Effectiveness evaluation of a hypertension management program in a Federally Qualified Health Center (FQHC)
Lowe Beasley K , Tucker-Brown A , Rein DB , Ahn R , Davis R , Spafford M , Dougherty M , Teachout E , Haynes SB . Prev Med Rep 2023 34 102271 The objective of this study was to examine effectiveness of a Hypertension Management Program (HMP) in a Federally Qualified Health Center (FQHC). From September 2018 through December 2019, we implemented HMP in seven clinics of an FQHC in rural South Carolina. A pre/post evaluation design estimated the association of HMP with hypertension control rates and systolic blood pressure using electronic health record data among 3,941 patients. A chi-square test estimated change in mean control rates in pre- and intervention periods. A multilevel multivariable logistic regression model estimated the incremental impact of HMP on odds of hypertension control. Results showed that 53.4% of patients had controlled hypertension pre-intervention (September 2016-September 2018); 57.3% had controlled hypertension at the end of the observed implementation period (September 2018-December 2019) (p < 0.01). Statistically significant increases in hypertension control rates were observed in six of seven clinics (p < 0.05). Odds of controlled hypertension were 1.21 times higher during the intervention period compared to pre-intervention (p < 0.0001). Findings can inform the replication of HMP in FQHCs and similar health care settings, which play a pivotal role in caring for patients with health and socioeconomic disparities. |
Cost-related prescription non-adherence and patient-reported outcomes in systemic lupus erythematosus: The Michigan Lupus Epidemiology & Surveillance program
Minhas D , Marder W , Hassett AL , Zick SM , Gordon C , Harlow SD , Wang L , Barbour KE , Helmick CG , McCune WJ , Somers EC . Lupus 2023 32 (9) 9612033231186113 OBJECTIVES: Medication access and adherence play key roles in determining patient outcomes. We investigated whether cost-related non-adherence (CRNA) to prescription medications was associated with worse patient-reported outcomes in a population-based systemic lupus erythematosus (SLE) cohort. METHODS: Sociodemographic and prescription data were collected by structured interviews in 2014-2015 from patients meeting SLE criteria in the established Michigan Lupus Epidemiology & Surveillance (MILES) Cohort. We examined the associations between CRNA and potential confounders such as sociodemographics and health insurance coverage, and outcome measures of SLE activity and damage using multivariable linear regression. RESULTS: 462 SLE participants completed the study visit: 430 (93.1%) female, 208 (45%) Black, and mean age 53.3 years. 100 (21.6%) participants with SLE reported CRNA in the preceding 12 months. After adjusting for covariates, CRNA was associated with both higher levels of current SLE disease activity [SLAQ: β coeff 2.7 (95% CI 1.3, 4.1), p < 0.001] and damage [LDIQ β coeff 1.4 (95% CI 0.5, 2.4), p = 0.003]. Race, health insurance status, and fulfilling Fibromyalgia (FM) Survey Criteria were independently associated with both higher (worse) SLAQ and LDIQ scores; female sex was further associated with higher SLAQ scores. CONCLUSION: Patients with SLE who reported CRNA in the previous 12 months had significantly worse self-reported current disease activity and damage scores compared to those not reporting CRNA. Raising awareness and addressing barriers or concerns related to financial implications and accessibility issues in care plans may help to improve these outcomes. |
Neuron-astrocyte omnidirectional signaling in neurological health and disease
Pathak D , Sriram K . Front Mol Neurosci 2023 16 1169320 Astrocytes are an abundantly distributed population of glial cells in the central nervous system (CNS) that perform myriad functions in the normal and injured/diseased brain. Astrocytes exhibit heterogeneous phenotypes in response to various insults, a process known as astrocyte reactivity. The accuracy and precision of brain signaling are primarily based on interactions involving neurons, astrocytes, oligodendrocytes, microglia, pericytes, and dendritic cells within the CNS. Astrocytes have emerged as a critical entity within the brain because of their unique role in recycling neurotransmitters, actively modulating the ionic environment, regulating cholesterol and sphingolipid metabolism, and influencing cellular crosstalk in diverse neural injury conditions and neurodegenerative disorders. However, little is known about how an astrocyte functions in synapse formation, axon specification, neuroplasticity, neural homeostasis, neural network activity following dynamic surveillance, and CNS structure in neurological diseases. Interestingly, the tripartite synapse hypothesis came to light to fill some knowledge gaps that constitute an interaction of a subpopulation of astrocytes, neurons, and synapses. This review highlights astrocytes' role in health and neurological/neurodegenerative diseases arising from the omnidirectional signaling between astrocytes and neurons at the tripartite synapse. The review also recapitulates the disruption of the tripartite synapse with a focus on perturbations of the homeostatic astrocytic function as a key driver to modulate the molecular and physiological processes toward neurodegenerative diseases. |
Changes in health care utilization among Medicare beneficiaries with diabetes two years into the COVID-19 pandemic
Zhou X , Andes LJ , Rolka DB , Imperatore G . AJPM Focus 2023 100117 IMPORTANCE: The coronavirus 2019 (COVID-19) pandemic abruptly impacted health care service delivery and utilization. However, the impact on older adults with diabetes in the United States is unclear. OBJECTIVE: To estimate changes in health care utilization among older adults with diabetes during the initial 2 years of the COVID-19 pandemic compared to the 2 years before, and to examine the variation in utilization changes by demographic and socioeconomic characteristics. DESIGN SETTING AND PARTICIPANTS: In this study, we analyzed changes in utilization, measured by the average use of health care services per 1,000 persons with diabetes, using medical claims for Medicare fee-for-service beneficiaries aged 67 years and above. Utilization changes by setting (acute inpatient, emergency room [ER], hospital outpatient, physician office, and ambulatory surgery center [ASC]) and by media (telehealth and in-person) were examined for 22 months of the pandemic (03/2020-12/2021) compared with pre-pandemic period (03/2018-12/2019). We also estimated utilization changes by beneficiaries' age group, sex, race/ethnicity, and residential urbanicity. RESULTS: The study sample consisted of approximately 6 million beneficiaries with diabetes each month. In the first 2 years of the pandemic, the average use of health care services by setting was 5-17% lower than the pre-pandemic level for all types of services. Phase 1 (03/2020-05/2020) had the largest decrease in utilization: physician office visits changed by -51.2% (95% CI, -55.0% to -47.5%), ASC procedures by -45.1% (95% CI, -49.8% to -40.4%), ER visits by -36.9% (95% CI, -39.0% to -34.7%), acute inpatient stays by -31.5% (95% CI, -33.6% to -29.3%), and hospital outpatient visits by -27% (95% CI, -29.3% to -24.8%). The reduction in utilization varied by sociodemographic subgroup. During the pandemic, the use of telehealth visits increased by 511.1% (95% CI, 502.2% to 520.0%) compared to the pre-pandemic period. The increase was smaller among rural residents. CONCLUSIONS AND RELEVANCE: Medicare beneficiaries with diabetes experienced a reduction in the use of health care services during the COVID-19 pandemic, some of which persisted through two years into the pandemic. Telehealth visits increased, but not enough to overcome decreases in in-person visits. Understanding these patterns may help to optimize the use of health care resources for diabetes management in the post-pandemic era and during future emergencies. |
The promise of pre-exposure prophylaxis - examining awareness, knowledge, and willingness to use different modalities among US-based African immigrants
Aidoo-Frimpong G , Agbemenu K , Adzrago D , Akyirem S , Boateng S , Nelson LE . J Immigr Minor Health 2023 25 (6) 1331-1338 This study aims to describe and understand the relationship between sociodemographic factors and PrEP awareness, and willingness to use a PrEP modality (oral or injectable).Despite the availability of effective prevention tools such as HIV preexposure prophylaxis (PrEP), African immigrants in the United States are disproportionately affected by HIV. Although PrEP can significantly reduce HIV infection in this population, research evidence on PrEP outcomes, such as awareness, knowledge, and willingness to use, is extremely limited. Between April and May 2022, 92 participants completed an online survey assessing their awareness, knowledge, and willingness to use oral or injectable PrEP. The association between sociodemographic characteristics and PrEP-related measures was examined using descriptive and Pearson's chi-squared or Fisher's exact tests. Participants (N = 92) were born between 1990 and 1999 (46.7%), female (70.76%) and highly educated (59.6%). About 52.2% were unaware of PrEP, and 65.6% were willing to use a PrEP modality. Findings indicate that individuals who reported being aware of PrEP demonstrated a high level of knowledge regarding the medication. Having a healthcare provider was associated with PrEP awareness and willingness to use, while educational status was associated with PrEP awareness. 51.1% of participants were willing to use an oral pill for prevention and 47.8% were willing to use injectable PrEP. Our findings highlight the need for PrEP-related research and interventions for African immigrants to increase awareness and provide options for HIV prevention, as African immigrants are currently not well-represented in PrEP delivery systems in the US. |
Notes from the field: Emergence of an mpox cluster primarily affecting persons previously vaccinated against mpox - Chicago, Illinois, March 18-June 12, 2023
Faherty EAG , Holly T , Ogale YP , Crisler G , Becht A , Kern D , Nicolae L , Spencer H , Wasz M , Kerins JL , Kittner A , Staton A , Hardnett C , Hutson C , Gigante CM , Quilter L , Kracalik I , Black S , McCollum AM , Rao AK , Tabidze I . MMWR Morb Mortal Wkly Rep 2023 72 (25) 696-698 During April 17–May 5, 2023, 13 monkeypox (mpox) cases were reported to the Chicago Department of Public Health (CDPH) after 2 months during which only a single case had been reported. The cluster was remarkable because it comprised more than 10 cases at a time when sporadic cases or small clusters (i.e., involving fewer than three cases) were being reported in the United States, and >69% of the persons in this cluster had received 2 doses of JYNNEOS or 1 dose of ACAM2000 vaccine.* Some cases among persons who received doses of JYNNEOS vaccine are expected to occur based on vaccine effectiveness data (1,2); however, the observed proportion of cases among persons who had received 2 doses of JYNNEOS or 1 dose of ACAM2000 in this cluster was unusual. This increase in cases before large summer events scheduled nationwide and in Chicago raised concerns about possible future case increases. | | On May 9, 2023, CDPH issued a health alert,† urging clinicians to remain vigilant for mpox cases and encouraging vaccination for persons at risk for mpox.§ CDPH and CDC launched an investigation to 1) determine the cluster’s scope and etiology by evaluating patients’ commonalities, JYNNEOS¶ vaccine cold-chain management, whole genome sequencing of clinical samples, and serologic immune response after infections, and to 2) identify important risk factors for mpox exposure to guide prevention efforts. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.** |
Progress toward rubella elimination - World Health Organization South-East Asia Region, 2013-2021
Khanal S , Bahl S , Sangal L , Dhongde D , O'Connor PM , Crowcroft NS , Morales M . MMWR Morb Mortal Wkly Rep 2023 72 (25) 678-682 During 2013, the 11 countries of the World Health Organization (WHO) South-East Asia Region* (SEAR) adopted the goals of measles elimination and rubella and congenital rubella syndrome (CRS) control(†) by 2020. During 2019, SEAR countries declared a broader goal for eliminating both measles and rubella(§) by 2023 (1). Before 2013, only five SEAR countries had introduced rubella-containing vaccine (RCV). This report updates a previous report and describes progress toward rubella elimination in SEAR during 2013-2021 (2). During 2013-2021, six SEAR countries introduced RCV; all countries in the Region now use RCV in routine immunization. Routine immunization coverage with the first dose of a rubella-containing vaccine (RCV1) increased >600%, from 12% during 2013 to 86% during 2021, and an estimated 515 million persons were vaccinated via RCV supplementary immunization activities (SIAs)(¶) during 2013-2021. During this time, annual reported rubella incidence declined by 80%, from 5.5 to 1.1 cases per million population. Maldives and Sri Lanka are verified as having achieved rubella elimination; Bhutan, North Korea, and Timor-Leste have halted endemic transmission of rubella virus for >36 months. SEAR has made substantial progress toward rubella elimination; however, intensified measures are needed to achieve elimination. |
Neurological diagnoses in hospitalized COVID-19 patients during the B.1.1.529 surge
Kim CY , Sardar Z , Ayele BA , Fleck-Derderian S , Barrett CE , Sun Y , Clague M , Hurst HA , Boruah A , Zucker J , Maddox R , Sejvar J , Thakur KT . Ann Clin Transl Neurol 2023 10 (8) 1433-1441 OBJECTIVE: Emerging variants and sublineages of SARS-CoV-2 have differing disease severity, transmissibility, and immune evasion. The neurological conditions associated with the original strain of SARS-CoV-2 are well established. Our study assessed the neurological presentations specific to hospitalized patients during the B.1.1.529 (Omicron) variant surge in New York City. METHODS: A total of 178 cases with positive RT-PCR result within 6 weeks before admission, and subsequent development of select neurological conditions during the SARS-CoV-2 B.1.1.529 (Omicron) surge between December 1, 2021 and February 28, 2022, were included from 12,800 SARS-CoV-2-positive hospital admissions. Clinical data from acute hospitalizations were compared to findings of inpatient neurological cases with COVID-19 infections from the initial surge in NYC in the same hospital system. RESULTS: Compared to SARS-CoV-2 infections of the original strain, COVID-19 cases hospitalized during the Omicron surge (B.1.1.529) were associated with incidental and/or asymptomatic COVID-19 cases (96, 53.9%) and an increased incidence of pre-existing neurological and immunocompromising conditions. Encephalopathy, seizures, and stroke remained the most prevalent neurological conditions identified in hospitalized COVID-19 cases during the study period, reflecting a similar distribution of neurological presentations associated with the original strain. INTERPRETATION: In our cohort of 178 admitted SARS-CoV-2-positive patients with select neurological conditions during the Omicron B.1.1.529 surge, 54% of COVID-19 cases were considered incidental and/or asymptomatic, and the identified neurological conditions resembled those associated with the original SARS-CoV-2 strain. Further studies characterizing neurological presentation in Omicron sublineages and other variants are warranted in an ongoing COVID-19 pandemic. |
Trends in laboratory-confirmed SARS-CoV-2 reinfections and associated hospitalizations and deaths among adults aged 18 years - 18 U.S. Jurisdictions, September 2021-December 2022
Ma KC , Dorabawila V , León TM , Henry H , Johnson AG , Rosenberg E , Mansfield JA , Midgley CM , Plumb ID , Aiken J , Khanani QA , Auche S , Bayoumi NS , Bennett SA , Bernu C , Chang C , Como-Sabetti KJ , Cueto K , Cunningham S , Eddy M , Falender RA , Fleischauer A , Frank DM , Harrington P , Hoskins M , Howsare A , Ingaiza LM , Islam AS , Jensen SA , Jones JM , Kambach G , Kanishka F , Levin Y , Masarik JF 3rd , Meyer SD , Milroy L , Morris KJ , Olmstead J , Olsen NS , Omoike E , Patel K , Pettinger A , Pike MA , Reed IG , Slocum E , Sutton M , Tilakaratne BP , Vest H , Vostok J , Wang JS , Watson-Lewis L , Wienkes HN , Hagen MB , Silk BJ , Scobie HM . MMWR Morb Mortal Wkly Rep 2023 72 (25) 683-689 Although reinfections with SARS-CoV-2 have occurred in the United States with increasing frequency, U.S. epidemiologic trends in reinfections and associated severe outcomes have not been characterized. Weekly counts of SARS-CoV-2 reinfections, total infections, and associated hospitalizations and deaths reported by 18 U.S. jurisdictions during September 5, 2021-December 31, 2022, were analyzed overall, by age group, and by five periods of SARS-CoV-2 variant predominance (Delta and Omicron [BA.1, BA.2, BA.4/BA.5, and BQ.1/BQ.1.1]). Among reported reinfections, weekly trends in the median intervals between infections and frequencies of predominant variants during previous infections were calculated. As a percentage of all infections, reinfections increased substantially from the Delta (2.7%) to the Omicron BQ.1/BQ.1.1 (28.8%) periods; during the same periods, increases in the percentages of reinfections among COVID-19-associated hospitalizations (from 1.9% [Delta] to 17.0% [Omicron BQ.1/BQ.1.1]) and deaths (from 1.2% [Delta] to 12.3% [Omicron BQ.1/BQ.1.1]) were also substantial. Percentages of all COVID-19 cases, hospitalizations, and deaths that were reinfections were consistently higher across variant periods among adults aged 18-49 years compared with those among adults aged ≥50 years. The median interval between infections ranged from 269 to 411 days by week, with a steep decline at the start of the BA.4/BA.5 period, when >50% of reinfections occurred among persons previously infected during the Alpha variant period or later. To prevent severe COVID-19 outcomes, including those following reinfection, CDC recommends staying up to date with COVID-19 vaccination and receiving timely antiviral treatments, when eligible. |
Effectiveness of up-to-date COVID-19 vaccination in preventing SARS-CoV-2 infection among nursing home residents - United States, November 20, 2022-January 8, 2023
Wong E , Barbre K , Wiegand RE , Reses HE , Dubendris H , Wallace M , Dollard P , Edwards J , Soe M , Meng L , Benin A , Bell JM . MMWR Morb Mortal Wkly Rep 2023 72 (25) 690-693 Nursing home residents have been disproportionately affected by the COVID-19 pandemic; their age, comorbidities, and exposure to a congregate setting has placed them at high risk for both infection and severe COVID-19-associated outcomes, including death (1). Receipt of a primary COVID-19 mRNA vaccination series (2) and monovalent booster doses (3) have been demonstrated to be effective in reducing COVID-19-related morbidity and mortality in this population. Beginning in October 2022, the National Healthcare Safety Network (NHSN) defined up-to-date vaccination as receipt of a bivalent COVID-19 mRNA vaccine dose or completion of a primary series within the preceding 2 months.* The effectiveness of being up to date with COVID-19 vaccination among nursing home residents in preventing SARS-CoV-2 infection is not known. This analysis used NHSN nursing home COVID-19 data reported during November 20, 2022-January 8, 2023, to describe effectiveness of up-to-date vaccination status (versus not being up to date) against laboratory-confirmed SARS-CoV-2 infection among nursing home residents. Adjusting for calendar week, county-level COVID-19 incidence, county-level social vulnerability index (SVI), and facility-level percentage of staff members who were up to date, up-to-date vaccine effectiveness (VE) against infection was 31.2% (95% CI = 29.1%-33.2%). Nursing home residents should stay up to date with recommended age-appropriate COVID-19 vaccination, which now includes an additional bivalent vaccine dose for moderately or severely immunocompromised adults aged ≥65 years to increase protection against SARS-CoV-2 infection. |
Implementation of point-of-care testing and prevalence of cryptococcal antigenaemia among patients with advanced HIV disease in Mumbai, India
Acharya S , Allam RR , Karanjkar VK , Rathod D , Mahajan R , Deshpande P , Palkar A , Todmal S , Koli S , Dhande S , Dale J , Yeldandi VV , Harshana A , Agarwal R , Upadhyaya S , Nyendak M . BMJ Open 2023 13 (6) e070500 OBJECTIVES: To describe the implementation of screening for cryptococcal antigenaemia by point-of-care (POC) serum cryptococcal antigen (CrAg) lateral flow assay, measure the prevalence and factors associated with serum cryptococcal antigenaemia in the routine programmatic setting. DESIGN: Cross-sectional study. SETTING: Seventeen publicly funded antiretroviral therapy (ART) centres in Mumbai, India. PARTICIPANTS: Serum CrAg screening was offered to all adolescents (>10 years of age) and adults with advanced HIV disease (AHD) (CD4 <200 cells/mm(3) or with WHO clinical stage III/IV) regardless of symptoms of cryptococcal meningitis. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was to describe the implementation of serum CrAg screening and secondary outcome was to measure the prevalence of serum cryptococcal antigenaemia and its risk factors. RESULTS: A total of 2715 patients with AHD were tested for serum CrAg by POC assay. Of these, 25 (0.9%) had a CrAg positive result. Among CrAg-positive patients, only one had symptoms. Serum CrAg positivity was 3.6% (6/169) and 1.6% (6/520) among those presenting with CD4 <100 cells/mm(3) in the treatment naïve and treatment experienced group, respectively. On multivariable analysis, CD4 count <100 cells/mm(3) (OR: 2.3, 95% CI 1.01 to 5.3; p=0.05) and people living with HIV who were treatment naïve (OR: 2.5, 95% CI 1.04 to 6.0; p=0.04) were significantly associated with a positive serum CrAg result. Lumbar puncture was obtained in 20/25 patients within 4 days (range: 1-4 days) of positive serum CrAg result and one person was confirmed to have meningitis. All serum CrAg-positive patients who had a negative cerebrospinal fluid CrAg were offered pre-emptive therapy. CONCLUSIONS: Implementation of a POC CrAg assay was possible with existing ART centre staff. Initiation of pre-emptive therapy and management of cryptococcal antigenaemia are operationally feasible at ART centres. The Indian National AIDS Control Programme may consider reflexive CrAg screening of all AHD patients with CD4 <100 cells/mm(3). |
Assessment of suspected COVID-19 deaths in nonhealthcare settings in Cote d'Ivoire, March 11 to July 31, 2020
Ndiaye SM , Tiembre I , Amani YMR , Zamina BYG , Vroh JBB , Diarrassouba M . Health Secur 2023 21 (4) 280-285 According to hospital records, 5 months after reporting its first case of COVID-19, Cote d'Ivoire reported only 102 deaths. We conducted a community mortality survey in the 13 districts where 95% of COVID-19 cases were reported to assess COVID-19 mortality in nonhealthcare settings. To identify suspected COVID-19 deaths in communities, we used data from social and administrative institutions, such as police and fire departments, funeral homes, and places of worship, whose functions include providing services related to deaths. Our survey identified 54 (17.6%) suspected COVID-19 deaths, which is more than half of the official reported number. Our study showed that in areas with low access to healthcare and poorly functioning death notification and registration systems, community-based data sources could be used to identify suspected COVID-19 deaths outside of the health sector. They can provide early warning data on events, such as an unusual number of community deaths or diseases. |
Respiratory syncytial virus (RSV) disease and prevention products: Knowledge, attitudes, and preferences of Kenyan healthcare workers in two counties in 2021
Nyawanda BO , Opere VA , Nyiro JU , Vodicka E , Fleming JA , Baral R , Khan S , Pecenka C , Ayugi JO , Atito R , Ougo J , Bigogo G , Emukule GO , Otieno NA , Munywoki PK . Vaccines (Basel) 2023 11 (6) Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infection (LRTI) among infants under 6 months of age. Yet, in Kenya, little is known about healthcare workers' (HCWs) knowledge, attitudes, and perceptions around RSV disease and the prevention products under development. Between September and October 2021, we conducted a mixed methods cross-sectional survey to assess HCWs' knowledge, attitudes, and perceptions of RSV disease and RSV vaccinations in two counties. We enrolled HCWs delivering services directly at maternal and child health (MCH) departments in selected health facilities (frontline HCWs) and health management officers (HMOs). Of the 106 respondents, 94 (88.7%) were frontline HCWs, while 12 were HMOs. Two of the HMOs were members of the Kenya National Immunization Technical Advisory Group (KENITAG). Of the 104 non-KENITAG HCWs, only 41 (39.4%) had heard about RSV disease, and 38/41 (92.7%) felt that pregnant women should be vaccinated against RSV. Most participants would recommend a single-dose vaccine schedule (n = 62, 58.5%) for maximal adherence and compliance (n = 38/62, 61.3%), single dose/device vaccines (n = 50/86, 58.1%) to prevent wastage and contamination, and maternal vaccination through antenatal care clinics (n = 53, 50%). We found the need for increased knowledge about RSV disease and prevention among Kenyan HCWs. |
Measurable radiation levels around individuals externally contaminated by nuclear fallout
Samuels C , Ansari A , Finklea L , Hertel N . Radiat Prot Dosimetry 2023 199 (12) 1310-1323 During the early response to large-scale radioactive contamination events, people who are potentially affected need to be screened for radioactive contamination and public health staff need to triage individuals who may need immediate decontamination. This is typically done by screening individuals for external contamination using ionising radiation detection equipment. In this study, spatially and temporally dependent isotopic compositions from a simulated nuclear detonation and Monte Carlo methods were used to relate contamination activity levels to the measurable radiation levels at select distances away from an individual with whole-body contamination. Radionuclide-specific air kerma rate coefficients and Geiger-Mueller instrument response coefficients at five select distances from contaminated individuals are presented for 662 radionuclides. Temporally and spatially dependent incident-specific coefficients are presented for a hypothetical surface detonation of a 235U-fueled device. |
Public health emergency operations center operations and coordination among Thailand, Cambodia, Lao PDR, and Malaysia during the COVID-19 pandemic
Tsukayama R , Wodniak N , Hinjoy S , Bunthi C , Akarasewi P , Jiaranairungroj W , Pueyo W , Masunglong W , Kleblumjeak P , MacArthur JR , Bloss E . Glob Secur 2023 8 (1) 1-14 Public Health Emergency Operations Centers (PHEOCs) are the critical units to lead communications, information sharing, and resource mobilisation during national and international health emergencies, and are key components for maintaining global health security. This assessment sought to examine the coordination mechanisms between national and sub-national PHEOCs in Thailand, Cambodia, Lao People’s Democratic Republic, and Malaysia (TCLM countries) during the COVID-19 pandemic. Information was collected on PHEOC structures, functions, and cross-border communications in three stages: a literature review of national PHEOC and emergency preparedness capacities; questionnaire responses from stakeholders to describe PHEOC activity at the national level; and meetings with emergency response staff in five border provinces of Thailand to assess communications between sub-national PHEOCs across country borders. The findings showed that each of the countries has demonstrated a commitment to strengthening their national PHEOCs and improving cross-border communication in the face of the COVID-19 pandemic. Strong existing relationships between TCLM countries assisted in activating a coordinated pandemic response, but gaps remain in efficient data sharing, workforce capacity, and the utilisation of consistent communication platforms among countries. Lessons learned from the pandemic can be used to further strengthen countries’ preparedness for future health emergencies, in line with International Health Regulations (2005) and regional plans to build health security in the Southeast Asia region. This assessment provides TCLM countries with the opportunity to address weaknesses in national and international PHEOC capacities. It may be used alongside existing guidelines to prepare the region for a stronger response to future global and regional health emergencies. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. |
The epidemiology of HIV population viral load in twelve sub-Saharan African countries
Hladik W , Stupp P , McCracken SD , Justman J , Ndongmo C , Shang J , Dokubo EK , Gummerson E , Koui I , Bodika S , Lobognon R , Brou H , Ryan C , Brown K , Nuwagaba-Biribonwoha H , Kingwara L , Young P , Bronson M , Chege D , Malewo O , Mengistu Y , Koen F , Jahn A , Auld A , Jonnalagadda S , Radin E , Hamunime N , Williams DB , Kayirangwa E , Mugisha V , Mdodo R , Delgado S , Kirungi W , Nelson L , West C , Biraro S , Dzekedzeke K , Barradas D , Mugurungi O , Balachandra S , Kilmarx PH , Musuka G , Patel H , Parekh B , Sleeman K , Domaoal RA , Rutherford G , Motsoane T , Bissek AZ , Farahani M , Voetsch AC . PLoS One 2023 18 (6) e0275560 BACKGROUND: We examined the epidemiology and transmission potential of HIV population viral load (VL) in 12 sub-Saharan African countries. METHODS: We analyzed data from Population-based HIV Impact Assessments (PHIAs), large national household-based surveys conducted between 2015 and 2019 in Cameroon, Cote d'Ivoire, Eswatini, Kenya, Lesotho, Malawi, Namibia, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe. Blood-based biomarkers included HIV serology, recency of HIV infection, and VL. We estimated the number of people living with HIV (PLHIV) with suppressed viral load (<1,000 HIV-1 RNA copies/mL) and with unsuppressed viral load (viremic), the prevalence of unsuppressed HIV (population viremia), sex-specific HIV transmission ratios (number female incident HIV-1 infections/number unsuppressed male PLHIV per 100 persons-years [PY] and vice versa) and examined correlations between a variety of VL metrics and incident HIV. Country sample sizes ranged from 10,016 (Eswatini) to 30,637 (Rwanda); estimates were weighted and restricted to participants 15 years and older. RESULTS: The proportion of female PLHIV with viral suppression was higher than that among males in all countries, however, the number of unsuppressed females outnumbered that of unsuppressed males in all countries due to higher overall female HIV prevalence, with ratios ranging from 1.08 to 2.10 (median: 1.43). The spatial distribution of HIV seroprevalence, viremia prevalence, and number of unsuppressed adults often differed substantially within the same countries. The 1% and 5% of PLHIV with the highest VL on average accounted for 34% and 66%, respectively, of countries' total VL. HIV transmission ratios varied widely across countries and were higher for male-to-female (range: 2.3-28.3/100 PY) than for female-to-male transmission (range: 1.5-10.6/100 PY). In all countries mean log10 VL among unsuppressed males was higher than that among females. Correlations between VL measures and incident HIV varied, were weaker for VL metrics among females compared to males and were strongest for the number of unsuppressed PLHIV per 100 HIV-negative adults (R2 = 0.92). CONCLUSIONS: Despite higher proportions of viral suppression, female unsuppressed PLHIV outnumbered males in all countries examined. Unsuppressed male PLHIV have consistently higher VL and a higher risk of transmitting HIV than females. Just 5% of PLHIV account for almost two-thirds of countries' total VL. Population-level VL metrics help monitor the epidemic and highlight key programmatic gaps in these African countries. |
SARS-CoV-2 case detection using community event-based surveillance system-February-September 2020: lessons learned from Senegal
Seck O , Loko Roka J , Ndiaye M , Namageyo-Funa A , Abdoulaye S , Mangane A , Dieye NL , Ndoye B , Diop B , Ting J , Pasi O . BMJ Glob Health 2023 8 (6) The COVID-19 pandemic necessitated the rapid development and implementation of effective surveillance systems to detect and respond to the outbreak in Senegal. In this documentation, we describe the design and implementation of the Community Event-Based Surveillance (CEBS) system in Senegal to strengthen the existing Integrated Disease Surveillance and Response system. The CEBS system used a hotline and toll-free number to collect and triage COVID-19-related calls from the community. Data from the CEBS system were integrated with the national system for further investigation and laboratory testing. From February to September 2020, a total of 10 760 calls were received by the CEBS system, with 10 751 calls related to COVID-19. The majority of calls came from the Dakar region, which was the epicentre of the outbreak in Senegal. Of the COVID-19 calls, 50.2% were validated and referred to health districts for further investigation, and 25% of validated calls were laboratory-confirmed cases of SARS-CoV-2. The implementation of the CEBS system allowed for timely detection and response to potential COVID-19 cases, contributing to the overall surveillance efforts in the country. Lessons learned from this experience include the importance of decentralised CEBS, population sensitisation on hotlines and toll-free usage, and the potential role of Community Health Workers in triaging alerts that needs further analysis. This experience highlights the contribution of a CEBS system in Senegal and provides insights into the design and operation of such a system. The findings can inform other countries in strengthening their surveillance systems and response strategies. |
Evaluation of Ortho VITROS and Roche Elecsys S and NC immunoassays for SARS-CoV-2 serosurveillance applications
Sulaeman H , Grebe E , Dave H , McCann L , Di Germanio C , Sanghavi A , Sclar V , Bougie DW , Chatelain G , Biggerstaff BJ , Jones JM , Thornburg NJ , Kleinman S , Stone M , Busch MP . Microbiol Spectr 2023 11 (4) e0323422 SARS-CoV-2 seroprevalence studies are instrumental in monitoring epidemic activity and require well-characterized, high-throughput assays, and appropriate testing algorithms. The U.S. Nationwide Blood Donor Seroprevalence Study performed monthly cross-sectional serological testing from July 2020 to December 2021, implementing evolving testing algorithms in response to changes in pandemic activity. With high vaccine uptake, anti-Spike (S) reactivity rates reached >80% by May 2021, and the study pivoted from reflex Roche anti-nucleocapsid (NC) testing of Ortho S-reactive specimens to parallel Ortho S/NC testing. We evaluated the performance of the Ortho NC assay as a replacement for the Roche NC assay and compared performance of parallel S/NC testing on both platforms. Qualitative and quantitative agreement of Ortho NC with Roche NC assays was evaluated on preselected S/NC concordant and discordant specimens. All 190 Ortho S+/Roche NC+ specimens were reactive on the Ortho NC assay; 34% of 367 Ortho S+/Roche NC- specimens collected prior to vaccine availability and 43% of 37 Ortho S-/Roche NC+ specimens were reactive on the Ortho NC assay. Performance of parallel S/NC testing using Ortho and Roche platforms was evaluated on 200 specimens collected in 2019 and 3,903 study specimens collected in 2021. All 200 pre-COVID-19 specimens tested negative on the four assays. Cross-platform agreement between Roche and Ortho platforms was 96.4% (3,769/3,903); most discordant results had reactivity close to the cutoffs on the alternate assays. These findings, and higher efficiency and throughput, support the use of parallel S/NC testing on either Roche or Ortho platforms for large serosurveillance studies. IMPORTANCE Seroprevalence studies like the U.S. Nationwide Blood Donor Seroprevalence Study (NBDS) have been critical in monitoring SARS-CoV-2 epidemic activity. These studies rely on serological assays to detect antibodies indicating prior infection. It is critical that the assays and testing algorithms used in seroprevalence studies have adequate performance (high sensitivity, high specificity, ability to discriminate vaccine-induced and infection-induced antibodies, etc.), as well as appropriate characteristics to support large-scale studies, such as high throughput and low cost. In this study we evaluated the performance of Ortho's anti-nucleocapsid assay as a replacement for the Roche anti-nucleocapsid assay and compared performance of parallel anti-spike and anti-nucleocapsid testing on both platforms. These data demonstrate similar performance of the Ortho and Roche anti-nucleocapsid assays and that parallel anti-spike and anti-nucleocapsid testing on either platform could be used for serosurveillance applications. |
Epidemiology of SARS-CoV-2 transmission and superspreading in Salt Lake County, Utah, March-May 2020
Walker J , Tran T , Lappe B , Gastanaduy P , Paul P , Kracalik IT , Fields VL , Lopez A , Schwartz A , Lewis NM , Tate JE , Kirking HL , Hall AJ , Pevzner E , Khong H , Smithee M , Lowry J , Dunn A , Kiphibane T , Tran CH . PLoS One 2023 18 (6) e0275125 BACKGROUND: Understanding the drivers of SARS-CoV-2 transmission can inform the development of interventions. We evaluated transmission identified by contact tracing investigations between March-May 2020 in Salt Lake County, Utah, to quantify the impact of this intervention and identify risk factors for transmission. METHODS: RT-PCR positive and untested symptomatic contacts were classified as confirmed and probable secondary case-patients, respectively. We compared the number of case-patients and close contacts generated by different groups, and used logistic regression to evaluate factors associated with transmission. RESULTS: Data were collected on 184 index case-patients and up to six generations of contacts. Of 1,499 close contacts, 374 (25%) were classified as secondary case-patients. Decreased transmission odds were observed for contacts aged <18 years (OR = 0.55 [95% CI: 0.38-0.79]), versus 18-44 years, and for workplace (OR = 0.36 [95% CI: 0.23-0.55]) and social (OR = 0.44 [95% CI: 0.28-0.66]) contacts, versus household contacts. Higher transmission odds were observed for case-patient's spouses than other household contacts (OR = 2.25 [95% CI: 1.52-3.35]). Compared to index case-patients identified in the community, secondary case-patients identified through contract-tracing generated significantly fewer close contacts and secondary case-patients of their own. Transmission was heterogeneous, with 41% of index case-patients generating 81% of directly-linked secondary case-patients. CONCLUSIONS: Given sufficient resources and complementary public health measures, contact tracing can contain known chains of SARS-CoV-2 transmission. Transmission is associated with age and exposure setting, and can be highly variable, with a few infections generating a disproportionately high share of onward transmission. |
Travel-related diagnoses among U.S. nonmigrant travelers or migrants presenting to U.S. GeoSentinel Sites - GeoSentinel Network, 2012-2021
Brown AB , Miller C , Hamer DH , Kozarsky P , Libman M , Huits R , Rizwan A , Emetulu H , Waggoner J , Chen LH , Leung DT , Bourque D , Connor BA , Licitra C , Angelo KM . MMWR Surveill Summ 2023 72 (7) 1-22 PROBLEM/CONDITION: During 2012-2021, the volume of international travel reached record highs and lows. This period also was marked by the emergence or large outbreaks of multiple infectious diseases (e.g., Zika virus, yellow fever, and COVID-19). Over time, the growing ease and increased frequency of travel has resulted in the unprecedented global spread of infectious diseases. Detecting infectious diseases and other diagnoses among travelers can serve as sentinel surveillance for new or emerging pathogens and provide information to improve case identification, clinical management, and public health prevention and response. REPORTING PERIOD: 2012-2021. DESCRIPTION OF SYSTEM: Established in 1995, the GeoSentinel Network (GeoSentinel), a collaboration between CDC and the International Society of Travel Medicine, is a global, clinical-care-based surveillance and research network of travel and tropical medicine sites that monitors infectious diseases and other adverse health events that affect international travelers. GeoSentinel comprises 71 sites in 29 countries where clinicians diagnose illnesses and collect demographic, clinical, and travel-related information about diseases and illnesses acquired during travel using a standardized report form. Data are collected electronically via a secure CDC database, and daily reports are generated for assistance in detecting sentinel events (i.e., unusual patterns or clusters of disease). GeoSentinel sites collaborate to report disease or population-specific findings through retrospective database analyses and the collection of supplemental data to fill specific knowledge gaps. GeoSentinel also serves as a communications network by using internal notifications, ProMed alerts, and peer-reviewed publications to alert clinicians and public health professionals about global outbreaks and events that might affect travelers. This report summarizes data from 20 U.S. GeoSentinel sites and reports on the detection of three worldwide events that demonstrate GeoSentinel's notification capability. RESULTS: During 2012-2021, data were collected by all GeoSentinel sites on approximately 200,000 patients who had approximately 244,000 confirmed or probable travel-related diagnoses. Twenty GeoSentinel sites from the United States contributed records during the 10-year surveillance period, submitting data on 18,336 patients, of which 17,389 lived in the United States and were evaluated by a clinician at a U.S. site after travel. Of those patients, 7,530 (43.3%) were recent migrants to the United States, and 9,859 (56.7%) were returning nonmigrant travelers.Among the recent migrants to the United States, the median age was 28.5 years (range = <19 years to 93 years); 47.3% were female, and 6.0% were U.S. citizens. A majority (89.8%) were seen as outpatients, and among 4,672 migrants with information available, 4,148 (88.8%) did not receive pretravel health information. Of 13,986 diagnoses among migrants, the most frequent were vitamin D deficiency (20.2%), Blastocystis (10.9%), and latent tuberculosis (10.3%). Malaria was diagnosed in 54 (<1%) migrants. Of the 26 migrants diagnosed with malaria for whom pretravel information was known, 88.5% did not receive pretravel health information. Before November 16, 2018, patients' reasons for travel, exposure country, and exposure region were not linked to an individual diagnosis. Thus, results of these data from January 1, 2012, to November 15, 2018 (early period), and from November 16, 2018, to December 31, 2021 (later period), are reported separately. During the early and later periods, the most frequent regions of exposure were Sub-Saharan Africa (22.7% and 26.2%, respectively), the Caribbean (21.3% and 8.4%, respectively), Central America (13.4% and 27.6%, respectively), and South East Asia (13.1% and 16.9%, respectively). Migrants with diagnosed malaria were most frequently exposed in Sub-Saharan Africa (89.3% and 100%, respectively).Among nonmigrant travelers returning to the United States, the median age was 37 years (range = <19 years to 96 years); 55.7% were female, 75.3% were born in the United States, and 89.4% were U.S. citizens. A majority (90.6%) were seen as outpatients, and of 8,967 nonmigrant travelers with available information, 5,878 (65.6%) did not receive pretravel health information. Of 11,987 diagnoses, the most frequent were related to the gastrointestinal system (5,173; 43.2%). The most frequent diagnoses among nonmigrant travelers were acute diarrhea (16.9%), viral syndrome (4.9%), and irritable bowel syndrome (4.1%).Malaria was diagnosed in 421 (3.5%) nonmigrant travelers. During the early (January 1, 2012, to November 15, 2018) and later (November 16, 2018, to December 31, 2021) periods, the most frequent reasons for travel among nonmigrant travelers were tourism (44.8% and 53.6%, respectively), travelers visiting friends and relatives (VFRs) (22.0% and 21.4%, respectively), business (13.4% and 12.3%, respectively), and missionary or humanitarian aid (13.1% and 6.2%, respectively). The most frequent regions of exposure for any diagnosis among nonmigrant travelers during the early and later period were Central America (19.2% and 17.3%, respectively), Sub-Saharan Africa (17.7% and 25.5%, respectively), the Caribbean (13.0% and 10.9%, respectively), and South East Asia (10.4% and 11.2%, respectively).Nonmigrant travelers who had malaria diagnosed were most frequently exposed in Sub-Saharan Africa (88.6% and 95.9% during the early and later period, respectively) and VFRs (70.3% and 57.9%, respectively). Among VFRs with malaria, a majority did not receive pretravel health information (70.2% and 83.3%, respectively) or take malaria chemoprophylaxis (88.3% and 100%, respectively). INTERPRETATION: Among ill U.S. travelers evaluated at U.S. GeoSentinel sites after travel, the majority were nonmigrant travelers who most frequently received a gastrointestinal disease diagnosis, implying that persons from the United States traveling internationally might be exposed to contaminated food and water. Migrants most frequently received diagnoses of conditions such as vitamin D deficiency and latent tuberculosis, which might result from adverse circumstances before and during migration (e.g., malnutrition and food insecurity, limited access to adequate sanitation and hygiene, and crowded housing,). Malaria was diagnosed in both migrants and nonmigrant travelers, and only a limited number reported taking malaria chemoprophylaxis, which might be attributed to both barriers to acquiring pretravel health care (especially for VFRs) and lack of prevention practices (e.g., insect repellant use) during travel. The number of ill travelers evaluated by U.S. GeoSentinel sites after travel decreased in 2020 and 2021 compared with previous years because of the COVID-19 pandemic and associated travel restrictions. GeoSentinel detected limited cases of COVID-19 and did not detect any sentinel cases early in the pandemic because of the lack of global diagnostic testing capacity. PUBLIC HEALTH ACTION: The findings in this report describe the scope of health-related conditions that migrants and returning nonmigrant travelers to the United States acquired, illustrating risk for acquiring illnesses during travel. In addition, certain travelers do not seek pretravel health care, even when traveling to areas in which high-risk, preventable diseases are endemic. Health care professionals can aid international travelers by providing evaluations and destination-specific advice.Health care professionals should both foster trust and enhance pretravel prevention messaging for VFRs, a group known to have a higher incidence of serious diseases after travel (e.g., malaria and enteric fever). Health care professionals should continue to advocate for medical care in underserved populations (e.g., VFRs and migrants) to prevent disease progression, reactivation, and potential spread to and within vulnerable populations. Because both travel and infectious diseases evolve, public health professionals should explore ways to enhance the detection of emerging diseases that might not be captured by current surveillance systems that are not site based. |
Building evidence for principles to guide the development of products for adults with intellectual and developmental disabilities and extreme low literacy-a product development tool
Squiers L , Lynch MM , Holt SL , Rivell A , Walker K , Robison S , Mitchell EW , Flores AL . Healthcare (Basel) 2023 11 (12) This article presented a new product development tool for adults with intellectual and developmental disabilities (IDD) developed by the Centers for Disease Control and Prevention (CDC). People with IDD who also have extreme low literacy (ELL) have unique communication needs; public health communicators often face challenges developing effective communication materials for this audience. To support CDC communication specialists with the development of communication products for adults with IDD/ELL, CDC, with its partners RTI International and CommunicateHealth, created a product development tool for this audience through literature review, expert input, and interviews with adults with IDD/ELL and caregivers of adults with IDD/ELL. To build evidence around the principles described in the tool, RTI conducted interviewer-administered surveys with 100 caregivers who support people with IDD/ELL. During the interviews, we presented caregivers with stimuli (portions of a communication product) that either did or did not apply a single principle and asked which would be easier for the person they support to understand. Across all 14 principles tested, the caregiver respondents indicated that the principle-based version would be easier for the person they support to understand compared with the non-principle-based version(s). These findings provide additional evidence to support the principles included in CDC's Tool for Developing Products for People with IDD/ELL. |
Investigation of barriers to county-level seasonal influenza vaccine uptake among Medicare beneficiaries in the United States 20182019 seasonal influenza season
Cho BH , O'Halloran A , Pike J . Vaccine X 2023 14 Introduction: As most public health decisions are made at the local level, public health interventions implemented at the local level may vary by their own unique circumstances, such as demographic composition or the availability of resources. Our objective is to estimate and characterize county-level flu vaccine uptakes among Medicare-covered adults aged 65 years. Methods: The flu vaccine uptake was estimated from Medicare Fee-for-Service claims for those who continuously enrolled during the 20182019 flu season. County-level characteristics were obtained from Centers for Disease Control and Prevention (CDC)s Minority Health Social Vulnerability Index and Behavioral Risk Factor Surveillance System data as well as Health Resources and Services Administration's Area Health Resources File. A generalized linear regression was used to assess the relationship between selected characteristics and uptake. Results: A total of 30,265,047 beneficiaries from 3,125 counties were identified, of which 53% received a flu vaccination during the 20182019 flu season. For 3,006 counties with more than 500 Medicare beneficiaries, the mean county-level uptake was estimated to be 47.7%. The mean uptakes in counties designated as a health professional shortage area (HPSA) (42.6% and 48.4%, respectively), were lower than the uptakes for the non-HPSA counties (53.8%). Metro counties (53.2%) showed higher uptakes than non-metro counties (44.2%). Regression analysis results showed that the percent of working adults aged 1864 years and female were positively associated, while the percent of Black and Hispanic adults were negatively associated. Proportions of persons with limited proficiency of English, college education or above, single parent families, multi-unit housing, and living in group quarters were positively associated and significant. Conclusions: The results confirmed that county-level flu vaccine uptakes are low, reflect persistent racial disparities in vaccine uptake, and that Medicare populations in medically underserved communities with lower socioeconomic status need more attention in improving flu vaccine uptake. 2023 |
Investigation of barriers to county-level seasonal influenza vaccine uptake among Medicare beneficiaries in the United States – 2018–2019 seasonal influenza season
Cho BH , O'Halloran A , Pike J . Vaccine X 2023 14 100326 Introduction: As most public health decisions are made at the local level, public health interventions implemented at the local level may vary by their own unique circumstances, such as demographic composition or the availability of resources. Our objective is to estimate and characterize county-level flu vaccine uptakes among Medicare-covered adults aged ≥65 years. Methods: The flu vaccine uptake was estimated from Medicare Fee-for-Service claims for those who continuously enrolled during the 2018–2019 flu season. County-level characteristics were obtained from Centers for Disease Control and Prevention (CDC)’s Minority Health Social Vulnerability Index and Behavioral Risk Factor Surveillance System data as well as Health Resources and Services Administration's Area Health Resources File. A generalized linear regression was used to assess the relationship between selected characteristics and uptake. Results: A total of 30,265,047 beneficiaries from 3,125 counties were identified, of which 53% received a flu vaccination during the 2018–2019 flu season. For 3,006 counties with more than 500 Medicare beneficiaries, the mean county-level uptake was estimated to be 47.7%. The mean uptakes in counties designated as a health professional shortage area (HPSA) (42.6% and 48.4%, respectively), were lower than the uptakes for the non-HPSA counties (53.8%). Metro counties (53.2%) showed higher uptakes than non-metro counties (44.2%). Regression analysis results showed that the percent of working adults aged 18–64 years and female were positively associated, while the percent of Black and Hispanic adults were negatively associated. Proportions of persons with limited proficiency of English, college education or above, single parent families, multi-unit housing, and living in group quarters were positively associated and significant. Conclusions: The results confirmed that county-level flu vaccine uptakes are low, reflect persistent racial disparities in vaccine uptake, and that Medicare populations in medically underserved communities with lower socioeconomic status need more attention in improving flu vaccine uptake. © 2023 |
Respiratory syncytial virus and other respiratory virus infections in residents of homeless shelters - King County, Washington, 2019-2021
McCulloch DJ , Rogers JH , Wang Y , Chow EJ , Link AC , Wolf CR , Uyeki TM , Rolfes MA , Mosites E , Sereewit J , Duchin JS , Sugg NK , Greninger AL , Boeckh MJ , Englund JA , Shendure J , Hughes JP , Starita LM , Roychoudhury P , Chu HY . Influenza Other Respir Viruses 2023 17 (6) e13166 Respiratory syncytial virus (RSV) causes disproportionate morbidity and mortality in vulnerable populations. We tested residents of homeless shelters in Seattle, Washington for RSV in a repeated cross-sectional study as part of community surveillance for respiratory viruses. Of 15 364 specimens tested, 35 had RSV detected, compared to 77 with influenza. The most common symptoms for both RSV and influenza were cough and rhinorrhea. Many individuals with RSV (39%) and influenza (58%) reported that their illness significantly impacted their ability to perform their regular activities. RSV and influenza demonstrated similar clinical presentations and burden of illness in vulnerable populations living in congregate settings. |
Asthma disparities among U.S. children and adults
Pate CA , Qin X , Johnson C , Zahran HS . J Asthma 2023 60 (12) 1-16 Objective: To assess factors that are associated with asthma prevalence and asthma attacks among children (0-17 years) and adults (18 years and over) in the United States of America.Methods: The 2019-2021 National Health Interview Survey data were analyzed using multivariable logistic regression models to determine associations between health outcomes (i.e., current asthma and asthma attacks) and demographic and socioeconomic factors. Each health outcome was regressed over each characteristic variable, adjusting for age, sex, and race/ethnicity for adults and sex and race/ethnicity for children.Results: Asthma was more common among children who were male, blacks, parental education less than bachelor's, or had public health insurance, and among adults who had less than a bachelor's degree, do not own a home, or not in the workforce. Persons in families facing difficulty paying medical bills were more likely to have current asthma (children: aPR = 1.62[1.40-1.88]; adults: aPR = 1.67[1.55-1.81]) and asthma attacks (children: aPR = 1.34[1.15-1.56]; adults: aPR = 1.31[1.20-1.43]). Persons with family income <100% federal poverty threshold (FPT) (children: aPR = 1.39[1.17-1.64]; adults: aPR = 1.64[1.50-1.80]) or adults 100%-199% FPT (aPR = 1.28[1.19-1.39]) were more likely to have current asthma. Children and adults with family income <100% FPT and adults 100%-199% FPT were also more likely to have asthma attacks. Having asthma attacks was common among adults not in the workforce as well (aPR = 1.17[1.07-1.27]).Conclusions: Asthma affects certain groups disproportionately. The findings of this paper suggesting asthma disparities continue to persist, may increase public health programs awareness to better deliver effective and evidence-based interventions. |
Systematic contact investigation: an essential infection prevention skill to prevent tuberculosis transmission in healthcare settings
Adams T , Miller K , Law M , Pitcher E , Chinpar B , White K , Deutsch-Feldman M , Li R , Filardo TD , Romieu-Hernandez AC , Schwartz NG , Haddad MB , Glowicz J . Am J Infect Control 2023 A systematic approach to contact investigations has long been a cornerstone of interrupting transmission of tuberculosis (TB) in community settings. This paper describes the implementation of a systematic 10-step contact investigation within an acute care setting during a multistate outbreak of healthcare-associated TB. A systematic approach to contact investigations might have applicability to the prevention of other communicable infections within healthcare settings. |
Effectiveness of four vaccines in preventing SARS-CoV-2 infection in Almaty, Kazakhstan in 2021: retrospective population-based cohort study
Nabirova D , Horth R , Smagul M , Nukenova G , Yesmagambetova A , Singer D , Henderson A , Tsoy A . Front Public Health 2023 11 1205159 BACKGROUND: In February 2021 Kazakhstan began offering COVID-19 vaccines to adults. Breakthrough SARS-CoV-2 infections raised concerns about real-world vaccine effectiveness. We aimed to evaluate effectiveness of four vaccines against SARS-CoV-2 infection. METHODS: We conducted a retrospective cohort analysis among adults in Almaty using aggregated vaccination data and individual-level breakthrough COVID-19 cases (≥14 days from 2nd dose) using national surveillance data. We ran time-adjusted Cox-proportional-hazards model with sensitivity analysis accounting for varying entry into vaccinated cohort to assess vaccine effectiveness for each vaccine (measured as 1-adjusted hazard ratios) using the unvaccinated population as reference (N = 565,390). We separately calculated daily cumulative hazards for COVID-19 breakthrough among vaccinated persons by age and vaccination month. RESULTS: From February 22 to September 1, 2021, in Almaty, 747,558 (57%) adults were fully vaccinated (received 2 doses), and 108,324 COVID-19 cases (11,472 breakthrough) were registered. Vaccine effectiveness against infection was 79% [sensitivity estimates (SE): 74%-82%] for QazVac, 77% (SE: 71%-81%) for Sputnik V, 71% (SE: 69%-72%) for Hayat-Vax, and 70% (SE: 65%-72%) for CoronaVac. Among vaccinated persons, the 90-day follow-up cumulative hazard for breakthrough infection was 2.2%. Cumulative hazard was 2.9% among people aged ≥60 years versus 1.9% among persons aged 18-39 years (p < 0.001), and 1.2% for people vaccinated in February-May versus 3.3% in June-August (p < 0.001). CONCLUSION: Our analysis demonstrates high effectiveness of COVID-19 vaccines against infection in Almaty similar to other observational studies. Higher cumulative hazard of breakthrough among people ≥60 years of age and during variant surges warrants targeted booster vaccination campaigns. |
Two-year duration of immunity of inactivated poliovirus vaccine: A follow-up study in Pakistan in 2020
Saleem AF , Parkar S , Zehra SM , Kazi Z , Pethani A , Zhang Y , Mainou BA , Cavestany RL , Macklin G , Jeyaseelan V , Mach O . J Infect Dis 2023 This was a follow-up study conducted in 2020 assessing changes in levels of type 2 poliovirus-neutralizing antibodies two years post-immunization in children who received inactivated poliovirus vaccine (IPV) in Karachi, Pakistan. Unexpectedly, the findings revealed an increase in seroprevalence of type 2 antibodies from 73.1% to 81.6% one and two years after IPV, respectively. The increase in type 2 immunity could result from the intensive transmission of circulating vaccine-derived poliovirus type 2 (cVDPV2) in Karachi during the second year of IPV administration. This study suggests that the cVDPV2 outbreak detected in Pakistan infected large proportions of children in Karachi. Clinical Trial Registration NCT03286803. |
Community barriers, enablers, and normative embedding of second year of life vaccination in Ghana: A qualitative study
Wolff B , Aborigo RA , Dalaba M , Opare JKL , Conklin L , Bonsu G , Amponsa-Achiano K . Glob Health Sci Pract 2023 11 (3) INTRODUCTION: Coverage rates for second year of life (2YL) vaccination still lag behind infant vaccination in most settings. We conducted a qualitative baseline study of community barriers and enablers to acceptance of 2YL vaccines in Ghana 4 years after introducing the second dose of the measles-containing vaccine. METHODS: We conducted 26 focus group discussions in 2016 with men and women caregivers from mixed urban, peri-urban, and rural areas, as well as pastoralists, using semistructured topic guides based on the Health Belief Model theory. We conducted a thematic analysis of the discussion using NVivo software. We use Normalization Process Theory to contextualize results as a snapshot of a dynamic process of community adaptation to change to a well-established routine immunization schedule following 2YL introduction. RESULTS: Routine immunization for infants enjoys resilient demand, grounded in strong community norms despite surprisingly low levels of vaccine literacy. Despite best practices like integration with the established 18-month "weighing visit," demand for 2YL vaccination is still conditional on individual awareness and competition for limited maternal time, household resources, and other health concerns. An embedded norm that children should be fully vaccinated by 12 months originally sustained Expanded Programme for Immunization goals but now discouraged some caregivers from seeking vaccines for children perceived to be "too old" to vaccinate. Caregivers cited greater costs and inconvenience of taking older, heavier children in for vaccination and anticipated criticism from both community members and health care providers for coming "too late." CONCLUSION: Closing the 2YL vaccination coverage gap will ultimately require modifying embedded norms among caregivers and health care providers alike. Time is necessary but not sufficient to reach this goal. Progress can be accelerated by increasing the level of community and institutional engagement and adapting services where possible to minimize added costs to caregivers of vaccinating older children. |
The Biosafety Research Road Map: The search for evidence to support practices in human and veterinary laboratories
Blacksell SD , Dhawan S , Kusumoto M , Le KK , Summermatter K , O'Keefe J , Kozlovac J , Almuhairi SS , Sendow I , Scheel CM , Ahumibe A , Masuku ZM , Bennett AM , Kojima K , Harper DR , Hamilton K . Appl Biosaf 2023 28 (2) 64-71 INTRODUCTION: Lack of evidence-based information regarding potential biological risks can result in inappropriate or excessive biosafety and biosecurity risk-reduction strategies. This can cause unnecessary damage and loss to the physical facilities, physical and psychological well-being of laboratory staff, and community trust. A technical working group from the World Organization for Animal Health (WOAH, formerly OIE), World Health Organization (WHO), and Chatham House collaborated on the Biosafety Research Roadmap (BRM) project. The goal of the BRM is the sustainable implementation of evidence-based biorisk management of laboratory activities, particularly in low-resource settings, and the identification of gaps in the current biosafety and biosecurity knowledge base. METHODS: A literature search was conducted for the basis of laboratory design and practices for four selected high-priority subgroups of pathogenic agents. Potential gaps in biosafety were focused on five main sections, including the route of inoculation/modes of transmission, infectious dose, laboratory-acquired infections, containment releases, and disinfection and decontamination strategies. Categories representing miscellaneous, respiratory, bioterrorism/zoonotic, and viral hemorrhagic fever pathogens were created within each group were selected for review. RESULTS: Information sheets on the pathogens were developed. Critical gaps in the evidence base for safe sustainable biorisk management were identified. CONCLUSION: The gap analysis identified areas of applied biosafety research required to support the safety, and the sustainability, of global research programs. Improving the data available for biorisk management decisions for research with high-priority pathogens will contribute significantly to the improvement and development of appropriate and necessary biosafety, biocontainment and biosecurity strategies for each agent. |
The Biosafety Research Road Map: The search for evidence to support practices in the laboratory-Bacillus anthracis and Brucella melitensis
Blacksell SD , Dhawan S , Kusumoto M , Le KK , Summermatter K , O'Keefe J , Kozlovac J , Almuhairi SS , Sendow I , Scheel CM , Ahumibe A , Masuku ZM , Bennett AM , Kojima K , Harper DR , Hamilton K . Appl Biosaf 2023 28 (2) 72-86 INTRODUCTION: Brucella melitensis and Bacillus anthracis are zoonoses transmitted from animals and animal products. Scientific information is provided in this article to support biosafety precautions necessary to protect laboratory workers and individuals who are potentially exposed to these pathogens in the workplace or other settings, and gaps in information are also reported. There is a lack of information on the appropriate effective concentration for many chemical disinfectants for this agent. Controversies related to B. anthracis include infectious dose for skin and gastrointestinal infections, proper use of personal protective equipment (PPE) during the slaughter of infected animals, and handling of contaminated materials. B. melitensis is reported to have the highest number of laboratory-acquired infections (LAIs) to date in laboratory workers. METHODS: A literature search was conducted to identify potential gaps in biosafety and focused on five main sections including the route of inoculation/modes of transmission, infectious dose, LAIs, containment releases, and disinfection and decontamination strategies. RESULTS: Scientific literature currently lacks information on the effective concentration of many chemical disinfectants for this agent and in the variety of matrices where it may be found. Controversies related to B. anthracis include infectious dose for skin and gastrointestinal infections, proper use of PPE during the slaughter of infected animals, and handling contaminated materials. DISCUSSION: Clarified vulnerabilities based on specific scientific evidence will contribute to the prevention of unwanted and unpredictable infections, improving the biosafety processes and procedures for laboratory staff and other professionals such as veterinarians, individuals associated with the agricultural industry, and those working with susceptible wildlife species. |
Multiplexing iduronate-2-sulphatase (MPS-II) into a 7-plex lysosomal storage disorder MS/MS assay using cold-induced phase separation
Courtney E , Pickens CA , Cuthbert C , Petritis K . Int J Neonatal Screen 2023 9 (2) Mucopolysaccharidosis type II (MPS-II, Hunter syndrome, OMIM:30990) is a lysosomal storage disorder (LSD) that results in iduronate 2-sulphatase (I2S) enzyme deficiency. MPS-II was added to the Recommended Uniform Screening Panel (RUSP) in August 2022; thus, there is an increased demand for multiplexing I2S into existing LSD screening assays. After incubation with LSD synthetic substrates, extracts are cleaned using liquid-liquid extraction with ethyl acetate or protein precipitation using acetonitrile (ACN). We investigated cold-induced water ACN phase separation (CIPS) to improve the combination of 6-plex and I2S extracts to create a 7-plex assay, and compared it to room temperature ACN and ethyl acetate liquid-liquid extraction. The extracts were dried and resuspended in the mobile phase, and then analyzed using an optimized 1.9 min injection-to-injection liquid chromatography method coupled with tandem mass spectrometry (LC-MS/MS). The combination of ACN and CIPS improved the detection for I2S products without significant detriment to other analytes, which is attributable to a more complete coagulation and separation of heme, proteins, and extracted residual salts. Using CIPS for sample cleanup in dried blood spots (DBS) appears to represent a promising and straightforward way of achieving cleaner sample extracts in a new 7-plex LSD screening panel. |
Late remdesivir treatment initiation partially protects African green monkeys from lethal Nipah virus infection
de Wit E , Williamson BN , Feldmann F , Goldin K , Lo MK , Okumura A , Lovaglio J , Bunyan E , Porter DP , Cihlar T , Saturday G , Spiropoulou CF , Feldmann H . Antiviral Res 2023 216 105658 Remdesivir is a nucleotide prodrug with preclinical efficacy against lethal Nipah virus infection in African green monkeys when administered 1 day post inoculation (dpi) (Lo et al., 2019). Here, we determined whether remdesivir treatment was still effective when treatment administration initiation was delayed until 3 dpi. Three groups of six African green monkeys were inoculated with a lethal dose of Nipah virus, genotype Bangladesh. On 3 dpi, one group received a loading dose of 10 mg/kg remdesivir followed by daily dosing with 5 mg/kg for 11 days, one group received 10 mg/kg on 12 consecutive days, and the remaining group received an equivalent volume of vehicle solution. Remdesivir treatment initiation on 3 dpi provided partial protection from severe Nipah virus disease that was dose dependent, with 67% of animals in the high dose group surviving the challenge. However, remdesivir treatment did not prevent clinical disease, and surviving animals showed histologic lesions in the brain. Thus, early administration seems critical for effective remdesivir treatment during Nipah virus infection. |
Pathogenicity of Lloviu and Bombali viruses in IFNAR-/- mice
Fletcher P , Feldmann F , Takada A , Crossland NA , Hume AJ , Albariño C , Kemenesi G , Feldmann H , Mühlberger E , Marzi A . J Infect Dis 2023 228 S548-S553 Type I interferon receptor knockout (IFNAR-/-) mice are not able to generate a complete innate immune response, therefore, these mice are often considered to assess the pathogenicity of emerging viruses. We sought to assess the pathogenicity of emerging wildtype filovirus infections in IFNAR-/- mice since filovirus models using immunocompetent mice require a mouse-adapted viral strain. We infected IFNAR-/- mice with a low or high dose of Lloviu virus (LLOV) or Bombali virus (BOMV) by the intranasal (i.n.) or intraperitoneal (i.p.) route and compared virus loads at early and late timepoints after infection. No signs of disease and no viral RNA were detected after i.n. infection regardless of LLOV dose. In contrast, i.p. infections resulted in increased viral loads in the high-dose LLOV and BOMV groups at the early timepoint. The low-dose LLOV and BOMV groups achieved higher viral loads at the late timepoint. However, there was 100% survival in all groups and no signs of disease. In conclusion, our results indicate a limited value of the IFNAR-/- mouse model for investigation of the pathogenicity of LLOV and BOMV. |
Characterization of reference materials for CYP3A4 and CYP3A5: A genetic testing reference material coordination program collaborative project
Gaedigk A , Boone EC , Turner AJ , van Schaik RHN , Chernova D , Wang WY , Broeckel U , Granfield CA , Hodge JC , Ly RC , Lynnes TC , Mitchell MW , Moyer AM , Oliva J , Kalman LV . J Mol Diagn 2023 25 (9) 655-664 Pharmacogenetic testing for CYP3A4 is increasingly provided by clinical and research laboratories; however, only a limited number of quality control and reference materials are currently available for many of the CYP3A4 variants included in clinical tests. To address this need, the Division of Laboratory Systems, CDC-based Genetic Testing Reference Material Coordination Program, in collaboration with members of the pharmacogenetic testing and research communities and the Coriell Institute for Medical Research, has characterized 30 DNA samples derived from Coriell cell lines for CYP3A4. Samples were distributed to five volunteer laboratories for genotyping using a variety of commercially available and laboratory-developed tests. Sanger and next-generation sequencing were also utilized by some of the laboratories. Whole-genome sequencing data from the 1000 Genomes Projects were utilized to inform genotype. Twenty CYP3A4 alleles were identified in the 30 samples characterized for CYP3A4: CYP3A4∗4, CYP3A4∗5, CYP3A4∗6, CYP3A4∗7, CYP3A4∗8, CYP3A4∗9, CYP3A4∗10, CYP3A4∗11, CYP3A4∗12, CYP3A4∗15, CYP3A4∗16, CYP3A4∗18, CYP3A4∗19, CYP3A4∗20, CYP3A4∗21, CYP3A4∗22, CYP3A4∗23, CYP3A4∗24, CYP3A4∗35, and a novel allele, CYP3A4∗38. Nineteen additional samples with preexisting data for CYP3A4 or CYP3A5 were re-analyzed to generate comprehensive reference material panels for these genes. These publicly available and well-characterized materials can be used to support the quality assurance and quality control programs of clinical laboratories performing clinical pharmacogenetic testing. |
Associations of maternal urinary concentrations of phenols, individually and as a mixture, with serum biomarkers of thyroid function and autoimmunity: Results from the EARTH Study
McGee G , Génard-Walton M , Williams PL , Korevaar TIM , Chavarro JE , Meeker JD , Braun JM , Broeren MA , Ford JB , Calafat AM , Souter I , Hauser R , Mínguez-Alarcón L . Toxics 2023 11 (6) The associations between urinary phenol concentrations and markers of thyroid function and autoimmunity among potentially susceptible subgroups, such as subfertile women, have been understudied, especially when considering chemical mixtures. We evaluated cross-sectional associations of urinary phenol concentrations, individually and as a mixture, with serum markers of thyroid function and autoimmunity. We included 339 women attending a fertility center who provided one spot urine and one blood sample at enrollment (2009-2015). We quantified four phenols in urine using isotope dilution high-performance liquid chromatography-tandem mass spectrometry, and biomarkers of thyroid function (thyroid-stimulating hormone (TSH), free and total thyroxine (fT4, TT4), and triiodothyronine (fT3, TT3)), and autoimmunity (thyroid peroxidase (TPO) and thyroglobulin (Tg) antibodies (Ab)) in serum using electrochemoluminescence assays. We fit linear and additive models to investigate the association between urinary phenols-both individually and as a mixture-and serum thyroid function and autoimmunity, adjusted for confounders. As a sensitivity analysis, we also applied Bayesian Kernel Machine Regression (BKMR) to investigate non-linear and non-additive interactions. Urinary bisphenol A was associated with thyroid function, in particular, fT(3) (mean difference for a 1 log unit increase in concentration: -0.088; 95% CI [-0.151, -0.025]) and TT(3) (-0.066; 95% CI [-0.112, -0.020]). Urinary methylparaben and triclosan were also associated with several thyroid hormones. The overall mixture was negatively associated with serum fT(3) concentrations (mean difference comparing all four mixture components at their 75th vs. 25th percentiles: -0.19, 95% CI [-0.35, -0.03]). We found no evidence of non-linearity or interactions. These results add to the current literature on phenol exposures and thyroid function in women, suggesting that some phenols may alter the thyroid system. |
First round of external quality assessment scheme for SARS-CoV-2 laboratories during the COVID-19 pandemic in Thailand
Saeng-Aroon S , Changsom D , Boonmuang R , Waicharoen S , Buayai K , Okada P , Uppapong B , Chittaganpitch M , Soisangwan P , Praphasiri P , Skaggs BA . Health Secur 2023 21 (3) 183-192 The emergence of SARS-CoV-2 necessitated the rapid deployment of tests to diagnose COVID-19. To monitor the accuracy of testing across the COVID-19 laboratory network in Thailand, the Department of Medical Sciences under the Ministry of Public Health launched a national external quality assessment (EQA) scheme using samples containing inactivated SARS-CoV-2 culture supernatant from a predominant strain in the early phase of the Thailand outbreak. All 197 laboratories in the network participated; 93% (n=183) of which reported correct results for all 6 EQA samples. Ten laboratories reported false-negative results, mostly for samples with low viral concentrations, and 5 laboratories reported false-positive results (1 laboratory reported false positives and false negatives). An intralaboratory investigation of 14 laboratories reporting incorrect results revealed 2 main causes of error: (1) RNA contamination of the rRT-PCR reaction and (2) poor-quality RNA extraction. Specific reagent combinations were significantly associated with false-negative reports. Thailand's approach to national EQA for SARS-CoV-2 can serve as a roadmap for other countries interested in implementing a national EQA program to ensure laboratories provide accurate testing results, which is crucial in diagnosis, prevention, and control strategies. A national EQA program can be less costly and thus more sustainable than commercial EQA programs. National EQA is recommended to detect and correct testing errors and provide postmarket surveillance for diagnostic test performance. |
Analysis of the N-glycosylation profiles of the spike proteins from the Alpha, Beta, Gamma, and Delta variants of SARS-CoV-2
Wang D , Baudys J , Osman SH , Barr JR . Anal Bioanal Chem 2023 415 (19) 4779-4793 N-Glycosylation plays an important role in the structure and function of membrane and secreted proteins. Viral proteins used in cell entry are often extensively glycosylated to assist in protein folding, provide stability, and shield the virus from immune recognition by its host (described as a "glycan shield"). The SARS-CoV-2 spike protein (S) is a prime example, having 22 potential sites of N-glycosylation per protein protomer, as predicted from the primary sequence. In this report, we conducted mass spectrometric analysis of the N-glycosylation profiles of recombinant spike proteins derived from four common SARS-CoV-2 variants classified as Variant of Concern, including Alpha, Beta, Gamma, and Delta along with D614G variant spike as a control. Our data reveal that the amino acid substitutions and deletions between variants impact the abundance and type of glycans on glycosylation sites of the spike protein. Some of the N-glycosylation sequons in S show differences between SARS-CoV-2 variants in the distribution of glycan forms. In comparison with our previously reported site-specific glycan analysis on the S-D614G and its ancestral protein, glycan types on later variants showed high similarity on the site-specific glycan content to S-D614G. Additionally, we applied multiple digestion methods on each sample, and confirmed the results for individual glycosylation sites from different experiment conditions to improve the identification and quantification of glycopeptides. Detailed site-specific glycan analysis of a wide variety of SARS-CoV-2 variants provides useful information toward the understanding of the role of protein glycosylation on viral protein structure and function and development of effective vaccines and therapeutics. |
Disrupted routine medical visits in children and adolescents during the COVID-19 pandemic, January-June 2021
Badeh SM , Elam-Evans LD , Hill HA , Fredua B . AJPM Focus 2023 100119 INTRODUCTION: Recent studies have indicated the coronavirus disease 2019 (COVID-19) pandemic has disrupted routine vaccinations. This study describes the prevalence and characteristics of children and adolescents experiencing disrupted routine vaccination and other medical visits in the United States between January and June 2021. METHODS: The National Immunization Surveys were the source of data for this cross-sectional analysis (n= 86,893). Parents/guardians of children aged 6 months through 17 years were identified through random digit dialing of cellular phone numbers and interviewed. Disrupted visits were assessed by asking, "In the last two months, was a medical check-up, well child visit, or vaccination appointment for the child delayed, missed, or not scheduled for any reason?" Respondents answering yes were asked "Was it because of COVID-19?" Sociodemographic characteristics of children/adolescents with (1) COVID-19-related missed visits and (2) non-COVID-19-related missed visits were examined. Statistical differences within demographic subgroups were determined using t-tests, with p<0.05 considered statistically significant. Linear regression models were used to examine trends in disrupted visits over time. RESULTS: An estimated 7.9% of children/adolescents had a missed visit attributed to COVID-19; 5.2% had a missed visit that was not COVID-19-related. Among children/adolescents with a COVID-19-related missed visit, a higher percentage were of minority race or ethnicity, lived below the poverty level, had a mother without a college degree, and lived in the western United States. There was a significant decline in COVID-19-related missed visits over time. CONCLUSION: COVID-19 disrupted routine vaccination or other medical visits inequitably. Catch-up immunizations are essential for achieving adequate vaccination of all children/adolescents. |
Achieving elimination of perinatal HIV in the United States
Lampe MA , Nesheim SR , Oladapo KL , Ewing AC , Wiener J , Kourtis AP . Pediatrics 2023 151 (5) In 2012, the Centers for Disease Control and Prevention published a Framework for Elimination of Perinatal Transmission of HIV in the United States in Pediatrics, setting the goals of an incidence of <1 case of perinatal HIV per 100 000 live births, and a perinatal transmission rate of <1%. We used National HIV Surveillance System data to monitor the numbers of perinatally acquired HIV cases among US-born persons and perinatal HIV diagnosis rates per 100 000 live births to approximate incidence. Perinatal HIV transmission rates from 2010 to 2019 were calculated by using estimates of live births to women with an HIV diagnosis from the National Inpatient Sample, Healthcare Cost and Utilization Project. The annual estimated number of live births to women with diagnosed HIV decreased from 4587 in 2010 to 3525 in 2019, and the number of US-born infants with perinatally acquired HIV decreased from 74 in 2010 to 32 in 2019. Annual perinatal HIV diagnosis rates declined from 1.9 to 0.9 per 100 000 live births, and perinatal HIV transmission rates declined from 1.6% to 0.9%. Racial and ethnic disparities in HIV diagnosis rates persisted but declined substantially over the 10-year period. Both diagnosis and transmission rate elimination goals were first achieved in 2019. To maintain the elimination of perinatal HIV, and to eliminate racial disparities, the continued coordinated effort of health care and public health is required. The approach to perinatal HIV elimination is a public health model that can be replicated or expanded to areas beyond HIV. |
Patterns of prescription medication use during the first trimester of pregnancy in the United States, 1997-2018
Werler MM , Kerr SM , Ailes EC , Reefhuis J , Gilboa SM , Browne ML , Kelley KE , Hernandez-Diaz S , Smith-Webb RS , Huezo Garcia M , Mitchell AA . Clin Pharmacol Ther 2023 114 (4) 836-844 The objective of this analysis was to describe patterns of prescription medication use during pregnancy, including secular trends, with consideration of indication, and distributions of use within demographic subgroups. We conducted a descriptive secondary analysis using data from 9,755 women whose infants served as controls in two large United States case-control studies from 1997-2011 and 2014-2018. After excluding vitamin, herbal, mineral, vaccine, IV fluid, and topical products and over-the-counter medications, the proportion of women that reported taking at least one prescription medication in the first trimester increased over the study years, from 37% to 50% of women. The corresponding proportions increased with increasing maternal age and years of education, were highest for non-Hispanic White women (47%) and lowest for Hispanic women (24%). The most common indication for first trimester use of a medication was infection (12-15%). Increases were observed across the years for medications used for indications related to nausea/vomiting, depression/anxiety, infertility, thyroid disease, diabetes, and epilepsy. The largest relative increase in use among women was observed for medications to treat nausea/vomiting, which increased from 3.8% in the earliest years of the study (1997-2001) to 14.8% in 2014-2018, driven in large part by ondansetron use. Prescription medication use in the first trimester of pregnancy is common and increasing. Many medical conditions require treatments among pregnant women, often involving pharmacotherapy, which necessitates consideration of the risk and safety profiles for both mother and fetus. |
Epigenetic analysis in a murine genetic model of Gulf War illness
Mozhui K , O'Callaghan JP , Ashbrook DG , Prins P , Zhao W , Lu L , Jones BC . Front Toxicol 2023 5 1162749 Of the nearly 1 million military personnel who participated in the 1990-1991 Gulf War, between 25% and 35% became ill with what now is referred to as Gulf War Illness (GWI) by the Department of Defense. Symptoms varied from gastrointestinal distress to lethargy, memory loss, inability to concentrate, depression, respiratory, and reproductive problems. The symptoms have persisted for 30 years in those afflicted but the basis of the illness remains largely unknown. Nerve agents and other chemical exposures in the war zone have been implicated but the long-term effects of these acute exposures have left few if any identifiable signatures. The major aim of this study is to elucidate the possible genomic basis for the persistence of symptoms, especially of the neurological and behavioral effects. To address this, we performed a whole genome epigenetic analysis of the proposed cause of GWI, viz., exposure to organophosphate neurotoxicants combined with high circulating glucocorticoids in two inbred mouse strains, C57BL/6J and DBA/2J. The animals received corticosterone in their drinking water for 7 days followed by injection of diisopropylfluorophosphate, a nerve agent surrogate. Six weeks after DFP injection, the animals were euthanized and medial prefrontal cortex harvested for genome-wide DNA methylation analysis using high-throughput sequencing. We observed 67 differentially methylated genes, notably among them, Ttll7, Akr1c14, Slc44a4, and Rusc2, all related to different symptoms of GWI. Our results support proof of principle of genetic differences in the chronic effects of GWI-related exposures and may reveal why the disease has persisted in many of the now aging Gulf War veterans. |
Streamlining micronutrient biomarker statistical analysis in populations: an introduction to the SAMBA R package
Luo H , Beal T , Blake T , Zeiler M , Geng J , Werner ER , Addo OY , Suchdev PS , Young MF . J Nutr 2023 153 (9) 2753-2761 Micronutrient deficiency is a common global health problem, and accurately assessing micronutrient biomarkers is crucial for planning and managing effective intervention programs. However, analyzing micronutrient data and applying appropriate cutoffs to define deficiencies can be challenging, particularly when considering the confounding effects of inflammation on certain micronutrient biomarkers. To address this challenge, we developed the Statistical Apparatus of Micronutrient Biomarker Analysis (SAMBA) R package, a new tool that increases ease and accessibility of population-based micronutrient biomarker analysis. The SAMBA package can analyze various micronutrient biomarkers to assess status of iron, vitamin A, zinc, and B vitamins, adjust for inflammation, account for complex survey design when appropriate, and produce reports of summary statistics and prevalence estimates of micronutrient deficiencies using recommended age- and sex-specific cutoffs. We have provided a step-by-step procedure for how to use the SAMBA R package, including how to customize it for broader use, and made both the package and user manual publicly available on GitHub. SAMBA was validated by comparing results from analyzing 24 datasets on non-pregnant women of reproductive age from 23 countries and 30 datasets on preschool-age children from 26 countries with those obtained by an independent analyst. SAMBA generated identical means, percentiles, and prevalence of micronutrient deficiencies to those calculated by the independent analyst. In conclusion, SAMBA simplifies and standardizes the process for deriving survey-weighted and inflammation-adjusted (when appropriate) estimates of the prevalence of micronutrient deficiencies, reducing the time from data cleaning to result generation. SAMBA is a valuable tool that facilitates the accurate and rapid analysis of population-based micronutrient biomarker data, which can inform public health research, programs, and policy across contexts. |
Florence (Flo) Anne Jones 1948-2023
Connelly CR . J Am Mosq Control Assoc 2023 39 (2) 146-148 Florence Anne Jones, known to all as “Flo,” passed away on January 21, 2023, in the care of hospice in Inverness, Florida. Her career in mosquito control began in 1975 and lasted until her retirement in 2006, although she remained involved in teaching about and advocating for mosquito control well beyond her retirement. During her career in mosquito control, Flo was a member of the American Mosquito Control Association, Florida Mosquito Control Association (FMCA), and Haiti Mosquito Control Association. She was also an active member of the Citrus County Historical Society, starting in 2017. Flo was a colleague, friend, biologist, teacher, author, pilot, philanthropist, friend to animals, and lover of nature and history. |
Utilization of statistical analysis to identify influential slope parameters associated with rockfall at open pit mines
Bourgeois J , Warren S , Armstrong J . Min Metall Explor 2023 The application of statistical analysis software programs has proven useful for the investigation of rockfall runout distance along a designed slope. Rockfall modeling programs are continually being upgraded with more sophisticated analysis tools, such as the use of the rigid body versus lump mass models. Engineers at mine sites utilizing the software may have varied experience related to these models, their associated input parameters, and how to interpret the generated results. To address this concern, researchers at the Spokane Mining Research Division (SMRD) of the US National Institute for Occupational Safety and Health (NIOSH) investigated the influence of slope height, slope angle, slope material, and rock size for both rigid body and lump mass models in a 2-D statistical analysis program. Based on a literature search and industry input, specific ranges common to that of an open pit mining environment were chosen for each of the input parameters to determine 90% rock runout distance as well as their sensitivity to change. Data collected from this numerical analysis and simulation will be compared to empirical rockfall data gathered through the duration of the Highwall Safety project conducted by NIOSH from 2022–2026. © 2023, This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply. |
Commercial fishing fatalities and injuries described by linked vessel incidents
Kincl L , Doza S , Nahorniak J , Case S , Vaughan A , Bovbjerg V . J Agromedicine 2023 28 (4) 1-9 OBJECTIVES: The Risk Information System for Commercial Fishing (RISC Fishing) merged information on fishermen and vessel incident types from various databases. This descriptive study examined linked fisherman injury records (fatal and nonfatal) and vessel incident records in Oregon and Washington from 2000 to 2018 in the RISC Fishing database. The circumstances of incidents and any association with fishermen outcomes were explored to identify injury prevention opportunities. METHODS: The statistical analyses included a descriptive study of incidents related to the injury characteristics and frequency of outcomes by incident type. Further analyses included contingency tables and Pearson Chi-Square tests for selected variables to determine if there were associations between vessel incident outcomes (fatality, nonfatal injury, no injury). RESULTS: A total of 375 reported incidents with 93 cases of fatalities, 239 nonfatal injuries, and over 6,575 fishermen with no injury were described. Of fatalities, 90% were due to drowning, with only 2% of victims reported donning survival equipment. Deckhands experienced fatal and nonfatal injuries most frequently. The most common factors associated with nonfatal injuries included contact with objects (event), walking on vessel and hauling gear (work activities), and fractures and open wounds (nature). The most common final event leading to a vessel disaster with no injury being reported was sinking (76%). Distributions between the incident outcomes (fatality, nonfatal injury, and no injury) differed by vessel activity/type, fishery/gear, and event leading to the incident. CONCLUSION: Linked information of fishermen injury outcomes and vessel incident information showed that events and settings that involve fatalities are qualitatively different from incidents resulting in only nonfatal injuries or uninjured survivors. Vessel-level approaches for mitigating fatalities, such as ensuring vessel stability, improving navigation/operation decisions, and spotlighting survival equipment policies/rescue priorities could have a significant impact. Work task-specific prevention strategies for nonfatal injuries related to the larger vessels (catcher/processors and processors) and smaller vessels (with pot/trap gears) are paramount. The use of linked information provided in reports can provide a fuller incident picture to advance efforts to improve the working conditions of commercial fishermen. |
Inhalation of polycarbonate emissions generated during 3D printing processes affects neuroendocrine function in male rats
Krajnak K , Farcas M , McKinney W , Waugh S , Mandler K , Knepp A , Jackson M , Richardson D , Hammer M , Matheson J , Thomas T , Qian Y . J Toxicol Environ Health A 2023 86 (16) 1-22 Three-dimensional (3D) printing of manufactured goods has increased in the last 10 years. The increased use of this technology has resulted in questions regarding the influence of inhaling emissions generated during printing. The goal of this study was to determine if inhalation of particulate and/or toxic chemicals generated during printing with polycarbonate (PC) plastic affected the neuroendocrine system. Male rats were exposed to 3D-printer emissions (592 µg particulate/m(3) air) or filtered air for 4 h/day (d), 4 days/week and total exposures lengths were 1, 4, 8, 15 or 30 days. The effects of these exposures on hormone concentrations, and markers of function and/or injury in the olfactory bulb, hypothalamus and testes were measured after 1, 8 and 30 days exposure. Thirty days of exposure to 3D printer emissions resulted in reductions in thyroid stimulating hormone, follicle stimulating hormone and prolactin. These changes were accompanied by (1) elevation in markers of cell injury; (2) reductions in active mitochondria in the olfactory bulb, diminished gonadotropin releasing hormone cells and fibers as well as less tyrosine hydroxylase immunolabeled fibers in the arcuate nucleus; and (3) decrease in spermatogonium. Polycarbonate plastics may contain bisphenol A, and the effects of exposure to these 3D printer-generated emissions on neuroendocrine function are similar to those noted following exposure to bisphenol A. |
Increased mortality associated with disability among workers' compensation claimants with upper extremity neuropathy
Martin CJ , Woods S , Bertke S , Pinkerton L , Jin C . J Occup Environ Med 2023 65 (9) 798-802 OBJECTIVE: To evaluate and compare mortality after disabling and non-disabling occupational injuries. METHODS: Vital status was ascertained through 2020 for 2077 individuals with a workers' compensation claim for upper extremity neuropathy in West Virginia in 1998 or 1999. Standardized mortality ratios (SMRs) compared mortality to the West Virginia general population. Hazard ratios (HRs) obtained from Cox regression models compared mortality among those with and without lost work time or permanent disability. RESULTS: Overall, the SMR for accidental poisoning deaths was elevated (1.75, 95% CI 1.08-2.68). All-cause mortality HRs and cancer HRs were elevated for lost work time (HR 1.09, 95% CI 0.93-1.28; HR 1.50, 95% CI 1.09-2.08, respectively) and permanent disability (HR 1.22, 95% CI 1.04-1.44; HR 1.78, 95% CI 1.27-2.48, respectively). CONCLUSIONS: Work-related disability was associated with broad elevations in mortality. |
Evaluating exposure to VOCs and naphthalene for firefighters wearing different ppe configurations through measures in air, exhaled breath, and urine
Mayer AC , Fent KW , Wilkinson AF , Chen IC , Siegel MR , Toennis C , Sammons D , Meadows J , Kesler RM , Kerber S , Smith DL , Masoud F , Bhandari D , Wang Y , Blount BC , Calafat AM , Horn GP . Int J Environ Res Public Health 2023 20 (12) Firefighters are at an increased risk of cancer due to their occupational exposure to combustion byproducts, especially when those compounds penetrate the firefighter personal protective equipment (PPE) ensemble. This has led to questions about the impact of base layers (i.e., shorts vs. pants) under PPE ensembles. This study asked 23 firefighters to perform firefighting activities while wearing one of three different PPE ensembles with varying degrees of protection. Additionally, half of the firefighters unzipped their jackets after the scenario while the other half kept their jackets zipped for five additional minutes. Several volatile organic compound (VOC) and naphthalene air concentrations outside and inside of hoods, turnout jackets, and turnout pants were evaluated; biological (urinary and exhaled breath) samples were also collected. VOCs and naphthalene penetrated the three sampling areas (hoods, jackets, pants). Significant (p-value < 0.05) increases from pre- to post-fire for some metabolites of VOCs (e.g., benzene, toluene) and naphthalene were found. Firefighters wearing shorts and short sleeves absorbed higher amounts of certain compounds (p-value < 0.05), and the PPE designed with enhanced interface control features appeared to provide more protection from some compounds. These results suggest that firefighters can dermally absorb VOCs and naphthalene that penetrate the PPE ensemble. |
COVID-19 attitudes and vaccine hesitancy among an agricultural community in southwest Guatemala: A cross-sectional survey
Rojop N , Calvimontes DM , Barrios E , Lamb MM , Paniagua-Avila A , Monzon J , Duca LM , Iwamoto C , Chard AN , Gomez M , Arias K , Roell Y , Bolanos GA , Zielinski-Gutierrez E , Azziz-Baumgartner E , Lopez MR , Cordon-Rosales C , Asturias EJ , Olson D . Vaccines (Basel) 2023 11 (6) Despite offering free-of-charge COVID-19 vaccines starting July 2021, Guatemala has one of the lowest vaccination rates in Latin America. From 28 September 2021 to 11 April 2022, we conducted a cross-sectional survey of community members, adapting a CDC questionnaire to evaluate COVID-19 vaccine access and hesitancy. Of 233 participants ≥ 12 years, 127 (55%) received ≥1 dose of COVID-19 and 4 (2%) reported prior COVID-19 illness. Persons ≥ 12 years old who were unvaccinated (n = 106) were more likely to be female (73% vs. 41%, p < 0.001) and homemakers (69% vs. 24%, p < 0.01) compared with vaccinated participants (n = 127). Among those ≥18 years, the main reported motivation for vaccination among vaccinated participants was to protect the health of family/friends (101/117, 86%); on the other hand, 40 (55%) unvaccinated persons reported little/no confidence in public health institutions recommending COVID-19 vaccination. Community- and/or home-based vaccination programs, including vaccination of families through the workplace, may better reach female homemakers and reduce inequities and hesitancy. |
Mixed messages and COVID-19 prevention: Why information isn't always enough to protect meat processing workers
Sivén JM , Coburn J , Call TP , Mahoney D , Flores RR , Kaur H , Flynn MA , Menéndez CC . AJPM Focus 2023 100128 INTRODUCTION: The objective of this project was to investigate U.S. meat and poultry processing workers' knowledge of COVID-19, perceived ability to protect themselves from infection, and perspectives on COVID-19 vaccines to inform COVID-19 prevention efforts within this linguistically, racially, and ethnically diverse workforce. METHODS: Qualitative semi-structured in-depth interviews were conducted with Mexican, Central American, Congolese refugee, and Black or African American meat/poultry processing workers from Mississippi, Minnesota, Virginia, and Kentucky (N=40). Data were collected from December 5, 2020, to January 28, 2021. Interview audio was transcribed, and rapid qualitative data analysis was used to analyze transcripts. RESULTS: Most participants expressed receiving mixed messages about COVID-19 protection measures: they were told how to protect themselves (n=38), but workplace policies (such as lack of paid sick leave) often undermined their efforts. Participants who were asked about COVID-19 vaccines (n=31) were aware there were one or more vaccines available to protect them from COVID-19; one-third were eager to get vaccinated. CONCLUSIONS: Community-based efforts may consider supplementing large scale unified information campaigns in order to prevent mixed messages, address worker needs to accurately gauge the threat of illness to their families and communities and empower them to prevent infection. |
Multiplexed ddPCR-amplicon sequencing reveals isolated Plasmodium falciparum populations amenable to local elimination in Zanzibar, Tanzania
Holzschuh A , Lerch A , Gerlovina I , Fakih BS , Al-Mafazy AH , Reaves EJ , Ali A , Abbas F , Ali MH , Ali MA , Hetzel MW , Yukich J , Koepfli C . Nat Commun 2023 14 (1) 3699 Zanzibar has made significant progress toward malaria elimination, but recent stagnation requires novel approaches. We developed a highly multiplexed droplet digital PCR (ddPCR)-based amplicon sequencing method targeting 35 microhaplotypes and drug-resistance loci, and successfully sequenced 290 samples from five districts covering both main islands. Here, we elucidate fine-scale Plasmodium falciparum population structure and infer relatedness and connectivity of infections using an identity-by-descent (IBD) approach. Despite high genetic diversity, we observe pronounced fine-scale spatial and temporal parasite genetic structure. Clusters of near-clonal infections on Pemba indicate persistent local transmission with limited parasite importation, presenting an opportunity for local elimination efforts. Furthermore, we observe an admixed parasite population on Unguja and detect a substantial fraction (2.9%) of significantly related infection pairs between Zanzibar and the mainland, suggesting recent importation. Our study provides a high-resolution view of parasite genetic structure across the Zanzibar archipelago and provides actionable insights for prioritizing malaria elimination efforts. |
Malaria-related psychosocial factors, past antenatal care-seeking behaviors, and future antenatal care-seeking intentions by maternal age in Malawi and Democratic Republic of the Congo
Olapeju B , Bride M , Gutman JR , Butts JK , Malpass A , McCartney-Melstad A , Van Lith LM , Rodriguez K , Youll S , Mbeye N , Ntoya F , Lankhulani S , Mpata F , Babalola S . Am J Trop Med Hyg 2023 109 (2) 277-283 Young women in sub-Saharan Africa are a group at increased risk for malaria in pregnancy. Early antenatal care (ANC) seeking makes it more likely that women will receive the recommended doses of intermittent preventive treatment of malaria in pregnancy. This study used data from national Malaria Behavior Surveys conducted in Malawi and the Democratic Republic of the Congo (DRC) in 2021 to explore the association between intention to attend ANC in the first trimester for a future pregnancy (early ANC intention) and psychosocial factors among women aged 15-49 years. Eight psychosocial factors related to ANC and based on the ideation model were included, including knowledge, attitudes, and self-efficacy. The study used multivariable logistic regression models controlling for demographic characteristics to evaluate associations between early ANC intention and the individual ideational factors and the composite measure. Analysis included 2,148 women aged 15-49 years (Malawi: 827, DRC: 1,321). Antenatal care ideation was lower among young (aged 15-20 years) than among older (aged 21-49 years) women in Malawi. Young mothers with higher ANC ideation were more likely to intend to attend ANC early in their next pregnancy in both countries. Specific ideational factors associated with intention to attend ANC early varied by country and included positive attitudes, knowledge of ANC, and positive self-efficacy. In Malawi and the DRC, youth-friendly social and behavior change interventions to increase ANC-related ideation could increase future early ANC attendance among young women to improve malaria and birth outcomes. |
E-cigarette unit sales by product and flavor type, and top-selling brands, United States, 2020-2022
Ali FRM , Seidenberg AB , Crane E , Seaman E , Tynan MA , Marynak K . MMWR Morb Mortal Wkly Rep 2023 72 (25) 672-677 E-cigarette products, related policies, and use patterns change rapidly. In the United States, the prevalence of e-cigarette use is markedly higher among youths and young adults than it is among adults overall. In 2021, 4.5% of all adults aged ≥18 years (an estimated 11.1 million) and 11.0% of young adults aged 18-24 years (an estimated 3.1 million) currently (≥1 day during the previous 30 days) used e-cigarettes; during 2022, 14.1% of high school students (an estimated 2.14 million) currently used e-cigarettes (1,2). E-cigarettes often contain high concentrations of nicotine. Nicotine is highly addictive and can harm the adolescent brain, which continues to develop through approximately age 25 years (3). Since 2020, the availability of e-cigarette products has changed in response to multiple factors, including local and state policies to address flavored e-cigarette sales, actions undertaken by the Food and Drug Administration (FDA), COVID-19-related closures, and global supply chain disruptions. To assess trends in unit sales of e-cigarettes in the United States, by product and flavor, and top-selling brands, the CDC Foundation, Truth Initiative,* and CDC analyzed retail scanner data during January 26, 2020-December 25, 2022, from Information Resources, Inc. (IRI), a U.S. data analytics and market research company. Overall, unit sales increased by 46.6% during the study period. The unit share of menthol-flavored product sales remained relatively stable during this period, whereas nonmenthol flavor unit shares changed. During January 26, 2020-December 25, 2022, unit shares of tobacco-flavored and mint-flavored products decreased (from 28.4% to 20.1% and from 10.1% to 5.9%, respectively), whereas shares of other flavor sales increased (from 29.2% to 41.3%). In addition, during January 2020-December 2022, unit shares of prefilled cartridges decreased from 75.2% to 48.0%, and disposable e-cigarette unit share increased from 24.7% to 51.8% of total unit sales. The five top-selling e-cigarette brands for the 4-week period ending December 25, 2022, were Vuse, JUUL, Elf Bar, NJOY, and Breeze Smoke. Analysis of information on e-cigarette retail sales can guide strategies to prevent youth access to and use of e-cigarettes, including restrictions on flavored tobacco products (4). |
Concordance of ethyl glucuronide, blood alcohol content, and self-reported alcohol use in Russian women with HIV and hepatitis C virus co-infection
Brown JL , Capasso A , Revzina N , Boeva E , Rassokhin V , Sales JM , Gutova LV , Khalezova NB , Hitch AE , Twitty TD , DiClemente RJ . AIDS Behav 2023 27 (12) 4062-4069 Problematic alcohol use is prevalent in Russia and is deleterious for individuals with HIV and Hepatitis C Virus (HCV). Ethyl glucuronide (EtG) and blood alcohol content (BAC) provide Substance Use and Abuseobjective biomarkers of drinking that can be compared to self-reported alcohol use. This paper describes patterns of alcohol use measured by biomarkers and self-report along with concordance across measures. Participants were Russian women with HIV and HCV co-infection (N = 200; Mean age = 34.9) from two Saint Petersburg comprehensive HIV care centers enrolled in an alcohol reduction intervention clinical trial. Measures were: (a) urine specimen analyzed for EtG; (b) breathalyzer reading of BAC; and (c) self-reported frequency of drinking, typical number of drinks consumed, and number of standard drinks consumed in the past month. At baseline, 64.0% (n = 128) had a positive EtG (> 500 ng/mL) and 76.5% (n = 153) had a positive breathalyzer reading (non-zero reading). There was agreement between EtG and BAC (kappa = 0.66, p < .001; Phi coefficient = 0.69, p < .001); self-reported alcohol measures were positively correlated with positive EtG and BAC (p's < 0.001). There was concordance between EtG and BAC measures, which have differing alcohol detection windows. Most participants endorsed frequent drinking at high quantities, with very few reporting no alcohol consumption in the past month. Concordance between biomarkers and self-reported alcohol use suggests that underreporting of alcohol use was minimal. Results highlight the need for alcohol screening within HIV care. Implications for alcohol assessment within research and clinical contexts are discussed. |
Occurrence of Rickettsia spp. and Coxiella burnetii in ixodid ticks in Kassena-Nankana, Ghana
Addo SO , Bentil RE , Baako BOA , Yartey KN , Behene E , Asiamah B , Nyarko AA , Asoala V , Sallam M , Mate S , Dunford JC , Larbi JA , Baidoo PK , Wilson MD , Diclaro Ii JW , Dadzie SK . Exp Appl Acarol 2023 90 137-153 Ticks are arthropods of veterinary and medical importance which spread zoonotic pathogens that link animal and human health. In this study, ticks were collected from 448 livestock between February and December 2020 in the Kassena-Nankana Districts of Ghana and screened for the presence of zoonotic pathogens DNA using PCR and sequencing approaches. In total, 1550 ticks were collected and morphologically identified. Three tick genera were identified with Amblyomma variegatum (63%) as the predominant tick species collected. DNA was extracted from 491 tick pools and screened for the presence of DNA of Rickettsia spp. based on the 115 bp fragment of the 17 kDa surface protein and 639 bp of the Outer membrane protein A (ompA) gene and the 295 bp fragment of the transposase gene of Coxiella burnetii IS1111a element. From the 491 pools screened, the DNA of Rickettsia spp. and C. burnetii was detected in 56.8 and 3.7%, respectively. Coinfections were identified in 2.4% of the tick pools. Characterization of the Rickettsia spp. in this study based on the ompA gene showed that the DNA of Rickettsia africae and Rickettsia aeschlimannii accounted for 39.7 and 14.7%, respectively, and were 100% similar to sequences in GenBank. Most R. africae and C. burnetii infections occurred in ticks collected in the wet season, whereas R. aeschlimannii occurred mostly in the dry season. These pathogens are potential public health threats, thus there is a need to implement control measures to reduce the risk of infections in vulnerable populations. |
A perilous combination: Streptococcus coinfection with human plague-report of two cases and review of the literature, 1937-2022
Erly B , Fleck-Derderian S , Cooley KM , Meyer-Lee K , House J , VinHatton E , Nelson CA . Vector Borne Zoonotic Dis 2023 23 (7) 371-377 Background: Plague in humans and animals is caused by Yersinia pestis, a zoonotic gram-negative bacterium endemic in certain regions of Asia, Africa, and the United States. Coinfection with both Y. pestis and Streptococci species has been anecdotally reported in humans and associated with severe and rapidly fatal disease. Methods: This report presents two cases of patients who died following Y. pestis and Streptococcus coinfection. Additional cases of previously published Y. pestis-Streptococcus coinfection were identified and reviewed using a search of electronic databases. Results: The first case patient developed cough and dyspnea following 4 days of fever, malaise, and back pain and died before receiving medical care. Postmortem blood cultures were positive for Y. pestis, Streptococcus pyogenes, and Streptococcus dysgalactiae. The second case patient was hospitalized with fever, vomiting, diarrhea, and dyspnea and died of sepsis and respiratory failure on the day of admission. Y. pestis and Streptococcus pneumoniae were isolated from blood cultures drawn on admission. Seven additional cases of Y. pestis and Streptococcus coinfection were identified, dating between 1948 and 2009. These patients were healthy overall before their illness, with ages ranging from 9 to 60 years. The majority of patients had primary bubonic plague with associated pneumonia or septicemia. None of the patients who died received timely antimicrobial therapy directed against gram-negative pathogens. In every case but one, an occupational or environmental risk factor for plague was later identified. Conclusion: Y. pestis infection begins with a pre-inflammatory phase, during which Y. pestis and other pathogens can rapidly proliferate. Streptococci, which are frequently asymptomatic colonizers, may become invasive in this environment, leading to coinfection. The challenges of diagnosing Y. pestis in the context of coinfection may delay effective treatment. This case series and literature review illustrate the importance of clinicians remaining alert to environmental and occupational exposures in patients presenting with an infectious syndrome, especially in those who have an unexpectedly severe clinical presentation. |
Strengthening COVID-19 pandemic response coordination through public health emergency operations centres (PHEOC) in Africa: Review of a multi-faceted knowledge management and sharing approach, 2020-2021
Eteng WO , Lilay A , Tekeste S , Mankoula W , Collard E , Waya C , Rosenfeld E , Wilton CM , Muita M , McGinley L , Kawe Y , Abdullah A , Halm A , Li J , Lokossou VL , Kanoute Y , Sonko I , Aragaw M , Ouma AO . PLOS Glob Public Health 2023 3 (6) e0001386 The coronavirus disease 2019 (COVID-19) pandemic disrupted health security program implementation and incremental gains achieved after the West African Ebola outbreak in 2016 across Africa. Following cancellation of in-person events, a multi-faceted intervention program was established in May 2020 by Africa Centres for Disease Control and Prevention (Africa CDC), the World Health Organisation, and partners to strengthen national COVID-19 response coordination through public health emergency operations centres (PHEOC) utilizing continuous learning, mentorship, and networking. We present the lessons learned and reflection points. A multi-partner program coordination group was established to facilitate interventions' delivery including webinars and virtual community of practice (COP). We retrieved data from Africa CDC's program repository, synthesised major findings and describe these per thematic area. The virtual COP recorded 1,968 members and approximately 300 engagements in its initial three months. Fifty-six webinar sessions were held, providing 97 cumulative learning hours to 12,715 unique participants. Zoom data showed a return rate of 85%; 67% of webinar attendees were from Africa, and about 26 interactions occurred between participants and facilitators per session. Of 4,084 (44%) participants responding to post-session surveys, over 95% rated the topics as being relevant to their work and contributing to improving their understanding of PHEOC operationalisation. In addition, 95% agreed that the simplicity of the training delivery encouraged a greater number of public health staff to participate and spread lessons from it to their own networks. This just-in-time, progressively adaptive multi-faceted learning and knowledge management approach in Africa, with a consequential global audience at the peak of the COVID-19 pandemic, served its intended audience, had a high number of participants from Africa and received greatly satisfactory feedback. |
Ticks and tick-borne microbes identified through passive and active surveillance in Alaska
Hahn MB , Hojgaard A , Disler G , George W , Droghini A , Schlaht R , Durden LA , Coburn S , Gerlach R , Eisen RJ . J Med Entomol 2023 60 (5) 1099-1107 Rapid environmental change in Alaska and other regions of the Arctic and sub-Arctic has raised concerns about increasing human exposure to ticks and the pathogens they carry. We tested a sample of ticks collected through a combination of passive and active surveillance from humans, domestic animals, and wildlife hosts in Alaska for a panel of the most common tick-borne pathogens in the contiguous United States to characterize the diversity of microbes present in this region. We tested 189 pooled tick samples collected in 2019-2020 for Borrelia spp., Anaplasma spp., Ehrlichia spp., and Babesia spp. using a multiplex PCR amplicon sequencing assay. We found established populations of Ixodes angustus Neumann (Acari: Ixodidae), Ixodes uriae White (Acari: Ixodidae), and Haemaphysalis leporispalustris Packard (Acari: Ixodidae) in Alaska, with I. angustus found on a variety of hosts including domestic companion animals (dogs and cats), small wild mammals, and humans. Ixodes angustus were active from April through October with peaks in adult and nymphal activity observed in summer months (mainly July). Although no known human pathogens were detected, Babesia microti-like parasites and candidatus Ehrlichia khabarensis were identified in ticks and small mammals. The only human pathogen detected (B. burgdorferi s.s.) was found in a tick associated with a dog that had recently traveled to New York, where Lyme disease is endemic. This study highlights the value of a combined passive and active tick surveillance system to detect introduced tick species and pathogens and to assess which tick species and microbes are locally established. |
Predicted reduction in transmission from deployment of ivermectin-treated birdfeeders for local control of West Nile virus
Holcomb KM , Nguyen C , Komar N , Foy BD , Panella NA , Baskett ML , Barker CM . Epidemics 2023 44 100697 Ivermectin (IVM)-treated birds provide the potential for targeted control of Culex mosquitoes to reduce West Nile virus (WNV) transmission. Ingestion of IVM increases mosquito mortality, which could reduce WNV transmission from birds to humans and in enzootic maintenance cycles affecting predominantly bird-feeding mosquitoes and from birds to humans. This strategy might also provide an alternative method for WNV control that is less hampered by insecticide resistance and the logistics of large-scale pesticide applications. Through a combination of field studies and modeling, we assessed the feasibility and impact of deploying IVM-treated birdfeed in residential neighborhoods to reduce WNV transmission. We first tracked 105 birds using radio telemetry and radio frequency identification to monitor their feeder usage and locations of nocturnal roosts in relation to five feeder sites in a neighborhood in Fort Collins, Colorado. Using these results, we then modified a compartmental model of WNV transmission to account for the impact of IVM on mosquito mortality and spatial movement of birds and mosquitoes on the neighborhood level. We found that, while the number of treated lots in a neighborhood strongly influenced the total transmission potential, the arrangement of treated lots in a neighborhood had little effect. Increasing the proportion of treated birds, regardless of the WNV competency status, resulted in a larger reduction in infection dynamics than only treating competent birds. Taken together, model results indicate that deployment of IVM-treated feeders could reduce local transmission throughout the WNV season, including reducing the enzootic transmission prior to the onset of human infections, with high spatial coverage and rates of IVM-induced mortality in mosquitoes. To improve predictions, more work is needed to refine estimates of daily mosquito movement in urban areas and rates of IVM-induced mortality. Our results can guide future field trials of this control strategy. |
Intracellular diversity of WNV within circulating avian peripheral blood mononuclear cells reveals host-dependent patterns of polyinfection
Talmi-Frank D , Byas AD , Murrieta R , Weger-Lucarelli J , Rückert C , Gallichotte EN , Yoshimoto JA , Allen C , Bosco-Lauth AM , Graham B , Felix TA , Brault AC , Ebel GD . Pathogens 2023 12 (6) Arthropod-borne virus (arbovirus) populations exist as mutant swarms that are maintained between arthropods and vertebrates. West Nile virus (WNV) population dynamics are host-dependent. In American crows, purifying selection is weak and population diversity is high compared to American robins, which have 100- to 1000-fold lower viremia. WNV passed in robins leads to fitness gains, whereas that passed in crows does not. Therefore, we tested the hypothesis that high crow viremia allows for higher genetic diversity within individual avian peripheral blood mononuclear cells (PBMCs), reasoning that this could have produced the previously observed host-specific differences in genetic diversity and fitness. Specifically, we infected cells and birds with a molecularly barcoded WNV and sequenced viral RNA from single cells to quantify the number of WNV barcodes in each. Our results demonstrate that the richness of WNV populations within crows far exceeds that in robins. Similarly, rare WNV variants were maintained by crows more frequently than by robins. Our results suggest that increased viremia in crows relative to robins leads to the maintenance of defective genomes and less prevalent variants, presumably through complementation. Our findings further suggest that weaker purifying selection in highly susceptible crows is attributable to this higher viremia, polyinfections and complementation. |
Spatial prediction of Crimean Congo hemorrhagic fever virus seroprevalence among livestock in Uganda
Telford C , Nyakarahuka L , Waller L , Kitron U , Shoemaker T . One Health 2023 17 100576 Crimean-Congo Hemorrhagic Fever (CCHF) is a viral disease that can infect humans via contact with tick vectors or livestock reservoirs and can cause moderate to severe disease. The first human case of CCHF in Uganda was identified in 2013. To determine the geographic distribution of the CCHF virus (CCHFV), serosampling among herds of livestock was conducted in 28 Uganda districts in 2017. A geostatistical model of CCHF seroprevalence among livestock was developed to incorporate environmental and anthropogenic variables associated with elevated CCHF seroprevalence to predict CCHF seroprevalence on a map of Uganda and estimate the probability that CCHF seroprevalence exceeded 30% at each prediction location. Environmental and anthropogenic variables were also analyzed in separate models to determine the spatially varying drivers of prediction and determine which covariate class resulted in best prediction certainty. Covariates used in the full model included distance to the nearest croplands, average annual change in night-time light index, percent sand soil content, land surface temperature, and enhanced vegetation index. Elevated CCHF seroprevalence occurred in patches throughout the country, being highest in northern Uganda. Environmental covariates drove predicted seroprevalence in the full model more than anthropogenic covariates. Combination of environmental and anthropogenic variables resulted in the best prediction certainty. An understanding of the spatial distribution of CCHF across Uganda and the variables that drove predictions can be used to prioritize specific locations and activities to reduce the risk of future CCHF transmission. © 2023 The Authors |
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