Female chromosome X mosaicism is age-related and preferentially affects the inactivated X chromosome.
Machiela MJ , Zhou W , Karlins E , Sampson JN , Freedman ND , Yang Q , Hicks B , Dagnall C , Hautman C , Jacobs KB , Abnet CC , Aldrich MC , Amos C , Amundadottir LT , Arslan AA , Beane-Freeman LE , Berndt SI , Black A , Blot WJ , Bock CH , Bracci PM , Brinton LA , Bueno-de-Mesquita HB , Burdett L , Buring JE , Butler MA , Canzian F , Carreon T , Chaffee KG , Chang IS , Chatterjee N , Chen C , Chen C , Chen K , Chung CC , Cook LS , Crous Bou M , Cullen M , Davis FG , De Vivo I , Ding T , Doherty J , Duell EJ , Epstein CG , Fan JH , Figueroa JD , Fraumeni JF , Friedenreich CM , Fuchs CS , Gallinger S , Gao YT , Gapstur SM , Garcia-Closas M , Gaudet MM , Gaziano JM , Giles GG , Gillanders EM , Giovannucci EL , Goldin L , Goldstein AM , Haiman CA , Hallmans G , Hankinson SE , Harris CC , Henriksson R , Holly EA , Hong YC , Hoover RN , Hsiung CA , Hu N , Hu W , Hunter DJ , Hutchinson A , Jenab M , Johansen C , Khaw KT , Kim HN , Kim YH , Kim YT , Klein AP , Klein R , Koh WP , Kolonel LN , Kooperberg C , Kraft P , Krogh V , Kurtz RC , LaCroix A , Lan Q , Landi MT , Marchand LL , Li D , Liang X , Liao LM , Lin D , Liu J , Lissowska J , Lu L , Magliocco AM , Malats N , Matsuo K , McNeill LH , McWilliams RR , Melin BS , Mirabello L , Moore L , Olson SH , Orlow I , Park JY , Patino-Garcia A , Peplonska B , Peters U , Petersen GM , Pooler L , Prescott J , Prokunina-Olsson L , Purdue MP , Qiao YL , Rajaraman P , Real FX , Riboli E , Risch HA , Rodriguez-Santiago B , Ruder AM , Savage SA , Schumacher F , Schwartz AG , Schwartz KL , Seow A , Wendy Setiawan V , Severi G , Shen H , Sheng X , Shin MH , Shu XO , Silverman DT , Spitz MR , Stevens VL , Stolzenberg-Solomon R , Stram D , Tang ZZ , Taylor PR , Teras LR , Tobias GS , Van Den Berg D , Visvanathan K , Wacholder S , Wang JC , Wang Z , Wentzensen N , Wheeler W , White E , Wiencke JK , Wolpin BM , Wong MP , Wu C , Wu T , Wu X , Wu YL , Wunder JS , Xia L , Yang HP , Yang PC , Yu K , Zanetti KA , Zeleniuch-Jacquotte A , Zheng W , Zhou B , Ziegler RG , Perez-Jurado LA , Caporaso NE , Rothman N , Tucker M , Dean MC , Yeager M , Chanock SJ . Nat Commun 2016 7 11843 To investigate large structural clonal mosaicism of chromosome X, we analysed the SNP microarray intensity data of 38,303 women from cancer genome-wide association studies (20,878 cases and 17,425 controls) and detected 124 mosaic X events >2 Mb in 97 (0.25%) women. Here we show rates for X-chromosome mosaicism are four times higher than mean autosomal rates; X mosaic events more often include the entire chromosome and participants with X events more likely harbour autosomal mosaic events. X mosaicism frequency increases with age (0.11% in 50-year olds; 0.45% in 75-year olds), as reported for Y and autosomes. Methylation array analyses of 33 women with X mosaicism indicate events preferentially involve the inactive X chromosome. Our results provide further evidence that the sex chromosomes undergo mosaic events more frequently than autosomes, which could have implications for understanding the underlying mechanisms of mosaic events and their possible contribution to risk for chronic diseases. |
Reduced prevalence of obesity in 14 disadvantaged Black communities in the United States: a successful 4-year place-based participatory intervention
Liao Y , Siegel PZ , Garraza LG , Xu Y , Yin S , Scardaville M , Gebreselassie T , Stephens RL . Am J Public Health 2016 106 (8) e1-e7 OBJECTIVES: To assess the impact of a large-scale place-based intervention on obesity prevalence in Black communities. METHODS: The Racial and Ethnic Approaches to Community Health across the United States (REACH US) project was conducted in 14 predominantly Black communities in California, Illinois, Massachusetts, New York, Ohio, Pennsylvania, South Carolina, Virginia, Washington, and West Virginia. We measured trends from 2009 to 2012 in the prevalence of obesity. We used Behavioral Risk Factor Surveillance System data to compare these trends with trends among non-Hispanic Whites and non-Hispanic Blacks in the United States and in the 10 states where REACH communities were located, and with a propensity score-matched national sample of non-Hispanic Blacks. RESULTS: The age-standardized prevalence of obesity decreased in REACH US communities (P = .045), but not in the comparison populations (P = .435 to P = .996). The relative change was -5.3% in REACH US communities versus +2.4% in propensity score-matched controls (P value for the difference = .031). The net effect on the reduction of obesity prevalence was about 1 percentage point per year for REACH. CONCLUSIONS: Obesity prevalence was reduced in 14 disadvantaged Black communities that participated in the REACH project. (Am J Public Health. Published online ahead of print June 16, 2016: e1-e7. doi:10.2105/AJPH.2016.303253). |
Surveillance of a chronic liver disease of unidentified cause in a rural setting of Ethiopia: A case study
Chiu C , Martin C , Woldemichael D , WSelasie G , Tareke I , Luce R , GLibanos G , Hunt D , Bayleyegn T , Addissie A , Buttke D , Bitew A , Vagi S , Murphy M , Seboxa T , Jima D , Debella A . Ethiop Med J 2016 54 (1) 27-32 BACKGROUND: An outbreak of a chronic liver disease of unidentified cause, known as "Unidentified Liver Disease (ULD)" by local communities was first observed in a rural village in Tigray, northern-Ethiopia in 2001. Little was known about the geographical extent, trend, and epidemiology of the disease. METHODS: The Ethiopian Public Health Institute (EPHI) by then Ethiopian Health and Nutrition Research Institute (EHNRI), Centers for Disease Control and Prevention, World Health Organization, and Tigray Regional Health Bureaue established the ULD surveillance system in 2009 to characterize and monitor trends for this emerging disease and to identify cases for treatment and follow up. A large-scale official training was provided to the surveillance staff on case identification, management and reporting. In absence of a confirmatory test, the system used simple case definitions that could be applied by frontline staff with varying clinical training. To maximize resources, health extension workers already conducting household visits in affected communities identified cases and increased community awareness about the disease. A team was placed in Shire, in close proximity to the outbreak region, to provide support and collect reports from health facilities and district health offices. RESULTS: As of September 2011, a total of 1,033 cases, including 314 deaths were identified. Contamination of locally produced grains with several pyrrolizidine alkaloid producing plants was identified cause of the disease. Staff interviews identified that shortage and turnover of trained staff were major challenges. LESSONS LEARNED: Long term dedication by frontline staff, using simple case definitions to identify cases, and active collection of missing reports were critical for surveillance of this chronic non-infectious disease of unknown cause in a rural, resource-limited setting. |
What women and their physicians need to know about the UKCTOCS study and ovarian cancer screening
Balas C , Barley D , Baugh E , Berchuck A , Boyd J , Chiuzan C , DeFeo S , Ebell M , Ellis A , Gavin K , Levin B , Matteson K , Moran A , Narod S , Ramsey C , Seiden M , Stewart SL . Am Fam Physician 2016 93 (11) 903-904 In February 2016, the Ovarian Cancer Research Fund Alliance convened a group of 25 scientists, clinicians, and advocates to meet at the Banbury Center, Cold Spring Harbor Laboratory, to discuss the recent results from the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) and implications for clinical practice and public health. | Ovarian cancer is a relatively rare type of cancer that affects approximately 1.5% of U.S. women during their lifetime, but it is the fifth most common cause of cancer death among women.1 The five-year survival rate is only about 45% because most women present with advanced-stage disease.1 There has not been an accepted early detection test because of a lack of evidence that any screening approach reduces death from ovarian cancer. At the time of the conference, no organization had issued a guideline recommending screening for ovarian cancer in women not at increased risk. | The current recommendations against screening for ovarian cancer are based on the large U.S. prospective randomized Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial.2 The PLCO trial demonstrated that an annual cancer antigen (CA) 125 measurement (using a fixed cutoff value for a positive test result) and ultrasonography were not associated with a reduction in mortality from ovarian cancer. Furthermore, screening was associated with significant harms resulting from surgeries that were triggered by false-positive findings. |
A novel staging system for caries severity in the primary dentition
Robertson LD , Beltran-Aguilar E , Dasanayake A , Phipps KR , Warren JJ , Hennessy TW . J Public Health Dent 2016 77 (1) 6-12 OBJECTIVES: Caries in the primary dentition (CIPD) has a high prevalence in U.S. children compared to other diseases, with substantial disparities among different population groups. Few reports correlate CIPD prevalence with clinical impairment of children's quality of life, such as tooth pain, speech delay or trauma to the child from operative restorations, which we collectively term morbidity. Likewise, current case definitions (ECC, S-ECC) and disease metrics (mean dmfs/dmft) are not helpful in assessing morbidity for individual or groups of children. We describe a construct to stage caries severity for children ages 0 -5, called "CIPD Levels." This metric is based on small interval age-group dmft scores, and has a direct link to current and predicted morbidity for the child. It is modeled after staging systems for medical diseases in which the various stages or levels are correlated with the probability of morbidity or mortality. METHODS: We created a matrix in which CIPD Levels 0-4 are assigned for dmft scores 0-7 depending on a child's age. CIPD Level-4 is the highest level, and frequently results in clinical adverse outcomes, including pain and extensive restorations. We next tested this matrix with data from a high-risk population. RESULTS: Among children with any cavitated caries at age <24 months, 82.8% reached the adverse outcomes threshold (CIPD Level-4) at age 36 months. For children with dmft = 0 at 24 months, 71.4% did not reach CIPD Level-4 at age 36 months. CONCLUSION: Our new metric is useful for quantifying disease burden from caries for high-risk children. |
Examining the feasibility, tolerability, and preliminary efficacy of repetitive task-specific practice for people with unilateral spatial neglect
Grattan ES , Lang CE , Birkenmeier R , Holm M , Rubinstein E , Van Swearingen J , Skidmore ER . Am J Occup Ther 2016 70 (4) 7004290020p1-8 OBJECTIVE: We examined the feasibility, tolerability, and preliminary efficacy of repetitive task-specific practice for people with unilateral spatial neglect (USN). METHOD: People with USN ≥6 mo poststroke participated in a single-group, repeated-measures study. Attendance, total repetitions, and satisfaction indicated feasibility and pain indicated tolerability. Paired t tests and effect sizes were used to estimate changes in upper-extremity use (Motor Activity Log), function (Action Research Arm Test), and attention (Catherine Bergego Scale). RESULTS: Twenty participants attended 99.4% of sessions and completed a high number of repetitions. Participants reported high satisfaction and low pain, and they demonstrated small, significant improvements in upper-extremity use (before Bonferroni corrections; t = -2.1, p = .04, d = .30), function (t = -3.0, p < .01, d = .20), and attention (t = -3.4, p < .01, d = -.44). CONCLUSION: Repetitive task-specific practice is feasible and tolerable for people with USN. Improvements in upper-extremity use, function, and attention may be attainable. |
High school students' self-reported use of school clinics and nurses
Harper CR , Liddon N , Dunville R , Habel MA . J Sch Nurs 2016 32 (5) 324-8 Access to school health clinics and nurses has been linked with improved student achievement and health. Unfortunately, no studies have examined how many students report using school clinics or nurses and for which services. This study addressed this gap with data from a nationally representative sample of 15- to 25-year-olds. Respondents who reported being in high school were provided a list of services and asked whether they had gone to a school nurse or clinic for any of the listed services. Nearly 90% reported having access to a school clinic or nurse. Among students with access, 65.6% reported using at least one service. Non-White students and younger students were more likely to report having access to a clinic or nurse. These results show many students have access to clinics or nurses and are using these services, although not uniformly for all services. |
Breast cancer screening among women with medicaid, 2006-2008: a multilevel analysis
Mobley LR , Subramanian S , Tangka FK , Hoover S , Wang J , Hall IJ , Singh SD . J Racial Ethn Health Disparities 2016 4 (3) 446-454 INTRODUCTION: Nationally, about one third of women with breast cancer (BC) are diagnosed at late stage, which might be reduced with greater utilization of BC screening. The purpose of this paper is to examine the predictors of BC mammography use among women with Medicaid, and differences among Medicaid beneficiaries in their propensity to use mammography. METHODS: The sample included 2,450,527 women drawn from both fee-for-service and managed care Medicaid claims from 25 states, during 2006-2008. The authors used multilevel modeling of predictors at person, county, and state levels of influence and examined traditional factors affecting access and the expanded scope of practice allowed for the nurse practitioner (NP) in some states to provide primary care independent of physician oversight. RESULTS: Black [OR = 0.87; 95 % CI (0.87-0.88)] and American Indian women [OR = 0.74; 95 % CI (0.71-0.76)] had lower odds ratio of mammography use than white women, while Hispanic [OR = 1.06; 95 % CI (1.05-1.07)] had higher odds ratio of mammography use than white women. Living in counties with higher Hispanic residential segregation [OR = 1.16; 95 % CI (1.10-1.23)] was associated with a higher odds ratio of mammography use compared to areas with low Hispanic residential segregation, whereas living among more segregated black [OR = 0.78; 95 % CI (0.75-0.81)] or Asian [OR = 0.19; 95 % CI (0.17-0.21)] communities had lower odds ratio compared to areas with low segregation. Holding constant statistically the perceived shortage of MDs, which was associated with significantly lower mammography use, the NP regulatory variable [OR = 1.03; 95 % CI (1.01-1.07)] enhanced the odds ratio of mammography use among women in the six states with expanded scope of practice, compared with women residing in 19 more restrictive states. CONCLUSIONS: Racial and ethnic disparities exist in the use of mammography among Medicaid-insured women. More expansive NP practice privileges in states are associated with higher utilization, and may help reduce rural disparities. |
Compression of disability between two birth cohorts of US adults with diabetes, 1992-2012: a prospective longitudinal analysis
Bardenheier BH , Lin J , Zhuo X , Ali MK , Thompson TJ , Cheng YJ , Gregg EW . Lancet Diabetes Endocrinol 2016 4 (8) 686-694 BACKGROUND: The life expectancy of the average American with diabetes has increased, but the quality of health and functioning during those extra years are unknown. We aimed to investigate the net effect of recent trends in diabetes incidence, disability, and mortality on the average age of disability onset and the number of healthy and disabled years lived by adults with and without diabetes in the USA. We assessed whether disability expanded or was compressed in the population with diabetes and compared the findings with those for the population without diabetes in two consecutive US birth cohorts aged 50-70 years. METHODS: In this prospective longitudinal analysis, we analysed data for two cohorts of US adults aged 50-70 years from the Health and Retirement Study, including 1367 people with diabetes and 11 414 without diabetes. We assessed incident disability, remission from disability, and mortality between population-based cohort 1 (born 1931-41, follow-up 1992-2002) and cohort 2 (born 1942-47, follow up 2002-12). Disability was defined by mobility loss, difficulty with one or more instrumental activities of daily living, and difficulty with one or more activities of daily living. We entered age-specific probabilities representing the two birth cohorts into a five-state Markov model to estimate the number of years of disabled and disability-free life and life-years lost by age 70 years. FINDINGS: In people with diabetes, compared with cohort 1 (n=1067), cohort 2 (n=300) had more disability-free and total years of life, later onset of disability, and fewer disabled years. Simulations of the Markov models suggest that in men with diabetes aged 50 years, this difference between cohorts amounted to a 0.8-2.3 year delay in disability across the three metrics (mobility, 63.0 [95% CI 62.3-63.6] to 64.8 [63.6-65.7], p=0.01; instrumental activities of daily living, 63.5 [63.0-64.0] to 64.3 [63.0-65.3], p=0.24; activities of daily living, 62.7 [62.1-63.3] to 65.0 [63.5-65.9], p<0.0001) and 1.3 fewer life-years lost (ie, fewer remaining life-years up to age 70 years; from 2.8 [2.5-3.2] to 1.5 [1.3-1.9]; p<0.0001 for all three measures of disability). Among women with diabetes aged 50 years, this difference between cohorts amounted to a 1.1-2.3 year delay in disability across the three metrics (mobility, 61.3 [95% CI 60.5-62.1] to 63.2 [61.5-64.5], p=0.0416; instrumental activities of daily living, 63.0 [62.4-63.7] to 64.1 [62.7-65.2], p=0.16; activities of daily living, 62.3 [61.6-63.0] to 64.6 [63.1-65.6], p<0.0001) and 0.8 fewer life-years lost by age 70 years (1.9 [1.7-2.2] to 1.1 [0.9-1.5]; p<0.0001 for all three measures of disability). Parallel improvements were gained between cohorts of adults without diabetes (cohort 1, n=8687; cohort 2, n=2727); within both cohorts, those without diabetes had significantly more disability-free years than those with diabetes (p<0.0001 for all comparisons). INTERPRETATION: Irrespective of diabetes status, US adults saw a compression of disability and gains in disability-free life-years. The decrease in disability onset due to primary prevention of diabetes could play an important part in achieving longer disability-free life-years. FUNDING: US Department of Health & Human Services and the US Centers for Disease Control and Prevention. |
Epidemiology of a Novel Recombinant MERS-CoV in Humans in Saudi Arabia.
Assiri AM , Midgley CM , Abedi GR , Bin Saeed A , Almasri MM , Lu X , Al-Abdely HM , Abdalla O , Mohammed M , Algarni HS , Alhakeem RF , Sakthivel SK , Nooh R , Alshayab Z , Alessa M , Srinivasamoorthy G , AlQahtani SY , Kheyami A , HajOmar WH , Banaser TM , Esmaeel A , Hall AJ , Curns AT , Tamin A , Alsharef AA , Erdman D , Watson JT , Gerber SI . J Infect Dis 2016 214 (5) 712-21 BACKGROUND: The Middle East respiratory syndrome coronavirus (MERS-CoV) causes severe respiratory illness in humans. Fundamental questions about circulating viruses and transmission routes remain. METHODS: We assessed routinely collected epidemiologic data for MERS-CoV cases reported in Saudi Arabia during January 01 - June 30, 2015, and conducted a more detailed investigation of cases reported during February 2015. Available respiratory specimens were obtained for sequencing. RESULTS: During the study period, 216 MERS-CoV cases were reported. Spike gene or full genome sequences (n=17) were obtained from 99 individuals. Most (72 of 99, 73%) sequences formed a discrete, novel recombinant clade (NRC-2015), which was detected in 6 regions and became predominant by June, 2015. No clinical differences were noted between clades. Among 87 cases reported during February 2015, 13 had no recognized risks for secondary acquisition; 12 of these 13 also denied camel contact. Most viruses (8 of 9) from these 13 individuals belonged to NRC-2015. DISCUSSION: Our findings document the spread and eventual predominance of NRC-2015 in humans in Saudi Arabia during the first half of 2015. Our identification of cases without recognized risk factors but with similar virus sequences suggests that additional study is needed to better understand risk factors for MERS-CoV infection. |
Penicillin-Binding Protein Transpeptidase Signatures for Tracking and Predicting ß-Lactam Resistance Levels in Streptococcus pneumoniae.
Li Y , Metcalf BJ , Chochua S , Li Z , Gertz RE Jr , Walker H , Hawkins PA , Tran T , Whitney CG , McGee L , Beall BW . mBio 2016 7 (3) beta-Lactam antibiotics are the drugs of choice to treat pneumococcal infections. The spread of beta-lactam-resistant pneumococci is a major concern in choosing an effective therapy for patients. Systematically tracking beta-lactam resistance could benefit disease surveillance. Here we developed a classification system in which a pneumococcal isolate is assigned to a "PBP type" based on sequence signatures in the transpeptidase domains (TPDs) of the three critical penicillin-binding proteins (PBPs), PBP1a, PBP2b, and PBP2x. We identified 307 unique PBP types from 2,528 invasive pneumococcal isolates, which had known MICs to six beta-lactams based on broth microdilution. We found that increased beta-lactam MICs strongly correlated with PBP types containing divergent TPD sequences. The PBP type explained 94 to 99% of variation in MICs both before and after accounting for genomic backgrounds defined by multilocus sequence typing, indicating that genomic backgrounds made little independent contribution to beta-lactam MICs at the population level. We further developed and evaluated predictive models of MICs based on PBP type. Compared to microdilution MICs, MICs predicted by PBP type showed essential agreement (MICs agree within 1 dilution) of >98%, category agreement (interpretive results agree) of >94%, a major discrepancy (sensitive isolate predicted as resistant) rate of <3%, and a very major discrepancy (resistant isolate predicted as sensitive) rate of <2% for all six beta-lactams. Thus, the PBP transpeptidase signatures are robust indicators of MICs to different beta-lactam antibiotics in clinical pneumococcal isolates and serve as an accurate alternative to phenotypic susceptibility testing. IMPORTANCE: The human pathogen Streptococcus pneumoniae is a leading cause of morbidity and mortality worldwide. beta-Lactam antibiotics such as penicillin and ceftriaxone are the drugs of choice to treat pneumococcal infections. Some pneumococcal strains have developed beta-lactam resistance through altering their penicillin-binding proteins (PBPs) and have become a major concern in choosing effective patient therapy. To systematically track and predict beta-lactam resistance, we obtained the sequence signatures of PBPs from a large collection of clinical pneumococcal isolates using whole-genome sequencing data and found that these "PBP types" were predictive of resistance levels. Our findings can benefit the current era of strain surveillance when whole-genome sequencing data often lacks detailed resistance information. Using PBP positions that we found are always substituted within highly resistant strains may lead to further refinements. Sequence-based predictions are accurate and may lead to the ability to extract critical resistance information from nonculturable clinical specimens. |
Sexual relationship power and semen exposure among female patients at a sexually transmitted infection clinic in Kingston, Jamaica
Gallo MF , Legardy-Williams J , Steiner MJ , Macaluso M , Carter M , Hobbs MM , Hylton-Kong T , Anderson C , Costenbader E , Warner L . Arch Sex Behav 2016 46 (7) 2157-2164 Women's power in sexual relationships is thought to be an important predictor of condom use. However, research on correlates of condom use often relies on participant reporting of behavior, which has questionable validity. We evaluated the association between scores from the modified Sexual Relationship Power Scale (SRPS-M) and biological detection of semen exposure in a prospective study of adult women attending a sexually transmitted infection clinic in Kingston, Jamaica with cervicitis or abnormal vaginal discharge in 2010-2011. At enrollment, women were counseled to avoid sex while on treatment and were asked to return in 6 days for a follow-up visit. At both study visits, women were administered a questionnaire and had vaginal swabs collected to test for prostate-specific antigen (PSA), a biological marker of recent semen exposure. We found no significant association at enrollment or follow-up between SRPS-M scores and semen exposure, as measured with either self-reported data or PSA positivity. Semen biomarkers could be used to develop and validate new scales on relationship power and self-efficacy related to condom use. |
Universal antiretroviral treatment eligibility for children and adolescents living with HIV: A new era
Dziuban EJ , Rivadeneira ED . Pediatr Infect Dis J 2016 35 (11) 1225-1228 Antiretroviral treatment coverage for children living with HIV is low, and new efforts are underway to expand eligibility so that all children and adolescents qualify for treatment regardless of immune suppression or clinical stage. While recent trials provide direct evidence of the benefit of this approach in adults, no such studies have been performed in children. This paper examines the available body of evidence regarding universal HIV treatment for children and adolescents. The benefits and challenges for individual patient health, as well as programmatic-level outcomes, are assessed. Universal treatment eligibility for children with HIV has great potential for improved growth and neurodevelopment and fewer morbidities for children, and treatment coverage would be expected to increase though guideline simplification. However, concerns regarding toxicities, drug resistance, and costs require careful planning. Successful implementation will depend on effective strategies for case-finding, treatment adherence support, and program monitoring that will contribute to the growing evidence base for this pivotal pediatric HIV policy shift. |
Willingness to take, use of, and indications for pre-exposure prophylaxis among men who have sex with men - 20 U.S. cities, 2014
Hoots BE , Finlayson T , Nerlander L , Paz-Bailey G . Clin Infect Dis 2016 63 (5) 672-7 BACKGROUND: Pre-exposure prophylaxis (PrEP) is an effective prevention tool for people at substantial risk of acquiring HIV. To 1) monitor the current state of PrEP use among men who have sex with men (MSM), we report on willingness to use PrEP and PrEP utilization, and 2) assess whether the MSM sub-populations at highest risk for infection have indications for PrEP according to the 2014 clinical guidelines, we estimated indications for PrEP for MSM by demographics. METHODS: We analyzed data from the 2014 cycle of the National HIV Behavioral Surveillance system among MSM who tested HIV-negative in NHBS and were currently sexually active. Adjusted prevalence ratios and 95% confidence intervals were estimated from log-linked Poisson regression with generalized estimating equations to explore differences in willingness to take PrEP, PrEP use, and indications for PrEP. RESULTS: Whereas over half of MSM said they were willing to take PrEP, only about 4% reported using PrEP. There was no difference in willingness to take PrEP between black and white MSM. PrEP use was higher among white compared to black MSM and among those with greater education and income levels. Young, black MSM were less likely to have indications for PrEP compared to young MSM of other races/ethnicities. CONCLUSIONS: Young, black MSM, despite being at high risk of HIV acquisition, may not have indications for PrEP under the current guidelines. Clinicians may need to consider other factors besides risk behaviors such as HIV incidence and prevalence in sub-groups of their communities when considering prescribing PrEP. |
Willingness to use health insurance at a sexually transmitted disease clinic: A survey of patients at 21 US clinics
Pearson WS , Cramer R , Tao G , Leichliter JS , Gift TL , Hoover KW . Am J Public Health 2016 106 (8) e1-e3 OBJECTIVES: To survey patients of publicly funded sexually transmitted disease (STD) clinics across the United States about their willingness to use health insurance for their visit. METHODS: In 2013, we identified STD clinics in 21 US metropolitan statistical areas with the highest rates of chlamydia, gonorrhea, and syphilis according to Centers for Disease Control and Prevention surveillance reports. Patients attending the identified STD clinics completed a total of 4364 surveys (response rate = 86.6%). RESULTS: Nearly half of the insured patients were willing to use their health insurance. Patients covered by government insurance were more likely to be willing to use their health insurance compared with those covered by private insurance (odds ratio [OR] = 3.60; 95% confidence interval [CI] = 2.79, 4.65), and patients covered by their parents' insurance were less likely to be willing to use their insurance compared with those covered by private insurance (OR = 0.72; 95% CI = 0.52, 1.00). Reasons for unwillingness to use insurance were privacy and out-of-pocket cost. CONCLUSIONS: Before full implementation of the Affordable Care Act, privacy and cost were barriers to using health insurance for STD services. PUBLIC HEALTH IMPLICATIONS: Barriers to using health insurance for STD services could be reduced through addressing issues of stigma associated with STD care and considering alternative payment sources for STD services. |
Norovirus in a United States Virgin Islands resort: outbreak investigation, response, and costs
Leshem E , Gastanaduy PA , Trivedi T , Laufer Halpin A , Pringle J , Lang F , Gregoricus N , Vinje J , Behravesh CB , Parashar U , Hall AJ . J Travel Med 2016 23 (5) BACKGROUND: During 8-20 April 2012, an outbreak of gastrointestinal illness occurred among guests and employees of a resort hotel in St. Thomas, US Virgin Islands. We describe outbreak characteristics, and estimate indirect (non-medical) costs to travellers. METHODS: Employees who met the case definition were interviewed and provided stool samples. Samples were tested for norovirus by real-time reverse-transcription polymerase chain reaction. Guests were asked to complete a survey aimed to identify and characterize cases, and to estimate quality adjusted vacation days (QAVD) lost. RESULTS: Overall, 66 persons (20 employees and 46 guests) met the probable case definition. The first reported illness onset occurred in a hotel employee on 8 April, while the first reported onset in a guest occurred on 13 April. An employee suffered a public diarrhoea incident on 13 April in the central kitchen, followed by illness onset in the next day among employees that assisted with the clean-up. On 15 April, after 10 guests reported ill, the hotel implemented an outbreak response protocol instructing ill employees to take a 3-day leave, and obtain medical clearance prior to resuming work. Ill guests were advised to self-isolate, and rapid cleaning of public areas and guest rooms where suspected contamination occurred was implemented. We estimated that 65 QAVDs were lost by 43 guests (1.5 days/guest). Using an approximate cost of $450 per vacation day, we estimated indirect illness cost at $675 per guest case. Seven (64%) of 11 cases' stool specimens were positive for norovirus genotype GII.4 Den Haag. CONCLUSIONS: A norovirus outbreak in a resort hotel resulted in substantial indirect costs and loss of vacation days to ill travellers. We recommend outbreak control measures including exclusion of ill employees, until ≥48-72 h after resolution of symptoms, self-isolation of ill guests and appropriate cleaning in hotel-associated norovirus outbreaks. |
Notes from the field: Typhoid fever outbreak associated with an asymptomatic carrier at a restaurant - Weld County, Colorado, 2015
Hancock-Allen J , Cronquist AB , Peden J , Adamson D , Corral N , Brown K . MMWR Morb Mortal Wkly Rep 2016 65 (23) 606-607 On September 11, 2015, a single case of typhoid fever, caused by Salmonella Typhi infection, was reported to the Colorado Department of Public Health and Environment (CDPHE). Because the patient (patient A) had symptom onset September 2 and had traveled internationally for 4 days 60 days before symptom onset, the case initially was thought to be travel-associated* (1,2). On October 1, a second case of S. Typhi infection was reported in patient B, with symptom onset September 20. Patient B reported no international travel or contact with ill persons or known carriers. Patients A and B resided approximately 6 miles (10 kilometers) apart and had no discernible epidemiologic connection. Family members of patients A and B tested negative for S. Typhi. CDPHE and the Weld County Department of Public Health and Environment (WCDPHE) investigated to 1) determine whether these cases represented a larger outbreak, 2) identify common exposure sources, and 3) stop transmission. Investigators determined that the typhoid fever in both patients and in a third patient (patient C) was associated with eating in the same restaurant during a 5-day period. |
Perinatal HIV-1 transmission: Fc gamma receptor variability associates with maternal infectiousness and infant susceptibility
Lassauniere R , Musekiwa A , Gray GE , Kuhn L , Tiemessen CT . Retrovirology 2016 13 (1) 40 BACKGROUND: Accumulating data suggest that immune effector functions mediated through the Fc portion of HIV-1-specific immunoglobulin G (IgG) are a key component of HIV-1 protective immunity, affecting both disease progression and HIV-1 acquisition. Through studying Fc gamma receptor (FcgammaR) variants known to alter IgG Fc-mediated immune responses, we indirectly assessed the role of FcgammaR-mediated effector functions in modulating perinatal HIV-1 transmission risk. In this study, genotypic data from 79 HIV-1 infected mothers and 78 HIV-1 infected infants (transmitting cases) were compared to 234 HIV-1 infected mothers and 235 HIV-1 exposed-uninfected infants (non-transmitting controls). Associations, unadjusted and adjusted for multiple comparisons, were assessed for overall transmission and according to mode of transmission-intrapartum (n = 31), in utero (n = 20), in utero-enriched (n = 48). RESULTS: The maternal FcgammaRIIIa-158V allele that confers enhanced antibody binding affinity and antibody-dependent cellular cytotoxicity capacity significantly associated with reduced HIV-1 transmission [odds ratio (OR) 0.47, 95 % confidence interval (CI) 0.28-0.79, P = 0.004; PBonf > 0.05]. In particular, the FcgammaRIIIa-158V allele was underrepresented in the in utero transmitting group (P = 0.048; PBonf > 0.05) and in utero-enriched transmitting groups (P = 0.0001; PBonf < 0.01). In both mother and infant, possession of an FcgammaRIIIb-HNA1b allotype that reduces neutrophil-mediated effector functions associated with increased transmission (OR 1.87, 95 % CI 1.08-3.21, P = 0.025; PBonf > 0.05) and acquisition (OR 1.91, 95 % CI 1.11-3.30, P = 0.020; PBonf > 0.05), respectively. Conversely, the infant FcgammaRIIIb-HNA1a|1a genotype was significantly protective of perinatal HIV-1 acquisition (OR 0.42, 95 % CI 0.18-0.96, P = 0.040; PBonf > 0.05). CONCLUSIONS: The findings of this study suggest a potential role for FcgammaR-mediated effector functions in perinatal HIV-1 transmission. However, future studies are required to validate the findings of this study, in particular associations that did not retain significance after adjustment for multiple comparisons. |
Pre-treatment drug resistance among patients initiating antiretroviral therapy (ART) in Zimbabwe: 2008-2010
Mungati M , Mhangara M , Gonese E , Mugurungi O , Dzangare J , Ngwende S , Musasa P , Wellington M , Shambira G , Apollo T , Yang C , DeVos J , Sabatier J , Kilmarx P , Chakanyuka-Musanhu C , Tshimanga M . BMC Res Notes 2016 9 (1) 302 BACKGROUND: Zimbabwe set up 12 sentinel sites to monitor HIV drug resistance (HIVDR) following the international standards for prevention of HIVDR from 2008 to 2010. METHODS: Participants were consecutively enrolled. Blood was collected and used for CD4 count, viral load (VL) and pre-treatment DR (PDR) tests besides routine baseline tests. We analyzed the characteristics of participants enrolled into the survey and estimated the point prevalence of PDR and its associated factors among ART initiators in a cross-sectional analysis using the baseline data collected from a prospective cohort in 12 purposefully selected sentinel sites. RESULTS: A total of 1728 participants (96 % response rate) were enrolled and 1610 had complete data. Of the 1610 there were more females (68.7 %) than males (31.3 %). The median CD4 count was 168 cells/mm(3) with males having lower values (P = 0.003). Ninety-six percent of participants had a VL ≥ 1000 copies/ml and the median VL was 128,000. Previous exposure to antiretroviral drugs (ARVs) was mainly through PMTCT (5 % of the participants). Overall, PDR mutations were detected in 6.3 % (95 % CI 5.2-7.7) of the 1480 successfully genotyped participants. However, the prevalence of PDR mutations was double for those with previous exposure (12.1 %) to ARVs compared with those without previous exposure (5.7 %, P = 0.002). CONCLUSIONS: The results show a moderate level of PDR prevalence among ART initiators. To maintain the efficacy of the current first-line regimens, there is need to strengthen all HIVDR prevention efforts and to conduct further studies to investigate optimal strategies that can prolong the efficacy of first-line ARV regimens in the country. |
Evaluation of a TB infection control implementation initiative in out-patient HIV clinics in Zambia and Botswana
Emerson C , Lipke V , Kapata N , Mwananyambe N , Mwinga A , Garekwe M , Lanje S , Moshe Y , Pals SL , Nakashima AK , Miller B . Int J Tuberc Lung Dis 2016 20 (7) 941-7 SETTING: Out-patient human immunodeficiency virus (HIV) care and treatment clinics in Zambia and Botswana, countries with a high burden of HIV and TB infection. OBJECTIVE: To develop a tuberculosis infection control (TB IC) training and implementation package and evaluate the implementation of TB IC activities in facilities implementing the package. DESIGN: Prospective program evaluation of a TB IC training and implementation package using a standardized facility risk assessment tool, qualitative interviews with facility health care workers and measures of pre- and post-test performance. RESULTS: A composite measure of facility performance in TB IC improved from 32% at baseline to 50% at 1 year among eight facilities in Zambia, and from 27% to 80% at 6 months among 10 facilities in Botswana. Although there was marked improvement in indicators of managerial, administrative and environmental controls, key ongoing challenges remained in ensuring access to personal protective equipment and implementing TB screening in health care workers. CONCLUSION: TB IC activities at out-patient HIV clinics in Zambia and Botswana improved after training using the implementation package. Continued infrastructure support, as well as monitoring and evaluation, are needed to support the scale-up and sustainability of TB IC programs in facilities in low-resource countries. |
Exchange sex and HIV infection among men who have sex with men: 20 US cities, 2011
Nerlander L M , Hess KL , Sionean C , Rose C E , Thorson A , Broz D , Paz-Bailey G . AIDS Behav 2016 21 (8) 2283-2294 This study assessed the prevalence of exchanging sex for money or drugs among men who have sex with men (MSM) in the 2011 US National HIV Behavioral Surveillance system. Prevalence of HIV, being HIV-positive but unaware (HIV-positive-unaware), risk behaviors and use of services were compared between MSM who did and did not receive money or drugs from one or more casual male partners in exchange for oral or anal sex in the past 12 months. Among 8411 MSM, 7.0 % exchanged sex. MSM who exchanged sex were more likely to be non-Hispanic black, live in poverty, have injected drugs, have multiple condomless anal sex partners, be HIV-positive and be HIV-positive-unaware. In multivariable analysis, exchange sex was associated with being HIV-positive-unaware (aPR 1.34, 95 % CI 1.05-1.69) after adjusting for race/ethnicity, age, education, poverty, and injecting drugs. MSM who exchange sex represent an important group to reach with HIV prevention, testing, and care services as they were more likely to report behavioral risk factors that put them at risk of HIV. |
Faster entry into HIV care among HIV-infected drug users who had been in drug-use treatment programs
Gardner LI , Marks G , Strathdee SA , Loughlin AM , Del Rio C , Kerndt P , Mahoney P , Pitasi MA , Metsch LR . Drug Alcohol Depend 2016 165 15-21 OBJECTIVE: We evaluated whether being in drug use treatment improves linkage to HIV medical care for HIV-infected drug users. We assessed whether an evidence-based intervention for linkage to care ['ARTAS'] works better for HIV-infected drug users who had been in drug use treatment than those who had not. DESIGN: Randomized trial. METHODS: 295 Participants in the Antiretroviral Treatment Access Study ['ARTAS'] trial were followed for time to first HIV medical care. Drug use (injected and non-injected drugs) in the last 30days and being in drug treatment in the last 12 months were assessed by audio-CASI. We used a proportional hazards model of time to care in drug users with and without drug treatment, adjusting for barriers to care, AIDS symptoms, and demographic factors. We tested whether drug treatment modified the intervention effect by using a drug use/drug treatment*intervention interaction term. RESULTS: Ninety-nine participants (30%) reported drug use in the 30days before enrollment. Fifty-three (18%) reported being in a drug treatment program in the last 12 months. Drug users reporting methadone maintenance became engaged in care in less than half the time of drug users without a treatment history [HR 2.97 (1.20, 6.21)]. The ARTAS intervention effect was significantly larger for drug users with a treatment history compared to drug users without a treatment history (AHR 5.40, [95% CI, 2.03-14.38]). CONCLUSIONS: Having been in drug treatment programs facilitated earlier entry into care among drug users diagnosed with HIV infection, and improved their response to the ARTAS linkage intervention. |
HIV provider and patient perspectives on the development of a health department "Data to Care" program: a qualitative study
Dombrowski JC , Carey JW , Pitts N , Craw J , Freeman A , Golden MR , Bertolli J . BMC Public Health 2016 16 (1) 491 BACKGROUND: U.S. health departments have not historically used HIV surveillance data for disease control interventions with individuals, but advances in HIV treatment and surveillance are changing public health practice. Many U.S. health departments are in the early stages of implementing "Data to Care" programs to assists persons living with HIV (PLWH) with engaging in care, based on information collected for HIV surveillance. Stakeholder engagement is a critical first step for development of these programs. In Seattle-King County, Washington, the health department conducted interviews with HIV medical care providers and PLWH to inform its Data to Care program. This paper describes the key themes of these interviews and traces the evolution of the resulting program. METHODS: Disease intervention specialists conducted individual, semi-structured qualitative interviews with 20 PLWH randomly selected from HIV surveillance who had HIV RNA levels >10,000 copies/mL in 2009-2010. A physician investigator conducted key informant interviews with 15 HIV medical care providers. Investigators analyzed de-identified interview transcripts, developed a codebook of themes, independently coded the interviews, and identified codes used most frequently as well as illustrative quotes for these key themes. We also trace the evolution of the program from 2010 to 2015. RESULTS: PLWH generally accepted the idea of the health department helping PLWH engage in care, and described how hearing about the treatment experiences of HIV seropositive peers would assist them with engagement in care. Although many physicians were supportive of the Data to Care concept, others expressed concern about potential health department intrusion on patient privacy and the patient-physician relationship. Providers emphasized the need for the health department to coordinate with existing efforts to improve patient engagement. As a result of the interviews, the Data to Care program in Seattle-King County was designed to incorporate an HIV-positive peer component and to ensure coordination with HIV care providers in the process of relinking patients to care. CONCLUSIONS: Health departments can build support for Data to Care efforts by gathering input of key stakeholders, such as HIV medical and social service providers, and coordinating with clinic-based efforts to re-engage patients in care. |
The intersection of care seeking and clinical capacity for patients with highly pathogenic avian influenza A (H5N1) virus in Indonesia: knowledge and treatment practices of the public and physicians
Kreslake JM , Wahyuningrum Y , Iuliano AD , Storms AD , Lafond KE , Mangiri A , Praptiningsih CY , Safi B , Uyeki TM , Storey JD . Disaster Med Public Health Prep 2016 10 (6) 1-10 BACKGROUND: Indonesia has the highest human mortality from highly pathogenic avian influenza (HPAI) A (H5N1) virus infection in the world. METHODS: A survey of households (N=2520) measured treatment sources and beliefs among symptomatic household members. A survey of physicians (N=554) in various types of health care facilities measured knowledge, assessment and testing behaviors, and perceived clinical capacity. RESULTS: Households reported confidence in health care system capacity but infrequently sought treatment for potential HPAI H5N1 signs/symptoms. More clinicians were confident in their knowledge of diagnosis and treatment than in the adequacy of related equipment and resources at their facilities. Physicians expressed awareness of the HPAI H5N1 suspect case definition, yet expressed only moderate knowledge in questioning symptomatic patients about exposures. Self-reported likelihood of testing for HPAI H5N1 virus was high after learning of certain exposures. Knowledge of antiviral treatment was moderate, but it was higher among clinicians in puskesmas. Physicians in private outpatient clinics, the most heavily used facilities, reported the lowest confidence in their diagnostic and treatment capabilities. CONCLUSIONS: Educational campaigns can encourage recall of possible poultry exposure when patients are experiencing signs/symptoms and can raise awareness of the effectiveness of antivirals to drive people to seek health care. Clinicians may benefit from training regarding exposure assessment and referral procedures, particularly in private clinics. (Disaster Med Public Health Preparedness. 2016;page 1 of 10). |
Dual simian foamy virus/human immunodeficiency virus type 1 infections in persons from Cote d'Ivoire
Switzer WM , Tang S , Zheng H , Shankar A , Sprinkle PS , Sullivan V , Granade TC , Heneine W . PLoS One 2016 11 (6) e0157709 Zoonotic transmission of simian retroviruses in West-Central Africa occurring in primate hunters has resulted in pandemic spread of human immunodeficiency viruses (HIVs) and human T-lymphotropic viruses (HTLVs). While simian foamy virus (SFV) and simian T- lymphotropic virus (STLV)-like infection were reported in healthy persons exposed to nonhuman primates (NHPs) in West-Central Africa, less is known about the distribution of these viruses in Western Africa and in hospitalized populations. We serologically screened for SFV and STLV infection using 1,529 specimens collected between 1985 and 1997 from Cote d'Ivoire patients with high HIV prevalence. PCR amplification and analysis of SFV, STLV, and HIV/SIV sequences from PBMCs was used to investigate possible simian origin of infection. We confirmed SFV antibodies in three persons (0.2%), two of whom were HIV-1-infected. SFV polymerase (pol) and LTR sequences were detected in PBMC DNA available for one HIV-infected person. Phylogenetic comparisons with new SFV sequences from African guenons showed infection likely originated from a Chlorocebus sabaeus monkey endemic to Cote d'Ivoire. 4.6% of persons were HTLV seropositive and PCR testing of PBMCs from 15 HTLV seroreactive persons identified nine with HTLV-1 and one with HTLV-2 LTR sequences. Phylogenetic analysis showed that two persons had STLV-1-like infections, seven were HTLV-1, and one was an HTLV-2 infection. 310/858 (53%), 8/858 (0.93%), and 18/858 (2.1%) were HIV-1, HIV-2, and HIV-positive but undifferentiated by serology, respectively. No SIV sequences were found in persons with HIV-2 antibodies (n = 1) or with undifferentiated HIV results (n = 7). We document SFV, STLV-1-like, and dual SFV/HIV infection in Cote d'Ivoire expanding the geographic range for zoonotic simian retrovirus transmission to West Africa. These findings highlight the need to define the public health consequences of these infections. Studying dual HIV-1/SFV infections in immunocompromised populations may provide a new opportunity to better understand SFV pathogenicity and transmissibility in humans. |
Reported distribution of Aedes (Stegomyia) aegypti and Aedes (Stegomyia) albopictus in the United States, 1995-2016 (Diptera: Culicidae)
Hahn MB , Eisen RJ , Eisen L , Boegler KA , Moore CG , McAllister J , Savage HM , Mutebi JP . J Med Entomol 2016 53 (5) 1169-1175 Aedes (Stegomyia) aegypti (L.) and Aedes (Stegomyia) albopictus (Skuse) transmit arboviruses that are increasing threats to human health in the Americas, particularly dengue, chikungunya, and Zika viruses. Epidemics of the associated arboviral diseases have been limited to South and Central America, Mexico, and the Caribbean in the Western Hemisphere, with only minor localized outbreaks in the United States. Nevertheless, accurate and up-to-date information for the geographical ranges of Ae. aegypti and Ae. albopictus in the United States is urgently needed to guide surveillance and enhance control capacity for these mosquitoes. We compiled county records for presence of Ae. aegypti and Ae. albopictus in the United States from 1995-2016, presented here in map format. Records were derived from the Centers for Disease Control and Prevention ArboNET database, VectorMap, the published literature, and a survey of mosquito control agencies, university researchers, and state and local health departments. Between January 1995 and March 2016, 183 counties from 26 states and the District of Columbia reported occurrence of Ae. aegypti, and 1,241 counties from 40 states and the District of Columbia reported occurrence of Ae. albopictus During the same time period, Ae. aegypti was collected in 3 or more years from 94 counties from 14 states and the District of Columbia, and Ae. albopictus was collected during 3 or more years from 514 counties in 34 states and the District of Columbia. Our findings underscore the need for systematic surveillance of Ae. aegypti and Ae. albopictus in the United States and delineate areas with risk for the transmission of these introduced arboviruses. |
Tick-, mosquito-, and rodent-borne parasite sampling designs for the National Ecological Observatory Network
Springer YP , Hoekman D , Johnson PTJ , Duffy PA , Hufft RA , Barnett DT , Allan BF , Amman BR , Barker CM , Barrera R , Beard CB , Beati L , Begon M , Blackmore MS , Bradshaw WE , Brisson D , Calisher CH , Childs JE , Diuk-Wasser MA , Douglass RJ , Eisen RJ , Foley DH , Foley JE , Gaff HD , Gardner SL , Ginsberg HS , Glass GE , Hamer SA , Hayden MH , Hjelle B , Holzapfel CM , Juliano SA , Kramer LD , Kuenzi AJ , LaDeau SL , Livdahl TP , Mills JN , Moore CG , Morand S , Nasci RS , Ogden NH , Ostfeld RS , Parmenter RR , Piesman J , Reisen WK , Savage HM , Sonenshine DE , Swei A , Yabsley MJ . Ecosphere 2016 7 (5) e01271 Parasites and pathogens are increasingly recognized as significant drivers of ecological and evolutionary change in natural ecosystems. Concurrently, transmission of infectious agents among human, livestock, and wildlife populations represents a growing threat to veterinary and human health. In light of these trends and the scarcity of long-term time series data on infection rates among vectors and reservoirs, the National Ecological Observatory Network (NEON) will collect measurements and samples of a suite of tick-, mosquito-, and rodent-borne parasites through a continental-scale surveillance program. Here, we describe the sampling designs for these efforts, highlighting sampling priorities, field and analytical methods, and the data as well as archived samples to be made available to the research community. Insights generated by this sampling will advance current understanding of and ability to predict changes in infection and disease dynamics in novel, interdisciplinary, and collaborative ways. |
Modeling the geographic distribution of Ixodes scapularis and Ixodes pacificus (Acari: Ixodidae) in the contiguous United States
Hahn MB , Jarnevich CS , Monaghan AJ , Eisen RJ . J Med Entomol 2016 53 (5) 1176-1191 In addition to serving as vectors of several other human pathogens, the black-legged tick, Ixodes scapularis Say, and western black-legged tick, Ixodes pacificus Cooley and Kohls, are the primary vectors of the spirochete (Borrelia burgdorferi) that causes Lyme disease, the most common vector-borne disease in the United States. Over the past two decades, the geographic range of I. pacificus has changed modestly while, in contrast, the I. scapularis range has expanded substantially, which likely contributes to the concurrent expansion in the distribution of human Lyme disease cases in the Northeastern, North-Central and Mid-Atlantic states. Identifying counties that contain suitable habitat for these ticks that have not yet reported established vector populations can aid in targeting limited vector surveillance resources to areas where tick invasion and potential human risk are likely to occur. We used county-level vector distribution information and ensemble modeling to map the potential distribution of I. scapularis and I. pacificus in the contiguous United States as a function of climate, elevation, and forest cover. Results show that I. pacificus is currently present within much of the range classified by our model as suitable for establishment. In contrast, environmental conditions are suitable for I. scapularis to continue expanding its range into northwestern Minnesota, central and northern Michigan, within the Ohio River Valley, and inland from the southeastern and Gulf coasts. Overall, our ensemble models show suitable habitat for I. scapularis in 441 eastern counties and for I. pacificus in 11 western counties where surveillance records have not yet supported classification of the counties as established. |
Using the CDC guideline and tools for opioid prescribing in patients with chronic pain
Dowell D , Haegerich TM . Am Fam Physician 2016 93 (12) 970-2 Pain is one of the most common problems affecting patients. By one estimate, 11% of Americans experience daily pain.1 Over the past two decades in the United States, opioids have been used much more often—and other treatments less often—to manage chronic pain. In the 1990s, it was hoped that opioids could relieve chronic pain as effectively as they relieve suffering at the end of life, and that they could be used safely in the long term. Physicians were encouraged to discard “opiophobia”2 and use opioids to manage chronic pain based on small, uncontrolled studies reporting low rates of addiction. Now, however, it is unclear how effective long-term opioid therapy is for managing pain.3 | Because of the unique effects of opioids, including tolerance and physical dependence, the question of whether opioids relieve pain in the long term is important. Most controlled trials have evaluated their effectiveness for six weeks or less.3 Long-term opioid use is associated with significant risks, such as opioid use disorder, potentially fatal overdose, falls, motor vehicle injuries, and myocardial infarctions, and evidence shows that these risks increase with dose and duration of use.3 As many as one in four patients receiving long-term opioid therapy for noncancer pain in primary care settings has opioid use disorder.4 A recent population-based cohort study found that one out of 550 patients receiving opioid therapy for noncancer pain died from opioid-related causes at a median of 2.6 years from the first prescription.5 In patients whose dose was increased to more than 200 morphine milligram equivalents per day, 3.1% died of opioid-related causes. |
Urinary concentrations of phthalate metabolites and pregnancy loss among women conceiving with medically assisted reproduction
Messerlian C , Wylie BJ , Minguez-Alarcon L , Williams PL , Ford JB , Souter IC , Calafat AM , Hauser R . Epidemiology 2016 27 (6) 879-88 BACKGROUND: Animal studies demonstrate that several phthalates are embryofetotoxic and are associated with increased pregnancy loss and malformations. Results from human studies on phthalates and pregnancy loss are inconsistent. METHODS: We examined pregnancy loss prospectively in relation to urinary phthalate metabolite concentrations among women undergoing medically assisted reproduction. We used data from 256 women conceiving 303 pregnancies recruited between 2004 and 2012 from the Massachusetts General Hospital Fertility Center. We quantified eleven phthalate metabolite concentrations and calculated the molar sum of four di(2-ethylhexyl) phthalate (DEHP) metabolites (SigmaDEHP). We estimated risk ratios (RRs) and 95% confidence intervals (CIs) for biochemical loss and total pregnancy loss (<20 weeks' gestation) across quartiles using repeated measures log-binomial models, adjusted for age, body mass index, smoking and infertility diagnosis. RESULTS: Of the 303 pregnancies, 83 (27%) ended in loss less than 20 weeks' gestation and among these, 31 (10%) ended in biochemical loss. Although imprecise, the RRs for biochemical loss increased across quartiles of summation operatorDEHP and three individual DEHP metabolites. For summation operatorDEHP, the RRs (CIs) were: 2.3 (0.63, 8.5), 2.0 (0.58, 7.2), and 3.4 (0.97, 11.7) for quartiles two, three and four, compared to one, respectively (p-trend=0.04). RRs for total pregnancy loss were elevated in the highest quartiles of SigmaDEHP and three DEHP metabolites. The remaining seven phthalate metabolite concentrations evaluated were not associated with either outcome. CONCLUSIONS: We found a suggestive pattern of association between conception cycle-specific urinary concentrations of DEHP metabolites and biochemical and total pregnancy loss among women undergoing medically assisted reproduction. |
Use of lead-glazed ceramic ware and lead-based folk remedies in a rural community of Baja California, Mexico
Welton M , Rodriguez-Lainz A , Loza O , Brodine S , Fraga M . Glob Health Promot 2016 25 (1) 6-14 BACKGROUND: Lead exposure from lead-glazed ceramics (LGCs) and traditional folk remedies have been identified as significant sources of elevated blood lead levels in Mexico and the United States. This study took place from 2005 to 2012 in a rural community in Baja California, Mexico. OBJECTIVES: 1) Investigate the knowledge, attitudes, and practices related to lead and lead exposures from LGCs and two lead-based folk remedies (azarcon and greta); and 2) evaluate a pilot intervention to provide alternative lead-safe cookware. METHODS: A baseline household survey was conducted in 2005, followed by the pilot intervention in 2006, and follow-up surveys in 2007 and 2012. For the pilot intervention, families who reported using LGCs were given lead-safe alternative cookware to try and its acceptance was evaluated in the following year. RESULTS: The community was mostly of indigenous background from Oaxaca and a high proportion of households had young children. In 2006, all participants using traditional ceramic ware at the time (n = 48) accepted lead-safe alternative cookware to try, and 97% reported that they were willing to exchange traditional ceramic ware for lead-safe alternatives. The use of ceramic cookware decreased from over 90% during respondents' childhood household use in Oaxaca to 47% in 2006 among households in Baja California, and further reduced to 16.8% in 2012. While empacho, a folk illness, was widely recognized as an intestinal disorder, there was almost universal unfamiliarity with the use and knowledge of azarcon and greta for its treatment. CONCLUSION: This pilot evaluation provides evidence 1) for an effective and innovative strategy to reduce lead exposure from LGCs and 2) of the feasibility of substituting lead-free alternative cookware for traditional ceramic ware in a rural indigenous community, when delivered in a culturally appropriate manner with health education. This strategy could complement other approaches to reduce exposure to lead from LGCs. |
Medication use associated with exposure to manganese in two Ohio towns
Bowler RM , Adams SW , Wright CW , Kim Y , Booty A , Colledge M , Gocheva VV , Lobdell DT . Int J Environ Health Res 2016 26 1-14 This report describes the use of medications as a proxy when medical record reviews are unavailable, to study the health effects of residents environmentally exposed to air-manganese (n = 185) compared to unexposed residents (n = 90). Participants' current medication lists and medication questionnaire responses were collected in clinical interviews and categorized into 13 domains. Exposed participants reported fewer hours of sleep than controls (6.6 vs. 7.0). The exposed used significantly more medications than unexposed participants (82.2 % vs. 67.8 %) and, when adjusting for age, education, and personal income, also for pain (aOR = 2.40) and hypothyroidism (aOR = 7.03). Exposed participants with higher air-Mn concentrations, monitored for 10 years by the U.S. Environmental Protection Agency, were 1.5 times more likely to take pain medications. The exposed participants take significantly more medications than unexposed participants in the categories of hypothyroidism, pain, supplements, and total medications. |
Prenatal polybrominated diphenyl ether exposure and body mass index in children up to 8 years of age
Vuong AM , Braun JM , Sjodin A , Webster GM , Yolton K , Lanphear BP , Chen A . Environ Health Perspect 2016 124 (12) 1891-1897 BACKGROUND: Prenatal exposure to endocrine disruptors has been associated with increased risk of childhood obesity. However, epidemiologic studies on polybrominated diphenyl ethers (PBDEs) are limited despite animal studies indicating its potential role as an obesogen. OBJECTIVES: We investigated whether maternal concentrations of BDE-28, -47, -99, -100, -153, and summation operatorPBDEs during pregnancy were associated with anthropometric measures in children aged 1-8 years. METHODS: We examined 318 mother-child pairs in the Health Outcomes and Measures of the Environment Study, a birth cohort enrolled from 2003-2006 (Cincinnati, OH). Serum PBDEs were measured at 16+/-3 weeks gestation. We measured child height (1-8 years), weight (1-8 years), BMI (2-8 years), waist circumference (4-8 years), and body fat (8 years). To account for repeated measures, we used linear mixed models and generalized estimating equations to estimate associations between maternal PBDEs and child anthropometric measures. RESULTS: We found no statistically significant associations between prenatal PBDEs and height or weight z-score. A 10-fold increase in maternal serum BDE-153 was associated with lower BMI z-score (beta=-0.36, 95% CI -0.60, -0.13) at 2-8 years, smaller waist circumference (beta=-1.81 cm, 95% CI -3.13, -0.50) at 4-8 years, and lower percent body fat (beta=-2.37%, 95% CI -4.21, -0.53) at 8 years. A decrease in waist circumference at 4-8 years was observed with a 10-fold increase in BDE-100 (beta=-1.50 cm, 95% CI -2.93, -0.08) and summation operatorPBDEs (beta=-1.57 cm, 95% CI -3.11, -0.02). CONCLUSIONS: Reverse causality may have resulted in prenatal PBDEs, particularly BDE-153, and decreased BMI, waist circumference, and body fat. |
In utero exposure to organochlorine pesticides and early menarche in the Avon Longitudinal Study of Parents and Children
Namulanda G , Maisonet M , Taylor E , Flanders WD , Olson D , Sjodin A , Qualters JR , Vena J , Northstone K , Naeher L . Environ Int 2016 94 467-472 INTRODUCTION: Epidemiologic data supporting the role of organochlorine pesticides in pubertal development are limited. METHODS: Using a nested case-control design, serum collected during pregnancy from mothers of 218 girls who reported menarche before 11.5years of age (cases) and 230 girls who reported menarche at or after 11.5years of age (controls) was analyzed for 9 organochlorines and metabolites. We analyzed the association between in utero organochlorine concentrations and early menarche using multivariate logistic regression controlling for mother's age at menarche, or mother's prenatal BMI. RESULTS: We did not observe an association between in utero exposure to HCB, beta-HCH, Upsilon-HCH, p,p'-DDT, p,p'-DDE, oxychlordane or trans-nonachlor and early menarche. CONCLUSIONS: This study is the first to examine the association between in utero exposure to HCB, beta-HCH, Upsilon-HCH, oxychlordane or trans-nonachlor and early menarche. In utero exposure to organochlorine pesticides does not appear to have a role in the timing of menarche in this study. |
Factors associated with adequate weekly reporting for disease surveillance data among health facilities in Nairobi County, Kenya, 2013
Mwatondo AJ , Ng'ang'a Z , Maina C , Makayotto L , Mwangi M , Njeru I , Arvelo W . Pan Afr Med J 2016 23 165 INTRODUCTION: Kenya adopted the Integrated Disease Surveillance and Response (IDSR) strategy in 1998 to strengthen disease surveillance and epidemic response. However, the goal of weekly surveillance reporting among health facilities has not been achieved. We conducted a cross-sectional study to determine the prevalence of adequate reporting and factors associated with IDSR reporting among health facilities in one Kenyan County. METHODS: Health facilities (public and private) were enrolled using stratified random sampling from 348 facilities prioritized for routine surveillance reporting. Adequately-reporting facilities were defined as those which submitted >10 weekly reports during a twelve-week period and a poor reporting facilities were those which submitted <10 weekly reports. Multivariate logistic regression with backward selection was used to identify risk factors associated with adequate reporting. RESULTS: From September 2 through November 30, 2013, we enrolled 175 health facilities; 130(74%) were private and 45(26%) were public. Of the 175 health facilities, 77 (44%) facilities classified as adequate reporting and 98 (56%) were reporting poorly. Multivariate analysis identified three factors to be independently associated with weekly adequate reporting: having weekly reporting forms at visit (AOR19, 95% CI: 6-65], having posters showing IDSR functions (AOR8, 95% CI: 2-12) and having a designated surveillance focal person (AOR7, 95% CI: 2-20). CONCLUSION: The majority of health facilities in Nairobi County were reporting poorly to IDSR and we recommend that the Ministry of Health provide all health facilities in Nairobi County with weekly reporting tools and offer specific trainings on IDSR which will help designate a focal surveillance person. |
Genomic Investigation Reveals Highly Conserved, Mosaic, Recombination Events Associated with Capsular Switching among Invasive Neisseria meningitidis Serogroup W Sequence Type (ST) - 11 Strains.
Mustapha MM , Marsh JW , Krauland MG , Fernandez JO , de Lemos AP , Dunning Hotopp JC , Wang X , Mayer LW , Lawrence JG , Hiller NL , Harrison LH . Genome Biol Evol 2016 8 (6) 2065-75 Neisseria meningitidis is an important cause of meningococcal disease globally. Sequence type (ST)-11 clonal complex (cc11) is a hypervirulent meningococcal lineage historically associated with serogroup C capsule and is believed to have acquired the W capsule through a C to W capsular switching event. We studied the sequence of capsule gene cluster (cps) and adjoining genomic regions of 524 invasive W cc11 strains isolated globally. We identified recombination breakpoints corresponding to two distinct recombination events within W cc11: a 8.4 kb recombinant region likely acquired from W cc22 including the sialic acid/ glycosyl-transferase gene, csw resulted in a C-->W change in capsular phenotype and a 13.7 kb recombinant segment likely acquired from Y cc23 lineage includes 4.5 kb of cps genes and 8.2 kb downstream of the cps cluster resulting in allelic changes in capsule translocation genes. A vast majority of W cc11 strains (497/524, 94.8%) retain both recombination events as evidenced by sharing identical or very closely related capsular allelic profiles. These data suggest that the W cc11 capsular switch involved two separate recombination events and that current global W cc11 meningococcal disease is caused by strains bearing this mosaic capsular switch. |
Domain I of the 5' non-translated genomic region in coxsackievirus B3 RNA is not required for productive replication.
Jaramillo L , Smithee S , Tracy S , Chapman NM . Virology 2016 496 127-130 Domain I is a cloverleaf-like secondary structure at the 5' termini of all enterovirus genomes, comprising part of a cis-acting replication element essential for efficient enteroviral replication. 5' genomic terminal deletions up to as much as 55% of domain I can occur without lethality following coxsackie B virus infections. We report here that the entire CVB structural domain I can be deleted without lethality. |
SSTAR, a Stand-Alone Easy-To-Use Antimicrobial Resistance Gene Predictor.
de Man TJ , Limbago BM . mSphere 2016 1 (1) We present the easy-to-use Sequence Search Tool for Antimicrobial Resistance, SSTAR. It combines a locally executed BLASTN search against a customizable database with an intuitive graphical user interface for identifying antimicrobial resistance (AR) genes from genomic data. Although the database is initially populated from a public repository of acquired resistance determinants (i.e., ARG-ANNOT), it can be customized for particular pathogen groups and resistance mechanisms. For instance, outer membrane porin sequences associated with carbapenem resistance phenotypes can be added, and known intrinsic mechanisms can be included. Unique about this tool is the ability to easily detect putative new alleles and truncated versions of existing AR genes. Variants and potential new alleles are brought to the attention of the user for further investigation. For instance, SSTAR is able to identify modified or truncated versions of porins, which may be of great importance in carbapenemase-negative carbapenem-resistant Enterobacteriaceae. SSTAR is written in Java and is therefore platform independent and compatible with both Windows and Unix operating systems. SSTAR and its manual, which includes a simple installation guide, are freely available from https://github.com/tomdeman-bio/Sequence-Search-Tool-for-Antimicrobial-Resistance -SSTAR-. IMPORTANCE Whole-genome sequencing (WGS) is quickly becoming a routine method for identifying genes associated with antimicrobial resistance (AR). However, for many microbiologists, the use and analysis of WGS data present a substantial challenge. We developed SSTAR, software with a graphical user interface that enables the identification of known AR genes from WGS and has the unique capacity to easily detect new variants of known AR genes, including truncated protein variants. Current software solutions do not notify the user when genes are truncated and, therefore, likely nonfunctional, which makes phenotype predictions less accurate. SSTAR users can apply any AR database of interest as a reference comparator and can manually add genes that impact resistance, even if such genes are not resistance determinants per se (e.g., porins and efflux pumps). |
Genome Structural Diversity among 31 Bordetella pertussis Isolates from Two Recent U.S. Whooping Cough Statewide Epidemics.
Bowden KE , Weigand MR , Peng Y , Cassiday PK , Sammons S , Knipe K , Rowe LA , Loparev V , Sheth M , Weening K , Tondella ML , Williams MM . mSphere 2016 1 (3) During 2010 and 2012, California and Vermont, respectively, experienced statewide epidemics of pertussis with differences seen in the demographic affected, case clinical presentation, and molecular epidemiology of the circulating strains. To overcome limitations of the current molecular typing methods for pertussis, we utilized whole-genome sequencing to gain a broader understanding of how current circulating strains are causing large epidemics. Through the use of combined next-generation sequencing technologies, this study compared de novo, single-contig genome assemblies from 31 out of 33 Bordetella pertussis isolates collected during two separate pertussis statewide epidemics and 2 resequenced vaccine strains. Final genome architecture assemblies were verified with whole-genome optical mapping. Sixteen distinct genome rearrangement profiles were observed in epidemic isolate genomes, all of which were distinct from the genome structures of the two resequenced vaccine strains. These rearrangements appear to be mediated by repetitive sequence elements, such as high-copy-number mobile genetic elements and rRNA operons. Additionally, novel and previously identified single nucleotide polymorphisms were detected in 10 virulence-related genes in the epidemic isolates. Whole-genome variation analysis identified state-specific variants, and coding regions bearing nonsynonymous mutations were classified into functional annotated orthologous groups. Comprehensive studies on whole genomes are needed to understand the resurgence of pertussis and develop novel tools to better characterize the molecular epidemiology of evolving B. pertussis populations. IMPORTANCE Pertussis, or whooping cough, is the most poorly controlled vaccine-preventable bacterial disease in the United States, which has experienced a resurgence for more than a decade. Once viewed as a monomorphic pathogen, B. pertussis strains circulating during epidemics exhibit diversity visible on a genome structural level, previously undetectable by traditional sequence analysis using short-read technologies. For the first time, we combine short- and long-read sequencing platforms with restriction optical mapping for single-contig, de novo assembly of 31 isolates to investigate two geographically and temporally independent U.S. pertussis epidemics. These complete genomes reshape our understanding of B. pertussis evolution and strengthen molecular epidemiology toward one day understanding the resurgence of pertussis. |
Human tuberculosis caused by Mycobacterium bovis in the United States, 2006-2013.
Scott C , Cavanaugh JS , Pratt R , Silk BJ , LoBue P , Moonan PK . Clin Infect Dis 2016 63 (5) 594-601 BACKGROUND: Using genotyping techniques that have differentiated Mycobacterium bovis from M. tuberculosis since 2005, we review the epidemiology of human TB caused by M. bovis in the United States and validate previous findings nationally. METHODS: All TB cases with a genotyped M. tuberculosis complex isolate reported during 2006-2013 in the United States were eligible for analysis. We used binomial regression to identify characteristics independently associated with M. bovis disease using adjusted prevalence ratios (aPRs) and corresponding 95% confidence intervals (95%CI). RESULTS: During 2006-2013, the annual percentages of TB cases attributable to M. bovis remained consistent nationally (range: 1.3-1.6%) among all TB cases (n=59,273). Compared with adults 25-44 years of age, infants 0-4 years (aPR 1.9, 95% CI 1.4-2.8) and children 5-14 years (aPR 4.0, 95% CI 3.1-5.3) had higher prevalences of M. bovis disease. Patients who were foreign-born (aPR 1.4, 95% CI 1.2-1.7), Hispanic (aPR 3.9, 95% CI 3.0-5.0), female (aPR 1.4, 95% CI 1.3-1.6),), and resided in U.S.-Mexico border counties (aPR 2.0, 95% CI 1.7-2.4) also had higher M. bovis prevalences. Exclusively extrapulmonary disease (aPR 3.7, 95% CI 3.3-4.2) or disease that was both pulmonary and extrapulmonary (aPR 2.4, 95% CI 2.1-2.9) were associated with a higher prevalence of M. bovis disease CONCLUSIONS: Children, foreign-born persons, Hispanics, and women are disproportionately affected by M. bovis, which was independently associated with extrapulmonary disease. Targeted prevention efforts aimed at Hispanic mothers and caregivers are warranted. |
Association of MHC region SNPs with irritant susceptibility in healthcare workers.
Yucesoy B , Talzhanov Y , Michael Barmada M , Johnson VJ , Kashon ML , Baron E , Wilson NW , Frye B , Wang W , Fluharty K , Gharib R , Meade J , Germolec D , Luster MI , Nedorost S . J Immunotoxicol 2016 13 (5) 1-7 Irritant contact dermatitis is the most common work-related skin disease, especially affecting workers in "wet-work" occupations. This study was conducted to investigate the association between single nucleotide polymorphisms (SNPs) within the major histocompatibility complex (MHC) and skin irritant response in a group of healthcare workers. 585 volunteer healthcare workers were genotyped for MHC SNPs and patch tested with three different irritants: sodium lauryl sulfate (SLS), sodium hydroxide (NaOH) and benzalkonium chloride (BKC). Genotyping was performed using Illumina Goldengate MHC panels. A number of SNPs within the MHC Class I (OR2B3, TRIM31, TRIM10, TRIM40 and IER3), Class II (HLA-DPA1, HLA-DPB1) and Class III (C2) genes were associated (p < 0.001) with skin response to tested irritants in different genetic models. Linkage disequilibrium patterns and functional annotations identified two SNPs in the TRIM40 (rs1573298) and HLA-DPB1 (rs9277554) genes, with a potential impact on gene regulation. In addition, SNPs in PSMB9 (rs10046277 and ITPR3 (rs499384) were associated with hand dermatitis. The results are of interest as they demonstrate that genetic variations in inflammation-related genes within the MHC can influence chemical-induced skin irritation and may explain the connection between inflamed skin and propensity to subsequent allergic contact sensitization. |
Estimating tuberculosis cases and their economic costs averted in the United States over the past two decades
Castro KG , Marks SM , Chen MP , Hill AN , Becerra JE , Miramontes R , Winston CA , Navin TR , Pratt RH , Young KH , LoBue PA . Int J Tuberc Lung Dis 2016 20 (7) 926-33 BACKGROUND: Following a concerted public health response to the resurgence of tuberculosis (TB) in the United States in the late 1980s, annual TB incidence decreased substantially. However, no estimates exist of the number and cost savings of TB cases averted. METHODS: TB cases averted in the United States during 1995-2014 were estimated: Scenario 1 used a static 1992 case rate; Scenario 2 applied the 1992 rate to foreign-born cases, and a pre-resurgence 5.1% annual decline to US-born cases; and a statistical model assessed human immunodeficiency virus and TB program indices. We applied the cost of illness to estimate the societal benefits (costs averted) in 2014 dollars. RESULTS: During 1992-2014, 368 184 incident TB cases were reported, and cases decreased by two thirds during that period. In the scenarios and statistical model, TB cases averted during 1995-2014 ranged from approximately 145 000 to 319 000. The societal benefits of averted TB cases ranged from US$3.1 to US$6.7 billion, excluding deaths, and from US$6.7 to US$14.5 billion, including deaths. CONCLUSIONS: Coordinated efforts in TB control and prevention in the United States yielded a remarkable number of TB cases averted and societal economic benefits. We illustrate the value of concerted action and targeted public health funding. |
Associations between vitamin D level and hospitalizations with and without an infection in a national cohort of Medicare beneficiaries
Kempker JA , Magee MJ , Cegielski JP , Martin GS . Am J Epidemiol 2016 183 (10) 920-9 Research has implicated low 25-hydroxyvitamin D (25(OH)D) level as a risk factor for infection; however, results have not been consistent. To further determine the nature of this relationship, we conducted a cohort study using Medicare beneficiaries participating in the 2001-2002 and 2003-2004 cycles of the National Health and Nutrition Examination Survey with data individually linked to hospital records from the Centers for Medicare and Medicaid Services. The primary exposure was a 25(OH)D level of <15 ng/mL versus ≥15 ng/mL. The outcomes were a hospitalization with or without an infection within 1 year of participation in the National Health and Nutrition Examination Survey, as determined from the final hospital discharge codes (International Classification of Diseases, Ninth Revision, Clinical Modification). Of 1,713 individuals, 348 had a baseline serum 25(OH)D level of <15 ng/mL, 77 experienced a hospitalization with an infection, and 287 experienced a hospitalization without an infection. In multivariable analyses, a serum 25(OH)D level of <15 ng/mL was associated with a higher risk of hospitalization with an infection (risk ratio = 2.8, 95% confidence interval: 1.3, 5.9, P < 0.01) but not of hospitalization without an infection (risk ratio = 1.4, 95% confidence interval: 0.9, 2.1, P = 0.1). In this study, we found an association between a serum 25(OH)D concentration of <15 ng/mL and a higher subsequent risk for hospitalization with an infection among Medicare beneficiaries. |
Transmission of blood-borne pathogens in US dental health care settings: 2016 update
Cleveland JL , Gray SK , Harte JA , Robison VA , Moorman AC , Gooch BF . J Am Dent Assoc 2016 147 (9) 729-38 BACKGROUND: During the past decade, investigators have reported transmissions of blood-borne pathogens (BBPs) in dental settings. In this article, the authors describe these transmissions and examine the lapses in infection prevention on the basis of available information. METHODS: The authors reviewed the literature from 2003 through 2015 to identify reports of the transmission of BBPs in dental settings and related lapses in infection prevention efforts, as well as to identify reports of known or suspected health care-associated BBP infections submitted by state health departments to the Centers for Disease Control and Prevention. RESULTS: The authors identified 3 published reports whose investigators described the transmission of hepatitis B virus and hepatitis C virus. In 2 of these reports, the investigators described single-transmission events (from 1 patient to another) in outpatient oral surgery practices. The authors of the third report described the possible transmission of hepatitis B virus to 3 patients and 2 dental health care personnel in a large temporary dental clinic. The authors identified lapses in infection prevention practices that occurred during 2 of the investigations; however, the investigators were not always able to link a specific lapse to a transmission event. Examples of lapses included the failure to heat-sterilize handpieces between patients, a lack of training for volunteers on BBPs, and the use of a combination of unsafe injection practices. CONCLUSIONS: The authors found that reports describing the transmission of BBPs in dental settings since 2003 were rare. Failure to adhere to Centers for Disease Control and Prevention recommendations for infection control in dental settings likely led to disease transmission in these cases. PRACTICAL IMPLICATIONS: The existence of these reports emphasizes the need to improve dental health care personnel's understanding of the basic principles and implementation of standard precautions through the use of checklists, policies, and practices. |
Notes from the field: strongyloidiasis at a long-term-care facility for the developmentally disabled - Arizona, 2015
Jones JM , Hill C , Briggs G , Gray E , Handali S , McAuliffe I , Montgomery S , Komatsu K , Adams L . MMWR Morb Mortal Wkly Rep 2016 65 (23) 608-609 Strongyloides stercoralis is an intestinal nematode endemic in the tropics and subtropics. Infection is usually acquired through skin contact with contaminated soil, or less commonly, from person to person through fecal contamination of the immediate environment. Infections are often asymptomatic, but can result in a pruritic rash, respiratory symptoms (e.g., cough or wheeze), and gastrointestinal symptoms (e.g., diarrhea and vomiting). Immunosuppressed persons can develop strongyloides hyperinfection syndrome, which can be fatal (1). In June 2015, the Pinal County Public Health Services District in Arizona was notified of a suspected strongyloidiasis infection in a resident of a long-term-care facility for developmentally disabled persons. The patient had anemia and chronic eosinophilia. The patient's serum tested positive for S. stercoralis-specific immunoglobulin G (IgG) by a commercial enzyme-linked immunosorbent assay (ELISA) and at CDC by a crude antigen ELISA, a quantitative assay for detection of IgG against S. stercoralis. An investigation was conducted to determine the infection source and identify additional cases. |
Outbreak of group A Streptococcus infections in an outpatient wound clinic-Colorado, 2014
Hancock-Allen JB , Janelle SJ , Lujan K , Bamberg WM . Am J Infect Control 2016 44 (10) 1133-1138 BACKGROUND: In September 2014, wound clinic A reported a cluster of group A Streptococcus (GAS) infections to public health authorities. Although clinic providers were individually licensed, the clinic, affiliated with hospital A, was not licensed or subject to regulation. We investigated to identify cases, determine risk factors, and implement control measures. METHODS: A case was defined as GAS isolation from a wound or blood specimen during March 28-November 19, 2014, from a patient treated at wound clinic A or by a wound clinic A provider within the previous 7 days. All wound clinic A staff were screened for GAS carriage. Wound care procedures were assessed for adherence to infection control principles and possible GAS transmission routes. RESULTS: We identified 16 patients with 19 unique infections: 9 (56%) patients required hospitalization, and 7 (44%) required surgical debridement procedures. One patient died. Six (37%) patients received negative pressure wound therapy at GAS onset. Staff self-screening found no GAS carriers. Breaches in infection control and poor wound care practices were widespread. CONCLUSIONS: This GAS outbreak was associated with a wound care clinic not subject to state or federal regulation. Lapses in infection control practices and inadequate oversight contributed to the outbreak. |
Rotavirus Strain Trends During the Postlicensure Vaccine Era: United States, 2008-2013.
Bowen MD , Mijatovic-Rustempasic S , Esona MD , Teel EN , Gautam R , Sturgeon M , Azimi PH , Baker CJ , Bernstein DI , Boom JA , Chappell J , Donauer S , Edwards KM , Englund JA , Halasa NB , Harrison CJ , Johnston SH , Klein EJ , McNeal MM , Moffatt ME , Rench MA , Sahni LC , Selvarangan R , Staat MA , Szilagyi PG , Weinberg GA , Wikswo ME , Parashar UD , Payne DC . J Infect Dis 2016 214 (5) 732-8 BACKGROUND: Group A rotaviruses (RVA) are a significant cause of pediatric gastroenteritis worldwide. The New Vaccine Surveillance Network (NVSN) has conducted active surveillance for RVA at pediatric hospitals and emergency departments at three to seven geographically diverse sites in the U.S. since 2006. METHODS: Over six consecutive years, from 2008 to 2013, 1,523 samples from NVSN sites that were test-positive by Rotaclone(R) enzyme immunoassay were submitted to the CDC for genotyping. RESULTS: In the 2009, 2010, and 2011 seasons, genotype G3P[8] was the predominant genotype throughout the network with 46-84% prevalence. In the 2012 season, G12P[8] replaced G3P[8] as the most common genotype with 70% prevalence and this trend persisted in 2013 (68.0% prevalence). Vaccine (RotaTeq(R), Rotarix(R)) strains were detected in 0.6-3.4% of genotyped samples each season. Uncommon and unusual strains (e.g., G8P[4], G3P[24], G2P[8], G3P[4], G3P[6], G24P[14], G4P[6], G9P[4]) were detected sporadically over the study period. Year, study site, and race were found to be significant predictors of genotype. CONCLUSION: Continued active surveillance is needed to monitor RVA genotypes in the U.S. and to detect potential changes since vaccine licensure. |
Monitoring for Human Papillomavirus Vaccine Impact Among Gay, Bisexual, and Other Men Who Have Sex With Men-United States, 2012-2014
Meites E , Gorbach PM , Gratzer B , Panicker G , Steinau M , Collins T , Parrish A , Randel C , McGrath M , Carrasco S , Moore J , Zaidi A , Braxton J , Kerndt PR , Unger ER , Crosby RA , Markowitz LE . J Infect Dis 2016 BACKGROUND: Gay, bisexual, and other men who have sex with men (MSM) are at high risk for HPV; vaccination is recommended for U.S. males, including MSM through age 26. We assessed evidence of HPV among vaccine-eligible MSM and transgender women to monitor vaccine impact. METHODS: During 2012-14, MSM age 18-26 at selected clinics completed a computer-assisted self-interview regarding sexual behavior, HIV status, and vaccinations. Self-collected anal swab and oral rinse specimens were tested for HPV DNA (37 types) by L1 consensus PCR; serum was tested for HPV antibodies (4 types) by multiplexed VLP-based IgG direct ELISA. RESULTS: Among 922 vaccine-eligible participants, mean age was 23, and mean number of lifetime sex partners was 37. Among 834 without HIV, any anal HPV was detected in 69.4% and any oral HPV in 8.4%, yet only 8.5% had evidence of exposure to all quadrivalent vaccine types. In multivariate analysis, HPV prevalence varied significantly (p<0.05) by HIV status, sexual orientation, and lifetime sex partners, but not race/ethnicity. DISCUSSION: Most young MSM lacked evidence of current or past infection with all vaccine-type HPV, suggesting they could benefit from vaccination. Vaccination impact among MSM may be assessed by monitoring HPV prevalence, including in self-collected specimens. |
Effectiveness of the 2013 and 2014 Southern hemisphere influenza vaccines against laboratory-confirmed influenza in young children using a test-negative design, Bangkok, Thailand
Kittikraisak W , Suntarattiwong P , Ditsungnoen D , Klungthong C , Fernandez S , Yoon IK , Lindblade K , Dawood FS , Olsen SJ , Chotpitayasunondh T . Pediatr Infect Dis J 2016 35 (10) e318-25 BACKGROUND: The Thai Advisory Committee on Immunization Practices recommends annual influenza vaccination for children six months through two years of age, although older children may be vaccinated on request. We evaluated effectiveness of the 2013 and 2014 inactivated influenza vaccines to reduce medically-attended laboratory-confirmed influenza illness among Thai children aged 7-60 months. METHODS: From September 2013-May 2015, children with influenza-like illness (ILI) were screened with a rapid influenza diagnostic test. Enrolled children had nasal and throat swabs tested for influenza viruses using polymerase chain reaction (PCR). Cases and controls were subjects testing positive and negative, respectively, for influenza viruses by PCR. Vaccination status was ascertained from vaccination cards. Vaccine effectiveness (VE) was calculated as 100%*(1-odds ratio of vaccination among cases versus controls). RESULTS: Of 1,377 children enrolled, cases (n=490) and controls (n=887) were similar in demographic characteristics. Cases were less likely to receive influenza vaccine than controls in 2013 (6% vs. 14%; p=0.02), but not in 2014 (6% vs. 7%; p=0.57). Among cases, 126 (26%) were positive for influenza A(H1N1)pdm09 virus, 239 (49%) for influenza A(H3N2) and 124 (25%) for influenza B. One specimen was positive for both influenza A(H3N2) and B viruses. VE for full vaccination against all viruses was 64% (95% confidence interval [CI], 21%, 84%) in 2013 and 26% (95% CI, -47%, 63%) in 2014. CONCLUSIONS: Influenza vaccination was low among Thai children in our study, and VE varied by year, highlighting the need for annual monitoring of VE to better understand vaccine program effectiveness. |
Assessing fever frequency after pediatric live attenuated versus inactivated influenza vaccination
Stockwell MS , Broder KR , Lewis P , Jakob K , Iqbal S , Fernandez N , Sharma D , Barrett A , LaRussa P . J Pediatric Infect Dis Soc 2016 6 (3) e7-e14 OF KEY POINTS: The frequencies of fever in young children after live attenuated influenza versus inactivated influenza vaccine were low during the 2013-2014 influenza season and did not differ among vaccine types. Results from text message-only data were similar to those from all sources. BACKGROUND: Some studies have found a higher frequency of fever with trivalent live attenuated influenza vaccine (LAIV) than with inactivated influenza vaccine (IIV), but quadrivalent LAIV has not been assessed. Understanding fever is important for safety reviews and for parents and providers. In addition, there have been only a limited number of studies in which text messaging was used for vaccine adverse-event (AE) surveillance. METHODS: We conducted a prospective observational study in 3 community clinics in New York City to assess post-influenza vaccination fever in 24- to 59-month-olds during the 2013-2014 season. Enrolled families of children who received quadrivalent LAIV (LAIV4) or IIV (trivalent IIV3 or quadrivalent IIV4) replied to text messages that assessed their temperature on vaccination night and the next 10 nights (days 0 to 10); missing data were collected via telephone and a diary. We compared frequencies of fever (temperature ≥ 100.4 degrees F) according to vaccine group on days 0 to 2 and 3 to 10 by using chi2 and multivariate log-binomial regression adjusted for age, previous influenza vaccination, and vaccine coadministration. We also assessed outcomes using all sources versus only text messages. RESULTS: Most (84.1% [n = 540]) eligible parents enrolled. Fever frequencies on days 0 to 2 did not differ between LAIV4 and any IIV (3.8% vs 5.7%, respectively; adjusted relative risk [aRR] [95% confidence interval], 0.60 [0.25-1.46]), between LAIV4 and IIV4 (4.2% vs 7.1%, respectively; aRR, 0.58 [0.19-1.72]), or between IIV4 and IIV3 (7.1% vs 6.0%, respectively; aRR, 1.02 [0.30-3.46]). The findings were similar when all data sources versus text-message data alone were used. There were no significant differences on days 3 to 10. CONCLUSIONS: Postvaccination fever frequencies were low overall and did not differ according to influenza vaccine type during the 2013-2014 influenza season. The similarity of results when data were limited to text messages lends support to its use for surveillance of vaccine adverse events. |
Control of HPV-associated cancers with HPV vaccination
Schiffman M , Saraiya M . Lancet Infect Dis 2016 17 (1) 6-8 In the Lancet Infectious Diseases, Eric Chow and colleagues1 present evidence of remarkable population effectiveness against human papillomavirus (HPV), with virtual eradication of targeted types, among heterosexual men within a few years after vaccination of the young Australian female population with the quadrivalent HPV vaccine (4vHPV). Their study is notable because of its inventive observational methods and compelling implications. | To study the effectiveness of the vaccine in this population, they tracked trends in the prevalence of specified HPV genotypes in mainly urine specimens from 1466 heterosexual men aged 25 years or younger who had tested positive for Chlamydia trachomatis at the Melbourne Sexual Health Centre from 2004 to 2015. By studying men with chlamydia, which is also transmitted by sexual contact, the investigators had a population with high exposure to HPV, including to the 13 high-risk genotypes that cause almost all cases of cervical cancer and many oropharyngeal, anal, penile, vaginal, and vulvar cancers (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68; Chow and colleagues also included genotype 66 in their analysis although there is limited evidence that it causes cervical cancer).2 |
Seat belt use among adult workers - 21 states, 2013
Boal WL , Li J , Rodriguez-Acosta RL . MMWR Morb Mortal Wkly Rep 2016 65 (23) 593-597 Roadway incidents involving motorized vehicles accounted for 24% of fatal occupational injuries in the United States during 2013 and were the leading cause of fatal injuries among workers. In 2013, workers' compensation costs for serious, nonfatal injuries among work-related roadway incidents involving motorized land vehicles were estimated at $2.96 billion.dagger Seat belt use is a proven method to reduce injuries to motor vehicle occupants. Use of lap/shoulder seat belts reduces the risk for fatal injuries to front seat occupants of cars by 45% and the risk to light truck occupants by 60%. section sign To characterize seat belt use among adult workers by occupational group, CDC analyzed data from the 2013 Behavioral Risk Factor Surveillance System (BRFSS) and found that not always using a seat belt was significantly associated with occupational group after controlling for factors known to influence seat belt use. Occupational groups with the highest prevalences of not always using a seat belt included construction and extraction; farming, fishing, and forestry; and installation, maintenance, and repair. To increase seat belt use among persons currently employed, states can enact and enforce primary seat belt laws, employers can set and enforce safety policies requiring seat belt use by all vehicle occupants, and seat belt safety advocates can target interventions to workers in occupational groups with lower reported seat belt use. |
Genomic resolution of outbreak-associated Legionella pneumophila serogroup 1 isolates from New York State.
Raphael BH , Baker DJ , Nazarian E , Lapierre P , Bopp D , Kozak-Muiznieks NA , Morrison SS , Lucas CE , Mercante JW , Musser KA , Winchell JM . Appl Environ Microbiol 2016 82 (12) 3582-90 A total of 30 Legionella pneumophila serogroup 1 isolates representing 10 separate legionellosis laboratory investigations ("outbreaks") that occurred in New York State between 2004 and 2012 were selected for evaluation of whole-genome sequencing (WGS) approaches for molecular subtyping of this organism. Clinical and environmental isolates were available for each outbreak and were initially examined by pulsed-field gel electrophoresis (PFGE). Sequence-based typing alleles were extracted from WGS data yielding complete sequence types (ST) for isolates representing 8 out of the 10 outbreaks evaluated in this study. Isolates from separate outbreaks sharing the same ST also contained the fewest differences in core genome single nucleotide polymorphisms (SNPs) and the greatest proportion of identical allele sequences in a whole-genome multilocus sequence typing (wgMLST) scheme. Both core SNP and wgMLST analyses distinguished isolates from separate outbreaks, including those from two outbreaks sharing indistinguishable PFGE profiles. Isolates from a hospital-associated outbreak spanning multiple years shared indistinguishable PFGE profiles but displayed differences in their genome sequences, suggesting the presence of multiple environmental sources. Finally, the rtx gene demonstrated differences in the repeat region sequence among ST1 isolates from different outbreaks, suggesting that variation in this gene may be useful for targeted molecular subtyping approaches for L. pneumophila This study demonstrates the utility of various genome sequence analysis approaches for L. pneumophila for environmental source attribution studies while furthering the understanding of Legionella ecology. IMPORTANCE: We demonstrate that whole-genome sequencing helps to improve resolution of Legionella pneumophila isolated during laboratory investigations of legionellosis compared to traditional subtyping methods. These data can be important in confirming the environmental sources of legionellosis outbreaks. Moreover, we evaluated various methods to analyze genome sequence data to help resolve outbreak-related isolates. |
Purification and Characterization of Botulinum Neurotoxin FA from a Genetically Modified Clostridium botulinum Strain.
Pellett S , Tepp WH , Bradshaw M , Kalb SR , Dykes JK , Lin G , Nawrocki EM , Pier CL , Barr JR , Maslanka SE , Johnson EA . mSphere 2016 1 (1) Botulinum neurotoxins (BoNTs), produced by neurotoxigenic clostridial species, are the cause of the severe disease botulism in humans and animals. Early research on BoNTs has led to their classification into seven serotypes (serotypes A to G) based upon the selective neutralization of their toxicity in mice by homologous antibodies. Recently, a report of a potential eighth serotype of BoNT, designated "type H," has been controversial. This novel BoNT was produced together with BoNT/B2 in a dual-toxin-producing Clostridium botulinum strain. The data used to designate this novel toxin as a new serotype were derived from culture supernatant containing both BoNT/B2 and novel toxin and from sequence information, although data from two independent laboratories indicated neutralization by antibodies raised against BoNT/A1, and classification as BoNT/FA was proposed. The sequence data indicate a chimeric structure consisting of a BoNT/A1 receptor binding domain, a BoNT/F5 light-chain domain, and a novel translocation domain most closely related to BoNT/F1. Here, we describe characterization of this toxin purified from the native strain in which expression of the second BoNT (BoNT/B) has been eliminated. Mass spectrometry analysis indicated that the toxin preparation contained only BoNT/FA and confirmed catalytic activity analogous to that of BoNT/F5. The in vivo mouse bioassay indicated a specific activity of this toxin of 3.8 x 10(7) mouse 50% lethal dose (mLD50) units/mg, whereas activity in cultured human neurons was very high (50% effective concentration [EC50] = 0.02 mLD50/well). Neutralization assays in cells and mice both indicated full neutralization by various antibodies raised against BoNT/A1, although at 16- to 20-fold-lower efficiency than for BoNT/A1. IMPORTANCE Botulinum neurotoxins (BoNTs), produced by anaerobic bacteria, are the cause of the potentially deadly, neuroparalytic disease botulism. BoNTs have been classified into seven serotypes, serotypes A to G, based upon their selective neutralization by homologous antiserum, which is relevant for clinical and diagnostic purposes. Even though supportive care dramatically reduces the death rate of botulism, the only pharmaceutical intervention to reduce symptom severity and recovery time is early administration of antitoxin (antiserum raised against BoNTs). A recent report of a novel BoNT serotype, serotype H, raised concern of a "treatment-resistant" and highly potent toxin. However, the toxin's chimeric structure and characteristics indicate a chimeric BoNT/FA. Here we describe the first characterization of this novel toxin in purified form. BoNT/FA was neutralized by available antitoxins, supporting classification as BoNT/FA. BoNT/FA required proteolytic activation to achieve full toxicity and had relatively low potency in mice compared to BoNT/A1 but surprisingly high activity in cultured neurons. |
Plasticity of a critical antigenic determinant in the West Nile virus NY99 envelope protein domain III
Plante JA , Torres M , Huang CY , Beasley DW . Virology 2016 496 97-105 West Nile virus (WNV) is a mosquito-borne flavivirus that causes febrile illness, encephalitis, and occasionally death in humans. The envelope protein is the main component of the WNV virion surface, and domain III of the envelope protein (EIII) is both a putative receptor binding domain and a target of highly specific, potently neutralizing antibodies. Envelope E-332 (E-332) is known to have naturally occurring variation and to be a key determinant of neutralization for anti-EIII antibodies. A panel of viruses containing all possible amino acid substitutions at E-332 was constructed. E-332 was found to be highly tolerant of mutation, and almost all of these changes had large impacts on antigenicity of EIII but only limited effects on growth or virulence phenotypes. |
Effects of titanium dioxide nanoparticles on human keratinocytes
Wright C , Iyer AK , Wang L , Wu N , Yakisich JS , Rojanasakul Y , Azad N . Drug Chem Toxicol 2016 40 (1) 1-11 Titanium dioxide (TiO2) is a ubiquitous whitening compound widely used in topical products such as sunscreens, lotions and facial creams. The damaging health effects of TiO2 inhalation has been widely studied in rats, mice and humans showing oxidative stress increase, DNA damage, cell death and inflammatory gene upregulation in lung and throat cells; however, the effects on skin cells from long-term topical use of various products remain largely unknown. In this study, we assessed the effect of specific TiO2 nanoparticles (H2TiO7) on a human keratinocyte cell line (HaCaT). We performed a comparative analysis using three TiO2 particles varying in size (Fine, Ultrafine and H2TiO7) and analyzed their effects on HaCaTs. There is a clear dose-dependent increase in superoxide production, caspase 8 and 9 activity, and apoptosis in HaCaTs after treatment with all three forms of TiO2; however, there is no consistent effect on cell viability and proliferation with either of these TiO2 particles. While there is data suggesting UV exposure can enhance the carcinogenic effects of TiO2, we did not observe any significant effect of UV-C exposure combined with TiO2 treatment on HaCaTs. Furthermore, TiO2-treated cells showed minimal effects on VEGF upregulation and Wnt signaling pathway thereby showing no potential effect on angiogenesis and malignant transformation. Overall, we report here an increase in apoptosis, which may be caspase 8/Fas-dependent, and that the H2TiO7 nanoparticles, despite their smaller particle size, had no significant enhanced effect on HaCaT cells as compared to Fine and Ultrafine forms of TiO2. |
Influenza-associated outpatient visits among children less than 5 years of age in eastern China, 2011-2014
Zhang T , Zhang J , Hua J , Wang D , Chen L , Ding Y , Zeng S , Wu J , Jiang Y , Geng Q , Zhou S , Song Y , Iuliano AD , Greene CM , McFarland J , Zhao G . BMC Infect Dis 2016 16 (1) 267 BACKGROUND: The disease burden of influenza in China has not been well described, especially among young children. The aim of this study was to estimate the incidence of outpatient visits associated with influenza in young children in Suzhou, a city of more than 11 million residents in Jiangsu Province in eastern China. METHODS: Influenza-like illness (ILI) was defined as the presence of fever (axillary temperature ≥38 degrees C) and cough or sore throat. We collected throat swabs for children less than 5 years of age with ILI who visited Suzhou University Affiliated Children's Hospital (SCH) outpatient clinic or emergency room between April 2011 and March 2014. Suzhou CDC, a national influenza surveillance network laboratory, tested for influenza viruses by real-time reverse transcription-polymerase chain reaction assay (rRT-PCR). Influenza-associated ILI was defined as ILI with laboratory-confirmed influenza by rRT-PCR. To calculate the incidence of influenza-associated outpatient visits, we conducted community-based healthcare utilization surveys to determine the proportion of hospital catchment area residents who sought care at SCH. RESULTS: The estimated incidence of influenza-associated ILI outpatient visits among children aged <5 years in the catchment area of Suzhou was, per 100 population, 17.4 (95 % CI 11.0-25.3) during April 2011-March 2012, 14.6 (95 % CI 5.2-26.2) during April 2012-March 2013 and 21.4 (95 % CI: 10.9-33.5) during April 2013-March 2014. The age-specific outpatient visit rates of influenza-associated ILI were 4.9, 21.1 and 21.2 per 100 children aged 0- <6 months, 6- <24 months and 24- <60 months, respectively. CONCLUSION: Influenza virus infection causes a substantial burden of outpatient visits among young children in Suzhou, China. Targeted influenza prevention and control strategies for young children in Suzhou are needed to reduce influenza-associated outpatient visits in this age group. |
Causes of death among children aged 5 to 14 years old from 2008 to 2013 in Kersa Health and Demographic Surveillance System (Kersa HDSS), Ethiopia
Dedefo M , Zelalem D , Eskinder B , Assefa N , Ashenafi W , Baraki N , Damena Tesfatsion M , Oljira L , Haile A . PLoS One 2016 11 (6) e0151929 BACKGROUND: The global burden of mortality among children is still very huge though its trend has started declining following the improvements in the living standard. It presents serious challenges to the well-being of children in many African countries. Today, Sub-Saharan Africa alone accounts for about 50% of global child mortality. The overall objective of this study was to determine the magnitude and distribution of causes of death among children aged 5 to 14 year olds in the population of Kersa HDSS using verbal autopsy method for the period 2008 to 2013. METHODS: Kersa Health and Demographic Surveillance System(Kersa HDSS) was established in September 2007. The center consists of 10 rural and 2 urban kebeles which were selected randomly from 38 kebeles in the district. Thus this study was conducted in Kersa HDSS and data was taken from Kersa HDSS database. The study population included all children aged 5 to 14 years registered during the period of 2008 to 2013 in Kersa HDSS using age specific VA questionnaires. Data were extracted from SPSS database and analyzed using STATA. RESULTS: A total of 229 deaths were recorded over the period of six years with a crude death rate of 219.6 per 100,000 population of this age group over the study period. This death rate was 217.5 and 221.5 per 100,000 populations for females and males, respectively. 75% of deaths took place at home. The study identified severe malnutrition(33.9%), intestinal infectious diseases(13.8%) and acute lower respiratory infections(9.2%) to be the three most leading causes of death. In broad causes of death classification, injuries have been found to be the second most cause of death next to communicable diseases(56.3%) attributing to 13.1% of the total deaths. CONCLUSION AND RECOMMENDATION: In specific causes of death classification severe malnutrition, intestinal infectious diseases and acute lower respiratory infections were the three leading causes of death where, in broad causes of death communicable diseases and injuries were among the leading causes of death. Hence, concerned bodies should take measures to avert the situation of mortality from these causes of death and further inferential analysis into the prevention and management of infectious diseases should also be taken. |
Secondhand smoke in the operating room? Precautionary practices lacking for surgical smoke
Steege AL , Boiano JM , Sweeney MH . Am J Ind Med 2016 59 (11) 1020-1031 BACKGROUND: Consensus organizations, government bodies, and healthcare organization guidelines recommend that surgical smoke be evacuated at the source by local exhaust ventilation (LEV) (i.e., smoke evacuators or wall suctions with inline filters). METHODS: Data are from NIOSH's Health and Safety Practices Survey of Healthcare Workers module on precautionary practices for surgical smoke. RESULTS: Four thousand five hundred thirty-three survey respondents reported exposure to surgical smoke: 4,500 during electrosurgery; 1,392 during laser surgery procedures. Respondents were mainly nurses (56%) and anesthesiologists (21%). Only 14% of those exposed during electrosurgery reported LEV was always used during these procedures, while 47% reported use during laser surgery. Those reporting LEV was always used were also more likely to report training and employer standard procedures addressing the hazards of surgical smoke. Few respondents reported use of respiratory protection. CONCLUSIONS: Study findings can be used to raise awareness of the marginal use of exposure controls and impediments for their use. Am. J. Ind. Med. Published 2016. This article is a U.S. Government work and is in the public domain in the USA. |
Uncovering effective strategies for hearing loss prevention
Morata Thais C , Meinke Deanna . Acoust Aust 2016 44 (1) 67-75 Occupational health agencies, researchers, and policy makers have recognized the need for evidence on the effectiveness of interventions designed to reduce or prevent workplace injuries and illnesses. While many workplaces comply with legal or obligatory requirements and implement recommended interventions, few publications exist documenting the effectiveness of these actions. Additionally, some workplaces have discovered through their own processes, novel ways to reduce the risk of injury. Peer-reviewed information on the effectiveness of the many strategies and approaches currently in use could help correct weaknesses, or further encourage their adoption and expansion. The evaluation of intervention effectiveness would certainly contribute to improved worker health and safety. This need is particularly relevant regarding noise exposure in the workplace and hearing loss prevention interventions. In a 2006 review of the U.S. National Institute for Occupational Safety and Health (NIOSH) Hearing Loss Research Program, the independent National Academies of Sciences recommended that NIOSH place greater emphasis on identifying the effectiveness of hearing loss prevention measures on the basis of outcomes that are as closely related as possible to reducing noise exposure and work-related hearing loss (http://www.nap.edu/openbook.php?record_id=11721). NIOSH used two different approaches to address that recommendation: the first one was to conduct research, including broad systematic reviews on the effectiveness of interventions to prevent occupational noise-induced hearing loss. The second was to create an award program, the Safe-In-Sound Excellence in Hearing Loss Prevention AwardTM, to identify and honor excellent real-world examples of noise control and other hearing loss prevention practices and innovations. 2016, Australian Acoustical Society. |
The efficacy of anti-vibration gloves
Hewitt Sue , Dong Ren , McDowell Tom , Welcome Daniel . Acoust Aust 2016 44 (1) 121-127 Anyone seeking to control the risks from vibration transmitted to the hands and arms may contemplate the use of anti-vibration gloves. To make an informed decision about any type of personal protective equipment, it is necessary to have performance data that allow the degree of protection to be estimated. The information provided with an anti-vibration glove may not be easy to understand without some background knowledge of how gloves are tested and does not provide any clear route for estimating likely protection. Some of the factors that influence the potential efficacy of an anti-vibration glove include how risks from handarm vibration exposure are assessed, how the standard test for a glove is carried out, the frequency range and direction of the vibration for which protection is sought, how much hand contact force or pressure is applied and the physical limitations due to glove material and construction. This paper reviews some of the background issues that are useful for potential purchasers of anti-vibration gloves. Ultimately, anti-vibration gloves cannot be relied on to provide sufficient and consistent protection to the wearer and before their use is contemplated all other available means of vibration control ought first to be implemented. 2016, The Author(s). |
Investigation of methods for estimating hand bone dimensions Using X-ray hand anthropometric data
Kong YK , Freivalds A , Kim DM , Chang J . Int J Occup Saf Ergon 2016 23 (2) 1-34 This study examined two conversion methods, M1 and M2, to predict finger/phalange bone lengths based on finger/phalange surface lengths. 41 Korean college students (25 males and 16 females) were recruited and their finger/phalange surface lengths, bone lengths and grip strengths were measured using a vernier caliper, X-ray generator, and a double handle force measurement (DFM) system, respectively. M1 and M2 were defined as formulas being able to estimate finger/phalange bone lengths based on one dimension (i.e., surface hand length) and four finger dimensions (surface finger lengths), respectively. As a result of conversion, the estimation errors by M1 presented mean 1.22 mm, which was smaller than those (1.29 mm) by M2. The estimated bone lengths by M1 (mean r = 0.81) presented higher correlations with the measured bone lengths than those by M2 (0.79). Thus, the M1 method was recommended in the present study, based on conversion simplicity and accuracy. |
Buy quiet initiative in the USA
Beamer B , McCleery T , Hayden C . Acoust Aust 2016 44 (1) 51-54 Noise-induced hearing loss is still considered one of the most common work-related illnesses in the United States of America. The U.S. National Institute for Occupational Safety and Health launched a national Buy Quiet campaign to raise awareness of the importance of purchasing quieter equipment. Buy Quiet encourages companies to seek out and demand quieter equipment thus driving the market to design and create quieter products. In the long run, investment in noise controls should be more prevalent as the market demands quieter products. This paradigm occurs as the market for quieter products expands both from the supply side (manufacturers) and the demand side (tool and equipment purchasers). The key to experiencing the reduced costs and increased benefits of Buy Quiet will be to develop partnerships between manufacturers and consumers. To this end, the U.S. National Institute for Occupational Safety and Health continues to work with partners to educate stakeholders about the risks and true costs of noise-induced hearing loss, as well as the economic benefits of buying quieter equipment. |
Differences in hospital managers', unit managers', and health care workers' perceptions of the safety climate for respiratory protection
Peterson K , Rogers BM , Brosseau LM , Payne J , Cooney J , Joe L , Novak D . Workplace Health Saf 2016 64 (7) 326-36 This article compares hospital managers' (HM), unit managers' (UM), and health care workers' (HCW) perceptions of respiratory protection safety climate in acute care hospitals. The article is based on survey responses from 215 HMs, 245 UMs, and 1,105 HCWs employed by 98 acute care hospitals in six states. Ten survey questions assessed five of the key dimensions of safety climate commonly identified in the literature: managerial commitment to safety, management feedback on safety procedures, coworkers' safety norms, worker involvement, and worker safety training. Clinically and statistically significant differences were found across the three respondent types. HCWs had less positive perceptions of management commitment, worker involvement, and safety training aspects of safety climate than HMs and UMs. UMs had more positive perceptions of management's supervision of HCWs' respiratory protection practices. Implications for practice improvements indicate the need for frontline HCWs' inclusion in efforts to reduce safety climate barriers and better support effective respiratory protection programs and daily health protection practices. |
Medium-frequency signal propagation characteristics of a lifeline as a transmission line in underground coal mines
Li J , Reyes MA , Damiano NW , Whisner BG , Matetic RJ . IEEE Trans Ind Appl 2016 52 (3) 2724-2730 Underground coal mines in the United States of America are required to install lifeline (LL) cable inside escapeways to guide miners out of a mine when visibility becomes poor due to heavy smoke. Some LLs consist of single or multiple steel conductors covered with a protective plastic outer layer. Research has shown that this type of LL can be a good conductor to guide a medium-frequency (MF) communication system signal to travel over large distances. To understand the MF propagation characteristics of an LL, National Institute for Occupational Safety and Health researchers took measurements on a section of LL in a coal mine, and obtained propagation parameters for analysis. The measurement data show that MF signals have a low attenuation which can enable the use of an LL for communication throughout a mine. The propagation parameters measured are presented in this paper. © 2016 IEEE. |
Decline in frequency of the 2La chromosomal inversion in Anopheles gambiae (s.s.) in Western Kenya: correlation with increase in ownership of insecticide-treated bed nets.
Matoke-Muhia D , Gimnig JE , Kamau L , Shililu J , Bayoh MN , Walker ED . Parasit Vectors 2016 9 (1) 334 BACKGROUND: The 2La chromosomal inversion, a genetic polymorphism in An. gambiae (sensu stricto) (s.s.), is associated with adaptation to microclimatic differences in humidity and desiccation resistance and mosquito behaviors. Ownership of insecticide-treated bed nets (ITNs) for malaria control has increased markedly in western Kenya in the last 20 years. An increase in the frequency of ITNs indoors could select against house entering or indoor resting of Anopheles mosquitoes. Thus, the frequency of the 2La inversion is postulated to change in An. gambiae (s.s.) with the increase of ITN ownership over time. METHODS: Anopheles gambiae mosquitoes were sampled between 1994 and 2011 using pyrethrum knockdown, bednet traps and human landing catches (HLC) from Asembo and Seme, western Kenya. The 2La inversion was detected by a PCR assay with primers designed for proximal breakpoints of the 2La/a and 2L+(a)/+(a) chromosomal conformation. Mosquitoes were tested for malaria parasite infection by sporozoite ELISA. RESULTS: The frequency of the 2La chromosomal inversion declined from 100 % of all chromosomes in 1994 to 17 % in 2005 and remained low through 2011 (21 %). ITN ownership increased from 0 to > 90 % of houses in the study area during this interval. The decline in the frequency of the 2La chromosomal inversion was significantly, negatively correlated with year (r = -0.93) and with increase in ITN ownership (r = -0.96). The frequency of the homo- and heterokaryotypes departed significantly from Hardy-Weinberg equilibrium, suggesting that 2La/a karyotype was under selection, earlier in its favor and later, against it. Precipitation and maximum monthly temperature did not vary over time, therefore there was no trend in climate that could account for the decline. There was no significant difference in frequency of the 2La inversion in An. gambiae (s.s.) females sampled indoors or outdoors in HCL in 2011, nor was there an association between the 2La inversion and infection with Plasmodium falciparum sporozoites. CONCLUSIONS: The increase in ITN ownership in the study area was negatively correlated with the frequency of 2La inversion. The decline in 2La frequency in western Kenya is postulated to be due to differential impacts of ITNs on mosquitoes with different 2La karyotypes, possibly mediated by differences in behavior associated with the 2La karyotypes. Further research is required to determine if this is a widespread phenomenon, to further determine the association of the 2La karyotypes with mosquito behavior, and to assess whether ITNs are exerting selection mediated by differences in behavior on the different karyotypes. |
Elimination of Taenia solium transmission in northern Peru
Garcia HH , Gonzalez AE , Tsang VC , O'Neal SE , Llanos-Zavalaga F , Gonzalvez G , Romero J , Rodriguez S , Moyano LM , Ayvar V , Diaz A , Hightower A , Craig PS , Lightowlers MW , Gauci CG , Leontsini E , Gilman RH . N Engl J Med 2016 374 (24) 2335-44 BACKGROUND: Taeniasis and cysticercosis are major causes of seizures and epilepsy. Infection by the causative parasite Taenia solium requires transmission between humans and pigs. The disease is considered to be eradicable, but data on attempts at regional elimination are lacking. We conducted a three-phase control program in Tumbes, Peru, to determine whether regional elimination would be feasible. METHODS: We systematically tested and compared elimination strategies to show the feasibility of interrupting the transmission of T. solium infection in a region of highly endemic disease in Peru. In phase 1, we assessed the effectiveness and feasibility of six intervention strategies that involved screening of humans and pigs, antiparasitic treatment, prevention education, and pig replacement in 42 villages. In phase 2, we compared mass treatment with mass screening (each either with or without vaccination of pigs) in 17 villages. In phase 3, we implemented the final strategy of mass treatment of humans along with the mass treatment and vaccination of pigs in the entire rural region of Tumbes (107 villages comprising 81,170 people and 55,638 pigs). The effect of the intervention was measured after phases 2 and 3 with the use of detailed necropsy to detect pigs with live, nondegenerated cysts capable of causing new infection. The necropsy sampling was weighted in that we preferentially included more samples from seropositive pigs than from seronegative pigs. RESULTS: Only two of the strategies implemented in phase 1 resulted in limited control over the transmission of T. solium infection, which highlighted the need to intensify the subsequent strategies. After the strategies in phase 2 were implemented, no cyst that was capable of further transmission of T. solium infection was found among 658 sampled pigs. One year later, without further intervention, 7 of 310 sampled pigs had live, nondegenerated cysts, but no infected pig was found in 11 of 17 villages, including all the villages in which mass antiparasitic treatment plus vaccination was implemented. After the final strategy was implemented in phase 3, a total of 3 of 342 pigs had live, nondegenerated cysts, but no infected pig was found in 105 of 107 villages. CONCLUSIONS: We showed that the transmission of T. solium infection was interrupted on a regional scale in a highly endemic region in Peru. (Funded by the Bill and Melinda Gates Foundation and others.). |
Occupational physical activity and weight-related outcomes in immigrant mothers
Sliwa SA , Must A , Perea FC , Boulos RJ , Economos CD . Am J Prev Med 2016 51 (5) 637-646 INTRODUCTION: New immigrants are likely to be employed in occupations that provide physical activity; however, these positions may place workers at risk for adverse health outcomes. Relationships between occupational physical activity (OPA); weight-related behaviors; obesity; and depression remain underexplored among recent immigrants. METHODS: Participants (N=385) were Brazilian, Haitian, and Latino mothers enrolled in a community-based participatory research lifestyle intervention among immigrant mothers (<10 years in U.S.). Baseline BMI was calculated using objectively measured height and weight. Self-reported baseline data included sociodemographics; physical activity (Pregnancy Physical Activity Questionnaire); depressive symptoms (Center for Epidemiological Studies-Depression Scale); and prepared food purchasing frequency. Logistic regression models estimated the odds of obesity (BMI ≥30.0); high depressive symptoms (score ≥16); and purchasing prepared foods (≥1 times/week) by OPA quartile. Models adjusted for covariates, including household composition, origin group, maternal age, education, household income, and recruitment year (2010, 2011). Data were analyzed in 2013. RESULTS: Employed participants (49%) primarily worked as domestic workers, nursing assistants, and food service staff. In adjusted models, women in the highest OPA quartile versus lowest had 65% lower obesity odds (95% CI=0.16, 0.76) and approximately twice the odds of presenting high depressive symptoms (2.01, 95% CI=1.02, 4.27) and purchasing takeout food (1.85, 95% CI=0.90, 3.90), which was attenuated after adjusting for income and education (unadjusted OR=1.98, 95% CI=1.10, 3.52). CONCLUSIONS: OPA contributes to energy expenditure and may protect against obesity among new immigrant mothers; however, it is also associated with high depressive symptoms. Implications for physical and psychosocial well-being are mixed. |
Athletic Training and Public Health Summit
Hoffman M , Bovbjerg V , Hannigan K , Hootman JM , Johnson ST , Kucera KL , Norcross MF . J Athl Train 2016 51 (7) 576-80 OBJECTIVE: To introduce athletic trainers to the benefits of using a population-based approach to injury and illness prevention and to explore opportunities for partnering with public health professionals on these initiatives. BACKGROUND: Athletic trainers play leading roles in individual injury and illness prevention but are less familiar with policy development, evaluation, and implementation from a population-level standpoint. The Athletic Training and Public Health Summit was convened to understand, explore, and develop the intersection of athletic training and public health. CONCLUSIONS: To further the integration of athletic training within the public health arena, athletic trainers must expand their professional focus beyond the individual to the population level. |
Disparities in adolescents' residence in neighborhoods supportive of physical activity - United States, 2011-2012
Watson KB , Harris CD , Carlson SA , Dorn JM , Fulton JE . MMWR Morb Mortal Wkly Rep 2016 65 (23) 598-601 In 2013, only 27% of adolescents in grades 9-12 met the current federal guideline for aerobic physical activity (at least 60 minutes of physical activity each day*), and sex and racial/ethnic disparities in meeting the guideline exist (1). The Community Preventive Services Task Force has recommended a range of community-level evidence-based approachesdagger to increase physical activity by improving neighborhood supports for physical activity. section sign To assess the characteristics of adolescents who live in neighborhoods that are supportive of physical activity, CDC analyzed data on U.S. children and adolescents aged 10-17 years (defined as adolescents for this report) from the 2011-2012 National Survey of Children's Health (NSCH). Overall, 65% of U.S. adolescents live in neighborhoods supportive of physical activity, defined as neighborhoods that are perceived as safe and have sidewalks or walking paths and parks, playgrounds, or recreation centers. Adolescents who were Hispanic and non-Hispanic black race/ethnicity; who lived in lower-income households, households with less educated parents, and rural areas; or who were overweight or obese were less likely to live in neighborhoods supportive of physical activity than were white adolescents and adolescents from higher income households, with a more highly educated parent, living in urban areas, and not overweight or obese. Within demographic groups, the largest disparity in the percentage of adolescents living in these neighborhoods was observed between adolescents living in households with a family income <100% of the Federal Poverty Level (FPL) (51%) and adolescents living in households with a family income ≥400% of the FPL (76%). Efforts to improve neighborhood supports, particularly in areas with a substantial percentage of low-income and minority residents, might increase physical activity among adolescents and reduce health disparities. |
The 2015 legal preparedness roadshow: A summer road trip to teach government personnel the basics of public health emergency law
Sunshine GJd , Ransom MJd Mph . ABA Health eSource 2016 12 (9) Planning, simulations, and post-emergency assessments have demonstrated that successful public health emergency response hinges on the effective use of relevant legal authorities for legal preparedness.1 Public health practitioners must have a better understanding of the legal underpinnings of emergency preparedness and response systems, including knowing what actions are authorized and how to minimize liabilities during large-scale public health emergencies.2 In May 2015, the Public Health Law Program (PHLP) at the Centers for Disease Control and Prevention (CDC) embarked on a unique effort to train state and local public health personnel on the intricacies of legal issues in emergency preparedness and response over the course of one summer. This course was also offered to CDC staff because knowledge regarding state and local legal issues in emergencies is vital to their ability to work with partners in the field. | By August, PHLP staff had travelled to 11 states and delivered 13 Public Health Emergency Law 4.0 trainings to nearly 550 people. The summer road trip was exciting and enlightening and made the case for providing future public health law trainings. |
Male attendance at Title X Family Planning Clinics - United States, 2003-2014
Besera G , Moskosky S , Pazol K , Fowler C , Warner L , Johnson DM , Barfield WD . MMWR Morb Mortal Wkly Rep 2016 65 (23) 602-605 Although both men and women have reproductive health care needs, family planning providers traditionally focus services toward women. Challenges in providing family planning services to men, including preconception health, infertility, contraceptive, and sexually transmitted disease (STD) care, include their infrequent use of preventive health services, a perceived lack of need for these services, and the lack of provider guidance regarding men's reproductive health care needs. Since 1970, the National Title X Family Planning Program has provided cost-effective and confidential family planning and related preventive health services with priority for services to low-income women and men. To examine men's use of services at Title X service sites, CDC and the U.S. Department of Health and Human Services' Office of Population Affairs (OPA) analyzed data from the 2003-2014 Family Planning Annual Reports (FPAR), annual data that are required of all Title X-funded agencies. During 2003-2014, 3.8 million males visited Title X service sites in the United States and the percentage of family planning users who were male nearly doubled from 4.5% (221,425 males) in 2003 to 8.8% (362,531 males) in 2014. In 2014, the percentage of family planning users who were male varied widely by state, ranging from ≤1% in Mississippi, Tennessee, and Alabama to 27.2% in the District of Columbia (DC). Title X service sites are increasingly providing services for males. Health care settings might want to adopt the framework employed by Title X clinics to better provide family planning and related preventative services to men. |
Chronic diseases and use of contraception among women at risk of unintended pregnancy
Phillips-Bell GS , Sappenfield W , Robbins CL , Hernandez L . J Womens Health (Larchmt) 2016 25 (12) 1262-1269 BACKGROUND: Women with chronic diseases are at increased risk of having unintended pregnancies. Little is known whether chronic diseases are associated with increased likelihood of effective/highly effective contraceptive use. METHODS: We analyzed 2008-2010 Florida Behavioral Risk Factor Surveillance System data for women aged 18-44 years who were at risk of unintended pregnancy. Multivariable Poisson regression estimated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for contraceptive use in relation to diabetes, cardiovascular disease (CVD), and current asthma. We assessed the association of chronic disease status with use of three different contraception outcomes: (1) any method versus none, (2) less effective methods (methods associated with ≥10 unintended pregnancies/100 women/year) versus none, and (3) effective/highly effective methods (<10 unintended pregnancies/100 women/year) versus none. RESULTS: Among 4473 women at risk for unintended pregnancy, 87% were using any method of contraception (22.5% less effective methods and 64.5% effective/highly effective methods). Women with CVD were more likely than those without CVD to use any contraception (aPR = 1.09, 95% CI: 1.04, 1.15), less effective (aPR = 1.39, 95% CI: 1.13, 1.70), and effective/highly effective (aPR = 1.10, 95% CI: 1.03, 1.19) contraception. Women with diabetes were more likely to use less effective methods than women without diabetes (aPR = 1.34, 95% CI: 1.05, 1.72). No significant associations were observed for asthma, regardless of contraceptive effectiveness. CONCLUSIONS: Self-reported use of effective/highly effective contraception was higher than nonuse or use of less effective methods among all women at risk of unintended pregnancy, but could be improved, especially among women with chronic diseases. |
Contraceptive safety among women with cystic fibrosis: A systematic review
Whiteman MK , Oduyebo T , Zapata LB , Walker S , Curtis KM . Contraception 2016 94 (6) 621-629 BACKGROUND: With dramatic improvements in life expectancy for cystic fibrosis (CF) patients, contraception for women with CF has become an important issue. There are theoretical concerns that hormonal contraceptive use among women with CF may impact disease severity or risk for other adverse health outcomes, including thrombosis and poor bone health, as well as concerns that malabsorption or altered drug metabolism might impact contraceptive effectiveness. OBJECTIVE: To evaluate evidence on the safety and effectiveness of contraceptive methods among women with CF. SEARCH STRATEGY: We searched the PubMed database for all articles published from database inception through October 2015. SELECTION CRITERIA: We included studies that examined measures of disease severity, other health outcomes, or indicators of contraceptive effectiveness among women with CF initiating or continuing a contraceptive method. RESULTS: Seven studies met our inclusion criteria. Three observational studies of fair to poor quality suggest that use of oral contraceptives (OCs) does not negatively impact CF disease severity, defined as changes in pulmonary function, number of exacerbations, or need for intravenous antibiotics. Three small studies of poor quality reported on contraceptive failure among women with CF using combined hormonal contraceptives (combined OCs, patch, or ring). One pregnancy was reported in a patch user out of 43 hormonal contraceptive users across all studies. One pharmacokinetic study reported that women with CF achieve steroid hormone plasma concentrations similar to healthy women after ingestion of COCs. CONCLUSIONS: Limited evidence suggests that hormonal contraceptive use does not negatively impact disease severity among women with CF and that hormonal contraceptive effectiveness is not impaired by CF. Studies were limited by small sample sizes and short duration of follow-up. No studies examined the effect of hormonal contraception on thrombosis or bone health among women with CF. |
Conditions for valid estimation of causal effects on prevalence in cross-sectional and other studies
Flanders WD , Klein M , Mirabelli MC . Ann Epidemiol 2016 26 (6) 389-394 e2 PURPOSE: Causal effects in epidemiology are almost invariably studied by considering disease incidence even when prevalence data are used to estimate the causal effect. For example, if certain conditions are met, a prevalence odds ratio can provide a valid estimate of an incidence rate ratio. Our purpose and main result are conditions that assure causal effects on prevalence can be estimated in cross-sectional studies, even when the prevalence odds ratio does not estimate incidence. METHODS: Using a general causal effect definition in a multivariate counterfactual framework, we define causal contrasts that compare prevalences among survivors from a target population had all been exposed at baseline with that prevalence had all been unexposed. Although prevalence is a measure reflecting a moment in time, we consider the time sequence to study causal effects. RESULTS: Effects defined using a contrast of counterfactual prevalences can be estimated in an experiment and, with conditions provided, in cross-sectional studies. Proper interpretation of the effect includes recognition that the target is the baseline population, defined at the age or time of exposure. CONCLUSIONS: Prevalences are widely reported, readily available measures for assessing disabilities and disease burden. Effects on prevalence are estimable in cross-sectional studies but only if appropriate conditions hold. |
Stuck in neutral: stalled progress in statewide comprehensive smoke-free laws and cigarette excise taxes, United States, 2000-2014
Holmes CB , King BA , Babb SD . Prev Chronic Dis 2016 13 E80 INTRODUCTION: Increasing tobacco excise taxes and implementing comprehensive smoke-free laws are two of the most effective population-level strategies to reduce tobacco use, prevent tobacco use initiation, and protect nonsmokers from secondhand smoke. We examined state laws related to smoke-free buildings and to cigarette excise taxes from 2000 through 2014 to see how implementation of these laws from 2000 through 2009 differs from implementation in more recent years (2010-2014). METHODS: We used legislative data from LexisNexis, an online legal research database, to examine changes in statewide smoke-free laws and cigarette excise taxes in effect from January 1, 2000, through December 31, 2014. A comprehensive smoke-free law was defined as a statewide law prohibiting smoking in all indoor areas of private work sites, restaurants, and bars. RESULTS: From 2000 through 2009, 21 states and the District of Columbia implemented comprehensive smoke-free laws prohibiting smoking in work sites, restaurants, and bars. In 2010, 4 states implemented comprehensive smoke-free laws. The last state to implement a comprehensive smoke-free law was North Dakota in 2012, bringing the total number to 26 states and the District of Columbia. From 2000 through 2009, 46 states and the District of Columbia implemented laws increasing their cigarette excise tax, which increased the national average state excise tax rate by $0.92. However, from 2010 through 2014, only 14 states and the District of Columbia increased their excise tax, which increased the national average state excise tax rate by $0.20. CONCLUSION: The recent stall in progress in enacting and implementing statewide comprehensive smoke-free laws and increasing cigarette excise taxes may undermine tobacco prevention and control efforts in the United States, undercutting efforts to reduce tobacco use, exposure to secondhand smoke, health disparities, and tobacco-related illness and death. |
Zika virus disease in Colombia - preliminary report
Pacheco O , Beltran M , Nelson CA , Valencia D , Tolosa N , Farr SL , Padilla AV , Tong VT , Cuevas EL , Espinosa-Bode A , Pardo L , Rico A , Reefhuis J , Gonzalez M , Mercado M , Chaparro P , Martinez Duran M , Rao CY , Munoz MM , Powers AM , Cuellar C , Helfand R , Huguett C , Jamieson DJ , Honein MA , Ospina Martinez ML . N Engl J Med 2016 383 (6) e44 Background Colombia began official surveillance for Zika virus disease (ZVD) in August 2015. In October 2015, an outbreak of ZVD was declared after laboratory-confirmed disease was identified in nine patients. Methods Using the national population-based surveillance system, we assessed patients with clinical symptoms of ZVD from August 9, 2015, to April 2, 2016. Laboratory test results and pregnancy outcomes were evaluated for a subgroup of pregnant women. Concurrently, we investigated reports of microcephaly for evidence of congenital ZVD. Results By April 2, 2016, there were 65,726 cases of ZVD reported in Colombia, of which 2485 (4%) were confirmed by means of reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay. The overall reported incidence of ZVD among female patients was twice that in male patients. A total of 11,944 pregnant women with ZVD were reported in Colombia, with 1484 (12%) of these cases confirmed on RT-PCR assay. In a subgroup of 1850 pregnant women, more than 90% of women who were reportedly infected during the third trimester had given birth, and no infants with apparent abnormalities, including microcephaly, have been identified. A majority of the women who contracted ZVD in the first or second trimester were still pregnant at the time of this report. Among the cases of microcephaly investigated from January 2016 through April 2016, four patients had laboratory evidence of congenital ZVD; all were born to asymptomatic mothers who were not included in the ZVD surveillance system. Conclusions Preliminary surveillance data in Colombia suggest that maternal infection with the Zika virus during the third trimester of pregnancy is not linked to structural abnormalities in the fetus. However, the monitoring of the effect of ZVD on pregnant women in Colombia is ongoing. (Funded by Colombian Instituto Nacional de Salud and the Centers for Disease Control and Prevention.). |
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