLUSIONS: As the foundation to achieving and verifying rubella elimination, high-quality rubella and CRS surveillance needs to be implemented and sustained in all Member States. |
Toward rubella elimination in Poland: need for supplemental immunization activities, enhanced surveillance, and further integration with measles elimination efforts
Zimmerman L , Rogalska J , Wannemuehler KA , Haponiuk M , Kosek A , Pauch E , Plonska E , Veltze D , Czarkowski MP , Buddh N , Reef S , Stefanoff P . J Infect Dis 2011 204 Suppl 1 S389-95 BACKGROUND: All Member States of the World Health Organization (WHO) European Region have endorsed rubella elimination and congenital rubella syndrome (CRS) prevention. However, Poland has continued high levels of reported rubella. METHODS: We reviewed rubella incidence in Poland since 1966 and analyzed national aggregated surveillance data from the period 2003-2008 and case-based data from 4 provinces from the period 2006-2008. We described CRS cases since 1997 and assessed maternal receipt of vaccine. We reviewed national vaccination coverage from 1992 through 2008. RESULTS: Since 1966, rubella outbreaks have occurred every 4-6 years in Poland. Aggregate and case-based data from the period 2003-2008 indicate that rubella virus transmission has occurred across wide age ranges (from <1 year to 60 years), with disproportionately higher percentage of cases among adolescent boys. Of 18 children with reported CRS cases from 1997 through 2008, 15 (83%) of their mothers had not been vaccinated. Measles-mumps-rubella dose 1 vaccination coverage ranged from 97% to 99%. CONCLUSIONS: Poland had the highest incidence of rubella in the WHO European Region in 2007 and 2008. Rubella occurs predominantly in age and sex cohorts historically not included in vaccination recommendations. The risk for CRS continues. To achieve rubella elimination, supplemental immunization activities among adolescent boys are needed, as is integration with measles elimination efforts. |
Two case studies of modified measles in vaccinated physicians exposed to primary measles cases: high risk of infection but low risk of transmission
Rota JS , Hickman CJ , Sowers SB , Rota PA , Mercader S , Bellini WJ . J Infect Dis 2011 204 Suppl 1 S559-63 In 2009, measles outbreaks in Pennsylvania and Virginia resulted in the exposure and apparent infection of 2 physicians, both of whom had a documented history of vaccination with >2 doses of measles-mumps-rubella vaccine. These physicians were suspected of having been infected with measles after treating patients who subsequently received a diagnosis of measles. The clinical presentation was nonclassical in regard to progression, duration, and severity. It is hypothesized that the 2 physicians mounted vigorous secondary immune responses typified by high avidity measles immunoglobulin G antibody and remarkably high neutralizing titers in response to intense and prolonged exposure to a primary measles case patient. Both of the physicians continued to see patients, because neither considered that they could have measles. Despite surveillance for cases among contacts, including unvaccinated persons, no additional cases were identified. |
XIth International Symposium on Respiratory Viral Infections
Belser JA , Snider CB , Cox NJ , Hayden FG . Influenza Other Respir Viruses 2011 5 (6) 443-52, e455-7 Please cite this paper as: Belser et al. (2011) XIth International Symposium on Respiratory Viral Infections. Influenza and Other Respiratory Viruses 5(6), 443-e457. |
Pandemic and seasonal influenza viruses among patients with acute respiratory illness in Kashmir (India)
Koul PA , Mir MA , Bali NK , Chawla-Sarkar M , Sarkar M , Kaushik S , Khan UH , Ahmad F , Garten R , Lal RB , Broor S . Influenza Other Respir Viruses 2011 5 (6) e521-7 BACKGROUND: With the emergence of pandemic influenza A (2009A/H1N1) virus in India, we sought to determine the prevalence and clinical presentations of seasonal and pandemic influenza viruses among acute respiratory illness (ARI) patients from Srinagar, a temperate climate area in northern India, during the peak winter season. METHODS: Combined throat and nasal swabs, obtained from 194 (108 male) presenting with ARI from January to March 2010 (Week 53-week 10), were tested by RT-PCR for influenza A and B, including 2009A/H1N1 viruses. HA1 gene of selected 2009A/H1N1-positive samples was sequenced, and phylogenetic analysis was carried out. RESULTS: Twenty-one (10.8%, age 15-80 years, median age 40 years) patients tested positive for influenza viruses: 13 (62%) for 2009A/H1N1 virus, 6 (28.5%) for seasonal influenza A (H3N2), and 2 (9.5%) for influenza B. Twelve of the 13 patients with 2009A/H1N1 presented with febrile ARI, and eight had associated comorbidities. All of the patients recovered. Phylogenetic analysis of HA gene (n = 8) revealed that all strains from Srinagar clustered in 2009A/H1N1 clade seven along with the other 2009A/H1N1 strains from India. Amino acid substitutions in the HA protein defining clade seven (P83S, S203T, and I321V) were found in almost all isolates from Srinagar. CONCLUSIONS: Both seasonal and 2009A/H1N1 viruses appear to be associated with ARI in Srinagar. The 2009A/H1N1 in Srinagar is genetically similar to globally circulating clade 7 strains, with unique signature sequences in the HA gene. Further investigations into ascertain the role of these mutations in possible alteration of the virulence and transmissibility of the virus are needed. |
Pandemic influenza in Africa, lessons learned from 1968: a systematic review of the literature
Ortiz JR , Lafond KE , Wong TA , Uyeki TM . Influenza Other Respir Viruses 2011 6 (1) 11-24 BACKGROUND: To help understand the potential impact of the 2009 H1N1 pandemic in Africa, we reviewed published data from Africa of the two previous influenza pandemics. METHODS: We conducted a systematic search of three biomedical databases for articles in any language on 1957 H2N2 or 1968 H3N2 pandemic influenza virus infection in Africa published from January 1950 through August 2008. RESULTS: We identified 1327 potentially relevant articles, and 298 warranted further review. Fourteen studies on 1968 H3N2 influenza met inclusion criteria, while two studies identified describing 1957 H2N2 were excluded for data limitations. Among these 14 studies, community attack rates for symptomatic infection during all 1968 pandemic waves were around 20%. However, the proportion infected in communities ranged from 6% in isolated communities to 100% in enclosed populations. A total of 22-64% of sampled clinic patients and 8-72% of hospitalized patients had evidence of 1968 H3N2 virus infection. After the second pandemic wave, up to 41-75% of persons tested had serological evidence of 1968 H3N2 virus infection. CONCLUSION: The 1968 H3N2 influenza pandemic, generally regarded as mild worldwide, appears to have had a substantial impact upon public health in Africa. Without more epidemiologic data the impact of the 2009 H1N1 pandemic in Africa cannot be assumed to have been mild. Assessment of the burden of 2009 H1N1 virus and future influenza pandemics in Africa should attempt to assess disease impact by a variety of methods, including substudies among specific populations. |
Progress toward control of rubella and prevention of congenital rubella syndrome--worldwide, 2009
Reef SE , Strebel P , Dabbagh A , Gacic-Dobo M , Cochi S . J Infect Dis 2011 204 Suppl 1 S24-7 Rubella, usually a mild rash illness in children and adults, can cause serious consequences when a pregnant woman is infected, particularly in early pregnancy. These serious consequences include miscarriage, fetal death or an infant born with birth defects (i.e., congenital rubella syndrome (CRS)). The primary purpose for rubella vaccination is the prevention of congenital rubella infection including CRS. Since 1969, several rubella virus vaccines have been licensed for use; however, until the 1990s, use of rubella-containing vaccine (RCV) was limited primarily to developed countries. In 1996, it was estimated that 110,000 infants with CRS were born annually in developing countries. In 2000, the first World Health Organization rubella vaccine position paper was published to guide introduction of RCV in national childhood immunization schedules. From 1996 to 2009, the number of countries that introduced RCV into their national routine childhood immunization programs increased by 57% from 83 countries in 1996 to 130 countries in 2009. In addition, three of the six WHO regions established rubella control and CRS prevention goals: Region of the Americas and Europe rubella elimination by 2010 and 2015, respectively, and Western Pacific Region-accelerated rubella control and CRS prevention by 2015. Also, during this time period, the number of rubella cases reported decreased from 670,894 in 2000 to 121,344 in 2009. Rubella control and prevention of CRS can be accelerated by integrating with current global measles mortality reduction and regional elimination activities. |
Haemophilus influenzae type b infection, vaccination, and H. influenzae carriage in children in Minnesota, 2008-2009
Lowther SA , Shinoda N , Juni BA , Theodore MJ , Wang X , Jawahir SL , Jackson ML , Cohn A , Danila R , Lynfield R . Epidemiol Infect 2011 140 (3) 1-9 An increase in invasive Haemophilus influenzae type b (Hib) cases occurred in Minnesota in 2008 after the recommended deferral of the 12-15 months Hib vaccine boosters during a US vaccine shortage. Five invasive Hib cases (one death) occurred in children; four had incomplete Hib vaccination (three refused/delayed); one was immunodeficient. Subsequently, we evaluated Hib carriage and vaccination. From 18 clinics near Hib cases, children (aged 4 weeks-60 months) were surveyed for pharyngeal Hib carriage. Records were compared for Hib, diphtheria-tetanus-acellular pertussis (DTaP), and pneumococcal (PCV-7) vaccination. Parents completed questionnaires on carriage risk factors and vaccination beliefs. In 1631 children (February-March 2009), no Hib carriage was detected; Hib vaccination was less likely to be completed than DTaP and PCV-7. Non-type b H. influenzae, detected in 245 (15%) children, was associated with: male sex, age 24-60 months, daycare attendance >15 h/week, a household smoker, and Asian/Pacific Islander race/ethnicity. In 2009, invasive Hib disease occurred in two children caused by the same strain that circulated in 2008. Hib remains a risk for vulnerable/unvaccinated children, although Hib carriage is not widespread in young children. |
Bacterial vaginosis, alterations in vaginal flora and HIV genital shedding among HIV-1-infected women in Mozambique
Kirkcaldy RD , Mika J , Newman LM , Langa J , Tian LH , Jani I , Ballard R , Nelson L , Folgosa E . South Afr J HIV Med 2011 12 (2) 22-24 OBJECTIVES: We investigated whether abnormal vaginal flora, including bacterial vaginosis (BV), are associated with detection of cervical HIV-1 RNA among HIV-infected women in Mozambique. METHODS: We obtained clinical data and vaginal specimens from HIV-infected women registering for their first visit at one of two HIV care clinics in Mozambique. We compared women with detectable cervical HIV viral load (≥40 copies/ml) with women with undetectable cervical HIV. RESULTS: We enrolled 106 women. Women with abnormal vaginal flora (intermediate Nugent scores, 4-6) were more likely to have detectable cervical HIV RNA then women with normal vaginal flora (adjusted odds ratio 7.2 (95% confidence interval 1.8-29.1), adjusted for CD4 count). Women with BV had a non-significantly higher likelihood of detectable cervical HIV than women with normal flora. CONCLUSIONS: Abnormal vaginal flora were significantly associated with cervical HIV expression. Further research is needed to confirm this relationship. |
Changing epidemiology of measles in Africa
Goodson JL , Masresha BG , Wannemuehler K , Uzicanin A , Cochi S . J Infect Dis 2011 204 Suppl 1 S205-14 BACKGROUND: In Africa before the introduction of measles vaccination, measles primarily affected young children. To describe measles epidemiology in Africa since the start of accelerated measles control activities in 2001, we analyzed regional measles case-based surveillance data for 2002-2009. METHODS: Country-years were grouped by 10-year moving average of routine measles vaccination coverage (aMCV1). Age was log transformed, and pair-wise comparisons of means were made. A chi(2) test was used to assess association between coverage and age groups. Cumulative percent curves and percentiles of age, dot plots with Loess curve, and Spearman rank correlation coefficient were calculated. RESULTS: Of 180,284 suspected cases, 73,009 (41%) were confirmed as measles. Of these, the mean age was 79 months (median, 36 months; interquartile range, 16-96 months) and significantly younger in country-years with <50% aMCV1 than those with 50%-74% aMCV1 (P=.03) and ≥75% (P=.02). With increasing coverage, there was a slight decrease in age in the 10th and 25th and moderate increase in age in the 50th, 75th, and 90th percentiles. CONCLUSIONS: During 2002-2009, the median age of confirmed measles was 36 months. In countries with ≥50% aMCV1 coverage compared with low-coverage countries, age shifted to older children and young adults; for infants, age decreased slightly with higher coverage. |
Comparison of clinical features and outcomes of medically attended influenza A and influenza B in a defined population over four seasons: 2004-2005 through 2007-2008
Irving SA , Patel DC , Kieke BA , Donahue JG , Vandermause MF , Shay DK , Belongia EA . Influenza Other Respir Viruses 2011 6 (1) 37-43 BACKGROUND: There are few prospectively collected data comparing illnesses caused by different subtypes of influenza. We compared the clinical presentation and outcomes of subjects with primarily outpatient-attended influenza A and B infections during four consecutive influenza seasons (2004-2005 through 2007-2008). METHODS: Patients were prospectively enrolled and tested for influenza following an encounter for acute respiratory illness. Influenza infections were confirmed by culture or reverse transcription polymerase chain reaction; subtype was determined for a sample of influenza A isolates each season. Clinical characteristics of influenza A and B infections were compared across and within individual seasons. RESULTS: We identified 901 cases of influenza A and 284 cases of influenza B; 98% of cases were identified through an outpatient medical encounter. Thirty-six percent of patients with each strain had received seasonal influenza vaccine prior to illness onset. There were no consistent differences in symptoms associated with influenza A and B. Influenza A infection was associated with earlier care seeking compared with influenza B during the 2005-2006 and 2007-2008 seasons, when H3N2 was the dominant type A virus, and in a combined analysis that included all seasons. Twenty-six (2.2%) of 1185 cases were diagnosed with radiographically confirmed pneumonia, and 59 (5%) of 1185 patients were hospitalized within 30 days of illness onset. CONCLUSIONS: Over four influenza seasons, aside from shorter intervals from illness onset to clinical encounter for infections with the A(H3N2) subtype, clinical symptoms and outcomes were similar for patients with predominantly outpatient-attended influenza A and B infections. |
WISEWOMAN: addressing the needs of women at high risk for cardiovascular disease
Vaid I , Wigington C , Borbely D , Ferry P , Manheim D . J Womens Health (Larchmt) 2011 20 (7) 977-82 In the United States, the cardiovascular health of women is affected by the disparate impact of cardiovascular diseases (CVDs) on many minority ethnic and racial groups. Women with low income also endure a disproportionate impact of the burden of CVD. The Centers for Disease Control and Prevention's (CDC's) Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) Program was authorized by Congress in 1993 to extend the preventive health services offered to participants of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). These are low-income, uninsured, and underinsured women. The intent was to expand services of an existing federal program to address cardiovascular health concerns in this vulnerable, high-risk population. CDC funds 19 state health departments and 2 tribal organizations (both in Alaska) to implement WISEWOMAN. In the first 2 years of the current 5-year funding cycle, which began in June 2008, the WISEWOMAN grantees succeeded in providing almost 78,000 screenings, of which 46% were to women of minority racial and ethnic groups. The individual successes are important, and the WISEWOMAN Program also has achieved success in the broader arenas of healthcare and the communities in which WISEWOMAN is implemented. WISEWOMAN impacts clinical systems of care, provider education, physician extenders, and the broader community and will continue to play an important role in connecting low-income, uninsured, and underinsured women with clinical systems of care and other community resources that will result in the prevention, treatment, and management of their CVD risk. |
Community health workers "101" for primary care providers and other stakeholders in health care systems
Brownstein JN , Hirsch GR , Rosenthal EL , Rush CH . J Ambul Care Manage 2011 34 (3) 210-20 Today's ambulatory care providers face numerous challenges as they try to practice efficient, patient-centered medicine. This article explains how community health workers (CHWs) can be engaged to address many patient- and system-related barriers currently experienced in ambulatory care practices. Community health workers are frontline public health workers who serve as a trusted bridge between community members and health care providers. Among their varied roles, CHWs can educate and support patients in managing their risk factors and diseases and link these patients to needed resources. As shown in this overview (CHW 101), including CHWs as members of multidisciplinary care teams has the potential to strengthen both current and emerging models of health care delivery. |
The relative abundance of deer mice with antibody to Sin Nombre virus corresponds to the occurrence of hantavirus pulmonary syndrome in nearby humans
Calisher CH , Mills JN , Root JJ , Doty JB , Beaty BJ . Vector Borne Zoonotic Dis 2011 11 (5) 577-82 Sin Nombre virus (SNV) is the principal cause of hantavirus pulmonary syndrome (HPS) in the United States and deer mice (Peromyscus maniculatus) are its principal rodent host, and thus the natural cycle of the virus is related to the occurrence of HPS. Prevalence of rodent infection appears to be associated with fluctuations in deer mouse populations and, indirectly, with timing and amount of precipitation, a complex of biologic events. Given that rodent population abundances fluctuate, often acutely, it is not unreasonable to assume a direct correlation between the numbers of infected rodents and the number of human infections, unless confounding factors are involved. During a 13-year longitudinal study at a site in southwestern Colorado, we accumulated data regarding deer mice and antibody to SNV and therefore had the opportunity to compare dynamics of deer mouse populations, seroprevalence of antibody to SNV in the rodents, and numbers of HPS cases in Durango and in the State of Colorado as a whole. If abundances of deer mouse populations are directly correlated with occurrence of HPS, it is reasonable to assume that low densities of deer mice and low prevalences of antibody to SNV would lead to fewer human cases than would high densities and high prevalences. Our results substantiate such an assumption and suggest that the risk of acquisition of HPS is likely related to both high numbers of infected deer mice and human activities, rather than being strictly related to prevalence of SNV in the host rodent. |
Cattle and the natural history of Rickettsia parkeri in Mississippi
Edwards KT , Goddard J , Jones TL , Paddock CD , Varela-Stokes AS . Vector Borne Zoonotic Dis 2011 11 (5) 485-91 Cattle have been recognized as hosts for Amblyomma maculatum, the Gulf Coast tick, for over 100 years. For nearly as long, A. maculatum have been known to harbor the spotted fever group Rickettsia (SFGR), now known as Rickettsia parkeri. However, human infection with R. parkeri was not documented until 2004. Results presented herein describe a laboratory and a field study evaluating cattle and the natural history of A. maculatum and R. parkeri in Mississippi. In the laboratory study, seroconversion to R. parkeri antigen occurred in calves exposed to R. parkeri by injection or by feeding R. parkeri-infected A. maculatum, and two out of six animals were transiently rickettsemic. All calves remained clinically normal during the study, except for gotch ear-like lesions in all tick-infested calves, regardless of infection status of ticks, suggesting that R. parkeri is not involved in the condition. In the field study, A. maculatum (n = 34) removed from Mississippi sale barn cattle (n = 183) and the cattle hosts were tested for R. parkeri. Cattle were not rickettsemic by polymerase chain reaction, but 49.7% demonstrated low titers to R. parkeri antigen when tested by indirect fluorescent antibody for SFGR. Of ticks removed from cattle, 11.8% were hemolymph positive and 8.7% were indirect fluorescent antibody positive. Approximately 22% (5/23) and 4% (1/23) of harvested tick extracts were positive for R. parkeri by polymerase chain reaction of the 17 kDa antigen gene and ompA gene, respectively. An amplicon for the ompA gene from one tick was successfully sequenced and showed 100% similarity with the homologous sequence of R. parkeri. Thus, cattle may harbor R. parkeri-infected A. maculatum and produce antibodies to SFGR. Cattle may play a role in the natural history of R. parkeri infection by expanding populations of A. maculatum and transporting R. parkeri-infected ticks to various locations, rather than as a reservoir for R. parkeri. |
The relationships between blood lead levels and serum follicle stimulating hormone and luteinizing hormone in the National Health and Nutrition Examination Survey 1999-2002
Krieg EF Jr , Feng HA . Reprod Toxicol 2011 32 (3) 277-85 The relationships between blood lead levels and serum follicle stimulating hormone and luteinizing hormone were assessed in a nationally representative sample of women, 35-60 years old, from the National Health and Nutrition Examination Survey 1999-2002. The blood lead levels of the women ranged from 0.2 to 17.0mcg/dL. The estimated geometric mean was 1.4mcg/dL, and the estimated arithmetic mean was 1.6mcg/dL. As the blood lead level increased, the concentration of serum follicle stimulating hormone increased in post-menopausal women, women who had both ovaries removed, and pre-menopausal women. The concentration of luteinizing hormone increased as blood lead level increased in post-menopausal women and women who had both ovaries removed. The lowest concentrations of blood lead at which a relationship was detected were 0.9mcg/dL for follicle stimulating hormone and 3.2mcg/dL for luteinizing hormone. Lead may act directly or indirectly at ovarian and non-ovarian sites to increase the concentrations of follicle stimulating hormone and luteinizing hormone. |
Use of parks or playgrounds: reported access to drinking water fountains among US adults, 2009
Park S , Sherry B , Wethington H , Pan L . J Public Health (Oxf) 2011 34 (1) 65-72 BACKGROUND: As a first step to determining the public availability of drinking water, self-reported access to water fountains in parks and playgrounds was examined. METHODS: A cross-sectional analysis was conducted on a convenience sample of 4163 US adults (aged ≥18 years) using the 2009 HealthStyles Survey. The outcome measure was reported access to water fountains in parks/playgrounds. Among those who reported using parks/playgrounds, multivariable logistic regression was used to examine the associations between sociodemographic variables and reported access to water fountains. RESULTS: About half (54.7%) of participants used parks/playgrounds. Among those, 55.0% reported access to water fountains. Factors significantly associated with reported access to water fountains were being male [odds ratio (OR) = 1.42; 95% confidence interval (CI) = 1.09, 1.85] and living in the Pacific region (versus East North Central region, OR = 2.56; 95% CI = 1.61, 4.06). Age, race/ethnicity, household income, marital status, education, smoking and physical activity were not significantly associated with reported access to water fountains. CONCLUSIONS: Among 54.7% of adults using parks/playgrounds, reported access to water fountains was significantly differed by sex and region. This study provides information that can be considered when developing interventions to increase access to drinking water in public facilities. |
Environmental public health systems and services research
Sarisky J , Gerding J . J Environ Health 2011 73 (10) 24-5 Current economic conditions have affected the operating budgets of all | levels of government. Many environmental public health program managers are being asked to do more with fewer | resources. Those in government who are | charged with making funding decisions are | requesting information about the effectiveness and efficiency of the programs for which | funding is requested. The public is also trying to understand the value and importance | of government service programs. In short, | environmental public health practitioners, | government decision makers, and the public | are looking for evidence of program success | and effectiveness. Answering critical questions about the effectiveness and worthiness | of environmental public health systems requires considerable investigation in the form | of systems research. The concept of systems | research applies to all the aspects, both internal and external, of a system. In terms of public health, the U.S. Department of Health and | Human Services (HHS) defines the public | health system as “…the complex network of | organizations that work towards fulfilling the | public health mission of assuring conditions | for a healthy population (HHS, 2011).” The field of environmental public health is certainly a critically important part of the public | health system as defined by HHS. |
Status of global virologic surveillance for rubella viruses
Abernathy ES , Hubschen JM , Muller CP , Jin L , Brown D , Komase K , Mori Y , Xu W , Zhu Z , Siqueira MM , Shulga S , Tikhonova N , Pattamadilok S , Incomserb P , Smit SB , Akoua-Koffi C , Bwogi J , Lim WW , Woo GK , Triki H , Jee Y , Mulders MN , de Filippis AM , Ahmed H , Ramamurty N , Featherstone D , Icenogle JP . J Infect Dis 2011 204 Suppl 1 S524-32 The suspected measles case definition captures rubella cases. Therefore, measles surveillance will be improved in the course of the control and eventual elimination of rubella transmission. One aspect of rubella control, virologic surveillance, is reviewed here. A systematic nomenclature for rubella viruses (RVs) based on 13 genotypes has been established and is updated when warranted by increases in information about RVs. From 2005 through 2010, the genotypes of RVs most frequently reported were 1E, 1G, and 2B, and genotypes 1a, 1B, 1C, 1h, 1j, and 2C were less frequently reported. Virologic surveillance can support rubella control and elimination. Synopses of rubella virologic surveillance in various countries, regions, and globally are given, including characterization of viruses from imported cases in a country that has eliminated rubella and studies of endemic viruses circulating in countries without rubella control objectives. Current challenges are discussed. |
National Healthcare Safety Network (NHSN) report, data summary for 2009, device-associated module
Dudeck MA , Horan TC , Peterson KD , Allen-Bridson K , Morrell GC , Pollock DA , Edwards JR . Am J Infect Control 2011 39 (5) 349-367 This report is a summary of Device-Associated (DA) module data collected by hospitals participating in the National Healthcare Safety Network (NHSN) for events occurring between January and December 2009 and reported to the Centers for Disease Control and Prevention (CDC) by October 18, 2010. This report updates previously published DA module data from the NHSN and provides contemporary comparative rates.1 Procedure-Associated module data will be reported separately. Surgical site infection data will be reported as standardized infection ratios using new logistic regression models, and postprocedure pneumonia rates for 2009 are available on the NHSN's public Web site. This report complements other NHSN reports, including national and state-specific standardized infection ratios for selected health care–associated infections (HAIs).2, 3, 4 | The NHSN was established in 2005 to integrate and supersede 3 legacy surveillance systems at the CDC: the National Nosocomial Infections Surveillance system, the Dialysis Surveillance Network, and the National Surveillance System for Healthcare Workers. NHSN data collection, reporting, and analysis are organized into 3 components—Patient Safety, Healthcare Personnel Safety, and Biovigilance—and use standardized methods and definitions in accordance with specific module protocols.5, 6, 7 The modules may be used singly or simultaneously, but once selected, they must be used for a minimum of 1 calendar month. All infections are categorized using standard CDC definitions that include laboratory and clinical criteria.7 The DA module may be used by facilities other than hospitals, including long-term care facilities and outpatient dialysis centers. A report of data from this module for outpatient dialysis centers has been published separately.8 For this report, only data from the Patient Safety component are presented. NHSN facilities report their HAI surveillance data voluntarily or in response to state mandatory reporting requirements. The CDC aggregates these data into a single national database for the stated purposes in place in 2009, as follows: | • | Collect data from a sample of US health care facilities to permit valid estimation of the magnitude of adverse events among patients and health care personnel. | • | Collect data from a sample of US health care facilities to permit valid estimation of the adherence to practices known to be associated with prevention of these adverse events. | • | Analyze and report collected data to permit recognition of trends. | • | Provide facilities with risk-adjusted metrics that can be used for interfacility comparisons and local quality improvement activities. | • | Assist facilities in developing surveillance and analysis methods that permit timely recognition of patient and health care worker safety problems and prompt intervention with appropriate measures. | • | Conduct collaborative research studies with NHSN member facilities (eg, describe the epidemiology of emerging HAIs and pathogens, assess the importance of potential risk factors, further characterize HAI pathogens and their mechanisms of resistance, and evaluate alternative surveillance and prevention strategies). | | The identity of each NHSN facility is kept confidential by the CDC in accordance with Sections 304, 306, and 308(d) of the Public Health Service Act [42 USC 242b, 242K, and 242m(d)]. |
Improving global virologic surveillance for measles and rubella
Rota PA , Brown KE , Hubschen JM , Muller CP , Icenogle J , Chen MH , Bankamp B , Kessler JR , Brown DW , Bellini WJ , Featherstone D . J Infect Dis 2011 204 Suppl 1 S506-13 An important aspect of laboratory surveillance for measles and rubella is the genetic characterization of circulating wild-type viruses to support molecular epidemiologic studies and to track transmission pathways. Virologic surveillance that is sufficient to document the interruption of transmission of measles and rubella viruses will be an essential criterion for verification of elimination. Laboratories in the World Health Organization (WHO) Measles and Rubella Laboratory Network have worked to improve and expand virologic surveillance as many regions move toward elimination of measles and rubella/congenital rubella syndrome. As countries approach elimination, it will be necessary to obtain genetic information from as many chains of transmission as possible. In addition, baseline virologic surveillance, especially for rubella, needs to be improved in many countries. This report contains a summary of recent improvements to the methods used for virologic surveillance. |
Chronic disease surveillance systems within the US Associated Pacific Island jurisdictions
Hosey G , Ichiho H , Satterfield D , Dankwa-Mullan I , Kuartei S , Rhee K , Belyeu-Camacho T , Debrum I , Demei Y , Lippwe K , Luces PS , Roby F . Prev Chronic Dis 2011 8 (4) A86 In recent years, illness and death due to chronic disease in the US Associated Pacific Islands (USAPI) jurisdictions have dramatically increased. Effective chronic disease surveillance can help monitor disease trends, evaluate public policy, prioritize resource allocation, and guide program planning, evaluation, and research. Although chronic disease surveillance is being conducted in the USAPI, no recently published capacity assessments for chronic disease surveillance are available. The objective of this study was to assess the quality of existing USAPI chronic disease data sources and identify jurisdictional capacity for chronic disease surveillance. The assessment included a chronic disease data source inventory, literature review, and review of surveillance documentation available from the web or through individual jurisdictions. We used the World Health Organization's Health Metric Network Framework to assess data source quality and to identify jurisdictional capacity. Results showed that USAPI data sources are generally aligned with widely accepted chronic disease surveillance indicators and use standardized data collection methodology to measure chronic disease behavioral risks, preventive practices, illness, and death. However, all jurisdictions need to strengthen chronic disease surveillance through continued assessment and expanded support for valid and reliable data collection, analysis and reporting, dissemination, and integration among population-based and institution-based data sources. For sustained improvement, we recommend investment and technical assistance in support of a chronic disease surveillance system that integrates population-based and institution-based data sources. An integrated strategy that bridges and links USAPI data sources can support evidence-based policy and population health interventions. |
Recordkeeping practices of beef grinding activities at retail establishments
Gould LH , Seys S , Everstine K , Norton D , Ripley D , Reimann D , Dreyfuss M , Chen WS , Selman CA . J Food Prot 2011 74 (6) 1022-4 Ground beef has been implicated as a transmission vehicle in foodborne outbreaks of infection with pathogens such as Escherichia coli O157:H7 and Salmonella. During outbreak investigations, traceback of contaminated beef to the producing facility is often unsuccessful because of inadequate recordkeeping at retail establishments that grind beef products. We conducted a survey in three states participating in the Environmental Health Specialists Network to describe beef grinding and recordkeeping practices at retail establishments. In each establishment that maintained grinding logs, three randomly selected records were reviewed to determine whether important data elements for traceback investigations were recorded. One hundred twenty-five stores were surveyed, of which 60 (49%) kept grinding logs, including 54 (74%) of 73 chain stores and 6 (12%) of 51 independent stores. One hundred seventy-six grinding records from 61 stores were reviewed. Seventy-three percent of the records included the establishment code of the source beef, 72% included the grind date and time, and 59% included the lot number of the source beef. Seventy-five percent of records noted whether trimmings were included in grinds, and 57% documented cleanup activities. Only 39 (22%) records had all of these variables completed. Of stores that did not keep grinding logs, 40% were unaware of their purpose. To facilitate effective and efficient traceback investigations by regulatory agencies, retail establishments should maintain records more detailed and complete of all grinding activities. |
Multistate outbreak of Listeria monocytogenes associated with Mexican-style cheese made from pasteurized milk among pregnant, Hispanic women
Jackson KA , Biggerstaff M , Tobin-D'Angelo M , Sweat D , Klos R , Nosari J , Garrison O , Boothe E , Saathoff-Huber L , Hainstock L , Fagan RP . J Food Prot 2011 74 (6) 949-53 Listeriosis is a severe infection caused by Listeria monocytogenes. Since 2004, the Centers for Disease Control and Prevention has requested that listeriosis patients be interviewed using a standardized Listeria Initiative (LI) questionnaire. In January 2009, states and the Centers for Disease Control and Prevention began investigating a multistate outbreak of listeriosis among pregnant, Hispanic women. We defined a case as an illness occurring between October 2008 and March 2009 with an L. monocytogenes isolate indistinguishable from the outbreak strain by pulsed-field gel electrophoresis. We conducted a multistate case-control study using controls that were selected from L. monocytogenes illnesses in non-outbreak-related pregnant, Hispanic women that were reported to the LI during 2004 to 2008. Eight cases in five states were identified. Seven of these were pregnant, Hispanic females aged 21 to 43 years, and one was a 3-year-old Hispanic girl, who was excluded from the study. Seven (100%) cases but only 26 (60%) of 43 controls had consumed Mexican-style cheese in the month before illness (odds ratio, 5.89; 95% confidence interval, 1.07 to infinity; P = 0.04). Cultures of asadero cheese made from pasteurized milk collected at a manufacturing facility during routine sampling by the Michigan Department of Agriculture on 23 February 2009 yielded the outbreak strain, leading to a recall of cheeses produced in the plant. Recalled product was traced to stores where at least three of the women had purchased cheese. This investigation highlights the usefulness of routine product sampling for identifying contaminated foods, of pulsed-field gel electrophoresis analysis to detect multistate outbreaks, and of the LI for providing timely exposure information for case-control analyses. Recalls of contaminated cheeses likely prevented additional illnesses. |
Ciprofloxacin-resistant Salmonella enterica serotype Typhi, United States, 1999-2008
Medalla F , Sjolund-Karlsson M , Shin SH , Harvey E , Joyce K , Theobald L , Nygren BL , Pecic G , Gay K , Austin J , Stuart A , Blanton E , Mintz ED , Whichard JM , Barzilay EJ . Emerg Infect Dis 2011 17 (6) 1095-1098 We report 9 ciprofloxacin-resistant Salmonella enterica serotype Typhi isolates submitted to the US National Antimicrobial Resistance Monitoring System during 1999-2008. The first 2 had indistinguishable pulsed-field gel electrophoresis patterns and identical gyrA and parC mutations. Eight of the 9 patients had traveled to India within 30 days before illness onset. |
Genetic characterization of measles vaccine strains.
Bankamp B , Takeda M , Zhang Y , Xu W , Rota PA . J Infect Dis 2011 204 Suppl 1 S533-48 The complete genomic sequences of 9 measles vaccine strains were compared with the sequence of the Edmonston wild-type virus. AIK-C, Moraten, Rubeovax, Schwarz, and Zagreb are vaccine strains of the Edmonston lineage, whereas CAM-70, Changchun-47, Leningrad-4 and Shanghai-191 were derived from 4 different wild-type isolates. Nucleotide substitutions were found in the noncoding regions of the genomes as well as in all coding regions, leading to deduced amino acid substitutions in all 8 viral proteins. Although the precise mechanisms involved in the attenuation of individual measles vaccines remain to be elucidated, in vitro assays of viral protein functions and recombinant viruses with defined genetic modifications have been used to characterize the differences between vaccine and wild-type strains. Although almost every protein contributes to an attenuated phenotype, substitutions affecting host cell tropism, virus assembly, and the ability to inhibit cellular antiviral defense mechanisms play an especially important role in attenuation. |
Global distribution of measles genotypes and measles molecular epidemiology
Rota PA , Brown K , Mankertz A , Santibanez S , Shulga S , Muller CP , Hubschen JM , Siqueira M , Beirnes J , Ahmed H , Triki H , Al-Busaidy S , Dosseh A , Byabamazima C , Smit S , Akoua-Koffi C , Bwogi J , Bukenya H , Wairagkar N , Ramamurty N , Incomserb P , Pattamadilok S , Jee Y , Lim W , Xu W , Komase K , Takeda M , Tran T , Castillo-Solorzano C , Chenoweth P , Brown D , Mulders MN , Bellini WJ , Featherstone D . J Infect Dis 2011 204 Suppl 1 S514-23 A critical component of laboratory surveillance for measles is the genetic characterization of circulating wild-type viruses. The World Health Organization (WHO) Measles and Rubella Laboratory Network (LabNet), provides for standardized testing in 183 countries and supports genetic characterization of currently circulating strains of measles viruses. The goal of this report is to describe the lessons learned from nearly 20 years of virologic surveillance for measles, to describe the global databases for measles sequences, and to provide regional updates about measles genotypes detected by recent surveillance activities. Virologic surveillance for measles is now well established in all of the WHO regions, and most countries have conducted at least some baseline surveillance. The WHO Global Genotype Database contains >7000 genotype reports, and the Measles Nucleotide Surveillance (MeaNS) contains >4000 entries. This sequence information has proven to be extremely useful for tracking global transmission patterns and for documenting the interruption of transmission in some countries. The future challenges will be to develop quality control programs for molecular methods and to continue to expand virologic surveillance activities in all regions. |
Risks to health among American Indian/Alaska Native high school students in the United States
Everett Jones S , Anderson K , Lowry R , Conner H . Prev Chronic Dis 2011 8 (4) A76 INTRODUCTION: According to the World Health Organization, the 10 leading risk factor causes of death in high-income countries are tobacco use, high blood pressure, overweight and obesity, physical inactivity, high blood glucose, high cholesterol, low fruit and vegetable intake, urban air pollution, alcohol use, and occupational risks. We examined the prevalence of some of the leading risks to health among nationally representative samples of American Indian/Alaska Native (AI/AN) high school students and compared rates across racial/ethnic groups. METHODS: We combined data from the 2001, 2003, 2005, 2007, and 2009 national Youth Risk Behavior Survey. The survey is a biennial, self-administered, school-based survey of 9th- through 12th-grade students in the United States. Overall response rates for the surveys ranged from 63% to 72%. Of 73,183 participants, 952 were AI/AN students. RESULTS: For 7 of the 16 variables examined in this study, the prevalence among AI/AN high school students was higher than the prevalence among white high school students. For 1 variable (ate fruit and vegetables <5 times per day), the prevalence among AI/AN students was significantly lower than that among white students. The prevalence for the remaining 8 variables was similar among AI/AN students and white students. These findings also show differences in the prevalence of some behaviors among AI/AN, black, and Hispanic students. CONCLUSION: These findings show the prevalence of some health risk behaviors was significantly higher among AI/AN high school students than among high school students in other racial/ethnic groups. |
Outbreak of Burkholderia cepacia complex among ventilated pediatric patients linked to hospital sinks
Lucero CA , Cohen AL , Trevino I , Rupp AH , Harris M , Forkan-Kelly S , Noble-Wang J , Jensen B , Shams A , Arduino MJ , Lipuma JJ , Gerber SI , Srinivasan A . Am J Infect Control 2011 39 (9) 775-8 We investigated a cluster of Burkholderia cepacia complex colonization in ventilated pediatric patients. Isolates from 15 patients, 2 sink drains, and several ventilator components were found to belong to a single B cenocepacia clone. Hospital tap water used during oral and tracheostomy care was identified as the most likely mechanism for transmission. |
In vitro echinocandin susceptibility of Aspergillus isolates from patients enrolled in the Transplant-Associated Infection Surveillance Network
Lockhart SR , Zimbeck AJ , Baddley JW , Marr KA , Andes DR , Walsh TJ , Kauffman CA , Kontoyiannis DP , Ito JI , Pappas PG , Chiller T . Antimicrob Agents Chemother 2011 55 (8) 3944-6 We determined the echinocandin minimum effective concentration (MEC) values for caspofungin, micafungin and anidulafungin against 288 Aspergillus isolates prospectively collected from transplant patients with proven or probable invasive aspergillosis between 2001 and 2006 as part of the Transplant-Associated Infection Surveillance Network (TRANSNET). We demonstrated that the vast majority of Aspergillus isolates had MEC values at or below the epidemiological cutoff values for caspofungin, micafungin and anidulafungin, even from patients who had received caspofungin. |
Rubella epidemiology in Africa in the prevaccine era, 2002-2009
Goodson JL , Masresha B , Dosseh A , Byabamazima C , Nshimirimana D , Cochi S , Reef S . J Infect Dis 2011 204 Suppl 1 S215-25 Rubella virus infection is transmitted by respiratory droplets and causes a generally mild disease characterized by a rash and fever, primarily in children. However, infection in women during early pregnancy may cause fetal death or congenital rubella syndrome (CRS) in the infant [1]. CRS is a significant cause of deafness, blindness, congenital heart disease, and mental retardation [2]; although precise burden of disease is unknown, it is estimated that 110,000 CRS cases occur each year in developing countries [1, 3]. | Rubella is vaccine-preventable; the primary objective of rubella-control programs is prevention of congenital rubella virus infection, which includes CRS. Rubella is among the small number of viral diseases considered to be potentially eradicable [4, 5]. Rubella can be eliminated in countries that have introduced routine rubella vaccination for children and achieved high coverage in the population. In September 2010, achievement of the goal of rubella and CRS elimination in the region of the Americas was announced by the Pan American Health Organization [6, 7, 8]. However, countries that introduce rubella vaccine and achieve suboptimal vaccination coverage may be at risk for a paradoxical increase in susceptibility among older age groups, potentially leading to acquisition of rubella virus infections among women of childbearing age and to an increase in CRS cases [9–11]. To decrease the risk of rubella virus infections among pregnant women and consequent CRS cases, the World Health Organization (WHO) recommends introduction of rubella vaccine should be considered only in countries that have achieved high (>80%) coverage with the first-dose measles-containing vaccine [1]. |
Should outbreak response immunization be recommended for measles outbreaks in middle- and low-income countries? An update
Cairns KL , Perry RT , Ryman TK , Nandy RK , Grais RF . J Infect Dis 2011 204 Suppl 1 S35-46 BACKGROUND: Measles caused mortality in >164,000 children in 2008, with most deaths occurring during outbreaks. Nonetheless, the impact and desirability of conducting measles outbreak response immunization (ORI) in middle- and low-income countries has been controversial. World Health Organization guidelines published in 1999 recommended against ORI in such settings, although recently these guidelines have been reversed for countries with measles mortality reduction goals. METHODS: We searched literature published during 1995-2009 for papers reporting on measles outbreaks. Papers identified were reviewed by 2 reviewers to select those that mentioned ORI. World Bank classification of country income was used to identify reports of outbreaks in middle- and low-income countries. RESULTS: We identified a total of 485 articles, of which 461 (95%) were available. Thirty-eight of these papers reported on a total of 38 outbreaks in which ORI was used. ORI had a clear impact in 16 (42%) of these outbreaks. In the remaining outbreaks, we were unable to independently assess the impact of ORI. CONCLUSIONS: These findings generally support ORI in middle- and low-income countries. However, the decision to conduct ORI and the nature and extent of the vaccination response need to be made on a case-by-case basis. |
Supplementary immunization activities to achieve measles elimination: experience of the European Region
Khetsuriani N , Deshevoi S , Goel A , Spika J , Martin R , Emiroglu N . J Infect Dis 2011 204 Suppl 1 S343-52 BACKGROUND: Supplementary immunization activities (SIAs) using measles-containing vaccine (MCV) have had a substantial impact on reducing mortality associated with measles worldwide. METHODS: To assess impact of SIAs on measles incidence in the World Health Organization European Region and their role at the final stages of measles elimination efforts in Europe, we reviewed information on SIAs, measles surveillance, and routine vaccination coverage during 2000-2009. RESULTS: During 2000-2009, >57 million persons received MCV through SIAs in 16 countries. The Region primarily focused on catch-up campaigns with wider target age groups than in other regions and subsequently relied on routine vaccination rather than periodic follow-up SIAs for the second MCV dose. In addition, the concept of SIAs has been expanded from short-term (<30 days) mass campaigns implemented in other regions to incorporate vaccination efforts over longer periods and outbreak response vaccination. In 2009, 14 of 16 countries that conducted SIAs reported no measles cases or <1 case per 1,000,000 population, reflecting the post-SIA decrease in incidence. CONCLUSIONS: SIAs have made a substantial contribution to the success of measles elimination efforts and will likely remain an important strategy for interrupting measles virus transmission in the European Region, although specific approaches will vary by country. |
Persistence of vaccine-induced measles antibody beyond age 12 months: a comparison of response to one and two doses of Edmonston-Zagreb measles vaccine among HIV-infected and uninfected children in Malawi
Fowlkes A , Witte D , Beeler J , Audet S , Garcia P , Curns A , Yang C , Fudzulani R , Broadhead R , Bellini WJ , Cutts F , Helfand RF . J Infect Dis 2011 204 Suppl 1 S149-57 BACKGROUND: Previously, we demonstrated that measles antibody prevalence was lower at age 12 months among children infected with human immunodeficiency virus (HIV) than uninfected children following measles vaccination (MV) at ages 6 and 9 months. Among HIV-uninfected children, measles antibody prevalence was lower among 1- than 2-dose MV recipients. Here, we report results through age 24 months. METHODS: Children born to HIV-infected mothers received MV at 6 and 9 months, and children of HIV-uninfected mothers were randomized to MV at 6 and 9 months or MV at 9 months. We followed children through age 24 months. The child's HIV status was determined and measles immunoglobulin G (IgG) level was measured by enzyme immunoassay (EIA) and by plaque reduction neutralization (PRN) on a subset. RESULTS: Among HIV-uninfected children, the difference in measles antibody prevalence at age 12 months between one- and two-dose recipients reported previously by EIA was shown to be smaller by PRN. By age 24 months, 84% and 87% of HIV-uninfected children receiving 1 or 2 doses, respectively, were seroprotected. Only 41% of 22 HIV-infected children were measles seroprotected at age 20 months. DISCUSSION: Measles seroprotection persisted through age 24 months among HIV-uninfected children who received 1 or 2 doses of MV. HIV-infected children demonstrated seroprotection through age 12 months, but this was not sustained. |
Preplanned national measles vaccination campaign at the beginning of a measles outbreak--Sierra Leone, 2009-2010
Sugerman DE , Fall A , Guigui MT , N'Dolie M , Balogun T , Wurie A , Goodson JL . J Infect Dis 2011 204 Suppl 1 S260-9 BACKGROUND: Large-scale measles outbreaks occurred throughout Africa from 2008-2010. In Sierra Leone, in November 2009, preceding a measles supplemental immunization activity (SIA), the largest measles outbreak in a decade started. METHODS: We analyzed data from the national measles case-based surveillance system, developed a susceptibility profile of the population, and calculated vaccine effectiveness (VE) among children 12-59 months of age. RESULTS: From November 1, 2009 to July 13, 2010, 1,094 confirmed cases, including 9 deaths, were reported; 716 (66%) were <5 years of age. B3 genotype was identified. Measles attack rates per 100,000 population were highest among infants aged 6-8 months (56.4) and in Bo district (49.4). Districts with higher estimated SIA coverage tended to have lower attack rates (Spearman Correlation Coefficient=-0.63), p=0.07. Among 473 cases with information on vaccination status, 222 (47%) were unvaccinated; estimated VE was 74%. The 2009 measles SIA led to 165,000 fewer estimated susceptible individuals. CONCLUSIONS: The 2009 measles SIA reduced the overall magnitude of the outbreak, though routine and SIA coverage was insufficient to prevent it entirely. Maintaining high coverage through routine services and SIAs in all districts and conducting follow-up SIAs prior to the end of the low transmission season may prevent future outbreaks. |
Field effectiveness of live attenuated measles-containing vaccines: a review of published literature
Uzicanin A , Zimmerman L . J Infect Dis 2011 204 Suppl 1 S133-48 BACKGROUND: Information on measles vaccine effectiveness (VE) is critical to help inform policies for future global measles control goals. METHODS: We reviewed results of VE studies published during 1960-2010. RESULTS: Seventy papers with 135 VE point estimates were identified. For a single dose of vaccine administered at 9-11 months of age and ≥12 months, the median VE was 77.0% (interquartile range [IQR], 62%-91%) and 92.0% (IQR, 86%-96%), respectively. When analysis was restricted to include only point estimates for which vaccination history was verified and cases were laboratory confirmed, the median VE was 84.0% (IQR, 72.0%-95.0%) and 92.5% (IQR, 84.8%-97.0%) when vaccine was received at 9-11 and ≥12 months, respectively. Published VE vary by World Health Organization region, with generally lower estimates in countries belonging to the African and SouthEast Asian Regions. For 2 doses of measles-containing vaccine, compared with no vaccination, the median VE was 94.1% (IQR, 88.3%-98.3%). CONCLUSIONS: The VE of the first dose of measles-containing vaccine administered at 9-11 months was lower than what would be expected from serologic evaluations but was higher than expected when administered at ≥12 months. The median VE increased in a subset of articles in which classification bias was reduced through verified vaccination history and laboratory confirmation. In general, 2 doses of measles-containing vaccine provided excellent protection against measles. |
Guillain-Barre syndrome following influenza vaccination: causal or coincidental?
Sejvar JJ , Pfeifer D , Schonberger LB . Curr Infect Dis Rep 2011 13 (4) 387-98 In 1976, the emergence of a new swine-origin influenza virus prompted concerns about an impending influenza pandemic. Although the outbreak never materialized, the epidemiological link between Guillain-Barre syndrome, a potentially severe peripheral nerve disorder, and the influenza vaccines developed against this virus caught public health officials, clinicians, and the public by surprise. Subsequently, a great deal of scrutiny has been placed on the possible risk of other formulations of influenza vaccine causing this adverse event. Several epidemiologic and biological assessments have been performed in subsequent years to assess this risk, yet considerable uncertainty remains among health care providers about the possible association. The development and rapid implementation of vaccines against the pandemic 2009 A(H1N1) influenza virus once again highlighted this issue. This article reviews the evidence for and against the association of the 1976 influenza vaccines and subsequent seasonal influenza vaccines with the development of Guillain-Barre syndrome. |
Impact of a measles outbreak response immunization campaign: Maroua, Cameroon, 2009
Goodson JL , Sosler S , Pasi O , Johnson T , Kobella M , Monono ME , Uzicanin A . J Infect Dis 2011 204 Suppl 1 S252-9 A large measles outbreak occurred in Maroua, Cameroon during October 2008-April 2009; a nine-day outbreak response immunization (ORI) campaign was initiated 15 weeks after the start of the outbreak during high transmission season. To assess the impact of ORI, we described changes to case counts and characteristics before and after ORI, and the reporting efficiency of measles cases to the surveillance system. A sharp decrease in cases occurred from 555 cases during the period before ORI to 162 cases during the period after ORI; reporting efficiency was 79.5% before ORI and 93.0% after ORI. These findings highlight the potential benefits of rapid implementation of recommended ORI strategies during measles outbreaks in Africa. |
Intussusception risk and health benefits of rotavirus vaccination in Mexico and Brazil
Patel MM , Lopez-Collada VR , Bulhoes MM , De Oliveira LH , Bautista Marquez A , Flannery B , Esparza-Aguilar M , Montenegro Renoiner EI , Luna-Cruz ME , Sato HK , Hernandez-Hernandez Ldel C , Toledo-Cortina G , Ceron-Rodriguez M , Osnaya-Romero N , Martinez-Alcazar M , Aguinaga-Villasenor RG , Plascencia-Hernandez A , Fojaco-Gonzalez F , Hernandez-Peredo Rezk G , Gutierrez-Ramirez SF , Dorame-Castillo R , Tinajero-Pizano R , Mercado-Villegas B , Barbosa MR , Maluf EM , Ferreira LB , de Carvalho FM , dos Santos AR , Cesar ED , de Oliveira ME , Silva CL , de Los Angeles Cortes M , Ruiz Matus C , Tate J , Gargiullo P , Parashar UD . N Engl J Med 2011 364 (24) 2283-92 BACKGROUND: Because postlicensure surveillance determined that a previous rotavirus vaccine, RotaShield, caused intussusception in 1 of every 10,000 recipients, we assessed the association of the new monovalent rotavirus vaccine (RV1) with intussusception after routine immunization of infants in Mexico and Brazil. METHODS: We used case-series and case-control methods to assess the association between RV1 and intussusception. Infants with intussusception were identified through active surveillance at 69 hospitals (16 in Mexico and 53 in Brazil), and age-matched infants from the same neighborhood were enrolled as controls. Vaccination dates were verified by a review of vaccination cards or clinic records. RESULTS: We enrolled 615 case patients (285 in Mexico and 330 in Brazil) and 2050 controls. An increased risk of intussusception 1 to 7 days after the first dose of RV1 was identified among infants in Mexico with the use of both the case-series method (incidence ratio, 5.3; 95% confidence interval [CI], 3.0 to 9.3) and the case-control method (odds ratio, 5.8; 95% CI, 2.6 to 13.0). No significant risk was found after the first dose among infants in Brazil, but an increased risk, albeit smaller than that seen after the first dose in Mexico--an increase by a factor of 1.9 to 2.6 - was seen 1 to 7 days after the second dose. A combined annual excess of 96 cases of intussusception in Mexico (approximately 1 per 51,000 infants) and in Brazil (approximately 1 per 68,000 infants) and of 5 deaths due to intussusception was attributable to RV1. However, RV1 prevented approximately 80,000 hospitalizations and 1300 deaths from diarrhea each year in these two countries. CONCLUSIONS: RV1 was associated with a short-term risk of intussusception in approximately 1 of every 51,000 to 68,000 vaccinated infants. The absolute number of deaths and hospitalizations averted because of vaccination far exceeded the number of intussusception cases that may have been associated with vaccination. (Funded in part by the GAVI Alliance and the U.S. Department of Health and Human Services.). |
Raw single-walled carbon nanotube-induced cytotoxic effects in human bronchial epithelial cells: comparison to asbestos
Pacurari M , Schwegler-Berry D , Friend S , Leonard SS , Mercer RR , Vallyathan V , Castranova V . Toxicol Environ Chem 2011 93 (5) 1045-1072 Single-walled carbon nanotubes (SWCNT) are being developed to be used in many industrial and biomedical applications. However, SWCNT's durability and likely fibrous morphology have raised health concerns. The present investigations were focused on understanding the cellular and molecular mechanisms induced by raw SWCNT (SWCNT) in human bronchial-epithelial cells (BEAS-2B). Asbestos (crocidolite) was used as a positive control. Exposure of BEAS-2B cells to SWCNT induced apoptosis, DNA damage, and oxidative stress. The generation of hydroxyl radical (center dot OH) and increase of superoxide dismutase (SOD) activity were concentration-dependent. The increase in apoptosis was associated with activation of caspase-3, caspase-7, and poly (ADP-ribose) polymerase-1 (PARP-1). A short recovery period of 6 h of cells from SWCNT exposure resulted in reversal of caspase-3 and caspase-7, and a partial reversal of PARP-1 activation. The activation of PARP-1, caspase-3, and caspase-7 was only partially diminished after a recovery of 6 h from the exposure to crocidolite. Exposure of BEAS-2B cells to SWCNT resulted in the phosphorylation of protein p42/44 (p42/44) and protein p38 (p38). SWCNT did not induce protein serine-threonine kinase (AKT) phosphorylation. For all the above end points, crocidolite induced a greater response compared to SWCNT. SWCNT induced a significant activation of activator protein-1 (AP-1) and nuclear factor kappa B (NF-B), and the effect was inhibited by mitogen-activated protein kinase (MAPK) inhibitors. SWCNT also induced significant increase in the expression levels of c-Jun, IGH3, and CD44 genes. The results of this study show that the molecular mechanism for raw SWCNT-mediated toxicity in BEAS-2B cells is through the activation of caspase-3, caspase-7, and PARP-1. Furthermore, the mechanism of AP-1 and NF-B activation is through MAPK. This bioactivity of raw SWCNT is associated with the generation of oxidative stress and DNA damage. Considering the role of airway epithelium as a critical barrier for normal pulmonary function and focal point for tumor development, this study demonstrates that raw SWCNT activate molecular events which may be linked to adverse biological responses implicated in pulmonary diseases. |
Microbial biofilms on the surface of intravaginal rings worn in non-human primates
Gunawardana M , Moss JA , Smith TJ , Kennedy S , Kopin E , Nguyen C , Malone AM , Rabe L , Schaudinn C , Webster P , Srinivasan P , Sweeney ED , Smith JM , Baum MM . J Med Microbiol 2011 60 828-37 Millions of intravaginal rings (IVRs) are used by women worldwide for contraception and for the treatment of vaginal atrophy. These devices also are suitable for local and systemic sustained release drug delivery, notably for antiviral agents in human immunodeficiency virus pre-exposure prophylaxis. Despite the widespread use of IVRs, no studies have examined whether surface-attached bacterial biofilms develop in vivo, an important consideration when determining the safety of these devices. The present study used scanning electron microscopy, fluorescence in situ hybridization and confocal laser scanning microscopy to study biofilms that formed on the surface of IVRs worn for 28 days by six female pig-tailed macaques, an excellent model organism for the human vaginal microbiome. Four of the IVRs released the nucleotide analogue reverse transcriptase inhibitor tenofovir at a controlled rate and the remaining two were unmedicated. Large areas of the ring surfaces were covered with monolayers of epithelial cells. Two bacterial biofilm phenotypes were found to develop on these monolayers and both had a broad diversity of bacterial cells closely associated with the extracellular material. Phenotype I, the more common of the two, consisted of tightly packed bacterial mats approximately 5 microm in thickness. Phenotype II was much thicker, typically 40 microm, and had an open architecture containing interwoven networks of uniform fibres. There was no significant difference in biofilm thickness and appearance between medicated and unmedicated IVRs. These preliminary results suggest that bacterial biofilms could be common on intravaginal devices worn for extended periods of time. |
Enhanced detection of infectious airborne influenza virus
Blachere FM , Cao G , Lindsley WG , Noti JD , Beezhold DH . J Virol Methods 2011 176 120-4 Current screening methodologies for detecting infectious airborne influenza virus are limited and lack sensitivity. To increase the sensitivity for detecting infectious influenza virus in an aerosol sample, the viral replication assay was developed. With this assay, influenza virus is first amplified by replication in Mandin-Darby canine kidney (MDCK) cells followed by detection with quantitative PCR (qPCR). Spanning a 20-h replication period, matrix gene expression levels from infectious virus were measured at several time points using qPCR and found to exponentially increase. Compared with the traditional culture-based viral plaque assay, the viral replication assay resulted in a 4.6x10(5) fold increase in influenza virus detection. Furthermore, viral replication assay results were obtained in half the time of the viral plaque assay. To demonstrate that the viral replication assay is capable of detecting airborne influenza virus, dilute preparations of strain A/WS/33 were loaded into a nebulizer, aerosolized within a calm-air settling chamber and subsequently collected using NIOSH Two-Stage Bioaerosol Samplers. At the most diluted concentration corresponding to a chicken embryo infectious dose 50% endpoint (CEID(50)) of 2.8E+02/ml, the viral replication assay was able to detect infectious influenza virus that was otherwise undetectable by viral plaque assay. The results obtained demonstrate that the viral replication assay is highly sensitive at detecting infectious influenza virus from aerosol samples. |
High prevalence and genotypes of Toxoplasma gondii isolated from goats, from a retail meat store, destined for human consumption in the USA
Dubey JP , Rajendran C , Ferreira LR , Martins J , Kwok OC , Hill DE , Villena I , Zhou H , Su C , Jones JL . Int J Parasitol 2011 41 (8) 827-33 Little information is available concerning the presence of viable Toxoplasma gondii in tissues of goats worldwide. In the present study, hearts of 234 goats obtained from a local USA grocery store were examined for T. gondii infection. Blood clot or fluid removed from each heart was tested for antibodies to T. gondii by using the modified agglutination test (MAT). Antibodies to T. gondii were found in 125 (53.4%) of 234 goats, with titers of 1:5 in 20, 1:10 in 44, 1:20 in 16, 1:40 in five, 1:160 in five, 1:320 in five, and 1:640 or higher in 30 goats. Hearts of 112 goats (46 goats <1:5, and 66 goats 1:10 or higher) were used for isolation of viable T. gondii by bioassays in mice. For bioassays, 50g of the myocardium were digested in an acid pepsin solution and the digest inoculated into mice; the recipient mice were examined for T. gondii infection. Toxoplasma gondii was isolated from 29 goats; from hearts of one of 46 with titers of <1:5, one of nine with titers of 1:10, one of three with titers of 1:40, and 26 of 40 with titers of 1:160 or higher. Two isolates were highly virulent to outbred Swiss Webster mice; all infected mice died of toxoplasmosis, irrespective of the dose. All T. gondii isolates were subsequently grown in cell cultures. Genotyping of the 29 T. gondii isolates using 10 PCR-restriction fragment length polymorphism markers (SAG1, SAG2, SAG3, BTUB, GRA6, c22-8, c29-2, L358, PK1 and Apico) from DNA obtained from cell culture grown tachyzoites revealed 12 genotypes. Nine isolates were clonal Type II lineage, four isolates had type II alleles at all loci except a type I allele at the Apico locus, and four isolates were clonal Type III. The remaining 12 strains were divided into nine atypical genotypes, including five new and four previously identified genotypes. DNA sequences of four introns (EF1, HP2, UPRT1 and UPRT7) and two genes (GRA6 and GRA7) were generated for the five new genotypes. Comparing these sequences with previously published data revealed no unique sequences in these goat strains. Taken together, these results indicate high parasite prevalence and moderate genetic diversity of T. gondii in goats, which have important implications in public health. We believe this is the first genetic analysis of T. gondii isolates from goats in the USA. |
Impairment of CD4+ T cell polarization by dengue virus-infected dendritic cells
Chase AJ , Medina FA , Munoz-Jordan JL . J Infect Dis 2011 203 (12) 1763-74 BACKGROUND: The production of type I interferon alpha/beta (IFN-alpha/beta) is crucial to viral clearance during dengue virus (DENV) infection; however, in vitro-infected dendritic cells (DCs) exhibit a decreased capacity to respond to IFN-alpha/beta stimulation, and antigen-presenting cells (APCs) isolated from patients with acute DENV infection exhibit defects in T cell priming. METHODS: In order to ascertain the stimulatory capacity of primary human monocyte-derived DCs infected with wild-type DENV isolates, representing a range of genotypes and disease outcomes, we cocultured infected DCs with allogeneic-naive CD4(+) T cells. The gene expression patterns of IFN-alpha/beta sensitive genes were quantitated to determine if the infected DCs displayed a blunted IFN-alpha/beta response. RESULTS: DENV-infected DCs induced the initial proliferation of naive CD4(+) T cells but they remained nonpolarized in effector function. The expression of IFN-alpha/beta-stimulated genes was downregulated, revealing that the inhibition of IFN-alpha/beta signaling is conserved among endemic DENV serotype 2 strains. CONCLUSIONS: The failure of naive CD4(+) T cells to differentiate into IFN gamma-producing effector T cells when primed by DENV-infected DCs cannot be explained solely by a block in IFN-alpha/beta signaling, suggesting that the ability of DENV to evade the early host response is multifaceted. |
Cytomegalovirus (CMV) shedding is highly correlated with markers of immunosuppression in CMV-seropositive women
Schoenfisch AL , Dollard SC , Amin M , Gardner LI , Klein RS , Mayer K , Rompalo A , Sobel JD , Cannon MJ . J Med Microbiol 2011 60 768-74 Cytomegalovirus (CMV) enters latency following primary infection and can subsequently reactivate. Reinfection with a different viral strain can also occur. During these events, CMV is shed in bodily fluids. This study examined correlates of CMV shedding in specimens obtained from the HIV Epidemiology Research Study, a multicenter cohort study of US women with or at high risk for human immunodeficiency virus (HIV) infection. Among the women studied, 91.4 % (911/997) were CMV IgG seropositive. Of these women, 2.7 % (25/911) were CMV IgM seropositive. CMV DNA was detected via real-time PCR more frequently in cervicovaginal lavage (CVL) specimens (55/764, 7.2 %) than in peripheral blood mononuclear cells (PBMCs) (26/897, 2.9 %). CMV viral loads in 1 ml CVL (median 534; mean 2598; range = 40-74 844) were higher than in 10(6) PBMCs (median 264; mean 1287; range = 35-13 250). CMV DNA in PBMCs was associated with HIV seropositivity [odds ratio (OR) 13.5; 95 % confidence interval (CI) 1.8-100], increasing HIV viral load (P<0.001 for trend), decreasing CD4 cell counts (P<0.001 for trend) and CMV DNA in CVL (OR 26; 95 % CI 10.7-64). CMV DNA in CVL specimens was associated with CMV IgM seropositivity (OR 4.3; 95 % CI 1.5-12.3), HIV seropositivity (OR 7.3; 95 % CI 2.6-20), increasing HIV viral load (P<0.001 for trend) and decreasing CD4 cell counts (P<0.001 for trend). The positive predictive value of CMV IgM seropositivity for CMV DNA shedding in either PBMCs or CVL was 20 %. In summary, CMV shedding in CVL and PBMCs was highly correlated with each other and with markers of immune suppression. |
Direct effects of carbon nanotubes on dendritic cells induce immune suppression upon pulmonary exposure
Tkach AV , Shurin GV , Shurin MR , Kisin ER , Murray AR , Young SH , Star A , Fadeel B , Kagan VE , Shvedova AA . ACS Nano 2011 5 (7) 5755-62 Pharyngeal aspiration of single-walled carbon nanotubes (SWCNTs) caused inflammation, pulmonary damage, and an altered cytokine network in the lung. Local inflammatory response in vivo was accompanied by modified systemic immunity as documented by decreased proliferation of splenic T cells. Preincubation of naive T cells in vitro with SWCNT-treated dendritic cells reduced proliferation of T cells. Our data suggest that in vivo exposure to SWCNT modifies systemic immunity by modulating dendritic cell function. |
Dried blood spots on filter paper as an alternative specimen for measles diagnostics: detection of measles immunoglobulin M antibody by a commercial enzyme immunoassay
Uzicanin A , Lubega I , Nanuynja M , Mercader S , Rota P , Bellini W , Helfand R . J Infect Dis 2011 204 Suppl 1 S564-9 BACKGROUND: We compared the results of a serum-based measles immunoglobulin M (IgM) test with results of tests using paired reconstituted dried filter paper blood spot (DBS) samples to assess the feasibility of using DBS samples for measles diagnostic procedures. METHODS: We collected 588 paired serum and DBS samples from 349 children aged 8 months through 12 years at Mulago Hospital in Kampala, Uganda; of these samples, 513 (87%) were collected from children with a clinical diagnosis of measles 0-33 days after rash, and 75(13%) were collected from children hospitalized for other reasons. Eluted DBS and serum samples were tested using a commercial measles IgM enzyme immunoassay. Detection of viral RNA was attempted on a subset of 20 DBS by reverse-transcriptase polymerase chain reaction. RESULTS: Among the 513 sample pairs collected from children with measles, the concordances for samples collected during days 0-6 and >1 week after rash were 95.7% and 100%, respectively (P<.01). The relative sensitivity and specificity of the DBS-based assay during the first week were 98.7% and 88.9%, respectively, and the sensitivity and specificity >1 week after rash were 100% and 100%, respectively. Viral RNA was detected in 5 (26%) of 19 DBS samples tested. Among 75 sample pairs collected from children hospitalized for other reasons, concordance was 94.7%. CONCLUSIONS: DBS samples are a feasible alternative sample for measles diagnostic procedures in high-incidence settings. |
Monitoring of vitamin B-12 nutritional status in the United States by using plasma methylmalonic acid and serum vitamin B-12
Bailey RL , Carmel R , Green R , Pfeiffer CM , Cogswell ME , Osterloh JD , Sempos CT , Yetley EA . Am J Clin Nutr 2011 94 (2) 552-61 BACKGROUND: Various definitions, criteria, tests, and cutoffs have been used to define vitamin B-12 status; however, a need exists for the systematic study of vitamin B-12 status in the United States because of concerns about high folic acid intakes and the potential for associated adverse effects. OBJECTIVE: The objective was to determine the effect of different cutoff choices on outcomes and of the different degrees of serum vitamin B-12 status, definable by the concurrent use of a functional and circulating marker as the first steps to developing a data-based consensus on the biochemical diagnosis of vitamin B-12 deficiency. DESIGN: Data from NHANES, a nationally representative cross-sectional survey, were examined for adults aged >19 y (mean +/- SD age: 45 +/- 1 y) from 1999 to 2004 (n = 12,612). RESULTS: Commonly used cutoffs had a greater effect on prevalence estimates of low vitamin B-12 status with the use of vitamin B-12 than with the use of methylmalonic acid (MMA; 3-26% and 2-6%, respectively). A cutoff of >148 pmol/L for vitamin B-12 and of ≤210 nmol/L for MMA resulted in significant misclassifications. Approximately 1% of adults had a clear vitamin B-12 deficiency (low vitamin B-12 and elevated MMA); 92% of adults had adequate vitamin B-12 status. A high percentage of younger women characterized the group with low vitamin B-12 and normal MMA (2% of adults) and may have falsely reflected low vitamin B-12. Adults with elevated MMA (5%) only were demographically similar (ie, by age and race) to the deficient group and may have included some individuals with early vitamin B-12 deficiency. CONCLUSIONS: These analyses indicate the challenges of assessing vitamin B-12 status when uncertainties exist about the appropriate cutoffs. Future studies should determine definable endpoints to achieve this goal. |
Safety and chemical exposure evaluation at a small biodiesel production facility
Law BF , Pearce T , Siegel PD . J Occup Environ Hyg 2011 8 (7) 68-72 Biodiesel is a renewable fuel produced when agricultural feedstocks such as vegetable oils, rendered animal fats, and used cooking oils are reacted with alcohol in the presence of a catalyst to form fatty acid esters, glycerin, and soap in a process known as transesterification. Because of economics and process considerations, methanol is the most commonly used alcohol in the transesterification process producing fatty acid methyl esters.( Citation1 ) Potential hazards of biodiesel production include (1) use of large quantities of methanol, (2) use of caustic chemicals as catalysts, (3) physical hazards, and (4) potential exposure to aldehydes. | The biodiesel industry recognizes its most significant hazard as methanol. The properties of methanol, both physical and chemical, make it a particularly hazardous chemical. Methanol is highly flammable, and exposures can cause a wide range of deleterious health effects. It is easily absorbed by all routes of exposure. Methanol is metabolized to formaldehyde that is then converted to formic acid, which can accumulate in the human body. Methanol toxicity is mediated, in large part, by the formic acid metabolite. Studies have shown that short-term inhalation exposure to 200 ppm methanol results in blood methanol concentrations of less than 10 mg/L with no observed increase in blood formic acid concentration.( Citation2 ) Acute methanol toxicity includes visual disturbances leading to blindness, mild dermal irritation, dizziness, giddiness, permanent motor dysfunction. and possibly death.( Citation3 – Citation5 ) Chronic exposure to methanol may result in headache, dizziness, giddiness, insomnia, nausea, gastric disturbances, conjunctivitis, visual disturbances, and blindness.( Citation3 ) The Occupational Safety and Health Administration (OSHA) permissible exposure limit (PEL) and the National Institute for Occupational Safety and Health (NIOSH) recommended exposure limit (REL) for methanol is 200 ppm time-weighted average (TWA). The short-term exposure limit (STEL) for methanol is 250 ppm; the concentration that is immediately dangerous to life and health (IDLH) is 6000 ppm.( Citation6 ) |
Work hours, sleep sufficiency, and prevalence of depression among full-time employees: a community-based cross-sectional study
Nakata A . J Clin Psychiatry 2011 72 (5) 605-14 OBJECTIVE: Depression due to long work hours and sleep deprivation is a major occupational health concern. The extent to which work hours and sleep are associated with depression was investigated in employees of small- and medium-scale businesses in the Japanese city of Yashio, Saitama, and in the Ohta ward of Tokyo, a suburb of Tokyo, controlling for various potential confounders. METHOD: In this cross-sectional study, a total of 2,643 full-time employees (1,928 men and 715 women), aged 18-79 years (mean = 45 years), in 296 small- and medium-scale businesses were surveyed from August 2002 to December 2002 using a self-administered questionnaire evaluating work hours, sleep status, and covariates including sociodemographic and socioeconomic factors, health behaviors, biological factors, medication usage, and occupational factors. Depression was assessed using the Center for Epidemiologic Studies Depression Scale. Prevalence of depression by work hours, sleep status, and covariates was analyzed by chi2 test. Risk of depression by work hours, sleep status, and both combined was estimated by multivariate logistic regression analysis. RESULTS: Participants working > 10 hours per day, sleeping < 6 hours per day, and reporting insufficient sleep were, respectively, 37%, 43%, and 97% more likely to be depressed than those working 6 to 8 hours per day, sleeping 6 to < 8 hours per day, and reporting sufficient sleep (P < .05). Participants working > 10 hours per day or > 8 to 10 hours per day with < 6 hours per day of sleep showed a 41%-169% higher prevalence of depression versus those working 6 to 8 hours per day with 6+ hours per day of sleep (P < .05). Participants reporting insufficient sleep in 3 work-hour categories (6 to 8, > 8 to 10, and > 10 hours per day) showed a 62%-179% increase in the prevalence of depression versus those working 6 to 8 hours per day and reporting sufficient sleep (P < .05). No significant effects on depression were found for subjects in any work-hour category with 6+ hours of sleep or with subjective sufficient sleep. CONCLUSIONS: Depression associated with long work hours is primarily a result of sleep deprivation. Greater attention should be paid to management of sleep deprivation to prevent workplace depression. |
Workshop summary: epidemiologic design strategies for studies of nanomaterial workers
Laney AS , McCauley LA , Schubauer-Berigan MK . J Occup Environ Med 2011 53 S87-90 OBJECTIVE: The potential health consequences of exposure to nanomaterials have yet to be elucidated though increasing evidence points to the potential for nanomaterials to cause adverse human health effects. This workshop addressed the feasibility of developing studies to measure health risks among nanomaterial workers. METHODS: Breakout groups discussed different epidemiologic designs and methods to encourage companies to collect and retain exposure and health data. RESULTS: Major challenges include defining and recruitment of appropriate study populations and obtaining adequate exposure data. Both prospective cohort studies and small cross-sectional panel studies utilizing biomarkers of exposure and effect offer approaches to study occupational groups. CONCLUSIONS: Potential exists to assemble cohorts to study the human health effects associated with nanomaterial exposure. Stakeholder partnerships are critical to the success of these studies and international partnerships hold great potential. |
Nanomaterials and worker health: medical surveillance, exposure registries, and epidemiologic research
Schulte PA , Trout DB . J Occup Environ Med 2011 53 S3-S7 OBJECTIVE: This article provides an overview of the issues that arise with medical surveillance, exposure registration, and epidemiologic research involving nanomaterial workers. METHODS: An occupational health perspective is applied to detecting risks in nanomaterial workers individually and as a group. RESULTS: General principles for medical surveillance, exposure registration, and epidemiologic research are identified. A model Nanomaterial Worker Health Study is for consideration. CONCLUSIONS: The Nanomaterial Worker Health Study can be developed as a tangible action in assuring the public that steps are being taken to learn of any adverse effects from exposure to nanomaterials. |
NIOSH Manual of Analytical Methods 5th Edition-new resources and direction
Schlecht P , O'Connor PF , Key-Schwartz R , Lunsford A , Gagnon Y . J Occup Environ Hyg 2011 8 (7) 59-62 In 1973, the National Institute for Occupational Safety and Health (NIOSH) published the first edition of the NIOSH Manual of Analytical Methods (NMAM®). It contained 38 procedures developed by chemists at NIOSH. Today, the NMAM is accessible on the Internet at http://www.cdc.gov/niosh/docs/2003-154/ and contains more than 300 methods. | The NMAM, a compendium of validated methods for measuring occupational exposures to hazardous substances, is one of the most successful products in NIOSH history. The current fourth edition( Citation1 ) is the second most visited and downloaded document on the NIOSH website (receiving an average 30,000 visits per month, 60% of these international; Figure 1 shows the distribution by region.) The methods most often downloaded are shown in Figure 2, with metals, hydrocarbons, and particulates comprising the top three. |
Occupational all-terrain vehicle deaths among workers 18 years and older in the United States, 1992-2007
Helmkamp JC , Marsh SM , Aitken ME . J Agric Saf Health 2011 17 (2) 147-55 The objective of this study was to summarize basic information on the characteristics of work-related A TV deaths among civilian persons 18 years of age or older in the U.S. from 1992 through 2007. Work-related ATV death data were obtained through the Bureau of Labor Statistics' annual Census of Fatal Occupational Injuries. From 1992 to 2007, 297 work-related ATV deaths occurred among persons over 17 in the U.S. Ninety-two percent were male, 93% were white, 23% were ages 18 to 34, 51% were ages 35 to 64, and 26% were ages > or = 65. Half of the fatal incidents involved overturns resulting in head and chest injuries. Sixty percent of crashes occurred on farms and 20% occurred on highways. The fatality rate among agricultural production workers was significantly higher than the rates in all other industries. While more in-depth analysis of incident and exposure data for this growing problem will more clearly define personal risk and causal factors in the long term, in the short term, stronger emphasis must be placed on the development of prevention strategies, particularly focused on older workers in the agriculture production industry. |
Effects of liquid cooling garments on recovery and performance time in individuals performing strenuous work wearing a firefighter ensemble
Kim JH , Coca A , Williams WJ , Roberge RJ . J Occup Environ Hyg 2011 8 (7) 409-16 This study investigated the effects of body cooling using liquid cooling garments (LCG) on performance time (PT) and recovery in individuals wearing a fully equipped prototype firefighter ensemble (PFE) incorporating a self-contained breathing apparatus (SCBA). Six healthy male participants (three firefighters and three non-firefighters) completed six experimental sessions in an environmental chamber (35 degrees C, 50% relative humidity), consisting of three stages of 15 min exercise at 75% VO(2max), and 10 min rest following each exercise stage. During each session, one of the following six conditions was administered in a randomized order: control (no cooling, CON); air ventilation of exhaust SCBA gases rerouted into the PFE (AV); top cooling garment (TCG); TCG combined with AV (TCG+AV); a shortened whole body cooling garment (SCG), and SCG combined with AV (SCG+AV). Results showed that total PT completed was longer under SCG and SCG+AV compared with CON, AV, TCG, and TCG+AV (p < 0.01). Magnitude of core temperature (T(c)) elevation was significantly decreased when SCG was utilized (p < 0.01), and heart rate recovery rate (10 min) was enhanced under SCG, SCG+AV, TCG, and TCG+AV compared with CON (p < 0.05). Estimated E(sw) rate (kg.h(-1)) was the greatest in CON, 1.62 (0.37), and the least in SCG+AV 0.98 (0.44): (descending order: CON > AV > TCG = TCG+AV > SCG > SCG+AV) without a statistical difference between the conditions (p < 0.05). Results of the present study suggest that the application of LCG underneath the PFE significantly improves the recovery during a short period of rest and prolongs performance time in subsequent bouts of exercise. LCG also appears to be an effective method for body cooling that promotes heat dissipation during uncompensable heat stress. |
Engineered carbonaceous nanomaterials manufacturers in the United States: workforce size, characteristics, and feasibility of epidemiologic studies
Schubauer Berigan MK , Dahm MM , Yencken MS . J Occup Environ Med 2011 53 S62-S67 OBJECTIVE: Toxicology studies suggest that carbon nanotube (CNT) exposures may cause adverse pulmonary effects. This study identified all US engineered carbonaceous nanomaterial (ECN) manufacturers, determined workforce size and growth, and characterized the materials produced to determine the feasibility of occupational ECN exposure studies. METHODS: Eligible companies were identified; information was assembled on the companies and nanomaterials they produced; and the workforce size, location, and growth were estimated. RESULTS: Sixty-one companies manufacturing ECN in the United States were identified. These companies employed at least 620 workers; workforce growth was projected at 15 percent to 17 percent annually. Most companies produced or used CNT. Half the eligible companies provided information about material dimensions, quantities, synthesis methods, and worker exposure reduction strategies. CONCLUSIONS: Industrywide exposure assessment studies appear feasible; however, cohort studies are likely infeasible because of the small, scattered workforce. |
The epidemiology of fatal occupational traumatic brain injury in the U.S.
Tiesman HM , Konda S , Bell JL . Am J Prev Med 2011 41 (1) 61-7 BACKGROUND: Although traumatic brain injury (TBI) is one of the leading causes of death and disability in the U.S., work-related TBI has not been well documented. PURPOSE: The aim of this study was to describe the epidemiologic characteristics and temporal trends of fatal occupational TBI in the U.S between 2003 and 2008. METHODS: A cross-sectional analysis of the Census of Fatal Occupational Injury database was performed. Both the Occupational Injury and Illness Classification System nature of injury codes and body part codes were used to define TBIs. Fatality rates were calculated using denominators derived from the Current Population Survey. Fatality rates were compared among industries, cause of death, and demographics with rate ratios (RRs) and 95% CIs. Poisson regression was used to assess trends in fatality rates. Data were analyzed in 2009-2010. RESULTS: Nearly 7300 occupational TBI deaths occurred between 2003 and 2008, for an average fatality rate of 0.8 per 100,000 workers per year. The leading causes of occupational TBI death were as follows: motor vehicle (31%); falls (29%); assaults and violent acts (20%); and contact with objects/equipment (18%). Fatality rates were 15 times higher in men compared with women (RR=15, 95% CI=13.7, 16.3). Workers aged ≥65 years experienced the highest TBI fatality rate of all age groups (2.5 per 100,000 per year). Construction, transportation, and agriculture/forestry/fishing industries recorded nearly half of all TBI fatalities (n=1828, n=825, n=761, respectively). Occupational TBI death rates declined 23% over the 6-year period (p<0.0001). CONCLUSIONS: This study provides the first national profile of fatal TBIs occurring in the U.S. workplace. Prevention efforts should be directed at those industries with the highest frequency and/or highest risk. The construction industry had the highest number of TBIs, and the agriculture, forestry, and fishing industry had the highest rates. Additionally, workers aged >65 years in all industries would be a good target for future prevention efforts. |
Exposure control strategies in the carbonaceous nanomaterial industry
Dahm MM , Yencken MS , Schubauer-Berigan MK . J Occup Environ Med 2011 53 S68-73 OBJECTIVE: Little is known about exposure control strategies currently being implemented to minimize exposures during the production or use of nanomaterials in the United States. Our goal was to estimate types and quantities of materials used and factors related to workplace exposure reductions among companies manufacturing or using engineered carbonaceous nanomaterials (ECNs). METHODS: Information was collected through phone surveys on work practices and exposure control strategies from 30 participating producers and users of ECN. The participants were classified into three groups for further examination. RESULTS: We report here the use of exposure control strategies. Observed patterns suggest that large-scale manufacturers report greater use of nanospecific exposure control strategies particularly for respiratory protection. CONCLUSION: Workplaces producing or using ECN generally report using engineering and administrative controls as well as personal protective equipment to control workplace employee exposure. |
Exposure registries: overview and utility for nanomaterial workers
Schulte PA , Mundt DJ , Nasterlack M , Mulloy KB , Mundt KA . J Occup Environ Med 2011 53 S42-S47 OBJECTIVE: This article provides the background for consideration of exposure registries to address potential disease risks in nanomaterial workers. METHODS: The history of exposure registries is reviewed with a focus on their purpose and criteria for establishment. RESULTS: A rationale is presented for developing registries of nanomaterial workers, and unresolved obstacles and challenges are identified. These include issues on inclusion criteria, funding, potential for legal risks, access to data, confidentiality of business information, privacy, and workers' expectations. CONCLUSION: If society is to gain the benefits from nanotechnology, it must take precautions and demonstrate care for those, such as workers, who may be most at risk of adverse effects. Establishing exposure registries is a part of such a precautionary and caring approach. |
Handwipe method for removing lead from skin
Esswein EJ , Boeniger MF , Ashley K . J ASTM Int 2011 8 (5) Researchers at the U.S. National Institute for Occupational Safety and Health (NIOSH) developed a handwipe removal method for lead (Pb) after field studies showed that workers in lead-acid battery plants had significant risks for dermal-oral lead exposures, despite their attempts to remove the lead by washing with soap and water. Hand washing with soap and water remains the standard recommendation for workers (as well as the public) to clean skin known or believed to be contaminated with toxic metals, such as lead. Despite longstanding recommendations for workers to "wash hands with soap and water", no efficacy studies show this to be a completely effective removal method for lead. Removal of toxic metals such as lead from skin constitutes a decontamination procedure; it is not, in fact, a hand-washing step. NIOSH scientists conceived and developed a highly effective (nearly 100 %) method for removal of lead from skin. A systems approach was devised incorporating four components deemed necessary for effective metal removal: Surfaction, pH control, chelation, and mechanical effects. The handwipe removal method evolved from a previous NIOSH invention, the handwipe disclosing method for the presence of lead, in the interests of providing complementary techniques for dermal lead detection and decontamination. The method is a patented, award-winning, commercialized technology that has significant potential to prevent occupational and public exposures to lead. |
Identification of systemic markers from a pulmonary carbon nanotube exposure
Erdely A , Liston A , Salmen-Muniz R , Hulderman T , Young SH , Zeidler-Erdely PC , Castranova V , Simeonova PP . J Occup Environ Med 2011 53 S80-6 OBJECTIVE: Interest exists for early monitoring of worker exposure to engineered nanomaterials. Here, we highlight quantitative systemic markers of early effects after carbon nanotube (CNT) exposure. METHODS: Mice were exposed by pharyngeal aspiration to 40-mug CNT and harvested 24 hours, 7 days, and 28 days postexposure for measurements of whole blood, lung and extrapulmonary tissue gene expression, blood and bronchoalveolar lavage (BAL) differentials, and serum protein profiling. RESULTS: Early effects included increased inflammatory blood gene expression and serum cytokines followed by an acute phase response (eg, CRP, SAA-1, SAP). Beyond 24 hours, there was a consistent increase in blood and BAL eosinophils. At 28 day, serum acute phase proteins with immune function including complement C3, apolipoproteins A-I and A-II, and alpha-macroglobulin were increased. CONCLUSIONS: Carbon nanotube exposure resulted in measurable systemic markers but lacked specificity to distinguish from other pulmonary exposures. |
Introduction to the JOEM supplement Nanomaterials and Worker Health: medical surveillance, exposure registries, and epidemiologic research
Schulte PA , Trout DB , Hodson LL . J Occup Environ Med 2011 53 S1-S2 This issue presents selected articles from the Nanomaterial Workers' Health Conference held in Keystone, Colorado, July 21 to 23, 2010. The conference addressed three critical and related topics: medical surveillance; formation of exposure registries; and the conduct of epidemiologic research. Each topic was introduced with a plenary session followed by group breakout sessions to obtain input from the approximately 120 attendees. This supplement issue of the Journal of Occupational and Environmental Medicine includes selected peer reviewed articles from the conference and summaries of the breakout sessions. The conference was initiated with a general session, and there are articles that provide an overview of the topics (Schulte and Trout) and describe lessons from air pollution particulate epidemiology (Peters et al) and the state-of-the-art of nanotoxicology (Castranova), both of which contributed to the initial concern about potential hazards of nanomaterials. The opening session also included an overview of medical surveillance in the context in which occupational physicians must regularly work and at a time when uncertainties about hazards and risks make decisions about medical surveillance of workers difficult (Nasterlack). |
Adoption of rollover protective structures (ROPS) on U.S. farm tractors by state: 1993-1995, 2001, and 2004
Hard DL , Myers JR . J Agric Saf Health 2011 17 (2) 157-72 This research compares state-level rollover protective structure (ROPS) prevalence rates from the early and mid-1990s to those observed in the years 2001 and 2004. In addition, state-level ROPS prevalence rates are compared to state-level tractor overturn fatality rates. Tractor data for 1993-1995 and for 2001 and 2004 for all tractors and ROPS-equipped tractors in use on U.S. farms were derived from surveys conducted for NIOSH by the USDA-NASS. Changes in ROPS prevalence rates at the state level between the two time periods were assessed using a two-sample paired t-test with unequal sample sizes. Poisson regression was used to assess the association between ROPS prevalence rates and tractor overturn fatality rates at the state level. Overall, 49 of the 50 states had an observed increase in the percentage of farm tractors equipped with ROPS from 1993-1995 to 2001 and 2004. This increase was statistically significant for 34 states. Large shifts in ROPS prevalence were found within individual states and in clusters of states. These include a major increase in the southeastern U.S. and some western states. However, a core of states in the northeast (many of them in or near the Appalachian Mountains) through the upper midwest remain in the bottom quartile for ROPS prevalence. For the years 1992 through 2004, the highest fatality rates were observed in many of the same states that were identified previously as having persistently low ROPS prevalence rates. There is a clear relationship between low state-level ROPS prevalence rates and high state-specific tractor overturn fatality rates. While progress has been made in increasing the percentage of ROPS-equipped farm tractors, it is projected that ROPS prevalence rates will not reach a protective level nationally until after 2015. Regionally, the northeast and midwest will not reach protective levels of ROPS-equipped tractors until after 2020. Based on the adoption rates observed, tractor overturn rates will likely continue to be a more localized, but significant, public health issue for several states beyond the year 2020. The results of this study show the geographic areas of the U.S. where the greatest need exists, and where a greater emphasis should be placed on ROPS promotion activities. However, addressing this public health issue on a large scale will require resources and an organized commitment, which have historically been lacking. |
Carbon nanotube risk assessment: implications for exposure and medical monitoring
Kuempel ED . J Occup Environ Med 2011 53 S91-7 OBJECTIVE: Quantitative risk estimates using toxicology data provide information for risk management to protect workers with potential exposure to carbon nanotubes (CNTs). METHODS: Dose-response data from subchronic inhalation studies in rats were used in benchmark dose modeling. Dose was airborne mass concentration of multiwalled CNTs. Responses included pulmonary inflammation, lipoproteinosis, and fibrosis. RESULTS: Estimated human-equivalent concentrations to the rat lowest observed adverse effect levels were similar to some workplace airborne concentrations of CNTs. Working lifetime risk estimates of early-stage adverse lung effects were more than 10% at the limit of quantification (7 mcg/m(3)) of the National Institute for Occupational Safety and Health analytical method for measuring CNT airborne concentrations. CONCLUSIONS: Exposure monitoring and control are the primary occupational health measures to protect workers from potential exposure to CNT. Medical monitoring for early detection of occupational respiratory diseases may also be warranted. |
Discomfort glare comparison for various LED cap lamps
Sammarco JJ , Mayton AG , Lutz T , Gallagher S . IEEE Trans Ind Appl 2011 47 (3) 1168-1174 Researchers at the National Institute for Occupational Safety and Health (NIOSH) are investigating different lighting technologies with the objective of improving mine safety. This paper presents the results from an ongoing study that compares discomfort glare for different light-emitting diode (LED) cap lamps using the de Boer glare rating scale. The cap lamps tested included two commercially-available LED cap lamps and one NIOSH prototype LED cap lamp tested at three different illumination levels. Prior research indicated that the NIOSH prototype enabled much better visual performance as compared to other LED cap lamps. It uses three LEDs that produce multiple illumination areas in comparison to commercially-available cap lamps that use one LED and projects a narrow spot pattern. Across subjects and cap lamp test conditions, measured illuminances (averaged at both eyes) varied from 0.62 to 3.73 lx, whereas the de Boer glare ratings varied from 4.86 to 7.71. An analysis of variance based on 15 subjects indicated a significant difference in the discomfort glare due to cap lamps (F4, 52 = 18.01, p 0.001). Post hoc tests indicate that one of the commercially available cap lamps exhibited lower discomfort scores, with no statistically significant differences detected between the others. Thus, the NIOSH prototype cap lamp does not cause excessive discomfort glare yet enables better visual performance. 2011 IEEE. |
Computer availability and principals' perceptions of online surveys
Eaton DK , Brener ND , Kann L , Roberts AM , Kyle TM , Flint KH , Ross AL . J Sch Health 2011 81 (7) 365-373 BACKGROUND: School-based risk behavior surveys traditionally have been administered via paper-and-pencil. This study assessed the feasibility of conducting in-class online surveys in US high schools. METHODS: A paper-and-pencil questionnaire assessing computer availability and perceptions of online surveys was mailed to a nationally representative sample of public and private high school principals in fall 2008. Completed surveys were returned by principals from 580 of 704 selected schools. Prevalence and 95% confidence intervals were computed. RESULTS: Most high schools have at least 1 computer lab, most computers in computer labs are connected to the Internet, and just under half of schools with a stationary computer lab had a sufficient number of computers to accommodate an in-class online survey administration. The 2 most common problems associated with online surveys were logistics of providing enough computers for an entire class and rotating classes into computer labs. Nearly two thirds of principals preferred online to paper-and-pencil surveys when administered to 4 randomly selected classes that met at different times during the school day, but less than half reported this preference when administered to 4 randomly selected classes that met at the same time during the school day. CONCLUSION: Many schools do not have sufficient computer capacity to participate in a voluntary in-class online survey. An online survey could impose significant perceived and actual burden on schools and therefore could result in unacceptably low school participation rates. Online administration for in-class surveys of students in US high schools are not recommended. |
U.S. medical eligibility criteria for contraceptive use, 2010
Curtis KM , Tepper NK , Marchbanks PA . J Womens Health (Larchmt) 2011 20 (6) 825-8 Women with unintended pregnancies are more likely to experience poor pregnancy outcomes. For women with medical conditions, unintended pregnancy may worsen the condition and carry even greater risk of adverse pregnancy outcomes, including maternal and perinatal death. Although safe and highly effective contraceptive methods are available to prevent unintended pregnancy, there may be concerns about the safety of contraceptive methods among women with medical conditions. The Centers for Disease Control and Prevention (CDC) has recently developed the U.S. Medical Eligibility Criteria for Contraceptive Use, 2010, which provides evidence-based recommendations for the safety of contraceptive use among women with medical conditions. Most women, even those with medical conditions, can safely use most methods of contraception. |
Multisystemic infection with an Acanthamoeba sp in a dog
Kent M , Platt SR , Rech RR , Eagleson JS , Howerth EW , Shoff M , Fuerst PA , Booton G , Visvesvara GS , Schatzberg SJ . J Am Vet Med Assoc 2011 238 (11) 1476-81 CASE DESCRIPTION: A 10-month-old Boxer was evaluated for fever and signs of cervical pain. CLINICAL FINDINGS: Physical examination revealed lethargy, fever, and mucopurulent ocular and preputial discharge. On neurologic examination, the gait was characterized by a short stride. The dog kept its head flexed and resisted movement of the neck, consistent with cervical pain. Clinicopathologic findings included neutrophilic leukocytosis, a left shift, and monocytosis. Cervical radiographs were unremarkable. Cerebrospinal fluid analysis revealed neutrophilic pleocytosis and high total protein content. On the basis of signalment, history, and clinicopathologic data, a diagnosis of steroid-responsive meningitis-arteritis was made. TREATMENT AND OUTCOME: The dog was treated with prednisone (3.2 mg/kg [1.45 mg/lb], PO, q 24 h), for 3 weeks with limited response. Consequently, azathioprine (2 mg/kg [0.9 mg/lb], PO, q 24 h) was administered. Three weeks later, the dog was evaluated for tachypnea and lethargy. Complete blood count revealed leukopenia, neutropenia, and a left shift. Thoracic radiography revealed a diffuse bronchointerstitial pattern. The dog subsequently went into respiratory arrest and died. On histologic evaluation, amoebic organisms were observed in the lungs, kidneys, and meninges of the brain and spinal cord. A unique Acanthamoeba sp was identified by use of PCR assay. CLINICAL RELEVANCE: This dog developed systemic amoebic infection presumed to be secondary to immunosuppression. The development of secondary infection should be considered in animals undergoing immunosuppression for immune-mediated disease that develop clinical signs unrelated to the primary disease. Although uncommon, amoebic infection may develop in immunosuppressed animals. Use of a PCR assay for identification of Acanthamoeba spp may provide an antemortem diagnosis. |
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