The high costs of cheap tanning: pricing and promotional practices of indoor tanning facilities in six cities in the United States
Asdigian NL , Liu Y , Mayer JA , Guy GPJr , Dickinson LM , Crane LA . J Public Health Policy 2019 40 (4) 448-458 Few studies have investigated pricing and promotional practices used by the indoor tanning industry, despite their potential to promote indoor UV tanning-a well-established risk factor for melanoma skin cancer. Posing as potential customers, we telephoned 94 indoor tanning businesses in six United States (U.S.) cities and requested pricing information. The price of a single tanning session ranged from $0 to $23, and was lower at facilities that offered indoor tanning as a secondary service (mean $4.82 and free in 35%) than at tanning salons (mean $16.45). Session prices in salons could be as low as $1.50 with daily use of an unlimited monthly plan. Free indoor tanning, monthly packages, and memberships encourage increased use. Policies that limit free indoor tanning or that restrict pricing and advertising for indoor tanning exist in several places in the U.S. and Europe. Future research should evaluate whether those policies are effective in reducing indoor tanning. |
Trends and factors associated with concordance between International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification Codes and stroke clinical diagnoses
Chang TE , Tong X , George MG , Coleman King SM , Yin X , O'Brien S , Ibrahim G , Liskay A , Wiltz JL . Stroke 2019 50 (8) Strokeaha118024092 Background and Purpose- International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification ( ICD-9-CM and ICD-10-CM) codes are often used for disease surveillance. We examined changes in concordance between ICD-CM codes and clinical diagnoses before and after the transition to ICD-10-CM in the United States (October 1, 2015), and determined if there were systematic variations in concordance by patient and hospital characteristics. Methods- We included Paul Coverdell National Acute Stroke Program patient discharges from 2014 to 2017. Concordance between ICD-CM codes and the clinical diagnosis documented by the physician (assumed as accurate) was calculated for each diagnosis category: ischemic stroke, transient ischemic attack, subarachnoid hemorrhage, and intracerebral hemorrhage. Results- In total, 314 857 patient records were included in the analysis (n=280 hospitals), 55.9% of which were obtained after the transition to ICD-10-CM. While concordance was generally high, a small, and temporary decline occurred from the last calendar quarter of ICD-9-CM (average unadjusted concordance =92.8%) to the first quarter of ICD-10-CM use (91.0%). Concordance differed by diagnosis category and was generally highest for ischemic stroke. In the analysis of ICD-10-CM records, disagreements often occurred between ischemic stroke and transient ischemic attack records and between subarachnoid and intracerebral hemorrhage records. Compared with the smallest hospitals (</=200 beds), larger hospitals had significantly higher odds of concordance (ischemic stroke adjusted odds ratio for >/=400 beds, 1.7; 95% CI, 1.5-1.9). Conclusions- This study identified a small and transient decline in concordance between ICD-CM codes and stroke clinical diagnoses during the coding transition, indicating no substantial impact on the overall identification of stroke patients. Researchers and policymakers should remain aware of potential changes in ICD-CM code accuracy over time, which may affect disease surveillance. Systematic variations in the accuracy of codes by hospital and patient characteristics have implications for quality-of-care studies and hospital comparative assessments. |
Overview and quality assurance for the oral health component of the National Health and Nutrition Examination Survey (NHANES), 2011-2014
Dye BA , Afful J , Thornton-Evans G , Iafolla T . BMC Oral Health 2019 19 (1) 95 BACKGROUND: Following implementation in 2009-2010 to the oral health component for the National Health and Nutrition Examination Survey (NHANES), a full-mouth periodontal examination was continued during 2011-2014. Additionally, a comprehensive dental caries assessment was re-introduced in 2011 after a 6-year absence from NHANES. This report provides oral health content information and results of dental examiner reliability statistics for key intraoral assessments conducted by dentists during 2011-2014. METHODS: During the 2011-2014 NHANES 17,463 persons age 1 and older representing the US civilian, non-institutionalized population received an oral health examination. From this group, 387 individuals underwent a repeat examination conducted by the survey reference examiner. A combination of examiner training and calibration, electronic data capture, and ongoing performance evaluation with statistical monitoring was used to ensure conformance with NHANES protocols and data comparability to prior data collection periods. RESULTS: During 2011-2014, the Kappa statistics for the tooth count assessment ranged from 0.96 to 1.00, for untreated dental caries Kappa scores were 0.93 to 1.00. The overall Kappa statistics for identifying combined moderate-severe periodontitis using the CDC/AAP case definition was 0.66 and 0.69 with percent agreement of 83 to 85% during 2011-2014. When evaluating inter-examiner agreement using information collected from 3 periodontal sites for comparability to the NHANES 2003-04 periodontal examination protocols, Kappa scores for combined moderate-severe periodontitis was 0.65 and 0.80 during 2011-2014. For total mean attachment loss and pocket depth across all 6 periodontal sites, the inter-class coefficients (ICCs) ranged from 0.80-0.90 and 0.79-0.86 respectively. Site-specific mean attachment loss ICCs were generally higher for the 4 interproximal measurements compared to the 2 mid-site probing measurements and this observation was similar in 2009-2010. CONCLUSION: During 2011-2014, results overall indicate a high level of data quality and substantial examiner reliability for tooth count and dentition; reliability for periodontal disease, across various assessments, was at least moderate. When comparing the 2011-2014 examiner performance to findings from 2003 to 2004, comparable concordance between the examiners and the reference examiner exists. |
Cancer mortality rates among US and foreign-born individuals: United States 2005-2014
Hallowell BD , Endeshaw M , McKenna MT , Senkomago V , Razzaghi H , Saraiya M . Prev Med 2019 126 105755 From 1970 to 2010 the foreign-born population in the United States has rapidly increased from 9.6 to 40.0 million individuals. Historically, differences in cancer rates have been observed between US-born and foreign-born individuals. However, comprehensive and up-to-date data on US cancer rates by birth place is lacking. To compare cancer mortality rates among foreign and US-born individuals, population-based cancer mortality data were obtained from the CDC's National Center for Health Statistics. Utilizing data recorded on death certificates, individuals were categorized as US-born or foreign-born. Annual population estimates were obtained from the American Community Survey. Age-adjusted mortality rates and rate ratios (RRs) for all cancer sites were calculated using SEER*Stat. A total of 5,670,535 deaths from malignant cancers were recorded in the US from 2005 to 2014 and 9% of deaths occurred among foreign-born individuals. Overall, foreign-born individuals had a 31% lower cancer mortality rate when compared to US-born individuals (Rate Ratio (RR): 0.69 (95% CI: 0.68-0.69)), and similar results were observed when stratifying by sex, race/ethnicity, age, and geographic region. However, foreign-born individuals did have significantly elevated cancer mortality rates for seven cancers sites, of which five were infection-related, including: nasopharynx (RR: 2.01), Kaposi Sarcoma (RR: 1.94), stomach (RR: 1.82), gallbladder (RR: 1.47), acute lymphocytic leukemia (RR: 1.27), liver and intrahepatic bile duct (RR: 1.24), and thyroid (RR: 1.22) cancers. Many of these deaths could be avoided through improved access to prevention, screening, and treatment services for immigrant populations in the US or in their country of origin. |
Burden of cardiovascular risk factors over time and arterial stiffness in youth with type 1 diabetes mellitus: The SEARCH for Diabetes in Youth Study
Urbina EM , Isom S , Bell RA , Bowlby DA , D'Agostino RJr , Daniels SR , Dolan LM , Imperatore G , Marcovina SM , Merchant AT , Reynolds K , Shah AS , Wadwa RP , Dabelea D . J Am Heart Assoc 2019 8 (13) e010150 Background The incidence of type 1 diabetes mellitus (T1DM) in children is increasing, resulting in higher burden of cardiovascular diseases due to diabetes mellitus-related vascular dysfunction. Methods and Results We examined cardiovascular risk factors ( CVRF s) and arterial parameters in 1809 youth with T1DM. Demographics, anthropometrics, blood pressure, and laboratory data were collected at T1DM onset and 5 years later. Pulse wave velocity and augmentation index were collected with tonometry. ANOVA or chi-square tests were used to test for differences in measures of arterial parameters by CVRF . Area under the curve of CVRF s was entered in general linear models to explore determinants of accelerate vascular aging. Participants at the time of arterial measurement were 17.6+/-4.5 years old, 50% female, 76% non-Hispanic white, and duration of T1DM was 7.8+/-1.9 years. Glycemic control was poor (glycated hemoglobin, 9.1+/-1.8%). All arterial parameters were higher in participants with glycated hemoglobin >/=9% and pulse wave velocity was higher with lower insulin sensitivity or longer duration of diabetes mellitus. Differences in arterial parameters were found by sex, age, and presence of obesity, hypertension, or dyslipidemia. In multivariable models, higher glycated hemoglobin, lower insulin sensitivity, body mass index, blood pressure, and lipid areas under the curve were associated with accelerated vascular aging. Conclusions In young people with T1DM, persistent poor glycemic control and higher levels of traditional CVRF s are independently associated with arterial aging. Improving glycemic control and interventions to lower CVRF s may prevent future cardiovascular events in young individuals with T1DM. |
Chronic obstructive pulmonary disease and smoking status - United States, 2017
Wheaton AG , Liu Y , Croft JB , VanFrank B , Croxton TL , Punturieri A , Postow L , Greenlund KJ . MMWR Morb Mortal Wkly Rep 2019 68 (24) 533-538 Cigarette smoking is the leading cause of chronic obstructive pulmonary disease (COPD) in the United States; however, an estimated one fourth of adults with COPD have never smoked (1). CDC analyzed state-specific Behavioral Risk Factor Surveillance System (BRFSS) data from 2017, which indicated that, overall among U.S. adults, 6.2% (age-adjusted) reported having been told by a health care professional that they had COPD. The age-adjusted prevalence of COPD was 15.2% among current cigarette smokers, 7.6% among former smokers, and 2.8% among adults who had never smoked. Higher prevalences of COPD were observed in southeastern and Appalachian states, regardless of smoking status of respondents. Whereas the strong positive correlation between state prevalence of COPD and state prevalence of current smoking was expected among current and former smokers, a similar relationship among adults who had never smoked suggests secondhand smoke exposure as a potential risk factor for COPD. Continued promotion of smoke-free environments might reduce COPD among both those who smoke and those who do not. |
Spread of measles in Europe and implications for US travelers
Angelo KM , Gastanaduy PA , Walker AT , Patel M , Reef S , Lee CV , Nemhauser J . Pediatrics 2019 144 (1) From January 2018 to June 2018, World Health Organization (WHO) European Region countries reported >41 000 measles cases, including 37 deaths, a record high since the 1990s. Low vaccination coverage in previous years is the biggest contributing factor to the increase in cases. The Ukraine reported the majority of cases, but France, Georgia, Greece, Italy, the Russian Federation, and Serbia also reported high case counts. Europe is the most common travel destination worldwide and is widely perceived as being without substantial infectious disease risks. For this reason, travelers may not consider the relevance of a pretravel health consultation, including vaccination, in their predeparture plans. Measles is highly contagious, and the record number of measles cases in the WHO European Region not only puts unvaccinated and inadequately vaccinated travelers at risk but also increases the risk for nontraveling US residents who come into close contact with returned travelers who are ill. The US Centers for Disease Control and Prevention encourage US travelers to be aware of measles virus transmission in Europe and receive all recommended vaccinations, including for measles, before traveling abroad. Health care providers must maintain a high degree of suspicion for measles among travelers returning from Europe or people with close contact with international travelers who present with a febrile rash illness. The current WHO European Region outbreak should serve to remind health care providers to stay current with the epidemiology of highly transmissible diseases, such as measles, through media, WHO, and Centers for Disease Control and Prevention reports and encourage measles vaccination for international travelers. |
The rise in travel-associated measles infections - GeoSentinel, 2015-2019
Angelo KM , Libman M , Gautret P , Barnett E , Grobusch MP , Hagmann SHF , Gobbi F , Schwartz E , van Genderen PJJ , Asgeirsson H , Hamer DH . J Travel Med 2019 26 (6) Measles remains a global threat to human health. In 2018, the World Health Organization (WHO) reported over 328,000 measles cases among 184 WHO member states, with the European Region reporting the most cases (25.6%) (1). From January to March 2019, reported cases rose 300% in comparison to the same months in 2018 (2). Low vaccination coverage for measles is presumed to be responsible for this recent increase (3–5). International travelers to measles-affected countries are at risk for infection and may contribute to disease importation (3, 4). |
Generalized anxiety disorder symptoms among persons with diagnosed HIV in the United States-2015-2016, medical monitoring project
Beer L , Tie Y , Padilla M , Shouse RL . AIDS 2019 33 (11) 1781-1787 OBJECTIVE: To estimate the prevalence of Generalized Anxiety Disorder (GAD) symptoms among adults with diagnosed HIV (PWH) in the United States in order to inform effective HIV prevention and care efforts. DESIGN: The Medical Monitoring Project (MMP) is a complex sample survey of adults with diagnosed HIV in the United States. METHODS: We used MMP data collected during 6/2015-5/2016 to calculate the weighted prevalence of GAD symptoms among PWH (N = 3654) and prevalence ratios with predicted marginal means to evaluate significant differences between groups. RESULTS: The estimated prevalence of GAD symptoms among PWH was 19%. GAD symptoms were associated with significantly lower antiretroviral therapy prescription and adherence, medical HIV care engagement, and sustained viral suppression. Persons with GAD symptoms were over 3 times as likely to have an unmet need for mental health services (23% vs. 7%) and had significantly more emergency room visits and hospitalizations than those without these symptoms. GAD symptoms were associated with significantly higher prevalence of condomless sex while not sustainably virally suppressed with a person not known to be taking preexposure prophylaxis (9% vs. 6%). CONCLUSIONS: GAD symptom prevalence among PWH was considerably higher than among the U.S. general adult population, indicating an excess burden of anxiety among PWH. Outcomes along the HIV care continuum were poorer, and risk for HIV transmission was higher, among persons with symptoms. Incorporating routine screening for GAD in HIV clinical settings may help improve health outcomes, reduce HIV transmission, and save healthcare costs. |
Does voluntary medical male circumcision protect against sexually transmitted infections among men and women in real-world scale-up settings Findings of a household survey in KwaZulu-Natal, South Africa
Davis S , Toledo C , Lewis L , Maughan-Brown B , Ayalew K , Kharsany ABM . BMJ Glob Health 2019 4 (3) e001389 Introduction Male circumcision (MC) confers partial protection to men against HIV and, in research settings, some sexually transmitted infections (STIs). It is also associated with protection from some STIs among female partners. However, real-world data on changes in STI transmission associated with large-scale public African medical male circumcision (MMC) conducted for HIV prevention are lacking and would improve estimates of the health impact of MMC. Methods The HIV Incidence Provincial Surveillance System is a community-based surveillance platform for HIV prevalence, incidence and intervention coverage trends in KwaZulu-Natal province, South Africa. HIPPS collected cross-sectional self-reported data on circumcision status (from men), partner circumcision status for past three partners (from women) and demographic characteristics and behavioural risk factors; and tested participants for HIV, herpes simplex virus type 2 (HSV-2), syphilis, hepatitis B, Neisseriagonorrhoeae, Chlamydiatrachomatis, Trichomonasvaginalis and Mycoplasmagenitalium. Bivariable and multivariable analyses were performed on associations between own (men) or partner's (women) circumcision status and each STI. Multivariable analyses adjusted for age, demographic characteristics and behavioural risk factors, and incorporated false discovery rate (FDR) correction. Results Among men, MMC had a protective association with HSV-2 (OR 0.66, 95% CI 0.50 to 0.86), hepatitis B (OR 0.53, 95% CI 0.30 to 0.95), HIV (OR 0.50, 95% CI 0.38 to 0.65) and M.genitalium (OR 0.53, 95% CI 0.32 to 0.88). Among women, partner circumcision had a protective association with HSV-2 (OR 0.71, 95% CI 0.53 to 0.95) and HIV (OR 0.66, 95% CI 0.49 to 0.90). Associations with HIV and HSV-2 remained significant for men and all women after FDR correction. Conclusion These real-world data, supporting protective associations between MMC conducted for HIV prevention and STIs in men and women, can help clarify the full impact of MMC and support a role in broader sexual health programming. |
Influenza antiviral prescribing practices and the influence of rapid testing among primary care providers in the US, 2009-2016
Fowlkes AL , Steffens A , Reed C , Temte JL , Campbell AP . Open Forum Infect Dis 2019 6 (6) ofz192 Background: Early influenza antiviral treatment within 2 days of illness onset can reduce illness severity and duration. Reliance on low sensitivity rapid influenza diagnostic tests (RIDTs) to guide antiviral prescribing has been reported. We describe antiviral prescribing practices among primary care providers from a large surveillance network in the United States. Methods: From 2009-2016, a network of 36 to 68 outpatient clinics per year collected respiratory specimens and clinical data for patients with influenza-like illness (ILI). Specimens were tested for influenza using polymerase chain reaction (PCR). We used multivariable logistic regression to assess factors influencing antiviral prescribing. Results: Among 13 540 patients with ILI, 2766 (20%) were prescribed antivirals. In age groups recommended to receive empiric antiviral treatment for suspected influenza, 11% of children <2 years and 23% of adults >/=65 years received a prescription. Among 3681 patients with a positive PCR test for influenza, 40% tested negative by RIDT. In multivariable analysis, prescription receipt was strongly associated with a positive RIDT (adjusted odds ratio [aOR] 12, 95% CI 11-14) and symptom onset </=2 days before visit (aOR 4.3, 95% CI 3.8-4.9). Antiviral prescribing was also more frequent among pediatric and private family practice clinics compared with community health centers (aOR 1.9, 95% CI 1.6-2.2, and 1.3, 95% CI 1.1-1.5, respectively). Conclusion: Primary care providers were more likely to prescribe antivirals to patients with a positive RIDT, but antivirals were prescribed infrequently even to patients in high-risk age groups. Understanding patient and provider characteristics associated with antiviral prescribing is important for communicating treatment recommendations. |
Prevalence, risk factors, and outcomes of bacteremic pneumonia in children
Fritz CQ , Edwards KM , Self WH , Grijalva CG , Zhu Y , Arnold SR , McCullers JA , Ampofo K , Pavia AT , Wunderink RG , Anderson EJ , Bramley AM , Jain S , Williams DJ . Pediatrics 2019 144 (1) BACKGROUND: Previous studies examining bacteremia in hospitalized children with pneumonia are limited by incomplete culture data. We sought to determine characteristics of children with bacteremic pneumonia using data from a large prospective study with systematic blood culturing. METHODS: Children <18 years hospitalized with pneumonia and enrolled in the multicenter Etiology of Pneumonia in the Community study between January 2010 and June 2012 were eligible. Bivariate comparisons were used to identify factors associated with bacteremia. Associations between bacteremia and clinical outcomes were assessed by using Cox proportional hazards regression for length of stay and logistic regression for ICU admission and invasive mechanical ventilation or shock. RESULTS: Blood cultures were obtained in 2143 (91%) of 2358 children; 46 (2.2%) had bacteremia. The most common pathogens were Streptococcus pneumoniae (n = 23, 50%), Staphylococcus aureus (n = 6, 13%), and Streptococcus pyogenes (n = 4, 9%). Characteristics associated with bacteremia included male sex, parapneumonic effusion, lack of chest indrawing or wheezing, and no previous receipt of antibiotics. Children with bacteremia had longer lengths of stay (median: 5.8 vs 2.8 days; adjusted hazard ratio: 0.79 [0.73-0.86]) and increased odds of ICU admission (43% vs 21%; adjusted odds ratio: 5.21 [3.82-6.84]) and invasive mechanical ventilation or shock (30% vs 8%; adjusted odds ratio: 5.28 [2.41-11.57]). CONCLUSIONS: Bacteremia was uncommonly detected in this large multicenter cohort of children hospitalized with community-acquired pneumonia but was associated with severe disease. S pneumoniae was detected most often. Blood culture was of low yield in general but may have greater use in those with parapneumonic effusion and ICU admission. |
Tuberculosis in the United States: Medical consultation services provided by 5 Tuberculosis Regional Training and Medical Consultation Centers, 2013-2017
Goswami ND , Mase S , Griffith D , Bhavaraju R , Lardizabal A , Lauzardo M , Chen L , Wilson J , Chappelle C , Haley CA . Open Forum Infect Dis 2019 6 (6) ofz167 With only 9105 new US tuberculosis (TB) cases reported in 2017, expert consultation is essential for TB care. Data were captured 2013-2017 from consultations by 5 CDC-funded centers, now the TB Centers of Excellence (COEs). 14 586 consultations were provided to TB providers, most related to TB disease and treatment regimens. |
Prevalence of risk and protective factors associated with HIV and HCV infections among male high school students who have sex with males - Hawai'i, 2013, 2015, and 2017
Holmes JR , Clayton HB , Pham T , Asher AK , Starr RR . Hawaii J Med Public Health 2019 78 (6) 191-194 Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections are increasing among young adults, and males who have sex with males (MSM) are at high risk for both infections. Limited Hawai'i data exists on the extent to which populations, such as MSM, are engaging in behaviors that place them at increased risk for either infection. This analysis quantified the proportion of Hawai'i public high school students who are MSM and are at risk for HCV and HIV infections. Data from the 2013, 2015, and 2017 Hawai'i Youth Risk Behavior Surveys (YRBS) were combined (n=16,751) to investigate the prevalence of risk factors associated with HIV and HCV infections (eg, sexual risk behaviors, substance use) and protective factors among MSM public high school students. Among sexually experienced male students (n=3,391), 13.1% were classified as MSM and among these, 40.3% identified as heterosexual despite reporting same-sex sexual contact. Multivariate modeling demonstrated that MSM students are significantly more likely than non-MSM students to engage in behaviors that increase their risk for HIV and HCV infections (composite risk variable; adjusted Prevalence Ratio: 1.40, 95% CI 1.15 - 1.70) and are significantly less likely to have protective factors. Evidence-based prevention strategies for reducing HIV and HCV risk behaviors while improving protective factors among sexual minority youth in Hawai'i are necessary and must address sexual behavior along with other dimensions of sexual orientation. |
Notes from the Field: Meningeal and pulmonary tuberculosis on a commercial fishing vessel - Hawaii, 2017
Imada EK , Roberson EK , Goswami ND , Brostrom RJ , Moser K , Tardivel K . MMWR Morb Mortal Wkly Rep 2019 68 (24) 554-555 In December 2016, U.S. Customs and Border Protection notified the CDC Honolulu Quarantine Station of a crewman on a commercial fishing vessel who was hospitalized with suspected tuberculosis (TB); the crewman, in his mid-30s, was unconsciousness, intubated, and dependent upon mechanical ventilation to maintain his respiratory status. He was a native of a high TB-burden country (one with TB incidence exceeding 10 cases per 100,000 population per year)* in the Pacific region. Nine days earlier, he had been hospitalized in Hawaii following a 1-month history of headache, fever, night sweats, chills, fatigue, weight loss, breathing difficulties, and cough and recent onset of abdominal pain, vomiting, dizziness, and blurred vision. Brain computerized tomography (CT) and magnetic resonance imaging scans showed lesions in the left basal ganglia and left temporal lobe; chest CT showed multiple bilateral lung opacities with central cavitation. Pathology results from a lung biopsy demonstrated acid-fast bacilli with molecular and culture tests positive for Mycobacterium tuberculosis complex, susceptible to all first-line drugs. Cerebrospinal fluid demonstrated low glucose (23 mg/dL), elevated protein (247 mg/dL), and elevated white blood cell count (298 cells/uL) with a relative lymphocytic predominance (50%), consistent with TB meningitis. Testing for human immunodeficiency virus infection was negative, and the patient had no medical comorbidities. The Hawaii Department of Health (Hawaii DOH) was contacted to assist with the investigation. |
Cervical determinants of anal HPV infection and high-grade anal lesions in women: a collaborative pooled analysis
Lin C , Slama J , Gonzalez P , Goodman MT , Xia N , Kreimer AR , Wu T , Hessol NA , Shvetsov Y , Ortiz AP , Grinsztejn B , Moscicki AB , Heard I , Del Refugio Gonzalez Losa M , Kojic EM , Schim van der Loeff MF , Wei F , Longatto-Filho A , Mbulawa ZA , Palefsky JM , Sohn AH , Hernandez BY , Robison K , Simpson SJr , Conley LJ , de Pokomandy A , van der Sande MAB , Dube Mandishora RS , Volpini LPB , Pierangeli A , Romero B , Wilkin T , Franceschi S , Hidalgo-Tenorio C , Ramautarsing RA , Park IU , Tso FK , Godbole S , D'Hauwers KWM , Sehnal B , Menezes LJ , Heraclio SA , Clifford GM . Lancet Infect Dis 2019 19 (8) 880-891 BACKGROUND: Cervical cancer screening might contribute to the prevention of anal cancer in women. We aimed to investigate if routine cervical cancer screening results-namely high-risk human papillomavirus (HPV) infection and cytohistopathology-predict anal HPV16 infection, anal high-grade squamous intraepithelial lesions (HSIL) and, hence, anal cancer. METHODS: We did a systematic review of MEDLINE, Embase, and the Cochrane library for studies of cervical determinants of anal HPV and HSIL published up to Aug 31, 2018. We centrally reanalysed individual-level data from 13 427 women with paired cervical and anal samples from 36 studies. We compared anal high-risk HPV prevalence by HIV status, cervical high-risk HPV, cervical cytohistopathology, age, and their combinations, using prevalence ratios (PR) and 95% CIs. Among 3255 women with anal cytohistopathology results, PRs were similarly calculated for all anal HSIL and HPV16-positive anal HSIL. FINDINGS: Cervical and anal HPV infections were highly correlated. In HIV-negative women, anal HPV16 prevalence was 41% (447/1097) in cervical HPV16-positive versus 2% (214/8663) in cervical HPV16-negative women (PR 16.5, 95% CI 14.2-19.2, p<0.0001); these values were 46% (125/273) versus 11% (272/2588) in HIV-positive women (4.4, 3.7-5.3, p<0.0001). Anal HPV16 was also associated with cervical cytohistopathology, with a prevalence of 44% [101/228] for cervical cancer in HIV-negative women (PR vs normal cytology 14.1, 11.1-17.9, p<0.0001). Anal HSIL was associated with cervical high-risk HPV, both in HIV-negative women (from 2% [11/527] in cervical high-risk HPV-negative women up to 24% [33/138] in cervical HPV16-positive women; PR 12.9, 95% CI 6.7-24.8, p<0.0001) and HIV-positive women (from 8% [84/1094] to 17% [31/186]; 2.3, 1.6-3.4, p<0.0001). Anal HSIL was also associated with cervical cytohistopathology, both in HIV-negative women (from 1% [5/498] in normal cytology up to 22% [59/273] in cervical HSIL; PR 23.1, 9.4-57.0, p<0.0001) and HIV-positive women (from 7% [105/1421] to 25% [25/101]; 3.6, 2.5-5.3, p<0.0001). Prevalence of HPV16-positive anal HSIL was 23-25% in cervical HPV16-positive women older than 45 years (5/20 in HIV-negative women, 12/52 in HIV-positive women). INTERPRETATION: HPV-based cervical cancer screening programmes might help to stratify anal cancer risk, irrespective of HIV status. For targeted secondary anal cancer prevention in high-risk groups, HIV-negative women with cervical HPV16, especially those older than 45 years, have a similar anal cancer risk profile to that of HIV-positive women. FUNDING: International Agency for Research on Cancer. |
Adjuvant ribavirin and longer direct-acting antiviral treatment duration improve sustained virological response among hepatitis C patients at risk of treatment failure
Lu M , Wu KH , Li J , Moorman AC , Spradling PR , Teshale EH , Boscarino JA , Daida YG , Schmidt MA , Rupp LB , Zhang T , Trudeau S , Gordon SC . J Viral Hepat 2019 26 (10) 1210-1217 The role of ribavirin (RBV) in the era of direct-acting antivirals (DAA) is not clear, and DAA studies have been largely genotype- and regimen-specific. Using data from the Chronic Hepatitis Cohort Study, we evaluated the role of RBV and increased DAA treatment duration among patients with chronic hepatitis C (HCV) in routine clinical care. Multivariable analysis of data from 4133 patients receiving any of the following: sofosbuvir (SOF); daclatasvir +SOF; grazoprevir +elbasvir; paritaprevir/ ritonavir +ombitasvir; simeprevir +SOF; and SOF +ledipasvir; SOF +velpatasvir +/-voxilaprevir; and glecaprevir+pibrentasvir-all with/ without RBV. Inverse probability treatment weighting was used to adjust for treatment-selection bias. Sustained virological response (SVR) was defined by undetectable HCV RNA 12 weeks after end of therapy. The overall SVR rate was 95%. Mean treatment duration was 12+/-4.5 weeks. The final model included treatment duration and diabetes, as well as the interaction of RBV with previous treatment status (treatment naive, interferon treatment failure [TF], or previous DAA TF), cirrhosis status, and HCV genotype (GT). Each one month increment of treatment duration increased odds of SVR by 99% (aOR=1.99). Diabetes, previous DAA TF, and decompensated cirrhosis significantly reduced odds of SVR. RBV significantly increased the likelihood of SVR among patients with decompensated cirrhosis (aOR=5.05), previous DAA treatment failure (aOR=5.43), and GT3 (aOR=13.28). Among RBV-free regimens, patients with GT3 were less likely to achieve SVR than those with GT1 or 2 (aOR 0.07). Diabetes, decompensated cirrhosis, and prior DAA TF independently reduced the likelihood of SVR. Longer treatment duration increased likelihood of SVR. RBV increased likelihood of SVR among patients with GT3, previous DAA TF, or decompensated cirrhosis. This article is protected by copyright. All rights reserved. |
Invasive pneumococcal infections in children with nephrotic syndrome in Bangladesh
Malaker R , Saha S , Hanif M , Ahmed A , Saha S , Hasanuzzaman M , Khondakar T , Islam M , Baqui AH , Santosham M , Darmstadt GL , Whitney CG , Saha SK . Pediatr Infect Dis J 2019 38 (8) 798-803 INTRODUCTION: Children with nephrotic syndrome are susceptible to invasive bacterial infections. In this study, we aimed to: (1) determine the pathogens associated with infections in children with nephrotic syndrome and (2) describe antimicrobial susceptibility and serotype distribution of Streptococcus pneumoniae to guide evidence-based treatment and prevention policies. METHODS: From June 2013 to March 2015, we collected blood and/or ascitic fluid from children hospitalized with nephrotic syndrome and suspected bacterial disease in the largest pediatric hospital of Bangladesh. We cultured all samples and performed polymerase chain reaction (PCR) and immunochromatographic test on ascitic fluid for detection of S. pneumoniae. Pneumococcal isolates were tested for antibiotic susceptibility using disc diffusion and serotyped using Quellung reaction and PCR. RESULTS: We identified 1342 children hospitalized with nephrotic syndrome. Among them, 608 children had suspected bacterial disease from whom blood and/or ascitic fluid were collected. A pathogen was identified in 8% (48/608) of cases, 94% (45/48) of which were S. pneumoniae. Most (73%, 33/45) pneumococcal infections were identified through culture of blood and ascitic fluid and 27% (12/45) through immunochromatographic test and PCR of ascitic fluid. In total, 24 different pneumococcal serotypes were detected; 51% are covered by PCV10 (+6A), 53% by PCV13 and 60% by PPSV23. All pneumococcal isolates were susceptible to penicillin. CONCLUSIONS: Because S. pneumoniae was the primary cause of invasive infections, pneumococcal vaccines may be considered as a preventive intervention in children with nephrotic syndrome. Additionally, penicillin can be used to prevent and treat pneumococcal infections in children with nephrotic syndrome in Bangladesh. |
Implementation of the Treat All Policy among persons with HIV infection enrolled in care but not on antiretroviral therapy - India, May 2017-June 2018
Mitruka K , Bamrotiya M , Agarwal R , Parvez A , Allam RR , Sivalenka S , Deoraj P , Prasad R , Devi U , Keskar P , Acharya S , Kannan P , Ganti R , Shah M , Todmal S , Kumar P , Chava N , Rao A , Tanwar S , Nyendak M , Ellerbrock T , Holtz TH , Gupta RS . MMWR Morb Mortal Wkly Rep 2018 67 (47) 1305-1309 Since September 2015, the World Health Organization has recommended antiretroviral therapy (ART) for all persons with human immunodeficiency virus (HIV) infection, regardless of clinical stage or CD4 count (1). This Treat All policy was based on evidence that ART initiation early in HIV infection as opposed to waiting for the CD4 count to decline to certain levels (e.g., <500 cells/mm(3), per previous guidelines), was associated with reduced morbidity, mortality, and HIV transmission (2-4). Further, approximately half of persons enrolled in non-ART care that included monitoring for HIV disease progression (i.e., in pre-ART care) were lost to follow-up before becoming ART-eligible (5). India, the country with the third largest number of persons with HIV infection in the world (2.1 million), adopted the Treat All policy on April 28, 2017. This report describes implementation of Treat All during May 2017-June 2018, by India's National AIDS Control Organization (NACO) and partners, by facilitating ART initiation among persons previously in pre-ART care at 46 ART centers supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR)* in six districts in the states of Maharashtra and Andhra Pradesh. Partners supported these 46 ART centers in identifying and attempting to contact persons who were enrolled in pre-ART care during January 2014-April 2017, and educating those reached about Treat All. ART center-based records were used to monitor implementation indicators, including ART initiation. A total of 9,898 (39.6%) of 25,007 persons previously enrolled in pre-ART care initiated ART; among these 9,898 persons, 6,315 (63.8%) initiated ART after being reached during May 2017-June 2018, including 1,635 (16.5%) who had been lost to follow-up before ART initiation. NACO scaled up efforts nationwide to build ART centers' capacity to implement Treat All. Active tracking and tracing of persons with HIV infection enrolled in care but not on ART, combined with education about the benefits of early HIV treatment, can facilitate ART initiation. |
Bacillus Calmette-Guerin cases reported to the National Tuberculosis Surveillance System, United States, 2004-2015
Wansaula Z , Wortham JM , Mindra G , Haddad MB , Salinas JL , Ashkin D , Morris SB , Grant GB , Ghosh S , Langer AJ . Emerg Infect Dis 2019 25 (3) 451-456 Mycobacterium bovis bacillus Calmette-Guerin (BCG) is used as a vaccine to protect against disseminated tuberculosis (TB) and as a treatment for bladder cancer. We describe characteristics of US TB patients reported to the National Tuberculosis Surveillance System (NTSS) whose disease was attributed to BCG. We identified 118 BCG cases and 91,065 TB cases reported to NTSS during 2004-2015. Most patients with BCG were US-born (86%), older (median age 75 years), and non-Hispanic white (81%). Only 17% of BCG cases had pulmonary involvement, in contrast with 84% of TB cases. Epidemiologic features of BCG cases differed from TB cases. Clinicians can use clinical history to discern probable BCG cases from TB cases, enabling optimal clinical management. Public health agencies can use this information to quickly identify probable BCG cases to avoid inappropriately reporting BCG cases to NTSS or expending resources on unnecessary public health interventions. |
Remdesivir (GS-5734) protects African green monkeys from Nipah virus challenge
Lo MK , Feldmann F , Gary JM , Jordan R , Bannister R , Cronin J , Patel NR , Klena JD , Nichol ST , Cihlar T , Zaki SR , Feldmann H , Spiropoulou CF , de Wit E . Sci Transl Med 2019 11 (494) Nipah virus is an emerging pathogen in the Paramyxoviridae family. Upon transmission of Nipah virus from its natural reservoir, Pteropus spp. fruit bats, to humans, it causes respiratory and neurological disease with a case-fatality rate about 70%. Human-to-human transmission has been observed during Nipah virus outbreaks in Bangladesh and India. A therapeutic treatment for Nipah virus disease is urgently needed. Here, we tested the efficacy of remdesivir (GS-5734), a broad-acting antiviral nucleotide prodrug, against Nipah virus Bangladesh genotype in African green monkeys. Animals were inoculated with a lethal dose of Nipah virus, and a once-daily intravenous remdesivir treatment was initiated 24 hours later and continued for 12 days. Mild respiratory signs were observed in two of four treated animals, whereas all control animals developed severe respiratory disease signs. In contrast to control animals, which all succumbed to the infection, all remsdesivir-treated animals survived the lethal challenge, indicating that remdesivir represents a promising antiviral treatment for Nipah virus infection. |
Uncovering environmental health: An initial assessment of the professions health department workforce and practice
Gerding JA , Landeen E , Kelly KR , Whitehead S , Dyjack DT , Sarisky J , Brooks BW . J Environ Health 2019 81 (10) 24-33 Environmental health (EH) professionals provide critical services and respond to complex and multifaceted public health threats. The role of these professionals is continually re-emphasized by emergencies requiring rapid and effective responses to address environmental issues and ensure protection of the public’s health. Given the prominence of the EH profession within the public health framework, assessing the governmental health department workforce, practice, and current and future challenges is crucial to ensure EH professionals are fully equipped and prepared to protect the nation’s health. Such an understanding of the EH profession is lacking; therefore, we initiated Understanding the Needs, Challenges, Opportunities, Vision, and Emerging Roles in Environmental Health (UNCOVER EH). Through a webbased survey, we identifi ed EH professional demographics, characteristics, education, practice areas, and aspects of leadership and satisfaction. We distributed the survey to a convenience sample of EH professionals working in health departments, limiting the generalizability of results to the entire EH workforce. The results were strengthened, however, by purposive sampling strategies to represent varied professional and workforce characteristics in the respondent universe. The UNCOVER EH initiative provides a primary source of data to inform EH workforce development initiatives, improve the practice, and establish uniform benchmarks and professional competencies. |
Fatal cases associated with eating chapatti contaminated with organophosphate in Tororo District, Eastern Uganda, 2015: case series
Kwesiga B , Ario AR , Bulage L , Harris J , Zhu BP . BMC Public Health 2019 19 (1) 767 BACKGROUND: Few cases of organophosphate poisoning in developing countries have been investigated using clinical and epidemiological methods. On 30 October 2015, 3 students at Mukuju School, Tororo District, Uganda, died soon after eating chapatti (locally-made flat bread) from the same food stand. Ministry of Health investigated to identify the cause and recommend prevention measures. METHODS: We defined a case as onset during 30-31 October 2015 in a resident of Mukuju Town of >/=1 of the following symptoms: excessive saliva, profuse sweating, dizziness, low blood pressure, constricted pupils or loss of consciousness. We reviewed medical/police records and interviewed survivors, healthcare workers, and police officers. We collected samples of implicated food for toxicological analysis. Autopsies were performed on decedents to identify the cause of death. RESULTS: We identified 7 cases with 3 deaths (case-fatality ratio = 43%). Clinical manifestations included acute onset of confusion (100%), constricted pupils (43%), excessive saliva (43%), and low blood pressure (43%). All 7 cases had onset from 16:00-18:00 h on 30 October, with a point-source exposure pattern. Of the 7 cases, 86% (6/7) were men; the mean age was 24 (range: 20-32) years. The 3 decedents each ate a whole chapatti while the other 4 cases ate half or less. Autopsy findings of the 3 decedents indicated organophosphate poisoning. Toxicological analysis found high levels of malathion in leftover foods (266 mg/L in dough and 258 mg/L in chapatti) and malaoxon (a highly toxic malathion derivative) in decedents' postmortem specimens (mean levels of 19 mg/L in the blood and 22 mg/L in the gastric contents). There was a delay of 4 h before the patients received appropriate treatment. Police investigations revealed that flour used to make the chapatti was intentionally contaminated with an organophosphate pesticide. CONCLUSION: This fatal outbreak of organophosphate poisoning was associated with consumption of roadside-vended chapatti made of flour contaminated with pesticide. Clinicians should be aware of symptoms of organophosphate poisoning and prepared to treat it quickly. Street vendors should carefully consider the source of their ingredients. An in-depth surveillance review of such poisonings in Uganda would guide policymakers in reducing access by criminals and accidental exposures for the public. |
Pneumococcal lineages associated with serotype replacement and antibiotic resistance in childhood invasive pneumococcal disease in the post-PCV13 era: an international whole-genome sequencing study.
Lo SW , Gladstone RA , van Tonder AJ , Lees JA , du Plessis M , Benisty R , Givon-Lavi N , Hawkins PA , Cornick JE , Kwambana-Adams B , Law PY , Ho PL , Antonio M , Everett DB , Dagan R , von Gottberg A , Klugman KP , McGee L , Breiman RF , Bentley SD . Lancet Infect Dis 2019 19 (7) 759-769 BACKGROUND: Invasive pneumococcal disease remains an important health priority owing to increasing disease incidence caused by pneumococci expressing non-vaccine serotypes. We previously defined 621 Global Pneumococcal Sequence Clusters (GPSCs) by analysing 20 027 pneumococcal isolates collected worldwide and from previously published genomic data. In this study, we aimed to investigate the pneumococcal lineages behind the predominant serotypes, the mechanism of serotype replacement in disease, as well as the major pneumococcal lineages contributing to invasive pneumococcal disease in the post-vaccine era and their antibiotic resistant traits. METHODS: We whole-genome sequenced 3233 invasive pneumococcal disease isolates from laboratory-based surveillance programmes in Hong Kong (n=78), Israel (n=701), Malawi (n=226), South Africa (n=1351), The Gambia (n=203), and the USA (n=674). The genomes represented pneumococci from before and after pneumococcal conjugate vaccine (PCV) introductions and were from children younger than 3 years. We identified predominant serotypes by prevalence and their major contributing lineages in each country, and assessed any serotype replacement by comparing the incidence rate between the pre-PCV and PCV periods for Israel, South Africa, and the USA. We defined the status of a lineage as vaccine-type GPSC (>/=50% 13-valent PCV [PCV13] serotypes) or non-vaccine-type GPSC (>50% non-PCV13 serotypes) on the basis of its initial serotype composition detected in the earliest vaccine period to measure their individual contribution toward serotype replacement in each country. Major pneumococcal lineages in the PCV period were identified by pooled incidence rate using a random effects model. FINDINGS: The five most prevalent serotypes in the PCV13 period varied between countries, with only serotypes 5, 12F, 15B/C, 19A, 33F, and 35B/D common to two or more countries. The five most prevalent serotypes in the PCV13 period varied between countries, with only serotypes 5, 12F, 15B/C, 19A, 33F, and 35B/D common to two or more countries. These serotypes were associated with more than one lineage, except for serotype 5 (GPSC8). Serotype replacement was mainly mediated by expansion of non-vaccine serotypes within vaccine-type GPSCs and, to a lesser extent, by increases in non-vaccine-type GPSCs. A globally spreading lineage, GPSC3, expressing invasive serotypes 8 in South Africa and 33F in the USA and Israel, was the most common lineage causing non-vaccine serotype invasive pneumococcal disease in the PCV13 period. We observed that same prevalent non-vaccine serotypes could be associated with distinctive lineages in different countries, which exhibited dissimilar antibiotic resistance profiles. In non-vaccine serotype isolates, we detected significant increases in the prevalence of resistance to penicillin (52 [21%] of 249 vs 169 [29%] of 575, p=0.0016) and erythromycin (three [1%] of 249 vs 65 [11%] of 575, p=0.0031) in the PCV13 period compared with the pre-PCV period. INTERPRETATION: Globally spreading lineages expressing invasive serotypes have an important role in serotype replacement, and emerging non-vaccine serotypes associated with different pneumococcal lineages in different countries might be explained by local antibiotic-selective pressures. Continued genomic surveillance of the dynamics of the pneumococcal population with increased geographical representation in the post-vaccine period will generate further knowledge for optimising future vaccine design. FUNDING: Bill & Melinda Gates Foundation, Wellcome Sanger Institute, and the US Centers for Disease Control. |
Emerging Concepts in Precision Medicine and Cardiovascular Diseases in Racial and Ethnic Minority Populations.
Mensah GA , Jaquish C , Srinivas P , Papanicolaou GJ , Wei GS , Redmond N , Roberts MC , Nelson C , Aviles-Santa L , Puggal M , Green Parker MC , Minear MA , Barfield W , Fenton KN , Boyce CA , Engelgau MM , Khoury MJ . Circ Res 2019 125 (1) 7-13 Cardiovascular diseases remain the leading cause of mortality and a major contributor to preventable deaths worldwide. The dominant modifiable risk factors and the social and environmental determinants that increase cardiovascular risk are known, and collectively, are as important in racial and ethnic minority populations as they are in majority populations. Their prevention and treatment remain the foundation for cardiovascular health promotion and disease prevention. Genetic and epigenetic factors are increasingly recognized as important contributors to cardiovascular risk and provide an opportunity for advancing precision cardiovascular medicine. In this review, we explore emerging concepts at the interface of precision medicine and cardiovascular disease in racial and ethnic minority populations. Important among these are the lack of racial and ethnic diversity in genomics studies and biorepositories; the resulting misclassification of benign variants as pathogenic in minorities; and the importance of ensuring ancestry-matched controls in variant interpretation. We address the relevance of epigenetics, pharmacogenomics, genetic testing and counseling, and their social and cultural implications. We also examine the potential impact of precision medicine on racial and ethnic disparities. The National Institutes of Health's All of Us Research Program and the National Heart, Lung, and Blood Institute's Trans-Omics for Precision Medicine Initiative are presented as examples of research programs at the forefront of precision medicine and diversity to explore research implications in minorities. We conclude with an overview of implementation research challenges in precision medicine and the ethical implications in minority populations. Successful implementation of precision medicine in cardiovascular disease in minority populations will benefit from strategies that directly address diversity and inclusion in genomics research and go beyond race and ethnicity to explore ancestry-matched controls, as well as geographic, cultural, social, and environmental determinants of health. |
Essential newborn care practice at four primary health facilities in conflict affected areas of Bossaso, Somalia: a cross-sectional study
Amsalu R , Morris CN , Chukwumalu K , Hynes M , Janjua S , Couture A , Summers A , Cannon A , Hulland EN , Baunach S . Confl Health 2019 13 27 Background: Newborn mortality is increasingly concentrated in contexts of conflict and political instability. However, there are limited guidelines and data on the availability and quality of newborn care in conflict settings. In 2016, an interagency collaboration developed the Newborn Health in Humanitarian Settings Field Guide- Interim version (Field Guide). In this study, we sought to understand the baseline availability and quality of essential newborn care in Bossaso, Somalia as part of an investigation to determine the feasibility and effectiveness of the Field Guide in improving newborn care in humanitarian settings. Methods: A cross-sectional study was conducted at four purposely selected health facilities serving internally displaced persons affected by conflict in Bossaso. Essential newborn care practice and patient experience with childbirth care received at the facilities were assessed via observation of clinical practice during childbirth and the immediate postnatal period, and through postnatal interviews of mothers. Descriptive statistics and logistic regression were employed to summarize and examine variation by health facility. Results: Of the 332 pregnant women approached, 253 (76.2%) consented and were enrolled. 97.2% (95% CI: 94.4, 98.9) had livebirths and 2.8% (95% CI: 1.1, 5.6) had stillbirths. The early newborn mortality was 1.7% (95% CI: 0.3, 4.8). Nearly all [95.7%, (95% CI: 92.4, 97.8)] births were attended by skilled health worker. Similarly, 98.0% (95% CI: 95.3, 99.3) of newborns received immediate drying, and 99.2% (95% CI: 97.1, 99.9) had delayed bathing. Few [8.6%, (95% CI: 5.4, 12.9)] received immediate skin-to-skin contact and the practice varied significantly by facility (p < 0.001). One-third of newborns [30.1%, (95% CI: 24.4, 36.2)] received early initiation of breastfeeding and there was significant variation by facility (p < 0.001). While almost all [99.2%, (95% CI: 97.2, 100)] service providers wore gloves while attending births, handwashing was not as common [20.2%, (95% CI: 15.4, 25.6)] and varied by facility (p < 0.001). Nearly all [92%, (95% CI: 86.9, 95.5)] mothers were either very happy or happy with the childbirth care received at the facility. Conclusion: Essential newborn care interventions were not universally available. Quality of care varied by health facility and type of intervention. Training and supervision using the Field Guide could improve newborn outcomes. |
Mapping health workforce development strategies across key global health agencies: an assessment of objectives and key interventions
Farrenkopf BA , Lee CW . Health Policy Plan 2019 34 (6) 461-468 The political and financial commitment to addressing the global shortage of health workers is stronger than ever before. Therefore, the global effort to strengthen human resources for health (HRH) must be co-ordinated and aligned to strategically utilize the current momentum and create sustainable impact. This paper assesses HRH strategies to (1) create greater understanding on the collective global action towards improving HRH, and (2) identify opportunities for greater co-ordination to improve sustainable health workforce development. We searched published and grey literature to identify the HRH strategies of select large-scale global health organizations. The most common approaches were increasing the supply of health workers, facilitating training and education and improving health worker management capacities. Overall, our analysis shows there is a need to (1) improve co-ordination among development partners, (2) ensure strong engagement and leadership of national governments and (3) generate scientific evidence on the best approaches for sustainable workforce development. |
Conducting the Joint External Evaluation in Uganda: The Process and Lessons Learned
Kayiwa J , Kasule JN , Ario AR , Sendagire S , Homsy J , Lubwama B , Aliddeki D , Kagirita A , Komakech I , Brown V , Wetaka MM , Zhu BP , Opar B , Kyazze S , Okware P , Okot P , Matseketse D , Tusiime P , Mwebesa H , Makumbi I . Health Secur 2019 17 (3) 174-180 Uganda is currently implementing the Global Health Security Agenda (GHSA), aiming at accelerating compliance to the International Health Regulations (IHR) (2005). To assess progress toward compliance, a Joint External Evaluation (JEE) was conducted by the World Health Organization (WHO). Based on this evaluation, we present the process and lessons learned. Uganda's methodological approach to the JEE followed the WHO recommendations, including conducting a whole-of-government in-country self-assessment prior to the final assessment, using the same tool at both assessments, and generating consensus scores during the final assessment. The in-country self-assessment process began on March 24, 2017, with a multisectoral representation of 203 subject matter experts from 81 institutions. The final assessment was conducted between June 26 and 30, 2017, by 15 external evaluators. Discrepancies between the in-country and final scores occurred in 27 of 50 indicators. Prioritized gaps from the JEE formed the basis of the National Action Plan for Health Security. We learned 4 major lessons from this process: subject matter experts should be adequately oriented on the scoring requirements of the JEE tool; whole-of-government representation should be ensured during the entire JEE process; equitable multisectoral implementation of IHR activities must be ensured; and over-reliance on external support is a threat to sustainability of GHSA gains. |
Methodological considerations for advancing research on the health and wellbeing of sexual and gender minority youth
Schrager SM , Steiner RJ , Bouris AM , Macapagal K , Brown CH . LGBT Health 2019 6 (4) 156-165 Continued research with sexual and gender minority (SGM) youth is essential both to understand health disparities and to develop interventions targeting those disparities, but conducting rigorous, ethical research with these populations remains a substantial challenge. In addition to considerations for research with adolescents in general, such as utilizing developmentally appropriate measures and obtaining parental permission, factors unique to SGM youth must be addressed at every step of the research process. Defining the study population is complex, as is recruiting a sample once it is defined. Measurement is another challenge, given the paucity of measures developed for or validated with SGM samples. Key constructs, such as sexual orientation, gender identity, and family acceptance, are not amenable to randomization and involving minor participants' parents poses ethical concerns given the precarious home and safety situations that can arise from employing typical study procedures with youth who have a stigmatized identity. In this article, we examine some of these unique methodological challenges. Informed by theoretical and empirical literature, practical experience, and an ongoing dialogue with SGM youth themselves, we present a guide to best practices for ethical, productive research with SGM youth. By discussing existing approaches to studying SGM youth and suggesting innovative ways to approach the questions that remain, we hope to assist the research community in addressing methodological gaps to advance research on SGM youth in relation to families and schools. |
Sepsis Attributed to Bacterial Contamination of Platelets Associated with a Potential Common Source - Multiple States, 2018.
Jones SA , Jones JM , Leung V , Nakashima AK , Oakeson KF , Smith AR , Hunter R , Kim JJ , Cumming M , McHale E , Young PP , Fridey JL , Kelley WE , Stramer SL , Wagner SJ , West FB , Herron R , Snyder E , Hendrickson JE , Peaper DR , Gundlapalli AV , Langelier C , Miller S , Nambiar A , Moayeri M , Kamm J , Moulton-Meissner H , Annambhotla P , Gable P , McAllister GA , Breaker E , Sula E , Halpin AL , Basavaraju SV . MMWR Morb Mortal Wkly Rep 2019 68 (23) 519-523 During May-October 2018, four patients from three states experienced sepsis after transfusion of apheresis platelets contaminated with Acinetobacter calcoaceticus-baumannii complex (ACBC) and Staphylococcus saprophyticus; one patient died. ACBC isolates from patients' blood, transfused platelet residuals, and two environmental samples were closely related by whole genome sequencing. S. saprophyticus isolates from two patients' blood, three transfused platelet residuals, and one hospital environmental sample formed two whole genome sequencing clusters. This whole genome sequencing analysis indicated a potential common source of bacterial contamination; investigation into the contamination source continues. All platelet donations were collected using apheresis cell separator machines and collection sets from the same manufacturer; two of three collection sets were from the same lot. One implicated platelet unit had been treated with pathogen-inactivation technology, and two had tested negative with a rapid bacterial detection device after negative primary culture. Because platelets are usually stored at room temperature, bacteria in contaminated platelet units can proliferate to clinically relevant levels by the time of transfusion. Clinicians should monitor for sepsis after platelet transfusions even after implementation of bacterial contamination mitigation strategies. Recognizing adverse transfusion reactions and reporting to the platelet supplier and hemovigilance systems is crucial for public health practitioners to detect and prevent sepsis associated with contaminated platelets. |
A multifaceted intervention improves prescribing for acute respiratory infection for adults and children in emergency department and urgent care settings
Yadav K , Meeker D , Mistry RD , Doctor JN , Fleming-Dutra KE , Fleischman RJ , Gaona SD , Stahmer A , May L . Acad Emerg Med 2019 26 (7) 719-731 BACKGROUND: Antibiotics are commonly prescribed during emergency department (ED) and urgent care center (UCC) visits for viral acute respiratory infection (ARI). We evaluate the comparative effectiveness of an antibiotic stewardship intervention adapted for acute care ambulatory settings (adapted intervention) to a stewardship intervention that additionally incorporates behavioral nudges (enhanced intervention) in reducing inappropriate prescriptions. METHODS: This study was a pragmatic, cluster-randomized clinical trial conducted in three academic health systems comprising five adult and pediatric EDs and four UCCs. Randomization of the nine sites was stratified by health system; all providers at each site received either the adapted or the enhanced intervention. The main outcome was the proportion of antibiotic-inappropriate ARI diagnosis visits that received an outpatient antibiotic prescription by individual providers. We estimated a hierarchical mixed-effects logistic regression model comparing visits during the influenza season for 2016 to 2017 (baseline) and 2017 to 2018 (intervention). RESULTS: There were 44,820 ARI visits among 292 providers across all nine cluster sites. Antibiotic prescribing for ARI visits dropped from 6.2% (95% confidence interval [CI] = 4.5% to 7.9%) to 2.4% (95% CI = 1.3% to 3.4%) during the study period. We found a significant reduction in inappropriate prescribing after adjusting for health-system and provider-level effects from 2.2% (95% CI = 1.0% to 3.4%) to 1.5% (95% CI = 0.7% to 2.3%) with an odds ratio of 0.67 (95% CI = 0.54 to 0.82). Difference-in-differences between the two interventions was not significantly different. CONCLUSION: Implementation of antibiotic stewardship for ARI is feasible and effective in the ED and UCC settings. More intensive behavioral nudging methods were not more effective in high-performance settings. |
Metal nanomaterials: Immune effects and implications of physicochemical properties on sensitization, elicitation, and exacerbation of allergic disease
Roach KA , Stefaniak AB , Roberts JR . J Immunotoxicol 2019 16 (1) 87-124 The recent surge in incorporation of metallic and metal oxide nanomaterials into consumer products and their corresponding use in occupational settings have raised concerns over the potential for metals to induce size-specific adverse toxicological effects. Although nano-metals have been shown to induce greater lung injury and inflammation than their larger metal counterparts, their size-related effects on the immune system and allergic disease remain largely unknown. This knowledge gap is particularly concerning since metals are historically recognized as common inducers of allergic contact dermatitis, occupational asthma, and allergic adjuvancy. The investigation into the potential for adverse immune effects following exposure to metal nanomaterials is becoming an area of scientific interest since these characteristically lightweight materials are easily aerosolized and inhaled, and their small size may allow for penetration of the skin, which may promote unique size-specific immune effects with implications for allergic disease. Additionally, alterations in physicochemical properties of metals in the nano-scale greatly influence their interactions with components of biological systems, potentially leading to implications for inducing or exacerbating allergic disease. Although some research has been directed toward addressing these concerns, many aspects of metal nanomaterial-induced immune effects remain unclear. Overall, more scientific knowledge exists in regards to the potential for metal nanomaterials to exacerbate allergic disease than to their potential to induce allergic disease. Furthermore, effects of metal nanomaterial exposure on respiratory allergy have been more thoroughly-characterized than their potential influence on dermal allergy. Current knowledge regarding metal nanomaterials and their potential to induce/exacerbate dermal and respiratory allergy are summarized in this review. In addition, an examination of several remaining knowledge gaps and considerations for future studies is provided. |
Sera Antibody Repertoire Analyses Reveal Mechanisms of Broad and Pandemic Strain Neutralizing Responses after Human Norovirus Vaccination.
Lindesmith LC , McDaniel JR , Changela A , Verardi R , Kerr SA , Costantini V , Brewer-Jensen PD , Mallory ML , Voss WN , Boutz DR , Blazeck JJ , Ippolito GC , Vinje J , Kwong PD , Georgiou G , Baric RS . Immunity 2019 50 (6) 1530-1541.e8 Rapidly evolving RNA viruses, such as the GII.4 strain of human norovirus (HuNoV), and their vaccines elicit complex serological responses associated with previous exposure. Specific correlates of protection, moreover, remain poorly understood. Here, we report the GII.4-serological antibody repertoire-pre- and post-vaccination-and select several antibody clonotypes for epitope and structural analysis. The humoral response was dominated by GII.4-specific antibodies that blocked ancestral strains or by antibodies that bound to divergent genotypes and did not block viral-entry-ligand interactions. However, one antibody, A1431, showed broad blockade toward tested GII.4 strains and neutralized the pandemic GII.P16-GII.4 Sydney strain. Structural mapping revealed conserved epitopes, which were occluded on the virion or partially exposed, allowing for broad blockade with neutralizing activity. Overall, our results provide high-resolution molecular information on humoral immune responses after HuNoV vaccination and demonstrate that infection-derived and vaccine-elicited antibodies can exhibit broad blockade and neutralization against this prevalent human pathogen. |
Global impact of rotavirus vaccine introduction on rotavirus hospitalisations among children under 5 years of age, 2008-16: findings from the Global Rotavirus Surveillance Network
Aliabadi N , Antoni S , Mwenda JM , Weldegebriel G , Biey JNM , Cheikh D , Fahmy K , Teleb N , Ashmony HA , Ahmed H , Daniels DS , Videbaek D , Wasley A , Singh S , de Oliveira LH , Rey-Benito G , Sanwogou NJ , Wijesinghe PR , Liyanage JBL , Nyambat B , Grabovac V , Heffelfinger JD , Fox K , Paladin FJ , Nakamura T , Agocs M , Murray J , Cherian T , Yen C , Parashar UD , Serhan F , Tate JE , Cohen AL . Lancet Glob Health 2019 7 (7) e893-e903 BACKGROUND: Rotavirus vaccine use in national immunisation programmes has led to declines in hospital admissions for rotavirus gastroenteritis among children; however, the global impact of rotavirus vaccine introduction has not been described using primary data. We describe the impact of rotavirus vaccine introduction on admissions for acute rotavirus gastroenteritis in primarily low-income and middle-income countries, using 9 years of data from the WHO-coordinated Global Rotavirus Surveillance Network (GRSN). METHODS: Between Jan 1, 2008, and Dec 31, 2016, children younger than 5 years of age who were admitted to hospital with acute gastroenteritis were prospectively enrolled in GRSN sites. We included sites that enrolled children and collected stool specimens monthly and tested at least 100 specimens annually in the impact analysis, with a separate analysis taking into account site continuity. We compared proportions of acute gastroenteritis cases positive for rotavirus in the pre-vaccine and post-vaccine periods and calculated mean proportion changes for WHO regions, with 95% CIs; these findings were then compared with interrupted time series analyses. We did further sensitivity analyses to account for rotavirus vaccination coverage levels and sites that collected specimens for at least 11 months per year and tested at least 80 specimens per year. We also analysed the age distribution of rotavirus-positive cases before and after vaccine introduction. FINDINGS: 403 140 children younger than 5 years of age admitted to hospital with acute gastroenteritis from 349 sites in 82 countries were enrolled over the study period, of whom 132 736 (32.9%) were positive for rotavirus. We included 305 789 children from 198 sites in 69 countries in the impact analysis. In countries that had not introduced rotavirus vaccine in their national immunisation programmes, rotavirus was detected in 38.0% (95% CI 4.8-73.4) of admissions for acute gastroenteritis annually whereas in those that have introduced the vaccine, rotavirus was detected in 23.0% (0.7-57.7) of admissions for acute gastroenteritis, showing a 39.6% (35.4-43.8) relative decline following introduction. Interrupted time series analyses confirmed these findings. Reductions by WHO regions ranged from 26.4% (15.0-37.8) in the Eastern Mediterranean Region to 55.2% (43.0-67.4) in the European Region and were sustained in nine countries (contributing up to 31 sites) for 6-10 years. The age distribution of children with rotavirus gastroenteritis shifted towards older children after rotavirus vaccine introduction. INTERPRETATION: A significant and sustained reduction in the proportion of hospital admissions for acute gastroenteritis due to rotavirus was seen among children younger than 5 years in GRSN sites following rotavirus vaccine introduction. These findings highlight the need to incorporate rotavirus vaccines into immunisation programmes in countries that have not yet introduced them and underline the importance of high-quality surveillance. FUNDING: The GRSN receives funding from Gavi, the Vaccine Alliance and the US Centers for Disease Control and Prevention. No specific funding was provided for this Article. |
Does rotavirus vaccination affect longer-term intussusception risk in US infants
Burke RM , Tate JE , Dahl RM , Aliabadi N , Parashar UD . J Pediatric Infect Dis Soc 2019 9 (2) 257-260 Rotavirus vaccination has been associated with a short-term increased risk of intussusception. Our analysis of insurance claims for 1 858 827 US children with 544 recorded cases of intussusception found a nonsignificant decrease in intussusception (hazard ratio, 0.79 [95% confidence interval, 0.57-1.09]) in fully rotavirus-vaccinated children followed up to the age of 2 years. |
Trends in the laboratory detection of rotavirus before and after implementation of routine rotavirus vaccination - United States, 2000-2018
Hallowell BD , Parashar UD , Curns A , DeGroote NP , Tate JE . MMWR Morb Mortal Wkly Rep 2019 68 (24) 539-543 Before the introduction of rotavirus vaccine in the United States in 2006, rotavirus infection was the leading cause of severe gastroenteritis among U.S. children (1). To evaluate the long-term impact of rotavirus vaccination on disease prevalence and seasonality in the United States, CDC analyzed national laboratory testing data for rotavirus from laboratories participating in CDC's National Respiratory and Enteric Viruses Surveillance System (NREVSS) during the prevaccine (2000-2006) and postvaccine (2007-2018) periods. Nationally, the median annual percentage of tests positive for rotavirus declined from 25.6% (range = 25.2-29.4) in the prevaccine period to 6.1% (range = 2.6-11.1) in the postvaccine period. When compared with the prevaccine period, the postvaccine period saw declines in the annual peak in rotavirus positivity from a median of 43.1% (range = 43.8-56.3) to a median of 14.0% (range = 4.8-27.3) and in the season duration from a median of 26 weeks (range = 23-27) to a median of 9 weeks (range = 0-18). In the postvaccine period, a biennial pattern emerged, with alternating years of low and high rotavirus activity. Implementation of the rotavirus vaccination program has substantially reduced prevalence of the disease and altered seasonal patterns of rotavirus in the United States; these changes have been sustained over 11 seasons after vaccine introduction. Ongoing efforts to improve coverage and on-time vaccination (2) can help maximize the public health impact of rotavirus vaccination. |
Notes from the field: Administration of expired injectable influenza vaccines reported to the Vaccine Adverse Event Reporting System - United States, July 2018-March 2019
Hesse EM , Hibbs BF , Cano MV . MMWR Morb Mortal Wkly Rep 2019 68 (23) 529-530 Influenza vaccination is recommended annually for persons aged ≥6 months for the prevention and control of influenza (1). Every year, injectable inactivated influenza vaccine (IIV) has a standard expiration date of June 30 for the upcoming influenza season (i.e., July 1–June 30 of the following year). Vaccination with an expired influenza vaccine might not protect against influenza infection because different influenza virus strains can be included in the vaccine each year; in addition, protection against viruses included in the vaccine could wane if vaccine potency decreases over time. During July 11, 2018–March 29, 2019 in the United States, the Vaccine Adverse Event Reporting System (VAERS) received 125 reports of 192 patients receiving expired IIV during the 2018–19 influenza season (2), during which time 169.1 million doses of seasonal influenza vaccine were distributed (3). Dates of vaccination were documented for 102 patients and ranged from July 2, 2018, to January 16, 2019. The number of expired vaccine doses administered increased in September and decreased after October, coinciding with dates when influenza vaccine is typically given (Figure). Ages were available for 103 vaccine recipients. Seventy-three recipients (70.1%) were identified as being in high-risk age groups for influenza; eight were aged <5 years, and 65 were aged >50 years (1). An additional six reports specified that the patient had been pregnant at time of vaccination; pregnancy outcomes were not reported. Adverse events after the administration of an expired IIV were rarely reported (four of 125 reports; 3.2%). None were serious, and adverse events were consistent with adverse events for seasonal IIV. |
Efficacy of inactivated trivalent influenza vaccine in rural India: a 3-year cluster-randomised controlled trial
Sullender WM , Fowler KB , Gupta V , Krishnan A , Ram Purakayastha D , Srungaram Vln R , Lafond KE , Saha S , Palomeque FS , Gargiullo P , Jain S , Lal R , Widdowson MA , Broor S . Lancet Glob Health 2019 7 (7) e940-e950 BACKGROUND: Paediatric vaccination against influenza can result in indirect protection, by reducing transmission to their unvaccinated contacts. We investigated whether influenza vaccination of children would protect them and their household members in a resource-limited setting. METHODS: We did a cluster-randomised, blinded, controlled study in three villages in India. Clusters were defined as households (ie, dwellings that shared a courtyard), and children aged 6 months to 10 years were eligible for vaccination as and when they became age-eligible throughout the study. Households were randomly assigned (1:1) by a computer-based system to intramuscular trivalent inactivated influenza vaccine (IIV3) or a control of inactivated poliovirus vaccine (IPV) in the beginning of the study; vaccination occurred once a year for 3 years. The primary efficacy outcome was laboratory-confirmed influenza in a vaccinated child with febrile acute respiratory illness, analysed in the modified intention-to-treat population (ie, children who received at least one dose of vaccine, were under surveillance, and had not an influenza infection within 15 days of last vaccine dose). The secondary outcome for indirect effectiveness (surveillance study) was febrile acute respiratory illness in an unvaccinated household member of a vaccine study participant. Data from each year (year 1: November, 2009, to October, 2010; year 2: October, 2010, to October, 2011; and year 3: October, 2011, to May, 2012) were analysed separately. Safety was analysed among all participants who were vaccinated with at least one dose of the vaccine. This trial is registered with ClinicalTrials.gov, number NCT00934245. FINDINGS: Between Nov 1, 2009, to May 1, 2012, we enrolled 3208 households, of which 1959 had vaccine-eligible children. 1010 households were assigned to IIV3 and 949 households were assigned to IPV. In 3 years, we vaccinated 4345 children (2132 with IIV3 and 2213 with IPV) from 1868 households (968 with IIV3 and 900 with IPV) with 10 813 unvaccinated household contacts. In year 1, influenza virus was detected in 151 (10%) of 1572 IIV3 recipients and 206 (13%) of 1633 of IPV recipients (total IIV3 vaccine efficacy 25.6% [95% CI 6.8-40.6]; p=0.010). In year 2, 105 (6%) of 1705 IIV3 recipients and 182 (10%) of 1814 IPV recipients had influenza (vaccine efficacy 41.0% [24.1-54.1]; p<0.0001). In year 3, 20 (1%) of 1670 IIV3 recipients and 81 (5%) of 1786 IPV recipients had influenza (vaccine efficacy 74.2% [57.8-84.3]; p<0.0001). In year 1, total vaccine efficacy against influenza A(H1N1)pdm09 was 14.5% (-20.4 to 39.3). In year 2, total vaccine efficacy against influenza A(H3N2) was 64.5% (48.5-75.5). Total vaccine efficacy against influenza B was 32.5% (11.3-48.6) in year 1, 4.9% (-38.9 to 34.9) in year 2, and 76.5% (59.4-86.4) in year 3. Indirect vaccine effectiveness was statistically significant only in year 3 (38.1% [7.4-58.6], p=0.0197) when influenza was detected in 39 (1%) of 4323 IIV3-allocated and 60 (1%) of 4121 IPV-allocated household unvaccinated individuals. In the IIV3 group, 225 (12%) of 1632 children in year 1, 375 (22%) of 1718 in year 2, and 209 (12%) of 1673 in year 3 had an adverse reaction (compared with 216 [13%] of 1730, 380 [21%] of 1825, and 235 [13%] of 1796, respectively, in the IPV group). The most common reactions in both groups were fever and tenderness at site. No vaccine-related deaths occurred in either group. INTERPRETATION: IIV3 provided variable direct and indirect protection against influenza infection. Indirect protection was significant during the year of highest direct protection and should be considered when quantifying the effect of vaccination programmes. FUNDING: US Centers for Disease Control and Prevention. |
Update: Influenza activity in the United States during the 2018-19 season and composition of the 2019-20 influenza vaccine
Xu X , Blanton L , Elal AIA , Alabi N , Barnes J , Biggerstaff M , Brammer L , Budd AP , Burns E , Cummings CN , Garg S , Kondor R , Gubareva L , Kniss K , Nyanseor S , O'Halloran A , Rolfes M , Sessions W , Dugan VG , Fry AM , Wentworth DE , Stevens J , Jernigan D . MMWR Morb Mortal Wkly Rep 2019 68 (24) 544-551 Influenza activity* in the United States during the 2018-19 season (September 30, 2018-May 18, 2019) was of moderate severity (1). Nationally, influenza-like illness (ILI)(dagger) activity began increasing in November, peaked during mid-February, and returned to below baseline in mid-April; the season lasted 21 weeks,( section sign) making it the longest season in 10 years. Illness attributed to influenza A viruses predominated, with very little influenza B activity. Two waves of influenza A were notable during this extended season: influenza A(H1N1)pdm09 viruses from October 2018 to mid-February 2019 and influenza A(H3N2) viruses from February through May 2019. Compared with the 2017-18 influenza season, rates of hospitalization this season were lower for adults, but were similar for children. Although influenza activity is currently below surveillance baselines, testing for seasonal influenza viruses and monitoring for novel influenza A virus infections should continue year-round. Receiving a seasonal influenza vaccine each year remains the best way to protect against seasonal influenza and its potentially severe consequences. |
The CDC Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children: What physical therapists need to know
Mucha A , DeWitt J , Greenspan AI . Phys Ther 2019 99 (10) 1278-1280 Mild traumatic brain injury (mTBI) or concussion, once thought to be a fairly benign injury with little or no long-term consequences, has been recognized as an important public health concern among children and adolescents. From 2005 to 2009, an estimated 3 million children were seen in emergency departments, and an additional 2 million were seen as outpatients for treatment of mTBI.1 Children with mTBI may experience symptoms that affect cognitive, physical, and psychological function.2 For most children with mTBI, symptoms resolve within 2 to 4 weeks; however, a subset of children will continue to experience symptoms for 3 or more months.3 |
Draft Genome Sequence of Kroppenstedtia sanguinis X0209 T , a Clinical Isolate Recovered from Human Blood.
Arthur RA , Nicholson AC , Humrighouse BW , McQuiston JR , Lasker BA . Microbiol Resour Announc 2019 8 (24) Kroppenstedtia sanguinis X0209(T), a thermoactinomycete, was isolated from the blood of a patient in Sweden. We report on the draft genome sequence obtained with an Illumina MiSeq instrument. The assembled genome totaled 3.73 Mb and encoded 3,583 proteins. Putative genes for virulence, transposons, and biosynthetic gene clusters have been identified. |
Comparison of Respiratory Specimen Collection Methods for Detection of Influenza Virus Infection by RT-PCR: A Literature Review.
Spencer S , Thompson MG , Flannery B , Fry A . J Clin Microbiol 2019 57 (9) Detection of influenza virus in respiratory specimens from ill individuals is the most commonly used method to identify influenza virus infection. A number of respiratory specimen types may be used, including swabs, brush, aspirate and wash, and specimens may be collected from numerous sites, including anterior and posterior nasopharynx, oropharynx and nares. Traditionally, respiratory specimens from the nasopharynx were considered to have highest sensitivity for viral detection. However, as molecular assays such as reverse transcription polymerase chain reaction (RT-PCR) have increased the sensitivity of viral detection from respiratory specimens, the use of less invasive and easier to obtain specimens has increased for the detection of influenza. This review presents and evaluates the sensitivities of respiratory specimen methods used in epidemiologic studies that used RT-PCR to detect influenza virus in respiratory specimens from ill patients. This literature review suggested that a combination of two less invasive swabbing methods, such as nasal and oropharyngeal swabs, had about the same sensitivity as nasopharyngeal specimens for influenza detection by RT-PCR. By combining two less invasive collection methods, it may be possible to reduce barriers to enrollment without compromising influenza detection sensitivity. |
To acclimate or not to acclimate Simultaneous positive and negative effects of acclimation on susceptibility of Tribolium confusum (Coleoptera: Tenebrionidae) and Oryzaephilus surinamensis (Coleoptera: Silvanidae) to low temperatures
Athanassiou CG , Arthur FH , Kavallieratos NG , Hartzer KL . J Econ Entomol 2019 112 (5) 2441-2449 Laboratory tests on acclimated and nonacclimated life stages of Tribolium confusum Jacquelin du Val (Coleoptera: Tenebrionidae) (adults, pupae, larvae, and eggs) and Oryzaephilus surinamensis (L.) (Coleoptera: Silvanidae) (adults, larvae, and eggs) were conducted at 0, -5, -10, and -15 degrees C to evaluate effects of acclimation on susceptibility to cold treatment. Acclimation of all tested life stages for 7 d at 15 degrees C affected susceptibility of both species to the cold temperatures. After 1 d exposures for >/=2 h, acclimated adults had a noticeable increase in cold tolerance compared with nonacclimated adults for both tested species. Nonacclimated pupae of T. confusum were equally susceptible to cold compared with acclimated pupae at short exposures to low temperatures. Exposure of nonacclimated life stages of T. confusum, at -10 degrees C for 1 d gave 0% survival. Similarly, almost all (99.6%) nonacclimated individuals of O. surinamensis died at -10 degrees C. At 0 degrees C, nonacclimated larvae were more cold tolerant than acclimated larvae, but this trend was reversed when larvae were exposed to -5 degrees C. Mixed results were obtained for larvae of O. surinamensis because in some of the combinations tested, nonacclimated larvae were more tolerant, even at temperatures that were lower than 0 degrees C. In contrast to O. surinamensis, eggs of T. confusum that had not been exposed to cold were not affected by acclimation, while exposure to cold showed increased cold hardiness in acclimated eggs. Results show that individual stored-product insect species may have mixed susceptibility to cold temperatures, which must be taken into account when using cold treatment as a management strategy. |
Integrating multiple biomarkers to increase sensitivity for the detection of Onchocerca volvulus infection
Bennuru S , Oduro-Boateng G , Osigwe C , Del-Valle P , Golden A , Ogawa GM , Cama V , Lustigman S , Nutman TB . J Infect Dis 2019 221 (11) 1805-1815 Serological assessments for human onchocerciasis are based on IgG4 reactivity against the OV-16 antigen, with sensitivity around 60-80%. We previously identified 7 novel proteins that could enhance onchocerciasis sero-diagnosis. Further screening by luciferase immunoprecipitation assays identified OVOC10469 and OVOC3261 as the most promising candidates. IgG4-based ELISA using recombinant proteins, yielded sensitivities of 53% for rOVOC10469 and 78% for rOVOC3261, while specificity for each was >99%. Moreover, the newly-identified biomarkers detected some (but not all) of the mf-positive samples not detected by OV-16. The new antigens in combination with OV-16, increased the sensitivity for patent infections to 94%, demonstrating the benefits of adding a complementary antigen to OV-16-based serology. The kinetics of appearance of these IgG4 responses based on experimentally infected non-human primates indicated that they were patency driven. Of note, the IgG4 responses to both OVOC10469 and OVOC3261 (as well as to OV-16) drop significantly (p<0.05) following successful treatment for onchocerciasis. A prototype of a lateral flow rapid assay was developed and tested, showing an overall 94% sensitivity. These data showed that the combined use of rOVOC3261 with OV-16 improved case detection, a current and urgent need for the efforts to achieve the worldwide elimination of transmission of O. volvulus. |
Field validation of limiting-antigen avidity enzyme immunoassay to estimate HIV-1 incidence in cross-sectional survey in Swaziland
Duong Pottinger Y , Dobbs T , Mavengere Y , Manjengwa J , Rottinghaus EK , Saito S , Bock N , Philip N , Justman J , Bicego G , Nkengasong JN , Parekh B . AIDS Res Hum Retroviruses 2019 35 (10) 896-905 Reliable and accurate laboratory assays to detect recent HIV-1 infection have potential as simple and practical methods of estimating HIV-1 incidence in cross-sectional surveys. This study describes validation of the limiting-antigen (LAg) Avidity enzyme immunoassay (EIA) in a cross-sectional national survey, conducted in Swaziland, comparing it to prospective follow up incidence. As part of the Swaziland HIV-1 Incidence Measurement Survey (SHIMS), 18,172 individuals underwent counselling and HIV rapid testing in a household-based, population survey conducted from December 2010 to June 2011. Plasma samples from HIV-positive persons were classified as recent infections using an incidence testing algorithm with LAg-Avidity EIA (ODn 1.5) followed by viral load (VL >/=1,000 copies/mL). All HIV-seronegative samples were tested for acute HIV-1 infection by nucleic acid amplification test (NAAT) pooling. HIV-seronegative individuals who consented to follow-up, were retested approximately 6 months later to detect observed HIV-1 seroconversion. HIV-1 incidence estimates based on LAg+VL and NAAT were calculated using assay-specific parameters and were compared with prospective incidence estimate. A total of 5,803 (31.9%) of 18,172 survey participants tested HIV-seropositive; of these 5683 (97.9%) were further tested with LAg+VL algorithm. The weighted annualized incidence from the longitudinal cohort study was 2.4% [95% CI 2.0, 2.7]. Based on cross-sectional testing of HIV-positives with LAg+VL algorithm, overall weighted annualized HIV-1 incidence was 2.5% [2.0, 3.0], while NAAT-based incidence was of 2.6%. In addition, LAg-based incidence in men (1.8%; 1.2-2.5) and women (3.2%; 2.4-3.9) were similar to estimates based on observed incidence (men=1.7%, women=3.1%). Changes in HIV-1 incidence with age in men and women further validate plausibility of the algorithm. These results demonstrate that the LAg EIA, in a serial algorithm with VL, is a cost-effective tool to estimate HIV-1 incidence in cross-sectional surveys. |
Evaluating the adoption of laboratory practice guidelines
Goldsmith JD , Fitzgibbons PL , Fatheree LA , Astles JR , Nowak JA , Souers RJ , Volmar KE , Nakhleh RE . Arch Pathol Lab Med 2019 144 (1) 83-89 CONTEXT.-: To date, the College of American Pathologists (CAP) has developed 17 laboratory practice guidelines (LPGs) including updates. In 2013, the CAP was awarded a 5-year cooperative agreement grant from the United States Centers for Disease Control and Prevention to increase the effectiveness of LPGs. OBJECTIVE.-: To assess the awareness and adoption of 2 CAP LPGs: immunohistochemical (IHC) assay validation and initial workup of acute leukemia. DESIGN.-: Baseline surveys for each LPG were conducted in 2010 and 2015, respectively. To measure the adoption of guideline recommendations and inform future updates, a follow-up study consisting of surveys, telephone interviews, and focus group sessions was conducted in laboratories that indicated they perform IHC testing. A follow-up study for the acute leukemia LPG is planned. RESULTS.-: For the IHC Validation LPG, a total of 1624 survey responses, 40 telephone interviews, and discussions with 5 focus group participants were analyzed. The response rate for the aforementioned 3 modalities was 46%, 13%, and 3%, respectively. All modalities indicated most respondents were aware of the LPG and had adopted most or all of its recommendations. Respondents expressed needs for continued communication, increased specificity, and more prescriptive recommendations when the guideline is updated. CONCLUSIONS.-: While data-driven development of evidence-based LPGs requires significant resources, active data collection to identify gaps and assess adoption contributes to improved laboratory testing practices in support of patient care. The CAP identified sustainable modalities to track metrics and developed multiple tools that should improve guideline development, adoption, and implementation. Of these modalities, written or electronic surveys were the most logistically feasible and had the highest response rate. |
Evaluation of a screening method for the detection of colistin-resistant Enterobacteriaceae in stool
Turbett SE , Desrosiers L , Andrews-Dunleavey C , Becker M , Walker AT , Esposito D , Woodworth KR , Branda JA , Rosenberg E , Ryan ET , LaRocque R . Open Forum Infect Dis 2019 6 (6) ofz211 Emergence of mobile colistin resistance (mcr)-containing Enterobacteriaceae is a public health threat, prompting enhanced surveillance through the Centers for Disease Control and Prevention. We evaluated a selective culture medium for the isolation of Enterobacteriaceae with non-wild-type colistin minimum inhibitory concentrations, including those with mcr-1 genes, in spiked stool samples. |
Highly sensitive lab on a chip (LOC) immunoassay for early diagnosis of respiratory disease caused by respirable crystalline silica (RCS)
Upaassana VT , Ghosh S , Chakraborty A , Birch ME , Joseph P , Han J , Ku BK , Ahn CH . Anal Chem 2019 91 (10) 6652-6660 Respirable crystalline silica (RCS) produced in mining and construction industries can cause life-threatening diseases such as silicosis, lung cancer, and chronic obstructive pulmonary disease (COPD). These diseases could be more effectively treated and prevented if RCS-related biomarkers were identified and measured at an early stage of disease progression, which makes development of a point of care test (POCT) platform extremely desirable for early diagnosis. In this work, a new, highly sensitive lab on a chip (LOC) immunoassay has been designed, developed, and characterized for tumor necrosis factor alpha (TNF-alpha), a protein biomarker that causes lung inflammation due to RCS exposure. The designed LOC device is composed of four reservoirs for sample, enzyme conjugated detection antibody, wash buffer, and chemiluminescence substrate in liquid form, along with three spiral reaction chambers for test, positive control, and negative control. All reservoirs and spiral microchannels were connected in series and designed to perform sequential delivery of immunoassay reagents with minimal user intervention. The developed LOC measured TNF-alpha concentrations as low as 16 pg/mL in plasma from RCS-exposed rats and also had a limit of detection (LOD) of 0.5 pg/mL in spiked artificial serum. In addition, the analysis time was drastically reduced to about 30 min, as opposed to hours in conventional methods. Successful implementation of a highly sensitive, chemiluminescence-based immunoassay on a preloaded LOC with proper quality control, as reported in this work, can pave the way toward developing a new rapid POCT platform for in-field clinical diagnosis. |
Cemented paste backfill geomechanics at a narrow-vein underhand cut-and-fill mine
Raffaldi MJ , Seymour JB , Richardson J , Zahl E , Board M . Rock Mech Rock Eng 2019 52 (12) 4925-4940 Underhand cut-and-fill mining has allowed for the safe extraction of ore in many mines operating in weak rock or highly stressed, rockburst-prone ground conditions. However, the design of safe backfill undercuts is typically based on historical experience at mine operations and on the strength requirements derived from analytical beam equations. In situ measurements in backfill are not commonplace, largely due to challenges associated with instrumenting harsh mining environments. In deep, narrow-vein mines, large deformations and induced stresses fracture the cemented fill, often damaging the instruments and preventing long-term measurements. Hecla Mining Company and the Spokane Mining Research Division of the National Institute for Occupational Safety and Health (NIOSH) have worked collaboratively for several years to better quantify the geomechanics of cemented paste backfill (CPB), thereby improving safety in underhand stopes. A significant focus of this work has been an extensive in situ backfill instrumentation program to monitor long-term stope closure and induced backfill stress. Rugged and durable custom-designed closure meters were developed, allowing measurements to be taken for up to five successive undercuts and measuring closures of more than 50 cm and horizontal fill pressures up to 5.5 MPa. These large stope closures require the stress–strain response of the fill to be considered in design, rather than to rely solely on traditional methods of backfill span design based on intact fill strength. Furthermore, long-term instrument response shows a change in behavior after 13–14% strain, indicating a transition from shear yielding of the intact, cemented material to compaction of the porosity between sand grains, typical of uncemented sand fills. This strain-hardening behavior is important for mine design purposes, particularly for the use of numerical models to simulate regional rock support and stress redistribution. These quantitative measurements help justify long-standing assumptions regarding the role of backfill in ground support and will be useful for other mines operating under similar conditions. |
Long-term stability of a 13.730.5-m (45100-ft) undercut span beneath cemented rockfill at the Turquoise Ridge Mine, Nevada
Seymour JB , Martin LA , Raffaldi MJ , Warren SN , Sandbak LA . Rock Mech Rock Eng 2019 2019 1-17 In 2001, researchers from the National Institute for Occupational Safety and Health (NIOSH) installed instruments at the Turquoise Ridge Mine in cooperation with Placer Dome, Inc. to monitor the geomechanical behavior and stability of a cemented rockfill (CRF) sill and the surrounding host rock during test mining of a large undercut span beneath backfill. Six parallel, adjacent drifts were mined and backfilled to construct a CRF sill, approximately 22.9 m (75 ft) wide by 30.5 m (100 ft) long. The sill was then partially undercut, successfully creating a 13.7-m (45-ft) wide by 30.5-m (100-ft) long span beneath the CRF. Only small vertical displacements were measured in the overlying host rock during mining, with most of the movement occurring at shallow depths in the mine roof. Because the back above the CRF sill remained stable, the majority of the mining-induced stress was transferred to the host rock abutments rather than to the backfilled drifts. During retreat mining of the undercut span, the CRF sill and the mine roof remained stable. Most of the measured vertical displacement was caused by separation of the backfill from the overlying host rock, or deflection of the CRF sill, which was comparable to the deflection of a monolithic, elastic plate having similar dimensions, material properties, and undercut spans. The CRF sill moved in mass as a single unit rather than as individual drift segments, and the vertical cold joints between adjacent backfill drifts did not adversely affect their stability. Additional measurements collected from the instruments have shown that the backfill span is still intact and in stable condition more than 16 years after the completion of undercut mining. Displacements in the mine roof and abutments have stabilized, and vertical stress and deformation within the CRF have generally leveled off or decreased. Although only slight mining-induced loads were transferred to the backfilled drifts, the CRF has confined the abutment ribs and mine roof, thereby improving their long-term stability. Results of compressive and tensile strength tests conducted with CRF samples from the test site indicate that the long-term compressive strength gain for CRF is similar to that of concrete, and that the tensile-to-compressive strength ratio for CRF is about 1/6 rather than 1/10. Assuming the in-place CRF gained strength at the same rate as the lab samples, an analytical analysis of the flexural stability of the CRF undercut span shows that the Factor of Safety for the span should have logically increased over time. By providing a better understanding of the long-term strength properties and geomechanical behavior of CRF, these research findings help improve the methods that are used for designing stable, long-term undercut entries beneath cemented backfill. |
Changes in obesity among US children aged 2 through 4 years enrolled in WIC during 2010-2016
Pan L , Freedman DS , Park S , Galuska DA , Potter A , Blanck HM . JAMA 2019 321 (23) 2364-2366 Prevalence of childhood obesity is high in the United States, especially among children from lower-income families.1 Among children aged 2 through 4 years enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), obesity prevalence increased between 2000 and 2010 but declined through 2014.2 The decline was statistically significant among all racial/ethnic groups and in 34 of 56 state WIC agencies. The present study examines trends in overweight and obesity by age, sex, and race/ethnicity using WIC data from 2010 to 2016. |
Effect of a fruit and vegetable prescription program on children's fruit and vegetable consumption
Ridberg RA , Bell JF , Merritt KE , Harris DM , Young HM , Tancredi DJ . Prev Chronic Dis 2019 16 E73 INTRODUCTION: Most children in families with low income do not meet dietary guidance on fruit and vegetable consumption. Fruit and vegetable prescription programs improve access to and affordability of health-supporting foods for adults, but their effect on dietary behavior among children is not known. The objective of this study was to describe the extent to which exposure to a fruit and vegetable prescription program was associated with changes in consumption among participants aged 2 to 18. METHODS: We used data from a modified National Cancer Institute screener to calculate fruit and vegetable intake among 883 children who were overweight or had obesity and participated in a 4- to 6-month fruit and vegetable prescription program at federally qualified health centers during 4 years (2012-2015). Secondary analyses in 2017 included paired t tests to compare change in fruit and vegetable consumption (cups/day) between first and last visits and multivariable linear regressions, including propensity dose-adjusted models, to model this change as a function of sociodemographic and program-specific covariates, such as number of clinical visits and value of prescription redemption. RESULTS: We found a dose propensity-adjusted increase of 0.32 cups (95% confidence interval, 0.19-0.45 cups) for each additional visit while holding constant the predicted number of visits and site. An equal portion of the change-score increase was attributed to vegetable consumption and fruit consumption (beta = 0.16 for each). CONCLUSION: Fruit and vegetable prescription programs in clinical settings may increase fruit and vegetable consumption among children in low-income households. Future research should use a comparison group and consider including qualitative analysis of site-specific barriers and facilitators to success. |
Individual, business-related, and work environment factors associated with driving tired among taxi drivers in two metropolitan U.S. cities
Menendez C , Socias-Morales C , Konda S , Ridenour M . J Safety Res 2019 70 71-77 Introduction: Violence-related events and roadway incidents are the leading causes of injury among taxi drivers. Fatigue is under-recognized and prevalent in this workforce and is associated with both injury outcomes. We describe the association of individual, business-related, and work environment factors with driving tired among taxi drivers in two very different cities. Method: We developed a comprehensive survey for licensed taxi drivers. We trained surveyors to administer the 30-min survey using systematic sampling among taxi drivers waiting for fares in two large U.S. cities: the Southwest (City 1) and the West (City 2). A driving tired scale of the Occupational Driver Behavior Questionnaire was the outcome. Multivariate logistic models described driving tired behavior in city-specific models using adjusted Odds Ratios (ORadj). Results: City 1 and City 2 had 496 and 500 participants, respectively. Each driving tired behavior was significantly more prevalent in City 2 than City 1 (p < .05). There were more variables and a greater diversity of variables in the models describing drowsy driving in City 1 than City 2. In City 1, variables describing negative safety climate (ORadj = 1.15), socio-demographic groups (identifying as Asian, educational attainment), passenger-related violence (ORadj = 1.79), and company tenure (ORadj = 1.15) were associated with driving tired. In City 2, high perceived safety training usefulness (ORadj = 0.48) was associated with driving tired. A risk factor for driving tired that was common to both cities was job demands (ORadj = 1.21 in City 1; 1.43 in City 2). Conclusions: These findings represent two diverse taxi populations driving in two geographically distinct regions that differ in safety regulation. It is important that safety measures that include fatigue awareness training are reaching all drivers. Fatigue management training should be integrated into driver safety programs regardless of location. Practical applications: Fatigue management strategies that recognize individual factors, business-related characteristics, and work environment are an important component of road safety and are particularly relevant for occupational drivers. |
Degree of integration between occupational safety and health programs and wellness programs: First-year results from an insurer-sponsored wellness grant for smaller employers
Meyers AR , Al-Tarawneh IS , Bushnell PT , Wurzelbacher SJ , Lampl MP , Tseng CY , Turner DM , Morrison CA . J Occup Environ Med 2019 61 (9) 704-717 OBJECTIVE: The aim of this study was to describe levels of integration between occupational safety and health (OSH) and workplace wellness programs/practices/policies ("programs") among participants in an insurer-sponsored wellness grant program. METHODS: We analyzed survey responses about year 1 of an insurer-sponsored grant to start a wellness program from 220 small- and medium-sized employers. Responses yielded 25 indicators of OSH-wellness integration, and 10 additional indicators to summarize multiple responses. RESULTS: At least half of the employers (N = 220) reported some level of integration within five of seven categories of OSH-wellness integration. Employers sometimes considered ergonomics, safety, or substance exposure hazards while designing their wellness program (15%) or reduced such hazards to support their wellness program (24%). Few meaningful differences were observed by employer size. CONCLUSION: Although high levels of integration were unusual, some degree of integration was common for most indicator categories. |
Administration of antineoplastic drugs and fecundity in female nurses
Nassan FL , Lawson CC , Gaskins AJ , Johnson CY , Boiano JM , Rich-Edwards JW , Chavarro JE . Am J Ind Med 2019 62 (8) 672-679 BACKGROUND: We examined the association between the administration of antineoplastic drugs (AD) and fecundity among female nurses. METHODS: AD administration and use of exposure controls (EC) such as gloves, gowns, and needleless systems were self-reported at baseline among 2649 participants of the Nurses' Health Study 3, who were actively attempting pregnancy. Every 6 months thereafter, the nurses reported the current duration of their pregnancy attempt. Multivariable accelerated failure time models were used to estimate time ratios (TR) and 95% confidence intervals (CI) adjusted for age, race, body mass index, smoking, marital status, hours of work, and other occupational risk factors. RESULTS: Mean (standard deviation) age and BMI at baseline were 30.7 years (4.7) and 26.0 kg/m(2) (6.4). Forty-one percent of nurses reported ever administering AD; 30% only in the past and 11% currently. The former administration of AD (TR = 1.02, 95% CI, 0.93-1.12) was unrelated to the ongoing duration of pregnancy attempt. Among nurses currently administering AD, those who had administered AD for 6 years and above had a 27% (95% CI, 6%-53%) longer duration of pregnancy attempt than nurses who never handled ADs in unadjusted analyses. This difference disappeared in multivariable analyses (TR = 1.01, 95% CI, 0.85-1.21). 93% (n = 270) of the nurses currently administering ADs reported consistent use of EC. These nurses had a similar median duration of pregnancy attempt to those who never handled AD (TR = 1.00, 95% CI, 0.87-1.15). CONCLUSIONS: Administration of ADs did not appear to have an impact on fecundity in a cohort of nurses planning for pregnancy with a high prevalence of consistent ECs. Our results may not be generalizable to women who are less compliant with PPE use or with less availability to ECs. Therefore, it is possible that we did not observe an association between occupational exposure to AD and reduced fecundity because of lower exposure due to the more prevalent use of effective ECs. |
Case investigations of infectious diseases occurring in workplaces, United States, 2006-2015
Su CP , de Perio MA , Cummings KJ , McCague AB , Luckhaupt SE , Sweeney MH . Emerg Infect Dis 2019 25 (3) 397-405 Workers in specific settings and activities are at increased risk for certain infectious diseases. When an infectious disease case occurs in a worker, investigators need to understand the mechanisms of disease propagation in the workplace. Few publications have explored these factors in the United States; a literature search yielded 66 investigations of infectious disease occurring in US workplaces during 2006-2015. Reported cases appear to be concentrated in specific industries and occupations, especially the healthcare industry, laboratory workers, animal workers, and public service workers. A hierarchy-of-controls approach can help determine how to implement effective preventive measures in workplaces. Consideration of occupational risk factors and control of occupational exposures will help prevent disease transmission in the workplace and protect workers' health. |
Step It Up! Prioritization of community supports for walking among US adults
Hyde ET , Omura JD , Watson KB , Fulton JE , Carlson SA . Am J Health Promot 2019 33 (8) 890117119856550 PURPOSE: Step It Up! The Surgeon General's Call to Action to Promote Walking and Walkable Communities (Call to Action) presents goals and supporting strategies to promote walking. We assessed the presence and prioritization of 4 community supports for walking related to the goals of the Call to Action from the perspective of US adults. DESIGN: Cross-sectional web-based survey. SETTING: US adults. PARTICIPANTS: A total of 4043 respondents. MEASURES: SummerStyles 2016 survey assessing the reported presence and prioritization of 4 community supports for walking. ANALYSIS: Estimated prevalence of the presence of supports overall and by demographic characteristics, and prevalence and adjusted prevalence ratios of their prioritization. RESULTS: The most commonly reported community supports for walking were access to walkable locations (46.5%) and safe streets (29.2%), followed by walking groups (12.9%) and promotional campaigns (9.6%). Access to walkable locations (60.0%) and safe streets (50.6%) were most often prioritized by respondents, followed by promotional campaigns (23.6%) and walking groups (18.8%). Many differences in prioritization by demographic characteristics remained significant after adjusting for presence and other demographic characteristics, such as increased prioritization of all supports with older age groups. CONCLUSIONS: Presence and prioritization of community supports for walking varied widely by type of support and by demographic characteristics. Opportunities exist to improve access and public sentiment related to these supports to promote walking in the United States. |
Trends in Meeting physical activity guidelines among urban and rural dwelling adults - United States, 2008-2017
Whitfield GP , Carlson SA , Ussery EN , Fulton JE , Galuska DA , Petersen R . MMWR Morb Mortal Wkly Rep 2019 68 (23) 513-518 Since the release of the 2008 Physical Activity Guidelines for Americans (https://health.gov/paguidelines/2008/pdf/paguide.pdf), the age-adjusted percentage of adults meeting the combined aerobic and muscle-strengthening guidelines increased from 18.2% to 24.3% in 2017 (1). Trends in urban and rural areas, across demographic subgroups, and among subgroups within urban and rural areas have not been reported. CDC analyzed 2008-2017 National Health Interview Survey (NHIS) data to examine trends in the age-standardized prevalence of meeting physical activity guidelines among adults aged >/=18 years living in urban and rural areas. Among urban and rural residents, prevalence increased from 19.4% to 25.3% and from 13.3% to 19.6%, respectively. Nationally, all demographic subgroups and regions experienced increases over this period; increases for several groups were not consistent year-to-year. Among urban residents, the prevalence was higher during 2016-2017 than during 2008-2009 for all demographic subgroups and regions. During the same period, prevalence was higher across all rural-dwelling subgroups except Hispanics, adults with a college education, and those living in the South U.S. Census region. Urban and rural communities can implement evidence-based approaches, including improved community design, improved access to indoor and outdoor recreation facilities, social support programs, and community-wide campaigns to make physical activity the safe and easy choice for persons of all ages and abilities (2-4). Incorporating culturally appropriate strategies into local programs might help address differences across subgroups. |
Judicial opinions arising from emergency preparedness, response, and recovery activities
McCourt AD , Sunshine G , Rutkow L . Health Secur 2019 17 (3) 240-247 Legal Perspectives is aimed at informing healthcare providers, emergency planners, public health practitioners, and other decision makers about important legal issues related to public health and healthcare preparedness and response. The articles describe these potentially challenging topics and conclude with the authors' suggestions for further action. The articles do not provide legal advice. Therefore, those affected by the issues discussed in this column should seek further guidance from legal counsel. Readers may submit topics of interest to the column's editor, Lainie Rutkow, JD, PhD, MPH, at lrutkow@jhu.edu. This article describes and analyzes the body of emergency preparedness, response, and recovery litigation that has arisen since the September 11, 2001, terrorist attacks. Search terms were developed to identify judicial opinions related to emergency preparedness, response, and recovery activities. Using the Thomson Reuters Westlaw legal database, searches were conducted to collect judicial opinions related to disasters that occurred in the United States between September 11, 2001, and December 31, 2015. An electronic form was used for data abstraction. Cases that did not directly involve emergency response, preparedness, or recovery activities were excluded. Data were summarized with descriptive statistics. We identified 215 cases for data abstraction. Many of the cases stemmed from preparedness, response, and recovery activities related to hurricanes (57.7%) and terrorist attacks (16.7%). The most prevalent emergency response activities at issue were disaster mitigation (29.3%), disaster clean-up (21.9%), a defendant's duty to plan (14.4%), evacuation (12.6%), and conditions of incarceration (12.1%). Although it can be anticipated that litigation will arise out of all phases of disaster preparedness, response, and recovery, policymakers can anticipate that the most litigation will result from pre-event mitigation and post-event recovery activities, and allocate resources accordingly. |
Socioecological risk factors associated with teen pregnancy or birth for young men: A scoping review
Fasula AM , Chia V , Murray CC , Brittain A , Tevendale H , Koumans EH . J Adolesc 2019 74 130-145 INTRODUCTION: Teen pregnancy prevention typically focuses on young women, overlooking the unique prevention needs of young men. Identifying factors associated with teen pregnancy for young men is essential to developing relevant and effective programming. METHODS: We conducted a scoping review of studies with findings on factors associated with pregnancies/birth specific to young men. We searched Scopus, OVID, and PubMed databases for peer-reviewed articles published from 2000 to 2015. We reviewed 1750 articles for inclusion of studies conducted in the United States with a sample size greater than 200 that assessed the effect of factors on teen pregnancy/birth using multivariate, male-specific analyses. Two coders abstracted 48 articles (having established 80% reliability with 10% of the articles). We grouped study variables into factors and used a matrix to summarize findings for each factor. During analysis, 29 articles were excluded for a final sample of 19 articles, each describing a separate study. RESULTS: Study settings included households, healthcare organizations, schools, neighborhoods, and correctional facilities. Factors showing associations with teen pregnancy/birth included: experiencing childhood abuse; engaging in serious or repeated delinquent behaviors; substance abuse; having a teen parent; serious family disruption; not living with either parent; and Hispanic ethnicity. No studies assessed knowledge and attitudes about contraceptive methods, or access and use of clinical services; and few assessed relationship factors (n=4) or gender and power (n=1). CONCLUSIONS: Factors related to disadvantaged social contexts were associated with teen pregnancy/birth. Resilience-based research may identify protective factors to support vulnerable families and youth. |
Disparities in current cigarette smoking among US adults, 2002-2016
Agaku IT , Odani S , Okuyemi KS , Armour B . Tob Control 2019 29 (3) 269-276 BACKGROUND: To assess disparities in current (past 30 days) cigarette smoking among US adults aged >/= 18 years during 2002-2016. METHODS: Nine indicators associated with social disadvantage were analysed from the 2002 to 2016 National Survey on Drug Use and Health: education, annual family income, sex, race/ethnicity, urbanicity, serious psychological distress, health insurance, public assistance, and employment status. Using descriptive and multivariable analyses, we measured trends in smoking overall and within the assessed variables. We also evaluated effect of interactions on disparities and estimated the excess number of smokers attributable to disparities. RESULTS: During 2002-2016, current cigarette smoking prevalence declined overall (27.5%-20.7%; p trend < 0.01), and among all subgroups except Medicare insurees and American Indians/Alaska Natives (AI/ANs). Overall inequalities in cigarette smoking grew even wider or remained unchanged for several indicators during the study period. In 2016, comparing groups with the least versus the most social advantage, the single largest disparity in current smoking prevalence was seen by race/ethnicity (prevalence ratio = 5.1, AI/ANs vs Asians). Education differences alone explained 38.0% of the observed racial/ethnic disparity in smoking prevalence. Interactions were also present; compared with the population-averaged prevalence among all AI/AN individuals (34.0%), prevalence was much higher among AI/ANs with <high school diploma (53.0%), unemployed (58.0%), or with serious psychological distress (66.9%). The burden of smoking attributable to race/ethnic disparities in smoking prevalence was an estimated 27.6 million smokers. CONCLUSIONS: Overall smoking inequality increased or remained unchanged because of slower declines in smoking prevalence among disadvantaged groups. Targeted interventions among high-risk groups can narrow disparities. |
Binge drinking and prescription opioid misuse in the U.S., 2012-2014
Esser MB , Guy GPJr , Zhang K , Brewer RD . Am J Prev Med 2019 57 (2) 197-208 INTRODUCTION: Prescription opioids were responsible for approximately 17,000 deaths in the U.S. in 2016. One in five prescription opioid deaths also involve alcohol. Drinkers who misuse prescription opioids (i.e., use without a prescription or use only for the experience or feeling it causes) are at a heightened risk of overdose. However, little is known about the relationship between drinking patterns and prescription opioid misuse. METHODS: Data were analyzed from 160,812 individuals (aged >/=12 years) who responded to questions about prescription opioid misuse and alcohol consumption in the 2012, 2013, or 2014 National Survey on Drug Use and Health (analyzed in 2017-2018). The prevalence of self-reported past-30-days prescription opioid misuse was assessed by sociodemographic characteristics, other substance use (i.e., cigarettes, marijuana), and drinking patterns. Multiple logistic regression analyses were used to calculate AORs. RESULTS: From 2012 to 2014, 1.6% (95% CI=1.5, 1.7) of all individuals aged >/=12 years (estimated 4.2 million) and 3.5% (95% CI=3.3, 3.8) of binge drinkers (estimated 2.2 million) reported prescription opioid misuse. Prescription opioid misuse was more common among binge drinkers than among nondrinkers (AOR=1.7, 95% CI=1.5, 1.9). Overall, the prevalence of prescription opioid misuse increased significantly with binge drinking frequency (p-value<0.001). CONCLUSIONS: More than half of the 4.2 million people who misused prescription opioids during 2012-2014 were binge drinkers, and binge drinkers had nearly twice the odds of misusing prescription opioids, compared with nondrinkers. Widespread use of evidence-based strategies for preventing binge drinking might reduce opioid misuse and overdoses involving alcohol. |
Socioeconomic differences in cigarette smoking among sociodemographic groups
Garrett BE , Martell BN , Caraballo RS , King BA . Prev Chronic Dis 2019 16 E74 We examined variations in cigarette smoking by socioeconomic status (education and poverty status) in relation to population sociodemographic characteristics (age, race/ethnicity, region and sex). We analyzed data from a nationally representative sample of US adults by using combined data from the National Survey on Drug Use and Health (2011-2014). Low socioeconomic status was generally associated with increased cigarette smoking prevalence by age, race/ethnicity, and region, irrespective of sex. The only exceptions were for Asian and Hispanic women, where low educational attainment was not associated with a high prevalence of cigarette smoking, and among Hispanic men and Asian women, where there was no association between poverty status and smoking. Efforts to reach smokers of low socioeconomic status by using proven tobacco control strategies could reduce disparities in cigarette smoking and smoking-related disease and death. |
Community understanding of contraception during the Zika virus outbreak in Puerto Rico
August EM , Rosenthal J , Torrez R , Romero L , Berry-Bibee EN , Frey MT , Torres R , Rivera-Garcia B , Honein MA , Jamieson DJ , Lathrop E . Health Promot Pract 2019 21 (1) 1524839919850764 In response to the Zika virus outbreak in Puerto Rico (2015-2016), the Zika Contraception Access Network (Z-CAN) was established to provide same-day access to the full range of reversible contraception at no cost to women. Formative research was conducted to inform the development of a communication campaign about Z-CAN. Ten focus groups with women and men, aged 18 to 49 years, in Puerto Rico were conducted to collect data on contraception awareness, use, and decision making during the Zika outbreak, as well as culturally appropriate messaging and outreach strategies. Thematic analysis was conducted using the constant comparative method. Data showed that there was community awareness regarding Zika in Puerto Rico. However, it was not a motivating factor in contraception decision making; instead, economic factors were the major drivers. Most participants preferred to receive information on contraception, potential side effects, and where to access contraceptive services via Internet-based channels and health care providers. Based on these findings, the Ante La Duda, Pregunta [When in Doubt, Ask] campaign was launched to promote awareness of Z-CAN services among those who chose to prevent pregnancy during the Zika outbreak. Our results underscore the importance of conducting formative research to develop communication initiatives, while also demonstrating that it is feasible to perform these activities as part of an emergency response. |
Downgrading disease transmission risk estimates using terminal importations
Fox SJ , Bellan SE , Perkins TA , Johansson MA , Meyers LA . PLoS Negl Trop Dis 2019 13 (6) e0007395 As emerging and re-emerging infectious arboviruses like dengue, chikungunya, and Zika threaten new populations worldwide, officials scramble to assess local severity and transmissibility, with little to no epidemiological history to draw upon. Indirect estimates of risk from vector habitat suitability maps are prone to great uncertainty, while direct estimates from epidemiological data are only possible after cases accumulate and, given environmental constraints on arbovirus transmission, cannot be widely generalized beyond the focal region. Combining these complementary methods, we use disease importation and transmission data to improve the accuracy and precision of a priori ecological risk estimates. We demonstrate this approach by estimating the spatiotemporal risks of Zika virus transmission throughout Texas, a high-risk region in the southern United States. Our estimates are, on average, 80% lower than published ecological estimates-with only six of 254 Texas counties deemed capable of sustaining a Zika epidemic-and they are consistent with the number of autochthonous cases detected in 2017. Importantly our method provides a framework for model comparison, as our mechanistic understanding of arbovirus transmission continues to improve. Real-time updating of prior risk estimates as importations and outbreaks arise can thereby provide critical, early insight into local transmission risks as emerging arboviruses expand their global reach. |
Vital Signs: Trends in Human rabies deaths and exposures - United States, 1938-2018
Pieracci EG , Pearson CM , Wallace RM , Blanton JD , Whitehouse ER , Ma X , Stauffer K , Chipman RB , Olson V . MMWR Morb Mortal Wkly Rep 2019 68 (23) 524-528 INTRODUCTION: Each year, rabies causes approximately 59,000 deaths worldwide, including approximately two deaths in the United States. Before 1960, dogs were a common reservoir of rabies in the United States; however, increasingly, species of wildlife (e.g., bats, raccoons) are the main reservoirs. This report characterizes human rabies deaths, summarizes trends in rabies mortality, and highlights current rabies risks in the United States. METHODS: Rabies trends in the United States during 1938-2018 were analyzed using national rabies surveillance data. Data from the Healthcare Cost and Utilization Project for 2006-2014 were used to estimate the number of postexposure prophylaxis (PEP) visits per 100,000 persons during 2017-2018. The Centers for Medicare & Medicaid Services' average sales price data were used to estimate PEP costs. RESULTS: From 1960 to 2018, a total of 125 human rabies cases were reported in the United States; 36 (28%) were attributed to dog bites during international travel. Among the 89 infections acquired in the United States, 62 (70%) were attributed to bats. In 2018, approximately 55,000 persons sought PEP after contact with a potentially rabid animal. CONCLUSIONS AND COMMENTS: In the United States, wildlife rabies, especially in bats, continues to pose a risk to humans. Travelers also might be exposed to canine rabies in countries where the disease is still present; increased awareness of rabies while traveling abroad is needed. Vaccinating pets, avoiding contact with wildlife, and seeking medical care if one is bitten or scratched by an animal are the most effective ways to prevent rabies. Understanding the need for timely administration of PEP to prevent death is critical. |
Dengue and Zika virus diagnostic testing for patients with a clinically compatible illness and risk for infection with both viruses
Sharp TM , Fischer M , Munoz-Jordan JL , Paz-Bailey G , Staples JE , Gregory CJ , Waterman SH . MMWR Recomm Rep 2019 68 (1) 1-10 Dengue and Zika viruses are closely related mosquitoborne flaviviruses with similar transmission cycles, distribution throughout the tropics and subtropics, and disease manifestations including fever, rash, myalgia, and arthralgia. For patients with suspected dengue or Zika virus disease, nucleic acid amplification tests (NAATs) are the preferred method of diagnosis. Immunoglobulin M (IgM) antibody testing can identify additional infections and remains an important tool for the diagnosis of these diseases, but interpreting the results is complicated by cross-reactivity, and determining the specific timing of infection can be difficult. These limitations are a particular challenge for pregnant women in determining whether Zika virus infection occurred during or before the pregnancy.This report summarizes existing and new guidance on dengue and Zika virus diagnostic testing for patients with a clinically compatible illness who live in or recently traveled to an area where there is risk for infection with both viruses. CDC recommendations for screening of asymptomatic pregnant women with possible Zika virus exposure are unchanged. For symptomatic nonpregnant persons, dengue and Zika virus NAATs should be performed on serum collected </=7 days after symptom onset. Dengue and Zika virus IgM antibody testing should be performed on NAAT-negative serum specimens or serum collected >7 days after onset of symptoms. For symptomatic pregnant women, serum and urine specimens should be collected as soon as possible within 12 weeks of symptom onset for concurrent dengue and Zika virus NAATs and IgM antibody testing. Positive IgM antibody test results with negative NAAT results should be confirmed by neutralizing antibody tests when clinically or epidemiologically indicated, including for all pregnant women. Data on the epidemiology of viruses known to be circulating at the location of exposure and clinical findings should be considered when deciding which tests to perform and for interpreting results.Patients with clinically suspected dengue should receive appropriate management to monitor and treat shock and hemorrhage. Women with laboratory evidence of possible Zika virus infection during pregnancy and their infants should be evaluated and managed for possible adverse outcomes. Dengue and Zika virus disease are nationally notifiable conditions, and cases should be reported to public health authorities. |
Nipah virus outbreaks: Still small but extremely lethal
Spiropoulou CF . J Infect Dis 2019 219 (12) 1855-1857 In May 2018, 23 cases of Nipah virus (NiV) infection were identified in Kozhikode District, Kerala State, India. The case-fatality rate reached 91%, with 21 individuals dying and only 2 surviving. While the outbreak lasted for <1 month, it created fear and panic in the local community, as well as nationally and internationally, even overshadowing the concurrent Ebola virus outbreak in the Equateur Province of the Democratic Republic of the Congo in the global news [1]. Early diagnosis and application of infection prevention and control measures were the main factors that quickly brought the Kerala NiV outbreak under control. |
Content Index (Achived Edition)
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