Characteristics of health care practices and systems that excel in hypertension control
Young A , Ritchey MD , George MG , Hannan J , Wright J . Prev Chronic Dis 2018 15 E73 Approximately 1 in 3 US adults has hypertension, but only half have their blood pressure controlled. We identified characteristics of health care practices and systems (hereinafter practices) effective in achieving control rates at or above 70% by using data collected via applications submitted from April through June 2017 for consideration in the Million Hearts Hypertension Control Challenge. We included 96 practices serving 635,000 patients with hypertension across 34 US states in the analysis. Mean hypertension control rate was 77.1%; 27.1% of practices had a control rate of 80% or greater. Although many practices served large populations with multiple risk factors for uncontrolled hypertension, high control rates were achieved with implementation of evidenced-based strategies. |
An innovative network approach to coordinating a national effort to improve cardiovascular health: The Case of Million Hearts
Varda DM , Williams MV , Schooley M , Duplantier D , Newman K , Lowe Beasley K , Lucido B , Marshall A . J Public Health Manag Pract 2018 25 (2) 156-164 OBJECTIVE: To assess the structure, content, quality, and quantity of partnerships that developed in response to a national cardiovascular health initiative, Million Hearts. DESIGN: This study used a social network analysis (SNA) approach to assess the Million Hearts initiative network partnerships and identify potential implications for policy and practice. SETTING/PARTICIPANTS: The Million Hearts network comprised a core group of federal and private sector partners that participate in Million Hearts activities and align with initiative priorities. To bound the network for the SNA, we used a list of 58 organizations (74% response rate) from a previously completed qualitative analysis of Million Hearts partnerships. MAIN OUTCOME MEASURES: We used the online PARTNER (Program to Analyze Record and Track Networks to Enhance Relationships-www.partnertool.net) survey to collect data on individual organizational characteristics and relational questions that asked organizations to identify and describe their relationships with other partners in the network. Key SNA measures include network density, centralizations, value, and trust. RESULTS: Our analyses show a network that is decentralized, has strong perceptions of trust and value among its members, and strong agreement on intended outcomes. Interestingly, partners report a desire and ability to contribute resources to Million Hearts; however, the perceptions between partners are that resources are not being contributed at the level they potentially could be. The majority of partners reported that being in the network helped them achieve their goals related to cardiovascular disease prevention. The largest barrier to successful activities within the network was cited as lack of targeted funding and staff to support participation in the network. CONCLUSIONS: The Million Hearts network described in this article is unique in its membership at the national level, agreement on outcomes, its powerful information-sharing abilities that require few resources, and its decentralized structure. We identified strategies that could be implemented to strengthen the network and its activities. By examining a national-level public-private partnership formed to address a public health issue, we can identify ways to strengthen the network and provide a framework for developing other initiatives. |
Obesity prevalence among adults living in metropolitan and nonmetropolitan counties - United States, 2016
Lundeen EA , Park S , Pan L , O'Toole T , Matthews K , Blanck HM . MMWR Morb Mortal Wkly Rep 2018 67 (23) 653-658 Approximately 46 million persons (14%) in the United States live in nonmetropolitan counties.* Compared with metropolitan residents, nonmetropolitan residents have a higher prevalence of obesity-associated chronic diseases such as diabetes (1), coronary heart disease (1), and arthritis (2). The 2005-2008 National Health and Nutrition Examination Survey (NHANES) found a significantly higher obesity prevalence among adults in nonmetropolitan (39.6%) than in metropolitan (33.4%) counties (3). However, this difference has not been examined by state. Therefore, CDC examined state-level 2016 Behavioral Risk Factor Surveillance System (BRFSS) data and found that the prevalence of obesity (body mass index [BMI] >/=30 kg/m(2)) was 34.2% among U.S. adults living in nonmetropolitan counties and 28.7% among those living in metropolitan counties (p<0.001). Obesity prevalence was significantly higher among nonmetropolitan county residents than among metropolitan county residents in all U.S. Census regions, with the largest absolute difference in the South (5.6 percentage points) and Northeast (5.4 percentage points). In 24 of 47 states, obesity prevalence was significantly higher among persons in nonmetropolitan counties than among those in metropolitan counties; only in Wyoming was obesity prevalence higher among metropolitan county residents than among nonmetropolitan county residents. Both metropolitan and nonmetropolitan counties can address obesity through a variety of policy and environmental strategies to increase access to healthier foods and opportunities for physical activity (4). |
Tracking and variability in childhood levels of BMI: The Bogalusa Heart Study
Freedman DS , Lawman HG , Galuska DA , Goodman AB , Berenson GS . Obesity (Silver Spring) 2018 26 (7) 1197-1202 OBJECTIVE: Although the tracking of BMI levels from childhood to adulthood has been examined, there is little information on the within-person variability of BMI. METHODS: Longitudinal data from 11,591 schoolchildren, 3,096 of whom were reexamined as adults, were used to explore the tracking and variability of BMI levels. This article focuses on changes in age-adjusted levels of BMI. RESULTS: There was strong tracking of BMI levels. The correlation of adjusted BMI levels was r = 0.88, and 78% of children with severe obesity at one examination had severe obesity at the next examination (mean interval, 2.7 years). Further, an increase in adjusted BMI from +5 kg/m(2) (above the median) to + 10 increased the risk for adult BMI >/= 40 by 2.7-fold. However, BMI levels among children and adolescents were variable. Over a 9- to 15-month interval, the SD of adjusted BMI change was 0.9 kg/m(2) , and 0.7% of children had an absolute change >/= 3.5. This variability was associated with the interval between examinations and with the initial BMI. CONCLUSIONS: Despite the high degree of tracking of BMI, annual changes of 3.5 kg/m(2) or more are plausible. Knowledge of this variability is important when following a child over time. |
Visualizing colonoscopy capacity for public health use
Vu MH , Tran JL . Prev Chronic Dis 2018 15 E75 In North Dakota, colorectal cancer (CRC) is the third most commonly diagnosed type of cancer and ranks second in late-stage diagnosis among all cancers (2). The public health community has prioritized improving colorectal cancer screening rates in North Dakota, which are currently at 64.7% (3). As a result, it is important to use and effectively communicate data in the process of developing strategies and making decisions. |
Distribution of influenza virus types by age using case-based global surveillance data from twenty-nine countries, 1999-2014
Caini S , Spreeuwenberg P , Kusznierz GF , Rudi JM , Owen R , Pennington K , Wangchuk S , Gyeltshen S , Ferreira de Almeida WA , Pessanha Henriques CM , Njouom R , Vernet MA , Fasce RA , Andrade W , Yu H , Feng L , Yang J , Peng Z , Lara J , Bruno A , de Mora D , de Lozano C , Zambon M , Pebody R , Castillo L , Clara AW , Matute ML , Kosasih H , Nurhayati , Puzelli S , Rizzo C , Kadjo HA , Daouda C , Kiyanbekova L , Ospanova A , Mott JA , Emukule GO , Heraud JM , Razanajatovo NH , Barakat A , El Falaki F , Huang SQ , Lopez L , Balmaseda A , Moreno B , Rodrigues AP , Guiomar R , Ang LW , Lee VJM , Venter M , Cohen C , Badur S , Ciblak MA , Mironenko A , Holubka O , Bresee J , Brammer L , Hoang PVM , Le MTQ , Fleming D , Seblain CE , Schellevis F , Paget J . BMC Infect Dis 2018 18 (1) 269 BACKGROUND: Influenza disease burden varies by age and this has important public health implications. We compared the proportional distribution of different influenza virus types within age strata using surveillance data from twenty-nine countries during 1999-2014 (N=358,796 influenza cases). METHODS: For each virus, we calculated a Relative Illness Ratio (defined as the ratio of the percentage of cases in an age group to the percentage of the country population in the same age group) for young children (0-4 years), older children (5-17 years), young adults (18-39 years), older adults (40-64 years), and the elderly (65+ years). We used random-effects meta-analysis models to obtain summary relative illness ratios (sRIRs), and conducted meta-regression and sub-group analyses to explore causes of between-estimates heterogeneity. RESULTS: The influenza virus with highest sRIR was A(H1N1) for young children, B for older children, A(H1N1)pdm2009 for adults, and (A(H3N2) for the elderly. As expected, considering the diverse nature of the national surveillance datasets included in our analysis, between-estimates heterogeneity was high (I(2)>90%) for most sRIRs. The variations of countries' geographic, demographic and economic characteristics and the proportion of outpatients among reported influenza cases explained only part of the heterogeneity, suggesting that multiple factors were at play. CONCLUSIONS: These results highlight the importance of presenting burden of disease estimates by age group and virus (sub)type. |
Estimated impact of screening on gonorrhea epidemiology in the United States: insights from a mathematical model
Tuite AR , Ronn MM , Wolf EE , Gift TL , Chesson HW , Berruti A , Galer K , Menzies NA , Hsu K , Salomon JA . Sex Transm Dis 2018 45 (11) 713-722 BACKGROUND: The burden of gonorrhea infections in the United States is high. There are marked disparities by race/ethnicity and sexual orientation. We quantified the impact of screening and treatment on gonorrhea rates in the US population aged 15-39 years for the time period 2000 to 2015 and estimated the impact that alternative screening strategies might have had over the same time period. METHODS: We developed a national-level transmission model that divides the population by race/ethnicity, preferred sex of sex partners, age, sex, and sexual activity level. We compared our fitted model ('base case') to four alternative strategies: (i) no screening; (ii) full adherence to current screening guidelines; (iii) annual universal screening; or (iv) enhanced screening in groups with the highest infection burden. Main outcomes were incidence, infections averted, and incidence rate ratios by race/ethnicity. Mean values and 95% credible intervals (CrI) were calculated from 1000 draws from parameter posterior distributions. RESULTS: The calibrated model reproduced observed trends in gonorrhea, including disparities in infection burden by race/ethnicity. We estimated that screening for gonorrhea from 2000-2015 averted 30% (95% CrI: 18-44%) of total infections that would otherwise have occurred. All alternative active screening strategies were estimated to further reduce, but not eliminate, gonorrhea infections relative to the base case, with differential impacts on the subpopulations of interest. CONCLUSIONS: Our model results suggest that screening has reduced gonorrhea incidence in the US population. Additional reductions in infection burden may have been possible over this time period with increased screening, but elimination was unlikely.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
HIV infection in patients with sexually transmitted infections in Zimbabwe - Results from the Zimbabwe STI etiology study
Kilmarx PH , Gonese E , Lewis DA , Chirenje ZM , Barr BAT , Latif AS , Gwanzura L , Handsfield HH , Machiha A , Mugurungi O , Rietmeijer CA . PLoS One 2018 13 (6) e0198683 BACKGROUND: HIV and other sexually transmitted infections (STI) frequently co-occur. We conducted HIV diagnostic testing in an assessment of the etiologies of major STI syndromes in Zimbabwe. METHODS: A total of 600 patients were enrolled at six geographically diverse, high-volume STI clinics in Zimbabwe in 2014-15: 200 men with urethral discharge, 200 women with vaginal discharge, and 100 men and 100 women each with genital ulcer disease (GUD). Patients completed a questionnaire, underwent a genital examination, and had specimens taken for etiologic testing. Patients were offered, but not required to accept, HIV testing using a standard HIV algorithm in which two rapid tests defined a positive result. RESULTS: A total of 489 participants (81.5%) accepted HIV testing; 201 (41.1%) tested HIV-1-positive, including 16 (11.9%) of 134 participants who reported an HIV-negative status at study enrollment, and 58 (28.2%) of 206 participants who reported their HIV status as unknown. Of 147 who self-reported being HIV-positive at study enrollment, 21 (14.3%) tested HIV negative. HIV infection prevalence was higher in women (47.3%) than in men (34.8%, p<0.01), and was 28.5% in men with urethral discharge, 40.5% in women with vaginal discharge, 45.2% in men with GUD, and 59.8% in women with GUD (p<0.001). CONCLUSIONS: The high prevalence of HIV infection in STI clinic patients in Zimbabwe underscores the importance of providing HIV testing and referral for indicated prevention and treatment services for this population. The discrepancy between positive self-reported and negative study HIV test results highlights the need for operator training, strict attention to laboratory quality assurance, and clear communication with patients about their HIV infection status. |
Multidrug-resistant tuberculosis in the end tuberculosis era
Cegielski JP . Rev Peru Med Exp Salud Publica 2018 35 (1) 110-117 Multidrug-resistant (MDR) tuberculosis (TB) emerged shortly after introduction of rifamycins in the 1960s; isoniazid resistance had already emerged by the mid-1950s. Without these two drugs, tuberculosis is very difficult and costly to treat, with unacceptably high rates of treatment failure, death, loss to follow-up, and no known preventive treatment. Global attention first focused on MDR TB in the early 1990s when nosocomial outbreaks with high case fatality rates were reported in many countries. Prevalence data for MDR TB on a global scale first became available in 1997. In 2016, about 4.1% of estimated ~10.4 million new TB patients plus 19% of ~1 million previously treated patients, that is ~600,000 people develop MDR TB or rifampicin resistant TB; 250,000 die annually. Ten years ago, <5% of them were diagnosed and enrolled on treatment, increasing to about 21.6% in 2016, leaving much room for improvement. Over that same period of time, momentum has been building to combat MDR TB, including advances in diagnostics, therapeutics, and care; decentralizing patient-centered care coupled with social support; growing improvements in prevention of transmission; increasing use of highly effective antiretroviral treatment; communications, advocacy, and social mobilization; leadership and updated policy guidance. Taking into account long-term epidemiological trends, all of these factors coupled with funding from the Global Fund and other major donors, suggest we may be on the verge of accelerating declines in MDR TB morbidity and mortality. Extreme poverty, which allows tuberculosis to flourish, has actually decreased by about one billion people over the past 25 years. What is needed now is political will on the part of national governments to apply these advances diligently and further reductions in poverty, pushing epidemiological trends past the inflection point to the downward slope. All these can be accelerated with increased support for science leading to better diagnosis, treatment and an effective vaccine to sustain and accelerate the meager declines reported thus far. |
Notes from the Field: Contact investigation for an infant with congenital tuberculosis infection - North Carolina, 2016
Rinsky JL , Farmer D , Dixon J , Maillard JM , Young T , Stout J , Ahmed A , Fleischauer A , MacFarquhar J , Moore Z . MMWR Morb Mortal Wkly Rep 2018 67 (23) 670-671 In November 2016, hospital A notified the North Carolina Division of Public Health (NCDPH) that annual tuberculosis screening of neonatal intensive care unit (NICU) staff members identified six health care staff members with newly positive tuberculin skin tests (TSTs). All six staff members had cared for an infant in whom a diagnosis of congenital tuberculosis was made after death. NCDPH worked with county health departments and hospital A to conduct a contact investigation. |
Outbreak of E. coli O157:H7 infections associated with exposure to animal manure in a rural community - Arizona and Utah, June-July 2017
Luna S , Krishnasamy V , Saw L , Smith L , Wagner J , Weigand J , Tewell M , Kellis M , Penev R , McCullough L , Eason J , McCaffrey K , Burnett C , Oakeson K , Dimond M , Nakashima A , Barlow D , Scherzer A , Sarino M , Schroeder M , Hassan R , Basler C , Wise M , Gieraltowski L . MMWR Morb Mortal Wkly Rep 2018 67 (23) 659-662 On June 26, 2017, a hospital in southern Utah notified the Utah Department of Health of Shiga toxin-producing Escherichia coli (STEC) O157:H7 infections in two children from a small community on the Arizona-Utah border. Both children developed hemolytic uremic syndrome, characterized by hemolytic anemia, acute kidney failure, and thrombocytopenia and died within a few days of illness onset. Over the next few days, several more STEC-associated illnesses were reported in residents of the community. A joint investigation by local and state health agencies from Arizona and Utah and CDC was initiated to identify the outbreak source and prevent additional cases; a total of 12 cases were identified, including the two children who died. Investigators initially explored multiple potential sources of illness; epidemiologic and environmental information revealed cow manure contact as the likely initial cause of the outbreak, which was followed by subsequent person-to-person transmission. One of the outbreak strains was isolated from bull and horse manure collected from a yard near a community household with two ill children. Local health agencies made recommendations to the public related to both animal contact and hand hygiene to reduce the risk for STEC transmission. Animal or animal manure contact should be considered a potential source of STEC O157:H7 during outbreaks in communities where ruminants are kept near the home. |
Peer-delivered linkage case management and same-day ART initiation for men and young persons with HIV infection - Eswatini, 2015-2017
MacKellar D , Williams D , Bhembe B , Dlamini M , Byrd J , Dube L , Mazibuko S , Ao T , Pathmanathan I , Auld AF , Faura P , Lukhele N , Ryan C . MMWR Morb Mortal Wkly Rep 2018 67 (23) 663-667 To achieve epidemic control of human immunodeficiency virus (HIV) infection, sub-Saharan African countries are striving to diagnose 90% of HIV infections, initiate and retain 90% of HIV-diagnosed persons on antiretroviral therapy (ART), and achieve viral load suppression* for 90% of ART recipients (90-90-90) (1). In Eswatini (formerly Swaziland), the country with the world's highest estimated HIV prevalence (27.2%), achieving 90-90-90 depends upon improving access to early ART for men and young adults with HIV infection, two groups with low ART coverage (1-3). Although community-based strategies test many men and young adults with HIV infection in Eswatini, fewer than one third of all persons who test positive in community settings enroll in HIV care within 6 months of diagnosis after receiving standard referral services (4,5). To evaluate the effectiveness of peer-delivered linkage case management(dagger) in improving early ART initiation for persons with HIV infection diagnosed in community settings in Eswatini, CDC analyzed data on 651 participants in CommLink, a community-based, mobile HIV-testing, point-of-diagnosis HIV care, and peer-delivered linkage case management demonstration project, and found that after diagnosis, 635 (98%) enrolled in care within a median of 5 days (interquartile range [IQR] = 2-8 days), and 541 (83%) initiated ART within a median of 6 days (IQR = 2-14 days), including 402 (74%) on the day of their first clinic visit (same-day ART). After expanding ART eligibility to all persons with HIV infection on October 1, 2016, 96% of 225 CommLink clients initiated ART, including 87% at their first clinic visit. Compared with women and adult clients aged >/=30 years, similar high proportions of men and persons aged 15-29 years enrolled in HIV care and received same-day ART. To help achieve 90-90-90 by 2020, the United States President's Emergency Plan for AIDS Relief (PEPFAR) is supporting the national scale-up of CommLink in Eswatini and recommending peer-delivered linkage case management as a potential strategy for countries to achieve >90% early enrollment in care and ART initiation after diagnosis of HIV infection (6). |
Phylogenetic analyses of local HIV transmission
Sullivan PS , Oster AM . Lancet HIV 2018 5 (6) e270-e271 In The Lancet HIV, Manon Ragonnet-Cronin and colleagues1 present an analysis of HIV sequence data from the UK to describe “potential non-disclosed men who have sex with men” (pnMSM). Their analysis is an illustration of the tremendous power of molecular analysis tools, applied to a powerful clinical dataset, generated through routine HIV resistance testing in clinical care settings. In the study, data about the relationship of viruses to one another were paired with data on sexual identity to identify men who were thought to be heterosexual, but whose HIV viruses clustered only with the viruses of men. It is important to discuss the limitations of data such as those analysed here, to be explicit about where such data can be useful in public health response, and to delineate which uses for such data exceed how the data can be meaningfully interpreted. |
Severe morbidity among hospitalised adults with acute influenza and other respiratory infections: 2014-2015 and 2015-2016
Segaloff HE , Petrie JG , Malosh RE , Cheng CK , McSpadden EJ , Ferdinands JM , Lamerato L , Lauring AS , Monto AS , Martin ET . Epidemiol Infect 2018 146 (11) 1-9 Our objective was to identify predictors of severe acute respiratory infection in hospitalised patients and understand the impact of vaccination and neuraminidase inhibitor administration on severe influenza. We analysed data from a study evaluating influenza vaccine effectiveness in two Michigan hospitals during the 2014-2015 and 2015-2016 influenza seasons. Adults admitted to the hospital with an acute respiratory infection were eligible. Through patient interview and medical record review, we evaluated potential risk factors for severe disease, defined as ICU admission, 30-day readmission, and hospital length of stay (LOS). Two hundred sixteen of 1119 participants had PCR-confirmed influenza. Frailty score, Charlson score and tertile of prior-year healthcare visits were associated with LOS. Charlson score >2 (OR 1.5 (1.0-2.3)) was associated with ICU admission. Highest tertile of prior-year visits (OR 0.3 (0.2-0.7)) was associated with decreased ICU admission. Increasing tertile of visits (OR 1.5 (1.2-1.8)) was associated with 30-day readmission. Frailty and prior-year healthcare visits were associated with 30-day readmission among influenza-positive participants. Neuraminidase inhibitors were associated with decreased LOS among vaccinated participants with influenza A (HR 1.6 (1.0-2.4)). Overall, frailty and lack of prior-year healthcare visits were predictors of disease severity. Neuraminidase inhibitors were associated with reduced severity among vaccine recipients. |
Tuberculosis case finding using population-based disease surveillance platforms in urban and rural Kenya
Bigogo G , Cain K , Nyole D , Masyongo G , Auko JA , Wamola N , Okumu A , Agaya J , Montgomery J , Borgdorff M , Burton D . BMC Infect Dis 2018 18 (1) 262 BACKGROUND: Tuberculosis (TB) case finding is an important component of TB control because it can reduce transmission of Mycobacterium tuberculosis (MTB) through prompt detection and treatment of infectious patients. METHODS: Using population-based infectious disease surveillance (PBIDS) platforms with links to health facilities in Kenya we implemented intensified TB case finding in the community and at the health facilities, as an adjunct to routine passive case finding conducted by the national TB program. From 2011 to 2014, PBIDS participants >/=15 years were screened either at home or health facilities for possible TB symptoms which included cough, fever, night sweats or weight loss in the preceding 2 weeks. At home, participants with possible TB symptoms had expectorated sputum collected. At the clinic, HIV-infected participants with possible TB symptoms were invited to produce sputum. Those without HIV but with symptoms lasting 7 days including the visit day had chest radiographs performed, and had sputum collected if the radiographs were abnormal. Sputum samples were tested for the presence of MTB using the Xpert MTB/RIF assay. TB detection rates were calculated per 100,000 persons screened. RESULTS: Of 11,191 participants aged >/=15 years screened at home at both sites, 2695 (23.9%) reported possible TB symptoms, of whom 2258 (83.8%) produced sputum specimens. MTB was detected in 32 (1.4%) of the specimens resulting in a detection rate of 286/100,000 persons screened. At the health facilities, a total of 11,762 person were screened, 7500 (63.8%) had possible TB symptoms of whom 1282 (17.1%) produced sputum samples. MTB was detected in 69 (5.4%) of the samples, resulting in an overall detection rate of 587/100,000 persons screened. The TB detection rate was higher in persons with HIV compared to those without at both home (HIV-infected - 769/100,000, HIV-uninfected 141/100,000, rate ratio (RR) - 5.45, 95% CI 3.25-22.37), and health facilities (HIV-infected 3399/100,000, HIV-uninfected 294/100,000, RR 11.56, 95% CI 6.18-18.44). CONCLUSION: Facility-based intensified TB case finding detected more TB cases per the number of specimens tested and the number of persons screened, including those with HIV, than home-based TB screening and should be further evaluated to determine its potential programmatic impact. |
Utility of state-level influenza disease burden and severity estimates to investigate an apparent increase in reported severe cases of influenza A(H1N1) pdm09 - Arizona, 2015-2016
Russell K , Herrick K , Venkat H , Brady S , Komatsu K , Goodin K , Berisha V , Sunenshine R , Perez-Velez C , Elliott S , Olsen SJ , Reed C . Epidemiol Infect 2018 146 (11) 1-7 The Arizona Department of Health Services identified unusually high levels of influenza activity and severe complications during the 2015-2016 influenza season leading to concerns about potential increased disease severity compared with prior seasons. We estimated state-level burden and severity to compare across three seasons using multiple data sources for community-level illness, hospitalisation and death. Severity ratios were calculated as the number of hospitalisations or deaths per community case. Community influenza-like illness rates, hospitalisation rates and mortality rates in 2015-2016 were higher than the previous two seasons. However, ratios of severe disease to community illness were similar. Arizona experienced overall increased disease burden in 2015-2016, but not increased severity compared with prior seasons. Timely estimates of state-specific burden and severity are potentially feasible and may provide important information during seemingly unusual influenza seasons or pandemic situations. |
Complete Anopheles funestus mitogenomes reveal an ancient history of mitochondrial lineages and their distribution in southern and central Africa.
Jones CM , Lee Y , Kitchen A , Collier T , Pringle JC , Muleba M , Irish S , Stevenson JC , Coetzee M , Cornel AJ , Norris DE , Carpi G . Sci Rep 2018 8 (1) 9054 Anopheles funestus s.s. is a primary vector of malaria in sub-Saharan Africa. Despite its important role in human Plasmodium transmission, evolutionary history, genetic diversity, and population structure of An. funestus in southern and central Africa remains understudied. We deep sequenced, assembled, and annotated the complete mitochondrial genome of An. funestus s.s. for the first time, providing a foundation for further genetic research of this important malaria vector species. We further analyzed the complete mitochondrial genomes of 43 An. funestus s.s. from three sites in Zambia, Democratic Republic of the Congo, and Tanzania. From these 43 mitogenomes we identified 41 unique haplotypes that comprised 567 polymorphic sites. Bayesian phylogenetic reconstruction confirmed the co-existence of two highly divergent An. funestus maternal lineages, herein defined as lineages I and II, in Zambia and Tanzania. The estimated coalescence time of these two mitochondrial lineages is ~500,000 years ago (95% HPD 426,000-594,000 years ago) with subsequent independent diversification. Haplotype network and phylogenetic analysis revealed two major clusters within lineage I, and genetic relatedness of samples with deep branching in lineage II. At this time, data suggest that the lineages are partially sympatric. This study illustrates that accurate retrieval of full mitogenomes of Anopheles vectors enables fine-resolution studies of intraspecies genetic relationships, population differentiation, and demographic history. Further investigations on whether An. funestus mitochondrial lineages represent biologically meaningful populations and their potential implications for malaria vector control are warranted. |
Trimester-specific phthalate concentrations and glucose levels among women from a fertility clinic
James-Todd TM , Chiu YH , Messerlian C , Minguez-Alarcon L , Ford JB , Keller M , Petrozza J , Williams PL , Ye X , Calafat AM , Hauser R . Environ Health 2018 17 (1) 55 BACKGROUND: Subfertile women are at increased risk of glucose intolerance in pregnancy. Based on epidemiologic studies, exposure to certain phthalates is associated with diabetes, elevated glucose, and increased insulin resistance. OBJECTIVES: To evaluate the association between urinary phthalate metabolites and pregnancy glucose levels in women seeking medically assisted reproduction. METHODS: We evaluated 245 women participating in a prospective cohort study based at a large fertility clinic who delivered live births and had data on pregnancy urinary phthalate metabolite concentrations and blood glucose levels. Urinary phthalate metabolite concentrations were from single spot urine samples collected in 1st and 2nd trimesters. Blood glucose data was abstracted from medical records for non-fasting 50-g glucose challenge tests at 24-28 weeks gestation. Multivariable linear regression models were used to evaluate associations between 7 urinary phthalate metabolites in quartiles and mean glucose adjusted for potential confounders. RESULTS: Eighteen percent of women had glucose levels >/= 140 mg/dL. Second trimester monoethyl phthalate (MEP) concentrations were positively associated with glucose levels, with adjusted mean (95%CI) glucose levels of 121 mg/dl (114, 128) vs. 109 mg/dL (103, 116) for women in highest and lowest quartiles, respectively. Women in the highest quartile of second trimester mono-isobutyl phthalate (MiBP) concentrations had a mean glucose level 14 mg/dL lower compared to women in the lowest quartile. No other urinary phthalate metabolites were associated with glucose levels. CONCLUSIONS: MEP and MiBP-metabolites of diethyl phthalate and dibutyl phthalate, respectively-were associated with higher pregnancy glucose in subfertile women-a population at high risk of glucose intolerance in pregnancy. |
Where there is smoke: Introduction to the virtual special issue of health impacts of wildland fire smoke exposure - Selected papers from the 2nd International Smoke Symposium
McCarty JL , Garbe PL . Sci Total Environ 2018 626 1259-1260 The Second International Smoke Symposium (ISS2: http://www.iawfonline.org/2016SmokeSymposium/), held in November 2016 in Long Beach, California, USA, was sponsored by the International Association of Wildland Fire and had participation from atmospheric scientists, ecologists, mathematicians, computer scientists, climatologists, social scientists, health professionals, smoke responders, wildland fire-fighters, business owners, national, tribal, state, and local government officials from North America, Europe, and Australia, and others to discuss the complex issues of wildland fire smoke and identify knowledge gaps and opportunities for innovation and development. This Virtual Special Issue, composed of five original contributions invited from the over 100 oral and poster presentations at ISS2, illustrates current interdisciplinary approaches and technological advances needed to quantify, understand, and communicate the human impact of wildland prescribed fires. |
Youth Risk Behavior Surveillance - United States, 2017
Kann L , McManus T , Harris WA , Shanklin SL , Flint KH , Queen B , Lowry R , Chyen D , Whittle L , Thornton J , Lim C , Bradford D , Yamakawa Y , Leon M , Brener N , Ethier KA . MMWR Surveill Summ 2018 67 (8) 1-114 PROBLEM: Health-risk behaviors contribute to the leading causes of morbidity and mortality among youth and adults in the United States. In addition, significant health disparities exist among demographic subgroups of youth defined by sex, race/ethnicity, and grade in school and between sexual minority and nonsexual minority youth. Population-based data on the most important health-related behaviors at the national, state, and local levels can be used to help monitor the effectiveness of public health interventions designed to protect and promote the health of youth at the national, state, and local levels. REPORTING PERIOD COVERED: September 2016-December 2017. DESCRIPTION OF THE SYSTEM: The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-related behaviors among youth and young adults: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors related to unintended pregnancy and sexually transmitted infections (STIs), including human immunodeficiency virus (HIV) infection; 5) unhealthy dietary behaviors; and 6) physical inactivity. In addition, YRBSS monitors the prevalence of other health-related behaviors, obesity, and asthma. YRBSS includes a national school-based Youth Risk Behavior Survey (YRBS) conducted by CDC and state and large urban school district school-based YRBSs conducted by state and local education and health agencies. Starting with the 2015 YRBSS cycle, a question to ascertain sexual identity and a question to ascertain sex of sexual contacts were added to the national YRBS questionnaire and to the standard YRBS questionnaire used by the states and large urban school districts as a starting point for their questionnaires. This report summarizes results from the 2017 national YRBS for 121 health-related behaviors and for obesity, overweight, and asthma by demographic subgroups defined by sex, race/ethnicity, and grade in school and by sexual minority status; updates the numbers of sexual minority students nationwide; and describes overall trends in health-related behaviors during 1991-2017. This reports also summarizes results from 39 state and 21 large urban school district surveys with weighted data for the 2017 YRBSS cycle by sex and sexual minority status (where available). RESULTS: Results from the 2017 national YRBS indicated that many high school students are engaged in health-risk behaviors associated with the leading causes of death among persons aged 10-24 years in the United States. During the 30 days before the survey, 39.2% of high school students nationwide (among the 62.8% who drove a car or other vehicle during the 30 days before the survey) had texted or e-mailed while driving, 29.8% reported current alcohol use, and 19.8% reported current marijuana use. In addition, 14.0% of students had taken prescription pain medicine without a doctor's prescription or differently than how a doctor told them to use it one or more times during their life. During the 12 months before the survey, 19.0% had been bullied on school property and 7.4% had attempted suicide. Many high school students are engaged in sexual risk behaviors that relate to unintended pregnancies and STIs, including HIV infection. Nationwide, 39.5% of students had ever had sexual intercourse and 9.7% had had sexual intercourse with four or more persons during their life. Among currently sexually active students, 53.8% reported that either they or their partner had used a condom during their last sexual intercourse. Results from the 2017 national YRBS also indicated many high school students are engaged in behaviors associated with chronic diseases, such as cardiovascular disease, cancer, and diabetes. Nationwide, 8.8% of high school students had smoked cigarettes and 13.2% had used an electronic vapor product on at least 1 day during the 30 days before the survey. Forty-three percent played video or computer games or used a computer for 3 or more hours per day on an average school day for something that was not school work and 15.4% had not been physically active for a total of at least 60 minutes on at least 1 day during the 7 days before the survey. Further, 14.8% had obesity and 15.6% were overweight. The prevalence of most health-related behaviors varies by sex, race/ethnicity, and, particularly, sexual identity and sex of sexual contacts. Specifically, the prevalence of many health-risk behaviors is significantly higher among sexual minority students compared with nonsexual minority students. Nonetheless, analysis of long-term temporal trends indicates that the overall prevalence of most health-risk behaviors has moved in the desired direction. INTERPRETATION: Most high school students cope with the transition from childhood through adolescence to adulthood successfully and become healthy and productive adults. However, this report documents that some subgroups of students defined by sex, race/ethnicity, grade in school, and especially sexual minority status have a higher prevalence of many health-risk behaviors that might place them at risk for unnecessary or premature mortality, morbidity, and social problems (e.g., academic failure, poverty, and crime). PUBLIC HEALTH ACTION: YRBSS data are used widely to compare the prevalence of health-related behaviors among subpopulations of students; assess trends in health-related behaviors over time; monitor progress toward achieving 21 national health objectives; provide comparable state and large urban school district data; and take public health actions to decrease health-risk behaviors and improve health outcomes among youth. Using this and other reports based on scientifically sound data is important for raising awareness about the prevalence of health-related behaviors among students in grades 9-12, especially sexual minority students, among decision makers, the public, and a wide variety of agencies and organizations that work with youth. These agencies and organizations, including schools and youth-friendly health care providers, can help facilitate access to critically important education, health care, and high-impact, evidence-based interventions. |
Multistate outbreak of Salmonella Paratyphi B variant L(+) tartrate(+) and Salmonella Weltevreden infections linked to imported frozen raw tuna: USA, March-July 2015.
Hassan R , Tecle S , Adcock B , Kellis M , Weiss J , Saupe A , Sorenson A , Klos R , Blankenship J , Blessington T , Whitlock L , Carleton HA , Concepcion-Acevedo J , Tolar B , Wise M , Neil KP . Epidemiol Infect 2018 146 (11) 1-7 Foodborne non-typhoidal salmonellosis causes approximately 1 million illnesses annually in the USA. In April 2015, we investigated a multistate outbreak of 65 Salmonella Paratyphi B variant L(+) tartrate(+) infections associated with frozen raw tuna imported from Indonesia, which was consumed raw in sushi. Forty-six (92%) of 50 case-patients interviewed ate sushi during the week before illness onset, and 44 (98%) of 45 who specified ate sushi containing raw tuna. Two outbreak strains were isolated from the samples of frozen raw tuna. Traceback identified a single importer as a common source of tuna consumed by case-patients; this importer issued three voluntary recalls of tuna sourced from one Indonesian processor. Four Salmonella Weltevreden infections were also linked to this outbreak. Whole-genome sequencing was useful in establishing a link between Salmonella isolated from ill people and tuna. This outbreak highlights the continuing foodborne illness risk associated with raw seafood consumption, the importance of processing seafood in a manner that minimises contamination with pathogenic microorganisms and the continuing need to ensure imported foods are safe to eat. People at higher risk for foodborne illness should not consume undercooked animal products, such as raw seafood. |
Cost-effectiveness of nonavalent HPV vaccination among males aged 22 through 26 years in the United States
Chesson HW , Meites E , Ekwueme DU , Saraiya M , Markowitz LE . Vaccine 2018 36 (29) 4362-4368 INTRODUCTION: In the United States, routine human papillomavirus (HPV) vaccination is recommended for females and males at age 11 or 12years; the series can be started at age 9years. Vaccination is also recommended for females through age 26years and males through age 21years. The objective of this study was to assess the health impact and cost-effectiveness of harmonizing female and male vaccination recommendations by increasing the upper recommended catch-up age of HPV vaccination for males from age 21 to age 26years. METHODS: We updated a published model of the health impact and cost-effectiveness of 9-valent human papillomavirus vaccine (9vHPV). We examined the cost-effectiveness of (1) 9vHPV for females aged 12 through 26years and males aged 12 through 21years, and (2) an expanded program including males through age 26years. RESULTS: Compared to no vaccination, providing 9vHPV for females aged 12 through 26years and males aged 12 through 21years cost an estimated $16,600 (in 2016 U.S. dollars) per quality-adjusted life year (QALY) gained. The estimated cost per QALY gained by expanding male vaccination through age 26years was $228,800 and ranged from $137,900 to $367,300 in multi-way sensitivity analyses. CONCLUSIONS: The cost-effectiveness ratios we estimated are not so favorable as to make a strong economic case for recommending expanding male vaccination, yet are not so unfavorable as to preclude consideration of expanding male vaccination. The wide range of plausible results we obtained may underestimate the true degree of uncertainty, due to model limitations. For example, the cost per QALY might be less than our lower bound estimate of $137,900 had our model allowed for vaccine protection against re-infection. Models that specifically incorporate men who have sex with men (MSM) are needed to provide a more comprehensive assessment of male HPV vaccination strategies. |
Transmission of Clostridium difficile from asymptomatically colonized or infected long-term care facility residents
Donskey CJ , Sunkesula VCK , Stone ND , Gould CV , McDonald LC , Samore M , Mayer J , Pacheco SM , Jencson AL , Sambol SP , Petrella LA , Gulvik CA , Gerding DN . Infect Control Hosp Epidemiol 2018 39 (8) 1-8 OBJECTIVE: To test the hypothesis that long-term care facility (LTCF) residents with Clostridium difficile infection (CDI) or asymptomatic carriage of toxigenic strains are an important source of transmission in the LTCF and in the hospital during acute-care admissions. DESIGN: A 6-month cohort study with identification of transmission events was conducted based on tracking of patient movement combined with restriction endonuclease analysis (REA) and whole-genome sequencing (WGS). SETTING: Veterans Affairs hospital and affiliated LTCF.ParticipantsThe study included 29 LTCF residents identified as asymptomatic carriers of toxigenic C. difficile based on every other week perirectal screening and 37 healthcare facility-associated CDI cases (ie, diagnosis >3 days after admission or within 4 weeks of discharge to the community), including 26 hospital-associated and 11 LTCF-associated cases. RESULTS: Of the 37 CDI cases, 7 (18.9%) were linked to LTCF residents with LTCF-associated CDI or asymptomatic carriage, including 3 of 26 hospital-associated CDI cases (11.5%) and 4 of 11 LTCF-associated cases (36.4%). Of the 7 transmissions linked to LTCF residents, 5 (71.4%) were linked to asymptomatic carriers versus 2 (28.6%) to CDI cases, and all involved transmission of epidemic BI/NAP1/027 strains. No incident hospital-associated CDI cases were linked to other hospital-associated CDI cases. CONCLUSIONS: Our findings suggest that LTCF residents with asymptomatic carriage of C. difficile or CDI contribute to transmission both in the LTCF and in the affiliated hospital during acute-care admissions. Greater emphasis on infection control measures and antimicrobial stewardship in LTCFs is needed, and these efforts should focus on LTCF residents during hospital admissions.Infection Control & Hospital Epidemiology (2018), 0 1-8. |
Adverse events following vaccination with an inactivated, Vero cell culture-derived Japanese encephalitis vaccine in the United States, 2012-2016
Walker WL , Hills SL , Miller ER , Fischer M , Rabe IB . Vaccine 2018 36 (29) 4369-4374 BACKGROUND: In March 2009, the U.S. Food and Drug Administration licensed an inactivated Vero cell culture-derived Japanese encephalitis vaccine (JE-VC [IXIARO(R)]) for use in persons aged >/=17years. In 2013, licensure was extended to include children aged >/=2months. A previous analysis reviewed adverse events reported to the U.S. Vaccine Adverse Event Reporting System (VAERS) from May 2009 through April 2012. METHODS: We reviewed adverse events reported to VAERS following JE-VC administered from May 1, 2012 through April 30, 2016. Adverse event reporting rates were calculated using 802,229 doses distributed. RESULTS: During the 4-year period, 119 adverse event reports were received for a reporting rate of 14.8 per 100,000 doses distributed. Nine (8%) adverse events were classified as serious for a reporting rate of 1.1 per 100,000 distributed. The most commonly reported event was hypersensitivity (n=24; 20%) for a rate of 3.0 per 100,000 doses distributed; 1 anaphylaxis event was reported. Ten (8%) neurologic events were reported for a rate of 1.2 per 100,000 doses distributed; 2 events were classified as seizures. Sixty-three (53%) adverse events occurred after a first dose of JE-VC. Eighty (67%) adverse events occurred after administration of JE-VC with other vaccines. Eleven (9%) adverse events were reported in children; 1 was considered serious. CONCLUSIONS: These data continue to support the generally favorable safety profile of JE-VC. Reporting rates of adverse events were similar to those of the previous analysis. Although reporting rates of adverse events in children could not be calculated, there were low numbers of reported events in this age group. Post-licensure adverse event surveillance for this relatively new vaccine continues to be important to monitor adverse event reporting rates and identify possible rare serious events. |
Childhood vaccine attitudes and information sources among Oregon parents and guardians
Deas J , Bean SJ , Sokolovska I , Fautin C . Health Promot Pract 2018 20 (4) 1524839918778830 We sought to examine parent vaccine information sources and to understand vaccine beliefs and concerns of a representative sample of Oregon parents from an area where low vaccination levels occur. We hoped to understand how these beliefs affect pediatric vaccine uptake and to inform efforts to shift vaccine-hesitant habits toward a norm of full vaccination. Oregon still permits nonmedical exemptions. We passively recruited parents of children ages 0 to 13 years, then divided them into focus groups by stance-whether vaccine-accepting or -hesitant. Because of recruitment challenges, we supplemented focus group data from 33 participants with six individual parent interviews. In focus groups and interviews, we probed for vaccine information sources perceived as credible as well as perceptions about vaccines and their utility, benefit, and safety, using constructs of the health belief model. The information sources included medical providers, family, and peers or social networks. We found that vaccine beliefs are not dichotomous but fall along a continuum from full acceptance to full opposition. Most parents who participated inclined toward flexible vaccination scheduling. Another new finding was that most participants, regardless of vaccine stance, acknowledged the tension between social responsibility and individual choice regarding vaccination; vaccine-accepters supported social responsibility and vaccine-hesitant participants stressed individual choice. In addition, parents across the spectrum expressed skepticism about the reliability of social media. |
Direct and possible indirect effects of vaccination on rotavirus hospitalisations among children in Malawi four years after programmatic introduction
Bennett A , Pollock L , Jere KC , Pitzer VE , Parashar U , Tate JE , Heyderman RS , Mwansambo C , French N , Nakagomi O , Iturriza-Gomara M , Everett D , Cunliffe NA , Bar-Zeev N . Vaccine 2018 36 (47) 7142-7148 INTRODUCTION: Despite increased use of vaccine in routine immunisation, rotavirus remains a major cause of acute gastroenteritis (AGE) in low-income countries. We describe rotavirus prevalence and hospitalisation in Malawi pre and four years post vaccine introduction; provide updated vaccine effectiveness (VE) estimates; and assess rotavirus vaccine indirect effects. METHODS: Children under five years of age presenting to a referral hospital in Blantyre with AGE were recruited. Stool samples were tested for rotavirus using Enzyme Immunoassay. The change in rotavirus prevalence was evaluated using Poisson regression. Time series analysis was used to further investigate trends in prevalence over time. VE against rotavirus diarrhoea of any severity was estimated using logistic regression. Indirect effects were estimated by evaluating rotavirus prevalence in unvaccinated children over time, and by comparing observed reductions in incidence of rotavirus hospitalisation to those expected based on vaccine coverage and trial efficacy estimates. RESULTS: 2320 children were included. Prevalence of rotavirus in hospitalised infants (<12months) with AGE decreased from 69/139(49.64%) prior to vaccine introduction to 197/607(32.45%) post-vaccine introduction (adjusted RR 0.67[95% CI 0.55, 0.82]). Prevalence in children aged 12-23months demonstrated a less substantial decline: 15/37(40.54%) pre- and 122/352(34.66%) post-vaccine introduction (adjusted RR 0.85, 95% CI 0.57, 1.28). Adjusted VE was 61.89%(95% CI 28.04-79.82), but lower in children aged 12-23months (31.69% [95% CI -139.03 to 80.48]). In hospitalised infants with rotavirus disease, the observed overall effect of the vaccine was 9% greater than expected according to vaccine coverage and efficacy estimates. Rotavirus prevalence among unvaccinated infants declined post-vaccine introduction (RR 0.70[95% CI 0.55-0.80]). CONCLUSIONS: Following rotavirus vaccine introduction in Malawi, prevalence of rotavirus in hospitalised children with AGE has declined significantly, with some evidence of an indirect effect in infants. Despite this, rotavirus remains an important cause of severe diarrhoea in Malawian children, particularly in the second year of life. |
Varicella vaccination among US adolescents: Coverage and missed opportunities, 2007-2014
Leung J , Reagan-Steiner S , Lopez A , Jeyarajah J , Marin M . J Public Health Manag Pract 2018 25 (3) E19-E26 CONTEXT: Since 2007, 2 doses of varicella vaccine have been routinely recommended, with a catch-up second dose recommended for those who received only 1 prior dose. OBJECTIVE: To examine varicella vaccination coverage with 2 or more doses and the proportions of adolescents with evidence of immunity to varicella (>/=2 doses of vaccine or varicella history) during 2007-2014. To assess timing of second-dose receipt, factors associated with 2 or more vaccine doses, and missed second-dose opportunities during 2014. DESIGN, SETTING, AND PARTICIPANTS: We used data from the 2007-2014 National Immunization Survey-Teen (NIS-Teen), which collects information on adolescents aged 13 to 17 years in the United States. RESULTS: From 2007 to 2014, varicella vaccination coverage with 2 or more doses increased from 8.3% to 66.9% in 13- to 15-year-olds and from 3.6% to 56.7% in 16- to 17-year-olds. The proportions with evidence of immunity also increased from 68.0% to 84.1% (13- to 15-year-olds) and 78.6% to 83.4% (16- to 17-year-olds). In 2014, 13.4% of 13- to 15-year-olds and 3.2% of 16- to 17-year-olds had received their second dose at 4 to 6 years of age. Factors most significantly associated with lower coverage with 2 or more doses were not having an 11- to 12-year well-child visit, not receiving an adolescent vaccine, and residence in a state with no 2-dose immunization school entry requirement. Seventy-seven percent of 1-dose vaccinated adolescents had 1 or more missed opportunities to receive their second dose; if were they not missed, 2-dose coverage would have increased from 79.5% to 94.8%. CONCLUSIONS: Levels of varicella vaccination coverage with 2 or more doses and the proportion of adolescents with evidence of immunity increased from 2007 to 2014, though 16% lacked evidence of immunity in 2014. Although catch-up campaigns have succeeded, missed vaccination opportunities persist. |
Resistome of carbapenem- and colistin-resistant Klebsiella pneumoniae clinical isolates.
Lomonaco S , Crawford MA , Lascols C , Timme RE , Anderson K , Hodge DR , Fisher DJ , Pillai SP , Morse SA , Khan E , Hughes MA , Allard MW , Sharma SK . PLoS One 2018 13 (6) e0198526 The emergence and dissemination of carbapenemases, bacterial enzymes able to inactivate most beta-lactam antibiotics, in Enterobacteriaceae is of increasing concern. The concurrent spread of resistance against colistin, an antibiotic of last resort, further compounds this challenge further. Whole-genome sequencing (WGS) can play a significant role in the rapid and accurate detection/characterization of existing and emergent resistance determinants, an essential aspect of public health surveillance and response activities to combat the spread of antimicrobial resistant bacteria. In the current study, WGS data was used to characterize the genomic content of antimicrobial resistance genes, including those encoding carbapenemases, in 10 multidrug-resistant Klebsiella pneumoniae isolates from Pakistan. These clinical isolates represented five sequence types: ST11 (n = 3 isolates), ST14 (n = 3), ST15 (n = 1), ST101 (n = 2), and ST307 (n = 1). Resistance profiles against 25 clinically-relevant antimicrobials were determined by broth microdilution; resistant phenotypes were observed for at least 15 of the 25 antibiotics tested in all isolates except one. Specifically, 8/10 isolates were carbapenem-resistant and 7/10 isolates were colistin-resistant. The blaNDM-1 and blaOXA-48 carbapenemase genes were present in 7/10 and 5/10 isolates, respectively; including 2 isolates carrying both genes. No plasmid-mediated determinants for colistin resistance (e.g. mcr) were detected, but disruptions and mutations in chromosomal loci (i.e. mgrB and pmrB) previously reported to confer colistin resistance were observed. A blaOXA-48-carrying IncL/M-type plasmid was found in all blaOXA-48-positive isolates. The application of WGS to molecular epidemiology and surveillance studies, as exemplified here, will provide both a more complete understanding of the global distribution of MDR isolates and a robust surveillance tool useful for detecting emerging threats to public health. |
Assessing the stability of Cd, Mn, Pb, Se, and total Hg in whole human blood by ICP-DRC-MS as a function of temperature and time
Tevis DS , Jarrett JM , Jones DR , Cheng PY , Franklin M , Mullinex N , Caldwell KL , Jones RL . Clin Chim Acta 2018 485 1-6 BACKGROUND: Comprehensive information on the effect of time and temperature storage on the measurement of elements in human, whole blood (WB) by inductively coupled plasma-dynamic reaction cell-mass spectrometry (ICP-DRC-MS) is lacking, particularly for Mn and Se. METHODS: Human WB was spiked at 3 concentration levels, dispensed, and then stored at 5 different temperatures: -70 degrees C, -20 degrees C, 4 degrees C, 23 degrees C, and 37 degrees C. At 3 and 5weeks, and at 2, 4, 6, 8, 10, 12, 36months, samples were analyzed for Pb, Cd, Mn, Se and total Hg, using ICP-DRC-MS. We used a multiple linear regression model including time and temperature as covariates to fit the data with the measurement value as the outcome. We used an equivalence test using ratios to determine if results from the test storage conditions, warmer temperature and longer time, were comparable to the reference storage condition of 3weeks storage time at -70 degrees C. RESULTS: Model estimates for all elements in human WB samples stored in polypropylene cryovials at -70 degrees C were equivalent to estimates from samples stored at 37 degrees C for up to 2months, 23 degrees C up to 10months, and -20 degrees C and 4 degrees C for up to 36months. Model estimates for samples stored for 3weeks at -70 degrees C were equivalent to estimates from samples stored for 2months at -20 degrees C, 4 degrees C, 23 degrees C and 37 degrees C; 10months at -20 degrees C, 4 degrees C, and 23 degrees C; and 36months at -20 degrees C and 4 degrees C. This equivalence was true for all elements and pools except for the low concentration blood pool for Cd. CONCLUSIONS: Storage temperatures of -20 degrees C and 4 degrees C are equivalent to -70 degrees C for stability of Cd, Mn, Pb, Se, and Hg in human whole blood for at least 36months when blood is stored in sealed polypropylene vials. Increasing the sample storage temperature from -70 degrees C to -20 degrees C or 4 degrees C can lead to large energy savings. The best analytical results are obtained when storage time at higher temperature conditions (e.g. 23 degrees C and 37 degrees C) is minimized because recovery of Se and Hg is reduced. Blood samples stored in polypropylene vials also lose volume over time and develop clots at higher temperature conditions (e.g., 23 degrees C and 37 degrees C), making them unacceptable for elemental testing after 10months and 2months, respectively. |
Broadly-reactive human monoclonal antibodies elicited following pandemic H1N1 influenza virus exposure protect mice from highly pathogenic H5N1 challenge
Nachbagauer R , Shore D , Yang H , Johnson SK , Gabbard JD , Tompkins SM , Wrammert J , Wilson PC , Stevens J , Ahmed R , Krammer F , Ellebedy AH . J Virol 2018 92 (16) Broadly cross-reactive antibodies that recognize conserved epitopes within the influenza virus hemagglutinin (HA) stalk domain are of particular interest for their potential use as therapeutic and prophylactic agents against multiple influenza virus subtypes including zoonotic virus strains. Here, we characterized four human HA stalk-reactive monoclonal antibodies (mAbs) for their binding breadth and affinity, in vitro neutralization capacity, and in vivo protective potential against an highly pathogenic avian influenza virus. The monoclonal antibodies were isolated from individuals shortly following infection with (70-1F02 and 1009-3B05) or vaccination against (05-2G02 and 09-3A01) A(H1N1)pdm09. Three of the mAbs bound HAs from multiple strains of group 1 viruses, and one mAb, 05-2G02, bound to both group 1 and group 2 influenza A HAs. All four antibodies prophylactically protected mice against a lethal challenge with the highly pathogenic A/Vietnam/1203/04 (H5N1) strain. Two mAbs, 70-1F02 and 09-3A01, were further tested for their therapeutic efficacy against the same strain and showed good efficacy in this setting as well. One mAb, 70-1F02, was co-crystallized with H5 HA and showed similar heavy chain only interactions as a the previously described anti-stalk antibody CR6261. Finally, we showed that antibodies that compete with these mAbs are prevalent in serum from an individual recently infected with A(H1N1)pdm09 virus. The antibodies described here can be developed into broad-spectrum antiviral therapeutics that could be used to combat infections with zoonotic or emerging pandemic influenza viruses.IMPORTANCE The rise in zoonotic infections of humans with emerging influenza viruses is a worldwide public health concern. The majority of recent zoonotic human influenza cases were caused by H7N9 and H5Nx viruses and were associated with high morbidity and mortality. In addition, seasonal influenza viruses are estimated to cause up to 650,000 deaths annually worldwide. Currently available anti-viral treatment options include only neuraminidase inhibitors, but some influenza viruses are naturally resistant to these drugs, and others quickly develop resistance-conferring mutations. Alternative therapeutics are urgently needed. Broadly protective antibodies that target the conserved 'stalk' domain of the hemagglutinin represent potential potent antiviral prophylactic and therapeutic agents that can assist pandemic preparedness. Here, we describe four human monoclonal antibodies that target conserved regions of influenza HA and characterize their binding spectrum, as well as their protective capacity in prophylactic and therapeutic settings against a lethal challenge with a zoonotic influenza virus. |
The effects of repeated automated plasmapheresis in goats (Capra hircus) in response to vaccination with purified influenza hemagglutinin proteins
Taylor WDJr , Langham GL , Weed JL , Rowe T , Song W , Isenberg KA , Xu X , Wentworth DE , Lathrop G , Powell N . PLoS One 2018 13 (6) e0195903 Seasonal influenza is a contagious respiratory illness that annually affects millions of people worldwide. To identify currently circulating influenza virus subtypes, the Centers for Disease Control and Prevention's International Reagent Resource distributes the World Health Organization (WHO) influenza reagent kits, which are used globally by testing laboratories for influenza surveillance. The data generated by the kits aid in strain selection for the influenza vaccine each season. The use of animals to produce high quality and quantities of antibodies is critical to the production of these kits. In this study, we assessed the effects and efficacy of repeated sampling from automated plasmapheresis in goats. Analysis of blood samples demonstrated that repeated automated plasmapheresis procedures did not adversely affect the immediate or long-term health of goats. Further, our results indicate that repeated plasmapheresis in goats was capable of generating 2 liters of antibody-rich plasma per goat per week. This volume is sufficient to produce enough WHO influenza kits to conduct over 1 million tests. Thus, we have shown that the rapid production of plasma in goats can positively impact the public health preparedness and response to influenza. |
Incorporation of IgG depletion in a neutralization assay facilitates differential diagnosis of Zika and dengue in secondary flavivirus infection cases
Calvert AE , Boroughs KL , Laven J , Stovall JL , Luy BE , Kosoy OI , Huang CY . J Clin Microbiol 2018 56 (6) Zika virus (ZIKV) has emerged as a major global public health concern due to its link as a causative agent of human birth defects. Laboratory diagnosis of suspected ZIKV infections by serological testing of specimens collected a week or more after symptom onset primarily relies on detection of anti-ZIKV-specific IgM antibodies by enzyme-linked immunosorbent assay coupled with detection of ZIKV-specific neutralizing antibody by neutralization tests. A definitive diagnosis based on serological assays is possible during primary ZIKV infections; however, due to the cross-reactivity of antibodies elicited during flaviviral infections, a definitive diagnosis is not always possible, especially among individuals who have previously been exposed to closely related flaviviruses, such as dengue virus (DENV). Here, we investigated the neutralizing IgM antibody profiles of 33 diagnostic specimens collected from individuals with suspected primary and secondary flaviviral infections acquired when visiting areas experiencing active ZIKV transmission in 2015 and 2016. Specimens collected between 1 day and 3 months postexposure were tested for ZIKV and dengue virus type 1 (DENV1) and type 2 (DENV2) by the plaque reduction neutralization test (PRNT) before and after IgG depletion. We found that IgG depletion prior to neutralization testing had little effect in differentiating samples from individuals with secondary infections taken less than 3 weeks postexposure; however, IgG depletion significantly reduced the cross-reactive neutralizing antibody titers and increased the percentage of cases discernible by PRNT from 15.4% (95% confidence interval [CI], 4.3 to 42.2%) to 76.9% (95% CI, 49.7 to 91.8%) for samples collected between roughly 3 and 12 weeks postexposure. These results highlight the potential of IgG depletion to improve the specificity of PRNT for better confirmation and differential diagnosis of flavivirus infections. |
Investigative Immunotoxicology
Anderson SE , Shane HL . Methods Mol Biol 2018 1803 27-46 Immunotoxicology is the study of immune system dysfunction that can result from occupational, inadvertent, or therapeutic exposure to a variety of chemical or biologic agents that alter the immune system and affect human health. Immunotoxicology can manifest in a variety of ways, with one of the most prominent effects being immunosuppression. Immunosuppression can be defined as a reduced ability of the immune system to respond to a challenge from a level considered normal, regardless of whether clinical disease results. Although immunosuppression can lead to an increased incidence and severity of infectious and neoplastic disease, interpreting data from experimental immunotoxicology studies, or even epidemiologic studies, for quantitative risk assessment has been a persistent challenge. Decades of research has resulted in the development of specific assays and the identification of sensitive endpoints that measure effects on the immune response, from which many regulatory agencies have developed specific immunotoxicity testing guidelines. However, establishing a direct link between exposure and disease manifestations for immunosuppression in humans is an ongoing challenge due to inherent limitations of epidemiological studies to draw causal conclusions. Efforts have been made to examine the relationships between laboratory measures of immune response and disease resistance in experimental animal models and also in human studies. The identification of sensitive endpoints and the development of experimental assays to identify suspect immunotoxicants are a primary focus of the field of immunotoxicology. This chapter is organized around sections discussing the impact and scientific basis of immunotoxicity testing, predictive immunotoxicity testing strategies, examples of immunotoxicity testing, and key considerations and recent developments related to effective testing strategies for health risk reduction. |
Multi-clade H5N1 virus-like particles: Immunogenicity and protection against H5N1 virus and effects of beta-propiolactone
Pushko P , Tretyakova I , Hidajat R , Sun X , Belser JA , Tumpey TM . Vaccine 2018 36 (29) 4346-4353 During the past decade, H5N1 highly pathogenic avian influenza (HPAI) viruses have diversified genetically and antigenically, suggesting the need for multiple H5N1 vaccines. However, preparation of multiple vaccines from live H5N1 HPAI viruses is difficult and economically not feasible representing a challenge for pandemic preparedness. Here we evaluated a novel multi-clade recombinant H5N1 virus-like particle (VLP) design, in which H5 hemagglutinins (HA) and N1 neuraminidase (NA) derived from four distinct clades of H5N1 virus were co-localized within the VLP structure. The multi-clade H5N1 VLPs were prepared by using a recombinant baculovirus expression system and evaluated for functional hemagglutination and neuraminidase enzyme activities, particle size and morphology, as well as for the presence of baculovirus in the purified VLP preparations. To remove residual baculovirus, VLP preparations were treated with beta-propiolactone (BPL). Immunogenicity and efficacy of multi-clade H5N1 VLPs were determined in an experimental ferret H5N1 HPAI challenge model, to ascertain the effect of BPL on immunogenicity and protective efficacy against lethal challenge. Although treatment with BPL reduced immunogenicity of VLPs, all vaccinated ferrets were protected from lethal challenge with influenza A/VietNam/1203/2004 (H5N1) HPAI virus, indicating that multi-clade VLP preparations treated with BPL represent a potential approach for pandemic preparedness vaccines. |
Notes from the Field: Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae from Less Common Enterobacteriaceae Genera - United States, 2014-2017
Walters MS , Witwer M , Lee YK , Albrecht V , Lonsway D , Rasheed JK , Anacker M , Snippes-Vagnone P , Lynfield R , Kallen AJ . MMWR Morb Mortal Wkly Rep 2018 67 (23) 668-669 Infections with carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) are associated with high mortality rates (1). Carbapenemases encoded on plasmids can move between bacterial strains and have the potential to rapidly increase the proportion of Enterobacteriaceae resistant to carbapenems; as such, CP-CRE have been a particular focus of public health response. Although the Enterobacteriaceae family includes approximately 50 recognized genera, surveillance for CP-CRE has focused on the organisms most associated with clinical infections: Klebsiella spp., Enterobacter spp., and Escherichia coli (2,3). CRE from other, less commonly encountered genera (hereafter referred to as less common genera) have generally not been targeted for carbapenemase testing, in part, because some of these organisms possess intrinsic resistance to the carbapenem imipenem and others express species-specific chromosomal carbapenemases. However, these organisms can also harbor plasmid-mediated carbapenemases. This report describes CP-CRE from less common genera identified through reference testing at CDC and surveillance at the Minnesota Department of Health (MDH) Public Health Laboratory. |
Performance of Chlamydia trachomatis OmcB ELISA in the serodiagnosis of Chlamydia trachomatis infection in women
Gupta K , Brown L , Bakshi RK , Press CG , Chi X , Gorwitz RJ , Papp JR , Geisler WM . J Clin Microbiol 2018 56 (9) Chlamydia trachomatis (CT) serological assays with improved sensitivity over commercially available assays are needed to evaluate the burden of CT infection and effectiveness of prevention efforts. We evaluated the performance of a CT outer membrane complex protein B (OmcB) ELISA in the detection of anti-CT antibody responses in CT-infected women. OmcB ELISA was less sensitive than our CT elementary body (EB ELISA), but was highly specific. The magnitude of the antibody response was higher in African Americans and those with prior CT infection. Unlike EB ELISA, the IgG1 response to CT OmcB was short-lived and not maintained by repeat CT infection. |
Maternal ambient heat exposure during early pregnancy in summer and spring and congenital heart defects - A large US population-based, case-control study
Lin S , Lin Z , Ou Y , Soim A , Shrestha S , Lu Y , Sheridan S , Luben TJ , Fitzgerald E , Bell E , Shaw GM , Reefhuis J , Langlois PH , Romitti P , Feldkamp ML , Malik S , Pantea C , Nayak S , Hwang SA , Browne M . Environ Int 2018 118 211-221 BACKGROUND/OBJECTIVE: Few studies have assessed the effect of ambient heat during the fetal development period on congenital heart defects (CHDs), especially in transitional seasons. We examined and compared the associations between extreme heat and CHD phenotypes in summer and spring, assessed their geographical differences, and compared different heat indicators. METHODS: We identified 5848 CHD cases and 5742 controls (without major structural defects) from the National Birth Defects Prevention Study, a US multicenter, population-based case-control study. Extreme heat events (EHEs) were defined by using the 95th (EHE95) or 90th (EHE90) percentile of daily maximum temperature and its frequency and duration during postconceptional weeks 3-8. We used a two-stage Bayesian hierarchical model to examine both regional and study-wide associations. Exposure odds ratios (ORs) were calculated using multivariate logistic regression analyses, while controlling for potential confounding factors. RESULTS: Overall, we observed no significant relationships between maternal EHE exposure and CHDs in most regions during summer. However, we found that 3-11days of EHE90 during summer and spring was significantly associated with ventricular septal defects (VSDs) study-wide (ORs ranged: 2.17-3.24). EHE95 in spring was significantly associated with conotruncal defects and VSDs in the South (ORs: 1.23-1.78). Most EHE indicators in spring were significantly associated with increased septal defects (both VSDs and atrial septal defects (ASDs)) in the Northeast. CONCLUSION: While generally null results were found, long duration of unseasonable heat was associated with the increased risks for VSDs and ASDs, mainly in South and Northeast of the US. Further research to confirm our findings is needed. |
Evaluation of fiber optic methane sensor using a smoke chamber
Li M , Dubaniewicz T , Dougherty H , Addis J . Int J Min Sci Technol 2018 28 (6) 969-974 This report presents the results of experiments to evaluate a prototype fiber optic methane monitor exposed to smoke using a smoke chamber to simulate atmospheric conditions in an underground coal mine after a fire or explosion. The experiments were conducted using test fires of different combustible sources commonly found in mines —douglas-fir wood, SBR belt, and Pittsburgh seam coal. The experiments were designed to assess the response of the fiber optic methane sensor to different contaminants, different contaminant levels and different contaminant durations produced from the test fires. Since the prototype methane monitor detects methane by measuring absorption at a specific wavelength, optical power at the absorption wavelength (1650 nm) was measured as a function of smoke concentration and duration. The other sensor response parameter-methane response times-were measured between smoke tests to assess the impact of soot accumulation on the sensor. Results indicate that the sensor screen effectively prevented smoke from obscuring the optical beam within the sensor head, with minimal impact on the system optical power budget. Methane response times increased with smoke exposure duration, attributed to soot loading on the protective screen. |
State-level guidance and district-level policies and practices for food marketing in US school districts
Merlo CL , Michael S , Brener ND , Blanck H . Prev Chronic Dis 2018 15 E74 State agencies play a critical role in providing school districts with guidance and technical assistance on school nutrition issues, including food and beverage marketing practices. We examined associations between state-level guidance and the policies and practices in school districts regarding food and beverage marketing and promotion. State policy guidance was positively associated with districts prohibiting advertisements for junk food or fast food restaurants on school property. Technical assistance from states was negatively associated with 2 district practices to restrict marketing of unhealthy foods and beverages, but positively associated with 1 practice to promote healthy options. These findings may help inform the guidance that states provide to school districts and help identify which districts may need additional assistance to address marketing and promotion practices. |
Drivers of international variation in prevalence of disabling low back pain: Findings from the CUPID study
Coggon D , Ntani G , Palmer KT , Felli VE , Harari F , Quintana LA , Felknor SA , Rojas M , Cattrell A , Vargas-Prada S , Bonzini M , Solidaki E , Merisalu E , Habib RR , Sadeghian F , Kadir MM , Warnakulasuriya SS , Matsudaira K , Nyantumbu-Mkhize B , Kelsall HL , Harcombe H . Eur J Pain 2018 23 (1) 35-45 BACKGROUND: Wide international variation in the prevalence of disabling low back pain (LBP) among working populations is not explained by known risk factors. It would be useful to know whether the drivers of this variation are specific to the spine or factors that predispose to musculoskeletal pain more generally. METHODS: Baseline information about musculoskeletal pain and risk factors was elicited from 11,710 participants aged 20-59 years, who were sampled from 45 occupational groups in 18 countries. Wider propensity to pain was characterised by the number of anatomical sites outside the low back that had been painful in the 12 months before baseline ("pain propensity index"). After a mean interval of 14 months, 9,055 participants (77.3%) provided follow-up data on disabling LBP in the past month. Baseline risk factors for disabling LBP at follow-up were assessed by random intercept Poisson regression. RESULTS: After allowance for other known and suspected risk factors, pain propensity showed the strongest association with disabling LBP (prevalence rate ratios up to 2.6, 95%CI 2.2-3.1; population attributable fraction 39.8%). Across the 45 occupational groups, the prevalence of disabling LBP varied sevenfold (much more than within-country differences between nurses and office workers), and correlated with mean pain propensity index (r = 0.58). CONCLUSIONS: Within our study, major international variation in the prevalence of disabling LBP appeared to be driven largely by factors predisposing to musculoskeletal pain at multiple anatomical sites rather than by risk factors specific to the spine. This article is protected by copyright. All rights reserved. |
Work-related injury and management strategies among certified athletic trainers
Kucera KL , Lipscomb HJ , Roos KG , Dement JM , Hootman JM . J Athl Train 2018 53 (6) 606-618 CONTEXT: Health care workers have high rates of musculoskeletal injuries, but many of these injuries go unreported to workers' compensation and national surveillance systems. Little is known regarding the work-related injuries of certified athletic trainers (ATs). OBJECTIVE: To determine the 12-month incidence and prevalence of work-related injuries and describe injury-reporting and -management strategies. DESIGN: Cross-sectional study. SETTING: Population-based online survey. PATIENTS OR OTHER PARTICIPANTS: Of the 29 051 ATs currently certified by the Board of Certification, Inc, who "opted in" to research studies, we randomly selected 10 000. Of these, 1826 (18.3%) ATs currently working in the clinical setting were eligible and participated in the baseline survey. MAIN OUTCOME MEASURES: An online survey was e-mailed in May of 2012. We assessed self-reported work-related injuries in the previous 12 months and management strategies including medical care, work limitations or modifications, and time off work. Statistics (frequencies and percentages) were calculated to describe injury rates per 200 000 work hours, injury prevalence, injury characteristics, and injury-reporting and -management strategies. RESULTS: A total of 247 ATs reported 419 work-related injuries during the previous 12 months, for an incidence rate of 21.6 per 200 000 hours (95% confidence interval [CI] = 19.6, 23.7) and injury prevalence of 13.5% (95% CI = 12.0%, 15.1%). The low back (26%), hand/fingers (9%), and knee (9%) were frequently affected body sites. Injuries were most often caused by bodily motion/overexertion/repetition (52%), contact with objects/equipment/persons (24%), or slips/trips/falls (15%). More than half of injured ATs (55.5%) sought medical care; 25% missed work, and most (77%) did not file a workers' compensation claim for their injury. Half of injured ATs were limited at work (n = 125), and 89% modified or changed their athletic training work as a result of the injury. CONCLUSIONS: More than half of AT work-related injuries required medical care or work limitations and were not reported for workers' compensation. Understanding how ATs care for and manage their work-related injuries is important given that few take time off work. |
Adherence to Ebola-specific malaria case management guidelines at health facilities in Guinea during the West African Ebola epidemic
Hennessee I , Guilavogui T , Camara A , Halsey ES , Marston B , McFarland D , Freeman M , Plucinski MM . Malar J 2018 17 (1) 230 BACKGROUND: Malaria case management in the context of the 2014-2016 West African Ebola virus disease (EVD) epidemic was complicated by a similar initial clinical presentation of the two diseases. In September 2014, the World Health Organization (WHO) released recommendations titled, "Guidance on temporary malaria control measures in Ebola-affected countries", which aimed at reducing the risk of EVD transmission and improving malaria outcomes. This guidance recommended malaria diagnostic testing of fever cases only if adequate personal protective equipment (PPE) was available, defined as examination gloves, face shield, disposable gown, boots, and head cover; otherwise presumptive anti-malarial treatment was recommended. The extent to which health workers adhered to these guidelines in affected countries has not been assessed. METHODS: A cross-sectional survey was conducted in 118 health units in Guinea in November 2014 to produce a representative and probabilistic sample of health facilities and patients. Adherence to the EVD-specific malaria case management guidelines during the height of the EVD epidemic was assessed. Associations between case management practices and possible determinants were calculated using multivariate logistic regression, controlling for expected confounders and the complex sample design. RESULTS: Most (78%) facilities reported availability of examination gloves, but adequate PPE was available at only 27% of facilities. Only 28% of febrile patients received correct malaria case management per the WHO temporary malaria case management guidelines. The most common error was diagnostic testing in the absence of adequate PPE (45% of febrile patients), followed by no presumptive treatment in the absence of adequate PPE (14%). Having had a report of an EVD case at a health facility and health worker-reported participation in EVD-specific malaria trainings were associated with lower odds of diagnostic testing and higher odds of presumptive treatment. CONCLUSIONS: Adherence to guidance on malaria case management in EVD-affected countries was low at the height of the EVD epidemic in Guinea, and there was substantial malaria diagnostic testing in the absence of adequate PPE, which could have contributed to increased EVD transmission in the healthcare setting. Conversely, low presumptive treatment when diagnostic tests were not performed may have led to additional morbidity and mortality among malaria positive patients. National malaria control programs may consider preparing contingency plans for future implementation of temporary changes to malaria case management guidelines to facilitate uptake by health workers. Additional training on standard and transmission-based precautions should help health workers understand how to protect themselves in the face of emerging and unknown pathogens. |
Schistosoma mansoni mass drug administration regimens and their effect on morbidity among schoolchildren over a 5-year period - Kenya, 2010-2015
Sircar AD , Mwinzi PNM , Onkanga IO , Wiegand RE , Montgomery SP , Secor WE . Am J Trop Med Hyg 2018 99 (2) 362-369 Schistosomiasis control programs are designed to reduce morbidity by providing mass drug administration (MDA) of praziquantel to at-risk populations. We compared morbidity markers between two cohorts of Kenyan schoolchildren that initially had high prevalence of Schistosoma mansoni infections. One cohort (N = 416 at year 1) received four rounds of annual MDA in a community-wide treatment (CWT) strategy. The other cohort (N = 386 at year 1) received school-based treatment (SBT) every other year over the 4-year period. We measured infection with S. mansoni and soil-transmitted helminths (STH) as well as subtle morbidity markers at year 1, year 3, and year 5 and compared cohorts with mixed models after controlling for age and gender. At year 5, neither overall S. mansoni prevalence nor the prevalence of high infection-intensity S. mansoni infection was significantly reduced compared with baseline in either the CWT cohort (N = 277 remaining) or the SBT cohort (N = 235 remaining). Nevertheless, by year 5, children in both cohorts demonstrated significant decreases in wasting, ultrasound-detected organomegaly, and STH infection along with significantly improved pediatric quality-of-life scores compared with year 1. Stunting did not change over time, but children who were S. mansoni egg-positive at year 5 had significantly more stunting than children without schistosomiasis. The only significant difference between arms at year 5 was a lower prevalence of STH infections in the CWT group. |
Racial and ethnic differences in perceived safety barriers to walking, United States National Health Interview Survey - 2015
Whitfield GP , Carlson SA , Ussery EN , Watson KB , Brown DR , Berrigan D , Fulton JE . Prev Med 2018 114 57-63 Barriers to safe walking may prevent people from being physically active, and previous reports have identified differences in barriers to safe walking across racial and ethnic groups. The purpose of this research was to determine the role demographic characteristics play on racial/ethnic differences in perceived barriers to safe walking and determine if racial/ethnic differences vary by urban/rural residence and Census region. Participants in the 2015 National Health Interview Survey Cancer Control Supplement (n=31,433 adults >/=18years) reported perceived barriers to safe walking (traffic, crime, and animals) and demographic characteristics. Urban/rural residence and Census region were based on home addresses. We calculated adjusted prevalence of barriers by race/ethnicity using logistic regression; geographic differences in barriers across racial/ethnic groups were examined via interaction terms. After adjustment for demographic characteristics, non-Hispanic blacks (blacks) and Hispanics reported crime and animals as barriers more frequently than non-Hispanic whites (whites) (crime: blacks, 22.2%; Hispanics, 16.7%; whites, 9.0%; animals: blacks, 18.0%; Hispanics, 12.4%; whites, 8.5%). Racial/ethnic differences in perceived crime as a barrier were more pronounced in the Northeast and Midwest than in the South and West. Urban-dwelling blacks (all regions) and Hispanics (Midwest and South) reported animals as barriers more frequently than whites. Racial/ethnic differences in perceived barriers to safe walking remained after adjusting for demographic characteristics and varied by geographic location. Addressing perceived crime and animals as barriers to walking could help reduce racial/ethnic differences in physical activity, and several barriers may need to be assessed to account for geographic variation. |
Practical recommendations for the evaluation of improvement initiatives
Parry G , Coly A , Goldmann D , Rowe AK , Chattu V , Logiudice D , Rabrenovic M , Nambiar B . Int J Qual Health Care 2018 30 29-36 A lack of clear guidance for funders, evaluators and improvers on what to include in evaluation proposals can lead to evaluation designs that do not answer the questions stakeholders want to know. These evaluation designs may not match the iterative nature of improvement and may be imposed onto an initiative in a way that is impractical from the perspective of improvers and the communities with whom they work. Consequently, the results of evaluations are often controversial, and attribution remains poorly understood. Improvement initiatives are iterative, adaptive and context-specific. Evaluation approaches and designs must align with these features, specifically in their ability to consider complexity, to evolve as the initiative adapts over time and to understand the interaction with local context. Improvement initiatives often identify broadly defined change concepts and provide tools for care teams to tailor these in more detail to local conditions. Correspondingly, recommendations for evaluation are best provided as broad guidance, to be tailored to the specifics of the initiative. In this paper, we provide practical guidance and recommendations that funders and evaluators can use when developing an evaluation plan for improvement initiatives that seeks to: identify the questions stakeholders want to address; develop the initial program theory of the initiative; identify high-priority areas to measure progress over time; describe the context the initiative will be applied within; and identify experimental or observational designs that will address attribution. |
The Environment and Reproductive Health (EARTH) Study: A prospective preconception cohort
Messerlian C , Williams PL , Ford JB , Chavarro JE , Minguez-Alarcon L , Dadd R , Braun JM , Gaskins AJ , Meeker JD , James-Todd T , Chiu YH , Nassan FL , Souter I , Petrozza J , Keller M , Toth TL , Calafat AM , Hauser R . Hum Reprod Open 2018 2018 (2) Background: The Environment and Reproductive Health (EARTH) Study is an ongoing prospective preconception cohort designed to investigate the impact of environmental, nutritional, and lifestyle factors among both women and men on fertility and pregnancy outcomes. Methods: The EARTH Study recruits women 18 to 45 years and men 18 to 55 years seeking fertility evaluation and treatment at the Massachusetts General Hospital (MGH) Fertility Center, Boston, USA. Women and men are eligible to join either independently or as a couple. Participants are followed from study entry throughout each fertility treatment cycle, once per trimester of pregnancy (for those achieving pregnancy), and up to labor and delivery, or until they discontinue treatment or withdraw from the study. The study collects biological samples, self-reported questionnaire data (including a food frequency questionnaire) and clinically abstracted information. Results: As of June 2017, the study cohort included 799 women and 487 men (447 couples; 40 men joined without female partners). Women were on average 34.7 years old at time of enrolment and predominantly Caucasian (81%), educated (49% have a graduate degree), and nulliparous (83%). Men were on average 36.6 years at baseline and mostly Caucasian (86%) and never-smokers (67%). Conclusions: The EARTH Study is one of the few cohorts designed to examine multiple potentially critical windows of vulnerability, including the paternal and maternal preconception windows and the periconception and prenatal windows in pregnancy. It is also one of the few human studies that has assessed potential interactions between environmental exposures and dietary factors. |
Exploring causality mechanism in the joint analysis of longitudinal and survival data
Liu L , Zheng C , Kang J . Stat Med 2018 37 (26) 3733-3744 In many biomedical studies, disease progress is monitored by a biomarker over time, eg, repeated measures of CD4 in AIDS and hemoglobin in end-stage renal disease patients. The endpoint of interest, eg, death or diagnosis of a specific disease, is correlated with the longitudinal biomarker. In this paper, we examine and compare different models of longitudinal and survival data to investigate causal mechanisms, specifically, those related to the role of random effects. We illustrate the methods by data from two clinical trials: an AIDS study and a liver cirrhosis study. |
Breast milk transmission of flaviviruses in the context of Zika virus: A systematic review.
Mann TZ , Haddad LB , Williams TR , Hills SL , Read JS , Dee DL , Dziuban EJ , Perez-Padilla J , Jamieson DJ , Honein MA , Shapiro-Mendoza CK . Paediatr Perinat Epidemiol 2018 32 (4) 358-368 BACKGROUND: Since the Zika virus epidemic in the Americas began in 2015, Zika virus transmission has occurred throughout the Americas. However, limited information exists regarding possible risks of transmission of Zika virus and other flaviviruses through breast feeding and human milk. We conducted a systematic review of the evidence regarding flaviviruses detection in and transmission through milk, specifically regarding Zika virus, Japanese encephalitis virus, tick-borne encephalitis virus, Powassan virus, West Nile virus, dengue virus, and yellow fever virus. METHODS: Medline, Embase, Global Health, CINAHL, Cochrane Library, Scopus, Popline, Virtual Health Library, and WorldCat were searched through June 2017. Two authors independently screened potential studies for inclusion and extracted data. Human and nonhuman (animal) studies describing: 1) confirmed or suspected cases of mother-to-child transmission through milk; or 2) the presence of flavivirus genomic material in milk. RESULTS: Seventeen studies were included, four animal models and thirteen observational studies. Dengue virus, West Nile virus, and Zika virus viral ribonucleic acid was detected in human milk, including infectious Zika virus and dengue virus viral particles. Human breast-feeding transmission was confirmed for only yellow fever virus. There was evidence of milk-related transmission of dengue virus, Powassan virus, and West Nile virus in animal studies. CONCLUSIONS: Because the health advantages of breast feeding are considered greater than the potential risk of transmission, the World Health Organization recommends that mothers with possible or confirmed Zika virus infection or exposure continue to breast feed. This review did not identify any data that might alter this recommendation. |
Content Index (Achived Edition)
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- Communicable Diseases
- Disease Reservoirs and Vectors
- Environmental Health
- Epidemiology and Surveillance
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- Immunity and Immunization
- Laboratory Sciences
- Maternal and Child Health
- Mining
- Nutritional Sciences
- Occupational Safety and Health
- Parasitic Diseases
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- Program Evaluation
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- Statistics as Topic
- Zoonotic and Vectorborne Diseases
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