Serogroup B meningococcal disease outbreak and carriage evaluation at a college - Rhode Island, 2015
Soeters HM , McNamara LA , Whaley M , Wang X , Alexander-Scott N , Kanadanian KV , Kelleher CM , MacNeil J , Martin SW , Raines N , Sears S , Vanner C , Vuong J , Bandy U , Sicard K , Patel M . MMWR Morb Mortal Wkly Rep 2015 64 (22) 606-7 On February 2, 2015, the Rhode Island Department of Health was notified of a case of meningococcal disease in a male undergraduate student at Providence College. Three days later, a second case was reported in a male undergraduate with no contact with the first student, indicating an attack rate of 44 cases per 100,000 students, nearly 500 times higher than the national incidence of 0.15 cases per 100,000 among persons aged 17-22 years (Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC, unpublished data, 2013). Both cases were caused by a rare outbreak strain of Neisseria meningitidis serogroup B (ST-9069); neither case was fatal. In response to the outbreak, potential contacts received antibiotic chemoprophylaxis, and a mass vaccination campaign with a recently licensed serogroup B meningococcal (MenB) vaccine was implemented. In collaboration with CDC, the first phase of a meningococcal carriage evaluation was undertaken. |
Mortality associated with seasonal and pandemic influenza among pregnant and non-pregnant women of childbearing age in a high HIV prevalence setting - South Africa, 1999-2009
Tempia S , Walaza S , Cohen AL , von Mollendorf C , Moyes J , McAnerney JM , Cohen C . Clin Infect Dis 2015 61 (7) 1063-70 BACKGROUND: Information on the mortality burden associated with seasonal and pandemic influenza virus infection among pregnant women is scarce in most settings, particularly in sub-Saharan Africa where pregnancy and maternal mortality rates as well as HIV prevalence are elevated. METHODS: We used an ecological study design to estimate the seasonal and A(H1N1)pdm09 influenza-associated mortality among pregnant and non-pregnant women of childbearing age (15-49 years) by HIV serostatus during 1999-2009 in South Africa. Mortality rates were expressed per 100,000 person-years. RESULTS: During 1999-2009 the estimated mean annual seasonal influenza-associated mortality rates were 12.6 (123 deaths) and 7.3 (914 deaths) among pregnant and non-pregnant women, respectively. Among pregnant women the estimated mean annual seasonal influenza-associated mortality rates were 74.9 (109 deaths) among HIV-infected and 1.5 (14 deaths) among HIV-uninfected individuals. Among non-pregnant women the estimated mean annual seasonal influenza-associated mortality rate was 41.2 (824 deaths) among HIV-infected and 0.9 (90 deaths) among HIV-uninfected individuals. Pregnant women experienced an increased risk of seasonal influenza-associated mortality compared to non-pregnant women (relative risk [RR]: 2.8; 95% confidence intervals [CI]: 2.1-3.7). In 2009 the estimated influenza A(H1N1)pdm09-associated mortality rates were 19.3 (181 deaths) and 9.4 (1189 deaths) among pregnant and non-pregnant women, respectively (RR: 3.2; 95% CI: 2.3-4.1). CONCLUSIONS: Among women of childbearing age, the majority of estimated seasonal influenza-associated deaths occurred in HIV-infected individuals. Pregnant women experienced an increased risk of death associated with seasonal and A(H1N1)pdm09 influenza infection compared to non-pregnant women. |
Mortality risk after AIDS-defining opportunistic illness among HIV-infected persons - San Francisco, 1981-2012
Djawe K , Buchacz K , Hsu L , Chen MJ , Selik RM , Rose C , Williams T , Brooks JT , Schwarcz S . J Infect Dis 2015 212 (9) 1366-75 OBJECTIVE: To examine whether improved human immunodeficiency virus (HIV) treatment was associated with better survival after diagnosis of AIDS-defining opportunistic illnesses (AIDS-OIs) and how survival differed by AIDS-OI. DESIGN: We used HIV surveillance data to conduct a survival analysis. METHODS: We estimated survival probabilities after first AIDS-OI diagnosis among adult patients with AIDS in San Francisco during 3 treatment eras: 1981-1986; 1987-1996; and 1997-2012. We used Cox proportional hazards models to determine adjusted mortality risk by AIDS-OI in the years 1997-2012. RESULTS: Among 20 858 patients with AIDS, the most frequently diagnosed AIDS-OIs were Pneumocystis pneumonia (39.1%) and Kaposi sarcoma (20.1%). Overall 5-year survival probability increased from 7% in 1981-1986 to 65% in 1997-2012. In 1997-2012, after adjustment for known confounders and using Pneumocystis pneumonia as the referent category, mortality rates after first AIDS-OI were highest for brain lymphoma (hazard ratio [HR], 5.14; 95% confidence interval [CI], 2.98-8.87) and progressive multifocal leukoencephalopathy (HR, 4.22; 95% CI, 2.49-7.17). CONCLUSION: Survival after first AIDS-OI diagnosis has improved markedly since 1981. Some AIDS-OIs remain associated with substantially higher mortality risk than others, even after adjustment for known confounders. Better prevention and treatment strategies are still needed for AIDS-OIs occurring in the current HIV treatment era. |
Progress toward measles elimination - South-East Asia region, 2003-2013
Thapa A , Khanal S , Sharapov U , Swezy V , Sedai T , Dabbagh A , Rota P , Goodson JL , McFarland J . MMWR Morb Mortal Wkly Rep 2015 64 (22) 613-7 In 2013, the 66th session of the Regional Committee of the World Health Organization (WHO) South-East Asia Region adopted the goal of measles elimination and rubella and congenital rubella syndrome control by 2020 after rigorous prior consultations. The recommended strategies include 1) achieving and maintaining ≥95% coverage with 2 doses of measles- and rubella-containing vaccine in every district through routine or supplementary immunization activities (SIAs); 2) developing and sustaining a sensitive and timely case-based measles surveillance system that meets recommended performance indicators; 3) developing and maintaining an accredited measles laboratory network; and 4) achieving timely identification, investigation, and response to measles outbreaks. This report updates previous reports and summarizes progress toward measles elimination in the South-East Asia Region during 2003-2013. Within the region, coverage with the first dose of a measles-containing vaccine (MCV1) increased from 67% to 78%; an estimated 286 million children (95% of the target population) were vaccinated in SIAs; measles incidence decreased 73%, from 59 to 16 cases per million population; and estimated measles deaths decreased 63%. To achieve measles elimination in the region, additional efforts are needed in countries with <95% 2-dose routine MCV coverage, particularly in India and Indonesia, to strengthen routine immunization services, conduct periodic high-quality SIAs, and strengthen measles case-based surveillance and laboratory diagnosis of measles. |
Global burden of invasive nontyphoidal Salmonella disease, 2010
Ao TT , Feasey NA , Gordon MA , Keddy KH , Angulo FJ , Crump JA . Emerg Infect Dis 2015 21 (6) 941-9 Nontyphoidal Salmonella is a major cause of bloodstream infections worldwide, and HIV-infected persons and malaria-infected children are at increased risk for the disease. We conducted a systematic literature review to obtain age group-specific, population-based invasive nontyphoidal Salmonella (iNTS) incidence data. Data were categorized by HIV and malaria prevalence and then extrapolated by using 2010 population data. The case-fatality ratio (CFR) was determined by expert opinion consensus. We estimated that 3.4 (range 2.1-6.5) million cases of iNTS disease occur annually (overall incidence 49 cases [range 30-94] per 100,000 population). Africa, where infants, young children, and young adults are most affected, has the highest incidence (227 cases [range 152-341] per 100,000 population) and number of cases (1.9 [range 1.3-2.9] million cases). An iNTS CFR of 20% yielded 681,316 (range 415,164-1,301,520) deaths annually. iNTS disease is a major cause of illness and death globally, particularly in Africa. Improved understanding of the epidemiology of iNTS is needed. |
The 13th International Workshops on Opportunistic Protists (IWOP13)
Calderon EJ , Cushion MT , Xiao L , Lorenzo-Morales J , Matos O , Kaneshiro ES , Weiss LM . J Eukaryot Microbiol 2015 62 (5) 701-9 The 13th International Workshops on Opportunistic Protists (IWOP-13) was held November 13-15, 2014 in Seville, Spain. The objectives of the IWOP meetings are to: (1) serve as a forum for exchange of new information among active researchers concerning the basic biology, molecular genetics, immunology, biochemistry, pathogenesis, drug development, therapy, and epidemiology of these immunodeficiency-associated pathogenic eukaryotic microorganisms that are seen in patients with AIDS and; (2) to foster the entry of new and young investigators into these underserved research areas. The IWOP meeting focuses on opportunistic protists; e.g. the free-living amoebae, Pneumocystis, Cryptosporidium, Toxoplasma, the Microsporidia, and kinetoplastid flagellates. This conference represents the major conference which brings together research groups working on these opportunistic pathogens. Progress has been achieved on understanding the biology of these pathogenic organisms, their involvement in disease causation in both immune deficient and immune competent hosts and is providing important insights into these emerging and reemerging pathogens. A continuing concern of the participants is the ongoing loss of scientific expertise and diversity in this research community. This decline is due to the small size of these research communities and an ongoing lack of understanding by the broader scientific community of the challenges and limitations faced by researchers working on these organisms, which makes these research communities very sensitive to declines in research funding. |
Cabotegravir long-acting for HIV-1 prevention
Andrews CD , Heneine W . Curr Opin HIV AIDS 2015 10 (4) 258-63 PURPOSE OF REVIEW: Preexposure prophylaxis (PrEP) with daily Truvada has demonstrated clinical efficacy against HIV-1 acquisition that correlates with high adherence. Long-acting antiretroviral drugs offer an alternative to daily regimens and may improve PrEP adherence. This review summarizes the preclinical nonhuman primate studies for evaluating the efficacy of cabotegravir long-acting as PrEP and the ongoing phase 2a studies assessing safety, tolerability, and acceptability of cabotegravir long-acting. RECENT FINDINGS: Cabotegravir is an HIV-1 integrase strand transfer inhibitor with intrinsic properties that permit its formulation as a long-acting injectable suspension. In clinical evaluation, cabotegravir long-acting has a half-life that permits infrequent dosing, possibly once every 3 months. In validated macaque models, cabotegravir long-acting demonstrated high protection against both rectal and vaginal transmission at clinically achievable drug concentrations. SUMMARY: PrEP, after approval of Truvada, continues to evolve to address adherence limitations of daily dosing. As a long-acting injectable antiretroviral drug, cabotegravir long-acting permits quarterly dosing and demonstrated high efficacy in macaque models supporting dose selection and clinical development. Clinical studies have confirmed dose selection in phase 2a trials with cabotegravir long-acting to ultimately lead to phase 2b/3 PrEP efficacy trials. |
Strengthening the effectiveness of state-level community health worker initiatives through ambulatory care partnerships
Allen C , Brownstein JN , Jayapaul-Philip B , Matos S , Mirambeau A . J Ambul Care Manage 2015 38 (3) 254-62 The transformation of the US health care system and the recognition of the effectiveness of community health workers (CHWs) have accelerated national, state, and local efforts to engage CHWs in the support of vulnerable populations. Much can be learned about how to successfully integrate CHWs into health care teams, how to maximize their impact on chronic disease self-management, and how to strengthen their role as emissaries between clinical services and community resources; we share examples of effective strategies. Ambulatory care staff members are key partners in statewide initiatives to build and sustain the CHW workforce and reduce health disparities. |
New baseline environmental assessment of mosquito ecology in northern Haiti during increased urbanization
Samson DM , Archer RS , Alimi TO , Arheart KL , Impoinvil DE , Oscar R , Fuller DO , Qualls WA . J Vector Ecol 2015 40 (1) 46-58 The catastrophic 2010 earthquake in Port-au-Prince, Haiti, led to the large-scale displacement of over 2.3 million people, resulting in rapid and unplanned urbanization in northern Haiti. This study evaluated the impact of this unplanned urbanization on mosquito ecology and vector-borne diseases by assessing land use and change patterns. Land-use classification and change detection were carried out on remotely sensed images of the area for 2010 and 2013. Change detection identified areas that went from agricultural, forest, or bare-land pre-earthquake to newly developed and urbanized areas post-earthquake. Areas to be sampled for mosquito larvae were subsequently identified. Mosquito collections comprised five genera and ten species, with the most abundant species being Culex quinquefasciatus 35% (304/876), Aedes albopictus 27% (238/876), and Aedes aegypti 20% (174/876). All three species were more prevalent in urbanized and newly urbanized areas. Anopheles albimanus, the predominate malaria vector, accounted for less than 1% (8/876) of the collection. A set of spectral indices derived from the recently launched Landsat 8 satellite was used as covariates in a species distribution model. The indices were used to produce probability surfaces maps depicting the likelihood of presence of the three most abundant species within 30 m pixels. Our findings suggest that the rapid urbanization following the 2010 earthquake has increased the amount of area with suitable habitats for urban mosquitoes, likely influencing mosquito ecology and posing a major risk of introducing and establishing emerging vector-borne diseases. |
Polychlorinated biphenyls: new evidence from the last decade
Faroon O , Ruiz P . Toxicol Ind Health 2015 32 (11) 1825-1847 Millions of pounds of polychlorinated biphenyl (PCB) compounds have been produced in multiple countries for industrial applications over the last several decades. PCB exposure induces various adverse health effects in animals and humans. Environmental and occupational exposures to PCBs have been associated with liver, kidney, endocrine, and neurodevelopmental adverse effects. We have collected and reviewed animal and human data cited in the US National Library of Medicine from 2000 to 2010. In brief, our review shows new evidence, that is, in animal studies, exposure to one of the PCBs, A1221, induces a significant alteration of serum luteinizing hormone. The effects were more profound in the F2 generation, particularly with respect to fluctuations in hormones and reproductive tract tissues across the estrous cycle. Morphological analyses of brain tissue from rats exposed to A1254 confirmed the results of an earlier work which showed that the relative size of the intra- and infrapyramidal (II-P) mossy fibers was smaller than that in the controls and also reduction in growth was selective for the II-P mossy fibers. PCB exposure increased anogenital distance and prostate size but decreased epididymal weight, epididymal sperm count, and motile epididymal sperm count. No effects were observed on testicular weight or size. The epidemiological data showed an association between diabetes mellitus prevalence and elevated concentrations of PCB 153. Additionally, prenatal PCB exposure studies were associated with a smaller thymic index at birth and could adversely affect immune responses to childhood vaccinations and resistance to respiratory infections. PCB exposure was also reported to adversely affect enamel development in children in a dose-dependent manner. Because PCBs and their metabolites are potential health hazards, understanding the risk factors associated with individual PCBs, PCB mixtures, and PCB metabolites is important. PCB exposures of vulnerable populations (pregnant women, fetuses, infants, and children) are of particular concern because of heightened sensitivity during this period of brain development. |
Geographic variation in the association between ambient fine particulate matter (PM) and term low birth weight in the United States
Hao Y , Strosnider H , Balluz L , Qualters JR . Environ Health Perspect 2015 124 (2) 250-5 BACKGROUND: Studies on the association between prenatal exposure to fine particulate matter with ≤ 2.5 micrometers in aerodynamic diameter (PM2.5) and term low birth weight (LBW) have resulted in inconsistent findings. Most studies were conducted in snapshots of small geographic areas and no national study exists. OBJECTIVES: We investigated geographic variation in the associations between ambient PM2.5 during pregnancy and term LBW in the contiguous United States (US). METHODS: 3,389,450 term singleton births in 2002 (37 - 44 weeks gestational age and birth weight of 1,000g - 5,500g) were linked to daily PM2.5 via imputed birth days. We generated average daily PM2.5 during the entire pregnancy and each trimester. Multilevel logistic regression models with county-level random effects were used to evaluate the associations between term LBW and PM2.5 during pregnancy. RESULTS: Without adjusting for covariates, the odds of term LBW increased 2% (OR=1.02; 95% CI: 1.00, 1.03) for every 5 microg/m3 increase in PM2.5 exposure during the second trimester only, which remained unchanged after adjusting for county-level poverty (OR=1.02; 95% CI: 1.01, 1.04). The odds did change to null after adjusting for individual-level predictors (OR=1.00; 95% CI: 0.99, 1.02). Multilevel analyses, stratified by census division, revealed significant positive associations of term LBW and PM2.5 exposure (during the entire pregnancy or a specific trimester) in three census divisions: Middle Atlantic, East North Central, and West North Central, and significant negative association in the Mountain division. CONCLUSIONS: Our study provided additional evidence on the associations between PM2.5 exposure during pregnancy and term LBW from a national perspective. The magnitude and direction of the estimated associations between PM2.5 exposure and term LBW varied by geographic locations in the US. |
Health effects of cut gas lines and other petroleum product release incidents - seven states, 2010-2012
Anderson AR . MMWR Morb Mortal Wkly Rep 2015 64 (22) 601-5 Large mass casualty gas explosions and catastrophic oil spills are widely reported and receive considerable regulatory attention. Smaller, less catastrophic petroleum product releases are less likely to receive publicity, although study of these incidents might help focus and prioritize prevention efforts. To describe the causes and health impacts of petroleum product release incidents (including gas explosions and oil spills), the Agency for Toxic Substances and Disease Registry (ATSDR) analyzed 2010-2012 data from the National Toxic Substance Incidents Program (NTSIP). A total of 1,369 petroleum product release incidents were reported from seven states, resulting in 512 injuries and 36 deaths. Approximately one fourth of the incidents were associated with utilities, and approximately one fifth were associated with private vehicles or residences. Approximately 10% of petroleum product releases resulted from inadvertent damage to utility lines. Understanding the characteristics of acute petroleum product releases can aid the public and utility workers in the development of preventive strategies and reduce the morbidity and mortality associated with such releases. |
Draft Whole-Genome Sequences of 10 Enterotoxigenic Escherichia coli Serogroup O6 Strains.
Pattabiraman V , Bopp CA . Genome Announc 2015 3 (3) Enterotoxigenic Escherichia coli (ETEC) is an important cause of diarrhea in children under the age of 5 years and in adults living in developing countries, as well as in travelers to these countries. In this announcement, we release the draft whole-genome sequences of 10 ETEC serogroup O6 strains. |
Hypothesis: Cryptosporidium genetic diversity mirrors national disease notification rate.
Takumi K , Caccio SM , van der Giessen J , Xiao L , Sprong H . Parasit Vectors 2015 8 308 BACKGROUND: Cryptosporidiosis is a gastrointestinal disease affecting many people worldwide. Disease incidence is often unknown and surveillance of human cryptosporidiosis is installed in only a handful of developed countries. A genetic marker that mirrors disease incidence is potentially a powerful tool for monitoring the two primary human infected species of Cryptosporidium. METHODS: We used the molecular epidemiological database with Cryptosporidium isolates from ZoopNet, which currently contains more than 1400 records with their sampling nations, and the names of the host species from which the isolates were obtained. Based on 296 C. hominis and 195 C. parvum GP60 sequences from human origin, the genetic diversities of Cryptosporidium was estimated for several nations. Notified cases of human cryptosporidiosis were collected from statistics databases for only four nations. RESULTS: Genetic diversities of C. hominis were estimated in 10 nations in 5 continents, and that of C. parvum of human origin were estimated in 15 nations. Correlation with reported incidence of human cryptosporidiosis in four nations (the Netherlands, United States, United Kingdom and Australia) was positive and significant. A linear model for testing the relationship between the genetic diversity and incidence produced a significantly positive estimate for the slope (P-value < 0.05). CONCLUSIONS: The hypothesis that genetic diversity at GP60 locus mirrors notification rates of human cryptosporidiosis was not rejected based on the data presented. Genetic diversity of C. hominis and C. parvum may therefore be an independent and complementary measure for quantifying disease incidence, for which only a moderate number of stool samples from each nation are sufficient data input. |
Genome-based discrimination between Group I Clostridium botulinum and Clostridium sporogenes strains: implications for bacterial taxonomy.
Weigand MR , Pena-Gonzalez A , Shirey TB , Broeker RG , Ishaq MK , Konstantinidis KT , Raphael BH . Appl Environ Microbiol 2015 81 (16) 5420-9 Taxonomic classification of Clostridium botulinum is based on the production of botulinum neurotoxin (BoNT) while closely-related, non-toxic organisms are classified as Clostridium sporogenes. However, this taxonomic organization does not accurately mirror phylogenetic relationships between these species. A phylogenetic reconstruction using 2,016 orthologous genes shared among strains of C. botulinum Group I and C. sporogenes clearly separated these two species into discrete clades which showed approximately 93% average nucleotide identity (ANI) between them. Clustering of strains based on the presence of variable orthologs revealed 143 C. sporogenes clade-specific genetic signatures, a subset of which was further evaluated for their ability to correctly classify a panel of presumptive C. sporogenes strains by PCR. Genome sequencing of several C. sporogenes strains lacking these signatures confirmed that they clustered with C. botulinum strains in a core genome phylogenetic tree. Our analysis also identified C. botulinum strains that contained C. sporogenes clade-specific signatures and phylogenetically clustered with C. sporogenes strains. The genome sequences of two bontB2-containing strains belonging to the C. sporogenes clade contained regions with similarity to a bont-encoding plasmid (pCLD) while two different strains belonging to the C. botulinum clade encoded bontB2 on the chromosome. These results indicate that bont/B2 was likely acquired by C. sporogenes strains through horizontal gene transfer. The genome-based classification of these species used to identify candidate genes for the development of rapid assays for molecular identification may be applicable to additional bacterial species that are challenging with respect to their classification. |
Impact of laws aimed at healthcare-associated infection reduction: a qualitative study
Stone PW , Pogorzelska-Maziarz M , Reagan J , Merrill JA , Sperber B , Cairns C , Penn M , Ramanathan T , Mothershed E , Skillen E . BMJ Qual Saf 2015 24 (10) 637-44 BACKGROUND: Healthcare-associated infections (HAIs) are preventable. Globally, laws aimed at reducing HAIs have been implemented. In the USA, these laws are at the federal and state levels. It is not known whether the state interventions are more effective than the federal incentives alone. OBJECTIVE: The aims of this study were to explore the impact federal and state HAI laws have on state departments of health and hospital stakeholders in the USA and to explore similarities and differences in perceptions across states. METHODS: A qualitative study was conducted. In 2012, we conducted semistructured interviews with key stakeholders from states with and without state-level laws to gain multiple perspectives. Interviews were transcribed and open coding was conducted. Data were analysed using content analysis and collected until theoretical saturation was achieved. RESULTS: Ninety interviews were conducted with stakeholders from 12 states (6 states with laws and 6 states without laws). We found an increase in state-level collaboration. The publicly reported data helped hospitals benchmark and focus leaders on HAI prevention. There were concerns about the publicly reported data (eg, lack of validation and timeliness). Resource needs were also identified. No major differences were expressed by interviewees from states with and without laws. CONCLUSIONS: While we could not tease out the impact of specific interventions, increased collaboration between departments of health and their partners is occurring. Harmonisation of HAI definitions and reporting between state and federal laws would minimise reporting burden. Continued monitoring of the progress of HAI prevention is needed. |
Use of serogroup B meningococcal vaccines in persons aged ≥10 years at increased risk for serogroup B meningococcal disease: recommendations of the Advisory Committee on Immunization Practices, 2015
Folaranmi T , Rubin L , Martin SW , Patel M , MacNeil JR . MMWR Morb Mortal Wkly Rep 2015 64 (22) 608-12 In October 2014, the Food and Drug Administration (FDA) licensed the first serogroup B meningococcal (MenB) vaccine (MenB-FHbp [Trumenba, Wyeth Pharmaceuticals, Inc.]) as a 3-dose series. In January 2015, FDA licensed a second MenB vaccine (MenB-4C [Bexsero, Novartis Vaccines]) as a 2-dose series. Both vaccines were approved for use in persons aged 10-25 years. Following outbreaks of serogroup B meningococcal disease on two college campuses in 2013, both MenB vaccines were granted Breakthrough Therapy designations, which expedites drug development and review by FDA, and were licensed based on accelerated approval regulations. On February 26, 2015, the Advisory Committee on Immunization Practices (ACIP) recommended use of MenB vaccines among certain groups of persons aged ≥10 years who are at increased risk for serogroup B meningococcal disease. This report summarizes information on MenB administration and provides recommendations and guidance for use of these vaccines among persons aged ≥10 years in certain groups who are at increased risk for serogroup B meningococcal disease, and reviews the evidence considered by ACIP to make these recommendations. Recommendations for broader use of MenB vaccines in adolescents and college students will be considered separately by ACIP. |
Oral cholera vaccine coverage, barriers to vaccination, and adverse events following vaccination, Haiti, 2013
Tohme RA , Francois J , Wannemuehler K , Iyengar P , Dismer A , Adrien P , Hyde TB , Marston BJ , Date K , Mintz E , Katz MA . Emerg Infect Dis 2015 21 (6) 984-91 In 2013, the first government-led oral cholera vaccination (OCV) campaign in Haiti was implemented in Petite Anse and Cerca Carvajal. To evaluate vaccination coverage, barriers to vaccination, and adverse events following vaccination, we conducted a cluster survey. We enrolled 1,121 persons from Petite Anse and 809 persons from Cerca Carvajal, categorized by 3 age groups (1-4, 5-14, >15 years). Two-dose OCV coverage was 62.5% in Petite Anse and 76.8% in Cerca Carvajal. Two-dose coverage was lowest among persons >15 years of age. In Cerca Carvajal, coverage was significantly lower for male than female respondents (69% vs. 85%; p<0.001). No major adverse events were reported. The main reason for nonvaccination was absence during the campaign. Vaccination coverage after this campaign was acceptable and comparable to that resulting from campaigns implemented by nongovernmental organizations. Future campaigns should be tailored to reach adults who are not available during daytime hours. |
Pneumonia prevention during a humanitarian emergency: cost-effectiveness of haemophilus influenzae type B conjugate vaccine and pneumococcal conjugate vaccine in Somalia
Gargano LM , Hajjeh R , Cookson ST . Prehosp Disaster Med 2015 30 (4) 1-10 BACKGROUND: Pneumonia is a leading cause of death among children less than five years old during humanitarian emergencies. Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae are the leading causes of bacterial pneumonia. Vaccines for both of these pathogens are available to prevent pneumonia. PROBLEM: This study describes an economic analysis from a publicly funded health care system perspective performed on a birth cohort in Somalia, a country that has experienced a protracted humanitarian emergency. METHODS: An impact and cost-effectiveness analysis was performed comparing: no vaccine, Hib vaccine only, pneumococcal conjugate vaccine 10 (PCV10) only, and both together administered through supplemental immunization activities (SIAs). The main summary measure was the incremental cost per disability-adjusted life-years (DALYs) averted. One-way sensitivity analysis was conducted for uncertainty in parameter values. RESULTS: Each SIA would avert a substantial number of cases and deaths. Compared with no vaccine, the DALYs averted by two SIAs for two doses of Hib vaccine was US $202.93 (lower and upper limits: $121.80-$623.52), two doses of PCV10 was US $161.51 ($107.24-$227.21), and two doses of both vaccines was US $152.42 ($101.20-$214.42). Variables that influenced the cost-effectiveness for each strategy most substantially were vaccine effectiveness, case fatality rates (CFRs), and disease burden. CONCLUSIONS: The World Health Organization (WHO) defines a cost-effective intervention as costing one to three times the per capita gross domestic product (GDP; in 2011, for Somalia=US $112). Based on the presented model, Hib vaccine alone, PCV10 alone, or Hib vaccine and PCV10 given together in SIAs are cost-effective interventions in Somalia. The WHO/Strategic Advisory Group of Experts decision-making factors for vaccine deployment appear to have all been met: the disease burden is large, the vaccine-related risk is low, prevention in this setting is more feasible than treatment, the vaccine duration probably is sufficient for the vulnerable period of the child's life, cost is reasonable, and herd immunity is possible. |
Factors associated with provider reporting of child and adolescent vaccination history to immunization information systems: results from the National Immunization Survey, 2006-2012
Cardemil CV , Cullen KA , Harris L , Greby SM , Santibanez TA . J Public Health Manag Pract 2015 22 (3) 245-54 CONTEXT: Use of Immunization information systems (IISs) by providers can improve vaccination rates by identifying missed opportunities. However, provider reporting of children's vaccination histories to IISs remains suboptimal. OBJECTIVE: To assess factors associated with provider reporting to an IIS. DESIGN: Analysis of 2006-2012 National Immunization Survey (NIS) and NIS-Teen data. NIS and NIS-Teen are ongoing random-digit-dial telephone surveys of households with children and adolescents, respectively, followed by a mail survey to providers to obtain the patient's vaccination history. SETTING AND PARTICIPANTS: A total of 115 285 children aged 19 to 35 months and 83 612 adolescents aged 13 to 17 years and their immunization providers in the United States. MAIN OUTCOME MEASURES: The percentage of children and adolescents with 1 or more providers reporting to or obtaining vaccination information from their local IISs. Multivariable logistic regression was used to examine patient and provider factors associated with provider reporting to IISs and adjusted prevalence of children and adolescents with 1 or more providers reporting to IISs. RESULTS: In 2012, 79.4% of children and 77.4% of adolescents had 1 or more providers report any of their vaccination data to an IIS, and 41.9% of children and 51.5% of adolescents had providers who obtained any of their vaccination histories from an IIS. During 2006-2012, children and adolescents were more likely to have any of their vaccination data reported to an IIS if they received care from all public versus all private providers (children: 84.4% vs 69.6%, P < .0001; adolescents: 84.6% vs 66.4%, P < .0001), had 1 or more providers who ordered vaccines from a state or local health department (children: 76.7% vs 59.5%, P < .0001; adolescents: 77.0% vs 55.6%, P < .0001), or had 1 or more providers obtain vaccination information from the IIS (children: 86.1% vs 71.2%, P < .0001; adolescents: 83.7% vs 64.6%, P < .0001). CONCLUSIONS: Health department staff should target providers less likely to use IIS services, including private providers, and providers not ordering vaccines from health departments to ensure they use IIS services. |
Acute gastroenteritis hospitalizations among US children following implementation of the rotavirus vaccine
Leshem E , Tate JE , Steiner CA , Curns AT , Lopman BA , Parashar UD . JAMA 2015 313 (22) 2282-4 Routine rotavirus vaccination of US children was implemented in 2006, with 2 or 3 doses recommended before the age of 8 months.1 Previous studies have demonstrated the association of rotavirus vaccine introduction with reductions in health care use during the early postintroduction period or with limited insurance databases.2-4 Because laboratory testing and coding for rotavirus are not routinely performed for patients with diarrhea, we examined both all-cause acute gastroenteritis and rotavirus-coded hospitalizations among children younger than 5 years from 2000 through 2012. |
Advanced clinical decision support for vaccine adverse event detection and reporting
Baker MA , Kaelber DC , Bar-Shain DS , Moro PL , Zambarano B , Mazza M , Garcia C , Henry A , Platt R , Klompas M . Clin Infect Dis 2015 61 (6) 864-70 BACKGROUND: Reporting of adverse events (AEs) following vaccination can help identify rare or unexpected complications of immunizations and aid in characterizing potential vaccine safety signals. We developed an open-source, generalizable clinical decision support system called Electronic Support for Public Health-Vaccine Adverse Event Reporting System (ESP-VAERS) to assist clinicians with AE detection and reporting. METHODS: ESP-VAERS monitors patients' electronic health records for new diagnoses, changes in laboratory values, and new allergies following vaccinations. When suggestive events are found, ESP-VAERS sends the patient's clinician a secure electronic message with an invitation to affirm or refute the message, add comments and submit an automated, pre-populated electronic report to VAERS. High probability AEs are reported automatically if the clinician does not respond. We implemented ESP-VAERS in 12/2012 throughout the MetroHealth System, an integrated healthcare system in Ohio. We queried the VAERS database to determine MetroHealth's baseline reporting rates from 1/2009-3/2012 and then assessed changes in reporting rates with ESP-VAERS. RESULTS: In the 8 months following implementation, 91,622 vaccinations were given. ESP-VAERS sent 1,385 messages to responsible clinicians describing potential AEs. Clinicians opened 1,304 (94.2%) messages, responded to 209 (15.1%), and confirmed 16 for transmission to VAERS. An additional 16 high probability AEs were sent automatically. Reported events included seizure, pleural effusion, and lymphocytopenia. The odds of a VAERS report submission during the implementation period were 30.2 (95% CI, 9.52-95.5) times greater than the odds during the comparable pre-implementation period. CONCLUSIONS: An open-source electronic health record-based clinical decision support system can increase AE detection and reporting rates in VAERS. |
Can reductions in the cross-reactivity of flavivirus structural proteins lead to improved safety and immunogenicity of tetravalent dengue vaccine?
Chao DY , Crill WD , Davis BS , Chang GJJ . Future Virol 2015 10 (5) 477-480 The most advanced dengue vaccine in clinical development is the tetravalent chimeric yellow fever-17D dengue (TCYD) vaccine. Optimistically, this vaccine could be available globally in the very near future, which may potentially reduce the burden of dengue disease [1]. The TCYD vaccine was estimated to achieve 56% efficacy based on primary end point calculations from two Phase III efficacy trials in Asia and Latin America and the efficacies were higher among trial participants with prior dengue virus (DENV) exposure [2]. Several concerns have been raised due to unexpected lower overall efficacy for all DENV serotypes, particularly for DENV-2 [3,4]; thus, there is a need to develop second-generation dengue vaccines to improve efficacy of the current TCYD vaccine. There are other dengue vaccine candidates in clinical trial and research development, but none of them are attempting to modulate the immune responses to improve the vaccine safety and efficacy. In this editorial, we will discuss the principle of immune modulation based on cross-reactivity reduction (CRR) immunogens and the rationale of this approach in the development of second-generation tetravalent dengue vaccine. |
A comprehensive approach to sexual violence prevention
Basile KC . N Engl J Med 2015 372 (24) 2350-2352 Sexual violence is a widespread problem that is associated with negative health outcomes throughout life.1 Recent national data reveal that, among women reporting a history of rape, 40% were first raped before 18 years of age and 38% between 18 and 24 years of age.1 The college years may be a particularly vulnerable time for women, given the increase in partying and alcohol use. One study showed that 20% of undergraduate women were victims of sexual violence since beginning college.2 Nevertheless, sexual violence is a preventable public health problem. | In this issue of the Journal, Senn et al.3 report the results of a randomized, controlled trial of an intervention designed to reduce the incidence of sexual violence victimization among first-year female university students in Canada. They found that an enhanced sexual assault resistance program led to reductions in the risk of completed rape and attempted rape and, to a lesser degree, attempted coercion and nonconsensual sexual contact over a 1-year follow-up period. The researchers calculated that for every 22 women enrolled, the intervention would prevent one additional completed rape within 1 year after participation. Their study has numerous strengths consistent with principles of effective prevention,4 including a rigorous design, assessment of several types of sexual violence, and an intervention informed by theory5 and administered in multiple sessions with the use of varied teaching methods. Its primary weakness is that it places the onus for prevention on potential victims, possibly obscuring the responsibility of perpetrators and others. What happens when women who complete the intervention cannot successfully resist rape? |
Articles published and downloaded by public health scientists: analysis of data from the CDC Public Health Library, 2011-2013
Iskander J , Bang G , Stupp E , Connick K , Gomez O , Gidudu J . J Public Health Manag Pract 2015 22 (4) 409-14 OBJECTIVE: To describe scientific information usage and publication patterns of the Centers for Disease Control and Prevention (CDC) Public Health Library and Information Center patrons. DESIGN: Administratively collected patron usage data and aggregate data on CDC-authored publications from the CDC Library for 3 consecutive years were analyzed. SETTING: The CDC Public Health Library and Information Center, which serves CDC employees nationally and internationally. PARTICIPANTS: Internal patrons and external users of the CDC Library. MAIN OUTCOME MEASURE(S): Three-year trends in full-text article publication and downloads including most common journals used for each purpose, systematic literature searches requested and completed, and subscriptions to a weekly public health current literature awareness service. RESULTS: From 2011 to 2013, CDC scientists published a total of 7718 articles in the peer-reviewed literature. During the same period, article downloads from the CDC Library increased 25% to more than 1.1 million, completed requests for reviews of the scientific literature increased by 34%, and electronic subscriptions to literature compilation services increased by 23%. CONCLUSIONS: CDC's scientific output and information use via the CDC Library are both increasing. Researchers and field staff are making greater use of literature review services and other customized information content delivery. Virtual public health library access is an increasingly important resource for the scientific practice of public health. |
Masculine discrepancy stress, teen dating violence, and sexual violence perpetration among adolescent boys
Reidy DE , Smith-Darden JP , Cortina KS , Kernsmith RM , Kernsmith PD . J Adolesc Health 2015 56 (6) 619-24 PURPOSE: Addressing gender norms is integral to understanding and ultimately preventing violence in both adolescent and adult intimate relationships. Males are affected by gender role expectations which require them to demonstrate attributes of strength, toughness, and dominance. Discrepancy stress is a form of gender role stress that occurs when boys and men fail to live up to the traditional gender norms set by society. Failure to live up to these gender role expectations may precipitate this experience of psychological distress in some males which, in turn, may increase the risk to engage in physically and sexually violent behaviors as a means of demonstrating masculinity. METHODS: Five-hundred eighty-nine adolescent males from schools in Wayne County, Michigan completed a survey assessing self-perceptions of gender role discrepancy, the experience of discrepancy stress, and history of physical and sexual dating violence. RESULTS: Logistic regression analyses indicated boys who endorsed gender role discrepancy and associated discrepancy stress were generally at greater risk to engage in acts of sexual violence but not necessarily physical violence. CONCLUSIONS: Boys who experience stress about being perceived as "sub-masculine" may be more likely to engage in sexual violence as a means of demonstrating their masculinity to self and/or others and thwarting potential "threats" to their masculinity by dating partners. Efforts to prevent sexual violence perpetration among male adolescents should perhaps consider the influence of gender socialization in this population and include efforts to reduce distress about masculine socialization in primary prevention strategies. |
Relationship of menstrual cycle and vaginal infection in female rhesus macaques challenged with repeated, low doses of SIVmac251
Morris MR , Byrareddy SN , Villinger F , Henning TC , Butler K , Ansari AA , McNicholl JM , Kersh EN . J Med Primatol 2015 44 (5) 301-5 Varying susceptibility during menstrual cycling could be a factor for S(H)IV infection risk in female rhesus macaques. We retrospectively determined vaginal SIV infection time points relative to the menstrual cycle in a group of rhesus macaques (n=11) enrolled in an HIV transmission trial. Eight of nine rhesus macaques became infected around menstruation time. |
Triclosan induces thymic stromal lymphopoietin in skin promoting Th2 allergic responses
Marshall NB , Lukomska E , Long CM , Kashon ML , Sharpnack DD , Nayak AP , Anderson KL , Meade BJ , Anderson SE . Toxicol Sci 2015 147 (1) 127-39 Triclosan is an antimicrobial chemical incorporated into many personal, medical and household products. 75% of the U.S. population has detectable levels of triclosan in their urine and although it is not typically considered a contact sensitizer, recent studies have begun to link triclosan exposure with augmented allergic disease. We examined the effects of dermal triclosan exposure on the skin and lymph nodes of mice and in a human skin model to identify mechanisms for augmenting allergic responses. Triclosan (0-3%) was applied topically at 24 hour intervals to the ear pinnae of OVA-sensitized BALB/c mice. Skin and draining lymph nodes were evaluated for cellular responses and cytokine expression over time. The effects of triclosan (0-0.75%) on cytokine expression in a human skin tissue model was also examined. Exposure to triclosan increased the expression of TSLP, IL-1beta and TNF-alpha in the skin with concomitant decreases in IL-25, IL-33 and IL-1alpha. Similar changes in TSLP, IL1B and IL33 expression occurred in human skin. Topical application of triclosan also increased draining lymph node cellularity consisting of activated CD86+GL-7+ B cells, CD80+CD86+ dendritic cells, GATA-3+OX-40+IL-4+IL-13+ Th2 cells and IL-17A+ CD4 T cells. In-vivo antibody blockade of TSLP reduced skin irritation, IL-1beta expression, lymph node cellularity, and Th2 responses augmented by triclosan. Repeated dermal exposure to triclosan induces TSLP expression in skin tissue as a potential mechanism for augmenting allergic responses. |
Lipopolysaccharide induced MAP kinase activation in RAW 264.7 cells attenuated by cerium oxide nanoparticles
Selvaraj V , Nepal N , Rogers S , Manne NDPK , Arvapalli R , Rice KM , Asano S , Fankenhanel E , Ma JY , Shokuhfar T , Maheshwari M , Blough ER . Data Brief 2015 4 96-99 High mortality rates are associated with the life threatening disease of sepsis. Improvements in septic patient survivability have failed to materialize with currently available treatments. This article represents data regarding a study published in biomaterials (Vellaisamy et al., Biomaterials, 2015, in press). with the purpose of evaluating whether severe sepsis mortality and associated hepatic dysfunction induced by lipopolysaccharide (LPS) can be prevented by cerium oxide nanoparticles (CeO2NPs) treatment in male Sprague Dawley rats. Here we provide the information about the method and processing of raw data related to our study publish in Biomaterials and Data in Brief (Vellaisamy et al., Biomaterials, 2015, in press; Vellaisamy et al., Data in Brief, 2015, in press.). The data contained in this article evaluates the contribution of MAPK signaling in LPS induced sepsis. Macrophage cells (RAW 264.7) were treated with a range of cerium oxide nanoparticle concentration in the presence and absence of LPS. Immunoblotting was performed on the cell lysates to evaluate the effect of cerium oxide nanoparticle treatment on LPS induced changes in Mitogen Activated Protein Kinases (MAPK) p-38, ERK 1/2, and SAPK/JNK phosphorylation. |
High-throughput determination of mercury in tobacco and mainstream smoke from little cigars
Fresquez MR , Gonzalez-Jimenez N , Gray N , Watson CH , Pappas RS . J Anal Toxicol 2015 39 (7) 545-50 A method was developed that utilizes a platinum trap for mercury from mainstream tobacco smoke, which represents an improvement over traditional approaches that require impingers and long sample preparation procedures. In this approach, the trapped mercury is directly released for analysis by heating the trap in a direct mercury analyzer. The method was applied to the analysis of mercury in the mainstream smoke of little cigars. The mercury levels in little cigar smoke obtained under Health Canada Intense smoking machine conditions ranged from 7.1 x 10-3 to 1.2 x 10-2 mg/m3. These air mercury levels exceed the chronic inhalation minimal risk level corrected for intermittent exposure to metallic mercury (e.g., 1 or 2 h per day, 5 days per week) determined by the Agency for Toxic Substances and Disease Registry. Multivariate statistical analysis was used to assess associations between mercury levels and little cigar physical design properties. Filter ventilation was identified as the principal physical parameter influencing mercury concentrations in mainstream little cigar smoke generated under ISO machine smoking conditions. With filter ventilation blocked under Health Canada Intense smoking conditions, mercury concentrations in tobacco and puff number (smoke volume) were the primary physical parameters that influenced mainstream smoke mercury concentrations. |
Cerium oxide nanoparticles inhibit lipopolysaccharide induced MAP kinase/NF-kB mediated severe sepsis
Selvaraj V , Nepal N , Rogers S , Manne NDPK , Arvapalli R , Rice KM , Asano S , Fankenhanel E , Ma JY , Shokuhfar T , Maheshwari M , Blough ER . Data Brief 2015 4 105-115 The life threatening disease of sepsis is associated with high mortality. Septic patient survivability with currently available treatments has failed to improve. The purpose of this study was to evaluate whether lipopolysaccharide (LPS) induced sepsis mortality and associated hepatic dysfunction can be prevented by cerium oxide nanoparticles (CeO2NPs) treatment in male Sprague Dawley rats. Here we provide the information about the methods processing of raw data related to our study published in Biomaterials (Selvaraj et al., Biomaterials. , 2015, In press) and Data in Brief (Selvaraj et al., Data in Brief, 2015, In Press). The data present here provides confirmation of cerium oxide nanoparticle treatments ability to prevent the LPS induced sepsis associated changes in physiological, blood cell count, inflammatory protein and growth factors in vivo. In vitro assays investigation the treated of macrophages cells with different concentrations of cerium oxide nanoparticle demonstrate that concentration of cerium oxide nanoparticles below 1 microg/ml did not significantly influence cell survival as determined by the MTT assay. |
Obesity in children with developmental and/or physical disabilities
Bandini L , Danielson M , Esposito LE , Foley JT , Fox MH , Frey GC , Fleming RK , Krahn G , Must A , Porretta DL , Rodgers AB , Stanish H , Urv T , Vogel LC , Humphries K . Disabil Health J 2015 8 (3) 309-16 Children with developmental or physical disabilities, many of whom face serious health-related conditions, also are affected by the current obesity crisis. Although evidence indicates that children with disabilities have a higher prevalence of obesity than do children without disabilities, little is known of the actual magnitude of the problem in this population. To address this concern, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) held a conference on obesity in children with intellectual, developmental, or physical disabilities, bringing together scientists and practitioners in the fields of obesity and disability to foster collaboration, identify barriers to healthy weight status in populations with disabilities, propose avenues to solutions through research and practice, and develop a research agenda to address the problem. This article describes current knowledge about prevalence of obesity in this population, discusses factors influencing obesity risk, and summarizes recommendations for research presented at the conference. |
Prevalence and factors associated with anemia among children under 5 years of age-Uganda, 2009
Menon MP , Yoon SS . Am J Trop Med Hyg 2015 93 (3) 521-6 Anemia in children under 5 years of age, defined by the World Health Organization as a hemoglobin concentration < 11 g/dL, is a global public health problem. According to the 2006 Demographic Health Survey, the prevalence of anemia among children under five in Uganda was 72% in 2006. The 2009 Uganda Malaria Indicator Survey was conducted in late 2009 and revealed that over 60% of children less than 5 years of age were anemic and that over half of children tested positive for malaria via a rapid diagnostic test. Children with concomitant malaria infection, and in households without any type of mosquito net were more likely to be anemic, confirming that children under 5 years, are vulnerable to both the threat of malaria and anemia and the beneficial effect of malaria prevention tools. However, prevention and treatment of other factors associated with the etiology of anemia (e.g., iron deficiency) are likely necessary to combat the toll of anemia in Uganda. |
Estimating the recurrence rate of gestational diabetes mellitus (GDM) in Massachusetts 1998-2007: methods and findings
England L , Kotelchuck M , Wilson HG , Diop H , Oppedisano P , Kim SY , Cui X , Shapiro-Mendoza CK . Matern Child Health J 2015 19 (10) 2303-13 OBJECTIVES: Women with gestational diabetes mellitus (GDM) may be able to reduce their risk of recurrent GDM and progression to type 2 diabetes mellitus through lifestyle change; however, there is limited population-based information on GDM recurrence rates. METHODS: We used data from a population of women delivering two sequential live singleton infants in Massachusetts (1998-2007) to estimate the prevalence of chronic diabetes mellitus (CDM) and GDM in parity one pregnancies and recurrence of GDM and progression from GDM to CDM in parity two pregnancies. We examined four diabetes classification approaches; birth certificate (BC) data alone, hospital discharge (HD) data alone, both sources hierarchically combined with a diagnosis of CDM from either source taking priority over a diagnosis of GDM, and both sources combined including only pregnancies with full agreement in diagnosis. Descriptive statistics were used to describe population characteristics, prevalence of CDM and GDM, and recurrence of diabetes in successive pregnancies. Diabetes classification agreement was assessed using the Kappa statistic. Associated maternal characteristics were examined through adjusted model-based t tests and Chi square tests. RESULTS: A total of 134,670 women with two sequential deliveries of parities one and two were identified. While there was only slight agreement on GDM classification across HD and BC records, estimates of GDM recurrence were fairly consistent; nearly half of women with GDM in their parity one pregnancy developed GDM in their subsequent pregnancy. While estimates of progression from GDM to CDM across sequential pregnancies were more variable, all approaches yielded estimates of ≤5 %. The development of either GDM or CDM following a parity one pregnancy with no diagnosis of diabetes was <3 % across approaches. Women with recurrent GDM were disproportionately older and foreign born. CONCLUSION: Recurrent GDM is a serious life course public health issue; the inter-pregnancy interval provides an important window for diabetes prevention. |
Global age distribution of pediatric norovirus cases
Shioda K , Kambhampati A , Hall AJ , Lopman BA . Vaccine 2015 33 (33) 4065-8 Norovirus is increasingly recognized as a major cause of acute gastroenteritis among children <5 years of age. We searched for publications that reported detailed age distributions of pediatric norovirus cases, and assessed associations between age distribution and socio-demographic factors to identify the most critical age periods to prevent norovirus cases among young children. Approximately 70% of pediatric norovirus cases occurred between 6 and 23 months of age. A younger age distribution was found in lower income countries and inpatient settings. These findings suggest that a norovirus immunization schedule completed by 6 months could have the potential to prevent about 85% of pediatric cases, while a vaccine delivered at 12 months of age would only have the potential to prevent about 50% of pediatric cases. With a younger age distribution in lower income settings, early prevention would be even more critical. |
Adherence to vitamin D recommendations among US infants aged 0 to 11 months, NHANES, 2009 to 2012
Ahrens KA , Rossen LM , Simon AE . Clin Pediatr (Phila) 2015 55 (6) 555-6 In 2008, the American Academy of Pediatrics (AAP) revised their recommended minimum daily intake of vitamin D for infants and children to 400 IU.1 This was based on the high prevalence of vitamin D deficiency, persistent incidence of rickets, and historical safety profile of 400 IU daily supplementation in infants and children.1 The AAP recommends that vitamin D supplementation should begin within the first few days of life and continue until the infant is consuming at least 1 liter of vitamin D–fortified formula or milk per day. Breastfed infants are at increased risk of vitamin D deficiency because human milk generally does not contain sufficient vitamin D, while infant formula is fortified to provide approximately 400 IU of vitamin D per liter (at normal dilution).2 Adherence to the revised recommended vitamin D intake guidelines has not been evaluated since enactment. | The objective of our analysis was to evaluate the percentage of US infants meeting the 2008 AAP vitamin D recommendations during 2009 to 2012. |
Autism spectrum disorder symptoms among children enrolled in the Study to Explore Early Development (SEED)
Wiggins LD , Levy SE , Daniels J , Schieve L , Croen LA , DiGuiseppi C , Blaskey L , Giarelli E , Lee LC , Pinto-Martin J , Reynolds A , Rice C , Rosenberg CR , Thompson P , Yeargin-Allsopp M , Young L , Schendel D . J Autism Dev Disord 2015 45 (10) 3183-94 This study examined the phenotypic profiles of children aged 30-68 months in the Study to Explore Early Development (SEED). Children classified as autism spectrum disorder (ASD), developmental delay (DD) with ASD symptoms, DD without ASD symptoms, and population comparison (POP) differed significantly from each other on cognitive, adaptive, behavioral, and social functioning and the presence of parent-reported conditions. Children with ASD and DD with ASD symptoms had mild to severe ASD risk on several measures compared to children with other DD and POP who had little ASD risk across measures. We conclude that children in SEED have varying degrees of ASD impairment and associated deficits. SEED thus provides a valuable sample to explore ASD phenotypes and inform risk factor analyses. |
Food insecurity and dietary intake among US youth, 2007-2010
Rossen LM , Kobernik EK . Pediatr Obes 2015 11 (3) 187-93 BACKGROUND: There is limited research describing associations between food insecurity and dietary intake. OBJECTIVE: To examine differences in dietary intake by food security status among a nationally representative sample of children and adolescents in the USA. METHODS: The sample included 5136 children, ages 2-15 years, from the National Nutrition and Health Examination Survey, 2007-2010. Propensity score weighting was used to improve covariate balance between food-secure and food-insecure (marginal, low or very low food security) participants. Multivariate measurement error models were used to model usual intake of various dietary components and assess differences by food security status. RESULTS: Initial analyses using multivariate measurement error models determined there were no differences between food-insecure and food-secure children across several dietary components. In sensitivity analyses, children experiencing very low food security consumed fewer whole grains and more solid fats and added sugars compared with their food-secure counterparts. Some of these differences were attenuated after propensity score weighting, although intake of whole grains and added sugars remained significantly different. CONCLUSIONS: Food insecurity was largely not associated with dietary intake among 2-15-year-old US children, although some differences were observed comparing food-secure children to those experiencing very low food security. |
Thirty-seven human cases of sparganosis from Ethiopia and South Sudan caused by Spirometra spp
Eberhard ML , Thiele EA , Yembo GE , Yibi MS , Cama VA , Ruiz-Tiben E . Am J Trop Med Hyg 2015 93 (2) 350-355 Thirty-seven unusual specimens, three from Ethiopia and 34 from South Sudan, were submitted since 2012 for further identification by the Ethiopian Dracunculiasis Eradication Program (EDEP) and the South Sudan Guinea Worm Eradication Program (SSGWEP), respectively. Although the majority of specimens emerged from sores or breaks in the skin, there was concern that they did not represent bona fide cases of Dracunculus medinensis and that they needed detailed examination and identification as provided by the World Health Organization Collaborating Center (WHO CC) at Centers for Disease Control and Prevention (CDC). All 37 specimens were identified on microscopic study as larval tapeworms of the spargana type, and DNA sequence analysis of seven confirmed the identification of Spirometra sp. Age of cases ranged between 7 and 70 years (mean 25 years); 21 (57%) patients were male and 16 were female. The presence of spargana in open skin lesions is somewhat atypical, but does confirm the fact that populations living in these remote areas are either ingesting infected copepods in unsafe drinking water or, more likely, eating poorly cooked paratenic hosts harboring the parasite. |
Long-lasting insecticidal nets in Zambia: a cross-sectional analysis of net integrity and insecticide content
Craig AS , Muleba M , Smith SC , Katebe-Sakala C , Chongwe G , Hamainza B , Walusiku B , Tremblay M , Oscadal M , Wirtz R , Tan KR . Malar J 2015 14 (1) 239 BACKGROUND: Long-lasting insecticidal nets (LLINs) are a mainstay of malaria prevention in Africa. More LLINs are available now than in any time previously due to increases in funding for malaria control. LLINs are expected to last three to five years before they need to be replaced. Reports of nets lasting less than three years are frequent in Zambia, which, if true, will increase the number of LLINs needed to maintain universal coverage. METHODS: This study collected nets distributed during mass distribution campaigns. One net was collected from each participating home in 12 districts in 2010 and all nets were examined for holes. One household member was surveyed about net use and care. RESULTS: The study collected 713 polyester nets with a median age of 31 months (range 27-44 months, interquartile (IQR) range: 29-36 months), median number of holes was 17 (IQR: 5-33), and median total hole size was 88.3 sq cm (IQR: 14.5-360.4). The median total number of holes did differ by age of the net, from 27-44 months, but not in a linear fashion. The difference in the number of holes in the newest and oldest nets was not statistically significant. The mean deltamethrin level for all nets was 23 mg/sq m (≥8 mg/sq m is considered effective). There was a larger total hole area in the lower half of the nets (repeat measures ANOVA, F = 228.43, df = 2, p < 0.0001) compared to the upper half and roof of the net. Only 8.7 % of nets had evidence of repairs. CONCLUSIONS: At 27 - 30 months, LLINs already had a large total hole surface area that was equivalent to the oldest nets observed. Nets were often tucked under reed mats which may explain the finding that the largest hole area was found in the lower half of the net. Studies need to be conducted prospectively to determine when physical deterioration occurs and why nets are discarded. Re-enforcing the lower half of the sides of LLINs may help decrease holes. |
Bed net durability assessments: exploring a composite measure of net damage
Vanden Eng JL , Chan A , Abilio AP , Wolkon A , Ponce de Leon G , Gimnig J , Morgan J . PLoS One 2015 10 (6) e0128499 BACKGROUND: The durability of Long Lasting Insecticidal Nets (LLINs) in field conditions is of great importance for malaria prevention and control efforts; however, the physical integrity of the net fabric is not well understood making it challenging to determine overall effectiveness of nets as they age. The 2011 World Health Organization Pesticide Evaluation Scheme (WHOPES) guidelines provide a simple, standardized method using a proportional hole index (PHI) for assessing net damage with the intent to provide national malaria control programs with guidelines to assess the useful life of LLINS and estimate the rate of replacement. METHODS: We evaluated the utility of the PHI measure using 409 LLINs collected over three years in Nampula Province, Mozambique following a mass distribution campaign in 2008. For each LLIN the diameter and distance from the bottom of the net were recorded for every hole. Holes were classified into four size categories and a PHI was calculated following WHOPES guidelines. We investigate how the size, shape, and location of holes influence the PHI. The areas of the WHOPES defined categories were compared to circular and elliptical areas based on approximate shape and actual measured axes of each hole and the PHI was compared to cumulative damaged surface area of the LLIN. RESULTS: The damaged area of small, medium, large, and extra-large holes was overestimated using the WHOPES categories compared to elliptical areas using the actual measured axes. Similar results were found when comparing to circular areas except for extra-large holes which were underestimated. (Wilcoxon signed rank test of differences p< 0.0001 for all sizes). Approximating holes as circular overestimated hole surface area by 1.5 to 2 times or more. There was a significant difference in the mean number of holes < 0.5 cm by brand and there were more holes of all sizes on the bottom of nets than the top. For a range of hypothetical PHI thresholds used to designate a "failed LLIN", roughly 75 to 80% of failed LLINs were detected by considering large and extra-large holes alone, but sensitivity varied by brand. CONCLUSIONS: Future studies may refine the PHI to better approximate overall damaged surface area. Furthermore, research is needed to identify whether or not appropriate PHI thresholds can be used to deem a net no longer protective. Once a cutoff is selected, simpler methods of determining the effective lifespan of LLINs can help guide replacement strategies for malaria control programs. |
Cysticercosis and epilepsy in rural Tanzania: a community-based case-control and imaging study
Hunter E , Burton K , Iqbal A , Birchall D , Jackson M , Rogathe J , Jusabani A , Gray W , Aris E , Kamuyu G , Wilkins PP , Newton CR , Walker R . Trop Med Int Health 2015 20 (9) 1171-1179 OBJECTIVE: To assess the contribution of neurocysticercosis (NCC) to the burden of epilepsy in a rural Tanzanian population. METHODS: We identified adult people with epilepsy (PWE) in a door-to-door study in an established demographic surveillance site. PWE and community controls were tested for antibodies to Taenia solium, the causative agent of NCC, and all PWE were offered a computed tomography (CT) head scan. Data on household occupancy and sanitation, pig-keeping and pork consumption were collected from PWE and controls and associations with epilepsy were assessed using chi-square or Fisher's exact tests. RESULTS: Six of 218 PWE had antibodies to T. solium (2.8%; 95% CI 0.6-4.9), compared to none of 174 controls (Fisher's exact test, P = 0.04). Lesions compatible with NCC were seen in eight of 200 CT scans (4.0%; 95% CI 1.3-6.7). A total of 176 PWE had both investigations of whom two had positive serology along with NCC-compatible lesions on CT (1.1%; 95% 0.3-4.0). No associations between epilepsy and any risk factors for NCC were identified. CONCLUSIONS: Neurocysticercosis is present in this population but at a lower prevalence than elsewhere in Tanzania and sub-Saharan Africa. Insights from low-prevalence areas may inform public health interventions designed to reduce the burden of preventable epilepsy. |
Embryo transfer practices and perinatal outcomes by insurance mandate status
Boulet SL , Crawford S , Zhang Y , Sunderam S , Cohen B , Bernson D , McKane P , Bailey MA , Jamieson DJ , Kissin DM . Fertil Steril 2015 104 (2) 403-9 e1 OBJECTIVE: To use linked assisted reproductive technology (ART) surveillance and birth certificate data to compare ET practices and perinatal outcomes for a state with a comprehensive mandate requiring coverage of IVF services versus states without a mandate. DESIGN: Retrospective cohort study. SETTING: Not applicable. PATIENT(S): Live-birth deliveries ascertained from linked 2007-2009 National ART Surveillance System and birth certificate data for a state with an insurance mandate (Massachusetts) and two states without a mandate (Florida and Michigan). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Number of embryos transferred, multiple births, low birth weight, preterm delivery. RESULT(S): Of the 230,038 deliveries in the mandate state and 1,026,804 deliveries in the nonmandate states, 6,651 (2.9%) and 8,417 (0.8%), respectively, were conceived by ART. Transfer of three or more embryos was more common in nonmandate states, although the effect was attenuated for women 35 years or older (33.6% vs. 39.7%; adjusted relative risk [RR], 1.46; 95% confidence interval [CI], 1.17-1.81) versus women younger than 35 (7.0% vs. 26.9%; adjusted RR, 4.18; 95% CI, 2.74-6.36). Lack of an insurance mandate was positively associated with triplet/higher order deliveries (1.0% vs. 2.3%; adjusted RR, 2.44; 95% CI, 1.81-3.28), preterm delivery (22.6% vs. 30.7%; adjusted RR, 1.31; 95% CI, 1.20-1.42), and low birth weight (22.3% vs. 29.5%; adjusted RR, 1.28; 95% CI, 1.17-1.40). CONCLUSION(S): Compared with nonmandate states, the mandate state had higher overall rates of ART use. Among ART births, lack of an infertility insurance mandate was associated with increased risk for adverse perinatal outcomes. |
Notes from the field: increase in reported adverse health effects related to synthetic cannabinoid use - United States, January-May 2015
Law R , Schier J , Martin C , Chang A , Wolkin A . MMWR Morb Mortal Wkly Rep 2015 64 (22) 618-9 On April 6, 2015, CDC received notification of an increase in telephone calls to U.S. poison centers related to synthetic cannabinoid use. Monthly calls to all poison centers are tracked by the National Poison Data System, which reported that adverse health effects or concerns about possible adverse health effects related to synthetic cannabinoid use increased 330% from 349 in January 2015 to 1,501 in April 2015. Synthetic cannabinoids include various psychoactive chemicals or a mixture of such chemicals that are sprayed onto plant material, which is then often smoked or ingested to achieve a "high." These products are sold under a variety of names (e.g., synthetic marijuana, spice, K2, black mamba, and crazy clown) and can be sold in retail outlets as herbal products. Law enforcement agencies have regulated a number of these substances; however, manufacturers of synthetic cannabinoids frequently change the formulation to avoid detection and regulation. After the initial notification, CDC analyzed information from the National Poison Data System on reported adverse health effects related to synthetic cannabinoid use for the period January-May 2015. |
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