Genetic testing for lynch syndrome in individuals newly diagnosed with colorectal cancer to reduce morbidity and mortality from colorectal cancer in their relatives.
Coates R , Williams M , Melillo S , Gudgeon J . PLoS Curr 2011 3 RRN1246 Individuals with Lynch syndrome, sometimes referred to as hereditary non-polyposis colorectal cancer (HNPCC), have an increased risk of developing colorectal cancer (CRC) as well as other cancers. The increased risk is due to inherited mutations in mismatch repair (MMR) genes, which reduce the ability of cells to repair DNA damage. Screening for Lynch syndrome in individuals newly diagnosed with colorectal cancer has been proposed as part of a strategy that combines tests and interventions to reduce the risk of colorectal cancer in the relatives of the colorectal cancer patients with Lynch Syndrome. |
Screening prevalence and incidence of colorectal cancer among American Indian/Alaskan Natives in the Indian Health Service
Day LW , Espey DK , Madden E , Segal M , Terdiman JP . Dig Dis Sci 2011 56 (7) 2104-13 BACKGROUND: Studies on colorectal cancer (CRC) screening and incidence among American Indian/Alaska Natives (AI/AN) are few. AIMS: Our aim was to determine CRC screening prevalence and to calculate CRC incidence among AI/AN receiving care within the Indian Health Service (IHS). METHODS: A retrospective cohort study of AI/AN who utilized IHS from 1996 to 2004. AI/AN who were average-risk for CRC and received primary care within IHS were identified by searching the IHS Resource Patient Management System for selected ICD-9/CPT codes (n = 142,051). CRC screening prevalence was calculated and predictors of screening were determined for this group. CRC incidence rates were ascertained for the entire AI/AN population ages 50-80 who received IHS medical care between 1996 and 2004 (n = 283,717). RESULTS: CRC screening was performed in 4.0% of average-risk AI/AN. CRC screening was more common among women than men (RR = 1.6, 95% CI 1.4-1.7) and among AI/AN living in the Alaska region compared to the Pacific Coast region (RR = 2.5, 95% CI 2.2-2.8) while patients living in the Northern Plains (RR = 0.4, 95% CI 0.3-0.4) were less likely to have been screened. CRC screening was less common among patients with a greater number of primary care visits. The age-adjusted CRC incidence among AI/AN ages 50-80 was 227 cancers per 100,000 person-years. CONCLUSIONS: CRC was common among AI/AN receiving medical care within IHS. However, CRC screening prevalence was far lower than has been reported for the U.S. population. |
Surveillance of female patients with inherited bleeding disorders in United States Haemophilia Treatment Centres
Byams VR , Kouides PA , Kulkarni R , Baker JR , Brown DL , Gill JC , Grant AM , James AH , Konkle BA , Maahs J , Dumas MM , McAlister S , Nance D , Nugent D , Philipp CS , Soucie JM , Stang E . Haemophilia 2011 17 6-13 Inherited bleeding disorders are especially problematic for affected girls and women due to the monthly occurrence of menstrual periods and the effects on reproductive health. Although heavy menstrual bleeding (HMB) is the most common manifestation, females with inherited bleeding disorders (FBD) experience other bleeding symptoms throughout the lifespan that can lead to increased morbidity and impairment of daily activities. The purpose of this article is to describe the utility of a female-focused surveillance effort [female Universal Data Collection (UDC) project] in the United States Haemophilia Treatment Centres (HTCs) and to describe the baseline frequency and spectrum of diagnoses and outcomes. All FBD aged 2years and older receiving care at selected HTCs were eligible for enrolment. Demographic data, diagnoses and historical data regarding bleeding symptoms, treatments, gynaecological abnormalities and obstetrical outcomes were analysed. Analyses represent data collected from 2009 to 2010. The most frequent diagnoses were type 1 von Willebrand's disease (VWD) (195/319; 61.1%), VWD type unknown (49/319; 15.4%) and factor VIII deficiency (40/319; 12.5%). HMB was the most common bleeding symptom (198/253; 78.3%); however, 157 (49.2%) participants reported greater than four symptoms. Oral contraceptives were used most frequently to treat HMB (90/165; 54.5%), followed by desmopressin [1-8 deamino-D-arginine vasopressin (DDAVP)] (56/165; 33.9%). Various pregnancy and childbirth complications were reported, including bleeding during miscarriage (33/43; 76.7%) and postpartum haemorrhage (PPH) (41/109; 37.6%). FBD experience multiple bleeding symptoms and obstetrical-gynaecological morbidity. The female UDC is the first prospective, longitudinal surveillance in the US focusing on FBD and has the potential to further identify complications and reduce adverse outcomes in this population. 2011 Blackwell Publishing Ltd. |
Trends in the control of risk factors for cardiovascular disease among adults with diagnosed diabetes: findings from the National Health and Nutrition Examination Survey 1999-2008
Ford ES . J Diabetes 2011 3 (4) 337-47 BACKGROUND: The objective of this study was to examine the trends in control of key risk factors for cardiovascular disease among adults with diagnosed diabetes in the United States from 1999 to 2008. METHODS: Data for up to 2623 adults aged ≥20 years with diagnosed diabetes who participated in 2-year cycles of the National Health and Nutrition Examination Surveys from 1999 to 2008 were examined. RESULTS: The control of HbA1c (37.0% to 55.2%), blood pressure (35.2% to 51.0%), and low-density lipoprotein cholesterol (LDLC) (32.5% to 52.9%) improved significantly. Both men and women experienced significant improvement in HbA1c and LDLC. Whites showed significant improvement in glycemic control, LDLC control, and the control of all three risk factors; African Americans in glycemic control and blood pressure control; and Mexican Americans in glycemic control and the control of all three risk factors. Compared with whites, African Americans (prevalence ratio [PR]=0.84; 95% confidence interval [CI]: 0.74-0.96) and Mexican Americans (PR=0.82; 95% CI: 0.72-0.92) had worse glycemic control, and Mexican Americans had worse control of LDLC (PR=0.70, 95% CI:0.57-0.87) and of all three risk factors (PR=0.46, 95% CI:0.23-0.90). Little change occurred in the prevalence of not currently smoking, having a C-reactive protein concentration <3 g/l, and having a urinary albumin-creatinine ratio <30 mg/g. The prevalence of having a body mass index <30 kg/m(2) decreased from 45.4% to 37.6% (p(linear trend) =0.045). CONCLUSIONS: Significant improvements in recommended levels of HbA1c, blood pressure, and LDLC occurred in diabetic adults in the United States between 1999 and 2008. |
Cancer screening practices among physicians in the national breast and cervical cancer early detection program
Benard VB , Saraiya MS , Soman A , Roland KB , Yabroff KR , Miller J . J Womens Health (Larchmt) 2011 20 (10) 1479-84 BACKGROUND: The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides low-income, uninsured women with screening and diagnostic services for breast and cervical cancer. Our study was conducted to describe the demographic and practice characteristics of participating and nonparticipating physicians, as well as their beliefs, adoption of new screening technologies, and recommendations for breast and cervical cancer screening. METHODS: From a 2006-2007 nationally representative survey, we identified 1,111 practicing primary care physicians who provide breast and cervical cancer screenings and assessed their recommendations using clinical vignettes related to screening initiation, frequency, and cessation. Responses of physicians participating in the NBCCEDP were compared with those from nonparticipating physicians. RESULTS: Of the physicians surveyed, 15% reported participation in the NBCCEDP, 65% were not participants, and 20% were not sure or did not respond to this question. Program physicians were significantly more likely to practice in multispecialty settings, in a rural location, and in a hospital or clinic setting and had more patients who were female and insured by Medicaid or uninsured compared with nonprogram physicians. Beliefs about the effectiveness of screening tools or procedures in reducing breast or cervical cancer mortality were similar by program participation. Adoption of new technologies, including digital mammography and human papillomavirus (HPV) testing, and making guideline-consistent recommendations for screening initiation, frequency, and cessation did not differ significantly by program participation. CONCLUSIONS: Although there may be differences in physician characteristics and practice settings, the beliefs and screening practices for both breast and cervical cancer are similar between program and nonprogram providers. |
Genomic evolution and phenotypic distinctions of Chikungunya viruses causing the Indian Ocean outbreak.
Powers AM . Exp Biol Med (Maywood) 2011 236 (8) 909-14 In our current global community with the rapid movement of products and people across and between continents, the emergence of a human pathogen can have devastating consequences. One dramatic example of this has been the emergence of Chikungunya virus (CHIKV), which causes a severe, prolonged, and debilitating arthralgic disease. This virus emerged in a large outbreak on the east coast of Africa in 2004; over the subsequent seven years, CHIKV has spread across the Indian Ocean, the Indian subcontinent, Southeast Asia and even reached Europe, leaving more than two million people affected. Because CHIKV has a small genome, currently available tools to analyze complete viral genomes have provided scientists with unique opportunities to understand the epidemiology, pathogenesis and transmission of the virus. The most commonly used application of these cutting edge tools has been to track the movement of the virus over time and space. While this is an important concept for identifying areas that remain at risk for outbreaks, these postgenomic era tools can also be applied to the highly significant tasks of understanding how viral microevolutionary changes can affect both invertebrate transmission and vertebrate virulence. Significant alterations in the patterns of CHIKV movement have already been identified using microevolutionary studies. These approaches now need to be further expanded to aid in expanding vaccine, therapeutic and control options. This review will highlight some of the most significant recent research developments obtained using these cutting edge approaches for CHIKV. |
Refugees, mass casualties, and hepatitis B transmission
Ward JW , Averhoff F . J Infect Dis 2011 204 (3) 338-9 The report by Italiano et al in this issue of the Journal presents a convincing case for hepatitis B virus (HBV) transmission among Afghan refugees injured in a ship explosion en route to resettlement in Australia. The acute cases of HBV infection were well documented serologically; the pattern of incubation periods suggested a point source exposure; and the molecular epidemiology demonstrated a high degree of viral relatedness, implicating a common transmission source. However, exactly when and how these men became infected remain intriguing questions. | A blood-borne pathogen, HBV is extremely infectious and can survive in the environment for up to 7 days. It is highly transmissible in settings where exposure to contaminated blood or other body fluids is possible, such as health care and residential care facilities [1]. Although risk is primarily associated with needle-stick injuries, transmission has been documented in these settings in the absence of this particular exposure [1]. For these reasons, HBV transmission could have occurred in the immediate aftermath of the explosion. |
Reticence to prescribe: utilization of expedited partner therapy among obstetrics providers in Arizona
Taylor MM , Collier MG , Winscott MM , Mickey T , England B . Int J STD AIDS 2011 22 (8) 449-52 Expedited partner therapy (EPT) is the practice of providing an extra dose or prescription of antibiotic to patients diagnosed with chlamydia or gonorrhoea to deliver to their sexual partner(s). Obstetrical providers who delivered more than 20 infants in Maricopa County, Arizona, USA, during the year 2008 were surveyed by telephone regarding their use of EPT. A total of 142 eligible respondents completed the survey, representing 34% (142/421) of the delivering providers, 67 (47%) of whom reported the use of EPT in their clinics. Having received information about EPT was significantly associated with its use (67% versus 41%) (P = 0.008). The most common reasons for not using EPT included the inability to obtain allergy history in partners (24%) and concern for liability (11%). Additional education regarding the use of EPT may increase the use of this personal and public health tool among some obstetrics providers in Maricopa County; however, concerns for liability may limit broad utilization. |
Rickettsia parkeri Rickettsiosis, Argentina
Romer Y , Seijo AC , Crudo F , Nicholson WL , Varela-Stokes A , Lash RR , Paddock CD . Emerg Infect Dis 2011 17 (7) 1169-1173 Rickettsia parkeri, a recently identified cause of spotted fever rickettsiosis in the United States, has been found in Amblyomma triste ticks in several countries of South America, including Argentina, where it is believed to cause disease in humans. We describe the clinical and epidemiologic characteristics of 2 patients in Argentina with confirmed R. parkeri infection and 7 additional patients with suspected R. parkeri rickettsiosis identified at 1 hospital during 2004-2009. The frequency and character of clinical signs and symptoms among these 9 patients closely resembled those described for patients in the United States (presence of an inoculation eschar, maculopapular rash often associated with pustules or vesicles, infrequent gastrointestinal manifestations, and relatively benign clinical course). Many R. parkeri infections in South America are likely to be misdiagnosed as other infectious diseases, including Rocky Mountain spotted fever, dengue, or leptospirosis. |
Severe Leptospirosis similar to pandemic (H1N1) 2009, Florida and Missouri, USA
Lo YC , Kintziger KW , Carson HJ , Patrick SL , Turabelidze G , Stanek D , Blackmore C , Lingamfelter D , Dudley MH , Shadomy SV , Shieh WJ , Drew CP , Batten BC , Zaki SR . Emerg Infect Dis 2011 17 (6) 1145-6 Leptospirosis is caused by pathogenic spirochetes of the genus Leptospira and transmitted through direct contact of skin or mucous membranes with urine or tissues of Leptospira-infected animals or through indirect contact with contaminated freshwater or soil. Leptospirosis shares common clinical signs with influenza, including fever, headache, myalgia, and sometimes cough and gastrointestinal symptoms. During 2009, acute complicated influenza-like illness (ILI) and rapid progressive pneumonia were often attributed to pandemic (H1N1) 2009; however, alternative final diagnoses were reported to be common. We report 3 cases of severe leptospirosis in Florida and Missouri with clinical signs similar to those of pandemic (H1N1) 2009. |
Sexually transmitted infections and hepatitis in men with a history of incarceration
Sosman J , MacGowan R , Margolis A , Gaydos CA , Eldridge G , Moss S , Flanigan T , Iqbal K , Belcher L . Sex Transm Dis 2011 38 (7) 634-639 BACKGROUND: Men entering correctional facilities have high rates of human immunodeficiency virus, sexually transmitted infections (STI), and hepatitis. Many prisons offer screening, treatment, and vaccination services; however, little is known about the rates of these infections in men after release to the community. METHODS: Young men were recruited from prisons in Mississippi, Rhode Island, and Wisconsin as part of a human immunodeficiency virus/STI/hepatitis intervention study. Participants were offered screening for Neisseria gonorrhoeae (GC), Chlamydia trachomatis, trichomoniasis, syphilis, hepatitis B (HBV) and C (HCV) 6 months after release. Logistic regression was performed to identify associations with prevalent infections. RESULTS: Of 248 eligible men, 178 (71.8%) participated. Their mean age was 22.5 years, and 92% reported multiple lifetime incarcerations. At 6-month postrelease, 79% reported unprotected vaginal or anal sex, and 26% tested positive for 1 or more infections (GC, 1%; C. trachomatis, 12%; trichomoniasis, 8%; syphilis, 0%; HCV, 6%; HBV, 1%). Of all, 55% were susceptible to HBV infection. Active STI (GC, C. trachomatis, or trichomoniasis) was associated with less education (odds ratios [OR], 2.25; P < 0.05). HCV infection was associated with injection drug use (OR, 69.70; P < 0.05) and being white (OR, 7.54; P < 0.05). HBV susceptibility was associated with older age (OR, 3.02; P < 0.05), more education (OR, 2.39; P < 0.05), or incarceration in Mississippi (OR, 6.69; P < 0.05) or Rhode Island (OR, 2.84; P < 0.05). CONCLUSIONS: Effective screening and prevention programs are needed for this population before and after release from custody to prevent acquisition and further transmission of these infections. 2011 American Sexually Transmitted Diseases Association All rights reserved. |
Swine influenza virus A (H3N2) infection in human, Kansas, USA, 2009
Cox CM , Neises D , Garten RJ , Bryant B , Hesse RA , Anderson GA , Trevino-Garrison I , Shu B , Lindstrom S , Klimov AI , Finelli L . Emerg Infect Dis 2011 17 (6) 1143-4 Triple-reassortant swine influenza viruses (SIVs), which contain genes from human, swine, and avian influenza A viruses, have been enzootic among swine herds in the United States since the late 1990s. Although uncommon, occasional transmission of triple-reassortant SIVs from swine to humans has occurred. Before April 2009, only limited, nonsustained human-to-human transmission of SIVs had been reported. Although an animal source for pandemic (H1N1) 2009 virus has yet to be identified, the pandemic strain resulted from the reassortment of 2 different lineages of SIV. |
Use of home-obtained vaginal swabs to facilitate rescreening for Chlamydia trachomatis infections: two randomized controlled trials
Xu F , Stoner BP , Taylor SN , Mena L , Tian LH , Papp J , Hutchins K , Martin DH , Markowitz LE . Obstet Gynecol 2011 118 231-9 OBJECTIVE: To determine whether the use of home-based, self-obtained vaginal swabs among women who were treated for Chlamydia infection can increase rescreening rates in comparison with clinic-based rescreening, and to identify subgroups in which rescreening could be enhanced using self-obtained vaginal swabs. METHODS: Two randomized trials were conducted: one with enrollment in sexually transmitted disease (STD) clinics and the other in family planning clinics. Study participants were recruited from STD (n=880) and family planning clinics (n=412) in three cities. Females aged 16 years or older who were treated for Chlamydia infection were randomly assigned to the home group (swab collection kits mailed to home) or the clinic group (made clinic appointments) for rescreening at 3 months after treatment, with reminder calls about 2 weeks before the scheduled rescreening date. RESULTS: Groups were similar with respect to age and other demographic characteristics. Women assigned to the home group had higher rescreening rates than those in the clinic group. In STD clinics, rescreening rates were 26.7% (home) compared with 19.1% (clinic) (P=.01). In family planning clinics, rescreening rates were 40.8% (home) compared with 20.7% (clinic) (P<.001). Among women reached by reminder calls, rescreening rates were also significantly higher in the home groups: 43.5% compared with 33.0% in STD clinic participants and 59.2% compared with 37.8% in family planning clinic participants (both P<.05). The rates of reinfection ranged from 12.9% to 19.4%, and the differences by group were not statistically significant (P≥.3). CONCLUSION: In STD and family planning clinics, use of home-based, self-obtained vaginal swabs resulted in significant increases in rescreening rates compared with rescreening in the clinic. Home-based specimen collection can be an alternative to clinic-based rescreening for Chlamydia infection in women. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov, www.clinicaltrials.gov, NCT 00132457. LEVEL OF EVIDENCE: I. |
Use of intravenous neuraminidase inhibitors during the 2009 pandemic: results from population-based surveillance
Fry AM , Perez A , Finelli L . JAMA 2011 306 (2) 160-2 During 2009, neuraminidase inhibitors (NAIs) were recommended for treatment of pandemic influenza A virus (pH1N1) infection1; oral oseltamivir and inhaled zanamivir are the only licensed NAIs in the United States. During the pandemic, 2 experimental intravenous (IV) NAIs, zanamivir and peramivir, were available by emergency investigational new drug or emergency use authorization request.2,3 We report the frequency and characteristics of patients who received an experimental IV NAI from a population-based, active surveillance of hospitalized patients. |
Vaccine-derived poliomyelitis 12 years after infection in Minnesota
DeVries AS , Harper J , Murray A , Lexau C , Bahta L , Christensen J , Cebelinski E , Fuller S , Kline S , Wallace GS , Shaw JH , Burns CC , Lynfield R . N Engl J Med 2011 364 (24) 2316-23 A 44-year-old woman with long-standing common variable immunodeficiency who was receiving intravenous immune globulin suddenly had paralysis of all four limbs and the respiratory muscles, resulting in death. Type 2 vaccine-derived poliovirus was isolated from stool. The viral capsid protein VP1 region had diverged from the vaccine strain at 12.3% of nucleotide positions, and the two attenuating substitutions had reverted to the wild-type sequence. Infection probably occurred 11.9 years earlier (95% confidence interval [CI], 10.9 to 13.2), when her child received the oral poliovirus vaccine. No secondary cases were identified among close contacts or 2038 screened health care workers. Patients with common variable immunodeficiency can be chronically infected with poliovirus, and poliomyelitis can develop despite treatment with intravenous immune globulin. |
Missed opportunities to prevent tuberculosis in foreign-born persons, Connecticut, 2005-2008
Guh A , Sosa L , Hadler JL , Lobato MN . Int J Tuberc Lung Dis 2011 15 (8) 1044-9 SETTING: Factors that influence testing for latent tuberculosis infection (LTBI) among foreign-born persons in Connecticut are not well understood. OBJECTIVE: To identify predictors for LTBI testing and challenges related to accessing health care among the foreign-born population in Connecticut. DESIGN: Foreign-born Connecticut residents with confirmed or suspected tuberculosis (TB) disease during June 2005-December 2008 were interviewed regarding health care access and immigration status. Predictors for self-reported testing for LTBI after US entry were determined. RESULTS: Of 161 foreign-born persons interviewed, 48% experienced TB disease within 5 years after arrival. One third (51/156) reported having undergone post-arrival testing for LTBI. Although those with established health care providers were more likely to have reported testing (aOR 4.49, 95%CI 1.48-13.62), only 43% of such persons were tested. Undocumented persons, the majority of whom lacked a provider (53%), were less likely than documented persons to have reported testing (aOR 0.20, 95%CI 0.06-0.67). Hispanic permanent residents (immigrants and refugees) and visitors (persons admitted temporarily) were more likely than non-Hispanics in the respective groups to have reported testing (OR 5.25, 95%CI 1.51-18.31 and OR 7.08, 95%CI 1.30-38.44, respectively). CONCLUSIONS: The self-reported rate of testing for LTBI among foreign-born persons in Connecticut with confirmed or suspected TB was low and differed significantly by ethnicity and immigration status. Strategies are needed to improve health care access for foreign-born persons and expand testing for LTBI, especially among non-Hispanic and undocumented populations. |
A multimodal behavioral intervention to impact adherence and risk behavior among perinatally and behaviorally HIV-infected youth: description, delivery, and receptivity of Adolescent Impact
Chandwani S , Abramowitz S , Koenig LJ , Barnes W , D'Angelo L . AIDS Educ Prev 2011 23 (3) 222-35 Secondary prevention programs are needed to help HIV-positive youth reduce risk behavior and improve adherence to HIV medications. This article provides an overview of Adolescent Impact, a secondary HIV prevention intervention, including its description, delivery, and receptivity among the two unique groups of participants. Adolescent Impact, a 12-session behavioral intervention incorporating individual and group components was designed to increase HIV knowledge, disease management and risk reduction skills, and motivate healthy lifestyles among HIV-infected adolescents. A standardized protocol was implemented at three sites in the northeastern United States. One hundred sixty-six HIV-positive youth, aged 13-21 (mean = 16.8 years), enrolled in the study were randomized to receive either the intervention (n = 83) or standard of care (n = 83). Participants were predominantly of minority race/ethnicity (94% African American or Hispanic); 53% were female and 59.6% were perinatally infected. Perinatally infected youth were significantly more likely to be young, had experienced HIV Class C-related symptoms and had CD4-positive T lymphocyte counts of fewer than 200 cells (all p values < .01). The mean number of sessions attended was 9.4, with most (83.3%) participants attending at least half (≥ 6) of the intervention sessions (86% perinatally infected, 78.6% behaviorally infected, p = .5). Participants' sociodemographic and clinical characteristics mirrored those of the larger HIV adolescent cohort in the United States Relatively high attendance rates suggest that youth were receptive to the program and its content. Through use of multiple intervention modalities, Adolescent Impact was able to accommodate a diverse group of clinic-attending HIV-positive youth and address the need for a compact intervention for use in the clinical setting. |
Provider-Initiated Counselling and Testing (PICT): an overview
Makhunga-Ramfolo N , Chidarikire T , Farirai T , Matji R . South Afr J HIV Med 2011 12 (2) South Africa has the highest number of people living with HIV in the world. Despite this, many South Africans do not know their HIV status and uptake of voluntary counselling and testing (VCT) has been suboptimal. In clinical settings there are many missed opportunities for HIV diagnosis as most patients are not routinely offered HIV counselling and testing (HCT). Provider-initiated counselling and testing (PICT) has been introduced to ensure that HCT becomes the standard of care in all consultations with health providers. PICT promotes universal access to prevention, care and treatment services for all clients by increasing the utilisation and acceptance of HCT services. This article outlines the rationale for PICT as well as providing an overview of the implementation protocol that will equip health care providers with the knowledge required to integrate HOT into routine medical care. |
Effect of earlier initiation of antiretroviral treatment and increased treatment coverage on HIV-related mortality in China: a national observational cohort study
Zhang F , Dou Z , Ma Y , Zhang Y , Zhao Y , Zhao D , Zhou S , Bulterys M , Zhu H , Chen RY . Lancet Infect Dis 2011 11 (7) 516-24 BACKGROUND: Overall HIV mortality rates in China have not been reported. In this analysis we assess overall mortality in treatment-eligible adults with HIV and attempt to identify risk factors for HIV-related mortality. METHODS: We used data from the national HIV epidemiology and treatment databases to identify individuals aged 15 years or older with HIV who were eligible for highly active antiretroviral therapy between 1985 and 2009. Mortality rates were calculated in terms of person-years, with risk factors determined by Cox proportional hazard regression. Treatment coverage was calculated as the proportion of time that patients who were eligible for treatment received treatment, with risk factors for not receiving treatment identified by use of logistic regression. FINDINGS: Of 323 252 people reported as having HIV in China by the end of 2009, 145 484 (45%) were identified as treatment-eligible and included in this analysis. Median CD4 count was 201 cells per muL (IQR 71-315) at HIV diagnosis and 194 cells per muL (73-293) when first declared eligible for treatment. Overall mortality decreased from 39.3 per 100 person-years in 2002 to 14.2 per 100 person-years in 2009, with treatment coverage concomitantly increasing from almost zero to 63.4%. By 2009, mortality was higher and treatment coverage lower in injecting drug users (15.9 deaths per 100 person-years; 42.7% coverage) and those infected sexually (17.5 deaths per 100 person-years; 61.7% coverage), compared with those infected through plasma donation or blood transfusion (6.7 deaths per 100 person-years; 80.2% coverage). The two strongest risk factors for HIV-related mortality were not receiving highly active antiretroviral therapy (adjusted hazard ratio 4.35, 95% CI 4.10-4.62) and having a CD4 count of less than 50 cells per muL when first declared eligible for treatment (7.92, 7.33-8.57). INTERPRETATION: An urgent need exists for earlier HIV diagnosis and better access to treatment for injecting drug users and patients infected with HIV sexually, especially before they become severely immunosuppressed. FUNDING: The National Centre for AIDS/STD Control and Prevention of the Chinese Centre for Disease Control and Prevention. |
Emergency department HIV screening with rapid tests: a cost comparison of alternative models
Hutchinson AB , Farnham PG , Lyss SB , White DA , Sansom SL , Branson BM . AIDS Educ Prev 2011 23 58-69 Although previous studies have shown that HIV screening in emergency departments (EDs) is feasible, the costs and outcomes of alternative methods of implementing ED screening have not been examined. We compared the costs and outcomes of a model that used the hospital's ED staff to conduct screening, a supplemental staff model that used non-ED staff hired to conduct screening and a hypothetical hybrid model that combined aspects of both approaches. We developed a decision analytic model to estimate the cost per HIV-infected patient identified using alternative ED testing models. The cost per new HIV infection identified was $3,319, $2,084 and $1,850 under the supplemental, existing staff and hybrid models, respectively. Assuming an annual ED census of 50,000 patients, the existing staff model identified 29 more HIV infections than the supplemental model and the hybrid model identified 76 more infections than the existing staff model. Our findings suggest that a hybrid model should be favored over either a supplemental staff or existing staff model in terms of cost per outcome achieved. |
Epidemiology and investigation of melioidosis, Southern Arizona
Stewart T , Engelthaler DM , Blaney DD , Tuanyok A , Wangsness E , Smith TL , Pearson T , Komatsu KK , Keim P , Currie BJ , Levy C , Sunenshine R . Emerg Infect Dis 2011 17 (7) 1286-1288 Burkholderia pseudomallei is a bacterium endemic to Southeast Asia and northern Australia, but it has not been found to occur endemically in the United States. We report an ostensibly autochthonous case of melioidosis in the United States. Despite an extensive investigation, the source of exposure was not identified. |
Exposure to lymphocytic choriomeningitis virus, New York, USA
Knust B , MacNeil A , Wong SJ , Backenson PB , Gibbons A , Rollin PE , Nichol ST . Emerg Infect Dis 2011 17 (7) 1324-5 Lymphocytic choriomeningitis virus (LCMV) is an arenavirus carried by the house mouse, Mus musculus. Human infections can range from mild febrile illness to severe encephalitis and disseminated disease. Infection during pregnancy is associated with teratogenic effects, including congenital hydrocephalus and chorioretinitis. |
Hepatitis C testing practices and prevalence in a high-risk urban ambulatory care setting
Southern WN , Drainoni ML , Smith BD , Christiansen CL , McKee D , Gifford AL , Weinbaum CM , Thompson D , Koppelman E , Maher S , Litwin AH . J Viral Hepat 2011 18 (7) 474-481 SUMMARY: Approximately 3.2 million persons are chronically infected with the hepatitis C virus (HCV) in the U.S.; most are not aware of their infection. Our objectives were to examine HCV testing practices to determine which patient characteristics are associated with HCV testing and positivity, and to estimate the prevalence of HCV infection in a high-risk urban population. The study subjects were all patients included in the baseline phase of the Hepatitis C Assessment and Testing Project (HepCAT), a serial cross-sectional study of HCV screening strategies. We examined all patients with a clinic visit to Montefiore Medical Center from 1/1/08 to 2/29/08. Demographic information, laboratory data and ICD-9 diagnostic codes from 3/1/97-2/29/08 were extracted from the electronic medical record. Risk factors for HCV were defined based on birth date, ICD-9 codes and laboratory data. The prevalence of HCV infection was estimated assuming that untested subjects would test positive at the same rate as tested subjects, based on risk-factors. Of 9579 subjects examined, 3803 (39.7%) had been tested for HCV and 438 (11.5%) were positive. The overall prevalence of HCV infection was estimated to be 7.7%. Risk factors associated with being tested and anti-HCV positivity included: born in the high-prevalence birth-cohort (1945-64), substance abuse, HIV infection, alcohol abuse, diagnosis of cirrhosis, end-stage renal disease, and alanine transaminase elevation. In a high-risk urban population, a significant proportion of patients were tested for HCV and the prevalence of HCV infection was high. Physicians appear to use a risk-based screening strategy to identify HCV infection. |
HIV counseling, testing and referral experiences of persons diagnosed with HIV who have never entered HIV medical care
Garland PM , Valverde EE , Fagan J , Beer L , Sanders C , Hillman D , Brady K , Courogen M , Bertolli J . AIDS Educ Prev 2011 23 117-27 The HIV counseling, testing, and referral (CTR) encounter represents an important opportunity to actively facilitate entry into medical care for those who test positive for HIV, but its potential is not always realized. Ways to improve facilitation of linkage to care through the CTR encounter haven't been explored among HIV-infected persons who have not entered care. We conducted 42 structured and qualitative interviews among HIV-infected persons, diagnosed 5-19 months previously, in Indiana, Philadelphia and Washington State, who had not received HIV medical care. Respondents related individual and system-level barriers, as well as recommendations for improving the effectiveness of CTR as a facilitator of linkage to HIV medical care through more active referrals, and for strengthening the bridge between CTR and linkage to care services. Our findings suggest that standards for active case referral by CTR staff and integration of CTR and linkage to care services are needed. |
HIV prevention among African American youth: how well have evidence-based interventions addressed key theoretical constructs?
Romero LM , Galbraith JS , Wilson-Williams L , Gloppen KM . AIDS Behav 2011 15 (5) 976-91 Certain constructs are demonstrated in the research literature to be related to HIV risk behaviors among African American adolescents. This study examines how well these constructs are addressed in evidence-based interventions (EBIs) developed for this population. A literature review on variables for sexual risk behaviors among African American adolescents was undertaken. Simultaneously, a review was conducted of the contents of HIV-prevention EBIs. To facilitate comparison, findings from both were organized into constructs from prominent behavior change theories. Analysis showed that environmental conditions and perceived norms were frequently associated with sexual risk behaviors in the literature, while EBIs devoted considerable time to knowledge, skills, and self-efficacy. Findings imply that (a) EBIs might be complemented with activities that focus on important constructs identified in the literature and (b) researchers should better assess the relationship between skill development and HIV risk behaviors. Implications for practice and research are discussed. |
Human herpesvirus 8 seropositivity among sexually active adults in Uganda
Shebl FM , Dollard SC , Pfeiffer RM , Biryahwaho B , Amin MM , Munuo SS , Hladik W , Parsons R , Graubard BI , Mbulaiteye SM . PLoS One 2011 6 (6) e21286 INTRODUCTION: Sexual transmission of human herpesvirus 8 (HHV8) has been implicated among homosexual men, but the evidence for sexual transmission among heterosexual individuals is controversial. We investigated the role of sexual transmission of HHV8 in a nationally representative sample in Uganda, where HHV8 infection is endemic and transmitted mostly during childhood. MATERIALS AND METHODS: The study population was a subset of participants (n = 2681) from a population-based HIV/AIDS serobehavioral survey of adults aged 15-59 years conducted in 2004/2005. High risk for sexual transmission was assessed by questionnaire and serological testing for HIV and herpes simplex virus 2. Anti-HHV8 antibodies were measured using two enzyme immunoassays targeting synthetic peptides from the K8.1 and orf65 viral genes. The current study was restricted to 2288 sexually active adults. ORs and 95% CIs for HHV8 seropositivity were estimated by fitting logistic regression models with a random intercept using MPLUS and SAS software. RESULTS: The weighted prevalence of HHV8 seropositivity was 56.2%, based on 1302 seropositive individuals, and it increased significantly with age (P(trend)<0.0001). In analyses adjusting for age, sex, geography, education, and HIV status, HHV8 seropositivity was positively associated with reporting two versus one marital union (OR:1.52, 95% CI: 1.17-1.97) and each unit increase in the number of children born (OR: 1.04, 95% CI: 1.00-1.08), and was inversely associated with ever having used a condom (OR: 0.64, 95% CI: 0.45-0.89). HHV8 seropositivity was not associated with HIV (P = 0.660) or with herpes simplex virus 2 (P = 0.732) seropositivity. Other sexual variables, including lifetime number of sexual partners or having had at least one sexually transmitted disease, and socioeconomic variables were unrelated to HHV8 seropositivity. CONCLUSION: Our findings are compatible with the conclusion that sexual transmission of HHV8 in Uganda, if it occurs, is weak. |
Implications of the introduction of cholera to Haiti
Dowell SF , Braden CR . Emerg Infect Dis 2011 17 (7) 1299-300 With more than 250,000 cases and 4,000 deaths in the first 6 months, the cholera epidemic in Haiti has been one of the most explosive and deadly in recent history. It is also one of the best documented, with detailed surveillance information available from the beginning of the epidemic, which allowed its spread to all parts of the country to be traced. Piarroux et al. make good use of this information, along with their own careful field investigations, to trace the epidemic to its beginning and propose an explanation for its origins (1). |
Incidence and severity of invasive Streptococcus pneumoniae, group A Streptococcus, and group B Streptococcus infections among pregnant and postpartum women
Deutscher M , Lewis M , Zell ER , Taylor TH Jr , Van Beneden C , Schrag S . Clin Infect Dis 2011 53 (2) 114-123 BACKGROUND: The epidemiology of streptococcal infection in pregnant and postpartum women is poorly described in recent literature. We used data from multistate surveillance for invasive Streptococcus pneumoniae, group A Streptococcus (GAS), and group B Streptococcus (GBS) infections to estimate disease incidence and severity in these populations. METHODS: Cases were reported through the Centers for Disease Control and Prevention Active Bacterial Core surveillance, an active population- and laboratory-based system. A case was defined as illness in a woman aged 15-44 years with streptococcus isolated from a normally sterile body site during 2007-2009. Pregnant or postpartum status was recorded at the time of culture. Incidence was calculated as cases per 1000 woman-years with use of national Census data; 95% confidence intervals were calculated on the basis of lambda distribution. We used multivariable logistic regression to explore associations between pregnant or postpartum status and hospital length of stay, a marker of disease severity. RESULTS: We identified 1848 cases in women; 6.0% of women were pregnant, and 7.5% were postpartum. Pregnant women had a higher mean incidence of GBS disease, compared with nonpregnant women (0.04 cases per 1000 woman-years [range, 0.03-0.05 cases per 1000 woman-years] vs 0.02 cases per 1000 woman-years [range, 0.02-0.02 cases per 1000 woman-years]). Postpartum women had elevated mean incidence of all 3 pathogens, compared with nonpregnant women (S. pneumoniae: 0.15 cases per 1000 woman-years [range, 0.09-0.25 cases per 1000 woman-years] vs 0.052 cases per 1000 woman-years [range, 0.049-0.056 cases per 1000 woman-years]; GAS: 0.56 cases per 1000 woman-years [range, 0.42-0.70 cases per 1000 woman-years] vs 0.019 cases per 1000 woman-years [range, 0.017-0.021 cases per 1000 woman-years]; GBS: 0.49 cases per 1000 woman-years [range, 0.36-0.64 cases per 1000 woman-years] vs 0.018 [range, 0.016-0.020 cases per 1000 woman-years]). Neither pregnancy nor postpartum status was associated with longer length of stay among women infected with any of the 3 pathogens. CONCLUSIONS: Although invasive streptococcal infections do not appear to be more severe in pregnant or postpartum women, postpartum women have a 20-fold increased incidence of GAS and GBS, compared with nonpregnant women. |
The acceptance and feasibility of replacement feeding at 6 months as an HIV prevention method in Lilongwe, Malawi: results from the BAN Study
Parker ME , Bentley ME , Chasela C , Adair L , Piwoz EG , Jamieson DJ , Ellington S , Kayira D , Soko A , Mkhomawanthu C , Tembo M , Martinson F , Van der Horst CM . AIDS Educ Prev 2011 23 (3) 281-95 International guidelines recommend EBF to age 6 months among HIV-infected mothers choosing to breast-feed and cessation thereafter if replacement feeding is acceptable, feasible, affordable, sustainable, and safe. When mothers wean, they are challenged to provide an adequate replacement diet. This study investigates the use and acceptability of a lipid-based nutrient supplement (LNS) as a breast-milk substitute when provided to infants (6-12mo) of HIV-positive mothers, as part of the Breast-feeding, Antiretroviral, and Nutrition (BAN) Study. A sub-sample of mothers (n = 45) participated in interviews that explored EBF, weaning, and strategies to feed LNS. Mothers reported several weaning strategies, including gradual reduction of breast-feeding, expressing breast-milk into a cup, and separation of mother and child. LNS, a peanut-based micronutrient fortified paste, was highly accepted and incorporated into the traditional diet. Weaning is a feasible HIV prevention method among this population in Malawi when supported by the provision of LNS as a breast-milk substitute. |
Can lay community health workers be trained to use diagnostics to distinguish and treat malaria and pneumonia in children? Lessons from rural Uganda
Mukanga D , Babirye R , Peterson S , Pariyo GW , Ojiambo G , Tibenderana JK , Nsubuga P , Kallander K . Trop Med Int Health 2011 16 (10) 1234-42 OBJECTIVE: To determine the competence of community health workers (CHWs) to correctly assess, classify and treat malaria and pneumonia among under-five children after training. METHODS: Consultations of 182 under-fives by 14 CHWs in Iganga district, Uganda, were observed using standardised checklists. Each CHW saw 13 febrile children. Two paediatricians observed CHWs' assessment, classification and prescription of treatment, while a laboratory scientist assessed CHW use of malaria rapid diagnostic tests (RDTs). The validity of CHWs' use of RDTs to detect malaria and respiratory timers to diagnose pneumonia was estimated using a laboratory scientist's RDT repeat reading and a paediatrician's repeat count of the respiratory rate, respectively. RESULTS: From the 182 consultations, overall CHWs' performance was adequate in taking history (97%), use (following procedures prior to reading result) of timers (96%) and use of RDTs (96%), but inadequate in classification (87%). Breath readings (classified as fast or normal) were 85% in agreement with the paediatrician (kappa = 0.665, P < 0.001). All RDT readings were in agreement with those obtained by the laboratory scientist. Ninety-six per cent (85/89) of children with a positive RDT were prescribed an antimalarial drug, 40% (4/10) with fast breathing (gold standard) were prescribed an antibiotic and 91% (48/53) with both were prescribed both medicines. CONCLUSION: Community health workers can be trained to use RDTs and timers to assess and manage malaria and pneumonia in children. We recommend integration of these diagnostics into community case management of fever. CHWs require enhanced practice in counting respiratory rates and simple job aides to enable them make a classification without thinking deeply about several assessment results. |
Characteristics of first-time and repeat HIV tests among men who have sex with men who test at CDC-supported sites, 2007
Fisher HH , Habarta N , Hardnett F , Toledo C , Hoyte T , Eke A , Valleroy L . AIDS Educ Prev 2011 23 17-29 This report describes characteristics of HIV test data for men who have sex with men (MSM) tested in 2007 through programs funded by the Centers for Disease Control and Prevention (CDC). HIV test-level data of MSM submitted by 29 health departments were analyzed to explore test characteristics among all tests, first-time tests, and repeat tests. Characteristics significantly associated with HIV-positive results among first-time tests were identified through logistic regression. Of the 129,893 tests conducted, 18% were first-time tests and 82% were repeat tests. HIV positivity among first-time tests was 4.1% and 3.7% among repeat tests. Among first-time tests, 46% of tests were among White MSM and 48% of HIV-positive test results were among African Americans. An HIV-positive test among first-time tests was strongly associated with being African American, being 40-49 years old, and testing in the southern United States. Race/ethnicity differences exist among MSM testing at CDC-funded sites. African American MSM accounted for the greatest proportion of HIV-positive results but White MSM represented the greatest proportion of tests conducted. HIV prevention strategies that include CDC-funded testing for MSM should increase targeting of African Americans. |
Comparison of Staphylococcus aureus from skin and soft-tissue infections in US emergency department patients, 2004 and 2008
Talan DA , Krishnadasan A , Gorwitz RJ , Fosheim GE , Limbago B , Albrecht V , Moran GJ . Clin Infect Dis 2011 53 (2) 144-149 BACKGROUND: In the past decade, new methicillin-resistant Staphylococcus aureus (MRSA) strains have emerged as a predominant cause of community-associated skin and soft-tissue infections (SSTIs). Little information exists regarding trends in MRSA prevalence and molecular characteristics or regarding antimicrobial susceptibility profiles of S. aureus isolates. METHODS: We enrolled adults with acute, purulent SSTIs presenting to a US network of 12 emergency departments during August 2008. Cultures and clinical information were collected. S. aureus isolates were characterized by antimicrobial susceptibility testing, pulsed-field gel electrophoresis, and toxin genes detection. The prevalence of S. aureus and MRSA and isolate genetic characteristics and susceptibilities were compared with those from a similar study conducted in August 2004. RESULTS: The prevalence of MRSA was 59% among all SSTIs during both study periods; however, the prevalence by site varied less in 2008 (38%-84%), compared with 2004 (15%-74%). Pulsed-field type USA300 continued to account for almost all MRSA isolates (98%). Susceptibility to trimethoprim-sulfamethoxazole, clindamycin, and tetracycline among MRSA isolates remained greater than 90% in 2008. A higher proportion of MRSA infections were treated with an agent to which the infecting isolate was susceptible in vitro in 2008 (97%), compared with 2004 (57%). CONCLUSIONS: Similar to 2004, MRSA remained the most common identifiable cause of purulent SSTIs among patients presenting to a network of US emergency departments in 2008. The infecting MRSA isolates continued to be predominantly pulsed-field type USA300 and susceptible to recommended non-beta-lactam oral agents. Clinician prescribing practices have shifted from MRSA-inactive to MRSA-active empirical antimicrobial regimens. |
Concurrent outbreak of norovirus genotype I and Enterotoxigenic Escherichia coli on a U.S. Navy Ship following a visit to Lima, Peru
Gonzaga VE , Ramos M , Maves RC , Freeman R , Montgomery JM . PLoS One 2011 6 (6) e20822 An outbreak of norovirus (NoV) genotype I and Enterotoxigenic Escherichia coli (ETEC) occurred among US Navy Ship personnel following a visit to Lima, Peru, in June 2008. Visiting a specific area in Lima was significantly associated with illness. While ETEC and NoV are commonly recognized as causative agents of outbreaks, co-circulation of both pathogens has been rarely observed in shipboard outbreaks. |
Condom use decision making in the context of hypothetical pre-exposure prophylaxis efficacy among substance-using men who have sex with men: Project MIX
Koblin BA , Mansergh G , Frye V , Van Tieu H , Hoover DR , Bonner S , Flores SA , Hudson SM , Colfax GN . J Acquir Immune Defic Syndr 2011 58 (3) 319-27 OBJECTIVE: To examine condom use decision making in the context of hypothetical pre-exposure prophylaxsis (PrEP) efficacy among men who have sex with men (MSM) who use alcohol and other substances during sex. METHODS: Substance-using MSM were recruited in four US cities for a behavioral intervention trial. Three groups were defined: men who indicated that in order to not use a condom for receptive/insertive anal intercourse (UAI) while using PrEP, PrEP would need to be: 1) almost always or always effective (high efficacy); 2) effective at least half the time or more but not almost always or always (mid-range efficacy corresponding to recent PrEP trial results); 3) effective less than half the time (low efficacy). The mid-range efficacy group was compared to the low efficacy group (as the reference) and to the high efficacy group (as the reference). RESULTS: Among 630 men who never used PrEP, 15.2% were in the mid-range efficacy group for receptive UAI and 34.1% in the mid-range efficacy group for insertive UAI. Scores on difficulty communicating about safer sex while high were significantly higher in the mid-range efficacy group compared to each of the other groups for both receptive and insertive UAI. Men who appeared to be differentiating PrEP use by anal sex role also scored higher on communication difficulties, while scoring lower on condom intentions. CONCLUSIONS: Communication about safer sex while under the influence of alcohol or other substances and condom intentions are important factors to consider for HIV prevention interventions for PrEP users. |
Costs and effectiveness of finding new HIV diagnoses by using rapid testing in transgender communities
Shrestha RK , Sansom SL , Schulden JD , Song B , Smith LC , Ramirez R , Mares-Delgrasso A , Heffelfinger JD . AIDS Educ Prev 2011 23 49-57 We assessed the costs and effectiveness of rapid HIV testing services provided to transgender communities in New York City and San Francisco from April 2005 to December 2006. Program costs were estimated based on service provider's perspective and included the costs attributable to staff time, incentives, transportation, test kits, office space, equipment, supplies, and utilities. The average annual numbers of persons tested were 195 and 106 persons and numbers notified of new HIV diagnoses were 35 (18.2%) in New York City and 8 (7.3%) in San Francisco, respectively. The estimated annual program costs were $125,879 and $64,323 and average costs per person notified of new diagnosis were $3,563 and $8,284 in New York City and San Francisco, respectively. The primary reason for differences in program costs by site was differences in the proportion of undiagnosed HIV infection among persons tested. Our findings can inform decisions about program planning and allocation of limited HIV testing resources. |
Dengue virus seroprevalence among febrile patients in Bamako, Mali: results of a 2006 surveillance study
Phoutrides EK , Coulibaly MB , George CM , Sacko A , Traore S , Bessoff K , Wiley MR , Kolivras KN , Adelman Z , Traore M , Hunsperger EA . Vector Borne Zoonotic Dis 2011 11 (11) 1479-85 BACKGROUND: Dengue viruses (DENV) are endemic in over 100 countries worldwide, and annually 50 to 100 million people are infected by one of the four DENV serotypes, whereas over 2.5 billion people are at risk for infection. West African countries lack the surveillance to determine the true incidence of dengue; hence, this disease is likely significantly underestimated. In Mali, approximately 14 million people are potentially at risk of acquiring a dengue infection. METHODS AND FINDINGS: A serosurvey for DENV was conducted on 95 human serum samples obtained from the Institute National de Recherche en Sante Publique in 2006. DENV-specific IgM and IgG enzyme-linked immunosorbent assays were performed on all samples, and a subset was tested using the plaque-reduction neutralization test against the DENV and yellow fever virus (YFV). Samples collected during the acute infection (0-5 days postonset of symptoms) were tested for dengue NS1 antigen and reverse-transcriptase polymerase chain reaction for Flaviviruses, Alphaviruses, and Bunyaviruses RNA. A total of 87 (93%) of samples were positive for anti-DENV IgG antibodies. Of a subset of 13 IgG positive samples, 2 samples neutralized monotypically against DENV-1 and -2, whereas 3 others neutralized broadly against YFV and multiple DENV. Although no polymerase chain reaction positives were found, DENV NS1 was detected in 1 of the 20 acute samples tested. CONCLUSIONS: Of the 93 human serum samples tested, the dengue prevalence based on dengue IgG enzyme-linked immunosorbent assay results was 93%. Three DENV specific positive samples and two YFV positives were identified by plaque-reduction neutralization test. Finally, one sample tested positive for dengue NS1, thus suggestive of an acute infection within 14 days of obtaining the sample from the patient. Based on these serological data from this study, YFV and DENV appear to be co-circulating in Mali. |
Using wild white-tailed deer to detect eastern equine encephalitis virus activity in Maine
Mutebi JP , Lubelczyk C , Eisen R , Panella N , Macmillan K , Godsey M , Swope B , Young G , Smith RP , Kantar L , Robinson S , Sears S . Vector Borne Zoonotic Dis 2011 11 (10) 1403-9 Serum from 226 free-ranging white-tailed deer (Odocoileus virginianus) was screened for Eastern Equine Encephalitis Virus (EEEV) antibodies using plaque reduction neutralization tests. EEEV antibodies were detected in 7.1% of samples. This is the first time EEEV antibodies have been detected in O. virginianus populations in the state of Maine (ME). The highest percentage of EEEV positive sera was in Somerset County (19%) in central ME, and this is the first time that EEEV activity has been detected in that County. EEEV RNA was not detected in any of the 150 harvested deer brain samples submitted to the ME Department of Inland Fisheries and Wildlife as a part of screening for Chronic Wasting Disease. This suggests that screening deer brains is not an efficient method to detect EEEV activity. For each serum sample tested, the geographic location in which the deer was harvested was recorded. Significant spatial clustering of antibody-positive sera samples was not detected. Relative to seronegative deer, seropositive deer were slightly more likely to be harvested in nonforested areas compared with forested areas. Results indicate that screening of free-ranging deer sera can be a useful tool for detecting EEEV activity in ME and other parts of North America. |
Annual seroprevalence of Yersinia pestis in coyotes as predictors of interannual variation in reports of human plague cases in Arizona, United States
Brown HE , Levy CE , Enscore RE , Schriefer ME , Deliberto TJ , Gage KL , Eisen RJ . Vector Borne Zoonotic Dis 2011 11 (11) 1439-46 Although several health departments collect coyote blood samples for plague surveillance, the association between reported human cases and coyote seroprevalence rates remains anecdotal. Using data from an endemic region of the United States, we sought to quantify this association. From 1974 to 1998, about 2,276 coyote blood samples from four Arizona counties were tested for serological evidence of exposure to Yersinia pestis, the causative agent of plague. Using a titer threshold presumed to be indicative of recent infection (serum titers of ≥1:256), we found a statistically significant relationship between years with >17% sero-positive coyotes and years with two or more human cases reported. Moreover, when the annual coyote seroprevalence rates were dichotomized at 17%, 84% of the years were correctly classified using four biologically relevant meteorological variables in a linear regression. This is the first time a statistically significant temporal association between human plague cases and coyote seroprevalence rates has been shown. However, issues with data resolution and surveillance effort that potentially limit the public health utility of using coyote seroprevalence rates are discussed. |
Bartonella spp. in bats, Guatemala
Bai Y , Kosoy M , Recuenco S , Alvarez D , Moran D , Turmelle A , Ellison J , Garcia DL , Estevez A , Lindblade K , Rupprecht C . Emerg Infect Dis 2011 17 (7) 1269-1272 To better understand the role of bats as reservoirs of Bartonella spp., we estimated Bartonella spp. prevalence and genetic diversity in bats in Guatemala during 2009. We found prevalence of 33% and identified 21 genetic variants of 13 phylogroups. Vampire bat-associated Bartonella spp. may cause undiagnosed illnesses in humans. |
Cyclic di-GMP is essential for the survival of the Lyme disease spirochete in ticks
He M , Ouyang Z , Troxell B , Xu H , Moh A , Piesman J , Norgard MV , Gomelsky M , Yang XF . PLoS Pathog 2011 7 (6) e1002133 Cyclic dimeric GMP (c-di-GMP) is a bacterial second messenger that modulates many biological processes. Although its role in bacterial pathogenesis during mammalian infection has been documented, the role of c-di-GMP in a pathogen's life cycle within a vector host is less understood. The enzootic cycle of the Lyme disease pathogen Borrelia burgdorferi involves both a mammalian host and an Ixodes tick vector. The B. burgdorferi genome encodes a single copy of the diguanylate cyclase gene (rrp1), which is responsible for c-di-GMP synthesis. To determine the role of c-di-GMP in the life cycle of B. burgdorferi, an Rrp1-deficient B. burgdorferi strain was generated. The rrp1 mutant remains infectious in the mammalian host but cannot survive in the tick vector. Microarray analyses revealed that expression of a four-gene operon involved in glycerol transport and metabolism, bb0240-bb0243, was significantly downregulated by abrogation of Rrp1. In vitro, the rrp1 mutant is impaired in growth in the media containing glycerol as the carbon source (BSK-glycerol). To determine the contribution of the glycerol metabolic pathway to the rrp1 mutant phenotype, a glp mutant, in which the entire bb0240-bb0243 operon is not expressed, was generated. Similar to the rrp1 mutant, the glp mutant has a growth defect in BSK-glycerol medium. In vivo, the glp mutant is also infectious in mice but has reduced survival in ticks. Constitutive expression of the bb0240-bb0243 operon in the rrp1 mutant fully rescues the growth defect in BSK-glycerol medium and partially restores survival of the rrp1 mutant in ticks. Thus, c-di-GMP appears to govern a catabolic switch in B. burgdorferi and plays a vital role in the tick part of the spirochetal enzootic cycle. This work provides the first evidence that c-di-GMP is essential for a pathogen's survival in its vector host. |
SAR/QSAR methods in public health practice
Demchuk E , Ruiz P , Chou S , Fowler BA . Toxicol Appl Pharmacol 2011 254 (2) 192-7 Methods of (Quantitative) Structure-Activity Relationship ((Q)SAR) modeling play an important and active role in ATSDR programs in support of the Agency mission to protect human populations from exposure to environmental contaminants. They are used for cross-chemical extrapolation to complement the traditional toxicological approach when chemical-specific information is unavailable. SAR and QSAR methods are used to investigate adverse health effects and exposure levels, bioavailability, and pharmacokinetic properties of hazardous chemical compounds. They are applied as a part of an integrated systematic approach in the development of Health Guidance Values (HGVs), such as ATSDR Minimal Risk Levels, which are used to protect populations exposed to toxic chemicals at hazardous waste sites. (Q)SAR analyses are incorporated into ATSDR documents (such as the toxicological profiles and chemical-specific health consultations) to support environmental health assessments, prioritization of environmental chemical hazards, and to improve study design, when filling the priority data needs (PDNs) as mandated by Congress, in instances when experimental information is insufficient. These cases are illustrated by several examples, which explain how ATSDR applies (Q)SAR methods in public health practice. |
Surveillance data on pesticide and agricultural chemical releases and associated public health consequences in selected US states, 2003-2007
Saw L , Shumway J , Ruckart P . J Med Toxicol 2011 7 (2) 164-71 BACKGROUND: While pesticides and agricultural chemicals are used to increase crop production and to reduce the spread of disease, their toxic nature also has the potential to threaten human health. Releases of pesticides and agricultural chemicals have resulted in human illness and death. This analysis examines releases of pesticides and agricultural chemicals and their associated injuries captured by the Hazardous Substances Emergency Events Surveillance (HSEES) system from 2003-2007. METHODS: Simple descriptive statistics are presented. Comparisons were made to data from all HSEES events when possible. RESULTS: Analysis of the data shows that farm workers are at particular risk for injury and that the most frequent months for releases of pesticides and agricultural chemicals were the spring planting months of April through June. Releases of pesticides and agricultural chemicals occurred more often during transport, had higher frequencies of patient decontamination associated with them, and lower frequencies of evacuation and shelter-in place orders compared with all HSEES events. CONCLUSION: Since exposures are precipitated by behavioral and environmental factors, especially in occupational settings, future interventions targeting employers, and transporters of agricultural chemicals, as well as physicians, are recommended. These interventions should be customized to fit local conditions. |
Ensuring mobility-supporting environments for an aging population: critical actors and collaborations
Kochtitzky CS , Freeland AL , Yen IH . J Aging Res 2011 2011 138931 Successful aging takes on an array of attributes, including optimal health and community participation. Research indicates that (1) persons with disabilities, including age-related disabilities, report frequent barriers to community participation, including unsuitable building design (43%), transportation (32%), and sidewalks/curbs (31%), and (2) many seniors report an inability to cross roads safely near their homes. This paper attempts to define mobility-related elements that contribute to optimal health and quality of life, within the context of successful aging. It then examines the impacts of community design on individual mobility, delving into which traditional and nontraditional actors-including architects, urban planners, transportation engineers, occupational therapists, and housing authorities-play critical roles in ensuring that community environments serve as facilitators (rather than barriers) to mobility. As America ages, mobility challenges for seniors will only increase unless both traditional aging specialists and many nontraditional actors make a concerted effort to address the challenges. |
Estimating the global public health implications of electricity and coal consumption
Gohlke JM , Thomas R , Woodward A , Campbell-Lendrum D , Pruss-Ustun A , Hales S , Portier CJ . Environ Health Perspect 2011 119 (6) 821-6 BACKGROUND: The growing health risks associated with greenhouse gas emissions highlight the need for new energy policies that emphasize efficiency and low-carbon energy intensity. OBJECTIVES: We assessed the relationships among electricity use, coal consumption, and health outcomes.Methods: Using time-series data sets from 41 countries with varying development trajectories between 1965 and 2005, we developed an autoregressive model of life expectancy (LE) and infant mortality (IM) based on electricity consumption, coal consumption, and previous year's LE or IM. Prediction of health impacts from the Greenhouse Gas and Air Pollution Interactions and Synergies (GAINS) integrated air pollution emissions health impact model for coal-fired power plants was compared with the time-series model results. RESULTS: The time-series model predicted that increased electricity consumption was associated with reduced IM for countries that started with relatively high IM (> 100/1,000 live births) and low LE (< 57 years) in 1965, whereas LE was not significantly associated with electricity consumption regardless of IM and LE in 1965. Increasing coal consumption was associated with increased IM and reduced LE after accounting for electricity consumption. These results are consistent with results based on the GAINS model and previously published estimates of disease burdens attributable to energy-related environmental factors, including indoor and outdoor air pollution and water and sanitation. CONCLUSIONS: Increased electricity consumption in countries with IM < 100/1,000 live births does not lead to greater health benefits, whereas coal consumption has significant detrimental health impacts. |
Impacts of climate change on public health in India: future research directions
Bush KF , Luber G , Kotha SR , Dhaliwal RS , Kapil V , Pascual M , Brown DG , Frumkin H , Dhiman RC , Hess J , Wilson ML , Balakrishnan K , Eisenberg J , Kaur T , Rood R , Batterman S , Joseph A , Gronlund CJ , Agrawal A , Hu H . Environ Health Perspect 2011 119 (6) 765-70 BACKGROUND: Climate change and associated increases in climate variability will likely further exacerbate global health disparities. More research is needed, particularly in developing countries, to accurately predict the anticipated impacts and inform effective interventions. OBJECTIVES: Building on the information presented at the 2009 Joint Indo-U.S. Workshop on Climate Change and Health in Goa, India, we reviewed relevant literature and data, addressed gaps in knowledge, and identified priorities and strategies for future research in India. DISCUSSION: The scope of the problem in India is enormous, based on the potential for climate change and variability to exacerbate endemic malaria, dengue, yellow fever, cholera, and chikungunya, as well as chronic diseases, particularly among the millions of people who already experience poor sanitation, pollution, malnutrition, and a shortage of drinking water. Ongoing efforts to study these risks were discussed but remain scant. A universal theme of the recommendations developed was the importance of improving the surveillance, monitoring, and integration of meteorological, environmental, geospatial, and health data while working in parallel to implement adaptation strategies. CONCLUSIONS: It will be critical for India to invest in improvements in information infrastructure that are innovative and that promote interdisciplinary collaborations while embarking on adaptation strategies. This will require unprecedented levels of collaboration across diverse institutions in India and abroad. The data can be used in research on the likely impacts of climate change on health that reflect India's diverse climates and populations. Local human and technical capacities for risk communication and promoting adaptive behavior must also be enhanced. |
Incidence of thyroid disease following exposure to polybrominated biphenyls and polychlorinated biphenyls, Michigan, 1974-2006
Yard EE , Terrell ML , Hunt DR , Cameron LL , Small CM , McGeehin MA , Marcus M . Chemosphere 2011 84 (7) 863-8 Thyroid hormones, which influence body metabolism and development, could be affected by persistent organic pollutants. We sought to examine the relationship between polybrominated biphenyls (PBBs) and polychlorinated biphenyls (PCBs) and thyroid disease. We employed incidence density sampling to perform a nested case control analysis of the Michigan Long-Term PBB Cohort. Cohort members (n=3333) were exposed to PBBs through contaminated cattle feed in 1973-1974 and to PCBs through daily life. Those with detectable serum PBB and PCB concentrations at enrollment were categorized into tertiles of PBB and PCB exposure. Case-patients were cohort members answering "Yes" to "Has a healthcare provider ever told you that you had a thyroid problem?" during follow-up interviews; control-patients were cohort members answering "No". We used odds ratios (OR) with 95% confidence intervals (CI) to compare odds of thyroid disease by PBB and PCB exposure and by various risk factors. Total cumulative thyroid disease incidence after 33years was 13.9% among women and 2.6% among men. After adjusting for body mass index, we found no statistically significant differences in odds of any type of thyroid disease among women or men with elevated PBB or PCB exposure. Compared to control-patients, women with thyroid disease had increased odds of being overweight/obese (OR=2.82, 95% CI: 1.94-4.11) and developing infertility (OR=1.71, 95% CI: 1.08-2.69), diabetes (OR=1.61, 95% CI: 1.04-2.51), or arthritis (OR=1.71, 95% CI: 1.18-2.50) during follow-up. Additional research should explore potential associations between PBBs/PCBs and thyroid disease among children exposed in utero. |
Psychological distress, depressive symptoms, and cellular immunity among healthy individuals: a 1-year prospective study
Nakata A , Irie M , Takahashi M . Int J Psychophysiol 2011 81 (3) 191-7 Cross-sectional and case-control studies have reported that psychological distress and depression are associated with reduced cellular immune competence but the directionality of the relationship remains uncertain. This study investigated whether levels of psychological distress and depressive symptoms are related to subsequent changes in counts of lymphocyte subsets (natural killer (NK), B, and T cell) and/or whether changes of immune markers predict psychological distress/depressive symptoms in a 1-year prospective study design. A total of 105 healthy employees (67 men and 38 women), aged 23-59 (mean 40) years with an average of 15years of education, underwent a blood draw for the measurement of circulating immune cells and completed the Japanese version of the 28-item General Health Questionnaire (GHQ-28) and the Center for Epidemiologic Studies Depression Scale (CES-D) in April 2002 (time 1) and 2003 (time 2). Hierarchical multiple linear regression analyses revealed that GHQ-28 and CES-D scores at time 1 were significantly (p<.05) and inversely associated with NK cells at time 2 controlling for potential confounders including time 1 NK cells (beta=-.221 and -.177, respectively). In contrast, NK cells and NK cell cytotoxicity at time 1 did not predict GHQ-28 or CES-D score at time 2 controlling for GHQ-28/CES-D score at time 1. GHQ-28 and CES-D scores were not related to T or B cells at times 1 and 2. The present findings indicate that psychological distress and depressive symptoms may precede and predict suppression of NK cell immunity while NK cells did not lead to subsequent psychological distress and depressive symptoms, suggesting an absence of the bi-directional relationships. |
Genetic variability in susceptibility to occupational respiratory sensitization.
Yucesoy B , Johnson VJ . J Allergy (Cairo) 2011 2011 346719 Respiratory sensitization can be caused by a variety of substances at workplaces, and the health and economic burden linked to allergic respiratory diseases continues to increase. Although the main factors that affect the onset of the symptoms are the types and intensity of allergen exposure, there is a wide range of interindividual variation in susceptibility to occupational/environmental sensitizers. A number of gene variants have been reported to be associated with various occupational allergic respiratory diseases. Examples of genes include, but are not limited to, genes involved in immune/inflammatory regulation, antioxidant defenses, and fibrotic processes. Most of these variants act in combination with other genes and environmental factors to modify disease progression, severity, or resolution after exposure to allergens. Therefore, understanding the role of genetic variability and the interaction between genetic and environmental/occupational factors provides new insights into disease etiology and may lead to the development of novel preventive and therapeutic strategies. This paper will focus on the current state of knowledge regarding genetic influences on allergic respiratory diseases, with specific emphasis on diisocyanate-induced asthma and chronic beryllium disease. |
Rabies-related knowledge and practices among persons at risk of bat exposures in Thailand
Robertson K , Lumlertdacha B , Franka R , Petersen B , Bhengsri S , Henchaichon S , Peruski LF , Baggett HC , Maloney SA , Rupprecht CE . PLoS Negl Trop Dis 2011 5 (6) e1054 BACKGROUND: Rabies is a fatal encephalitis caused by lyssaviruses. Evidence of lyssavirus circulation has recently emerged in Southeast Asian bats. A cross-sectional study was conducted in Thailand to assess rabies-related knowledge and practices among persons regularly exposed to bats and bat habitats. The objectives were to identify deficiencies in rabies awareness, describe the occurrence of bat exposures, and explore factors associated with transdermal bat exposures. METHODS: A survey was administered to a convenience sample of adult guano miners, bat hunters, game wardens, and residents/personnel at Buddhist temples where mass bat roosting occurs. The questionnaire elicited information on demographics, experience with bat exposures, and rabies knowledge. Participants were also asked to describe actions they would take in response to a bat bite as well as actions for a bite from a potentially rabid animal. Bivariate analysis was used to compare responses between groups and multivariable logistic regression was used to explore factors independently associated with being bitten or scratched by a bat. FINDINGS: Of 106 people interviewed, 11 (10%) identified bats as a potential source of rabies. A history of a bat bite or scratch was reported by 29 (27%), and 38 (36%) stated either that they would do nothing or that they did not know what they would do in response to a bat bite. Guano miners were less likely than other groups to indicate animal bites as a mechanism of rabies transmission (68% vs. 90%, p = 0.03) and were less likely to say they would respond appropriately to a bat bite or scratch (61% vs. 27%, p = 0.003). Guano mining, bat hunting, and being in a bat cave or roost area more than 5 times a year were associated with history of a bat bite or scratch. CONCLUSIONS: These findings indicate the need for educational outreach to raise awareness of bat rabies, promote exposure prevention, and ensure appropriate health-seeking behaviors for bat-inflicted wounds, particularly among at-risk groups in Thailand. |
Depression is associated with sexual risk among men who have sex with men, but is mediated by cognitive escape and self-efficacy
Alvy LM , McKirnan DJ , Mansergh G , Koblin B , Colfax GN , Flores SA , Hudson S . AIDS Behav 2011 15 (6) 1171-9 Men who have sex with men (MSM) show high rates of HIV infection, and higher rates of depression than non-MSM. We examined the association between depression and sexual risk among "high risk" MSM. Evidence has been mixed regarding the link between depression and risky sex, although researchers have rarely considered the role of psychosocial vulnerabilities such as self-efficacy for sexual safety or "escape" coping styles. In a national sample (N = 1,540) of HIV-positive and HIV-negative MSM who reported unprotected sex and drug use with sex partners, we found evidence that depression is related to HIV transmission risk. Self-efficacy for sexual safety and cognitive escape mediated the link between depression and risk behavior, suggesting that psychosocial vulnerability plays an important role in the association of depression with sexual risk. These findings may help us construct more accurate theories regarding depression and sexual behavior, and may inform the design of sexual safety interventions. |
Testing rules of thumb and the science of health literacy
Baur C , Ostrove N . Ann Intern Med 2011 155 (2) 129-30 Achieving perfect health outcomes would be easy if a particular treatment always cured the targeted disease, regardless of whether the disease occurred in a 47-year-old white man with high blood pressure and high cholesterol levels, an 18-year-old black woman with type 1 diabetes, or a 72-year-old Asian man with prostate cancer. Yet, as the emerging field of personalized medicine acknowledges, there are powerful interactions between individual characteristics and responses to treatment (1). Consequently, even when we are fortunate enough to have high-quality evidence, outcomes for specific situations can be difficult to predict and “rules of thumb” may not prove reliable. In the face of uncertainty, we must do our best to give patients and the public clear advice about what they can do to maintain and improve their health. Two articles in this issue (2, 3) remind us to rethink the conventional wisdom and rules of thumb that guide communication with patients. | The study by Woloshin and Schwartz (3) raises numerous questions about the most effective way to present probabilities about medication-related outcomes to lay people. Although previous studies have led to the conventional wisdom that lay people understand natural frequencies better than they understand percents (4), Woloshin and Schwartz's findings suggest the opposite. However, given that these findings stem from a single study that focused on the risks and benefits of prescription drugs, it would be premature to consider them as a definitive challenge to the idea that we should avoid percents when communicating risk estimates to lay people. Further study is needed in diverse populations about various health-related topics to answer such questions as, “Under what circumstances are percents better?” “When do natural frequencies win out?” “Is there a way to identify patients who might understand one construct better than the other?” |
When the facts are just not enough: credibly communicating about risk is riskier when emotions run high and time is short
Reynolds BJ . Toxicol Appl Pharmacol 2011 254 (2) 206-14 When discussing risk with people, commonly subject matter experts believe that conveying the facts will be enough to allow people to assess a risk and respond rationally to that risk. Because of this expectation, experts often become exasperated by the seemingly illogical way people assess personal risk and choose to manage that risk. In crisis situations when the risk information is less defined and choices must be made within impossible time constraints, the thought processes may be even more susceptible to faulty heuristics. Understanding the perception of risk is essential to understanding why the public becomes more or less upset by events. This article explores the psychological underpinnings of risk assessment within emotionally laden events and the risk communication practices that may facilitate subject matter experts to provide the facts in a manner so they can be more certain those facts are being heard. Source credibility is foundational to risk communication practices. The public meeting is one example in which these best practices can be exercised. Risks are risky because risk perceptions differ and the psychosocial environment in which risk is discussed complicates making risk decisions. Experts who want to influence the actions of the public related to a threat or risk should understand that decisions often involve emotional as well as logical components. The media and other social entities will also influence the risk context. The Center for Disease Control and Prevention's crisis and emergency-risk communication (CERC) principles are intended to increase credibility and recognize emotional components of an event. During a risk event, CERC works to calm emotions and increase trust which can help people apply the expertise being offered by response officials. |
Considering racial and ethnic preferences in communication and interactions among the patient, family member, and physician following diagnosis of localized prostate cancer: study of a US population
Rim SH , Hall IJ , Fairweather ME , Fedorenko CR , Ekwueme DU , Smith JL , Thompson IM , Keane TE , Penson DF , Moinpour CM , Zeliadt SB , Ramsey SD . Int J Gen Med 2011 4 481-6 Prostate cancer is the most commonly diagnosed cancer among American men. The multiple treatment options for localized prostate cancer and potential side effects can complicate the decision-making process. We describe the level of engagement and communication among the patient, family member, and physician (the decision-making "triad") in the decision process prior to treatment. Using the Family and Cancer Therapy Selection (FACTS) study baseline survey data, we note racial/ethnic variations in communication among the triad. Sensitivity to and awareness of decision-making styles of both the patient and their family member (or caregiver) may enable clinicians to positively influence communication exchanges about important clinical decisions. |
Severe methicillin-susceptible Staphylococcus aureus infections associated with epidural injections at an outpatient pain clinic
Radcliffe R , Meites E , Briscoe J , Gupta R , Fosheim G , McAllister SK , Jensen B , Noble-Wang J , Del Rosario M , Hageman J , Patel PR . Am J Infect Control 2011 40 (2) 144-9 BACKGROUND: Recent outbreaks in ambulatory care settings have highlighted infection control breaches as risk factors for disease transmission. In May 2009, 3 patients were hospitalized with severe methicillin-susceptible Staphylococcus aureus (MSSA) infections after receiving epidural injections at a West Virginia outpatient pain clinic. METHODS: We conducted a retrospective cohort study evaluating clinic patients who received injections during a 3-week period. A case was defined as laboratory-confirmed infection or clinical evidence of infection ≤ 14 days after a patient received an injection. Infection control procedures were assessed. MSSA isolates from patient infections and clinic staff nasal swabs were genotyped by using pulsed-field gel electrophoresis. RESULTS: Eight (7%) of 110 cohort patients met the case definition; 6 (75%) cases were laboratory confirmed. Eight (12%) of 69 patients who received epidural injections were case patients compared with none of the other 41 patients (P = .02). During procedures, staff use of face masks and preparation of patient skin were suboptimal; epidural injection syringes were reused to access shared medication vials. MSSA isolates from 2 patients and 1 staff member were indistinguishable by pulsed-field gel electrophoresis. CONCLUSION: Infection control breaches likely facilitated MSSA transmission to patients receiving epidural injections. Adhering to correct infection control practices in ambulatory care settings is critical to prevent disease transmission. |
Trends in catheter-associated urinary tract infections in adult intensive care units-United States, 1990-2007
Burton DC , Edwards JR , Srinivasan A , Fridkin SK , Gould CV . Infect Control Hosp Epidemiol 2011 32 (8) 748-56 BACKGROUND: Over the past 2 decades, multiple interventions have been developed to prevent catheter-associated urinary tract infections (CAUTIs). The CAUTI prevention guidelines of the Healthcare Infection Control Practices Advisory Committee were recently revised. Objective. To examine changes in rates of CAUTI events in adult intensive care units (ICUs) in the United States from 1990 through 2007. METHODS: Data were reported to the Centers for Disease Control and Prevention (CDC) through the National Nosocomial Infections Surveillance System from 1990 through 2004 and the National Healthcare Safety Network from 2006 through 2007. Infection preventionists in participating hospitals used standard methods to identify all CAUTI events (categorized as symptomatic urinary tract infection [SUTI] or asymptomatic bacteriuria [ASB]) and urinary catheter-days (UC-days) in months selected for surveillance. Data from all facilities were aggregated to calculate pooled mean annual SUTI and ASB rates (in events per 1,000 UC-days) by ICU type. Poisson regression was used to estimate percent changes in rates over time. RESULTS: Overall, 36,282 SUTIs and 22,973 ASB episodes were reported from 367 facilities representing 1,223 adult ICUs, including combined medical/surgical (505), medical (212), surgical (224), coronary (173), and cardiothoracic (109) ICUs. All ICU types experienced significant declines of 19%-67% in SUTI rates and 29%-72% in ASB rates from 1990 through 2007. Between 2000 and 2007, significant reductions in SUTI rates occurred in all ICU types except cardiothoracic ICUs. CONCLUSIONS: Since 1990, CAUTI rates have declined significantly in all major adult ICU types in facilities reporting to the CDC. Further efforts are needed to assess prevention strategies that might have led to these decreases and to implement new CAUTI prevention guidelines. |
Safety of adjuvanted pandemic influenza A (H1N1) 2009 vaccines
DeStefano F , Vellozzi C , Schonberger LB , Chen RT . BMJ 2011 343 d4159 Guillain-Barré syndrome has been a focus of safety monitoring since the report in 1976 of an increased risk of almost one extra case per 100 000 influenza vaccinations of swine origin.1 Subsequent studies have shown either no increased risk or a slightly increased risk (1-2 per million vaccinees) after vaccination for seasonal flu.2 The spread of the 2009 pandemic influenza A (H1N1) virus, which contained genes of swine origin, resulted in the development and widespread use of influenza A (H1N1) monovalent vaccines (2009 H1N1 vaccines).3 These included formulations containing oil in water adjuvants that had not previously been widely used in flu vaccines in Europe. Although available evidence suggested that the adjuvanted vaccines had acceptable safety profiles,3 data on the risk of rare adverse events, such as Guillain-Barré syndrome, were limited. | In the linked study (doi:10.1136/bmj.d3908), Dieleman and colleagues report the first data on adjuvanted 2009 H1N1 vaccines and the risk of Guillain-Barré syndrome from a case-control study conducted in five European countries.4 Overall, the results suggest that if there was an increased risk associated with the adjuvanted 2009 H1N1 vaccines studied, it was considerably smaller than that seen with the 1976 swine flu vaccines. Whether there was an increased risk, however, is not clear. |
Strategies to vaccinate against cancer of the cervix: feasibility of a school-based HPV vaccination program in Peru
Penny M , Bartolini R , Mosqueira NR , Lamontagne DS , Mendoza MA , Ramos I , Winkler JL , Villafana J , Janmohamed A , Jumaan AO . Vaccine 2011 29 (31) 5022-30 Operational research using a mixed method, cross-sectional, case-study approach assessed the feasibility and health system impact of large-scale implementation of human papillomavirus (HPV) vaccination into routine vaccine delivery by the Ministry of Health in Peru. The strategy was school-based vaccination of fifth grade girls in 527 primary schools in Piura region. Our evaluation showed that school-based HPV vaccination is feasible without major changes in existing health systems. This was reflected in the opinions of health personnel, the lack of impact on other vaccine coverage, and the high HPV vaccine coverage documented in routine records and by an independent community-based survey. |
Laboratory characterization of measles virus infection in previously vaccinated and unvaccinated individuals
Hickman CJ , Hyde TB , Sowers SB , Mercader S , McGrew M , Williams NJ , Beeler JA , Audet S , Kiehl B , Nandy R , Tamin A , Bellini WJ . J Infect Dis 2011 204 Suppl 1 S549-58 Waning immunity or secondary vaccine failure (SVF) has been anticipated by some as a challenge to global measles elimination efforts. Although such cases are infrequent, measles virus (MeV) infection can occur in vaccinated individuals following intense and/or prolonged exposure to an infected individual and may present as a modified illness that is unrecognizable as measles outside of the context of a measles outbreak. The immunoglobulin M response in previously vaccinated individuals may be nominal or fleeting, and viral replication may be limited. As global elimination proceeds, additional methods for confirming modified measles cases may be needed to understand whether SVF cases contribute to continued measles virus (MeV) transmission. In this report, we describe clinical symptoms and laboratory results for unvaccinated individuals with acute measles and individuals with SVF identified during MeV outbreaks. SVF cases were characterized by the serological parameters of high-avidity antibodies and distinctively high levels of neutralizing antibody. These parameters may represent useful biomarkers for classification of SVF cases that previously could not be confirmed as such using routine laboratory diagnostic techniques. |
Near real-time vaccine safety surveillance with partially accrued data
Greene SK , Kulldorff M , Yin R , Yih WK , Lieu TA , Weintraub ES , Lee GM . Pharmacoepidemiol Drug Saf 2011 20 (6) 583-90 PURPOSE: The Vaccine Safety Datalink (VSD) Project conducts near real-time vaccine safety surveillance using sequential analytic methods. Timely surveillance is critical in identifying potential safety problems and preventing additional exposure before most vaccines are administered. For vaccines that are administered during a short period, such as influenza vaccines, timeliness can be improved by undertaking analyses while risk windows following vaccination are ongoing and by accommodating predictable and unpredictable data accrual delays. We describe practical solutions to these challenges, which were adopted by the VSD Project during pandemic and seasonal influenza vaccine safety surveillance in 2009/2010. METHODS: Adjustments were made to two sequential analytic approaches. The Poisson-based approach compared the number of pre-defined adverse events observed following vaccination with the number expected using historical data. The expected number was adjusted for the proportion of the risk window elapsed and the proportion of inpatient data estimated to have accrued. The binomial-based approach used a self-controlled design, comparing the observed numbers of events in risk versus comparison windows. Events were included in analysis only if they occurred during a week that had already passed for both windows. RESULTS: Analyzing data before risk windows fully elapsed improved the timeliness of safety surveillance. Adjustments for data accrual lags were tailored to each data source and avoided biasing analyses away from detecting a potential safety problem, particularly early during surveillance. CONCLUSIONS: The timeliness of vaccine and drug safety surveillance can be improved by properly accounting for partially elapsed windows and data accrual delays. Copyright (c) 2011 John Wiley & Sons, Ltd. |
Pandemic (H1N1) 2009 and Hajj pilgrims who received predeparture vaccination, Egypt
Kandeel A , Deming M , Kereem EA , El-Refay S , Afifi S , Abukela M , Earhart K , El-Sayed N , El-Gabaly H . Emerg Infect Dis 2011 17 (7) 1266-1268 In Egypt, vaccination against pandemic (H1N1) 2009 virus was required of pilgrims departing for the 2009 Hajj. A survey of 551 pilgrims as they returned to Egypt found 542 (98.1% [weighted]) reported receiving the vaccine; 6 (1.0% [weighted]) were infected with influenza virus A (H3N2) but none with pandemic (H1N1) 2009 virus. |
Preparing for the availability of a partially effective HIV vaccine: lessons from other licensed vaccines
Chen RT , Hu DJ , Dunne E , Shaw M , Mullins J , Rerks-Ngarm S . Vaccine 2011 29 (36) 6072-8 The 2009 RV144 trial in Thailand shows that a partially effective vaccine against human immunodeficiency virus (HIV) acquisition is possible (1). Past mathematical models have shown HIV vaccines with partial effectiveness (assuming availability and no compensatory risk behavior) may have important public health impact (2). While we are still many years away from a licensed HIV vaccine, what might be some of the “downstream” considerations for the implementation of a partially effective HIV vaccine in the developed and developing world in the current era? Are there any changes since the HIV domain last considered this issue in anticipation of the results of the first Phase III trials of HIV vaccine (Vaxgen gp120) a decade earlier? (3, 4). | During the Acquired Immunodeficiency Disease Syndrome (AIDS) Vaccine 2010 Conference, a satellite symposium cosponsored by AIDS Vaccine Advocacy Coalition (AVAC), the U. S. Centers for Disease Control and Prevention (CDC), Gates Foundation, the Joint United Nations Programme on HIV/AIDS (UNAIDS), US Agency for International Development (USAID), US Military HIV Research Program (USMHRP), World Health Organization (WHO) took advantage of the conference location in Atlanta to draw upon some of the experience of CDC and its associated partners in preparing for the availability and implementation of newly licensed vaccines to further this dialogue. This paper summarizes the presentations on some lessons for future HIV vaccine implementation from the introduction of hepatitis B vaccine, human papillomavirus (HPV) vaccine, the annual influenza virus vaccine strain selection, a potential annual HIV vaccine strain selection, as well as planning for next steps in Thailand in response to the RV144 trial, and highlights from the moderated discussions with the audience on issues relevant to low/middle income countries and developed countries (Table 1). Hopefully these ideas will facilitate preparations for the introduction of a future licensed HIV vaccine. |
Hepatitis B vaccination coverage and documented seroprotection among matriculating healthcare students at an academic institution in the United States
Tohme RA , Ribner B , Huey MJ , Spradling PR . Infect Control Hosp Epidemiol 2011 32 (8) 818-21 We evaluated hepatitis B vaccination coverage and documentation of antibody to hepatitis B surface antigen (anti-HBs) concentration among a cohort of healthcare students. Of 4,075 students, 59.8% had documentation of vaccination and 83.8% had anti-HBs concentration greater than or equal to 10 mIU/mL. Documenting hepatitis B vaccination and anti-HBs concentration among healthcare students is needed to prevent transmission in healthcare settings. |
Immunogenicity and safety of a meningococcal A conjugate vaccine in Africans
Sow SO , Okoko BJ , Diallo A , Viviani S , Borrow R , Carlone G , Tapia M , Akinsola AK , Arduin P , Findlow H , Elie C , Haidara FC , Adegbola RA , Diop D , Parulekar V , Chaumont J , Martellet L , Diallo F , Idoko OT , Tang Y , Plikaytis BD , Kulkarni PS , Marchetti E , LaForce FM , Preziosi MP . N Engl J Med 2011 364 (24) 2293-304 BACKGROUND: Group A meningococci are the source of major epidemics of meningitis in Africa. An affordable, highly immunogenic meningococcal A conjugate vaccine is needed. METHODS: We conducted two studies in Africa to evaluate a new MenA conjugate vaccine (PsA-TT). In study A, 601 children, 12 to 23 months of age, were randomly assigned to receive PsA-TT, a quadrivalent polysaccharide reference vaccine (PsACWY), or a control vaccine (Haemophilus influenzae type b conjugate vaccine [Hib-TT]). Ten months later, these children underwent another round of randomization within each group to receive a full dose of PsA-TT, a one-fifth dose of PsACWY, or a full dose of Hib-TT, with 589 of the original participants receiving a booster dose. In study B, 900 subjects between 2 and 29 years of age were randomly assigned to receive PsA-TT or PsACWY. Safety and reactogenicity were evaluated, and immunogenicity was assessed by measuring the activity of group A serum bactericidal antibody (SBA) with rabbit complement and performing an IgG group A-specific enzyme-linked immunosorbent assay. RESULTS: In study A, 96.0% of the subjects in the PsA-TT group and 63.7% of those in the PsACWY group had SBA titers that were at least four times as high as those at baseline; in study B, 78.2% of the subjects in the PsA-TT group and 46.2% of those in the PsACWY group had SBA titers that were at least four times as high as those at baseline. The geometric mean SBA titers in the PsA-TT groups in studies A and B were greater by factors of 16 and 3, respectively, than they were in the PsACWY groups (P<0.001). In study A, the PsA-TT group had higher antibody titers at week 40 than the PsACWY group and had obvious immunologic memory after receiving a polysaccharide booster vaccine. Safety profiles were similar across vaccine groups, although PsA-TT recipients were more likely than PsACWY recipients to have tenderness and induration at the vaccination site. Adverse events were consistent with age-specific morbidity in the study areas; no serious vaccine-related adverse events were reported. CONCLUSIONS: The PsA-TT vaccine elicited a stronger response to group A antibody than the PsACWY vaccine. (Funded by the Meningitis Vaccine Project through a grant from the Bill and Melinda Gates Foundation; Controlled-Trials.com numbers, ISRCTN78147026 and ISRCTN87739946.). |
Actinic varicella vaccine rash
Theodoridou K , Papaevangelou V , Papadogeorgaki E , Quinlivan M , Theodoridou M , Kakourou T , Breuer J . Pediatr Infect Dis J 2011 30 (12) 1116-8 The case of an 18-month-old girl with vesicular rash confined to a sunburned area after significant ultraviolet radiation exposure is reported. The child had been vaccinated 32 days before presentation, and a high viral load of Oka strain virus was detected in vesicular fluid. Possible pathogenesis is discussed. |
Macro determinants of cause-specific injury mortality in the OECD countries: an exploration of the importance of GDP and unemployment
Muazzam S , Nasrullah M . J Community Health 2011 36 (4) 574-82 Gross Domestic Product (GDP) and unemployment has a strong documented impact on injury mortality. The aim of our study is to investigate the relationship of GDP per capita and unemployment with gender- and cause-specific injury mortalities in the member nations of Organization for Economic Cooperation and Development (OECD). Country-based data on injury mortality per 100,000 population, including males and females aged 1-74, for the 4 year period 1996-1999, were gathered from the World Health Organization's Statistical Information System. We selected fourteen cause-specific injury mortalities. Data on GDP, unemployment rate and population growth were taken from World Development Indicators. GDP and unemployment rate per 100 separately were regressed on total and cause-specific injury mortality rate per 100,000 for males and females. Overall in the OECD countries, GDP per capita increased 12.5% during 1996-1999 (P = 0.03) where as unemployment rate decreased by 12.3% (P = 0.05). Among males, most cause-specific injury mortality rates decreased with increasing GDP except motor vehicle traffic crashes (MTC) that increased with increasing GDP (coefficient = 0.75; P < 0.001). Similar trend was found in females, except suicidal injury mortalities that also increased with increasing GDP (coefficient = 0.31; P = 0.04). When we modeled cause-specific injury mortality rates with unemployment, injuries due to firearm missiles (coefficient = 0.53; P < 0.001), homicide (coefficient = 0.36; P < 0.001), and other violence (coefficient = 0.41; P < 0.001) increased with increase in unemployment rate among males. However, among females only accidental falls (coefficient = 0.36; P = 0.01) were found significantly associated with increasing unemployment rate. GDP is more related to cause-specific injury mortality than unemployment. Injury mortality does not relate similarly to each diagnosis-specific cause among males and females. Further research on causation with more predictors is needed. |
Impact of business cycles on US suicide rates, 1928-2007
Luo F , Florence CS , Quispe-Agnoli M , Ouyang L , Crosby AE . Am J Public Health 2011 101 (6) 1139-46 OBJECTIVES: We examined the associations of overall and age-specific suicide rates with business cycles from 1928 to 2007 in the United States. METHODS: We conducted a graphical analysis of changes in suicide rates during business cycles, used nonparametric analyses to test associations between business cycles and suicide rates, and calculated correlations between the national unemployment rate and suicide rates. RESULTS: Graphical analyses showed that the overall suicide rate generally rose during recessions and fell during expansions. Age-specific suicide rates responded differently to recessions and expansions. Nonparametric tests indicated that the overall suicide rate and the suicide rates of the groups aged 25 to 34 years, 35 to 44 years, 45 to 54 years, and 55 to 64 years rose during contractions and fell during expansions. Suicide rates of the groups aged 15 to 24 years, 65 to 74 years, and 75 years and older did not exhibit this behavior. Correlation results were concordant with all nonparametric results except for the group aged 65 to 74 years. CONCLUSIONS: Business cycles may affect suicide rates, although different age groups responded differently. Our findings suggest that public health responses are a necessary component of suicide prevention during recessions. |
Identification of Leishmania spp. by molecular amplification and DNA sequencing analysis of a fragment of rRNA internal transcribed spacer 2.
de Almeida ME , Steurer FJ , Koru O , Herwaldt BL , Pieniazek NJ , da Silva AJ . J Clin Microbiol 2011 49 (9) 3143-9 Isoenzyme analysis of cultured parasites is the conventional approach for Leishmania species identification. Molecular approaches have the potential to be more sensitive and rapid. We designed polymerase chain reaction (PCR) generic primers to amplify a segment of the rRNA Internal Transcribed Spacer 2 (ITS2) from multiple Leishmania species. To validate the selected ITS2 fragment, we tested clinical specimens and compared the species results obtained by the molecular approach (PCR, followed by DNA sequencing analysis) with those from the parasitologic approach (in vitro culture, followed by isoenzyme analysis). Among the 159 patients with clinical specimens positive by both approaches, a total of 8 Leishmania species were identified. The species results were concordant for all but two patients: for one patient, the results were L. (Viannia) guyanensis by the molecular approach versus L. (V.) braziliensis by the parasitologic approach; for the other patient, the results were L. (Leishmania) tropica versus L. (L.) major, respectively. ITS2 PCR, followed by sequencing analysis, can be used to detect and discriminate among Leishmania species. The results confirmed our hypothesis that a region of the ITS2 gene can complement the characterization of Leishmania parasites at the species level. The approach we developed can be used as a diagnostic tool in reference laboratories with adequate infrastructure to perform molecular characterization of pathogens. |
Influenza A virus nucleoprotein exploits Hsp40 to inhibit PKR activation.
Sharma K , Tripathi S , Ranjan P , Kumar P , Garten R , Deyde V , Katz JM , Cox NJ , Lal RB , Sambhara S , Lal SK . PLoS One 2011 6 (6) e20215 BACKGROUND: Double-stranded RNA dependent protein kinase (PKR) is a key regulator of the anti-viral innate immune response in mammalian cells. PKR activity is regulated by a 58 kilo Dalton cellular inhibitor (P58(IPK)), which is present in inactive state as a complex with Hsp40 under normal conditions. In case of influenza A virus (IAV) infection, P58(IPK) is known to dissociate from Hsp40 and inhibit PKR activation. However the influenza virus component responsible for PKR inhibition through P58(IPK) activation was hitherto unknown. PRINCIPAL FINDINGS: Human heat shock 40 protein (Hsp40) was identified as an interacting partner of Influenza A virus nucleoprotein (IAV NP) using a yeast two-hybrid screen. This interaction was confirmed by co-immunoprecipitation studies from mammalian cells transfected with IAV NP expressing plasmid. Further, the IAV NP-Hsp40 interaction was validated in mammalian cells infected with various seasonal and pandemic strains of influenza viruses. Cellular localization studies showed that NP and Hsp40 co-localize primarily in the nucleus. During IAV infection in mammalian cells, expression of NP coincided with the dissociation of P58(IPK) from Hsp40 and decrease PKR phosphorylation. We observed that, plasmid based expression of NP in mammalian cells leads to decrease in PKR phosphorylation. Furthermore, inhibition of NP expression during influenza virus replication led to PKR activation and concomitant increase in eIF2alpha phosphorylation. Inhibition of NP expression also led to reduced IRF3 phosphorylation, enhanced IFN beta production and concomitant reduction of virus replication. Taken together our data suggest that NP is the viral factor responsible for P58(IPK) activation and subsequent inhibition of PKR-mediated host response during IAV infection. SIGNIFICANCE: Our findings demonstrate a novel role of IAV NP in inhibiting PKR-mediated anti-viral host response and help us understand P58(IPK) mediated inhibition of PKR activity during IAV infection. |
Use of a novel virus detection assay to identify coronavirus HKU1 in the lungs of a hematopoietic stem cell transplant recipient with fatal pneumonia
Uhlenhaut C , Cohen JI , Pavletic S , Illei G , Gea-Banacloche JC , Abu-Asab M , Krogmann T , Gubareva L , McClenahan S , Krause PR . Transpl Infect Dis 2011 14 (1) 79-85 A 38-year-old female patient with systemic lupus erythematosus presented with pulmonary infiltrates and hypoxemia for several months following immunodepleting autologous hematopoietic stem cell transplantation. She was treated for influenza, which was isolated repeatedly from oropharynx and bronchoalveolar lavage (BAL) fluids, and later empirically for lupus pneumonitis, but died 6 months after transplant. Autopsy findings failed to show influenza in the lungs or lupus pneumonitis. A novel generic polymerase chain reaction (PCR)-based assay using degenerate primers identified human coronavirus (CoV) HKU1 RNA in BAL fluid at autopsy. CoV was confirmed by virus-specific PCRs of lung tissue at autopsy. Electron microscopy showed viral particles consistent with CoV HKU1 in lung tissue both at autopsy and from a previous biopsy. Although human CoV HKU1 infection is not usually severe, in highly immunocompromised patients, it can be associated with fatal pneumonia. |
Use of Sindbis/eastern equine encephalitis chimeric viruses in plaque reduction neutralization tests for arboviral disease diagnostics
Johnson BW , Kosoy O , Wang E , Delorey M , Russell B , Bowen RA , Weaver SC . Clin Vaccine Immunol 2011 18 (9) 1486-91 Eastern equine encephalitis virus (EEEV) is a highly virulent, mosquito-borne alphavirus that causes severe and often fatal neurological disease in humans and horses in eastern North American, the Caribbean, Mexico, and throughout Central and South America. EEEV infection is diagnosed serologically by anti-EEEV-specific IgM detection, with confirmation by the plaque reduction neutralization test (PRNT), which is highly specific for alphaviruses. Live virus is used in the PRNT procedure, which currently requires biosafety level 3 containment and select agent security in the case of EEEV. These requirements restrict the ability of public health laboratories to conduct PRNT. Sindbis (SIN)/EEEV recombinant constructs have been engineered to express the immunogenic structural proteins from 2 wild-type EEEV strains in an attenuated form. These SIN/EEEVs, which are not classified as select agents, were evaluated as alternative diagnostic reagents in a PRNT using human, equine, and murine sera. The results indicate that the chimeric viruses exhibit specificity comparable to wild-type EEEV, with only a slight reduction in sensitivity. Considering their benefits in increased safety and reduced regulatory requirements, these chimeric viruses should be highly useful in diagnostic laboratories throughout the Americas. |
The LLNA: a brief review of recent advances and limitations
Anderson SE , Siegel PD , Meade BJ . J Allergy (Cairo) 2011 2011 424203 Allergic contact dermatitis is the second most commonly reported occupational illness, accounting for 10% to 15% of all occupational diseases. This highlights the importance of developing rapid and sensitive methods for hazard identification of chemical sensitizers. The murine local lymph node assay (LLNA) was developed and validated for the identification of low molecular weight sensitizing chemicals. It provides several benefits over other tests for sensitization because it provides a quantitative endpoint, dose-responsive data, and allows for prediction of potency. However, there are also several concerns with this assay including: levels of false positive responses, variability due to vehicle, and predictivity. This report serves as a concise review which briefly summarizes the progress, advances and limitations of the assay over the last decade. |
miR-190-mediated downregulation of PHLPP contributes to arsenic-induced Akt activation and carcinogenesis
Beezhold K , Liu J , Kan H , Meighan T , Castranova V , Shi X , Chen F . Toxicol Sci 2011 123 (2) 411-20 The role of trivalent arsenic (As(3+)) on the regulation of the recently identified noncoding small RNAs, mainly, microRNAs (miRNAs), has not been explored so far. In the present study we provide evidence showing that As(3+) is a potent inducer for the expression of miR-190 in human bronchial epithelial cells. The induction of miR-190 by As(3+) is concentration-dependent and associated with the expression of the host gene of miR-190, talin 2, a gene encoding a high-molecular-weight cytoskeletal protein. The elevated level of miR-190 induced by As(3+) is capable of down-regulating the translation of the PH domain leucin-rich repeat protein phosphatase (PHLPP), a negative regulator of Akt signaling. Such a down-regulation is occurred through direct interaction of the miR-190 with the 3'-UTR region of the PHLPP mRNA, leading to a diminished PHLPP protein expression and consequently, an enhanced Akt activation and expression of vascular endothelial growth factor (VEGF), an Akt-regulated protein. Overexpression of miR-190 itself is able to enhance proliferation and malignant transformation of the cells as determined by anchorage-independent growth of the cells in soft agar. Accordingly, the data presented suggest that induction of miR-190 is one of the key mechanisms in As(3+)-induced carcinogenesis. |
Ocular tropism of influenza A viruses: identification of H7 subtype-specific host responses in human respiratory and ocular cells
Belser JA , Zeng H , Katz JM , Tumpey TM . J Virol 2011 85 (19) 10117-25 Highly pathogenic avian influenza (HPAI) H7 virus infection in humans frequently results in conjunctivitis as a major symptom. However, our understanding of what properties govern virus subtype-specific tropism, and the host responses responsible for eliciting ocular inflammation and pathogenicity following influenza virus infection, are not well understood. To study virus-host interactions in ocular tissue, we infected primary human corneal and conjunctival epithelial cells with H7, H5, and H1 subtype viruses. We found that numerous virus subtypes were capable of infecting and replicating in multiple human ocular cell types, with highest titers observed with highly pathogenic H7N7 and H5N1 viruses. Similar patterns of proinflammatory cytokine and chemokine production following influenza virus infection were observed between ocular and respiratory cells. However, primary ocular cells infected with HPAI H7N7 viruses were found to induce elevated levels of IL-1beta, a cytokine previously implicated in ocular disease pathology. Furthermore, H7N7 virus infection of corneal epithelial cells resulted in enhanced and significant increases in the expression of genes related to NFkappaB signal transduction compared with H5N1 or H1N1 virus infection. Differential induction of cytokines and signaling pathways in human ocular cells following H7 virus infection marks the first association of H7 subtype-specific host responses with ocular tropism and pathogenicity. In particular, heightened expression of genes related to NFkappaB-mediated signaling transduction following HPAI H7N7 virus infection in primary corneal epithelial cells, but not respiratory cells, identifies activation of a signaling pathway that correlates with the ocular tropism of influenza viruses within this subtype. |
Formulation, pharmacokinetics and biodistribution of Ofloxacin-loaded albumin microparticles and nanoparticles
Lee KN , Ye Y , Carr JH , Karem K , D'Souza MJ . J Microencapsul 2011 28 (5) 363-9 Albumin microparticles containing Ofloxacin (Fluoroquinolone derivative commonly used in hospitals) were formulated by the spray dry method. By decreasing the pump feed rate or the total polymer concentration, a mixture of albumin/hypromellose acetate succinate (HPMCAS) microparticles and nanoparticles (MP/NP), containing Ofloxacin, were formulated. MP/NP were characterized, in vitro (particle size, zeta potential, and encapsulation efficiency). A comparison of the pharmacokinetics and biodistribution of aqueous Ofloxacin and Ofloxacin-loaded MP/NP, in Balb/c mice, revealed that peak concentrations were reduced in the serum, liver, spleen and brain, and a more sustained release was observed in serum and all of the organs tested for Ofloxacin MP/NP, compared to aqueous Ofloxacin. The MP/NP formulation allowed extended release by 24 h in the liver and more than 48 h in the brain. In serum, the elimination rate of Ofloxacin MP/NP is slower, the half life is longer, area under the plasma concentration time curve is decreased and volume of distribution is increased. |
Isotope dilution-LC-MS/MS reference method assessment of serum folate assay accuracy and proficiency testing consensus mean
Blackmore S , Pfeiffer CM , Lee A , Fazili Z , Hamilton MS . Clin Chem 2011 57 (7) 986-94 BACKGROUND: Current methods for measuring folates in clinical laboratories are competitive folate binding protein assays. These assays show a considerable lack of agreement that has implications for the comparability of data across studies as well as for long-term population studies. The development of isotope dilution-liquid chromatography-tandem mass spectrometry (ID-LC-MS/MS) reference methods permitted the evaluation of method accuracy and consistency over time. METHODS: We measured 3 pools of human serum by ID-LC-MS/MS, calculated values for total folate, and distributed the same pools to participants in a national External Quality Assessment scheme. We used linear regression to compare the all-laboratory and method data with reference method values. The exercise was repeated after 18 months to assess the stability of the all-laboratory and method data. RESULTS: The distributed serum pools had mass spectrometry values for folate species typical of those found in healthy individuals from populations not receiving dietary folic acid fortification. There was good agreement of the all-laboratory data set with the reference method (y =0.86x + 0.91 mcg/L) at both time points. Linear regression demonstrated that the Abbott Architect showed the closest agreement with the reference method. The Roche Elecsys method was nonlinear and showed a calibration offset of 2.6 mcg/L (4.57 nmol/L). CONCLUSIONS: Calibration of serum folate assays traceable to higher-order reference methods increases method accuracy and improves consistency. The all-laboratory consensus mean proved sufficiently accurate and stable to be used as the target for monitoring laboratory performance. |
Analysis of Borrelia burgdorferi surface proteins as determinants in establishing host cell interactions
Schmit VL , Patton TG , Gilmore RD Jr . Front Microbiol 2011 2 141 Borrelia burgdorferi infection causes Lyme borreliosis in humans, a condition which can involve a systemic spread of the organism to colonize various tissues and organs. If the infection is left untreated by antimicrobials, it can lead to manifestations including, arthritis, carditis, and/or neurological problems. Identification and characterization of B. burgdorferi outer membrane proteins that facilitate cellular attachment and invasion to establish infection continue to be investigated. In this study, we sought to further define putative cell binding properties of surface-exposed B. burgdorferi proteins by observing whether cellular adherence could be blocked by antibodies. B. burgdorferi mixed separately with monoclonal antibodies (mAbs) against outer surface protein (Osp) A, OspC, decorin-binding protein (Dbp) A, BBA64, and RevA antigens were incubated with human umbilical vein endothelial cells (HUVEC) and human neuroglial cells (H4). B. burgdorferi treated with anti-OspA, -DbpA, and -BBA64 mAbs showed a significant decrease in cellular association compared to controls, whereas B. burgdorferi treated with anti-OspC and anti-RevA showed no reduction in cellular attachment. Additionally, temporal transcriptional analyses revealed upregulated expression of bba64, ospA, and dbpA during coincubation with cells. Together, the data provide evidence that OspA, DbpA, and BBA64 function in host cell adherence and infection mechanisms. |
Comparison of nasopharyngeal and oropharyngeal swabs for the diagnosis of eight respiratory viruses by real-time reverse transcription-PCR assays
Kim C , Ahmed JA , Eidex RB , Nyoka R , Waiboci LW , Erdman D , Tepo A , Mahamud AS , Kabura W , Nguhi M , Muthoka P , Burton W , Breiman RF , Njenga MK , Katz MA . PLoS One 2011 6 (6) e21610 BACKGROUND: Many acute respiratory illness surveillance systems collect and test nasopharyngeal (NP) and/or oropharyngeal (OP) swab specimens, yet there are few studies assessing the relative measures of performance for NP versus OP specimens. METHODS: We collected paired NP and OP swabs separately from pediatric and adult patients with influenza-like illness or severe acute respiratory illness at two respiratory surveillance sites in Kenya. The specimens were tested for eight respiratory viruses by real-time reverse transcription-polymerase chain reaction (qRT-PCR). Positivity for a specific virus was defined as detection of viral nucleic acid in either swab. RESULTS: Of 2,331 paired NP/OP specimens, 1,402 (60.1%) were positive for at least one virus, and 393 (16.9%) were positive for more than one virus. Overall, OP swabs were significantly more sensitive than NP swabs for adenovirus (72.4% vs. 57.6%, p<0.01) and 2009 pandemic influenza A (H1N1) virus (91.2% vs. 70.4%, p<0.01). NP specimens were more sensitive for influenza B virus (83.3% vs. 61.5%, p = 0.02), parainfluenza virus 2 (85.7%, vs. 39.3%, p<0.01), and parainfluenza virus 3 (83.9% vs. 67.4%, p<0.01). The two methods did not differ significantly for human metapneumovirus, influenza A (H3N2) virus, parainfluenza virus 1, or respiratory syncytial virus. CONCLUSIONS: The sensitivities were variable among the eight viruses tested; neither specimen was consistently more effective than the other. For respiratory disease surveillance programs using qRT-PCR that aim to maximize sensitivity for a large number of viruses, collecting combined NP and OP specimens would be the most effective approach. |
Results of evaluability assessments of local wellness policies in 6 US school districts
Pitt Barnes S , Robin L , O'Toole TP , Dawkins N , Kettel Khan L , Leviton LC . J Sch Health 2011 81 (8) 502-511 BACKGROUND: A US federal mandate that school districts devise and implement local wellness policies (LWPs) has potential widespread impact on the nutritional content of foods and beverages available in schools and on the amount of physical activity that students engage in; however, evidence concerning the mandate's effectiveness is limited. This study describes the content of LWPs of 6 US school districts and steps taken toward their implementation and evaluation. METHODS: During visits to 6 school districts, we interviewed 88 school and community representatives about the content of their district's LWPs and how the LWPs were being implemented and evaluated. RESULTS: The 6 LWPs were consistent with the federal mandate, although they varied in content and degree of specificity, and none had been fully implemented. All 6 districts were pursuing strategies to ensure that foods and beverages available at school met nutrition standards but did not offer nutrition education to all K-12 students. All 6 districts offered students only limited opportunities for physical activity, and all 6 collected data to monitor process and outcomes of their LWPs. CONCLUSIONS: Partial implementation of LWPs in the districts we visited resulted in significant improvement in the nutritional quality of foods available at district schools, but only slight improvement in students' opportunities for school-based physical activity. We provide recommendations for school districts on implementation and evaluation. Future research is needed to determine the impact of these LWPs on students' health. |
Maternal reports of child health status and health conditions: the influence of self-reported maternal health status
Pastor PN , Reuben CA . Acad Pediatr 2011 11 (4) 311-7 OBJECTIVE: The aim of this study was to examine the influence of maternal health status (MHS) on the relationship between child health conditions and child health status (CHS). METHODS: The study sample included 38 207 children aged 5 to 17 years in the 2001 to 2008 National Health Interview Surveys whose mothers were the survey respondent for the child and herself. Information was collected about CHS, MHS, diagnosed child health conditions, and sociodemographic characteristics. Responses to a question on general health status were used to rate CHS and MHS as "better" (excellent/very good health) or "worse" (good/fair/poor health). The percentage of children with worse CHS, adjusted for sociodemographic characteristics, was estimated using logistic regression. RESULTS: Adjusting for child and family sociodemographic characteristics had a negligible effect on the association between CHS and a 4-level variable that classified children by both MHS and child health conditions. The adjusted percentage of children with worse CHS was higher among children whose mothers had worse MHS compared with children whose mothers had better MHS. Moreover, among children whose mothers had worse MHS, there was a weak relationship between child health conditions and worse CHS. Among children whose mothers had better MHS, there was a strong relationship between child health conditions and worse CHS. CONCLUSION: Because mother-reported CHS is used widely in epidemiological studies as a measure of a child's actual state of health, it is important to consider how maternal characteristics may influence a mother's report of a child's status. In particular, CHS reported by mothers with worse health status merits further investigation. |
Medication use during pregnancy, with particular focus on prescription drugs: 1976-2008
Mitchell AA , Gilboa SM , Werler MM , Kelley KE , Louik C , Hernandez-Diaz S . Am J Obstet Gynecol 2011 205 (1) 51 e1-8 OBJECTIVE: The objective of the study was to provide information on overall medication use throughout pregnancy, with particular focus on the first trimester and specific prescription medications. STUDY DESIGN: The study design included the Slone Epidemiology Center Birth Defects Study, 1976-2008, and the National Birth Defects Prevention Study, 1997-2003, which together interviewed more than 30,000 women about their antenatal medication use. RESULTS: Over the last 3 decades, first-trimester use of prescription medication increased by more than 60%, and the use of 4 or more medications more than tripled. By 2008, approximately 50% of women reported taking at least 1 medication. Use of some specific medications markedly decreased or increased. Prescription medication use increased with maternal age and education, was highest for non-Hispanic whites, and varied by state. CONCLUSION: These data reflect the widespread and growing use of medications by pregnant women and reinforce the need to study their respective fetal risks and safety. |
Emerging issues in teratology: an introduction
Rasmussen SA , Friedman JM . Am J Med Genet C Semin Med Genet 2011 157 (3) 147-9 Teratology is the study of congenital anomalies and their causes, and interest in teratology has been longstanding, with Egyptian wall paintings depicting children with birth defects over 5,000 years ago [Barrow, 1971]. By definition, teratogenic factors include both non-genetic and genetic factors that increase the risk for birth defects [Fraser, 2010]; however, traditionally, the term “teratogenic” has been used to refer to non-genetic factors that cause birth defects. The study of human teratogenic exposures is a relatively new one, emerging in the past 70 years. Before maternal rubella infection during pregnancy was identified as a cause of birth defects and developmental disabilities in 1941 by an ophthalmologist, Norman Gregg, birth defects were generally believed to be inherited [Gregg, 1991; Webster, 1998]. The uterus was thought to serve as a barrier, protecting the infant from the effects of external factors [Fraser, 2010]. But recognition of maternal rubella syndrome and subsequently, of thalidomide as a cause of birth defects in 1961 by McBride and Lenz [McBride, 1961; Lenz and Knapp, 1962], increased awareness of the effects that non-genetic factors could have on the development of the embryo or fetus. | Much more is now known about teratogenic factors. Understanding these teratogenic exposures is important to geneticists and genetic counselors for several reasons. First, teratogenic conditions need to be included in the differential diagnosis for children and adults presenting to genetics clinic. Clinicians need to ask about potential exposures during pregnancy, be aware of those exposures recognized as causing adverse outcomes, and finally, think beyond what is known, to consider whether an exposure could be the cause of the abnormalities observed in a particular patient. In the past, key observations by astute clinicians have often been critical to the recognition that a particular exposure could be related to an adverse outcome [Carey et al., 2009]. Another reason that geneticists and genetic counselors need to know about teratogenic exposures is that genetic clinicians often serve as a source of information about these exposures. Clinicians who see women during pregnancy are often asked about the safety of a particular medication, and families who have had a child with a birth defect or developmental disability often also ask about whether a particular exposure during their pregnancy might have caused the defects in their child. Finally, identification of non-genetic factors that increase the risk for adverse outcomes can lead to the development of strategies for primary prevention, such as those developed for the prevention of fetal alcohol syndrome, following identification of alcohol as a teratogen [Rasmussen et al., 2009]. |
Influencing clinical practice regarding the use of antiepileptic medications during pregnancy: modeling the potential impact on the prevalences of spina bifida and cleft palate in the United States
Gilboa SM , Broussard CS , Devine OJ , Duwe KN , Flak AL , Boulet SL , Moore CA , Werler MM , Honein MA . Am J Med Genet C Semin Med Genet 2011 157 (3) 234-46 Selected antiepileptic drugs (AEDs) increase the risk of birth defects. To assess the impact of influencing AED prescribing practices on spina bifida and cleft palate we searched the literature for estimates of the association between valproic acid or carbamazepine use during pregnancy and these defects and summarized the associations using meta-analyses. We estimated distributions of the prevalence of valproic acid and carbamazepine use among women of childbearing age based on analyses of four data sets. We estimated the attributable fractions and the number of children born with each defect that could be prevented annually in the United States if valproic acid and carbamazepine were not used during pregnancy. The summary odds ratio estimate for the association between valproic acid and spina bifida was 11.9 (95% uncertainty interval (UI): 4.0-21.2); for valproic acid and cleft palate 5.8 (95% UI: 3.3-9.5); for carbamazepine and spina bifida 3.6 (95% UI: 1.3-7.8); and for carbamazepine and cleft palate 2.4 (95% UI: 1.1-4.5) in the United States. Approximately 40 infants (95% UI: 10-100) with spina bifida and 35 infants (95% UI: 10-70) with cleft palate could be born without these defects each year if valproic acid were not used during pregnancy; 5 infants (95% UI: 0-15) with spina bifida and 5 infants (95% UI: 0-15) with cleft palate could be born without these defects each year if carbamazepine were not used during pregnancy. This modeling approach could be extended to other medications to estimate the impact of translating pharmacoepidemiologic data to evidence-based prenatal care practice. Published 2011 Wiley-Liss, Inc. |
Sodium and potassium intake and mortality among US adults: prospective data from the Third National Health and Nutrition Examination Survey.
Yang Q , Liu T , Kuklina EV , Flanders WD , Hong Y , Gillespie C , Chang MH , Gwinn M , Dowling N , Khoury MJ , Hu FB . Arch Intern Med 2011 171 (13) 1183-91 BACKGROUND: Several epidemiologic studies suggested that higher sodium and lower potassium intakes were associated with increased risk of cardiovascular diseases (CVD). Few studies have examined joint effects of dietary sodium and potassium intake on risk of mortality. METHODS: To investigate estimated usual intakes of sodium and potassium as well as their ratio in relation to risk of all-cause and CVD mortality, the Third National Health and Nutrition Examination Survey Linked Mortality File (1988-2006), a prospective cohort study of a nationally representative sample of 12,267 US adults, studied all-cause, cardiovascular, and ischemic heart (IHD) diseases mortality. RESULTS: During a mean follow-up period of 14.8 years, we documented a total of 2270 deaths, including 825 CVD deaths and 443 IHD deaths. After multivariable adjustment, higher sodium intake was associated with increased all-cause mortality (hazard ratio [HR], 1.20; 95% confidence interval [CI], 1.03-1.41 per 1000 mg/d), whereas higher potassium intake was associated with lower mortality risk (HR, 0.80; 95% CI, 0.67-0.94 per 1000 mg/d). For sodium-potassium ratio, the adjusted HRs comparing the highest quartile with the lowest quartile were HR, 1.46 (95% CI, 1.27-1.67) for all-cause mortality; HR, 1.46 (95% CI, 1.11-1.92) for CVD mortality; and HR, 2.15 (95% CI, 1.48-3.12) for IHD mortality. These findings did not differ significantly by sex, race/ethnicity, body mass index, hypertension status, education levels, or physical activity. CONCLUSION: Our findings suggest that a higher sodium-potassium ratio is associated with significantly increased risk of CVD and all-cause mortality, and higher sodium intake is associated with increased total mortality in the general US population. |
Association of body fat percentage with lipid concentrations in children and adolescents: United States 1999-2004
Lamb MM , Ogden CL , Carroll MD , Lacher DA , Flegal KM . Am J Clin Nutr 2011 94 (3) 877-83 BACKGROUND: BMI is one factor that is used to determine a child's eligibility for lipid screening and treatment. BMI, which is an indirect measure of body fat, may inadequately represent the biological effect of body fat percentage on lipid concentrations. OBJECTIVE: We examined the relation between directly measured body fat percentage and lipid concentrations in a representative sample of US youths. DESIGN: Data from 7821 participants aged 8-19 y from the 1999-2004 NHANES were analyzed. Body fat percentage was measured by dual-energy X-ray absorptiometry. Total and HDL-cholesterol concentrations were measured in serum. Serum triglyceride and LDL-cholesterol concentrations were measured in a subsample of 2661 fasting NHANES participants aged 12-19 y. Prevalences of adverse total cholesterol (>200 mg/dL), LDL cholesterol (>130 mg/dL), triglycerides (>150 mg/dL), and HDL cholesterol (<35 mg/dL) were measured. RESULTS: Approximately 10.0% [+/-0.7% (SE)] of participants had high total cholesterol, 7.0 +/- 0.4% of participants had low HDL cholesterol, 9.7 +/- 1.0% of participants had high triglycerides, and 7.6 +/- 0.7% of participants had high LDL cholesterol. Prevalence of adverse total cholesterol, HDL cholesterol, triglycerides, and LDL cholesterol in US youths with high adiposity (greater than or equal to the age- and sex-specific 75th percentile of body fat percentage) was significantly greater (P < 0.01) than for participants without high adiposity. In multiple linear regressions adjusted for age, survey period, and race-ethnicity, the variance in lipid concentrations explained by body fat percentage was 2-20% (P < 0.001). CONCLUSION: Adverse lipid concentrations and high adiposity are significantly associated in youths. |
Consumption of added sugars is decreasing in the United States
Welsh JA , Sharma AJ , Grellinger L , Vos MB . Am J Clin Nutr 2011 94 (3) 726-34 BACKGROUND: The consumption of added sugars (caloric sweeteners) has been linked to obesity, diabetes, and heart disease. Little is known about recent consumption trends in the United States or how intakes compare with current guidelines. OBJECTIVE: We examined trends in intakes of added sugars in the United States over the past decade. DESIGN: A cross-sectional study of US residents ≥2 y of age (n = 42,316) was conducted by using dietary data from NHANES 1999-2008 (five 2-y cycles) and data for added-sugar contents from the MyPyramid Equivalents Database. Mean intakes of added sugars (grams and percentage of total energy intake) were weighted to obtain national estimates over time across age, sex, and race-ethnic groups. Linear trends were tested by using Wald's F tests. RESULTS: Between 1999-2000 and 2007-2008, the absolute intake of added sugars decreased from a mean (95% CI) of 100.1 g/d (92.8, 107.3 g/d) to 76.7 (71.6, 81.9 g/d); two-thirds of this decrease, from 37.4 g/d (32.6, 42.1 g/d) to 22.8 g/d (18.4, 27.3 g/d), resulted from decreased soda consumption (P-linear trend <0.001 for both). Energy drinks were the only source of added sugars to increase over the study period (P-linear trend = 0.003), although the peak consumption reached only 0.15 g/d (0.08, 0.22 g/d). The percentage of total energy from added sugars also decreased from 18.1% (16.9%, 19.3%) to 14.6% (13.7%, 15.5%) (P-linear trend <0.001). CONCLUSION: Although the consumption of added sugars in the United States decreased between 1999-2000 and 2007-2008, primarily because of a reduction in soda consumption, mean intakes continue to exceed recommended limits. |
Employment and work schedule are related to telomere length in women.
Parks CG , Deroo LA , Miller DB , McCanlies EC , Cawthon RM , Sandler DP . Occup Environ Med 2011 68 (8) 582-9 OBJECTIVES: To examine the association of employment and work schedule with shorter DNA telomeres, a marker of cellular ageing and disease risk factor, and consider whether differences were related to health, behaviours and sociodemographic factors, or varied by stress levels or menopausal status. METHODS: This cross-sectional analysis of 608 women aged 35-74 in the Sister Study examined determinants of relative telomere length (rTL) measured by quantitative PCR in leucocyte DNA. Age-adjusted regression models estimated base pair (bp) rTL differences for current and lifetime schedule characteristics (ie, part-time, full-time or overtime hours; multiple jobs; irregular hours; shiftwork; work at night). Covariates included race, smoking, perceived stress, sleep, physical activity, health and menopausal status, education, marital status, live births, children under 18, measured body mass index and urinary stress hormones. RESULTS: Compared with non-employed women with moderate or substantial past work histories (n=190), those currently working full-time (n=247; median 40 h/week) had a shorter rTL, an age-adjusted difference of -329 bp (95% CI -110 to -548). Longer-duration full-time work was also associated with shorter rTL (age-adjusted difference of -472 bp, 95% CI -786 to -158 for 20+ vs 1-5 years). Findings were not explained by health and demographic covariates. However, rTL differences for working at least full-time were greater in women with higher stress and epinephrine levels. CONCLUSIONS: Current and long-term full-time work were associated with shorter rTL, with differences of similar magnitude to smoking and history of heart disease or diabetes. Longitudinal data with specific stress measures are needed to further evaluate the impact of work schedule on rTL. |
Subjective perceptions and ergonomics evaluation of a liquid cooled garment worn under protective ensemble during an intermittent treadmill exercise
Kim JH , Coca A , Williams WJ , Roberge RJ . Ergonomics 2011 54 (7) 626-35 While a personal protective equipment (PPE) ensemble effectively provides workers with protection from occupational hazards, working in a vapour-resistant ensemble increases the risk of heat illness/injuries and physiological burdens. The purpose of this study was to investigate the effect of body cooling via a liquid-cooled garment (LCG) underneath a PPE ensemble on perceived thermal strain, physiological responses and ergonomics during an intermittent treadmill exercise in warm environmental conditions. The results of the present study indicated that the concomitant wearing of LCG underneath the PPE ensemble significantly reduced subjective perception of heat and alleviated overall increase in body temperature and heart rate while no impact of wearing LCG on ergonomic features was found. The extension of the present findings to practical applications in occupational settings requires further research on a LCG system design and performance evaluations while the LCG is incorporated within the PPE ensemble. Statement of Relevance: Implementation of a LCG underneath PPE for body cooling was investigated, focusing on its impact on individuals' perceived thermal strain, physiological responses and ergonomics. The findings of the present study indicated that body cooling via a wearable LCG underneath PPE significantly alleviated both perceived thermal and physiological strain in uncompensable heat stress condition. |
Surveillance of traumatic firefighter fatalities: an assessment of four systems
Estes CR , Marsh SM , Castillo DN . Public Health Rep 2011 126 (4) 540-551 OBJECTIVES: Firefighters regularly respond to hazardous situations that put them at risk for fatal occupational injuries. Traumatic occupational fatality surveillance is a foundation for understanding the problem and developing prevention strategies. We assessed four surveillance systems for their utility in characterizing firefighter fatalities and informing prevention measures. METHODS: We examined three population-based systems (the Bureau of Labor Statistics' Census of Fatal Occupational Injuries and systems maintained by the United States Fire Administration and the National Fire Protection Association) and one case-based system (data collected through the National Institute for Occupational Safety and Health Fire Fighter Fatality Investigation and Prevention Program). From each system, we selected traumatic fatalities among firefighters for 2003-2006. Then we compared case definitions, methods for case ascertainment, variables collected, and rate calculation methods. RESULTS: Overall magnitude of fatalities differed among systems. The population-based systems were effective in characterizing the circumstances of traumatic firefighter fatalities. The case-based surveillance system was effective in formulating detailed prevention recommendations, which could not be made based on the population-based data alone. Methods for estimating risk were disparate and limited fatality rate comparisons between firefighters and other workers. CONCLUSIONS: The systems included in this study contribute toward a greater understanding of firefighter fatalities. Areas of improvement for these systems should continue to be identified as they are used to direct research and prevention efforts. |
Work-related asthma among adults with current asthma in 33 states and DC: evidence from the Asthma Call-Back Survey, 2006–2007
Knoeller GE , Mazurek JM , Moorman JE . Public Health Rep 2011 126 (4) 603-611 Asthma is associated with a variety of physical, chemical, and biological stimuli1–4 including those found in the workplace.5 The term “work-related asthma” (WRA), representing a subset of all asthma, encompasses both occupational asthma (OA), which is asthma that is caused by workplace exposure to a sensitizing or irritant substance, and work-exacerbated asthma (WEA), which is asthma that is worsened by work-related factors.6 | WRA is a preventable7–9 and underdiagnosed10 occupational lung disease associated with adverse social and economic outcomes, disability, and mortality.11–16 Workers who leave their jobs due to WRA often experience loss in income and/or unemployment.11,17 A French study followed workers with WRA for an average of 3.1 years after diagnosis. At follow-up, 44% had left their jobs, 25% were unemployed, and 46% had experienced loss in income.18 Among adults with asthma, those with WRA have a lower quality of life11,15,19,20 and more frequent emergency department and doctors' visits for worsening asthma.21 WRA caused by a number of workplace agents may also lead to death.22 |
Occupational lung disease risk and exposure to butter-flavoring chemicals after implementation of controls at a microwave popcorn plant
Kanwal R , Kullman G , Fedan KB , Kreiss K . Public Health Rep 2011 126 (4) 480-494 OBJECTIVES: After an outbreak of severe lung disease among workers exposed to butter-flavoring chemicals at a microwave popcorn plant, we determined whether or not lung disease risk declined after implementation of exposure controls. METHODS: National Institute for Occupational Safety and Health staff performed eight serial cross-sectional medical and industrial hygiene surveys at the plant from November 2000 through August 2003. Medical surveys included standardized questionnaires and spirometry testing. Industrial hygiene surveys measured levels of production-related air contaminants, including butter-flavoring chemicals such as diacetyl. All diacetyl concentrations above detectable limits were corrected for the effects of absolute humidity and days to sample extraction. RESULTS: Ventilation and isolation of the production process resulted in one to three orders of magnitude reductions in diacetyl air concentrations in different areas of the plant. Workers with past high exposures had stable chest symptoms over time; nasal, eye, and skin irritation symptoms declined. New workers had lower symptom prevalences and higher lung function than workers with past high exposures, and they did not worsen over time. In workers who had at least three spirometry tests, those with past high exposures were more likely to experience rapid declines in lung function than new workers. CONCLUSIONS: Implemented controls lowered exposures to butter-flavoring chemicals and decreased lung disease risk for much of the plant workforce. Some workers with continuing potential for intermittent, short-term peak and measurable time-weighted exposures remain at risk and should use respiratory protection and have regularly scheduled spirometry to detect rapid lung function declines that may be work-related. Close follow-up of such workers is likely to yield additional information on risks due to peak and time-weighted exposure levels. |
Prevention of IgE sensitization to latex in health care workers after reduction of antigen exposures
Kelly KJ , Wang ML , Klancnik M , Petsonk EL . J Occup Environ Med 2011 53 (8) 934-40 OBJECTIVE: To investigate occupational latex allergy in health care workers (HCWs) before and after an intervention designed to reduce latex allergen exposure from gloves. METHODS: Latex antigen concentrations in work area air ducts were measured before the intervention. Symptoms and latex sensitization were monitored annually before and after the intervention in 805 HCWs, using questionnaires and skin prick testing. RESULTS: The prevalence of latex sensitization before the intervention correlated with air duct latex antigen measurements, for HCWs exposed to low (9/413, 2%), intermediate (23/292, 8%), and high (11/67, 16%) antigen levels, P < 0.0001. After the intervention, new latex sensitization rates declined 16-fold, and 25% of previously sensitized employees reverted to negative skin tests. CONCLUSION: Airborne antigen exposure is a major source of latex sensitization among HCWs. Use of powder-free latex gloves markedly reduces the risk of sensitization. |
Efficacy of predictive modeling as a scientific criterion in dermal hazard identification for assignment of skin notations
Chen CP , Ahlers HW , Dotson GS , Lin YC , Chang WC , Maier A , Gadagbui B . Regul Toxicol Pharmacol 2011 61 (1) 63-72 Skin notations (SNs) represent a hazard characterization tool for alerting workers of health hazards associated with dermal contact with chemicals. This study evaluated the efficacy of a predictive model utilized by the National Institute for Occupational Safety and Health to identify dermal hazards based on potential of systemic absorption compared to hazard assignments based on dermal lethal dose 50% or logarithm of octanol-water partition coefficient. A total of 480 chemicals assigned an SN from at least one of seven institutes were selected and partitioned into seven hazard categories by frequency of SN assignment to provide a basis of evaluation for the predictivity of the examined criteria. We find that all three properties serve as a qualitative indicator in support of a dichotomous decision on dermal hazard; the predictive modeling was identified from a multiple regression analysis as the most significant indicator. The model generated estimates that corresponded to anticipated hazard potentials, suggesting a role of the model to further serve as a hazard-ranking tool. The hazard-ranking capability of the model was consistent with the scheme of acute toxicity classification in the Globally Harmonized System of Classification and Labeling of Chemicals. |
Estimates of historical exposures by phase contrast and transmission electron microscopy for pooled exposure-response analyses of North Carolina and South Carolina, USA asbestos textile cohorts
Dement JM , Loomis D , Richardson D , Wolf SH , Kuempel ED . Occup Environ Med 2011 68 (8) 593-8 OBJECTIVES: To develop pooled size-specific asbestos fiber exposure estimates for North Carolina and South Carolina asbestos textile plants. METHODS: Airborne sample data and prior exposure estimates by phase-contrast microscopy (PCM) for the two cohorts were reviewed and compared. Estimates by transmission electron microscopy (TEM) for 160 membrane filter samples from all plant were pooled. Poisson regression models were developed to predict bivariate diameter/length airborne fiber size distributions based on independent categorical variables for fiber diameter, fiber length, plant, and exposure zone. The model predicted bivariate diameter/length distributions were expressed as the proportion of fibers in 28 size-specific cells and these data were used to calculate PCM to TEM adjustment factors in order to estimate fiber size-specific exposures for the pooled cohort. RESULTS: Exposure levels in the North Carolina plants were in excess of 50 f/cc for many operations through about 1955 owing to lack of dust control measures in early years whereas levels in the South Carolina plant were generally less than 10 f/cc by about 1950. The Poisson regression models found covariates for plant department to be a stronger predictor of bivariate size proportions than plant; however, a plant effect was observed. The final Poisson models demonstrated good fit to the observed data. CONCLUSIONS: Consistent with early studies, fiber exposures in the North Carolina plants were much higher than in South Carolina plant. Use of the predicted size-specific TEM exposures by plant and department based on the Poisson model predictions should reduce exposure. |
Industrial fungal enzymes: an occupational allergen perspective
Green BJ , Beezhold DH . J Allergy (Cairo) 2011 2011 682574 Occupational exposure to high-molecular-weight allergens is a risk factor for the development and pathogenesis of IgE-mediated respiratory disease. In some occupational environments, workers are at an increased risk of exposure to fungal enzymes used in industrial production. Fungal enzymes have been associated with adverse health effects in the work place, in particular in baking occupations. Exposure-response relationships have been demonstrated, and atopic workers directly handling fungal enzymes are at an increased risk for IgE-mediated disease and occupational asthma. The utilization of new and emerging fungal enzymes in industrial production will present new occupational exposures. The production of antibody-based immunoassays is necessary for the assessment of occupational exposure and the development of threshold limit values. Allergen avoidance strategies including personal protective equipment, engineering controls, protein encapsulation, and reduction of airborne enzyme concentrations are required to mitigate occupational exposure to fungal enzymes. |
Association of overtime work with cellular immune markers among healthy daytime white-collar employees
Nakata A , Takahashi M , Irie M . Scand J Work Environ Health 2011 38 (1) 56-64 OBJECTIVES: Even though overtime work has been suspected to be a risk factor for ill health, little research has been done to determine the underlying immunological mechanisms. This study investigated the association between overtime work and cellular immunity among Japanese white-collar workers. METHODS: A total of 306 healthy, full-time, non-shift, daytime employees (165 men and 141 women), aged 22-69 (mean 36) years, provided a blood sample for the measurement of circulating immune [natural killer (NK), B, and T] cells and NK cell cytotoxicity (NKCC) and completed a questionnaire survey including overtime/month. Blood samples were collected between 09.00-11.00 hours during the working days and participants completed the questionnaire within the two weeks prior to the blood sampling. Stepwise linear regression analyses controlling for confounders were carried out to examine the relationship between overtime work and immune markers. RESULTS: Overtime work was mainly related to short sleep duration, increased weight, and reduced job satisfaction, and it was more prevalent among men than women and among younger and married employees. Amount of overtime was inversely associated with NK (CD3-CD56+) cell counts (beta=-0.145; P =0.032) but was not associated with NKCC, NKCC/NK cell ratio, T or B cells. CONCLUSIONS: The NK cell is a lymphocyte that possesses killer activity against tumor and virus-infected cells and constitutes a major component of the innate immune system. A decrease of NK cell counts from overtime work suggests a dampened innate immune defense. However, the finding needs to be further validated with a well-designed study using objective overtime measures. |
Coal dust exposure and mortality from ischemic heart disease among a cohort of U.S. coal miners
Landen DD , Wassell JT , McWilliams L , Patel A . Am J Ind Med 2011 54 (10) 727-33 BACKGROUND: Particulate exposure from air pollution increases the risk of ischemic heart disease (IHD) mortality. Although coal miners are highly exposed to coal dust particulate, studies of IHD mortality risk among coal miners have had inconsistent results. Previous studies may have been biased by the healthy worker effect. METHODS: We examined the dose-response relationship between cumulative coal dust exposure, coal rank, and IHD mortality among a cohort of underground coal miners who participated in the National Study of Coal Workers' Pneumoconiosis. RESULTS: After adjusting for age, smoking, and body mass index, risk of IHD mortality increased at higher levels of coal dust exposure. Mortality risk was also associated with coal rank region. CONCLUSION: There was an increased risk of mortality from IHD associated with cumulative exposure to coal dust, and with coal rank. The effect of coal rank may be due differences in the composition of coal mine dust particulate. The association of risk of IHD mortality with cumulative particulate exposure is consistent with air pollution studies. Am. J. Ind. Med. (c) 2011 Wiley-Liss, Inc. |
Viability of Baylisascaris procyonis eggs
Shafir SC , Sorvillo FJ , Sorvillo T , Eberhard ML . Emerg Infect Dis 2011 17 (7) 1293-1295 Infection with Baylisascaris procyonis roundworms is rare but often fatal and typically affects children. We attempted to determine parameters of viability and methods of inactivating the eggs of these roundworms. Loss of viability resulted when eggs were heated to 62°C or desiccated for 7 months but not when frozen at -15°C for 6 months. |
Comment on zoonoses in the bedroom
Montgomery SP , Xiao L , Cama V . Emerg Infect Dis 2011 17 (7) 1340 In response to Chomel and Sun (1), we would like to correct potentially misleading representations of risk factors for parasitic diseases. The authors correctly described risk for Chagas disease from exposure to infected insect vectors but included Chagas disease in the table, "Zoonoses acquired by close contact with pet, 1974-2010." The bloodborne protozoan that causes Chagas disease is transmitted not by contact with an infected mammal but by contact with a vector insect that has bitten an infected mammal (2). |
Prevalence of smoking in China in 2010
Li Q , Hsia J , Yang G . N Engl J Med 2011 364 (25) 2469-70 The Global Adult Tobacco Survey (GATS) is a cross-sectional survey of tobacco use among adults that is carried out by individual countries in collaboration with the U.S. Centers for Disease Control and Prevention and the World Health Organization. From December 2009 through March 2010, the Chinese Center for Disease Control and Prevention conducted the GATS China; all noninstitutionalized persons 15 years of age or older (“adults”) who resided in China at the time of the survey were considered eligible to participate. A stratified, multistage cluster-sampling design was used to select 15,000 adults in 100 counties or districts in China to take the survey. In all, 13,354 participants completed the survey. | Estimated Prevalence of Current Smoking among Adults 15 Years of Age or Older, According to Sex and Selected Demographic Characteristics — GATS China, 2010. | In 2010, an estimated 28.1% of adults in China (52.9% of men and 2.4% of women) were current smokers — a prevalence ratio of 22 to 1 (Table 1). Among men, the prevalence was highest among those 45 to 64 years of age (63.0%) and lowest among those 15 to 24 years of age (33.6%). The prevalence of smoking among men was significantly higher among rural residents (56.1%), as compared with inhabitants of urban areas (49.2%). In terms of education level, the prevalence in men was highest among those who attended secondary school (63.2%) and lowest among those who were college graduates or postgraduates (44.0%). Of the occupations included, male machine operators had the highest prevalence of smoking (67.0%). |
Interventions targeting substance abuse among women survivors of intimate partner abuse: a meta-analysis
Fowler DN , Faulkner M . J Subst Abuse Treat 2011 41 (4) 386-98 In this article, meta-analytic techniques are used to examine existing intervention studies (n = 11) to determine their effects on substance abuse among female samples of intimate partner abuse (IPA) survivors. This research serves as a starting point for greater attention in research and practice to the implementation of evidence-based, integrated services to address co-occurring substance abuse and IPA victimization among women as major intersecting public health problems. The results show greater effects in three main areas. First, greater effect sizes exist in studies where larger numbers of women experienced current IPA. Second, studies with a lower mean age also showed greater effect sizes than studies with a higher mean age. Lastly, studies with smaller sample sizes have greater effects. This research helps to facilitate cohesion in the knowledge base on this topic, and the findings of this meta-analysis, in particular, contribute needed information to gaps in the literature on the level of promise of existing interventions to impact substance abuse in this underserved population. |
Characterization of the risk of deer-cattle interactions in Minnesota by use of an on-farm environmental assessment tool
Knust BM , Wolf PC , Wells SJ . Am J Vet Res 2011 72 (7) 924-31 OBJECTIVE: To characterize the risk of interactions that may lead to the transmission of Mycobacterium bovis between cattle and white-tailed deer (Odocoileus virginianus) on farms in northern Minnesota. SAMPLE: 53 cattle farms in northwestern Minnesota adjacent to an area where bovine tuberculosis-infected cattle and deer were detected. PROCEDURES: A semiquantitative deer-cattle interaction assessment tool was used for the 53 cattle herds. Farm risk scores were analyzed on the basis of deer damage to stored feed. RESULTS: 27 (51%) farms reported deer damage to stored cattle feeds within the year previous to the farm visit. A strong association was found between increases in the percentage of land that could serve as deer cover and deer damage to stored feeds on a farm. The total risk score was significantly associated with the probability of a farm having deer damage. By use of a logistic regression model, the total risk score and proportion of nonagricultural land around a farm could be used to predict the likelihood of deer damage to stored feeds. CONCLUSIONS AND CLINICAL RELEVANCE: Management practices on many farms in northwestern Minnesota allowed potential deer-cattle interactions. The on-farm risk assessment tool served as a valuable tool for prioritizing the biosecurity risks for farms. Continued development of biosecurity is needed to prevent potential transmission of bovine tuberculosis between deer and cattle, especially on farms that have a higher risk of deer damage. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Disease Reservoirs and Vectors
- Environmental Health
- Epidemiology and Surveillance
- Genetics and Genomics
- Health Behavior and Risk
- Health Communication and Education
- Healthcare Associated Infections
- Immunity and Immunization
- Injury and Violence
- Laboratory Sciences
- Maternal and Child Health
- Nutritional Sciences
- Occupational Safety and Health
- Occupational Safety and Health - Mining
- Parasitic Diseases
- Substance Use and Abuse
- Veterinary Medicine
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