Seroprevalence of herpes simplex virus 2 among Hispanics in the USA: National Health and Nutrition Examination Survey, 2007-2008
Molina M , Romaguera RA , Valentine J , Tao G . Int J STD AIDS 2011 22 (7) 387-90 To examine the seroprevalence of herpes simplex virus type 2 (HSV-2) among Hispanics in the USA, we used the cross-sectional, nationally representative National Health and Nutrition Examination Survey to compare the seroprevalence of HSV-2 between Hispanic persons of Mexican heritage and non-Mexican heritage aged 14-44 years, from survey years 2007-2008. The overall HSV-2 seroprevalence among Hispanics aged 14-44 years was 17.5% (95% confidence interval [CI], 15.2, 20.1) in the USA. HSV-2 seroprevalence was significantly lower among Mexican Americans than among other Hispanics (11.7% vs. 27.8%, P < 0.01). Prevalence of HSV-2 was also significantly associated with gender and age. The significant difference in HSV-2 seroprevalence between Hispanic persons of Mexican heritage and non-Mexican heritage suggested that targeting specific subgroups of Hispanics for preventive interventions may be a strategy to reduce the transmission of HSV-2 and HIV among Hispanics in the USA. |
Transmission dynamics of primary pneumonic plague in the USA
Hinckley AF , Biggerstaff BJ , Griffith KS , Mead PS . Epidemiol Infect 2011 140 (3) 1-7 SUMMARY: Plague is thought to have killed millions during three catastrophic pandemics. Primary pneumonic plague, the most severe form of the disease, is transmissible from person-to-person and has the potential for propagating epidemics. Efforts to quantify its transmission potential have relied on published data from large outbreaks, an approach that artificially inflates the basic reproductive number (R0) and skews the distribution of individual infectiousness. Using data for all primary pneumonic plague cases reported in the USA from 1900 to 2009, we determined that the majority of cases will fail to transmit, even in the absence of antimicrobial treatment or prophylaxis. Nevertheless, potential for sustained outbreaks still exists due to superspreading events. These findings challenge current concepts regarding primary pneumonic plague transmission. |
Outbreak of pneumonia in the setting of fatal pneumococcal meningitis among US Army trainees: potential role of Chlamydia pneumoniae infection
Dawood FS , Ambrose JF , Russell BP , Hawksworth AW , Winchell JM , Glass N , Thurman K , Soltis MA , McDonough E , Warner AK , Weston E , Clemmons NS , Rosen J , Mitchell SL , Faix DJ , Blair PJ , Moore MR , Lowery J . BMC Infect Dis 2011 11 (1) 157 BACKGROUND: Compared to the civilian population, military trainees are often at increased risk for respiratory infections. We investigated an outbreak of radiologically-confirmed pneumonia that was recognized after 2 fatal cases of serotype 7F pneumococcal meningitis were reported in a 303-person military trainee company (Alpha Company). METHODS: We reviewed surveillance data on pneumonia and febrile respiratory illness at the training facility; conducted chart reviews for cases of radiologically-confirmed pneumonia; and administered surveys and collected nasopharyngeal swabs from trainees in the outbreak battalion (Alpha and Hotel Companies), associated training staff, and trainees newly joining the battalion. RESULTS: Among Alpha and Hotel Company trainees, the average weekly attack rates of radiologically-confirmed pneumonia were 1.4% and 1.2% (most other companies at FLW: 0-0.4%). The pneumococcal carriage rate among all Alpha Company trainees was 15% with a predominance of serotypes 7F and 3. Chlamydia pneumoniae was identified from 31% of specimens collected from Alpha Company trainees with respiratory symptoms. CONCLUSION: Although the etiology of the outbreak remains unclear, the identification of both S. pneumoniae and C. pneumoniae among trainees suggests that both pathogens may have contributed either independently or as cofactors to the observed increased incidence of pneumonia in the outbreak battalion and should be considered as possible etiologies in outbreaks of pneumonia in the military population. |
Poliomyelitis-related case-fatality ratio in India, 2002-2006
Doshi SJ , Sandhu HS , Venczel LV , Hymbaugh KJ , Deshpande JM , Pallansch MA , Bahl S , Wenger JD , Cochi SL . Clin Infect Dis 2011 53 (1) 13-9 BACKGROUND: On the basis of studies from developed countries, the case-fatality ratio (CFR) of poliomyelitis generally ranges from 2%-5% among children <5 years of age to 10%-30% among adults. However, little information is available for poliomyelitis-related CFR in developing countries. We conducted a study to determine the CFR in India, 1 of the 4 remaining countries with endemic wild poliovirus (WPV) circulation, during outbreaks of WPV infection during 2002 and 2006 and during the inter-epidemic years of 2003-2005. METHODS: We conducted a descriptive analysis with use of data from the acute flaccid paralysis surveillance system in India. Variables analyzed included age, caregiver-reported vaccination status, date of paralysis onset, laboratory results, final case classification, and survival outcome. Our analysis also accounted for surveillance changes that occurred in 2005, impacting case definitions and final classification. RESULTS: In 2006, 45 deaths occurred among 676 WPV cases in India, yielding a CFR of 6.7%. By comparison, in 2002, there were 66 deaths among 1600 reported WPV cases (CFR, 4.2%) and during 2002-2005, CFR was 1.5%-5.2%. All 45 deaths were among 644 (95%) WPV cases in children aged <5 years (CFR, 7.0%). Among those who died, 33 (73%) were children aged <2 years (CFR, 7.1%). CONCLUSIONS: The CFR among children aged <2 years in India is high compared with previously published CFRs for young children, in part because of improved case finding through enhanced surveillance techniques. Fatal cases emphasize the lethal nature of the disease and the importance of achieving polio eradication in India. |
Incidence of bacteremic melioidosis in eastern and northeastern Thailand
Bhengsri S , Baggett HC , Jorakate P , Kaewpan A , Prapasiri P , Naorat S , Thamthitiwat S , Tanwisaid K , Chantra S , Salika P , Dejsirilert S , Peruski LF , Maloney SA . Am J Trop Med Hyg 2011 85 (1) 117-20 Burkholderia pseudomallei, the causative agent of melioidosis, is endemic in northeastern Thailand. Population-based disease burden estimates are lacking and limited data on melioidosis exist from other regions of the country. Using active, population-based surveillance, we measured the incidence of bacteremic melioidosis in the provinces of Sa Kaeo (eastern Thailand) and Nakhon Phanom (northeastern Thailand) during 2006-2008. The average annual incidence in Sa Kaeo and Nakhon Phanom per 100,000 persons was 4.9 (95% confidence interval [CI] = 3.9-6.1) and 14.9 (95% CI = 13.3-16.6). The respective population mortality rates were 1.9 (95% CI = 1.3-2.8) and 4.4 (95% CI = 3.6-5.3) per 100,000. The case-fatality proportion was 36% among those with known outcome. Our findings document a high incidence and case fatality proportion of bacteremic melioidosis in Thailand, including a region not traditionally considered highly endemic, and have potential implications for clinical management and health policy. |
Advancing the development of diagnostic tests and biomarkers for tuberculosis
Yasinskaya Y , Plikaytis B , Sizemore C , Sacks L . Int J Tuberc Lung Dis 2011 15 (7) 985-7 High costs and limited returns on investment have hampered progress in developing new diagnostic tests and treatments for tuberculosis (TB). We need new biomarkers to develop assays that can rapidly, efficiently and reliably detect Mycobacterium tuberculosis infection and disease, identify drug resistance and expedite drug and vaccine development. This can only be accomplished through cross-disciplinary collaborations to facilitate access to human specimens. The Food and Drug Administration, Centers for Disease Control and Prevention, National Institutes of Health, the industry and academia experts came together in a June 2010 workshop to examine the field of TB diagnostic test development and biomarker discovery, identify areas of most urgent need and formulate strategies to address those needs. |
Carbapenem-resistant enterobacteriaceae: epidemiology and prevention
Gupta N , Limbago BM , Patel JB , Kallen AJ . Clin Infect Dis 2011 53 (1) 60-7 Over the past 10 years, dissemination of Klebsiella pneumoniae carbapenemase (KPC) has led to an increase in the prevalence of carbapenem-resistant Enterobacteriaceae (CRE) in the United States. Infections caused by CRE have limited treatment options and have been associated with high mortality rates. In the previous year, other carbapenemase subtypes, including New Delhi metallo-beta-lactamase, have been identified among Enterobacteriaceae in the United States. Like KPC, these enzymes are frequently found on mobile genetic elements and have the potential to spread widely. As a result, preventing both CRE transmission and CRE infections have become important public health objectives. This review describes the current epidemiology of CRE in the United States and highlights important prevention strategies. |
Palliative care services in families of males with Duchenne muscular dystrophy
Arias R , Andrews J , Pandya S , Pettit K , Trout C , Apkon S , Karwoski J , Cunniff C , Matthews D , Miller T , Davis MF , Meaney FJ . Muscle Nerve 2011 44 (1) 93-101 INTRODUCTION: Palliative care services that address physical pain and emotional, psychosocial, and spiritual needs may benefit individuals with Duchenne muscular dystrophy (DMD). METHODS: The objective of this study was to describe the palliative care services that families of males with DMD report they receive. A questionnaire was administered to families of males with DMD born prior to January 1, 1982. Thirty-four families responded. RESULTS: Most families (85%) had never heard the term palliative care. Only attendant care and skilled nursing services showed much usage, with 44% and 50% indicating receipt of these services, respectively. Receipt of other services was reported less frequently: pastoral care (27%); respite care (18%); pain management (12%); and hospice care (6%). Only 8 respondents (25%) reported having any type of directive document in place. CONCLUSION: The data suggest a need for improved awareness of palliative care and related services among families of young men with DMD. Muscle Nerve 44: 93-101, 2011. |
Provision of HIV counseling and testing services at five community-based organizations among young men of color who have sex with men
Stein R , Green K , Bell K , Toledo CA , Uhl G , Moore A , Shelley GA , Hardnett FP . AIDS Behav 2011 15 (4) 743-50 In the context of monitoring and improving CDC-funded HIV prevention programs, we describe HIV tests and infections, provision of results, previous HIV tests, and risk behaviors for young (aged 13-29) men of color who have sex with men who received HIV tests at five community-based organizations. Of 1,723 tests provided, 2.1% were positive and 75.7% of positives were previously unaware of their infection. The highest positivity rate was among men aged 25-29 (4.7%). Thirty-four percent of tests were provided to men who were tested for the first time. Over half the tests (53.2%) were provided to men who reported sex with a person of unknown HIV status, and 34% to men who reported sex with an anonymous partner. Continued and more focused prevention efforts are needed to reach and test young men of color who have sex with men and to identify previously undiagnosed HIV infections among this target population. |
Subtype analysis of Cryptosporidium parvum and Cryptosporidium hominis isolates from humans and cattle in Iran.
Nazemalhosseini-Mojarad E , Haghighi A , Taghipour N , Keshavarz A , Mohebi SR , Zali MR , Xiao L . Vet Parasitol 2011 179 250-2 Cryptosporidium is an intestinal parasite associated with severe acute diarrhea in humans and animals. To investigate subtypes of Cryptosporidium spp. isolated from humans and cattle in Iran, 47 Cryptosporidium parvum (22 from children and 25 from cattle) and three Cryptosporidium hominis from children were characterized by sequence analysis of the 60kDa glycoprotein (gp60) gene. Nine subtypes (two of C. hominis and seven of C. parvum) in four subtype families were identified. Cattle were mainly infected with C. parvum IIa subtypes and humans mostly with the C. parvum IIa and IId subtypes. Consequently, cattle could be a source of human infection with C. parvum IIa in Iran. However, the occurrence of subtype IId families in Iranian children, suggests that other infection sources might also be involved in C. parvum transmission. To our knowledge, this is the first published record and description of Cryptosporidium subtypes in Iran. |
Exposure to phthalates among premenstrual girls from rural and urban Gharbiah, Egypt: a pilot exposure assessment study
Colacino JA , Soliman AS , Calafat AM , Nahar MS , Van Zomeren-Dohm A , Hablas A , Seifeldin IA , Rozek LS , Dolinoy DC . Environ Health 2011 10 40 BACKGROUND: Phthalates have been identified as endocrine active compounds associated with developmental and reproductive toxicity. The exposure to phthalates in premenstrual Egyptian females remains unknown. The objective of this study was to characterize phthalate exposure of a potentially vulnerable population of premenstrual girls from urban and rural Egypt. MATERIALS AND METHODS: We collected one spot urine sample from 60 10-13 year old females, 30 from rural Egypt, and 30 from urban Egypt from July to October 2009. Samples were analyzed for 11 phthalate metabolites. Additionally, we collected anthropometrics as well as questionnaire data concerning food storage behaviors, cooking practices, and cosmetic use. Phthalate metabolite concentrations were compared between urban and rural Egyptians as well as to age and gender matched Americans. RESULTS: Monoethyl phthalate (MEP), was detected at the highest concentration in urine of Egyptian girls (median: 43.2 ng/mL in rural, 98.8 ng/mL in urban). Concentrations of urinary metabolites of di-(2-ethylhexyl) phthalate and dibutyl phthalate were comparable between Egyptians and age matched US girls. Storage of food in plastic containers was a statistically significant predictor of urinary mono-isobutyl phthalate (MiBP) concentrations when comparing covariate adjusted means. CONCLUSIONS: Urinary concentrations of phthalate metabolites were similar in Egyptian and US populations, suggesting that phthalate exposure also occurs in developing nations. Dietary intake is likely an important route of exposure to phthalates in both urban and rural populations. |
Assessing the quantitative relationships between preschool children's exposures to bisphenol A by route and urinary biomonitoring
Morgan MK , Jones PA , Calafat AM , Ye X , Croghan CW , Chuang JC , Wilson NK , Clifton MS , Figueroa Z , Sheldon LS . Environ Sci Technol 2011 45 (12) 5309-16 Limited published information exists on young children's exposures to bisphenol A (BPA) in the United States using urinary biomonitoring. In a previous project, we quantified the aggregate exposures of 257 preschool children to BPA in environmental and personal media over 48-h periods in 2000-2001 at homes and daycares in North Carolina and Ohio. In the present study for 81 Ohio preschool children ages 23-64 months, we quantified the children's urinary total BPA (free and conjugated) concentrations over these same 48-h periods in 2001. Then, we examined the quantitative relationships between the children's intakes doses of BPA through the dietary ingestion, nondietary ingestion, and inhalation routes and their excreted amounts of urinary BPA. BPA was detected in 100% of the urine samples. The estimated median intake doses of BPA for these 81 children were 109 ng/kg/day (dietary ingestion), 0.06 ng/kg/day (nondietary ingestion), and 0.27 ng/kg/day (inhalation); their estimated median excreted amount of urinary BPA was 114 ng/kg/day. Our multivariable regression model showed that dietary intake of BPA (p = 0.04) and creatinine concentration (p = 0.004) were significant predictors of urinary BPA excretion, collectively explaining 17% of the variability in excretion. Dietary ingestion of BPA accounted for >95% of the children's excreted amounts of urinary BPA. |
Use of the state immunization information system to assess rotavirus vaccine effectiveness in Connecticut, 2006-2008
Guh A , Hadler J . Vaccine 2011 29 (37) 6155-8 Immunization information systems (IIS) contain individual vaccination records and have potential use for evaluating post-licensure vaccine effectiveness (VE). A matched case-control study was performed by using the Connecticut state IIS to calculate rotavirus VE against hospitalization; results were compared with pre-licensure efficacy and with estimates previously obtained by traditional case-control methods using matched controls from medical sources and medical chart abstracted data. Case-patients (n=54) were vaccine-eligible children with IIS entry and hospitalized for rotavirus gastroenteritis during July 2006-December 2008; each was matched to five control subjects (n=270) who were randomly selected from IIS based on case-patient's birth date and town of residence. VE of at least one dose was 90.6%, comparable to the pre-licensure efficacy of 96% and to the unadjusted 83.5-90.7% estimates by using traditional case-control methods. IIS can be a convenient and potentially accurate tool for calculating VE. |
Deaths associated with bacterial pathogens transmitted commonly through food: Foodborne Diseases Active Surveillance Network (FoodNet), 1996-2005
Barton Behravesh C , Jones TF , Vugia DJ , Long C , Marcus R , Smith K , Thomas S , Zansky S , Fullerton KE , Henao OL , Scallan E . J Infect Dis 2011 204 (2) 263-7 BACKGROUND: Foodborne diseases are typically mild and self-limiting but can cause severe illness and death. We describe the epidemiology of deaths associated with bacterial pathogens using data from the Foodborne Diseases Active Surveillance Network (FoodNet) in the United States. METHODS: We analyzed FoodNet data from 1996-2005 to determine the numbers and rates of deaths occurring within 7-days of laboratory-confirmation. RESULTS: During 1996-2005, FoodNet ascertained 121,536 cases of laboratory-confirmed bacterial infections, including 552 (.5%) deaths, of which 215 (39%) and 168 (30%) were among persons infected with Salmonella and Listeria, respectively. The highest age-specific average annual population mortality rates were in older adults (≥65 years) for all pathogens except Shigella, for which the highest age-specific average annual population mortality rate was in children <5 years (.2/1 million population). Overall, most deaths (58%; 318) occurred in persons ≥65 years old. Listeria had the highest case fatality rate overall (16.9%), followed by Vibrio (5.8%), Shiga toxin-producing Escherichia coli O157 (0.8%), Salmonella (0.5%), Campylobacter (0.1%), and Shigella (0.1%). CONCLUSIONS: Salmonella and Listeria remain the leading causes of death in the United States due to bacterial pathogens transmitted commonly through food. Most such deaths occurred in persons ≥65 years old, indicating that this age group could benefit from effective food safety interventions. |
Associations between electronic media use and involvement in violence, alcohol and drug use among United States high school students
Denniston MM , Swahn MH , Hertz MF , Romero LM . West J Emerg Med 2011 12 (3) 310-5 OBJECTIVE: We identified associations between time spent watching television and time spent playing video or computer games or using computers and involvement in interpersonal violence, alcohol and drug use in a nationally representative sample of United States high school students. METHODS: We analyzed data from the 2007 national Youth Risk Behavior Survey. Exposure variables were time spent watching television and time spent playing computer or video games or using computers (hereafter denoted as "computer/video game use") on an average school day; outcome variables included multiple measures assessing involvement in violence and alcohol or drug use. Chi-square tests were used to identify statistically significant associations between each exposure variable and each of the outcome variables. We used logistic regression to obtain crude odds ratios for outcome variables with a significant chi-square p-value and to obtain adjusted odds ratios controlling for sex, race, and grade in school. RESULTS: Overall, 35.4% (95% CI=33.1%-37.7%) of students reported frequent television (TV) use and 24.9% (95% CI=22.9%-27.0%) reported frequent computer/video game use. A number of risk behaviors, including involvement in physical fights and initiation of alcohol use before age 13, were significantly associated with frequent TV use or frequent computer/video game use, even after controlling for sex, race/ethnicity and grade. CONCLUSION: Findings highlight the need for additional research to better understand the mechanisms by which electronic media exposure and health-risk behaviors are associated and for the development of strategies that seek to understand how the content and context (e.g., watching with peers, having computer in common area) of media use influence risk behaviors among youth. |
Transmission of hepatitis C virus during myocardial perfusion imaging in an outpatient clinic
Moore ZS , Schaefer MK , Hoffmann KK , Thompson SC , Xia GL , Lin Y , Khudyakov Y , Maillard JM , Engel JP , Perz JF , Patel PR , Thompson ND . Am J Cardiol 2011 108 (1) 126-32 Reports of health care-associated viral hepatitis transmission have been increasing in the United States. Transmission due to poor infection control practices during myocardial perfusion imaging (MPI) has not previously been reported. The aim of this study was to identify the source of incident hepatitis C virus (HCV) infection in a patient without identified risk factors who had undergone MPI 6 weeks before diagnosis. Practices at the cardiology clinic and nuclear pharmacy were evaluated, and HCV testing was performed in patients with shared potential exposures. Clinical and epidemiologic information was obtained for patients with HCV infection, and molecular testing was performed to assess viral relatedness. Evidence of HCV transmission among patients who had undergone MPI at the cardiology clinic on 2 separate dates was found, involving 2 potential source patients and a total of 5 newly infected patients. Molecular testing identified a high degree of genetic homology among viruses from patients with common procedure dates. The nuclear medicine technologist routinely drew up flush from multidose vials of saline solution using the same needle and syringe that had been used to administer radiopharmaceutical doses. Multipatient use of vials was not observed, but a review of purchasing invoices and interviews with staff members suggested that this had occurred. No evidence of transmission via contamination of radiopharmaceuticals at the nuclear pharmacy was found. In conclusion, transmission of HCV occurred because of unsafe injection practices during MPI. Cardiologists should carefully review their infection control practices and the practices of other staff members involved with these procedures. |
Modeling spatial accessibility to parks: a national study
Zhang X , Lu H , Holt JB . Int J Health Geogr 2011 10 31 BACKGROUND: Parks provide ideal open spaces for leisure-time physical activity and important venues to promote physical activity. The spatial configuration of parks, the number of parks and their spatial distribution across neighborhood areas or local regions, represents the basic park access potential for their residential populations. A new measure of spatial access to parks, population-weighted distance (PWD) to parks, combines the advantages of current park access approaches and incorporates the information processing theory and probability access surface model to more accurately quantify residential population's potential spatial access to parks. RESULTS: The PWD was constructed at the basic level of US census geography - blocks - using US park and population data. This new measure of population park accessibility was aggregated to census tract, county, state and national levels. On average, US residential populations are expected to travel 6.7 miles to access their local neighborhood parks. There are significant differences in the PWD to local parks among states. The District of Columbia and Connecticut have the best access to local neighborhood parks with PWD of 0.6 miles and 1.8 miles, respectively. Alaska, Montana, and Wyoming have the largest PWDs of 62.0, 37.4, and 32.8 miles, respectively. Rural states in the western and Midwestern US have lower neighborhood park access, while urban states have relatively higher park access. CONCLUSIONS: The PWD to parks provides a consistent platform for evaluating spatial equity of park access and linking with population health outcomes. It could be an informative evaluation tool for health professionals and policy makers. This new method could be applied to quantify geographic accessibility of other types of services or destinations, such as food, alcohol, and tobacco outlets. |
Approaching injury and violence prevention through public health policy: a window of opportunity to renew our focus
Degutis LC . West J Emerg Med 2011 12 (3) 271-2 As the new leader of the Centers for Disease Control and Prevention (CDC) National Center for Injury Prevention and Control, I am thrilled by the opportunity to comment on the future direction of the Injury Center, as well as the intersection of policy and injury prevention. As the cost of healthcare continues to rise and greater demands are placed on the healthcare system, the use of public health policy becomes increasingly critical to protect the public’s health and prevent injury and its related morbidities and disabilities. I am committed to advancing the Injury Center’s focus on policy strategies to ensure that each person has the opportunity to live life to its fullest potential through the creation of an environment that decreases injury risks and promotes safety. | I recently came to the CDC from Yale University, where I served as research director for the Department of Emergency Medicine at Yale School of Medicine and director of the Yale Center for Public Health Preparedness (YCPHP) at the Yale School of Public Health. During 1996–97, I served in Senator Paul Wellstone’s office as a Robert Wood Johnson Health Policy Fellow, and several years later, as the president of the American Public Health Association. These experiences, along with many others at the local, state and national levels throughout my career, have contributed to my understanding of the importance and success of policy initiatives in addressing the problem of injury and protecting the health of our nation. |
NLRX1 protein attenuates inflammatory responses to infection by interfering with the RIG-I-MAVS and TRAF6-NF-?B signaling pathways.
Allen IC , Moore CB , Schneider M , Lei Y , Davis BK , Scull MA , Gris D , Roney KE , Zimmermann AG , Bowzard JB , Ranjan P , Monroe KM , Pickles RJ , Sambhara S , Ting JP . Immunity 2011 34 (6) 854-65 The nucleotide-binding domain and leucine-rich-repeat-containing (NLR) proteins regulate innate immunity. Although the positive regulatory impact of NLRs is clear, their inhibitory roles are not well defined. We showed that Nlrx1(-/-) mice exhibited increased expression of antiviral signaling molecules IFN-beta, STAT2, OAS1, and IL-6 after influenza virus infection. Consistent with increased inflammation, Nlrx1(-/-) mice exhibited marked morbidity and histopathology. Infection of these mice with an influenza strain that carries a mutated NS-1 protein, which normally prevents IFN induction by interaction with RNA and the intracellular RNA sensor RIG-I, further exacerbated IL-6 and type I IFN signaling. NLRX1 also weakened cytokine responses to the 2009 H1N1 pandemic influenza virus in human cells. Mechanistically, Nlrx1 deletion led to constitutive interaction of MAVS and RIG-I. Additionally, an inhibitory function is identified for NLRX1 during LPS activation of macrophages where the MAVS-RIG-I pathway was not involved. NLRX1 interacts with TRAF6 and inhibits NF-kappaB activation. Thus, NLRX1 functions as a checkpoint of overzealous inflammation. |
Replication of the primary dog kidney-53 dengue 2 virus vaccine candidate in Aedes aegypti is modulated by a mutation in the 5' untranslated region and amino acid substitutions in nonstructural proteins 1 and 3
Brault AC , Kinney RM , Maharaj PD , Green EN , Reisen WK , Huang CY . Vector Borne Zoonotic Dis 2011 11 (6) 683-9 Previous studies have demonstrated reduced replication of the cell culture-adapted Dengue-2 virus (DENV-2) vaccine candidate, primary dog kidney (PDK)-53, compared with the parental DENV-2 strain, 16681, in C6/36 cells. Various DENV-2 mutants incorporating PDK-53 substitutions singly and in combination into the 16681 genetic backbone were used to identify the genetic basis for impaired replication of the vaccine candidate in vitro in Aedes aegypti cell culture (Aag2 cells) as well as the reduced in vivo infectivity and transmissibility within Ae. aegypti infected by intrathoracic inoculation. 5' untranslated region (UTR-c57t) and nonstructural protein 1 (NS1-G53D) mutations were required to completely attenuate in vitro replication. In contrast, incorporation of the PDK-53-specific NS3-250V mutation into the 16681 virus resulted in reduced replication in mosquitoes but had no effect on in vitro replication. Further, reversion of the PDK-53 NS3-250 site to that of the wild-type 16681 virus (NS3-V250E) failed to increase either in vitro or in vivo replication. Intrathoracic inoculation of Ae. aegypti with mutants containing the PDK-53 NS1 substitution exhibited in vivo replication indistinguishable from the parental PDK-53 virus, implicating this mutation as the dominant determinant for impaired mosquito replication of the PDK-53 candidate; however, further attenuation of in vivo replication was magnified in mutants including the additional 5'UTR-c57t mutation. |
Toll-like and adenosine receptor expression in injured skeletal muscle
Warren GL , Hulderman T , Liston A , Simeonova PP . Muscle Nerve 2011 44 (1) 85-92 INTRODUCTION: Many aspects of skeletal muscle regeneration are now considered to be controlled by the innate immune system, specifically macrophages, but the mechanisms for activation and modulation of the innate immune system during injury are not well understood. METHODS: We analyzed the expression of toll-like receptors (TLRs) and adenosine receptors during traumatic skeletal muscle injury. mRNA expression and immunostaining of these receptors were evaluated in mouse skeletal muscle injured by freezing. RESULTS: Expression of nearly all mammalian TLRs was induced at 1 and/or 3 days postinjury with a common trend for higher expression at day 3. Injury also elicited a dramatic increase in the expression of adenosine receptors A(2B) and A(3) but not A(1) and A(2A) . CONCLUSIONS: Both receptor types may be potential targets for stimulation of skeletal muscle tissue regeneration and functional restoration after injury. Muscle Nerve 44: 85-92, 2011. |
Monoclonal antibodies to hyphal exoantigens derived from the opportunistic pathogen, Aspergillus terreus
Nayak AP , Green BJ , Janotka E , Hettick JM , Friend S , Vesper SJ , Schmechel D , Beezhold DH . Clin Vaccine Immunol 2011 18 (9) 1568-76 A. terreus has been difficult to identify in cases of aspergillosis and clinical identification has been restricted to the broad identification of aspergillosis lesions in affected organs or the detection of fungal carbohydrates. As a result, there is a clinical need to identify species-specific biomarkers that can be used to detect invasive A. terreus disease. Monoclonal antibodies (mAbs) were developed to a partially purified preparation of cytolytic hyphal exoantigens (HEA) derived from A. terreus culture supernatant (CSN). Twenty-three IgG(1) isotype murine mAbs were developed and tested for cross reactivity against hyphal extracts of 54 fungal species. Sixteen mAbs were shown to be specific for A. terreus. HEA antigens were detected in conidia, hyphae and in CSN of A. terreus. HEA antigens were expressed in high levels in the hyphae during early stages of A. terreus growth at 37 degrees C, whereas at room temperature, the expression of HEA antigens peaked by day 4-5. Expression kinetics of HEA antigens in CSN showed a lag, with peak levels at later time points at RT and 37 degrees C compared to hyphal extracts. Serum spiking experiments demonstrated that human serum components do not inhibit detection of the HEA antigen epitopes by mAb ELISA. Immunoprecipitation and proteomic analysis demonstrated that mAbs 13E11 and 12C4 immunoprecipitated a putative uncharacterized leucine aminopeptidase (Q0CAZ7), while mAb 19B2 recognized a putative dipeptidyl-peptidase V (DPP5). Studies using Confocal laser scanning microscopy showed that the uncharacterized leucine aminopeptidase mostly localized to extracellular matrix structures, while dipeptidyl-peptidase V was mostly confined to the cytoplasm. |
Fatal Cokeromyces recurvatus pneumonia: report of a case highlighting the potential for histopathologic misdiagnosis as Coccidioides
Ryan LJ , Ferrieri P , Powell RD Jr , Paddock CD , Zaki SR , Pambuccian SE . Int J Surg Pathol 2011 19 (3) 373-6 Cokeromyces recurvatus is a dimorphic zygomycete with histologic morphology similar to Coccidioides immitis. A 66-year-old man who was status-post bone marrow transplantation for chronic myelogenous leukemia was hospitalized with new onset rash, nausea, and vomiting and subsequently expired. A sputum culture collected on the day of death revealed heavy growth of C. recurvatus 6 days after collection. At autopsy, microscopic examination of the lungs revealed numerous thick-walled, nonbudding spherules ranging in size from 40 to 80 microm. Initial immunohistochemical staining of the formalin-fixed lung tissue was positive for Coccidioides . Additional immunoperoxidase staining revealed the organisms were consistent with a zygomycete fungus, compatible with C. recurvatus infection. Polymerase chain reaction using panfungal primers was attempted on the formalin-fixed tissue but was inconclusive. This case highlights the potential for misdiagnosing Cokeromyces as Coccidioides when the diagnosis is based on histology and immunohistochemical staining. |
Induction of efflux-mediated macrolide resistance in Streptococcus pneumoniae
Chancey ST , Zhou X , Zahner D , Stephens DS . Antimicrob Agents Chemother 2011 55 (7) 3413-22 The antimicrobial efflux system encoded by the operon mef(E)-mel on the mobile genetic element MEGA in Streptococcus pneumoniae and other Gram-positive bacteria is inducible by macrolide antibiotics and antimicrobial peptides. Induction may affect the clinical response to the use of macrolides. We developed mef(E) reporter constructs and a disk diffusion induction and resistance assay to determine the kinetics and basis of mef(E)-mel induction. Induction occurred rapidly, with a >15-fold increase in transcription within 1 h of exposure to subinhibitory concentrations of erythromycin. A spectrum of environmental conditions, including competence and nonmacrolide antibiotics with distinct cellular targets, did not induce mef(E). Using 16 different structurally defined macrolides, induction was correlated with the amino sugar attached to C-5 of the macrolide lactone ring, not with the size (e.g., 14-, 15- or 16-member) of the ring or with the presence of the neutral sugar cladinose at C-3. Macrolides with a monosaccharide attached to C-5, known to block exit of the nascent peptide from the ribosome after the incorporation of up to eight amino acids, induced mef(E) expression. Macrolides with a C-5 disaccharide, which extends the macrolide into the ribosomal exit tunnel, disrupting peptidyl transferase activity, did not induce it. The induction of mef(E) did not require macrolide efflux, but the affinity of macrolides for the ribosome determined the availability for efflux and pneumococcal susceptibility. The induction of mef(E)-mel expression by inducing macrolides appears to be based on specific interactions of the macrolide C-5 saccharide with the ribosome that alleviate transcriptional attenuation of mef(E)-mel. |
25-hydroxyvitamin D concentration is inversely associated with serum MMP-9 in a cross-sectional study of African American ESRD patients
Wasse H , Cardarelli F , De Staercke C , Hooper C , Veledar E , Guessous I . BMC Nephrol 2011 12 24 BACKGROUND: Circulating 25-hydroxyvitamin D [25(OH)D] concentration is inversely associated with peripheral arterial disease and hypertension. Vascular remodeling may play a role in this association, however, data relating vitamin D level to specific remodeling biomarkers among ESRD patients is sparse. We tested whether 25(OH)D concentration is associated with markers of vascular remodeling and inflammation in African American ESRD patients. METHODS: We conducted a cross-sectional study among ESRD patients receiving maintenance hemodialysis within Emory University-affiliated outpatient hemodialysis units. Demographic, clinical and dialysis treatment data were collected via direct patient interview and review of patients records at the time of enrollment, and each patient gave blood samples. Associations between 25(OH)D and biomarker concentrations were estimated in univariate analyses using Pearson's correlation coefficients and in multivariate analyses using linear regression models. 25(OH) D concentration was entered in multivariate linear regression models as a continuous variable and binary variable (<15 ng/ml and ≥15 ng/ml). Adjusted estimate concentrations of biomarkers were compared between 25(OH) D groups using analysis of variance (ANOVA). Finally, results were stratified by vascular access type. RESULTS: Among 91 patients, mean (standard deviation) 25(OH)D concentration was 18.8 (9.6) ng/ml, and was low (<15 ng/ml) in 43% of patients. In univariate analyses, low 25(OH) D was associated with lower serum calcium, higher serum phosphorus, and higher LDL concentrations. 25(OH) D concentration was inversely correlated with MMP-9 concentration (r = -0.29, p = 0.004). In multivariate analyses, MMP-9 concentration remained negatively associated with 25(OH) D concentration (P = 0.03) and anti-inflammatory IL-10 concentration positively correlated with 25(OH) D concentration (P = 0.04). CONCLUSIONS: Plasma MMP-9 and circulating 25(OH) D concentrations are significantly and inversely associated among ESRD patients. This finding may suggest a potential mechanism by which low circulating 25(OH) D functions as a cardiovascular risk factor. |
Accuracy and precision of Legionella isolation by US laboratories in the ELITE program pilot study
Lucas CE , Taylor TH Jr , Fields BS . Water Res 2011 45 (15) 4428-36 A pilot study for the Environmental Legionella Isolation Techniques Evaluation (ELITE) Program, a proficiency testing scheme for US laboratories that culture Legionella from environmental samples, was conducted September 1, 2008 through March 31, 2009. Participants (n=20) processed panels consisting of six sample types: pure and mixed positive, pure and mixed negative, pure and mixed variable. The majority (93%) of all samples (n=286) were correctly characterized, with 88.5% of samples positive for Legionella and 100% of negative samples identified correctly. Variable samples were incorrectly identified as negative in 36.9% of reports. For all samples reported positive (n=128), participants underestimated the cfu/ml by a mean of 1.25 logs with standard deviation of 0.78 logs, standard error of 0.07 logs, and a range of 3.57 logs compared to the CDC re-test value. Centering results around the interlaboratory mean yielded a standard deviation of 0.65 logs, standard error of 0.06 logs, and a range of 3.22 logs. Sampling protocol, treatment regimen, culture procedure, and laboratory experience did not significantly affect the accuracy or precision of reported concentrations. Qualitative and quantitative results from the ELITE pilot study were similar to reports from a corresponding proficiency testing scheme available in the European Union, indicating these results are probably valid for most environmental laboratories worldwide. The large enumeration error observed suggests that the need for remediation of a water system should not be determined solely by the concentration of Legionella observed in a sample since that value is likely to underestimate the true level of contamination. |
Differential chitinase activity and production within Francisella species, subspecies, and subpopulations
Chandler JC , Molins CR , Petersen JM , Belisle JT . J Bacteriol 2011 193 (13) 3265-75 Genotyping of Francisella tularensis (A1a, A1b, A2, and type B) and Francisella novicida has identified multiple differences between species and among F. tularensis subspecies and subpopulations. Variations in virulence, geographic distribution, and ecology are also known to exist among this group of bacteria, despite the >95% nucleotide identity in their genomes. This study expands the description of phenotypic differences by evaluating the ability of F. tularensis and F. novicida to degrade chitin analogs and produce active chitinases. Endochitinase activities were observed to vary among F. tularensis and F. novicida strains. The activity observed for F. tularensis strains was predominantly associated with whole-cell lysates, while the chitinase activity of F. novicida localized to the culture supernatant. In addition, the overall level of chitinase activity differed among the subpopulations of F. tularensis and between the species. Bioinformatic analyses identified two new putative chitinase genes (chiC and chiD), as well as the previously described chiA and chiB. However, the presence of these four open reading frames as intact genes or pseudogenes was found to differ between Francisella species and F. tularensis subspecies and subpopulations. Recombinant production of the putative chitinases and enzymatic evaluations revealed ChiA, ChiB, ChiC, and ChiD possessed dissimilar chitinase activities. These biochemical studies coupled with bioinformatic analyses and the evaluation of chiA and chiC knockouts in F. tularensis A1 and A2 strains, respectively, provided a molecular basis to explain the differential chitinase activities observed among the species and subpopulations of Francisella. |
The contribution of chromosomal abnormalities to congenital heart defects: a population-based study.
Hartman RJ , Rasmussen SA , Botto LD , Riehle-Colarusso T , Martin CL , Cragan JD , Shin M , Correa A . Pediatr Cardiol 2011 32 (8) 1147-57 We aimed to assess the frequency of chromosomal abnormalities among infants with congenital heart defects (CHDs) in an analysis of population-based surveillance data. We reviewed data from the Metropolitan Atlanta Congenital Defects Program, a population-based birth-defects surveillance system, to assess the frequency of chromosomal abnormalities among live-born infants and fetal deaths with CHDs delivered from January 1, 1994, to December 31, 2005. Among 4430 infants with CHDs, 547 (12.3%) had a chromosomal abnormality. CHDs most likely to be associated with a chromosomal abnormality were interrupted aortic arch (type B and not otherwise specified; 69.2%), atrioventricular septal defect (67.2%), and double-outlet right ventricle (33.3%). The most common chromosomal abnormalities observed were trisomy 21 (52.8%), trisomy 18 (12.8%), 22q11.2 deletion (12.2%), and trisomy 13 (5.7%). In conclusion, in our study, approximately 1 in 8 infants with a CHD had a chromosomal abnormality. Clinicians should have a low threshold at which to obtain testing for chromosomal abnormalities in infants with CHDs, especially those with certain types of CHDs. Use of new technologies that have become recently available (e.g., chromosomal microarray) may increase the identified contribution of chromosomal abnormalities even further. |
Parenting aggravation and autism spectrum disorders: 2007 National Survey of Children's Health
Schieve LA , Boulet SL , Kogan MD , Yeargin-Allsopp M , Boyle CA , Visser SN , Blumberg SJ , Rice C . Disabil Health J 2011 4 (3) 143-52 BACKGROUND: Studies suggest autism spectrum disorders (ASDs) are associated with high parenting stress and aggravation. Research on specific risk factors is needed. OBJECTIVE/HYPOTHESES: To assess aggravation level among parents of children with and without ASDs. METHODS: The sample of 73,030 children aged 4 to 17 years in the 2007 National Survey of Children's Health and their parent respondents were divided into mutually exclusive groups based on child ASD status and other special health care needs. Adjusted prevalence ratios (aPR) for associations between a high Aggravation in Parenting scale score and various risk factors were computed from multivariable models. RESULTS: High-aggravation percentages were comparable for parents of children with a current ASD (36.6%), ASD reported previously but not currently (35.2%), and another (non-ASD) developmental problem (31.2%) but were significantly lower for parents of children with other special health care needs (6.5%) and no special health care needs (5.1%). Within the current-ASD group, high aggravation was associated with young child age (aPR = 1.8 [1.2-2.6]), lack of health insurance (aPR = 1.5 [1.0-2.4]), lack of a medical home (aPR = 2.2 [1.4-3.5]), recent child mental health treatment (aPR = 2.1 [1.5-3.0]), lack of parenting emotional support (aPR = 1.5 [1.1-2.1]), and ASD severity (aPR = 1.4 [1.0-1.6]). Some of these same factors were associated with aggravation in the non-ASD groups. However, the medical home finding was specific to the ASD groups. CONCLUSIONS: Parenting a child with ASD is associated with high aggravation; however, there is variability within health care and social support subgroups. Strategies to strengthen medical home components for children with ASDs should be considered. |
Birth outcomes of intended pregnancies among women who used assisted reproductive technology, ovulation stimulation, or no treatment
D'Angelo DV , Whitehead N , Helms K , Barfield W , Ahluwalia IB . Fertil Steril 2011 96 (2) 314-320 e2 OBJECTIVE: To study birth outcomes among live born infants conceived by women who used infertility treatment. DESIGN: Population-based surveillance of women who recently delivered a live infant. SETTING: The birth outcomes among infants whose mothers used assisted reproductive technology (ART) or ovulation stimulation medications alone were compared with the outcomes of infants conceived without treatment. PATIENT(S): Stratified random sample of women who were attempting conception and gave birth to a live infant in six US states (n = 16,748). INTERVENTION(S): Assisted reproductive technology and ovulation stimulation. MAIN OUTCOME MEASURE(S): Adjusted odds ratios for perinatal outcomes. RESULT(S): The prevalence of infertility treatment use overall among women attempting conception was 10.9% (5.4% ART procedures, 5.5% ovulation stimulation medications). Singletons of mothers who received ART procedures were more likely to be born with low birthweight, preterm, and small for gestational age (SGA) than singleton infants conceived without treatment. Singleton infants of mothers who used ovulation stimulation medications alone were more likely to be SGA than singleton infants conceived without treatment. No differences were found between ART and no treatment twin infants. CONCLUSION(S): Among singleton infants, ART is associated with decreased fetal growth, decreased gestational length, and SGA; ovulation stimulation alone is associated with SGA. |
Methane-air detonation experiments at NIOSH Lake Lynn Laboratory
Zipf Jr RK , Gamezo VN , Sapko MJ , Marchewka WP , Mohamed KM , Oran ES , Kessler DA , Weiss ES , Addis JD , Karnack FA , Sellers DD . J Loss Prev Process Ind 2011 26 (2) 295-301 The methane-air detonation experiments are performed to characterize high pressure explosion processes that may occur in sealed areas of underground coal mines. The detonation tube used for these studies is 73m long, 105cm internal diameter, and closed at one end. The test gas is 97.5% methane with about 1.5% ethane, and the methane-air test mixtures varied between 4% and 19% methane by volume. Detonations were successfully initiated for mixtures containing between 5.3% and 15.5% methane. The detonations propagated with an average velocity between 1512 and 1863m/s. Average overpressures recorded behind the first shock pressure peak varied between 1.2 and 1.7MPa. The measured detonation velocities and pressures are close to their corresponding theoretical Chapman-Jouguet (CJ) detonation velocity (DCJ) and detonation pressure (PCJ). Outside of these detonability limits, failed detonations produced decaying detached shocks and flames propagating with velocities of approximately 1/2 DCJ. Cell patterns on smokefoils during detonations were very irregular and showed secondary cell structures inside primary cells. The measured width of primary cells varied between 20cm near the stoichiometry and 105cm (tube diameter) near the limits. The largest detonation cell (105cm wide and 170cm long) was recorded for the mixture containing 15.3% methane. |
Lumbar spine bone mineral density in US adults: demographic patterns and relationship with femur neck skeletal status
Looker AC , Melton LJ 3rd , Borrud LG , Shepherd JA . Osteoporos Int 2011 23 (4) 1351-60 This analysis examines lumbar spine bone mineral density (BMD) of US adults from NHANES 2005-2008 by age, sex, and race/ethnicity. Prevalence of low spine BMD and agreement between the prevalence of low BMD at the spine and femur neck in older adults are also assessed. INTRODUCTION: Lumbar spine BMD data from a representative sample of the US population have not been previously available. METHODS: We used data from the National Health and Nutrition Examination Survey 2005-2008 to examine demographic patterns in lumbar spine BMD among US adults age ≥20 years and the prevalence of low lumbar spine BMD in adults age ≥50 years. Agreement between the prevalence of low BMD at the femur neck and spine in older adults was also assessed. Dual-energy X-ray absorptiometry was used to measure lumbar spine and femur neck BMD. World Health Organization definitions were used to categorize skeletal status as normal, osteopenia, or osteoporosis. RESULTS: Compared to non-Hispanic whites, non-Hispanic blacks had higher and Mexican Americans had lower lumbar spine BMD. Lumbar spine BMD declined with age in women, but not in men. Approximately 4.7 million (10%) older US women and 1 million (3%) older men had lumbar spine osteoporosis in 2005-2008. Roughly one third of them differed in skeletal status at the spine and hip but most were normal at one site and osteopenic at the other. Only 3-10%, depending on sex, had osteoporosis at one skeletal site but not at the other skeletal site. Between 76% and 87% with discordant skeletal status had lumbar spine T-scores within 1 unit of the category threshold. CONCLUSIONS: These findings suggest that measuring either the femur neck or the lumbar spine will correctly classify the majority of individuals who present for care as osteoporotic or not. |
Folate and vitamin B-12 biomarkers in NHANES: history of their measurement and use
Yetley EA , Johnson CL . Am J Clin Nutr 2011 94 (1) 322S-31S NHANES measured folate and vitamin B-12 status biomarkers, starting with serum folate from NHANES I (1974-1975) through 2010. Subsequent NHANES measured additional biomarkers [eg, red blood cell folate, serum vitamin B-12, total homocysteine (tHcy), methylmalonic acid, serum folic acid, and 5-methyltetrahydrofolic acid]. Examples of the uses of these data are wide ranging and include public policy applications, the derivation of reference intervals, and research. Periodically, the National Center for Health Statistics and its federal partners convene expert panels to review the use of the folate- and vitamin B-12-related biomarkers in NHANES. These panels have evaluated the need for results to be comparable across time and with published data and the use of crossover studies and adjustment equations to ensure comparability. With the recent availability of reference methods and materials for serum folate and tHcy, NHANES has started to use traceability approaches to enhance the accuracy and comparability of its results. A major user concern over the years has been the use of cutoffs to estimate the prevalence of inadequate folate and vitamin B-12 status. Because these cutoffs depend on the measurement procedure, several expert panels suggested approaches for dealing with cutoff challenges. This review summarizes the history and use of folate- and vitamin B-12-related biomarkers beginning with NHANES I (1974-1975) through 2010. |
Dietary behaviors related to cancer prevention among pre-adolescents and adolescents: the gap between recommendations and reality
Holman DM , White MC . Nutr J 2011 10 60 BACKGROUND: Diet is thought to play an important role in cancer risk. This paper summarizes dietary recommendations for cancer prevention and compares these recommendations to the dietary behaviors of U.S. youth ages 8-18. METHODS: We identified cancer prevention-related dietary recommendations from key health organizations and assessed dietary consumption patterns among youth using published statistics from the National Health and Nutrition Examination Survey, the national Youth Risk Behavior Survey, and other supplemental sources. RESULTS: Cancer prevention guidelines recommend a diet rich in fruits, vegetables, and whole grains, recommend limiting sugary foods and beverages, red and processed meats, sodium, and alcohol, and recommend avoiding foods contaminated with carcinogens. However, youth typically do not meet the daily recommendations for fruit, vegetable, or whole grain consumption and are over-consuming energy-dense, sugary and salty foods. CONCLUSIONS: A large discrepancy exists between expert recommendations about diet and cancer and actual dietary practices among young people and points to the need for more research to better promote the translation of science into practice. Future research should focus on developing and evaluating policies and interventions at the community, state and national levels for aligning the diets of youth with the evolving scientific evidence regarding cancer prevention. |
Impact of three biological decontamination methods on filtering facepiece respirator fit, odor, comfort, and donning ease
Viscusi DJ , Bergman MS , Novak DA , Faulkner KA , Palmiero A , Powell J , Shaffer RE . J Occup Environ Hyg 2011 8 (7) 426-36 The objective of this study was to determine if ultraviolet germicidal irradiation (UVGI), moist heat incubation (MHI), or microwave-generated steam (MGS) decontamination affects the fitting characteristics, odor, comfort, or donning ease of six N95 filtering facepiece respirator (FFR) models. For each model, 10 experienced test subjects qualified for the study by passing a standard OSHA quantitative fit test. Once qualified, each subject performed a series of fit tests to assess respirator fit and completed surveys to evaluate odor, comfort, and donning ease with FFRs that were not decontaminated (controls) and with FFRs of the same model that had been decontaminated. Respirator fit was quantitatively measured using a multidonning protocol with the TSI PORTACOUNT Plus and the N95 Companion accessory (designed to count only particles resulting from face to face-seal leakage). Participants' subjective appraisals of the respirator's odor, comfort, and donning ease were captured using a visual analog scale survey. Wilcoxon signed rank tests compared median values for fit, odor, comfort, and donning ease for each FFR and decontamination method against their respective controls for a given model. Two of the six FFRs demonstrated a statistically significant reduction (p < 0.05) in fit after MHI decontamination. However, for these two FFR models, post-decontamination mean fit factors were still ≥100. One of the other FFRs demonstrated a relatively small though statistically significant increase (p < 0.05) in median odor response after MHI decontamination. These data suggest that FFR users with characteristics similar to those in this study population would be unlikely to experience a clinically meaningful reduction in fit, increase in odor, increase in discomfort, or increased difficulty in donning with the six FFRs included in this study after UVGI, MHI, or MGS decontamination. Further research is needed before decontamination of N95 FFRs for purposes of reuse can be recommended. |
Respondent-driven sampling on the Thailand-Cambodia border. I. Can malaria cases be contained in mobile migrant workers?
Khamsiriwatchara A , Wangroongsarb P , Thwing J , Eliades J , Satimai W , Delacollette C , Kaewkungwal J . Malar J 2011 10 120 BACKGROUND: Reliable information on mobility patterns of migrants is a crucial part of the strategy to contain the spread of artemisinin-resistant malaria parasites in South-East Asia, and may also be helpful to efforts to address other public health problems for migrants and members of host communities. In order to limit the spread of malarial drug resistance, the malaria prevention and control programme will need to devise strategies to reach cross-border and mobile migrant populations. METHODOLOGY: The Respondent-driven sampling (RDS) method was used to survey migrant workers from Cambodia and Myanmar, both registered and undocumented, in three Thai provinces on the Thailand-Cambodia border in close proximity to areas with documented artemisinin-resistant malaria parasites. 1,719 participants (828 Cambodian and 891 Myanmar migrants) were recruited. Subpopulations of migrant workers were analysed using the Thailand Ministry of Health classification based on length of residence in Thailand of greater than six months (long-term, or M1) or less than six months (short-term, or M2). Key information collected on the structured questionnaire included patterns of mobility and migration, demographic characteristics, treatment-seeking behaviours, and knowledge, perceptions, and practices about malaria. RESULTS: Workers from Cambodia came from provinces across Cambodia, and 22% of Cambodian M1 and 72% of Cambodian M2 migrants had been in Cambodia in the last three months. Less than 6% returned with a frequency of greater than once per month. Of migrants from Cambodia, 32% of M1 and 68% of M2 were planning to return, and named provinces across Cambodia as their likely next destinations. Most workers from Myanmar came from Mon state (86%), had never returned to Myanmar (85%), and only 4% stated plans to return. CONCLUSION: Information on migratory patterns of migrants from Myanmar and Cambodia along the malaria endemic Thailand-Cambodian border within the artemisinin resistance containment zone will help target health interventions, including treatment follow-up and surveillance. |
Respondent-driven sampling on the Thailand-Cambodia border. II. Knowledge, perception, practice and treatment-seeking behaviour of migrants in malaria endemic zones
Wangroongsarb P , Satimai W , Khamsiriwatchara A , Thwing J , Eliades JM , Kaewkungwal J , Delacollette C . Malar J 2011 10 117 BACKGROUND: Population movements along the Thailand-Cambodia border, particularly among highly mobile and hard-to-access migrant groups from Cambodia and Myanmar, are assumed to play a key role in the spread of artemisinin resistance. Data on treatment-seeking behaviours, knowledge and perceptions about malaria, and use of preventive measures is lacking as characteristics of this population prevent them from being represented in routine surveillance and the lack of a sampling frame makes reliable surveys challenging. METHODS: A survey of migrant populations from Cambodia and Myanmar was implemented in five selected rural locations in Thailand along the Thai-Cambodian border using respondent driven sampling (RDS) to determine demographic characteristics of the population, migratory patterns, knowledge about malaria, and health-care -seeking behaviours. RESULTS: The majority of migrants from Myanmar are long-term residents (98%) with no plans to move back to Myanmar, understand spoken Thai (77%) and can therefore benefit from health messages in Thai, have Thai health insurance (99%) and accessed public health services in Thailand (63%) for their last illness. In comparison, the majority of Cambodian migrants are short-term (72%). Of the short-term Cambodian migrants, 92% work in agriculture, 18% speak Thai, 3.4% have Thai health insurance, and the majority returned to Cambodia for treatment (45%), self-treated (11%), or did not seek treatment for their last illness (27%). CONCLUSION: Most highly mobile migrants along the Thai-Cambodia border are not accessing health messages or health treatment in Thailand, increasing their risk of malaria and facilitating the spread of potentially resistant Plasmodium falciparum as they return to Cambodia to seek treatment. Reaching out to highly mobile migrants with health messaging they can understand and malaria diagnosis and treatment services they can access is imperative in the effort to contain the spread of artemisinin-resistant P. falciparum. |
Schistosomiasis: from drug deployment to drug development
Caffrey CR , Secor WE . Curr Opin Infect Dis 2011 24 (5) 410-7 PURPOSE OF REVIEW: Schistosomiasis is a chronic and morbid disease that affects hundreds of millions of the poorest individuals in (sub)tropical regions, particularly sub-Saharan Africa. Just one drug, praziquantel (PZQ), is available. As discussed, efforts to expand mass drug administration programs may accelerate the emergence of resistance. In addition, PZQ's peculiar pharmacological profile and undefined mechanism of action(s) complicate discriminating incomplete efficacy from true resistance. Accordingly, and in spite of the challenges associated with developing new antischistosomals as discussed herein, alternatives to PZQ should be identified. Various strategies to do this are highlighted here. RECENT FINDINGS: The last 2 years have witnessed more engagement of the necessary infrastructure combined with the application of the latest strategies and technologies to facilitate antischistosomal drug discovery. Preclinical and clinical evaluation of new chemistries has benefited from various consortia and institutions that underwrite drug development for antiparasitics in general. Drug repositioning, target-based drug design, improved automation for compound screening, genomics and functional genomics are just some of the tools now being applied to identify possible new drugs and drug targets. SUMMARY: The new momentum toward the discovery of alternatives to PZQ is encouraging but needs to be sustained by a stronger advocacy for drug development, in addition to drug deployment. |
Intermittent preventive treatment with sulfadoxine-pyrimethamine against malaria and anemia in pregnant women
Wilson NO , Ceesay FK , Obed SA , Adjei AA , Gyasi RK , Rodney P , Ndjakani Y , Anderson WA , Lucchi NW , Stiles JK . Am J Trop Med Hyg 2011 85 (1) 12-21 The effectiveness of intermittent preventive treatment during pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) against malaria and anemia is unclear because of the spread of SP-resistant Plasmodium falciparum. This study evaluates the effectiveness of IPTp-SP among pregnant women attending the antenatal clinic at Korle-Bu Teaching Hospital in Accra, Ghana. A cross-sectional study comparing malaria and anemia prevalence among pregnant women using IPTp-SP with non-IPTp-SP users was conducted during June-August 2009. A total of 363 pregnant women (202 of IPTp users and 161 non-IPTp users) were recruited. A total of 15.3% of IPTp users had malaria compared with 44.7% of non-IPTp users (P < 0.001). A total of 58.4% of non-IPTp users were anemic compared with 22.8% of IPTp users (P < 0.001). When we controlled for other variables, the difference in the prevalence of malaria (odds ratio = 0.18, 95% confidence interval = 0.08-0.37) and anemia (odds ratio = 0.20, 95% confidence interval = 0.12-0.34) remained significant. The recommended IPTp-SP regimen is useful in preventing malaria and anemia among pregnant women in Ghana. |
Utilization of HIV voluntary counseling and testing in Vietnam: an evaluation of 5 years of routine program data for national response
Hong NT , Wolfe MI , Dat TT , McFarland DA , Lamb ML , Thang NT , Thai HN , Del Rio C . AIDS Educ Prev 2011 23 30-48 This study evaluated the utilization of HIV voluntary counseling-and-testing (VCT) services targeting high-risk populations in Vietnam in order to inform decisions on program improvement and expansion. A total of 158,888 records collected from 55 VCT sites supported by the U.S. Centers for Disease Control and Prevention's Global AIDS Program in the period of 2002 to 2007 were used to analyze sociodemographic characteristics, risk exposures, seropositivity, test refusal, and failure to return for test results among VCT clients. High-risk exposures, such as injection drug use, commercial sex work, homosexual contacts or heterosexual contacts with high-risk sex partners, were reported in 126,815 (81%) records. Among high-risk clients, any condom use in the past month ranged from 34% to 71%. During the study period, 19% of the VCT encounters resulted in a positive HIV test; of those persons tested, 23% of men and 13% of women were HIV-positive. High HIV positivity rates were associated with injection drug use, being ill/recommended by health care provider, and having an HIV-infected sex partner. Of all records, 6.1% documented refusal of HIV testing. Failure to return for results was reported in 3.5% of records for clients who were tested. Previously testing positive was the strongest predictor of test refusal, and being referred by peer educators was associated with failure to return for results. The VCT program in Vietnam successfully targeted high-risk populations, and clients had high return rates using a standard testing strategy. Interventions to increase consistent condom use and promote access to prevention services among sex partners of high-risk individuals should be implemented and evaluated. |
Public health and clinical impact of increasing emergency department-based HIV testing: perspectives from the 2007 conference of the National Emergency Department HIV Testing Consortium
Kecojevic A , Lindsell CJ , Lyons MS , Holtgrave D , Torres G , Heffelfinger J , Brown J , Couture E , Jung J , Connell S , Rothman RE . Ann Emerg Med 2011 58 Suppl 1 S151-S159 e1 OBJECTIVE: Understanding perceived benefits and disadvantages of HIV testing in emergency departments (EDs) is imperative to overcoming barriers to implementation. We codify those domains of public health and clinical care most affected by implementing HIV testing in EDs, as determined by expert opinion. METHODS: Opinions were systematically collected from attendees of the 2007 National ED HIV Testing Consortium meeting. Structured evaluation of strengths, weaknesses, opportunities, and threats analysis was conducted to assess the impact of ED-based HIV testing on public health. A modified Delphi method was used to assess the impact of ED-based HIV testing on clinical care from both individual patient and individual provider perspectives. RESULTS: Opinions were provided by 98 experts representing 42 academic and nonacademic institutions. Factors most frequently perceived to affect public health were (strengths) high volume of ED visits and high prevalence of HIV, (weaknesses) undue burden on EDs, (opportunities) reduction of HIV stigma, and (threats) lack of resources in EDs. Diagnostic testing and screening for HIV were considered to have a favorable impact on ED clinical care from both individual patient and individual provider perspectives; however, negative test results were not perceived to have any benefit from the provider's perspective. The need for HIV counseling in the ED was considered to have a negative impact on clinical care from the provider's perspective. CONCLUSION: Experts in ED-based HIV testing perceived expanded ED HIV testing to have beneficial impacts for both the public health and individual clinical care; however, limited resources were frequently cited as a possible impediment. Many issues must be resolved through further study, education, and policy changes if the full potential of HIV testing in EDs is to be realized. |
HIV screening in an urban emergency department: comparison of screening using an opt-in versus an opt-out approach
White DA , Scribner AN , Vahidnia F , Dideum PJ , Gordon DM , Frazee BW , Voetsch AC , Heffelfinger JD . Ann Emerg Med 2011 58 Suppl 1 S89-95 OBJECTIVE: We compare outcomes of opt-in and opt-out HIV screening approaches in an urban emergency department. METHODS: This was a 1-year prospective observational study comparing 2 6-month screening approaches. Eligibility for opt-in and opt-out screening was identical: aged 15 years or older, medically stable, and able to complete general consent. During the opt-in phase, triage nurses referred patients to HIV testers stationed at triage, who obtained separate opt-in written consent and performed rapid oral fluid tests. During the opt-out phase, registration staff conducted integrated opt-out consent and then referred patients to HIV testers. We assessed the proportion of potentially eligible patients who were offered screening (screening offer rate), the proportion offered screening who accepted (screening acceptance rate), the proportion who accepted screening and subsequently completed testing (test completion rate), and the proportion of potentially eligible patients who completed testing (overall screening rate) during each phase. RESULTS: For the opt-in versus the opt-out phases, respectively, there were 23,236 potentially eligible patients versus 26,757, screening offer rate was 27.9% versus 75.8% (P<.001), screening acceptance rate was 62.7% versus 30.9% (P<.001), test completion rate was 99.8% versus 74.6% (P<.001), and overall screening rate was 17.4% versus 17.5% (P=.90). CONCLUSION: A significantly higher proportion of patients were offered HIV screening with an opt-out approach at registration. However, this was offset by much higher screening acceptance and test completion rates with the opt-in approach at triage. Overall screening rates with the 2 approaches were nearly identical. |
HIV screening programs in US emergency departments: a cross-site comparison of structure, process, and outcomes
Torres GW , Heffelfinger JD , Pollack HA , Barrera SG , Rothman RE . Ann Emerg Med 2011 58 Suppl 1 S104-13 OBJECTIVE: We present findings from a multisite evaluation that systematically compares HIV screening programs in 6 emergency departments (EDs). METHODS: From 2007 to 2008, we collected previous-year data on structural factors, process attributes, testing outcomes, and cost-effectiveness from 6 ED HIV testing programs operating for 6 months or longer. We administered questionnaires to program directors, conducted site visits, and interviewed key informants. RESULTS: HIV care providers (n=3 sites), emergency physicians (n=2), or health departments (n=1) initiated the testing programs. ED leadership and providers helped design and implement the programs (n=5), and emergency physicians or administrators provided daily oversight (n=5). Testing strategies included targeted (patients selected from at-risk populations; n=2), nontargeted (patients selected without regard to risk or intention of testing all; n=3), and universal (all patients selected; n=1) screening. Testing was conducted by supplemental staff (n=4) and existing hospital staff (n=2). ED testing programs were funded by grants (n=3), city HIV prevention/care budgets (n=2), or the hospital (n=1). The median percentage of census tested was 4.7% (range 2.1% to 8.4%). The median rate of preliminary positive test results was 1.2% (range 1.0% to 7.3%). The median confirmed new HIV diagnosis rate was 0.9% (range 0.8% to 6.4%). The median linkage to care rate was 92.0% (range 50% to 100%). The median cost per patient receiving a new diagnosis and linked to care was $10,200 (range $3,400 to $12,300). CONCLUSION: Although structure and process of screening programs varied across EDs, outcomes were similar, which suggests that with current ED environments, testing methods, and resources available, the capacity and structure to increase testing in EDs has limits. These ED HIV screening programs were cost-effective according to standard thresholds. |
Introduction to special supplement: monitoring and evaluation of HIV counseling, testing and referral (CTR) and HIV testing services
Stein R , Grimes TS , Malow R , Stratford D , Spielberg F , Holtgrave DR . AIDS Educ Prev 2011 23 1-6 The Centers for Disease Control and Prevention (CDC) estimate that 1.1 million people are living with HIV in the United States and approximately 56,000 new infections occur each year (CDC, 2008; Hall et al., 2008). By the end of 2006, an estimated 21% of people with HIV did not know that they were infected (calculated using extended back-calculation methods) (Campsmith et al., 2010). Many of those who do learn their serostatus are diagnosed in the late stages of the disease—approx-imately 38% of those who are diagnosed with HIV progress to AIDS within a year of their first positive HIV test. HIV transmission rates from persons who are aware of their seropositivity is approximately 3.3 compared to a rate of approximately 11.4 of those unaware of their seropositivity (Holtgrave, 2010). Furthermore, with high-quality care, a 25-year-old HIV-positive person can live an additional 39 years (Lohse, 2007). This information confirms the importance of routine HIV testing and early linkage to care for persons who test positive (CDC, 2009). |
Adverse childhood experiences and smoking status in five states
Ford ES , Anda RF , Edwards VJ , Perry GS , Zhao G , Li C , Croft JB . Prev Med 2011 53 (3) 188-93 OBJECTIVE: Our objective was to examine the associations between adverse childhood experiences (ACEs) and smoking behavior among a random sample of adults living in five U.S. states. METHODS: We used data from 25,809 participants of the 2009 Behavioral Risk Factor Surveillance System to assess the relationship of each of the 8 adverse childhood experiences and the adverse childhood experience score to smoking status. RESULTS AND CONCLUSIONS: Some 59.5% of men and women reported at least one adverse childhood experience. Each of the eight adverse childhood experiences measures was significantly associated with smoking status after adjustment for demographic variables. The prevalence ratios for current and ever smoking increased in a positive graded fashion as the adverse childhood experience score increased. Among adults who reported no adverse childhood experiences, 13.0% were currently smoking and 38.3% had ever smoked. Compared to participants with an adverse childhood experience score of 0, those with an adverse childhood experience score of 5 or more were more likely to be a current smoker (adjusted prevalence ratio (aPR): 2.22, 95% confidence interval [CI]: 1.92-2.57) and to have ever smoked (aPR: 1.80, 95% CI: 1.67-1.93). Further research is warranted to determine whether the prevention of and interventions for adverse childhood experiences might reduce the burden of smoking-related illness in the general population. |
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