NHF-McMaster guideline on care models for haemophilia management
Pai M , Key NS , Skinner M , Curtis R , Feinstein M , Kessler C , Lane SJ , Makris M , Riker E , Santesso N , Soucie JM , Yeung CH , Iorio A , Schunemann HJ . Haemophilia 2016 22 Suppl 3 6-16 This guideline was developed to identify evidence-based best practices in haemophilia care delivery, and discuss the range of care providers and services that are most important to optimize outcomes for persons with haemophilia (PWH) across the United States. The guideline was developed following specific methods described in detail in this supplement and based on the GRADE (Grading of Recommendations, Assessment, Development and Evaluation approach). Direct evidence from published literature and the haemophilia community, as well as indirect evidence from other chronic diseases, were reviewed, synthesized and applied to create evidence-based recommendations. The Guideline panel suggests that the integrated care model be used over non-integrated care models for PWH (conditional recommendation, moderate certainty in the evidence). For PWH with inhibitors and those at high risk for inhibitor development, the same recommendation was graded as strong, with moderate certainty in the evidence. The panel suggests that a haematologist, a specialized haemophilia nurse, a physical therapist, a social worker and round-the-clock access to a specialized coagulation laboratory be part of the integrated care team, over an integrated care team that does not include all of these components (conditional recommendation, very low certainty in the evidence). Based on available evidence, the integrated model of care in its current structure, is suggested for optimal care of PWH. There is a need for further appropriately designed studies that address unanswered questions about specific outcomes and the optimal structure of the integrated care delivery model in haemophilia. |
Overview of the obesity intervention taxonomy and pooled analysis working group
Belle SH , Stevens J , Cella D , Foltz JL , Loria CM , Murray DM , Czajkowski SM , Arteaga SS , Thom E , Pratt CA . Transl Behav Med 2016 6 (2) 244-59 The National Heart, Lung, and Blood Institute and the National Institutes of Health Office of Disease Prevention convened a meeting on August 29-30, 2013 entitled "Obesity Intervention Taxonomy and Pooled Analysis." The overarching goals of the meeting were to understand how to decompose interventions targeting behavior change, and in particular, those that focus on obesity and to combine data from groups of related intervention studies to supplement what can be learned from the individual studies. This paper summarizes the workshop recommendations and provides an overview of the two other papers that originated from the workshop and that address decomposition of behavioral change interventions and pooling of data across diverse studies within a consortium. |
Indoor tanning promotions on social media in six US cities #UVTanning #tanning
Ricklefs CA , Asdigian NL , Kalra HL , Mayer JA , Dellavalle RP , Holman DM , Crane LA . Transl Behav Med 2016 6 (2) 260-70 There is no research investigating indoor tanning advertising on social media. We assessed the use of social media to promote indoor tanning. We subscribed to social media platforms in six US cities and content-analyzed promotional messages received. We captured 662 messages on Twitter and Facebook, through salon emails, and in daily deal coupons. Salon postings were most frequent on Twitter and Facebook, with an average of 2-3 postings per week. National chains posted more frequently than local businesses. Forty percent of messages were devoid of tanning content and included photos, jokes, or popular references. Thirty percent mentioned price reductions, and 28 % referenced an upcoming holiday. Sunless tanning (17 %) was promoted more often than ultraviolet tanning (9 %). Tanning salons actively use social media as a strategy for maintaining relationships with customers and offer pricing deals that promote loyalty and high-frequency tanning. |
Care models in the management of haemophilia: A systematic review
Yeung CH , Santesso N , Pai M , Kessler C , Key NS , Makris M , Navarro-Ruan T , Soucie JM , Schunemann HJ , Iorio A . Haemophilia 2016 22 Suppl 3 31-40 BACKGROUND: Haemophilia care is commonly provided via multidisciplinary specialized management. To date, there has been no systematic assessment of the impact of haemophilia care delivery models on patient-important outcomes. OBJECTIVE: To conduct a systematic review of published studies assessing the effects of the integrated care model for persons with haemophilia (PWH). SEARCH METHODS: We searched MEDLINE, EMBASE and CINAHL up to April 22, 2015, contacted experts in the field, and reviewed reference lists. SELECTION CRITERIA: Randomized and non-randomized studies of PWH or carriers, focusing mainly on the assessment of care models on delivery. DATA COLLECTION AND ANALYSIS: Two investigators independently screened title, abstract, and full text of retrieved articles for inclusion. Risk of bias and overall quality of evidence was assessed using Cochrane's ACROBAT-NRSI tool and GRADE respectively. Relative risks, mean differences, proportions, and means and their variability were calculated as appropriate. RESULTS: 27 non-randomized studies were included: eight comparative and 19 non-comparative studies. We found low- to very low-quality evidence that in comparison to other models of care, integrated care may reduce mortality, hospitalizations and emergency room visits, may lead to fewer missed days of school and work, and may increase knowledge seeking. CONCLUSION: Our comprehensive review found low- to very low-quality evidence from a limited number of non-randomized studies assessing the impact of haemophilia care models on some patient-important outcomes. While the available evidence suggests that adoption of the integrated care model may provide benefit to PWH, further high-quality research in the field is needed. |
Response to emergence of Middle East respiratory syndrome coronavirus, Abu Dhabi, United Arab Emirates, 2013-2014
Al Hosani FI , Pringle K , Al Mulla M , Kim L , Pham H , Alami NN , Khudhair A , Hall AJ , Aden B , El Saleh F , Al Dhaheri W , Al Bandar Z , Bunga S , Abou Elkheir K , Tao Y , Hunter JC , Nguyen D , Turner A , Pradeep K , Sasse J , Weber S , Tong S , Whitaker BL , Haynes LM , Curns A , Gerber SI . Emerg Infect Dis 2016 22 (7) 1162-8 In January 2013, several months after Middle East respiratory syndrome coronavirus (MERS-CoV) was first identified in Saudi Arabia, Abu Dhabi, United Arab Emirates, began surveillance for MERS-CoV. We analyzed medical chart and laboratory data collected by the Health Authority-Abu Dhabi during January 2013-May 2014. Using real-time reverse transcription PCR, we tested respiratory tract samples for MERS-CoV and identified 65 case-patients. Of these patients, 23 (35%) were asymptomatic at the time of testing, and 4 (6%) showed positive test results for >3 weeks (1 had severe symptoms and 3 had mild symptoms). We also identified 6 clusters of MERS-CoV cases. This report highlights the potential for virus shedding by mildly ill and asymptomatic case-patients. These findings will be useful for MERS-CoV management and infection prevention strategies. |
Sexually transmitted infection services for adolescents and youth in low- and middle-income countries: Perceived and experienced barriers to accessing care
Newton-Levinson A , Leichliter JS , Chandra-Mouli V . J Adolesc Health 2016 59 (1) 7-16 PURPOSE: Access to sexual and reproductive health (SRH) services is vital for sexually active adolescents; yet, their SRH care needs are often unmet. METHODS: We conducted a qualitative systematic review of mixed methods studies to assess adolescent and provider views of barriers to seeking appropriate medical care for sexually transmitted infection (STI) services for adolescents. We searched peer-reviewed literature for studies published between 2001 and 2014 with a study population of youth (aged 10-24 years) and/or health service providers. Nineteen studies were identified for inclusion from 15 countries. Thematic analyses identified key themes across the studies. RESULTS: Findings suggest that youth lacked knowledge about STIs and services. In addition, youth experienced barriers related to service availability and a lack of integration of services. The most reported barriers were related to acceptability of services. Youth reported avoiding services or having confidentiality concerns based on provider demographics and some behaviors. Finally, experiences of shame and stigma were common barriers to seeking care. CONCLUSIONS: Adolescents in low- and middle-income countries experience significant barriers in obtaining STI and SRH services. Improving uptake may require efforts to address clinic systems and provider attitudes, including confidentiality issues. Moreover, addressing barriers to STI services may require addressing cultural norms related to adolescent sexuality. |
Middle East Respiratory Syndrome Coronavirus infection during pregnancy: A report of 5 cases from Saudi Arabia
Assiri A , Abedi GR , Almasry M , Bin Saeed A , Gerber SI , Watson JT . Clin Infect Dis 2016 63 (7) 951-3 Little is known about the effects of Middle East Respiratory Coronavirus (MERS-CoV) during pregnancy. In Saudi Arabia, five cases of MERS-CoV infection among pregnant women were reviewed and all cases resulted in adverse outcomes. MERS-CoV infection during pregnancy may be associated with maternal and perinatal morbidity and mortality. |
Mixed impact of Xpert((R)) MTB/RIF on tuberculosis diagnosis in Cambodia
Auld SC , Moore BK , Kyle RP , Eng B , Nong K , Pevzner ES , Eam KK , Eang MT , Killam WP . Public Health Action 2016 6 (2) 129-35 SETTING: National Tuberculosis (TB) Program sites in northwest Cambodia. OBJECTIVE: To evaluate the impact of Xpert((R)) MTB/RIF at point of care (POC) as compared to non-POC sites on the diagnostic evaluation of people living with the human immunodeficiency virus (PLHIV) with TB symptoms and patients with possible multidrug-resistant (MDR) TB. DESIGN: Observational cohort of patients undergoing routine diagnostic evaluation for TB following the rollout of Xpert. RESULTS: Between October 2011 and June 2013, 431 of 822 (52%) PLHIV with TB symptoms and 240/493 (49%) patients with possible MDR-TB underwent Xpert. Xpert was more likely to be performed when available as POC. A smaller proportion of PLHIV at POC sites were diagnosed with TB than at non-POC sites; however, at POC sites, a higher proportion of those diagnosed with TB were bacteriologically positive. There was poor agreement between Xpert and other tests such as smear microscopy and culture. Overall, the evaluation of patients with possible MDR-TB increased following Xpert rollout, yet for patients confirmed as having drug resistance on drug susceptibility testing, only 46% had rifampin resistance that would be identified with Xpert. CONCLUSION: Although utilization of Xpert was low, it may have contributed to an increase in evaluations for possible MDR-TB and a decline in empiric treatment for PLHIV when available as POC. |
A mixed outbreak of epidemic typhus fever and trench fever in a youth rehabilitation center: Risk factors for illness from a case-control study, Rwanda, 2012
Umulisa I , Omolo J , Muldoon KA , Condo J , Habiyaremye F , Uwimana JM , Muhimpundu MA , Galgalo T , Rwunganira S , Dahourou AG , Tongren E , Koama JB , McQuiston J , Raghunathan PL , Massung R , Gatei W , Boer K , Nyatanyi T , Mills EJ , Binagwaho A . Am J Trop Med Hyg 2016 95 (2) 452-6 In August 2012, laboratory tests confirmed a mixed outbreak of epidemic typhus fever and trench fever in a male youth rehabilitation center in western Rwanda. Seventy-six suspected cases and 118 controls were enrolled into an unmatched case-control study to identify risk factors for symptomatic illness during the outbreak. A suspected case was fever or history of fever, from April 2012, in a resident of the rehabilitation center. In total, 199 suspected cases from a population of 1,910 male youth (attack rate = 10.4%) with seven deaths (case fatality rate = 3.5%) were reported. After multivariate analysis, history of seeing lice in clothing (adjusted odds ratio [aOR] = 2.6, 95% confidence interval [CI] = 1.1-5.8), delayed (≥ 2 days) washing of clothing (aOR = 4.0, 95% CI = 1.6-9.6), and delayed (≥ 1 month) washing of beddings (aOR = 4.6, 95% CI = 2.0-11) were associated with illness, whereas having stayed in the rehabilitation camp for ≥ 6 months was protective (aOR = 0.20, 95% CI = 0.10-0.40). Stronger surveillance and improvements in hygiene could prevent future outbreaks. |
Policies for controlling multidrug-resistant organisms in US healthcare facilities reporting to the National Healthcare Safety Network, 2014
Weiner LM , Webb AK , Walters MS , Dudeck MA , Kallen AJ . Infect Control Hosp Epidemiol 2016 37 (9) 1-4 We examined reported policies for the control of common multidrug-resistant organisms (MDROs) in US healthcare facilities using data from the National Healthcare Safety Network Annual Facility Survey. Policies for the use of Contact Precautions were commonly reported. Chlorhexidine bathing for preventing MDRO transmission was also common among acute care hospitals. |
Progress towards polio eradication worldwide, 2015-2016
Morales M , Tangermann RH , Wassilak SGF . Wkly Epidemiol Rec 2016 91 (19) 250-6 In 1988, the World Health Assembly resolved to eradicate poliomyelitis. Following the removal of Nigeria | from the list of polio-endemic countries in September | 2015, wild poliovirus (WPV) transmission currently | persists in only 2 countries – Afghanistan and Pakistan. Indigenous WPV type 2 (WPV2)_has not been detected | since 1999 and was declared eradicated by the Global | Commission for the Certification of Poliomyelitis Eradication (GCC) in September 2015.1 | Since November 2012, | when the last case of WPV type 3 (WPV3) was detected | in Nigeria,2 | WPV type 1 (WPV1) has been the only | circulating type of WPV |
Qualifications, demographics, satisfaction, and future capacity of the HIV care provider workforce in the United States, 2013-2014
Weiser J , Beer L , West BT , Duke CC , Gremel GW , Skarbinski J . Clin Infect Dis 2016 63 (7) 966-975 BACKGROUND: The U.S. HIV-infected population is increasing by about 30,000 annually (new infections minus deaths). With improvements in diagnosis and engagement in care, additional qualified HIV care providers may be needed. METHODS: We surveyed a probability sample of 2,023 U.S. HIV care providers in 2013-2014, including those at Ryan White HIV/AIDS Program (RWHAP)-funded facilities and in private practices. We estimated future patient care capacity by comparing counts of providers entering and planning to leave practice within five years, and the number of patients under their care. RESULTS: Of surveyed providers, 1,234 responded (adjusted response rate, 64%): 63% were white, 11% black, 11% Hispanic, and 16% other race/ethnicity; 37% were satisfied/very satisfied with salary/reimbursement, 33% were satisfied/very satisfied with administrative time. Compared to providers in private practice, more providers at RWHAP-funded facilities were HIV specialists (71% vs. 43%, p<.0001) and planned to leave HIV practice within five years (11% vs 4%, p=.0004). An estimated 190 more full-time equivalent (FTE) providers (defined as 40 HIV clinical care hours per week) entered practice in the past five years than expected to leave in the next five years. If these rates continue, by 2019 patient care capacity will increase by 65,000, compared to an increased requirement of at least 100,000. CONCLUSIONS: Projected workforce growth by 2019 will not accommodate the increased number of HIV-infected persons requiring care. RWHAP-funded facilities may face attrition of highly-qualified providers. Dissatisfaction with salary/reimbursement and administrative burden is substantial and black and Hispanic providers are underrepresented relative to HIV patients. |
Engaging private providers and Ayurvedic practitioners in Bilaspur, India: Did it increase TB case detection?
Bhardwaj RR , Oeltmann JE , Ravichandra C , Chadda VK , Das M , Kumar AM . Public Health Action 2016 6 (2) 154-6 To find 'missing' tuberculosis (TB) cases, in November 2014 we trained private practitioners (PPs) and Ayurvedic practitioners (APs; Indian system of medicine) in Bilaspur district, India, to identify patients with presumptive TB and refer them to sputum microscopy centres. To reinforce this training, we sent weekly text message reminders during January-March 2015. All 50 APs and 23 of 29 PPs participated. The number of patients with presumptive TB referred by the PPs and APs increased from 38 (January-March 2014) to 104 (January-March 2015), and the number of smear-positive TB patients diagnosed increased from 5 to 16, a 220% increase. While the intervention increased the number of referrals, it did not impact case detection at district level, due to the short duration of the intervention and the non-dominant private sector. |
Kinetic analysis of biomarkers in a cohort of US patients with Ebola virus disease
McElroy AK , Harmon JR , Flietstra TD , Campbell S , Mehta AK , Kraft CS , Lyon MG , Varkey JB , Ribner BS , Kratochvil CJ , Iwen PC , Smith PW , Ahmed R , Nichol ST , Spiropoulou CF . Clin Infect Dis 2016 63 (4) 460-7 BACKGROUND: Ebola virus (EBOV) infection causes a severe and often fatal disease. Despite the fact that more than 30 000 individuals have acquired Ebola virus disease (EVD), the medical and scientific community still does not have a clear understanding of the mechanisms by which EBOV causes such severe disease. METHODS: In this study, 54 biomarkers in plasma samples serially collected from 7 patients with EVD were analyzed in an attempt to define the kinetics of inflammatory modulators. Two clinical disease groups were defined (moderate and severe) based on the need for clinical support. Biomarkers were evaluated for correlation with viremia and clinical disease in an effort to identify pathways that could be useful targets of therapeutic intervention. RESULTS: Patients with severe disease had higher viremia than those with moderate disease. Several biomarkers of immune activation and control were significantly elevated in patients with moderate disease. A series of pro-inflammatory cytokines and chemokines were significantly elevated in patients with severe disease. CONCLUSIONS: Biomarkers that were associated with severe EVD were proinflammatory and indicative of endothelial or coagulation cascade dysfunction, as has been seen historically in patients with fatal outcomes. In contrast, biomarkers that were associated with moderate EVD were suggestive of a strong interferon response and control of both innate and adaptive responses. Therefore, clinical interventions that modulate the phenotype and magnitude of immune activation may be beneficial in treating EVD. |
Discovery and description of Ebola Zaire virus in 1976 and relevance to the West African epidemic during 2013-2016
Breman JG , Heymann DL , Lloyd G , McCormick JB , Miatudila M , Murphy FA , Muyembe-Tamfun JJ , Piot P , Ruppol JF , Sureau P , van der Groen G , Johnson KM . J Infect Dis 2016 214 S93-S101 BACKGROUND: In 1976, the first cases of Ebola virus disease in northern Democratic Republic of the Congo (then referred to as Zaire) were reported. This article addresses who was responsible for recognizing the disease; recovering, identifying, and naming the virus; and describing the epidemic. Key scientific approaches used in 1976 and their relevance to the 3-country (Guinea, Sierra Leone, and Liberia) West African epidemic during 2013-2016 are presented. METHODS: Field and laboratory investigations started soon after notification, in mid-September 1976, and included virus cell culture, electron microscopy (EM), immunofluorescence antibody (IFA) testing of sera, case tracing, containment, and epidemiological surveys. In 2013-2016, medical care and public health work were delayed for months until the Ebola virus disease epidemic was officially declared an emergency by World Health Organization, but research in pathogenesis, clinical presentation, including sequelae, treatment, and prevention, has increased more recently. RESULTS: Filoviruses were cultured and observed by EM in Antwerp, Belgium (Institute of Tropical Medicine); Porton Down, United Kingdom (Microbiological Research Establishment); and Atlanta, Georgia (Centers for Disease Control and Prevention). In Atlanta, serological testing identified a new virus. The 1976 outbreak (280 deaths among 318 cases) stopped in <11 weeks, and basic clinical and epidemiological features were defined. The recent massive epidemic during 2013-2016 (11 310 deaths among 28 616 cases) has virtually stopped after >2 years. Transmission indices (R0) are higher in all 3 countries than in 1976. CONCLUSIONS: An international commission working harmoniously in laboratories and with local communities was essential for rapid success in 1976. Control and understanding of the recent West African outbreak were delayed because of late recognition and because authorities were overwhelmed by many patients and poor community involvement. Despite obstacles, research was a priority in 1976 and recently. |
Durable viral suppression and transmission risk potential among persons with diagnosed HIV infection: United States, 2012-2013
Crepaz N , Tang T , Marks G , Mugavero MJ , Espinoza L , Hall HI . Clin Infect Dis 2016 63 (7) 976-83 BACKGROUND: To examine durable viral suppression, cumulative viral load (VL) burden, and transmission risk potential among HIV-diagnosed persons in care. METHODS: Using data from the National HIV Surveillance System from 17 jurisdictions with complete reporting of VL test results, we determined the percentage of persons in HIV care who achieved durable viral suppression (all VL results <200 copies/mL) and examined viremia copy-years and time spent above VL levels that increase the risk of HIV transmission during 2012-2013. RESULTS: Of 265,264 persons in HIV care in 2011, 238,641 had at least two VLs in 2012-2013. The median number of VLs per individual during the 2-year period was five. Approximately 62% had durable viral suppression. The remaining 38% had high VL burden (geometric mean of viremia copy-years: 7,261) and spent an average of 438 days, 316 days, and 215 days (60%, 43.2%, and 29.5% of the 2-year time) above 200, 1,500, and 10,000 copies/mL. Women, blacks/African Americans, Hispanics/Latinos, persons with HIV infection attributed to transmission other than male-to-male sexual contact, younger age groups, and persons with gaps in care had higher viral burden and transmission risk potential. CONCLUSIONS: Two-thirds of persons in HIV care had durable viral suppression during a 2-year period. One-third had high VL burden and spent substantial time above VL levels with increased risk of onward transmission. More intervention efforts are needed to improve retention in care and medication adherence so that more persons in HIV care achieve durable viral suppression. |
Notes from the field: Four multistate outbreaks of human Salmonella infections linked to small turtle exposure - United States, 2015
Gambino-Shirley K , Stevenson L , Wargo K , Burnworth L , Roberts J , Garrett N , Van Duyne S , McAllister G , Nichols M . MMWR Morb Mortal Wkly Rep 2016 65 (25) 655-6 In August 2015, the Food and Drug Administration (FDA) notified CDC of a consumer complaint involving Salmonella Sandiego infection in a child (the index patient), who had acquired a small turtle (shell length <4 inches [<10 cm]) at an Alabama flea market. The subsequent investigation, which included examining data from PulseNet, the national molecular subtyping network for foodborne disease surveillance, identified four multistate Salmonella outbreaks: two involving Salmonella Sandiego and two involving Salmonella Poona. These serotypes have been linked to small turtles in previous outbreaks. Although selling small turtles as pets in the United States has been banned since 1975, illegal sales still occur at discount stores and flea markets and by street vendors. CDC investigated to determine the extent of the outbreaks and prevent additional infections. |
Design for mosquito abundance, diversity, and phenology sampling within the National Ecological Observatory Network
Hoekman D , Springer YP , Barker CM , Barrera R , Blackmore MS , Bradshaw WE , Foley DH , Ginsberg HS , Hayden MH , Holzapfel CM , Juliano SA , Kramer LD , LaDeau SL , Livdahl TP , Moore CG , Nasci RS , Reisen WK , Savage HM . Ecosphere 2016 7 (5) e01320 The National Ecological Observatory Network (NEON) intends to monitor mosquito populations across its broad geographical range of sites because of their prevalence in food webs, sensitivity to abiotic factors, and relevance for human health. We describe the design of mosquito population sampling in the context of NEON's long-term continental scale monitoring program, emphasizing the sampling design schedule, priorities, and collection methods. Freely available NEON data and associated field and laboratory samples, will increase our understanding of how mosquito abundance, demography, diversity, and phenology are responding to land use and climate change. |
Prenatal exposure to perfluoroalkyl substances and adiposity in early and mid-childhood
Mora AM , Oken E , Rifas-Shiman SL , Webster TF , Gillman MW , Calafat AM , Ye X , Sagiv SK . Environ Health Perspect 2016 125 (3) 467-473 BACKGROUND: Few studies have examined whether prenatal exposure to perfluoroalkyl substances (PFASs) is associated with childhood adiposity. OBJECTIVE: To examine associations of prenatal exposure to PFASs with adiposity in early and mid-childhood. METHODS: We measured plasma PFAS concentrations in 1,645 pregnant women (median = 9.6 weeks gestation) enrolled in Project Viva, a prospective pre-birth cohort study in Massachusetts, U.S., between 1999 and 2002. We assessed overall and central adiposity in 1,006 children in early childhood (median = 3.2 years) and 876 in mid-childhood (median = 7.7 years) using anthropometric and dual X-ray absorptiometry (DXA) measurements. We fitted mu33ltivariable linear regression models to estimate exposure-outcome associations and evaluated effect modification by child sex. RESULTS: Median (25-75th percentiles) prenatal plasma perfluorooctanoate (PFOA), perfluorooctane sulfonate (PFOS), perfluorohexane sulfonate (PFHxS), and perfluorononanoate (PFNA) concentrations in children assessed in early childhood were 5.6 (4.1-7.7), 24.8 (18.4-33.9), 2.4 (1.6-3.8), and 0.6 (0.5-0.9) ng/mL, respectively. Among girls, each interquartile increment of prenatal PFOA concentrations was associated with 0.21 kg/m2 (95% CI: -0.05, 0.48) higher body mass index, 0.76 mm (95% CI: -0.17, 1.70) higher sum of subscapular and triceps skinfold thickness, and 0.17 kg/m2 (95% CI: -0.02, 0.36) higher DXA total fat mass index in mid-childhood. Similar associations were observed for PFOS, PFHxS, and PFNA. We observed null associations for boys and early-childhood adiposity measures. CONCLUSIONS: In this cohort, prenatal exposure to PFASs was associated with small increases in adiposity measurements in mid-childhood, but only among girls. |
Blood lead levels among children aged <6 years - Flint, Michigan, 2013-2016
Kennedy C , Yard E , Dignam T , Buchanan S , Condon S , Brown MJ , Raymond J , Rogers HS , Sarisky J , de Castro R , Arias I , Breysse P . MMWR Morb Mortal Wkly Rep 2016 65 (25) 650-4 During April 25, 2014-October 15, 2015, approximately 99,000 residents of Flint, Michigan, were affected by changes in drinking water quality after their water source was switched from the Detroit Water Authority (DWA), sourced from Lake Huron, to the Flint Water System (FWS), sourced from the Flint River.* Because corrosion control was not used at the FWS water treatment plant, the levels of lead in Flint tap water increased over time. Adverse health effects are associated with lead exposure (1). On January 2, 2015, a water advisory was issued because of detection of high levels of trihalomethanes, byproducts of disinfectants.(dagger)(,)( section sign) Studies conducted by local and national investigators detected an increase in the prevalence of blood lead levels (BLLs) ≥5 microg/dL (the CDC reference level) among children aged <5 years living in Flint (2) and an increase in water lead levels after the water source switch (3). On October 16, 2015, the Flint water source was switched back to DWA, and residents were instructed to use filtered tap water for cooking and drinking. During that time, pregnant and breastfeeding women and children aged <6 years were advised to consume bottled water.( paragraph sign) To assess the impact on BLLs of consuming contaminated drinking water, CDC examined the distribution of BLLs ≥5 microg/dL among children aged <6 years before, during, and after the switch in water source. This analysis enabled determination of whether the odds of having BLLs ≥5 microg/dL before the switch differed from the odds during the switch to FWS (before and after the January 2, 2015, water advisory was issued), and after the switch back to DWA. Overall, among 9,422 blood lead tests in children aged <6 years, 284 (3.0%) BLLs were ≥5 microg/dL during April 25, 2013-March 16, 2016. The adjusted probability of having BLLs ≥5 microg/dL was 46% higher during the period after the switch from DWA to FWS (and before the January 2, 2015, water advisory) than during the period before the water switch to FWS. Although unrelated to lead in the water, the water advisory likely reduced tap water consumption and increased consumption of bottled water. Characterizing exposure to lead contaminated drinking water among children aged <6 years living in Flint can help guide appropriate interventions. |
Communicating results of a dietary exposure study following consumption of traditionally smoked salmon
Rohlman D , Frey G , Kile ML , Harper B , Harris S , Motorykin O , Simonich SLM , Harding AK . Environ Justice 2016 9 (3) 85-92 One expectation of community-based participatory research (CBPR) is participant access to study results. However, reporting experimental data produced by studies involving biological measurements in the absence of clinical relevance can be challenging to scientists and participants. We applied best practices in data sharing to report the results of a study designed to explore polycyclic aromatic hydrocarbons absorption, metabolism, and excretion following consumption of traditionally smoked salmon by members of the Confederated Tribes of the Umatilla Indian Reservation (CTUIR). A dietary exposure study was developed, in which nine Tribal members consumed 50 g of traditionally smoked salmon and provided repeated urine samples over 24 hours. During recruitment, participants requested access to their data following analysis. Disclosing data is an important element of CBPR and must be treated with the same rigor as that given to the data analysis. The field of data disclosure is relatively new, but when handled correctly can improve education within the community, reduce distrust, and enhance environmental health literacy. Using the results from this study, we suggest mechanisms for sharing data with a Tribal community. |
Genome Sequence of Vaccinia virus Strain Lister-Butantan, a Lister Vaccine Variant Used during a Smallpox Eradication Campaign in Brazil.
Assis F , Trindade G , Drumond B , Frace M , Sammons S , Emerson G , Li Y , Carroll D , Batra D , Abrahao J , Kroon E . Genome Announc 2016 4 (3) Here, we report the 187.8-kb genome sequence of Vaccinia virus Lister-Butantan, which was used in Brazil during the WHO smallpox eradication campaign. Its genome showed an average similarity of 98.18% with the original Lister isolate, highlighting the low divergence among related Vaccinia virus vaccine strains, even after several passages in animals and cell culture. |
National surveillance of health care-associated infections in Egypt: Developing a sustainable program in a resource-limited country
Talaat M , El-Shokry M , El-Kholy J , Ismail G , Kotb S , Hafez S , Attia E , Lessa FC . Am J Infect Control 2016 44 (11) 1296-1301 BACKGROUND: Health care-associated infections (HAIs) are a major global public health concern. The lack of surveillance systems in developing countries leads to an underestimation of the global burden of HAI. We describe the process of developing a national HAI surveillance program and the magnitude of HAI rates in Egypt. METHODS: The detailed process of implementation of a national HAI surveillance program is described. A 3-phase surveillance approach was implemented in intensive care units (ICUs). This article focuses on results from the phase 2 surveillance. Standard surveillance definitions were used, clinical samples were processed by the hospital laboratories, and results were confirmed by a reference laboratory. RESULTS: Ninety-one ICUs in 28 hospitals contributed to 474,544 patient days and 2,688 HAIs. Of these, 30% were bloodstream infections, 29% were surgical site infections, 26% were pneumonia, and 15% were urinary tract infections. Ventilator-associated pneumonia had the highest incidence of device-associated infections (4.3/1,000 ventilator days). The most common pathogens reported were Klebsiella spp (28.7%) and Acinetobacter spp (13.7%). Of the Acinetobacter spp, 92.8% (157/169) were multidrug resistant, whereas 42.5% (151/355) of the Klebsiella spp and 54% (47/87) of Escherichia coli were extended-spectrum beta-lactamase producers. CONCLUSIONS: Implementation of a sustainable surveillance system in a resource-limited country was possible following a stepwise approach with continuous evaluation. Enhancing infection prevention and control programs should be an infection control priority in Egypt. |
Transmission of Balamuthia mandrillaris by organ transplantation
Farnon EC , Kokko K , Budge PJ , Mbaeyi C , Lutterloh E , Qvarnstrom Y , da Silva AJ , Shieh WJ , Roy S , Paddock CD , Sriram R , Zaki SR , Visvesvara G , Kuehnert MJ . Clin Infect Dis 2016 63 (7) 878-888 BACKGROUND: During 2009 and 2010, two clusters of organ transplant-transmitted Balamuthia mandrillaris, a free-living ameba, were detected by recognition of severe unexpected illness in multiple recipients from the same donor. METHODS: We investigated all recipients and the two donors through interview, medical record review, and testing of available specimens retrospectively. Surviving recipients were tested and treated prospectively. RESULTS: In the 2009 cluster of illness, two kidney recipients were infected and one died. The donor had Balamuthia encephalitis confirmed on autopsy. In the 2010 cluster, the liver and kidney-pancreas recipients developed Balamuthia encephalitis and died. The donor had a clinical syndrome consistent with Balamuthia infection and serologic evidence of infection. In both clusters, the two asymptomatic recipients were treated expectantly and survived; one asymptomatic recipient in each cluster had serologic evidence of exposure that decreased over time. Both donors had been presumptively diagnosed with other neurologic diseases prior to organ procurement. CONCLUSIONS: Balamuthia can be transmitted through organ transplantation with an observed incubation time of 17-24 days. Clinicians should be aware of Balamuthia as a cause of encephalitis with high rate of fatality, and should notify public health and evaluate transplant recipients from donors with signs of possible encephalitis to facilitate early diagnosis and targeted treatment. Organ procurement organizations and transplant centers should be aware of the potential for Balamuthia infection in donors with possible encephalitis and also assess donors carefully for signs of neurologic infection that may have been misdiagnosed as stroke or as non-infectious forms of encephalitis. |
Unique safety issues associated with virus-vectored vaccines: Potential for and theoretical consequences of recombination with wild type virus strains.
Condit RC , Williamson AL , Sheets R , Seligman SJ , Monath TP , Excler JL , Gurwith M , Bok K , Robertson JS , Kim D , Michael Hendry R , Singh V , Mac LM , Chen RT . Vaccine 2016 34 (51) 6610-6616 In 2003 and 2013, the World Health Organization convened informal consultations on characterization and quality aspects of vaccines based on live virus vectors. In the resulting reports, one of several issues raised for future study was the potential for recombination of virus-vectored vaccines with wild type pathogenic virus strains. This paper presents an assessment of this issue formulated by the Brighton Collaboration. To provide an appropriate context for understanding the potential for recombination of virus-vectored vaccines, we review briefly the current status of virus-vectored vaccines, mechanisms of recombination between viruses, experience with recombination involving live attenuated vaccines in the field, and concerns raised previously in the literature regarding recombination of virus-vectored vaccines with wild type virus strains. We then present a discussion of the major variables that could influence recombination between a virus-vectored vaccine and circulating wild type virus and the consequences of such recombination, including intrinsic recombination properties of the parent virus used as a vector; sequence relatedness of vector and wild virus; virus host range, pathogenesis and transmission; replication competency of vector in target host; mechanism of vector attenuation; additional factors potentially affecting virulence; and circulation of multiple recombinant vectors in the same target population. Finally, we present some guiding principles for vector design and testing intended to anticipate and mitigate the potential for and consequences of recombination of virus-vectored vaccines with wild type pathogenic virus strains. |
A longitudinal hepatitis B vaccine cohort demonstrates long-lasting hepatitis B virus (HBV) cellular immunity despite loss of antibody against HBV surface antigen
Simons BC , Spradling PR , Bruden DJ , Zanis C , Case S , Choromanski TL , Apodaca M , Brogdon HD , Dwyer G , Snowball M , Negus S , Bruce MG , Morishima C , Knall C , McMahon BJ . J Infect Dis 2016 214 (2) 273-80 BACKGROUND: Long-lasting protection resulting from hepatitis B vaccine, despite loss of antibody against hepatitis B virus (HBV) surface antigen (anti-HBs), is undetermined. METHODS: We recruited persons from a cohort vaccinated with plasma-derived hepatitis B vaccine in 1981 who have been followed periodically since. We performed serological testing for anti-HBs and microRNA-155 and assessed HBV-specific T-cell responses by enzyme-linked immunospot and cytometric bead array. Study subgroups were defined 32 years after vaccination as having an anti-HBs level of either ≥10 mIU/mL (group 1; n = 13) or <10 mIU/mL (group 2; n = 31). RESULTS: All 44 participants, regardless of anti-HBs level, tested positive for tumor necrosis factor alpha, interleukin 10, or interleukin 6 production by HBV surface antigen-specific T cells. The frequency of natural killer T cells correlated with the level of anti-HBs (P = .008). The proportion of participants who demonstrated T-cell responses to HBV core antigen varied among the cytokines measured, suggesting some natural exposure to HBV in the study group. No participant had evidence of breakthrough HBV infection. CONCLUSIONS: Evidence of long-lasting cellular immunity, regardless of anti-HBs level, suggests that protection afforded by primary immunization with plasma-derived hepatitis B vaccine during childhood and adulthood lasts at least 32 years. |
Monitoring the impact of HPV vaccine in males-considerations and challenges
Brotherton JML , Giuliano AR , Markowitz LE , Dunne EF , Ogilvie GS . Papillomavirus Res 2016 2 106-111 In this article, we examine the issues involved if national or sub-national programs are considering extending post HPV vaccine introduction monitoring to include males. Vaccination programs are now being extended to include males in some countries, in order to improve population level HPV infection control and to directly prevent HPV-related disease in males such as anogenital warts and anal cancers. Coverage and adverse events surveillance are essential components of post-vaccination monitoring. Monitoring the impact of vaccination on HPV infection and disease in men raises some similar challenges to monitoring in females, such as the long time frame until cancer outcomes, and also different ones given that genital specimens suitable for monitoring HPV prevalence are not routinely collected for other diagnostic or screening purposes in males. Thus, dedicated surveillance strategies must be designed; the framework of these may be country-specific, dependent upon the male population that is offered vaccination, the health care infrastructure and existing models of disease surveillance such as STI networks. The primary objective of any male HPV surveillance program will be to document changes in the prevalence of HPV infection and disease due to vaccine targeted HPV types occurring post vaccination. The full spectrum of outcomes to be considered for inclusion in any surveillance plan includes HPV prevalence monitoring, anogenital warts, potentially pre-cancerous lesions such as anal squamous intraepithelial lesions (SIL), and cancers. Ideally, a combination of short term and long term outcome measures would be included. Surveillance over time in specific targeted populations of men who have sex with men and HIV-infected men (populations at high risk for HPV infection and associated disease) could be an efficient use of resources to demonstrate impact. |
Electronic health record interventions at the point of care improve documentation of care processes and decrease orders for genetic tests commonly ordered by nongeneticists
Scheuner MT , Peredo J , Tangney K , Schoeff D , Sale T , Lubick-Goldzweig C , Hamilton A , Hilborne L , Lee M , Mittman B , Yano EM , Lubin IM . Genet Med 2016 19 (1) 112-120 OBJECTIVE: To determine whether electronic health record (EHR) tools improve documentation of pre- and postanalytic care processes for genetic tests ordered by nongeneticists. METHODS: We conducted a nonrandomized, controlled, pre-/postintervention study of EHR point-of-care tools (informational messages and template report) for three genetic tests. Chart review assessed documentation of genetic testing processes of care, with points assigned for each documented item. Multiple linear and logistic regressions assessed factors associated with documentation. RESULTS: Preimplementation, there were no significant site differences (P > 0.05). Postimplementation, mean documentation scores increased (5.9 (2.1) vs. 5.0 (2.2); P = 0.0001) and records with clinically meaningful documentation increased (score >5: 59 vs. 47%; P = 0.02) at the intervention versus the control site. Pre- and postimplementation, a score >5 was positively associated with abnormal test results (OR = 4.0; 95% CI: 1.8-9.2) and trainee provider (OR = 2.3; 95% CI: 1.2-4.6). Postimplementation, a score >5 was also positively associated with intervention site (OR = 2.3; 95% CI: 1.1-5.1) and specialty clinic (OR = 2.0; 95% CI: 1.1-3.6). There were also significantly fewer tests ordered after implementation (264/100,000 vs. 204/100,000; P = 0.03), with no significant change at the control site (280/100,000 vs. 257/100,000; P = 0.50). CONCLUSIONS: EHR point-of-care tools improved documentation of genetic testing processes and decreased utilization of genetic tests commonly ordered by nongeneticists.Genet Med advance online publication 30 June 2016Genetics in Medicine (2016); doi:10.1038/gim.2016.73. |
Suicide rates by occupational group - 17 states, 2012
McIntosh WL , Spies E , Stone DM , Lokey CN , Trudeau AR , Bartholow B . MMWR Morb Mortal Wkly Rep 2016 65 (25) 641-5 In 2012, approximately 40,000 suicides were reported in the United States, making suicide the 10th leading reported cause of death for persons aged ≥16 years (1). From 2000 to 2012, rates of suicide among persons in this age group increased 21.1%, from 13.3 per 100,000 to 16.1 (1). To inform suicide prevention efforts, CDC analyzed suicide by occupational group, by ascribing occupational codes to 12,312 suicides in 17 states in 2012 from the National Violent Death Reporting System (NVDRS) (2). The frequency of suicide in different occupational groups was examined, and rates of suicide were calculated by sex and age group for these categories. Persons working in the farming, fishing, and forestry group had the highest rate of suicide overall (84.5 per 100,000 population) and among males (90.5); the highest rates of suicide among females occurred among those working in protective service occupations (14.1). Overall, the lowest rate of suicide (7.5) was found in the education, training, and library occupational group. Suicide prevention approaches directed toward persons aged ≥16 years that enhance social support, community connectedness, access to preventive services, and the reduction of stigma and barriers to help-seeking are needed. |
Do self-reported data reflect the real burden of lifetime exposure to sexual violence among females aged 13-24 years in Malawi?
Fan AZ , Kress H , Gupta S , Wadonda-Kabondo N , Shawa M , Mercy J . Child Abuse Negl 2016 58 72-79 BACKGROUND: Under most circumstances, the lifetime experience of sexual violence (SV) among girls and young women would likely increase with age. However, the empirical data from a retrospective study may not necessarily conform to this belief. METHODS: Data from a nationally representative sample of females aged 13-24 years in Malawi in 2013 (n=1029) were analyzed. SV was defined as unwanted touching or attempted, pressured, or physically forced sex. The distribution of four types of SV among victims was compared between younger (13-18 years) and older (19-24 years) age groups. The strength of association between SV exposure and health outcomes was examined by age group. RESULTS: The risk of experiencing SV during their lifetime was three times greater for younger than that for older age females (Hazard ratio=3.32). Among females who had experienced SV, older age females were more likely to report forced or pressured sex (41.2%) as their initial SV experience than younger age females (17.8%). The strength of association between the SV exposure and health outcomes did not differ by age group. CONCLUSIONS: The self-report lifetime and childhood victimization to sexual violence may not necessarily higher among older than that among younger females. The current risk of exposure to sexual violence seems to influence the recall of lifetime and childhood victimization to a great extent. In order to make the field aware of this phenomenon, prevalence estimates from all three time frames (lifetime, childhood, and during the past 12 months) should be reported separately by age group. |
Rapid and non-destructive detection and identification of two strains of Wolbachia in Aedes aegypti by near-infrared spectroscopy
Sikulu-Lord MT , Maia MF , Milali MP , Henry M , Mkandawile G , Kho EA , Wirtz RA , Hugo LE , Dowell FE , Devine GJ . PLoS Negl Trop Dis 2016 10 (6) e0004759 The release of Wolbachia infected mosquitoes is likely to form a key component of disease control strategies in the near future. We investigated the potential of using near-infrared spectroscopy (NIRS) to simultaneously detect and identify two strains of Wolbachia pipientis (wMelPop and wMel) in male and female laboratory-reared Aedes aegypti mosquitoes. Our aim is to find faster, cheaper alternatives for monitoring those releases than the molecular diagnostic techniques that are currently in use. Our findings indicate that NIRS can differentiate females and males infected with wMelPop from uninfected wild type samples with an accuracy of 96% (N = 299) and 87.5% (N = 377), respectively. Similarly, females and males infected with wMel were differentiated from uninfected wild type samples with accuracies of 92% (N = 352) and 89% (N = 444). NIRS could differentiate wMelPop and wMel transinfected females with an accuracy of 96.6% (N = 442) and males with an accuracy of 84.5% (N = 443). This non-destructive technique is faster than the standard polymerase chain reaction diagnostic techniques. After the purchase of a NIRS spectrometer, the technique requires little sample processing and does not consume any reagents. |
Speech intelligibility assessment of protective facemasks and air-purifying respirators
Palmiero AJ , Symons D , Morgan JW 3rd , Shaffer RE . J Occup Environ Hyg 2016 13 (12) 0 Speech Intelligibility (SI) is the perceived quality of sound transmission. In healthcare settings, the ability to communicate clearly with coworkers, patients, etc. is crucial to quality patient care and safety. The objectives of this study were to 1) assess the suitability of the Speech Transmission Index (STI) methods for testing reusable and disposable facial and respiratory personal protective equipment (protective facemasks [PF], N95 filtering facepiece respirators [N95 FFR], and elastomeric half-mask air-purifying respirators [EAPR]) commonly worn by healthcare workers, 2) quantify STI levels of these devices, and 3) contribute to the scientific body of knowledge in the area of SI. SI was assessed using the STI under two experimental conditions: 1) a modified version of the National Fire Protection Association 1981 Supplementary Voice Communications System Performance Test at a Signal to Noise Ratio (SNR) of -15 (66 dBA) and 2) STI measurements utilizing a range of modified pink noise levels (52.5 dBA (-2 SNR) -72.5 dBA (+7 SNR)) in 5.0 dBA increments. The PF models (Kimberly Clark 49214 and 3M 1818) had the least effect on SI interference, typically deviating from the STI baseline (no-mask condition) by 3% and 4% STI, respectively. The N95FFR (3M 1870, 3M 1860) had more effect on SI interference, typically differing from baseline by 13% and 17%, respectively for models tested. The EAPR models (Scott Xcel and North 5500) had the most significant impact on SI, differing from baseline by 42% for models tested. This data offers insight into the performance of these apparatus with respect to STI and may serve as a reference point for future respirator design considerations, standards development, testing and certification activities. |
Ovine trophoblasts express cathelicidin host defence peptide in response to infection
Coyle C , Wheelhouse N , Jacques M , Longbottom D , Svoboda P , Pohl J , Duncan WC , Rae MT , Barlow PG . J Reprod Immunol 2016 117 10-16 Cationic host defence peptides (CHDP; also known as antimicrobial peptides) are key components of the immune response in the female reproductive tract. The role of the placental trophoblast in ovine host defence remains poorly understood. This study characterises expression of genes for cathelicidin and defensin peptides in primary ovine placental tissues, the ovine trophoblast cell line (AH-1) and in response to the TLR-4 ligand LPS, the abortifacient organism Waddlia chondrophila and 1alpha,25-dihydroxyvitamin D3. Using RT-PCR, expression of the CHDP SMAP-29, sBD-1 and sBD-2 was assessed in the AH-1 cell line in response to LPS, 1alpha,25-dihydroxyvitamin D3 exposure (a known stimulator of cathelicidin gene expression), or W. chondrophila infection. Expression of cathelicidin in the trophoblast compartment of the ovine placenta and in the ovine trophoblast cell line (AH-1) was also established. AH-1 cells did not upregulate expression of CHDP in response to LPS, but sBD-1 and sBD-2 expression was significantly increased in response to W. chondrophila infection. SMAP-29 expression was not altered by in vitro exposure to 1alpha,25-dihydroxyvitamin D3. This study demonstrates that the ovine trophoblast expresses cathelicidins, but does not upregulate expression of CHDP in response to LPS. Ovine trophoblasts are shown to differentially regulate expression of CHDP and lack a demonstrable vitamin D-mediated cathelicidin response. |
Effects of oil formulation, oil separator, and engine speed and load on the particle size, chemistry, and morphology of diesel crankcase aerosols
Uy Dairene , Storey John , Sluder CScott , Barone Teresa , Lewis Sam , Jagner Mark . SAE Int J Fuels Lubr 2016 9 (1) 224-238 The recirculation of gases from the crankcase and valvetrain can potentially lead to the entrainment of lubricant in the form of aerosols or mists. As boost pressures increase, the blow-by flow through both the crankcase and the valve cover increases. The resulting lubricant can then become part of the intake charge, potentially leading to fouling of intake components such as the intercooler and the turbocharger. The entrained aerosol which can contain the lubricant and soot may or may not have the same composition as the bulk lubricant. The complex aerodynamic processes that lead to entrainment can strip out heavy components or volatilize light components. Similarly, the physical size and numbers of aerosol particles can be dependent upon the lubricant formulation and engine speed and load. For instance, high rpm and load may increase not only the flow of gases but the amount of lubricant aerosol. In this study, the number, size distribution, composition, and morphology of entrained lubricant aerosol is examined on a medium-duty diesel engine operating at different speeds and loads. A unique sampling apparatus is described for sampling the aerosol in the same manner that it enters the intake. In addition, the performance of oil separators is examined. Results demonstrate that the size distribution changes with load, and contains both a sub-micron and super-micron component. The chemical composition of the aerosol varies depending on engine speed and load and oil separator used, while TEM results show that aerosol morphology changes with lubricant viscosity and also engine conditions. |
Evaluating the relationship between muscle and bone modeling response in older adults
Reider L , Beck T , Alley D , Miller R , Shardell M , Schumacher J , Magaziner J , Cawthon PM , Barbour KE , Cauley JA , Harris T . Bone 2016 90 152-8 Bone modeling, the process that continually adjusts bone strength in response to prevalent muscle-loading forces throughout an individual's lifespan, may play an important role in bone fragility with age. Femoral stress, an index of bone modeling response, can be estimated using measurements of DXA derived bone geometry and loading information incorporated into an engineering model. Assuming that individuals have adapted to habitual muscle loading forces, greater stresses indicate a diminished response and a weaker bone. The purpose of this paper was to evaluate the associations of lean mass and muscle strength with the femoral stress measure generated from the engineering model and to examine the extent to which lean mass and muscle strength account for variation in femoral stress among 2539 healthy older adults participating in the Health ABC study using linear regression.Mean femoral stress was higher in women (9.51, SD=1.85Mpa) than in men (8.02, SD=1.43Mpa). Percent lean mass explained more of the variation in femoral stress than did knee strength adjusted for body size (R2=0.187 vs. 0.055 in men; R2=0.237 vs. 0.095 in women). In models adjusted for potential confounders, for every percent increase in lean mass, mean femoral stress was 0.121Mpa lower (95% CI: -0.138, -0.104; p<0.001) in men and 0.139Mpa lower (95% CI: -0.158, -0.121; p<0.001) in women.The inverse association of femoral stress with lean mass and with knee strength did not differ by category of BMI. Results from this study provide insight into bone modeling differences as measured by femoral stress among older men and women and indicate that lean mass may capture elements of bone's response to load. |
Flow cytometric and cytokine ELISpot approaches to characterize the cell-mediated immune response in ferrets following influenza virus infection
DiPiazza A , Richards K , Batarse F , Lockard L , Zeng H , Garcia-Sastre A , Albrecht RA , Sant AJ . J Virol 2016 90 (17) 7991-8004 Influenza virus infections represent a significant socioeconomic and public health burden worldwide. Although ferrets are considered by many to be ideal for modeling human responses to influenza infection and vaccination, efforts to understand the cellular immune response have been severely hampered by a paucity of standardized procedures and reagents. In this report, we developed flow cytometric and T cell ELISpot approaches to characterize the leukocyte composition and antigen-specific T cell response within key lymphoid tissues following influenza virus infection in ferrets. Through a newly designed and implemented set of serological reagents, we used multi-parameter flow cytometry to directly quantify the frequency of CD4+ and CD8+ T cells, Ig+ B cells, CD11b+ myeloid-derived cells and MHC class II+ APCs both prior to and after intranasal infection with A/California/04/09 (H1N1). We found that the leukocyte composition was altered 10 days post-infection, with notable gains in the frequency of T cells and myeloid cells within the draining lymph node. Furthermore, these studies revealed that the antigen-specificity of influenza-reactive CD4 and CD8 T cells was very broad, with recognition of the viral HA, NA, M1, NS1 and NP proteins and that total reactivity to influenza post-infection represented approximately 0.1% of the circulating PBMCs. Finally, we observed distinct patterns of reactivity between individual animals, suggesting heterogeneity at the MHC locus in ferrets within commercial populations, a finding of considerable interest in efforts to move the ferret model forward for influenza vaccine and challenge studies. IMPORTANCE: Ferrets are an ideal animal model to study transmission, disease and vaccine efficacies of respiratory viruses because of their close anatomical and physiological resemblances to humans. However, a lack of reagents has limited our understanding of the cell-mediated immune response following infection and vaccination. In this study, we used cross-reactive and ferret-specific antibodies to study the leukocyte composition and antigen specific CD4 and CD8 T cell responses following influenza A/California/04/09 (H1N1) virus infection. These studies revealed strikingly distinct patterns of reactivity between CD4 and CD8 T cells, which was overlayed with differences in protein-specific responses between individual animals. Our results provide a first, in-depth look at the T cell repertoire in response to influenza infection and suggest there is considerable heterogeneity at the MHC locus, akin to humans and an area of intense research interest. |
Culture-independent diagnostics for health security
Doggett NA , Mukundan H , Lefkowitz EJ , Slezak TR , Chain PS , Morse S , Anderson K , Hodge DR , Pillai S . Health Secur 2016 14 (3) 122-42 The past decade has seen considerable development in the diagnostic application of nonculture methods, including nucleic acid amplification-based methods and mass spectrometry, for the diagnosis of infectious diseases. The implications of these new culture-independent diagnostic tests (CIDTs) include bypassing the need to culture organisms, thus potentially affecting public health surveillance systems, which continue to use isolates as the basis of their surveillance programs and to assess phenotypic resistance to antimicrobial agents. CIDTs may also affect the way public health practitioners detect and respond to a bioterrorism event. In response to a request from the Department of Homeland Security, Los Alamos National Laboratory and the Centers for Disease Control and Prevention cosponsored a workshop to review the impact of CIDTs on the rapid detection and identification of biothreat agents. Four panel discussions were held that covered nucleic acid amplification-based diagnostics, mass spectrometry, antibody-based diagnostics, and next-generation sequencing. Exploiting the extensive expertise available at this workshop, we identified the key features, benefits, and limitations of the various CIDT methods for providing rapid pathogen identification that are critical to the response and mitigation of a bioterrorism event. After the workshop we conducted a thorough review of the literature, investigating the current state of these 4 culture-independent diagnostic methods. This article combines information from the literature review and the insights obtained at the workshop. |
A depot medroxyprogesterone acetate dose that models human use and its effect on vaginal SHIV acquisition risk
Butler K , Ritter JM , Ellis S , Morris MR , Hanson DL , McNicholl JM , Kersh EN . J Acquir Immune Defic Syndr 2016 72 (4) 363-71 INTRODUCTION: Hormonal contraception with depot medroxyprogesterone acetate (DMPA) may increase HIV acquisition risk, but observational human studies are inconclusive, and animal models can help investigate this risk. In this study, we test the impact of a low DMPA dose, designed to resemble human contraceptive use, on Simian-Human Immunodeficiency Virus (SHIV) acquisition risk in pigtail macaques (Macaca nemestrina). METHODS: Macaques metabolize DMPA faster than humans. We previously identified a per-weight DMPA dose and administration frequency that achieves long-lasting suppression of ovulation in macaques. Eight macaques were given 1.5-mg/kg DMPA monthly, whereas 11 were untreated controls. For comparison, women receive 150 mg (approximately 2 mg/kg) every 3 months. We exposed monkeys to 20 suboptimal SHIV challenges, designed to slowly infect half of controls and allow increased infection in the DMPA group. RESULTS: It took a median 5.5 viral challenges to infect DMPA-treated macaques and 9 challenges for controls (P = 0.27; exact conditional logistic regression). The exact odds ratio was 2.2 (CI: 0.6 to 8.3). Ovulation was suppressed, and the vaginal epithelium was thinned after DMPA treatment in all animals (mean, 30 and 219 mm in DMPA-treated and control macaques, respectively, P = 0.03, t test using the Satterthwaite degrees-of-freedom approximation). CONCLUSIONS: SHIV infections in DMPA-treated macaques were 2.2 times those of controls, but this was not statistically significant. The result is remarkably similar to studies of human DMPA use, which have shown HIV risk increases of a similar magnitude and of variable significance. Taken together with previous studies of higher DMPA doses in macaques, the results suggest a dose-dependent effect of DMPA on Simian Immunodeficiency Virus (SIV) or SHIV acquisition. |
Reporting of birth defects in SART CORS: Time to rely on data linkage
Mendola P , Gilboa SM . Fertil Steril 2016 106 (3) 554-5 In this issue of Fertility and Sterility, Stern et al. (1) assessed the validity of the birth outcome data reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) compared with the outcome data from vital records and the Massachusetts Birth Defects Monitoring Program (BDMP), the statewide population-based active birth defects surveillance system for a cohort of 9,092 assisted reproductive technology (ART) deliveries from 2004 to 2008 in Massachusetts. Compared with vital records, the SART CORS does a great job of reporting for some outcomes, with >99% concordance on delivery outcome (live birth/fetal death) and plurality. More than 90% of birth dates match, and most singleton birth weights (87%) are different by <50 g. Maternal race/ethnicity is missing two-thirds of the time in SART CORS, but when not missing, it is reasonably accurate, with 95% concordance. So far, so good. When we look at birth defects, it is entirely another matter. | The SART CORS reported 135 birth defects among 132 infants compared with 184 birth defects among 132 infants in the BDMP data. Although it seems at first glance that we might still be on fairly solid ground with the same number of infants identified; the problem was that only 51 infants were identified with birth defects in both datasets. Overall, SART CORS is missing 81 infants (61%) that have birth defects confirmed by BDMP, and a corresponding 81 cases in the SART CORS are unconfirmed by BDMP. Compared with the active surveillance of the BDMP as the criterion standard, ART clinics appear to be missing the mark. The problem starts with the categories of birth defects reported in SART CORS; rather than capturing diagnostic codes or detailed information, the system allows for the following predefined categories, with no instruction provided as to which specific diagnoses are to be considered as relevant to a given category: none, unknown, cleft palate, genetic defect, limb defect, cardiac defect, and other. Given these limited and undefined categories, and that the SART CORS data come from a variety of reporting sources, including medical records, provider reports and parent self-reports, it is not surprising that there are inaccuracies. We were a bit surprised to see that the errors went in both directions, with similar numbers of false positives and false negatives. |
Psychosocial needs of perinatally HIV-infected youths in Thailand: Lessons learnt from instructive counseling
Manaboriboon B , Lolekha R , Chokephaibulkit K , Leowsrisook P , Naiwatanakul T , Tarugsa J , Durier Y , Aunjit N , Punpanich Vandepitte W , Boon-Yasidhi V . AIDS Care 2016 28 (12) 1-8 Identifying psychosocial needs of perinatally HIV-infected (pHIV) youth is a key step in ensuring good mental health care. We report psychosocial needs of pHIV youth identified using the "Youth Counseling Needs Survey" (YCS) and during individual counseling (IC) sessions. pHIV youth receiving care at two tertiary-care hospitals in Bangkok or at an orphanage in Lopburi province were invited to participate IC sessions. The youths' psychosocial needs were assessed using instructive IC sessions in four main areas: general health, reproductive health, mood, and psychosocial concerns. Prior to the IC session youth were asked to complete the YCS in which their concerns in the four areas were investigated. Issues identified from the YCS and the IC sessions were compared. During October 2010-July 2011, 150 (68.2%) of 220 eligible youths participated in the IC sessions and completed the YCS. Median age was 14 (range 11-18) years and 92 (61.3%) were female. Mean duration of the IC sessions was 36.5 minutes. One-hundred and thirty (86.7%) youths reported having at least one psychosocial problem discovered by either the IC session or the YCS. The most common problems identified during the IC session were poor health attitude and self-care (48.0%), lack of life skills (44.0%), lack of communication skills (40.0%), poor antiretroviral (ARV) adherence (38.7%), and low self-value (34.7%). The most common problems identified by the YCS were lack of communication skills (21.3%), poor health attitude and self-care (14.0%), and poor ARV adherence (12.7%). Youth were less likely to report psychosocial problems in the YCS than in the IC session. Common psychosocial needs among HIV-infected youth were issues about life skills, communication skills, knowledge on self-care, ARV adherence, and self-value. YCS can identify pHIV youths' psychosocial needs but might underestimate issues. Regular IC sessions are useful to detect problems and provide opportunities for counseling. |
The role of occupational status in the association between job strain and ambulatory blood pressure during working and nonworking days
Joseph NT , Muldoon MF , Manuck SB , Matthews KA , MacDonald LA , Grosch J , Kamarck TW . Psychosom Med 2016 78 (8) 940-949 OBJECTIVES: The objectives of this study were to determine whether job strain is more strongly associated with higher ambulatory blood pressure (ABP) among blue-collar workers compared with white-collar workers, to examine whether this pattern generalizes across working and nonworking days and across sex, and to examine whether this pattern is accounted for by psychosocial factors or health behaviors during daily life. METHODS: A total of 480 healthy workers (mean age = 43 years, 53% female) in the Adult Health and Behavior Project-Phase 2 completed ABP monitoring during 3 working days and 1 nonworking day. Job strain was operationalized as high psychological demand (> sample median) combined with low decision latitude (<sample median; Karasek model; Job Content Questionnaire). RESULTS: Covariate-adjusted multilevel random coefficient regressions demonstrated that associations between job strain and systolic and diastolic ABP were stronger among blue-collar workers compared with white-collar workers (b = 6.53 [F(1,464) = 3.89, p = .049] and b = 5.25 [F(1,464) = 6.09, p = .014], respectively). This pattern did not vary by sex, but diastolic ABP findings were stronger when participants were at work. The stronger association between job strain and ABP among blue-collar workers was not accounted for by education, momentary physical activity, or substance use, but was partially accounted for by covariation between higher hostility and blue-collar status. CONCLUSIONS: Job strain is associated with ABP among blue-collar workers. These results extend previous findings to a mixed-sex sample and nonworking days and provide, for the first time, comprehensive exploration of several behavioral and psychosocial explanations for this finding. |
Mortality among workers exposed to toluene diisocyanate in the US polyurethane foam industry: Update and exposure-response analyses
Pinkerton LE , Yiin JH , Daniels RD , Fent KW . Am J Ind Med 2016 59 (8) 630-43 BACKGROUND: Mortality among 4,545 toluene diisocyante (TDI)-exposed workers was updated through 2011. The primary outcome of interest was lung cancer. METHODS: Life table analyses, including internal analyses by exposure duration and cumulative TDI exposure, were conducted. RESULTS: Compared with the US population, all cause and all cancer mortality was increased. Lung cancer mortality was increased but was not associated with exposure duration or cumulative TDI exposure. In post hoc analyses, lung cancer mortality was associated with employment duration in finishing jobs, but not in finishing jobs involving cutting polyurethane foam. CONCLUSIONS: Dermal exposure, in contrast to inhalational exposure, to TDI is expected to be greater in finishing jobs and may play a role in the observed increase in lung cancer mortality. Limitations include the lack of smoking data, uncertainty in the exposure estimates, and exposure estimates that reflected inhalational exposure only. Am. J. Ind. Med. Published 2016. This article is a U.S. Government work and is in the public domain in the USA. |
Mortality of lead smelter workers: A follow-up study with exposure assessment
Bertke SJ , Lehman EJ , Wurzelbacher SJ , Hein MJ . Am J Ind Med 2016 59 (11) 979-986 BACKGROUND: Lead exposure has been linked to impaired renal function and kidney failure. High lead exposures have been associated with increased mortality from certain cancers, hypertension, cardiovascular disease, and amyotrophic lateral sclerosis (ALS). METHODS: We extended vital status follow-up on a cohort of 1,990 lead smelter workers by 25 years and computed standardized mortality ratios and rate ratios (RR) stratified by cumulative lead exposure. RESULTS: The update added 13,823 person-years at risk and 721 deaths. Increased risk of mortality was observed for the a priori outcomes of lung cancer, cardiovascular disease (including cerebrovascular disease), chronic kidney disease, and ALS. However, of these outcomes, only cardiovascular, cerebrovascular, and chronic kidney diseases were associated with a positive exposure-response in RR analyses. CONCLUSIONS: This study reaffirms the association of lead exposure with cardiovascular and kidney diseases; however, increased mortality observed for certain cancers is not likely to be due to lead exposure. Am. J. Ind. Med. Published 2016. This article is a U.S. Government work and is in the public domain in the USA. |
The perils of integrating wellness and safety and health and the possibility of a worker-oriented alternative
Howard J , Chosewood LC , Hudson HL . New Solut 2016 26 (3) 345-348 In response to the article by Michael B. Lax, MD entitled "The perils of integrating wellness and safety and health and the possibility of a worker-oriented alternative," the National Institute for Occupational Safety and Health (NIOSH) provides updated information on the current focus and priorities and addresses concerns raised regarding the Total Worker Health(R) initiative. Many of the concerns and criticisms in the report echo those NIOSH publicly shares on a regular basis. The theory and practice of Total Worker Health (TWH) continues to evolve in response to valuable stakeholder input like that provided by Dr. Lax. In 2015, NIOSH updated the TWH concept to emphasize the main focus of TWH is the primacy of traditional health protection which prioritizes employer responsibilities for the organization of work over individual worker health behaviors. NIOSH acknowledges the past lack of "fit" between theory and practice in some publications of TWH-funded grantees as Dr. Lax points out. NIOSH is hopeful that the solicitation of new research, which is now underway, will clarify the work-centered priorities for TWH-funded research. Based on input from Dr. Lax and other stakeholders, NIOSH looks forward to contributing more effectively to protecting and promoting worker safety and health in the new twenty-first century world of work. |
Evaluation of standardized sample collection, packaging, and decontamination procedures to assess cross-contamination potential during Bacillus anthracis incident response operations
Calfee MW , Tufts J , Meyer K , McConkey K , Mickelsen L , Rose L , Dowell C , Delaney L , Weber A , Morse S , Chaitram J , Gray M . J Occup Environ Hyg 2016 13 (12) 0 Sample collection procedures and primary receptacle (sample container and bag) decontamination methods should prevent contaminant transfer between contaminated and non-contaminated surfaces and areas during bio-incident operations. Cross-contamination of personnel, equipment, or sample containers may result in the exfiltration of biological agent from the exclusion (hot) zone and have unintended negative consequences on response resources, activities and outcomes. The current study was designed to 1) evaluate currently recommended sample collection and packaging procedures to identify procedural steps that may increase the likelihood of spore exfiltration or contaminant transfer, 2) evaluate the efficacy of currently recommended primary receptacle decontamination procedures, and 3) evaluate the efficacy of outer packaging decontamination methods. Wet- and dry-deposited fluorescent tracer powder was used in contaminant transfer tests to qualitatively evaluate the currently-recommended sample collection procedures. Bacillus atrophaeus spores, a surrogate for Bacillus anthracis, were used to evaluate the efficacy of spray- and wipe-based decontamination procedures. Both decontamination procedures were quantitatively evaluated on three types of sample packaging materials (corrugated fiberboard, polystyrene foam, and polyethylene plastic), and two contamination mechanisms (wet or dry inoculums). Contaminant transfer results suggested that size-appropriate gloves should be worn by personnel, templates should not be taped to or removed from surfaces, and primary receptacles should be selected carefully. The decontamination tests indicated that wipe-based decontamination procedures may be more effective than spray-based procedures; efficacy was not influenced by material type but was affected by the inoculation method. Incomplete surface decontamination was observed in all tests with dry inoculums. This study provides a foundation for optimizing current B. anthracis response procedures to minimize contaminant exfiltration. |
A knowledge, attitudes and practices survey conducted three years after halting ivermectin mass treatment for onchocerciasis in Guatemala
Richards FO Jr , Klein RE , de Leon O , Mendizabal-Cabrera R , Morales AL , Cama V , Crovella CG , Diaz Espinoza CE , Morales Z , Sauerbrey M , Rizzo N . PLoS Negl Trop Dis 2016 10 (6) e0004777 BACKGROUND: Mass drug administration (MDA) with ivermectin for onchocerciasis was provided in Guatemala's Central Endemic Zone (CEZ) over a 24 year period (1988-2011). Elimination of Onchocerca volvulus transmission was declared in 2015 after a three year post MDA surveillance period (2012-2014) showed no evidence of recrudescence. The purpose of the present study was to evaluate the knowledge, attitudes and practices (KAP) towards onchocerciasis and ivermectin among residents in the post endemic CEZ. A major interest in this study was to determine what community residents thought about the end of the ivermectin MDA program. METHODOLOGY/PRINCIPAL FINDINGS: A total of 148 interviews were conducted in November 2014 in four formerly hyperendemic communities using a standard questionnaire on smart phones. The majority (69%) of respondents knew that the MDA program had ended because the disease was no longer present in their communities, but a slight majority (53%) was personally unsure that onchocerciasis had really been eliminated. Sixty-three percent wanted to continue to receive ivermectin because of this uncertainty, or because ivermectin is effective against intestinal worms. Eighty-nine percent of respondents said that they would seek medical attention immediately if a family member had symptoms of onchocerciasis (especially the presence of a nodule), which is a finding very important for ongoing surveillance. CONCLUSIONS/SIGNIFICANCE: Many respondents wanted to continue receive ivermectin and more than half did not believe onchocerciasis had been eliminated. The ministry of health outreach services should be prepared to address ongoing concerns about onchocerciasis in the post endemic CEZ. |
Public health surveillance: At the core of the Global Health Security Agenda
Wolicki SB , Nuzzo JB , Blazes DL , Pitts DL , Iskander JK , Tappero JW . Health Secur 2016 14 (3) 185-8 Global health security involves developing the infrastructure and capacity to protect the health of people and societies worldwide. The acceleration of global travel and trade poses greater opportunities for infectious diseases to emerge and spread. The International Health Regulations (IHR) were adopted in 2005 with the intent of proactively developing public health systems that could react to the spread of infectious disease and provide better containment. Various challenges delayed adherence to the IHR. The Global Health Security Agenda came about as an international collaborative effort, working multilaterally among governments and across sectors, seeking to implement the IHR and develop the capacities to prevent, detect, and respond to public health emergencies of international concern. When examining the recent West African Ebola epidemic as a case study for global health security, both strengths and weaknesses in the public health response are evident. The central role of public health surveillance is a lesson reiterated by Ebola. Through further implementation of the Global Health Security Agenda, identified gaps in surveillance can be filled and global health security strengthened. |
Assessment of staffing, services, and partnerships of local health departments - United States, 2015
Newman SJ , Ye J , Leep CJ , Hasbrouck L , Zometa C . MMWR Morb Mortal Wkly Rep 2016 65 (25) 646-9 Beginning in 2008, the National Association of County and City Health Officials (NACCHO) periodically surveyed local health departments (LHDs) to assess the impact of the economic recession on jobs and budgets (1). In 2014, the survey was expanded to assess a wider range of factors affecting programs, services, and infrastructure in LHDs and renamed the Forces of Change survey (2). The survey was administered in to January-February 2015 to 948 LHDs across the United States to assess budget changes, job losses, changes in services, and collaboration with health care partners; 690 (73%) LHDs responded. Findings indicated a change in LHD infrastructure: compared with the previous fiscal year.* Overall, LHDs reported 3,400 jobs lost; 25% of LHDs reported budget decreases; 36% reported a reduction in at least one service area; and 35% reported serving fewer patients in clinics. In addition, up to 24% of LHDs reported expanding population-based prevention services, and LHDs reported exploring new collaborations with nonprofit hospitals and primary care providers (PCPs). |
An environmental scan of recent initiatives incorporating social determinants in public health
Koo D , O'Carroll PW , Harris A , DeSalvo KB . Prev Chronic Dis 2016 13 E86 The foundational importance of social, environmental, and economic factors as determinants of health has long been recognized (1–5). Until recently, this recognition had resulted in few sustained, organized efforts to positively influence these determinants to foster health at the community level. In recent years, however, numerous efforts have arisen across the United States that explicitly seek to improve the public’s health by catalyzing collaboration across multiple societal sectors, with the goal of leveraging policy, systems, and environmental changes to drive sustained improvements in the public’s health. Many are using concepts such as “Health in All Policies” (6,7) and collective impact (8) to structure their efforts. These initiatives vary in scope and scale, and they address the challenge of multisector approaches to the social determinants in a variety of ways, often innovating as they evolve. | These pioneering efforts face several challenges. First, they are generally not guided by any national strategy or coherent plan to promote such cross-sector partnerships or to leverage resources across these initiatives. Second, many community efforts are developing in relative isolation, with little opportunity to learn from the successes and failures of similar undertakings in other communities. Third, the accelerated pace at which broad, health-oriented community collaboratives are being launched makes it difficult to maintain awareness of the many opportunities, toolkits, and frameworks that already exist. | These efforts are laudable and offer much to adapt and apply in communities across the country. To begin to systematize such cross-sector, expansive approaches to community health, in this article we identify, categorize, and describe an array of multisector initiatives and collaborations currently under way across the United States that explicitly include attention to social, economic, and environmental factors to foster community health and well-being. |
Safety of intrauterine devices among women with HIV: A systematic review
Tepper NK , Curtis KM , Nanda K , Jamieson DJ . Contraception 2016 94 (6) 713-724 BACKGROUND: Use of highly effective contraception among women living with HIV is critical to prevent unintended pregnancy and subsequent risk of maternal complications and perinatal HIV transmission. However, it is not known whether use of intrauterine devices (IUDs) among women with advanced HIV disease poses an increased risk of pelvic infection or HIV progression and transmission. OBJECTIVES: To identify evidence regarding the risk of pelvic infection, HIV disease progression or HIV transmission among women with HIV using IUDs, and whether this risk differs by severity of HIV disease. METHODS: We searched the PubMed database for all articles published from database inception through January 2016. For the outcome of pelvic infection, we included studies that examined women using IUDs and reported risk of pelvic inflammatory disease (PID) or pelvic infections among women with varying levels of HIV severity or among women with HIV compared with women without HIV. For the outcomes of HIV disease progression and HIV transmission to noninfected male partners, we included studies of women with HIV using IUDs compared with other contraceptive methods or no method. RESULTS: The review identified eight articles from six study populations which addressed pelvic infections or other IUD-related complications and found mixed results. One study that directly compared women with varying levels of HIV disease severity found no differences in complication rates between those with severe or mild disease after short and longer-term follow-up. The remaining studies generally found low or no incidence of PID among IUD users. Among eight articles from seven study populations that reported on HIV disease progression, there were generally no differences between women using IUDs compared with other contraceptives, nor were there changes between baseline and follow up. One article that reported directly on HIV disease transmission to noninfected male partners found no difference in HIV disease transmission and 5 articles found no differences in genital viral shedding among women using IUDs. No direct evidence addresses potential differences in HIV disease progression or transmission by HIV disease severity. CONCLUSION: Limited evidence of fair to poor quality found no differences in infectious complications when comparing IUD complication rates among women with varying levels of HIV disease severity. One study found that IUD use was not associated with HIV transmission, and studies generally found no differences in genital viral shedding, or disease progression, however there was little direct evidence to address potential differences related to HIV severity. |
Exposure calls to U. S. poison centers involving electronic cigarettes and conventional cigarettes-September 2010-December 2014
Chatham-Stephens K , Law R , Taylor E , Kieszak S , Melstrom P , Bunnell R , Wang B , Day H , Apelberg B , Cantrell L , Foster H , Schier JG . J Med Toxicol 2016 12 (4) 350-357 INTRODUCTION: E-cigarette use is increasing, and the long-term impact on public health is unclear. We described the acute adverse health effects from e-cigarette exposures reported to U.S. poison centers. METHODS: We compared monthly counts and demographic, exposure, and health effects data of calls about e-cigarettes and conventional cigarettes made to poison centers from September 2010 through December 2014. RESULTS: Monthly e-cigarette calls increased from 1 in September 2010, peaked at 401 in April 2014, and declined to 295 in December 2014. Monthly conventional cigarette calls during the same period ranged from 302 to 514. E-cigarette calls were more likely than conventional cigarette calls to report adverse health effects, including vomiting, eye irritation, and nausea. Five e-cigarette calls reported major health effects, such as respiratory failure, and there were two deaths associated with e-cigarette calls. CONCLUSION: E-cigarette calls to U.S. poison centers increased over the study period, and were more likely than conventional cigarettes to report adverse health effects. It is important for health care providers and the public to be aware of potential acute health effects from e-cigarettes. Developing strategies to monitor and prevent poisonings from these novel devices is critical. |
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