Consensus Report of the 2015 Weinman International Conference on Mesothelioma.
Carbone M , Kanodia S , Chao A , Miller A , Wali A , Weissman D , Adjei A , Baumann F , Boffetta P , Buck B , de Perrot M , Dogan AU , Gavett S , Gualtieri A , Hassan R , Hesdorffer M , Hirsch FR , Larson D , Mao W , Masten S , Pass HI , Peto J , Pira E , Steele I , Tsao A , Woodard GA , Yang H , Malik S . J Thorac Oncol 2016 11 (8) 1246-62 On November 9 and 10, 2015, the International Conference on Mesothelioma in Populations Exposed to Naturally Occurring Asbestiform Fibers was held at the University of Hawaii Cancer Center in Honolulu, Hawaii. The meeting was cosponsored by the International Association for the Study of Lung Cancer, and the agenda was designed with significant input from staff at the U.S. National Cancer Institute and National Institute of Environmental Health Sciences. A multidisciplinary group of participants presented updates reflecting a range of disciplinary perspectives, including mineralogy, geology, epidemiology, toxicology, biochemistry, molecular biology, genetics, public health, and clinical oncology. The group identified knowledge gaps that are barriers to preventing and treating malignant mesothelioma (MM) and the required next steps to address barriers. This manuscript reports the group's efforts and focus on strategies to limit risk to the population and reduce the incidence of MM. Four main topics were explored: genetic risk, environmental exposure, biomarkers, and clinical interventions. Genetics plays a critical role in MM when the disease occurs in carriers of germline BRCA1 associated protein 1 mutations. Moreover, it appears likely that, in addition to BRCA1 associated protein 1, other yet unknown genetic variants may also influence the individual risk for development of MM, especially after exposure to asbestos and related mineral fibers. MM is an almost entirely preventable malignancy as it is most often caused by exposure to commercial asbestos or mineral fibers with asbestos-like health effects, such as erionite. In the past in North America and in Europe, the most prominent source of exposure was related to occupation. Present regulations have reduced occupational exposure in these countries; however, some people continue to be exposed to previously installed asbestos in older construction and other settings. Moreover, an increasing number of people are being exposed in rural areas that contain noncommercial asbestos, erionite, and other mineral fibers in soil or rock (termed naturally occurring asbestos [NOA]) and are being developed. Public health authorities, scientists, residents, and other affected groups must work together in the areas where exposure to asbestos, including NOA, has been documented in the environment to mitigate or reduce this exposure. Although a blood biomarker validated to be effective for use in screening and identifying MM at an early stage in asbestos/NOA-exposed populations is not currently available, novel biomarkers presented at the meeting, such as high mobility group box 1 and fibulin-3, are promising. There was general agreement that current treatment for MM, which is based on surgery and standard chemotherapy, has a modest effect on the overall survival (OS), which remains dismal. Additionally, although much needed novel therapeutic approaches for MM are being developed and explored in clinical trials, there is a critical need to invest in prevention research, in which there is a great opportunity to reduce the incidence and mortality from MM. |
State and regional prevalence of diagnosed multiple chronic conditions among adults aged ≥18 Years - United States, 2014
Ward BW , Black LI . MMWR Morb Mortal Wkly Rep 2016 65 (29) 735-8 The prevalence and care management of multiple (two or more) chronic conditions (MCC) are important public health concerns (1). Approximately 25% of U.S. adults have diagnoses of MCC (2). Care management of MCC presents a challenge to both patients and providers because of the substantial costs associated with treating more than one condition and the traditional care strategies that focus on single conditions as opposed to enhanced care coordination (3,4). Maintaining surveillance, targeting service delivery, and projecting resources are all important to meet this challenge, and these actions can be informed by identifying state and other regional variations in MCC prevalence (5,6). Data from the 2014 National Health Interview Survey (NHIS) were used to estimate prevalence of MCC (defined as two or more of 10 diagnosed chronic conditions) for each U.S. state and region by age and sex. Significant state and regional variation in MCC prevalence was found, with state-level estimates ranging from 19.0% in Colorado to 38.2% in Kentucky. MCC prevalence also varied by region, ranging from 21.4% in the Pacific region to 34.5% in the East South Central region. The prevalence of MCC was higher among women than among men within certain U.S. regions, and was higher in older persons in all regions. Such findings further the research and surveillance objectives stated in the U.S. Department of Health and Human Services (HHS) publication, Multiple Chronic Conditions: A Strategic Framework (1). Furthermore, geographic disparities in MCC prevalence can inform state-level surveillance programs and groups targeting service delivery or allocating resources for MCC prevention activities. |
When it all gets to be too much: Addressing diabetes distress in African Americans
Akindana A , Owens-Gary M , Williams A . AADE Pract 2016 4 (4) 44-49 Diabetes is a serious, common, and at times, overwhelming disease that disproportionately affects ethnic minority populations. According to the Centers for Disease Control and Prevention (CDC), about 29 million people in the United States have diabetes, and African Americans are almost twice as likely to have diabetes as non-Hispanic whites. | People with diabetes are susceptible to developing diabetes distress, which is emotional pain that people with diabetes may struggle with as they attempt to manage a chronic condition such as diabetes on a daily basis. When left unchecked, diabetes distress can lead to poor self-management and can directly affect their health. Though there is limited research on diabetes distress in African Americans, it is well documented that diabetes complications including distress disproportionately are seen within this group. | This article describes common knowledge of how diabetes distress can impact African Americans with diabetes and purport to introduce diabetes educators to a tool such as storytelling to help deal with emotional health in this patient population. |
More than 40% of those not taking antiseizure medication with recent seizures reported that epilepsy or its treatment interfered with their recent activities, 2010 and 2013 US National Health Interview Surveys
Kobau R , Cui W , Zack MM . Epilepsy Behav 2016 62 129-131 From the combined 2010 and 2013 National Health Interview Surveys, we estimated US national age-standardized prevalence of adults with active epilepsy who reported that a nervous system/sensory organ condition caused a limitation (e.g., walking; memory; or physical, mental, or emotional problems) and, separately, that epilepsy interfered with their activities (e.g., working, schooling, or socializing) during the 30days preceding the survey. Sixty-one percent of adults who took antiseizure medication and had recent seizures and 51% of those who took medication and had no seizures reported having limitations caused by a nervous system/sensory organ condition. Sixty-two percent of adults who took antiseizure medication and had recent seizures and 20% of those who took medication and had no seizures reported that epilepsy or its treatment interfered with their recent activities. Forty-one percent of those who did not take medication and had recent seizures also reported that epilepsy interfered with their activities. To reduce activity limitations in people with epilepsy, health and social service providers can ensure that adequate policies and practices that promote access to high quality care and social participation are in effect in organizations and communities. |
Prevention of stroke: a strategic global imperative
Feigin VL , Norrving B , George MG , Foltz JL , Roth GA , Mensah GA . Nat Rev Neurol 2016 12 (9) 501-12 The increasing global stroke burden strongly suggests that currently implemented primary stroke prevention strategies are not sufficiently effective, and new primary prevention strategies with larger effect sizes are needed. Here, we review the latest stroke epidemiology literature, with an emphasis on the recently published Global Burden of Disease 2013 Study estimates; highlight the problems with current primary stroke and cardiovascular disease (CVD) prevention strategies; and outline new developments in primary stroke and CVD prevention. We also suggest key priorities for the future, including comprehensive prevention strategies that target people at all levels of CVD risk; implementation of an integrated approach to promote healthy behaviours and reduce health disparities; capitalizing on information technology to advance prevention approaches and techniques; and incorporation of culturally appropriate education about healthy lifestyles into standard education curricula early in life. Given the already immense and fast-increasing burden of stroke and other major noncommunicable diseases (NCDs), which threatens worldwide sustainability, governments of all countries should develop and implement an emergency action plan addressing the primary prevention of NCDs, possibly including taxation strategies to tackle unhealthy behaviours that increase the risk of stroke and other NCDs. |
Associations between cardiovascular health and health-related quality of life, Behavioral Risk Factor Surveillance System, 2013
Odom EC , Fang J , Zack M , Moore L , Loustalot F . Prev Chronic Dis 2016 13 E99 INTRODUCTION: The American Heart Association established 7 cardiovascular health metrics as targets for promoting healthier lives. Cardiovascular health has been hypothesized to play a role in individuals' perception of quality of life; however, previous studies have mostly assessed the effect of cardiovascular risk factors on quality of life. METHODS: Data were from the 2013 Behavioral Risk Factor Surveillance System, a state-based telephone survey of adults 18 years or older (N = 347,073). All measures of cardiovascular health and health-related quality of life were self-reported. The 7 ideal cardiovascular health metrics were normal blood pressure, cholesterol, body mass index, not having diabetes, not smoking, being physically active, and having adequate fruit or vegetable intake. Cardiovascular health was categorized into meeting 0-2, 3-5, or 6-7 ideal cardiovascular health metrics. Logistic regression models examined the association between cardiovascular health, general health status, and 3 measures of unhealthy days per month, adjusting for age, sex, race/ethnicity, education, and annual income. RESULTS: Meeting 3 to 5 or 6 to 7 ideal cardiovascular health metrics was associated with a 51% and 79% lower adjusted prevalence ratio (aPR) of fair/poor health, respectively (aPR = 0.49, 95% confidence interval [CI] [0.47-0.50], aPR = 0.21, 95% CI [0.19-0.23]); a 47% and 72% lower prevalence of ≥14 physically unhealthy days (aPR = 0.53, 95% CI [0.51-0.55], aPR = 0.28, 95% CI [0.26-0.20]); a 43% and 66% lower prevalence of ≥14 mentally unhealthy days (aPR = 0.57, 95% CI [0.55-0.60], aPR = 0.34, 95% CI [0.31-0.37]); and a 50% and 74% lower prevalence of ≥14 activity limitation days (aPR = 0.50, 95% CI [0.48-0.53], aPR = 0.26, 95% CI [0.23-0.29]) in the past 30 days. CONCLUSION: Achieving a greater number of ideal cardiovascular health metrics may be associated with less impairment in health-related quality of life. |
Cardiometabolic risk factor changes observed in Diabetes Prevention Programs in US settings: a systematic review and meta-analysis
Mudaliar U , Zabetian A , Goodman M , Echouffo-Tcheugui JB , Albright AL , Gregg EW , Ali MK . PLoS Med 2016 13 (7) e1002095 BACKGROUND: The Diabetes Prevention Program (DPP) study showed that weight loss in high-risk adults lowered diabetes incidence and cardiovascular disease risk. No prior analyses have aggregated weight and cardiometabolic risk factor changes observed in studies implementing DPP interventions in nonresearch settings in the United States. METHODS AND FINDINGS: In this systematic review and meta-analysis, we pooled data from studies in the United States implementing DPP lifestyle modification programs (focused on modest [5%-7%] weight loss through ≥150 min of moderate physical activity per week and restriction of fat intake) in clinical, community, and online settings. We reported aggregated pre- and post-intervention weight and cardiometabolic risk factor changes (fasting blood glucose [FBG], glycosylated hemoglobin [HbA1c], systolic or diastolic blood pressure [SBP/DBP], total [TC] or HDL-cholesterol). We searched the MEDLINE, EMBASE, Cochrane Library, and Clinicaltrials.gov databases from January 1, 2003, to May 1, 2016. Two reviewers independently evaluated article eligibility and extracted data on study designs, populations enrolled, intervention program characteristics (duration, number of core and maintenance sessions), and outcomes. We used a random effects model to calculate summary estimates for each outcome and associated 95% confidence intervals (CI). To examine sources of heterogeneity, results were stratified according to the presence of maintenance sessions, risk level of participants (prediabetes or other), and intervention delivery personnel (lay or professional). Forty-four studies that enrolled 8,995 participants met eligibility criteria. Participants had an average age of 50.8 years and body mass index (BMI) of 34.8 kg/m2, and 25.2% were male. On average, study follow-up was 9.3 mo (median 12.0) with a range of 1.5 to 36 months; programs offered a mean of 12.6 sessions, with mean participant attendance of 11.0 core sessions. Sixty percent of programs offered some form of post-core maintenance (either email or in person). Mean absolute changes observed were: weight -3.77 kg (95% CI: -4.55; -2.99), HbA1c -0.21% (-0.29; -0.13), FBG -2.40 mg/dL (-3.59; -1.21), SBP -4.29 mmHg (-5.73, -2.84), DBP -2.56 mmHg (-3.40, 1.71), HDL +0.85 mg/dL (-0.10, 1.60), and TC -5.34 mg/dL (-9.72, -0.97). Programs with a maintenance component achieved greater reductions in weight (additional -1.66kg) and FBG (additional -3.14 mg/dl). Findings are subject to incomplete reporting and heterogeneity of studies included, and confounding because most included studies used pre-post study designs. CONCLUSIONS: DPP lifestyle modification programs achieved clinically meaningful weight and cardiometabolic health improvements. Together, these data suggest that additional value is gained from these programs, reinforcing that they are likely very cost-effective. |
Changes in regional body composition over 8 years in a randomized lifestyle trial: the Look AHEAD study
Pownall HJ , Schwartz AV , Bray GA , Berkowitz RI , Lewis CE , Boyko EJ , Jakicic JM , Chen H , Heshka S , Gregg EW , Johnson KC . Obesity (Silver Spring) 2016 24 (9) 1899-905 OBJECTIVE: To test the hypothesis that an 8-year intensive lifestyle intervention (ILI) suppresses aging-dependent changes in regional lean mass (LM) and fat mass (FM) among people with overweight/obesity and type 2 diabetes. METHODS: Regional body composition was measured by dual-energy X-ray absorptiometry within a subset of 1,019 volunteers (45-75 years old) in the Look AHEAD study randomized to ILI or diabetes support and education (DSE). The ILI goal was to achieve and maintain ≥7% weight loss through increased physical activity and reduced caloric intake. RESULTS: Over 8 years, the DSE group exhibited a linear loss of LM and FM. During year 1, the ILI group lost LM and FM. Between years 1 and 8, the ILI group regained most FM in all regions; regional LM converged with that of the DSE group; the percent of LM loss was greater for the leg than for the trunk. Among both groups, regional LM and FM change was proportional to the size of the region, trunk > leg > arm. CONCLUSIONS: Aging-dependent LM losses, particularly in the leg region, were not suppressed by ILI. The long-term consequences of rapid LM and FM loss and subsequent regain mostly as fat are unknown. |
HIV Infection Linked to Injection Use of Oxymorphone in Indiana, 2014-2015.
Peters PJ , Pontones P , Hoover KW , Patel MR , Galang RR , Shields J , Blosser SJ , Spiller MW , Combs B , Switzer WM , Conrad C , Gentry J , Khudyakov Y , Waterhouse D , Owen SM , Chapman E , Roseberry JC , McCants V , Weidle PJ , Broz D , Samandari T , Mermin J , Walthall J , Brooks JT , Duwve JM . N Engl J Med 2016 375 (3) 229-39 Background In January 2015, a total of 11 new diagnoses of human immunodeficiency virus (HIV) infection were reported in a small community in Indiana. We investigated the extent and cause of the outbreak and implemented control measures. Methods We identified an outbreak-related case as laboratory-confirmed HIV infection newly diagnosed after October 1, 2014, in a person who either resided in Scott County, Indiana, or was named by another case patient as a syringe-sharing or sexual partner. HIV polymerase (pol) sequences from case patients were phylogenetically analyzed, and potential risk factors associated with HIV infection were ascertained. Results From November 18, 2014, to November 1, 2015, HIV infection was diagnosed in 181 case patients. Most of these patients (87.8%) reported having injected the extended-release formulation of the prescription opioid oxymorphone, and 92.3% were coinfected with hepatitis C virus. Among 159 case patients who had an HIV type 1 pol gene sequence, 157 (98.7%) had sequences that were highly related, as determined by phylogenetic analyses. Contact tracing investigations led to the identification of 536 persons who were named as contacts of case patients; 468 of these contacts (87.3%) were located, assessed for risk, tested for HIV, and, if infected, linked to care. The number of times a contact was named as a syringe-sharing partner by a case patient was significantly associated with the risk of HIV infection (adjusted risk ratio for each time named, 1.9; P<0.001). In response to this outbreak, a public health emergency was declared on March 26, 2015, and a syringe-service program in Indiana was established for the first time. Conclusions Injection-drug use of extended-release oxymorphone within a network of persons who inject drugs in Indiana led to the introduction and rapid transmission of HIV. (Funded by the state government of Indiana and others.). |
What's in an identity label Correlates of sociodemographics, psychosocial characteristics, and sexual behavior among African American men who have sex with men
Rutledge SE , Jemmott JB 3rd , O'Leary A , Icard LD . Arch Sex Behav 2016 47 (1) 157-167 African American men who have sex with men (AAMSM) are vastly overrepresented among people with HIV/AIDS. Using data from 595 AAMSM in Philadelphia, we explored differences in sociodemographics, psychosocial characteristics related to beliefs about ethnicity, sexuality and masculinity, and sexual behavior with men and women by self-reported sexual identity (gay, bisexual, down low, straight). Roughly equivalent numbers identified as gay (40.6 %) and bisexual (41.3 %), while fewer identified as straight (7.6 %) or down low (10.5 %), with significant differences in age, income, history of incarceration, HIV status, alcohol and drug problems, childhood sexual abuse, and connection to the gay community evident among these groups. Analysis of psychosocial characteristics theorized to be related to identity and sexual behavior indicated significant differences in masculinity, homophobia, and outness as MSM. Gay and straight men appeared to be poles on a continuum of frequency of sexual behavior, with bisexual and down low men being sometimes more similar to gay men and sometimes more similar to straight men. The percentage of men having total intercourse of any kind was highest among down low and lowest among gay men. Gay men had less intercourse with women, but more receptive anal intercourse with men than the other identities. There were no significant differences by identity in frequency of condomless insertive anal intercourse with men, but gay men had significantly more condomless receptive anal intercourse. There were significant differences by identity for condomless vaginal and anal intercourse with women. This study demonstrates the importance of exploring differences in types of sex behavior for AAMSM by considering sexual identity. |
A randomized, double-blind, placebo-controlled trial evaluating the safety of early oseltamivir treatment among children 0-9 years of age hospitalized with influenza in El Salvador and Panama
Dawood FS , Jara J , Gonzalez R , Castillo JM , De Leon T , Estripeaut D , Luciani K , Sujey Brizuela Y , Barahona A , Cazares RA , Lawson AM , Rodriguez M , de Viana D , Franco D , Castillo M , Fry AM , Gubareva L , Tamura D , Hughes M , Gargiullo P , Clara W , Azziz-Baumgartner E , Widdowson MA . Antiviral Res 2016 133 85-94 BACKGROUND: Oseltamivir reduces symptom duration among children with uncomplicated influenza, but few data exist on treatment efficacy and tolerability among hospitalized children, particularly among infants aged <1 year. We evaluated tolerability and efficacy of oseltamivir treatment of children aged 0-9 years hospitalized with influenza. METHODS: We conducted a double-blind, randomized, placebo-controlled trial at tertiary care hospitals in El Salvador and Panama. Primary outcomes were length of hospitalization and increased work of breathing. Children were eligible if hospitalized <7 days after symptom onset with cough or sore throat plus tachypnea. Children were randomized 1:1 to receive oseltamivir or placebo; had swabs collected at enrollment for influenza RT-PCR testing; were assessed at enrollment and every 12 h for work of breathing; and were followed for adverse events through 7 days after discharge. Analyses were intention-to-treat. RESULTS: Overall, 683 children were randomized (oseltamivir, n = 341, placebo n = 342). Fifty-three percent were aged <1 year and 30 had influenza (oseltamivir, n = 19; placebo, n = 11). The study was terminated early after enrollment of 21% of the sample size due to lower than anticipated participant accrual. Using Kaplan-Meier analysis, there was no significant difference in median length of hospitalization (3 days, IQR 2-4 vs. 5 days, IQR 3-7, p = 0.22) and increased work of breathing (36 h, IQR 24-72 vs. 96 h, IQR 13-108, p = 0.14) between oseltamivir versus placebo recipients. There was no difference in adverse events between groups. CONCLUSION: Oseltamivir treatment was well tolerated among hospitalized children, including among infants aged <1 year. |
Reducing HIV risk among Hispanic/Latino men who have sex with men: Qualitative analysis of behavior change intentions by participants in a small-group intervention
Alonzo J , Mann L , Tanner AE , Sun CJ , Painter TM , Freeman A , Reboussin BA , Song E , Rhodes SD . J AIDS Clin Res 2016 7 (5) OBJECTIVE: The southeastern United States has the fastest-growing Hispanic/Latino population in the country and carries a disproportionate HIV burden. Among Hispanics/Latinos, men, and men who have sex with men (MSM) in particular, are at elevated risk of HIV infection; however, very few efficacious behavioral HIV prevention interventions are available for use with this vulnerable population. To address this shortage of prevention resources, our community-based participatory research (CBPR) partnership developed and is currently evaluating the efficacy of the HOLA en Grupos intervention to increase condom use and HIV testing among Hispanic/Latino MSM. METHODS: We recruited 304 Hispanic/Latino MSM who were randomized to receive the small group HOLA en Grupos intervention that was implemented during four 4-hour long sessions over four consecutive Sundays, or a 4-session small group general health education comparison intervention. At the end of the fourth session of the HOLA en Grupos intervention, the intervention facilitators asked participants to write down the sexual health-related behaviors they intended to change as a result of their participation. RESULTS: Qualitative analysis of the participants' responses identified six types of intended behavior changes: increasing and maintaining condom use; identifying strategies to support correct and consistent condom use; increasing communication and negotiation with sexual partners about condom use; getting tested for HIV and other sexually transmitted infections; applying other sexual health promotion strategies; and sharing newly learned sexual health information with their peers. CONCLUSION: Most risk-reduction intentions aligned with the intervention's key messages of using condoms consistently and getting tested for HIV. However, participants' stated intentions may have also depended on which behavior changes they perceived as most salient after participating in the intervention. Participants' intentions to share information with their peers may result in elements of the intervention content reaching others within their social networks, and potentially contributing to a broader community-level impact. |
Results from the Centers for Disease Control and Prevention's Predict the 2013-2014 Influenza Season Challenge
Biggerstaff M , Alper D , Dredze M , Fox S , Fung IC , Hickmann KS , Lewis B , Rosenfeld R , Shaman J , Tsou MH , Velardi P , Vespignani A , Finelli L . BMC Infect Dis 2016 16 357 BACKGROUND: Early insights into the timing of the start, peak, and intensity of the influenza season could be useful in planning influenza prevention and control activities. To encourage development and innovation in influenza forecasting, the Centers for Disease Control and Prevention (CDC) organized a challenge to predict the 2013-14 Unites States influenza season. METHODS: Challenge contestants were asked to forecast the start, peak, and intensity of the 2013-2014 influenza season at the national level and at any or all Health and Human Services (HHS) region level(s). The challenge ran from December 1, 2013-March 27, 2014; contestants were required to submit 9 biweekly forecasts at the national level to be eligible. The selection of the winner was based on expert evaluation of the methodology used to make the prediction and the accuracy of the prediction as judged against the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet). RESULTS: Nine teams submitted 13 forecasts for all required milestones. The first forecast was due on December 2, 2013; 3/13 forecasts received correctly predicted the start of the influenza season within one week, 1/13 predicted the peak within 1 week, 3/13 predicted the peak ILINet percentage within 1 %, and 4/13 predicted the season duration within 1 week. For the prediction due on December 19, 2013, the number of forecasts that correctly forecasted the peak week increased to 2/13, the peak percentage to 6/13, and the duration of the season to 6/13. As the season progressed, the forecasts became more stable and were closer to the season milestones. CONCLUSION: Forecasting has become technically feasible, but further efforts are needed to improve forecast accuracy so that policy makers can reliably use these predictions. CDC and challenge contestants plan to build upon the methods developed during this contest to improve the accuracy of influenza forecasts. |
Syphilis trends among men who have sex with men in the United States and western Europe: A systematic review of trend studies published between 2004 and 2015
Abara WE , Hess KL , Neblett Fanfair R , Bernstein KT , Paz-Bailey G . PLoS One 2016 11 (7) e0159309 Globally, men who have sex with men (MSM) are disproportionately burdened with syphilis. This review describes the published literature on trends in syphilis infections among MSM in the US and Western Europe from 1998, the period with the fewest syphilis infections in both geographical areas, onwards. We also describe disparities in syphilis trends among various sub-populations of MSM. We searched electronic databases (Medline, Embase, Global Health, PsychInfo, CAB Abstracts, CINAHL, Sociological Abstracts, Web of Science, Cochrane Library, and LILACS) for peer-reviewed journal articles that were published between January 2004 and June 2015 and reported on syphilis cases among MSM at multiple time points from 1998 onwards. Ten articles (12 syphilis trend studies/reports) from the US and eight articles (12 syphilis trend studies/reports) from Western Europe were identified and included in this review. Taken together, our findings indicate an increase in the numbers and rates (per 100,000) of syphilis infections among MSM in the US and Western Europe since 1998. Disparities in the syphilis trends among MSM were also noted, with greater increases observed among HIV-positive MSM than HIV-negative MSM in both the US and Western Europe. In the US, racial minority MSM and MSM between 20 and 29 years accounted for the greatest increases in syphilis infections over time whereas White MSM accounted for most syphilis infections over time in Western Europe. Multiple strategies, including strengthening and targeting current syphilis screening and testing programs, and the prompt treatment of syphilis cases are warranted to address the increase in syphilis infections among all MSM in the US and Western Europe, but particularly among HIV-infected MSM, racial minority MSM, and young MSM in the US. |
Middle East respiratory syndrome coronavirus transmission in extended family, Saudi Arabia, 2014
Arwady MA , Alraddadi B , Basler C , Azhar EI , Abuelzein E , Sindy AI , Sadiq BM , Althaqafi AO , Shabouni O , Banjar A , Haynes LM , Gerber SI , Feikin DR , Madani TA . Emerg Infect Dis 2016 22 (8) 1395-402 Risk factors for human-to-human transmission of Middle East respiratory syndrome coronavirus (MERS-CoV) are largely unknown. After MERS-CoV infections occurred in an extended family in Saudi Arabia in 2014, relatives were tested by using real-time reverse transcription PCR (rRT-PCR) and serologic methods. Among 79 relatives, 19 (24%) were MERS-CoV positive; 11 were hospitalized, and 2 died. Eleven (58%) tested positive by rRT-PCR; 8 (42%) tested negative by rRT-PCR but positive by serology. Compared with MERS-CoV-negative adult relatives, MERS-CoV-positive adult relatives were older and more likely to be male and to have chronic medical conditions. Risk factors for household transmission included sleeping in an index patient's room and touching respiratory secretions from an index patient. Casual contact and simple proximity were not associated with transmission. Serology was more sensitive than standard rRT-PCR for identifying infected relatives, highlighting the value of including serology in future investigations. |
An outbreak of fearsome photos and headlines: Ebola and local newspapers in West Africa
Halsey ES . Am J Trop Med Hyg 2016 95 (5) 988-992 Not unlike the United States and Europe, local West African media attention to the Ebola virus disease 2014-2015 epidemic sometimes involved sensationalized or outlandish coverage. This article provides visual examples from Liberian and Sierra Leonean newspapers and discusses both the potential consequences of this coverage and actions taken to improve it. |
Enterovirus D68 infection in children with acute flaccid myelitis, Colorado, USA, 2014
Aliabadi N , Messacar K , Pastula DM , Robinson CC , Leshem E , Sejvar JJ , Nix WA , Oberste MS , Feikin DR , Dominguez SR . Emerg Infect Dis 2016 22 (8) 1387-94 During August 8, 2014-October 14, 2014, a total of 11 children with acute flaccid myelitis and distinctive neuroimaging changes were identified near Denver, Colorado, USA. A respiratory prodrome was experienced by 10, and nasopharyngeal specimens were positive for enterovirus D68 (EV-D68) for 4. To determine whether an association exists between EV-D68 infection and acute flaccid myelitis, we conducted a retrospective case-control study comparing these patients with 2 groups of outpatient control children (1 group tested for acute respiratory illness and 1 for Bordetella pertussis infection). Adjusted analyses indicated that, for children with acute flaccid myelitis, the odds of having EV-D68 infection were 10.3 times greater than for those tested for acute respiratory infection and 4.5 times greater than for those tested for B. pertussis infection. No statistical association was seen between acute flaccid myelitis and non-EV-D68 enterovirus or rhinovirus infection. These findings support an association between EV-D68 infection and acute flaccid myelitis. |
Evolution of couples' voluntary counseling and testing for HIV in Rwanda: from research to public health practice
Karita E , Nsanzimana S , Ndagije F , Wall KM , Mukamuyango J , Mugwaneza P , Remera E , Raghunathan PL , Bayingana R , Kayitenkore K , Bekan-Homawoo B , Tichacek A , Allen S . J Acquir Immune Defic Syndr 2016 73 (3) e51-e58 BACKGROUND: Couples' Voluntary HIV Counseling and Testing (CVCT) is a WHO-recommended intervention for prevention of heterosexual HIV transmission which very few African couples have received. We report the successful nationwide implementation of CVCT in Rwanda. METHODS: From 1988-1994, pregnant and post-partum women were tested for HIV and requested testing for their husbands. Partner testing was associated with more condom use and lower HIV and STI rates, particularly among HIV discordant couples. After the 1994 genocide, the research team continued to refine CVCT procedures in Zambia. These were re-introduced to Rwanda in 2001 and continually tested and improved. In 2003, the Government of Rwanda (GoR) established targets for partner testing among pregnant women, with the proportion rising from 16% in 2003 to 84% in 2008 as the PMTCT program expanded to >400 clinics. In 2009 the GoR adopted joint post-test counseling procedures, and in 2010 a quarterly follow-up program was established in government clinics with training and technical assistance. An estimated 80-90% of Rwandan couples have now been jointly counseled and tested resulting in prevention of >70% of new HIV infections. CONCLUSION: Rwanda is the first African country to have established CVCT as standard of care in ANC. More than 20 countries have sent providers to Rwanda for CVCT training. To duplicate Rwanda's success, training and technical assistance must be part of a coordinated effort to set national targets, timelines, indicators and budgets. Governments, bilateral and multilateral funding agencies must jointly prioritize CVCT for prevention of new HIV infections. |
Incidence and predictors of HIV infection among men who have sex with men attending public sexually transmitted disease clinics, New York City, 2007-2012
Pathela P , Jamison K , Braunstein SL , Schillinger JA , Varma JK , Blank S . AIDS Behav 2016 21 (5) 1444-1451 We examined five annual cohorts (2007-2011) of men who have sex with men (MSM) attending New York City STD clinics who had negative HIV-1 nucleic acid amplification tests (NAATs) on the day of clinic visit. Annual HIV incidence was calculated using HIV diagnoses within 1 year of negative NAAT, determined by matching with the citywide HIV registry. Predictors (demographic; behavioral; bacterial STD from citywide STD registry match) of all new HIV diagnoses through 2012 were calculated from Cox proportional hazards models. Among 10,487 HIV NAAT-negative MSM, 371 had an HIV diagnosis within 1 year. Annual incidence was 2.4/100 person-years, and highest among non-Hispanic black MSM (4.1/100 person-years) and MSM aged <20 years (5.7/100 person-years). Characteristics associated with all 648 new HIV diagnoses included: black race (aHR 2.2; 95 % CI 1.6-3.1), condomless receptive anal sex (aHR 2.1; 95 % CI 1.5-2.8), condomless insertive anal sex (aHR 1.3; 95 % CI 1.1-1.8), and incident STD diagnosis (aHR 1.6; 95 % CI 1.3-1.9). MSM attending STD clinics have substantial HIV incidence and report risk behaviors that are highly associated with HIV acquisition. Increased uptake of effective interventions, e.g., pre- and post-exposure prophylaxis, is needed. |
Incidence of and temporal relationships between HIV, herpes simplex II virus, and syphilis among men who have sex with men in Bangkok, Thailand: an observational cohort
Thienkrua W , Todd CS , Chonwattana W , Wimonsate W , Chaikummao S , Varangrat A , Chitwarakorn A , van Griensven F , Holtz TH . BMC Infect Dis 2016 16 340 BACKGROUND: High HIV incidence has been detected among men who have sex with men (MSM) in Thailand, but the relationship and timing of HIV, herpes simplex virus 2 (HSV-2), and syphilis is unknown. This analysis measures incidence, temporal relationships, and risk factors for HIV, HSV-2, and syphilis among at-risk MSM in the Bangkok MSM Cohort Study. METHODS: Between April 2006 and December 2010, 960 men negative for HIV, HSV-2, and syphilis at entry enrolled and contributed 12-60 months of follow-up data. Behavioral questionnaires were administered at each visit; testing for HIV antibody was performed at each visit, while testing for syphilis and HSV-2 were performed at 12 month intervals. We calculated HIV, HSV-2, and syphilis incidence, assessed risk factors with complementary log-log regression, and among co-infected men, measured temporal relationships between infections with Kaplan-Meier survival analysis and paired t-test. RESULTS: The total number of infections and incidence density for HIV, HSV-2, and syphilis were 159 infections and 4.7 cases/100 PY (95 % Confidence Interval (CI): 4.0-5.4), 128 infections and 4.5/100 PY (95 % CI: 3.9-5.5), and 65 infections and 1.9/100 PY (95 % CI: 1.5-2.5), respectively. Among men acquiring >1 infection during the cohort period, mean time to HIV and HSV-2 infection was similar (2.5 vs. 2.9 years; p = 0.24), while syphilis occurred significantly later following HIV (4.0 vs. 2.8 years, p < 0.01) or HSV-2 (3.8 vs. 2.8 years, p = 0.04) infection. The strongest independent predictor of any single infection in adjusted analysis was acquisition of another infection; risk of syphilis (Adjusted Hazards Ratio (AHR) = 3.49, 95 % CI: 1.89-6.42) or HIV (AHR = 2.26, 95 % CI: 1.47-3.48) acquisition during the cohort was significantly higher among men with incident HSV-2 infection. No single independent behavioral factor was common to HIV, HSV-2, and syphilis acquisition. CONCLUSION: HIV and HSV-2 incidence was high among this Thai MSM cohort. However, acquisition of HIV and co-infection with either HSV-2 or syphilis was low during the time frame men were in the cohort. Evaluation of behavioral risk factors for these infections suggests different risks and possible different networks. |
Increased antiretroviral therapy prescription and HIV viral suppression among persons receiving clinical care for HIV infection
Bradley H , Mattson CL , Beer L , Huang P , Shouse RL . AIDS 2016 30 (13) 2117-24 OBJECTIVE: To assess trends during 2009-2013 in antiretroviral therapy (ART) prescription and viral suppression among adults receiving HIV clinical care in the United States. DESIGN: We used data from the Medical Monitoring Project, a surveillance system producing national estimates of characteristics of HIV-infected adults receiving clinical care in the United States. METHODS: We estimated weighted proportions of persons receiving HIV medical care who were prescribed ART and achieved HIV viral suppression (<200 copies/ml) at both last test and at all tests in the previous 12 months during 2009-2013. We assessed trends overall and by gender, age, race/ethnicity, and sexual behavior/orientation. RESULTS: ART prescription and viral suppression increased significantly during 2009-2013, overall and in subgroups. ART prescription increased from 89 to 94% (P for trend <0.01). Viral suppression at last measurement increased from 72 to 80% (P for trend <0.01). The largest increases were among 18-29 year olds (56-68%), 30-39 year olds (62-75%), and non-Hispanic blacks (64-76%). Sustained viral suppression increased from 58 to 68% (P for trend <0.01). The largest increases were among 18-29 year olds (32-51%), 30-39 year olds (47-63%), and non-Hispanic blacks (49-61%). CONCLUSION: Adults receiving HIV medical care are increasingly likely to be prescribed ART and achieve viral suppression. Recent efforts to promote early antiretroviral therapy use may have contributed to these increases, bringing us closer to realizing key goals of the National HIV/AIDS Strategy. |
Assessment of community event-based surveillance for Ebola virus disease, Sierra Leone, 2015
Ratnayake R , Crowe SJ , Jasperse J , Privette G , Stone E , Miller L , Hertz D , Fu C , Maenner MJ , Jambai A , Morgan O . Emerg Infect Dis 2016 22 (8) 1431-7 In 2015, community event-based surveillance (CEBS) was implemented in Sierra Leone to assist with the detection of Ebola virus disease (EVD) cases. We assessed the sensitivity of CEBS for finding EVD cases during a 7-month period, and in a 6-week subanalysis, we assessed the timeliness of reporting cases with no known epidemiologic links at time of detection. Of the 12,126 CEBS reports, 287 (2%) met the suspected case definition, and 16 were confirmed positive. CEBS detected 30% (16/53) of the EVD cases identified during the study period. During the subanalysis, CEBS staff identified 4 of 6 cases with no epidemiologic links. These CEBS-detected cases were identified more rapidly than those detected by the national surveillance system; however, too few cases were detected to determine system timeliness. Although CEBS detected EVD cases, it largely generated false alerts. Future versions of community-based surveillance could improve case detection through increased staff training and community engagement. |
Clinical characteristics and factors associated with severe acute respiratory infection and influenza among children in Jingzhou, China
Huai Y , Guan X , Liu S , Uyeki TM , Jiang H , Klena J , Huang J , Chen M , Peng Y , Yang H , Luo J , Zheng J , Peng Z , Huo X , Xiao L , Chen H , Zhang Y , Xing X , Feng L , Hu DJ , Yu H , Zhan F , Varma JK . Influenza Other Respir Viruses 2016 11 (2) 148-156 BACKGROUND: Influenza is an important cause of respiratory illness in children, but data are limited on hospitalized children with laboratory-confirmed influenza in China. METHODS: We conducted active surveillance for severe acute respiratory infection (SARI) (fever and at least one sign or symptom of acute respiratory illness) among hospitalized pediatric patients in Jingzhou, Hubei province from April 2010 to April 2012. Data were collected from enrolled SARI patients on demographics, underlying health conditions, clinical course of illness, and outcomes. Nasal swabs were collected and tested for influenza viruses by RT-PCR. We described the clinical and epidemiological characteristics of children with influenza, and analyzed the association between potential risk factors and SARI patients with influenza. RESULTS: During the study period, 15,354 children aged <15 years with signs and symptoms of SARI were enrolled at hospital admission.. SARI patients aged 5-15 years with confirmed influenza (H3N2) infection were more likely than children without influenza to have radiographic diagnosis of pneumonia (11/31, 36% vs 15/105, 14%. p-value<0.05). Only 16% (1,116/7,145) of enrolled patients had received seasonal trivalent influenza vaccination within 12 months of hospital admission.Non-vaccinated influenza cases were more likely than vaccinated influenza cases to have pneumonia (31/133, 23% vs 37/256, 15%, p-value<0.05). SARI cases aged 5-15 years diagnosed with influenza were also more likely to have a household member who smoked cigarettes compared to SARI cases without a smoking household member (54/208, 26% vs 158/960, 16%, p-value<0.05) CONCLUSIONS: Influenza A (H3N2) virus infection was an important contributor to pneumonia requiring hospitalization. Our results highlight the importance of surveillance in identifying factors for influenza hospitalization, monitoring adherence to influenza prevention and treatment strategies, and evaluating the disease burden among hospitalized pediatric SARI patients. Influenza vaccination promotion should target children. |
A decade of antiretroviral therapy scale-up in Mozambique: Evaluation of outcome trends and new models of service delivery among more than 300,000 patients enrolled during 2004-2013
Auld AF , Shiraishi RW , Couto A , Mbofana F , Colborn K , Alfredo C , Ellerbrock TV , Xavier C , Jobarteh K . J Acquir Immune Defic Syndr 2016 73 (2) e11-22 BACKGROUND: During 2004-2013 in Mozambique, 455,600 HIV-positive adults (≥15 years old) initiated antiretroviral therapy (ART). We evaluated trends in patient characteristics and outcomes during 2004-2013, outcomes of universal treatment for pregnant women (Option B+) implemented since 2013, and effect on outcomes of distributing ART to stable patients through Community ART Support Groups (CASG) since 2010. METHODS: Data for 306,335 adults starting ART during 2004-2013 at 170 ART facilities were analyzed. Mortality and loss to follow-up (LTFU) were estimated using competing risks models. Outcome determinants were estimated using proportional hazards models, including CASG participation as a time-varying covariate. RESULTS: Compared with ART enrollees in 2004, enrollees in 2013 were more commonly female (55% vs. 73%), more commonly pregnant if female (<1% vs. 30%), and had a higher median baseline CD4 count (139 vs. 235/microL). During 2004-2013, observed 6-month mortality declined from 7% to 2% but LTFU increased from 24% to 30%. Pregnant women starting ART with CD4 count >350/microL and WHO stage I/II under Option B+ guidelines in 2013 had low 6-month mortality (0.1%) but high 6-month LTFU (38%). During 2010-2013, 6,766 patients joined CASGs. In multivariable analysis, compared with non-participation in CASG, CASG participation was associated with 35% lower LTFU but similar mortality. CONCLUSIONS: Initiation of ART at earlier disease stages in later calendar years might explain observed declines in mortality. Retention interventions are needed to address trends of increasing LTFU overall and the high LTFU among Option B+ pregnant women specifically. Further expansion of CASG could help reduce LTFU. |
Relative contributions of agricultural drift, para-occupational, and residential use exposure pathways to house dust pesticide concentrations: Meta-regression of published data
Deziel NC , Beane Freeman LE , Graubard BI , Jones RR , Hoppin JA , Thomas K , Hines CJ , Blair A , Sandler DP , Chen H , Lubin JH , Andreotti G , Alavanja MC , Friesen MC . Environ Health Perspect 2016 125 (3) 296-305 BACKGROUND: Increased pesticide concentrations in house dust in agricultural areas have been attributed to several exposure pathways, including agricultural drift, para-occupational, and residential use. OBJECTIVE: To guide future exposure assessment efforts, we quantified relative contributions of these pathways using meta-regression models of published data on dust pesticide concentrations. METHODS: From studies in North American agricultural areas published from 1995-2015, we abstracted dust pesticide concentrations reported as summary statistics (e.g., geometric means (GM)). We analyzed these data using mixed-effects meta-regression models that weighted each summary statistic by its inverse variance. Dependent variables were either the log-transformed GM (drift) or the log-transformed ratio of GMs from two groups (para-occupational, residential use). RESULTS: For the drift pathway, predicted GMs decreased sharply and nonlinearly, with GMs 64% lower in homes 250 m versus 23 m from fields (inter-quartile range of published data) based on 52 statistics from 7 studies. For the para-occupational pathway, GMs were 2.3 times higher (95% confidence interval [CI]: 1.5-3.3; 15 statistics, 5 studies) in homes of farmers who applied pesticides more versus less recently or frequently. For the residential use pathway, GMs were 1.3 (95%CI: 1.1-1.4) and 1.5 (95%CI: 1.2-1.9) times higher in treated versus untreated homes, when the probability that a pesticide was used for the pest treatment was 1-19% and ≥20%, respectively (88 statistics, 5 studies). CONCLUSION: Our quantification of the relative contributions of pesticide exposure pathways in agricultural populations could improve exposure assessments in epidemiologic studies. The meta-regression models can be updated when additional data become available. |
Association between community socioeconomic factors, animal feeding operations, and campylobacteriosis incidence rates: Foodborne Diseases Active Surveillance Network (FoodNet), 2004-2010
Rosenberg Goldstein RE , Cruz-Cano R , Jiang C , Palmer A , Blythe D , Ryan P , Hogan B , White B , Dunn JR , Libby T , Tobin-D'Angelo M , Huang JY , McGuire S , Scherzinger K , Lee ML , Sapkota AR . BMC Infect Dis 2016 16 354 BACKGROUND: Campylobacter is a leading cause of foodborne illness in the United States. Campylobacter infections have been associated with individual risk factors, such as the consumption of poultry and raw milk. Recently, a Maryland-based study identified community socioeconomic and environmental factors that are also associated with campylobacteriosis rates. However, no previous studies have evaluated the association between community risk factors and campylobacteriosis rates across multiple U.S. states. METHODS: We obtained Campylobacter case data (2004-2010; n = 40,768) from the Foodborne Diseases Active Surveillance Network (FoodNet) and socioeconomic and environmental data from the 2010 Census of Population and Housing, the 2011 American Community Survey, and the 2007 U.S. Census of Agriculture. We linked data by zip code and derived incidence rate ratios using negative binomial regression models. RESULTS: Community socioeconomic and environmental factors were associated with both lower and higher campylobacteriosis rates. Zip codes with higher percentages of African Americans had lower rates of campylobacteriosis (incidence rate ratio [IRR]) = 0.972; 95 % confidence interval (CI) = 0.970,0.974). In Georgia, Maryland, and Tennessee, three leading broiler chicken producing states, zip codes with broiler operations had incidence rates that were 22 % (IRR = 1.22; 95 % CI = 1.03,1.43), 16 % (IRR = 1.16; 95 % CI = 0.99,1.37), and 35 % (IRR = 1.35; 95 % CI = 1.18,1.53) higher, respectively, than those of zip codes without broiler operations. In Minnesota and New York FoodNet counties, two top dairy producing areas, zip codes with dairy operations had significantly higher campylobacteriosis incidence rates (IRR = 1.37; 95 % CI = 1.22, 1.55; IRR = 1.19; 95 % CI = 1.04,1.36). CONCLUSIONS: Community socioeconomic and environmental factors are important to consider when evaluating the relationship between possible risk factors and Campylobacter infection. |
An integrated genomic and transcriptomic survey of mucormycosis-causing fungi.
Chibucos MC , Soliman S , Gebremariam T , Lee H , Daugherty S , Orvis J , Shetty AC , Crabtree J , Hazen TH , Etienne KA , Kumari P , O'Connor TD , Rasko DA , Filler SG , Fraser CM , Lockhart SR , Skory CD , Ibrahim AS , Bruno VM . Nat Commun 2016 7 12218 Mucormycosis is a life-threatening infection caused by Mucorales fungi. Here we sequence 30 fungal genomes, and perform transcriptomics with three representative Rhizopus and Mucor strains and with human airway epithelial cells during fungal invasion, to reveal key host and fungal determinants contributing to pathogenesis. Analysis of the host transcriptional response to Mucorales reveals platelet-derived growth factor receptor B (PDGFRB) signaling as part of a core response to divergent pathogenic fungi; inhibition of PDGFRB reduces Mucorales-induced damage to host cells. The unique presence of CotH invasins in all invasive Mucorales, and the correlation between CotH gene copy number and clinical prevalence, are consistent with an important role for these proteins in mucormycosis pathogenesis. Our work provides insight into the evolution of this medically and economically important group of fungi, and identifies several molecular pathways that might be exploited as potential therapeutic targets. |
Complete Genome Sequences of Three Outbreak-Associated Legionella pneumophila Isolates.
Morrison SS , Desai HP , Mercante JW , Lapierre P , Raphael BH , Musser K , Winchell JM . Genome Announc 2016 4 (4) We report here the complete genome sequences of three Legionella pneumophila isolates that are associated with a Legionnaires' disease outbreak in New York in 2012. Two clinical isolates (D7630 and D7632) and one environmental isolate (D7631) were recovered from this outbreak. A single isolate-specific virulence gene was found in D7632. These isolates were included in a large study evaluating the genomic resolution of various bioinformatics approaches for L. pneumophila serogroup 1 isolates. |
Multilocus Sequence Typing Tool for Cyclospora cayetanensis.
Guo Y , Roellig DM , Li N , Tang K , Frace M , Ortega Y , Arrowood MJ , Feng Y , Qvarnstrom Y , Wang L , Moss DM , Zhang L , Xiao L . Emerg Infect Dis 2016 22 (8) 1464-7 Because the lack of typing tools for Cyclospora cayetanensis has hampered outbreak investigations, we sequenced its genome and developed a genotyping tool. We observed 2 to 10 geographically segregated sequence types at each of 5 selected loci. This new tool could be useful for case linkage and infection/contamination source tracking. |
Promoting adolescent health through triadic interventions
Dittus PJ . J Adolesc Health 2016 59 (2) 133-4 Adolescents have a range of health care needs including receipt of recommended vaccinations and clinical preventive services and counseling to prevent or reduce risk behaviors and negative health outcomes, both during adolescence and later in life [1]. However, less than half of adolescents get preventive health care visits [2], less than three quarters of those have a sexual history taken (with internal medicine specialists being the least likely to take a sexual history), and even fewer receive recommended sexual and reproductive health services such as HPV vaccination, sexually transmitted disease testing, and effective contraception [3]. This may be due, in part, to inadequate time spent alone between adolescent patients and their physicians [4], as adolescents and their physicians are less likely to discuss any sex-related topics when a parent is present at the visit. Physician and patient discomfort in discussing sensitive topics such as sexual health, and inadequate time for the clinical encounter to allow for risk assessment and prevention counseling, have also been associated with fewer discussions about sexual topics and lower receipt of services [5,6]. | For many adolescents, particularly those at higher risk, assurances of confidentiality will continue to be important when seeking sensitive services [7]. However, there is some evidence to suggest that directly involving parents in adolescents’ health care can lead to positive outcomes, particularly for children with special health needs [8], and some have advocated for parental involvement in adolescents’ reproductive health decisions [9]. In addition, adolescents want to receive information about sexual and reproductive health from their parents. In a national survey, young people aged 15−17 years listed parents as a main source of information about a variety of topics related to sexual health, including decisions about sex, pregnancy, and preventing sexual violence, and named parents and doctors and other health care providers as their most trusted and accurate sources of information [10]. Thus, triadic interventions, or provider-initiated efforts targeting adolescents and their families, may represent an effective means of addressing a variety of health topics important for adolescents. |
A roundtable discussion: combating the complex challenge of healthcare-associated infections
Loughlin S , Alfa M , Arduino M , Gaffey A , Kumar A , Scott P , Swenson D , Tomac D , Waldowski L . Biomed Instrum Technol 2016 50 (4) 282-8 Sean Loughlin Why has concern regarding healthcare-associated infections (HAIs) escalated in recent years? | Donna Swenson One reason is simply because awareness of the problem has increased. The problem has existed for a long time, but people are more aware of it because of media attention, particularly in regard to duodenoscopes. Also, medical devices have become far more complex than they used to be, which has raised questions about how to reprocess reusable devices effectively. Finally, we are seeing problems with antibiotic-resistant bacteria. Bacteria have evolved; we've been attacking them, but they have developed defense mechanisms. As a result, our antibiotics aren't as effective as they used to be. | Michelle Alfa Some HAIs that are related to reservoirs or contaminated medical devices are preventable, and awareness of this has increased. So, we're seeing more attention given to the concept of exogenous infections, where the organisms are being introduced from the environment or from contaminated medical devices into the patient while they're in the hospital. This is very different from endogenous infections where the patient's own normal flora are causing an infection. I would agree that multiantibiotic-resistant organisms are one of the reasons that we're more aware of the issue, and that's because we can specifically track these multiresistant microorganisms and know that they are more likely coming from an exogenous source. Because of their unusual antimicrobial resistance profile, it triggers an infection control investigation. If a hospital has five cases of carbapenem-resistant Enterobacteriaceae (CRE), this suggests there may be a point-source issue. Finally, the world is “flat” in terms of the spread of infectious diseases—essentially we're only “one flight away” from the next multiantibiotic-resistant organism being on our doorstep. We certainly don't want such multiresistant organisms entering our healthcare facilities and causing HAIs. So we have to be vigilant, ensuring early detection, monitoring, tracking, and preventing the spread of multiresistant organisms as quickly as possible. | Ann Gaffey Patient safety has always been a top priority for hospitals, and we all are quite aware of the 1999 Institute of Medicine (IOM) report, To Err is Human: Building a Safer Health System, which focused on preventing patient harm, as well as subsequent data that have been presented. So, we have more information to look at. At a local level, we see the advantages of incident and event reporting systems. Also, data that are being fed into the patient safety organizations are helping us to identify and address these issues. Recognition has increased that patient safety should really be top of mind for folks who are looking at HAIs and other events that could cause patient harm. | Matt Arduino Awareness of HAIs really didn't gain traction in the community until the publication of the IOM report in 1999, which stated that about 98,000 deaths a year result from preventable events and errors in healthcare facilities, of which HAIs are a part. In 1999, this translated to about $29 billion a year. Since that report, we now have public reporting through the Department of Health & Human Services (HHS), which also has an action plan for reducing infections. We have the Centers for Medicare & Medicaid Services requirement for conditions of participation for facilities to report data. However, a problem is that not all HAIs are captured through those mechanisms. | Lisa Waldowski Other aspects that have resulted in increased attention include medical device and equipment recalls, along with regulatory and federal agencies making the prevention of HAIs a priority by updating their respective guidelines, as well as communications through advisories, alerts, and other related materials. In addition, the terminology has changed from “hospital-acquired infections” to “healthcare-associated infections,” which underscores the fact that this problem is not isolated to hospitals. |
Multistate US outbreak of rapidly growing mycobacterial infections associated with medical tourism to the Dominican Republic, 2013-2014(1)
Schnabel D , Esposito DH , Gaines J , Ridpath A , Barry MA , Feldman KA , Mullins J , Burns R , Ahmad N , Nyangoma EN , Nguyen DB , Perz JF , Moulton-Meissner HA , Jensen BJ , Lin Y , Posivak-Khouly L , Jani N , Morgan OW , Brunette GW , Pritchard PS , Greenbaum AH , Rhee SM , Blythe D , Sotir M . Emerg Infect Dis 2016 22 (8) 1340-7 During 2013, the Maryland Department of Health and Mental Hygiene in Baltimore, MD, USA, received report of 2 Maryland residents whose surgical sites were infected with rapidly growing mycobacteria after cosmetic procedures at a clinic (clinic A) in the Dominican Republic. A multistate investigation was initiated; a probable case was defined as a surgical site infection unresponsive to therapy in a patient who had undergone cosmetic surgery in the Dominican Republic. We identified 21 case-patients in 6 states who had surgery in 1 of 5 Dominican Republic clinics; 13 (62%) had surgery at clinic A. Isolates from 12 (92%) of those patients were culture-positive for Mycobacterium abscessus complex. Of 9 clinic A case-patients with available data, all required therapeutic surgical intervention, 8 (92%) were hospitalized, and 7 (78%) required ≥3 months of antibacterial drug therapy. Healthcare providers should consider infection with rapidly growing mycobacteria in patients who have surgical site infections unresponsive to standard treatment. |
Employment and socioeconomic factors associated with children's up-to-date vaccination status
Chen W , Elam-Evans LD , Hill HA , Yankey D . Clin Pediatr (Phila) 2016 56 (4) 348-356 This study examined whether additional information on parents' employment and household characteristics would help explain the differences in children's up-to-date (UTD) vaccination status using the 2008 National Immunization Survey and its associated Socioeconomic Status Module. After controlling for basic sociodemographic factors in multivariable analyses, parent's work schedules and ease of taking time off from work were not associated with UTD vaccination status among 19- to 35-month-old children. We also conducted a stratified analysis to test the heterogeneous effects of the factors among children at 3 age-restricted maternal education levels and found the benefit of paid sick leave had a significant association only among families where the mother had a college degree. Families who had moved since the child's birth, especially if the mother had high school or lower education, were less likely to have children UTD on the vaccine series. |
Adverse events following pandemic influenza A (H1N1) 2009 monovalent and seasonal influenza vaccinations during the 2009-2010 season in the active component U.S. military and civilians aged 17-44 years reported to the Vaccine Adverse Event Reporting System
Bardenheier BH , Duderstadt SK , Engler RJ , McNeil MM . Vaccine 2016 34 (37) 4406-14 BACKGROUND: No comparative review of Vaccine Adverse Event Reporting System (VAERS) submissions following pandemic influenza A (H1N1) 2009 and seasonal influenza vaccinations during the pandemic season among U.S. military personnel has been published. METHODS: We compared military vs. civilian adverse event reporting rates. Adverse events (AEs) following vaccination were identified from VAERS for adults aged 17-44years after pandemic (monovalent influenza [MIV], and seasonal (trivalent inactivated influenza [IIV3], live attenuated influenza [LAIV3]) vaccines. Military vaccination coverage was provided by the Department of Defense's Defense Medical Surveillance System. Civilian vaccination coverage was estimated using data from the National 2009 H1N1 Flu Survey and the Behavioral Risk Factor Surveillance System survey. RESULTS: Vaccination coverage was more than four times higher for MIV and more than twenty times higher for LAIV3 in the military than in the civilian population. The reporting rate of serious AE reports following MIV in service personnel (1.19 per 100,000) was about half that reported by the civilian population (2.45 per 100,000). Conversely, the rate of serious AE reports following LAIV3 among service personnel (1.32 per 100,000) was more than twice that of the civilian population. Although fewer military AEs following MIV were reported overall, the rate of Guillain-Barre Syndrome (GBS) (4.01 per million) was four times greater than that in the civilian population. (1.04 per million). CONCLUSIONS: Despite higher vaccination coverage in service personnel, the rate of serious AEs following MIV was about half that in civilians. The rate of GBS reported following MIV was higher in the military. |
Psychopathy traits and violent assault among men with and without history of arrest
Reidy DE , Lilienfeld SO , Berke DS , Gentile B , Zeichner A . J Interpers Violence 2016 34 (12) 2438-2457 Although research suggests that the antisocial behavior (ASB) facet of psychopathy generally carries the greatest predictive power for future violence, these findings are drawn primarily from forensic samples and may reflect criterion contamination between historical violence and future violence perpetration. Likewise, these findings do not negate the association of other psychopathy facets to violence or their role in the development of violence, nor do they offer practical utility in the primary prevention of violence. There are a number of empirical and theoretical reasons to suspect that the callous affect (CA) facet of psychopathy may demonstrate stronger statistical association to violence in nonforensic populations. We tested the association of CA to severe acts of violence (e.g., assault with intent to harm, injure, rape, or kill) among men with and without history of arrest (N = 600) using both the three- and four-facet models of psychopathy. CA was robustly associated with violence outcomes across the two groups in the three-facet model. When testing the four-facet model, CA was strongly associated with violence outcomes among men with no history of arrest, but only moderately associated with assaults causing injury among men with history of arrest. These results are consistent with data from youth populations that implicate early emotional deficits in later aggressive behavior and suggest CA may help to identify individuals at risk for violence before they become violent. Implications for the public health system and the primary prevention of violence are discussed. |
The relationship of adverse childhood events to smoking, overweight, obesity and binge drinking among women in Hawaii
Remigio-Baker RA , Hayes DK , Reyes-Salvail F . Matern Child Health J 2016 21 (2) 315-325 OBJECTIVES: To evaluate how the associations of adverse childhood events (ACEs) with smoking, overweight, obesity and binge drinking differ by race/ethnicity among women, including a large, understudied cohort of Asians and Native Hawaiians/Pacific Islanders (NHOPIs). METHODS: The number and type (household dysfunction, and physical, verbal and sexual abuse) of ACEs were examined in relation to adulthood smoking, overweight, obesity and binge drinking among 3354 women in Hawaii using the 2010 Behavioral Risk Factor Surveillance System data using Poisson regression with robust error variance. We additionally investigated for interaction by race/ethnicity. Covariates included age, race/ethnicity, education, emotional support, healthcare coverage, and the other health outcomes. RESULTS: Overall, 54.9 % reported at least 1 ACE. The prevalence of smoking (PR = 1.40 (1 ACE) to PR = 2.55 [5+ ACEs]), overweight (PR = 1.22 [1 ACE] to PR = 1.31 [5+ ACEs]) and obesity (PR = 1.00 [1 ACE] to PR = 1.85 [5+ ACEs]) increased with increasing ACE count. Smoking was associated with household dysfunction (PR = 1.67, CI = 1.26-2.22), and physical (PR = 2.04, CI = 1.50-2.78) and verbal (PR = 1.62, CI = 1.25-2.10) abuse. Obesity was also significantly related to household dysfunction (PR = 1.22, CI = 1.01-1.48), and physical (PR = 1.36, CI = 1.10-1.70), verbal (PR = 1.35, CI = 1.11-1.64) and sexual (PR = 1.53, CI = 1.25-1.88) abuse. Among Asians, sexual abuse was associated with a lower prevalence of binge drinking (PR = 0.26, CI = 0.07-0.93), which was significantly different from the null association among Whites (interaction p = 0.02). CONCLUSION: Preventing/addressing ACEs may help optimize childhood health, and reduce the likelihood of smoking/obesity among women including Asians/NHOPIs. Further studies are warranted to evaluate the sexual abuse-binge drinking association among Asians, which may support the need for culturally-tailored programs to address ACEs. |
Graduated driver licensing night driving restrictions and drivers aged 16 or 17 years involved in fatal night crashes - United States, 2009-2014
Shults RA , Williams AF . MMWR Morb Mortal Wkly Rep 2016 65 (29) 725-30 Fatal crash risk is higher at night for all drivers, but especially for young, inexperienced drivers (1). To help address the increased crash risk for beginner teen drivers, 49 states and the District of Columbia include a night driving restriction (NDR) in their Graduated Driver Licensing (GDL) system. NDRs have been shown to reduce crashes among newly licensed teens, with higher reductions associated with NDRs starting at 10:00 p.m. or earlier (2-3). However, in 23 states and the District of Columbia, NDRs begin at 12:00 a.m. or later, times when most teen drivers subject to GDL are not driving. CDC analyzed 2009-2014 national and state-level data from the Fatality Analysis Reporting System (FARS) to determine the proportion of drivers aged 16 or 17 years involved in fatal crashes who crashed at night (9:00 p.m.-5:59 a.m.) and the proportion of these drivers who crashed before 12:00 a.m. Nationwide, among 6,104 drivers aged 16 or 17 years involved in fatal crashes during 2009-2014, 1,865 (31%) were involved in night crashes. Among drivers involved in night crashes, 1,054 (57%) crashed before 12:00 a.m. State-level analyses revealed an approximately twofold variation among states in both the proportions of drivers aged 16 or 17 years involved in fatal crashes that occurred at night and the proportions of night fatal crash involvements that occurred before 12:00 a.m. Because nearly all of the night driving trips taken by drivers aged 16 or 17 years end before 12:00 a.m., NDRs beginning at 12:00 a.m. or later provide minimal protection. States could consider updating their NDR coverage to include earlier nighttime hours. This descriptive report summarizes the characteristics of NDRs, estimates the extent to which drivers aged 16 or 17 years drive at night, and describes their involvement in fatal nighttime crashes during 2009-2014. The effects of NDRs on crashes were not evaluated because of the small state-level sample sizes during the 6-year study period. |
RSV Growth and Quantification by Microtitration and qRT-PCR Assays.
Caidi H , Harcourt JL , Haynes LM . Methods Mol Biol 2016 1442 13-32 Defective interfering viral particles have been reported as important determinants of the course of viral infection, and they can markedly temper the virulence of the infection. Here, we describe a simple method, based on limiting dilution, for the removal of defective interfering particles from RSV. This method results in a high-titer viral preparation from both HEp-2 and Vero cell lines. We evaluated two concentrations of sucrose to stabilize the virus preparation, and demonstrate that RSV is stable when prepared and stored in 25 % sucrose at -152 degrees C. In addition, this chapter describes some commonly used methods of RSV titration, detection using microtitration and quantitative real-time RT-PCR, and the use of immunostaining for antigenic characterization. |
Rapamycin does not impede survival or induction of antibody responses to primary and heterosubtypic influenza infections in mice
Liepkalns JS , Pandey A , Hofstetter AR , Kumar A , Jones EN , Cao W , Liu F , Levine MZ , Sambhara S , Gangappa S . Viral Immunol 2016 29 (8) 487-493 Impairment of immune defenses can contribute to severe influenza infections. Rapamycin is an immunosuppressive drug often used to prevent transplant rejection and is currently undergoing clinical trials for treating cancers and autoimmune diseases. We investigated whether rapamycin has deleterious effects during lethal influenza viral infections. We treated mice with two concentrations of rapamycin and infected them with A/Puerto Rico/8/1934 (A/PR8), followed by a heterosubtypic A/Hong Kong/1/68 (A/HK68) challenge. Our data show similar morbidity, mortality, and lung viral titer with both rapamycin treatment doses compared to untreated controls, with a delay in morbidity onset in rapamycin high dose recipients during primary infection. Rapamycin treatment at high dose also led to increase in percent cytokine producing T cells in the spleen. However, all infected animals had similar serum antibody responses against A/PR8. Post-A/HK68 challenge, rapamycin had no impeding effect on morbidity or mortality and had similar serum antibody levels against A/PR8 and A/HK68. We conclude that rapamycin treatment does not adversely affect morbidity, mortality, or antibody production during lethal influenza infections. |
Evaluation of commercial assays for single-point diagnosis of pertussis in the US
Pawloski LC , Plikaytis BD , Martin MD , Martin SW , Prince HE , Lape-Nixon M , Tondella ML . J Pediatric Infect Dis Soc 2016 6 (3) e15-e21 BACKGROUND: Pertussis serodiagnosis is increasingly being used in the United States despite the lack of a US Food and Drug Administration-approved, commercially available assay. To better understand the utility of these assays in diagnosing pertussis, serology assays were evaluated for analytical parameters and clinical accuracy. METHODS: Forty-three antigen-antibody combinations were evaluated for single-point diagnosis of pertussis. Serum panels included sera from laboratory-confirmed cases, an international reference standard, and healthy donors. Phase I panel (n = 20) of sera was used to assess precision, linearity, and accuracy; Phase II panel (n = 226) followed with positive percent agreement (PPA) and negative percent agreement (NPA) estimates. Analytical analyses included coefficients of variation (CV) and concordance correlation coefficients (rc). RESULTS: Intra-analyst variability was found to be relatively low among samples per assay, with only 6% (78 of 1240) having CV >20%, primarily with the highly concentrated immunoglobulin (Ig)G anti-pertussis toxin (PT) specimens and IgM assays. The rc measurements to assess linearity ranged between 0.282 and 0.994, 0.332 and 0.999, and -0.056 and 0.482 for IgA, IgG, and IgM, respectively. Analytical accuracy for calibrated IgG anti-PT assays was 86%-115%. The PPA and NPA varied greatly for all assays; PPA/NPA ranges for IgA, IgG, and IgM assays, with culture and/or polymerase chain reaction positivity as control, were 29-90/13-100, 26-96/27-100, and 0-73/42-100, respectively. In IgG assays, mixing filamentous hemagglutinin antigen with PT increased PPA but decreased NPA. CONCLUSIONS: Seroassays varied substantially under both analytical and clinical parameters; however, those that were calibrated to a reference standard were highly accurate. Our findings support incorporation of calibrated pertussis seroassays to the pertussis case definition for improved diagnosis and surveillance. |
Chemoprophylaxis with oral emtricitabine and tenofovir alafenamide combination protects macaques from rectal SHIV infection
Massud I , Mitchell J , Babusis D , Deyounks F , Ray AS , Rooney JF , Heneine W , Miller MD , Garcia-Lerma JG . J Infect Dis 2016 214 (7) 1058-62 Tenofovir alafenamide (TAF) is a novel prodrug of tenofovir that efficiently delivers tenofovir-diphosphate to lymphoid cells following oral administration. We investigated if the combination of TAF and emtricitabine (FTC) could prevent simian HIV (SHIV) infection in macaques to determine the potential use of TAF for HIV pre-exposure prophylaxis (PrEP). Macaques were exposed rectally to SHIV once a week for up to 19 weeks and received saline or FTC/TAF 24h before and 2h after each virus inoculation. All 6 controls were infected, while the 6 PrEP-treated animals were protected from infection. Our results support the clinical investigation of FTC/TAF for PrEP. |
Systematic review of the manifestations of congenital rubella syndrome in infants and characterization of disability-adjusted life years (DALYs)
Simons EA , Reef SE , Cooper LZ , Zimmerman L , Thompson KM . Risk Anal 2016 36 (7) 1332-56 Congenital rubella syndrome (CRS) continues to cause disability among unvaccinated populations in countries with no or insufficient rubella vaccine coverage to prevent transmission. We systematically reviewed the literature on birth outcomes associated with CRS to estimate the duration, severity, and frequency of combinations of morbidities. We searched PubMed, the Science Citation Index, and references from relevant articles for studies in English with primary data on the frequency of CRS manifestations for ≥20 cases and identified 65 studies representing 66 study populations that met our inclusion criteria. We abstracted available data on CRS cases with one or more hearing, heart, and/or eye defect following maternal rubella infection during the period of 0-20 weeks since the last menstrual period. We assessed the quality and weight of the available evidence using a modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Most of the evidence originates from studies in developed countries of cohorts of infants identified with CRS in the 1960s and 1970s, prior to the development of standardized definitions for CRS and widespread use of vaccine. We developed estimates of undiscounted disability-adjusted life years (DALYs) lost per CRS case for countries of different income levels. The estimates ranged from approximately 19 to 39 for high-income countries assuming optimal treatment and from approximately 29 to 39 DALYs lost per CRS case in low- and lower- middle-income countries assuming minimal treatment, with the lower bound based on 2010 general global burden of disease disability weights and the upper bound based on 1990 age-specific and treatment-specific global burden of disease disability weights. Policymakers and analysts should appreciate the significant burden of disability caused by CRS as they evaluate opportunities to manage rubella. |
Early elevation in interleukin-6 is associated with reduced growth in extremely low birth weight infants
Denson LA , McDonald SA , Das A , Schendel DE , Skogstrand K , Hougaard DM , Shankaran S , Higgins RD , Carlo WA , Ehrenkranz RA . Am J Perinatol 2016 34 (3) 240-247 Objective To determine whether reduced growth velocity (GV) in extremely low birth weight infants is preceded by elevated inflammatory cytokines. Study Design GV was determined at 36 weeks' postmenstrual age (PMA) in 768 infants 401 to 1,000 g birth weight (BW). Association between blood cytokines measured through day of life 21 and GV was explored using linear regression models that adjusted for late-onset sepsis (LOS), BW, small for gestational age (SGA), gender, race, energy intake, and center. Results Serum interleukin-6 (IL-6) was increased at days 14 and 21 in LOS infants. LOS was associated with reduced energy intake and GV for weight (weight-GV) at 36 weeks' PMA. Linear regression analysis controlling for LOS and energy intake showed significant relationships between increased IL-6 at days 14 and 21 with reduced weight-GV at 36 weeks' PMA (p < 0.0001). The relationship between day 21 IL-6 and weight-GV was not associated with LOS (p = 0.12) when controlling for BW and energy intake. Both BW (p = 0.02) and energy intake (p = 0.003) influenced the relationship between day 14 IL-6 and weight-GV. Conclusion IL-6 elevation during the first month of life is associated with lower weight-GV at 36 weeks' PMA and may have a direct effect upon energy balance and postnatal growth. |
Five-year progress update on the Surgeon General's Call to Action to Support Breastfeeding, 2011
Anstey EH , MacGowan CA , Allen JA . J Womens Health (Larchmt) 2016 25 (8) 768-76 In 2011, Surgeon General Regina Benjamin issued a Call to Action to Support Breastfeeding (Call to Action) in an effort to mobilize families, communities, clinicians, healthcare systems, and employers to take action to improve support for breastfeeding. The Call to Action identified 20 key action steps to address society-wide breastfeeding barriers in six areas: mothers and families, communities, healthcare, employment, research, and public health infrastructure. This report highlights major federal activities that show progress toward answering the Call to Action in the first 5 years since its launch. |
Global burden of maternal and congenital syphilis in 2008 and 2012: a health systems modelling study
Wijesooriya NS , Rochat RW , Kamb ML , Turlapati P , Temmerman M , Broutet N , Newman LM . Lancet Glob Health 2016 4 (8) e525-33 BACKGROUND: In 2007, WHO launched a global initiative for the elimination of mother-to-child transmission of syphilis (congenital syphilis). An important aspect of the initiative is strengthening surveillance to monitor progress towards elimination. In 2008, using a health systems model with country data inputs, WHO estimated that 1.4 million maternal syphilis infections caused 520 000 adverse pregnancy outcomes. To assess progress, we updated the 2008 estimates and estimated the 2012 global prevalence and cases of maternal and congenital syphilis. METHODS: We used a health systems model approved by the Child Health Epidemiology Reference Group. WHO and UN databases provided inputs on livebirths, antenatal care coverage, and syphilis testing, seropositivity, and treatment in antenatal care. For 2012 estimates, we used data collected between 2009 and 2012. We updated the 2008 estimates using data collected between 2000 and 2008, compared these with 2012 estimates using data collected between 2009 and 2012, and performed subanalyses to validate results. FINDINGS: In 2012, an estimated 930 000 maternal syphilis infections caused 350 000 adverse pregnancy outcomes including 143 000 early fetal deaths and stillbirths, 62 000 neonatal deaths, 44 000 preterm or low weight births, and 102 000 infected infants worldwide. Nearly 80% of adverse outcomes (274 000) occurred in women who received antenatal care at least once. Comparing the updated 2008 estimates with the 2012 estimates, maternal syphilis decreased by 38% (from 1 488 394 cases in 2008 to 927 936 cases in 2012) and congenital syphilis decreased by 39% (from 576 784 to 350 915). India represented 65% of the decrease. Analysis excluding India still showed an 18% decrease in maternal and congenital cases of syphilis worldwide. INTERPRETATION: Maternal and congenital syphilis decreased worldwide from 2008 to 2012, which suggests progress towards the elimination of mother-to-child transmission of syphilis. Nonetheless, maternal syphilis caused substantial adverse pregnancy outcomes, even in women receiving antenatal care. Improved access to quality antenatal care, including syphilis testing and treatment, and robust data are all important for achieving the elimination of mother-to-child transmission of syphilis. FUNDING: The UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction in WHO, and the US Centers for Disease Control and Prevention. |
Characterization of the risks of adverse outcomes following rubella infection in pregnancy
Thompson KM , Simons EA , Badizadegan K , Reef SE , Cooper LZ . Risk Anal 2016 36 (7) 1315-31 Although most infections with the rubella virus result in relatively minor sequelae, rubella infection in early pregnancy may lead to severe adverse outcomes for the fetus. First recognized in 1941, congenital rubella syndrome (CRS) can manifest with a diverse range of symptoms, including congenital cataracts, glaucoma, and cardiac defects, as well as hearing and intellectual disability. The gestational age of the fetus at the time of the maternal rubella infection impacts the probability and severity of outcomes, with infection in early pregnancy increasing the risks of spontaneous termination (miscarriage), fetal death (stillbirth), birth defects, and reduced survival for live-born infants. Rubella vaccination continues to change the epidemiology of rubella and CRS globally, but no models currently exist to evaluate the economic benefits of rubella management. This systematic review provides an overall assessment of the weight of the evidence for the outcomes associated with rubella infections in the first 20 weeks of pregnancy. We identified, evaluated, and graded 31 studies (all from developed countries) that reported on the pregnancy outcomes of at least 30 maternal rubella infections. We used the available evidence to estimate the increased risks of spontaneous termination, fetal death, infant death, and CRS as a function of the timing of rubella infection in pregnancy and decisions about induced termination. These data support the characterization of the disability-adjusted life years for outcomes associated with rubella infection in pregnancy. We find significant impacts associated with maternal rubella infections in early pregnancy, which economic analyses will miss if they only focus on live births of CRS cases. Our estimates of fetal loss from increased induced terminations due to maternal rubella infections provide context that may help to explain the relatively low numbers of observed CRS cases per year despite potentially large burdens of disease. Our comprehensive review of the weight of the evidence of all pregnancy outcomes demonstrates the importance of including all outcomes in models that characterize rubella-related disease burdens and costs. |
Declines in traditional marine food intake and vitamin D levels from the 1960s to present in young Alaska Native women
O'Brien DM , Thummel KE , Bulkow LR , Wang Z , Corbin B , Klejka J , Hopkins SE , Boyer BB , Hennessy TW , Singleton R . Public Health Nutr 2016 20 (10) 1-8 OBJECTIVE: To measure the trends in traditional marine food intake and serum vitamin D levels in Alaska Native women of childbearing age (20-29 years old) from the 1960s to the present. DESIGN: We measured a biomarker of traditional food intake, the delta15N value, and vitamin D level, as 25-hydroxycholecalciferol (25(OH)D3) concentration, in 100 serum samples from 20-29-year-old women archived in the Alaska Area Specimen Bank, selecting twenty-five per decade from the 1960s to the 1990s. We compared these with measurements of red-blood-cell delta15N values and serum 25(OH)D3 concentrations from 20-29-year-old women from the same region collected during the 2000s and 2010s in a Center for Alaska Native Health Research study. SETTING: The Yukon Kuskokwim Delta region of south-west Alaska. SUBJECTS: Alaska Native women (n 319) aged 20-29 years at the time of specimen collection. RESULTS: Intake of traditional marine foods, as measured by serum delta15N values, decreased significantly each decade from the 1960s through the 1990s, then remained constant from the 1990s through the present (F 5,306=77.4, P<0.0001). Serum vitamin D concentrations also decreased from the 1960s to the present (F 4,162=26.1, P<0.0001). CONCLUSIONS: Consumption of traditional marine foods by young Alaska Native women dropped significantly between the 1960s and the 1990s and was associated with a significant decline in serum vitamin D concentrations. Studies are needed to evaluate the promotion of traditional marine foods and routine vitamin D supplementation during pregnancy for this population. |
Appreciation: Philip S. Brachman, 1927-2016
Flannery B , Del Rio C . Int J Epidemiol 2016 45 (3) 602-4 I have gone to heaven to teach an epidemiology course. At this point no return is planned… So we imagine his parting message. Philip Brachman served on the editorial board of the IJE from 1991 during the tenure of Peter Pharaoh as editor, until 2014 with George Davey Smith and Shah Ebrahim. He began when associate editors sent letters and thick envelopes to invited reviewers, and acknowledged their contributions on postcards; when he stepped down, all of these functions were done electronically, depriving his correspondents of his neatly hand-written notes. Not immune to bias, he stated in 2014 that IJE was his favorite epidemiology journal. One of his regrets was that he had not been able in all those years to attend a single meeting of the editorial board, most likely because of conflicts with his teaching schedule. Because, first and foremost, Philip was an educator. His concern was not just science but rather people, and how that science could change the quality of life for people. His is a great legacy. |
Research to practice implications of high-risk genotypes for beryllium sensitization and disease
Kreiss K , Fechter-Leggett ED , McCanlies EC , Schuler CR , Weston A . J Occup Environ Med 2016 58 (9) 855-60 OBJECTIVE: Beryllium workers may better understand their genetic susceptibility to chronic beryllium disease (CBD) expressed as population-based prevalence, rather than odds ratios from case-control studies. METHODS: We calculated CBD prevalences from allele-specific DNA sequences of 853 workers for Human Leukocyte Antigen (HLA)-DPB1 genotypes and groups characterized by number of E69-containing alleles and by calculated surface electronegativity of HLA-DPB1. RESULTS: Of 18 groups of at least 10 workers with specific genotypes, CBD prevalence was highest, 72.7%, for the HLA-DPB102:01:02/DPB117:01 genotype. Population-based grouped genotypes with two E69 alleles wherein one allele had -9 surface charge had a beryllium sensitization (BeS) of 52.6% and a CBD prevalence of 42.1%. CONCLUSIONS: The high CBD and BeS prevalences associated with -9-charged E69 alleles and two E69s suggest that workers may benefit from knowing their genetic susceptibility in deciding whether to avoid future beryllium exposure. |
Prevalence of respiratory protective devices in U.S. health care facilities: implications for emergency preparedness
Wizner K , Stradtman L , Novak D , Shaffer R . Workplace Health Saf 2016 64 (8) 359-68 An online questionnaire was developed to explore respiratory protective device (RPD) prevalence in U.S. health care facilities. The survey was distributed to professional nursing society members in 2014 and again in 2015 receiving 322 and 232 participant responses, respectively. The purpose of this study was to explore if the emergency preparedness climate associated with Ebola virus disease changed the landscape of RPD use and awareness. Comparing response percentages from the two sampling time frames using bivariate analysis, no significant changes were found in types of RPDs used in health care settings. N95 filtering facepiece respirators continue to be the most prevalent RPD used in health care facilities, but powered air-purifying respirators are also popular, with regional use highest in the West and Midwest. Understanding RPD use prevalence could ensure that health care workers receive appropriate device trainings as well as improve supply matching for emergency RPD stockpiling. |
Hearing protector fit testing with off-shore oil-rig inspectors in Louisiana and Texas
Murphy WJ , Themann CL , Murata TK . Int J Audiol 2016 55 (11) 1-11 OBJECTIVE: This field study aimed to assess the noise reduction of hearing protection for individual workers, demonstrate the effectiveness of training on the level of protection achieved, and measure the time required to implement hearing protector fit testing in the workplace. DESIGN: The National Institute for Occupational Safety and Health (NIOSH) conducted field studies in Louisiana and Texas to test the performance of HPD Well-Fit. STUDY SAMPLE: Fit tests were performed on 126 inspectors and engineers working in the offshore oil industry. RESULTS: Workers were fit tested with the goal of achieving a 25-dB PAR. Less than half of the workers were achieving sufficient protection from their hearing protectors prior to NIOSH intervention and training; following re-fitting and re-training, over 85% of the workers achieved sufficient protection. Typical test times were 6-12 minutes. CONCLUSIONS: Fit testing of the workers' earplugs identified those workers who were and were not achieving the desired level of protection. Recommendations for other hearing protection solutions were made for workers who could not achieve the target PAR. The study demonstrates the need for individual hearing protector fit testing and addresses some of the barriers to implementation. |
Comparing plasma, serum and whole blood indium concentrations from workers at an indium-tin oxide (ITO) production facility
Harvey RR , Virji MA , Edwards NT , Cummings KJ . Occup Environ Med 2016 73 (12) 864-867 OBJECTIVE: Occupational exposure to indium compounds including indium-tin oxide (ITO) can result in potentially fatal indium lung disease. We compared plasma, serum and whole blood indium concentrations (InP, InS and InB) from workers at a single ITO production facility to assess the comparability of these matrices used for biological monitoring of indium exposure. METHOD: InP, InS and InB were measured using inductively coupled mass spectrometry from consenting workers at an ITO production facility with specimen collection occurring during June-July 2014. Matched pairs from workers were assessed to determine the matrix relationships using the Pearson correlation, paired t-tests, per cent difference, linear regression and kappa statistics. RESULTS: Indium matrices were collected from 80 workers. Mean (SD) InP, InS and InB were 3.48 (3.84), 3.90 (4.15) and 4.66 (5.32) mcg/L, respectively. The InS-InP difference was 14%; InS was higher in all but two workers. InP and InS were highly correlated (r=>0.99). The InB-InS difference was 19%; InB was higher in 85% of workers. The InB-InP difference was 34%; InB was higher in 66% of workers. InB was highly correlated with both InP and InS (r=0.97 and 0.96, respectively). kappa Statistics were 0.84, 0.83 and 0.82 for InP, InS and InB, respectively, for individuals with each matrix ≥1 mcg/L (p<0.01). CONCLUSIONS: While all matrices were highly correlated, we encourage the use of InP and InS to reliably compare studies across different populations using different matrices. The higher per cent difference and increased variability of InB may limit its utility in comparisons with InP and InS in different populations. |
Improving mining equipment safety through human-centered design
Horberry T , Burgess-Limerick R , Cooke T , Steiner L . Ergon Des 2016 24 (3) 29-34 The need for human-centered design in the mining industry to help develop safe and fit-for-purpose equipment is first described. A tool that was specifically developed for mobile mining equipment by the authors and colleagues is introduced; it combines the application of participatory ergonomics, qualitative risk management, and safe design. A case study using this tool for mobile mining equipment access and egress is then presented. The case study shows that focusing on end users and their tasks by means of a structured, human-centered process can help to produce safer redesigns of mining equipment. |
Malaria vector research and control in Haiti: a systematic review
Frederick J , Saint Jean Y , Lemoine JF , Dotson EM , Mace KE , Chang M , Slutsker L , Le Menach A , Beier JC , Eisele TP , Okech BA , Beau de Rochars VM , Carter KH , Keating J , Impoinvil DE . Malar J 2016 15 (1) 376 BACKGROUND: Haiti has a set a target of eliminating malaria by 2020. However, information on malaria vector research in Haiti is not well known. This paper presents results from a systematic review of the literature on malaria vector research, bionomics and control in Haiti. METHODS: A systematic search of literature published in French, Spanish and English languages was conducted in 2015 using Pubmed (MEDLINE), Google Scholar, EMBASE, JSTOR WHOLIS and Web of Science databases as well other grey literature sources such as USAID, and PAHO. The following search terms were used: malaria, Haiti, Anopheles, and vector control. RESULTS: A total of 132 references were identified with 40 high quality references deemed relevant and included in this review. Six references dealt with mosquito distribution, seven with larval mosquito ecology, 16 with adult mosquito ecology, three with entomological indicators of malaria transmission, eight with insecticide resistance, one with sero-epidemiology and 16 with vector control. In the last 15 years (2000-2015), there have only been four published papers and three-scientific meeting abstracts on entomology for malaria in Haiti. Overall, the general literature on malaria vector research in Haiti is limited and dated. DISCUSSION: Entomological information generated from past studies in Haiti will contribute to the development of strategies to achieve malaria elimination on Hispaniola. However it is of paramount importance that malaria vector research in Haiti is updated to inform decision-making for vector control strategies in support of malaria elimination. |
Possible role of fish and frogs as paratenic hosts of Dracunculus medinensis, Chad
Eberhard ML , Yabsley MJ , Zirimwabagabo H , Bishop H , Cleveland CA , Maerz JC , Bringolf R , Ruiz-Tiben E . Emerg Infect Dis 2016 22 (8) 1428-30 Copepods infected with Dracunculus medinensis larvae collected from infected dogs in Chad were fed to 2 species of fish and tadpoles. Although they readily ingested copepods, neither species of fish, Nile tilapia (Oreochromis niloticus) nor fathead minnow (Pimephalis promelas), were found to harbor Dracunculus larvae when examined 2-3 weeks later. Tadpoles ingested copepods much more slowly; however, upon examination at the same time interval, tadpoles of green frogs (Lithobates [Rana] clamitans) were found to harbor small numbers of Dracunculus larvae. Two ferrets (Mustela putorius furo) were fed fish or tadpoles that had been exposed to infected copepods. Only the ferret fed tadpoles harbored developing Dracunculus larvae at necropsy 70-80 days postexposure. These observations confirm that D. medinensis, like other species in the genus Dracunculus, can readily survive and remain infective in potential paratenic hosts, especially tadpoles. |
The effectiveness of non-pyrethroid insecticide-treated durable wall lining to control malaria in rural Tanzania: study protocol for a two-armed cluster randomized trial
Mtove G , Mugasa JP , Messenger LA , Malima RC , Mangesho P , Magogo F , Plucinski M , Hashimu R , Matowo J , Shepard D , Batengana B , Cook J , Emidi B , Halasa Y , Kaaya R , Kihombo A , Lindblade KA , Makenga G , Mpangala R , Mwambuli A , Mzava R , Mziray A , Olang G , Oxborough RM , Seif M , Sambu E , Samuels A , Sudi W , Thomas J , Weston S , Alilio M , Binkin N , Gimnig J , Kleinschmidt I , McElroy P , Moulton LH , Norris L , Ruebush T , Venkatesan M , Rowland M , Mosha FW , Kisinza WN . BMC Public Health 2016 16 (1) 633 BACKGROUND: Despite considerable reductions in malaria achieved by scaling-up long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS), maintaining sustained community protection remains operationally challenging. Increasing insecticide resistance also threatens to jeopardize the future of both strategies. Non-pyrethroid insecticide-treated wall lining (ITWL) may represent an alternate or complementary control method and a potential tool to manage insecticide resistance. To date no study has demonstrated whether ITWL can reduce malaria transmission nor provide additional protection beyond the current best practice of universal coverage (UC) of LLINs and prompt case management. METHODS/DESIGN: A two-arm cluster randomized controlled trial will be conducted in rural Tanzania to assess whether non-pyrethroid ITWL and UC of LLINs provide added protection against malaria infection in children, compared to UC of LLINs alone. Stratified randomization based on malaria prevalence will be used to select 22 village clusters per arm. All 44 clusters will receive LLINs and half will also have ITWL installed on interior house walls. Study children, aged 6 months to 11 years old, will be enrolled from each cluster and followed monthly to estimate cumulative incidence of malaria parasitaemia (primary endpoint), time to first malaria episode and prevalence of anaemia before and after intervention. Entomological inoculation rate will be estimated using indoor CDC light traps and outdoor tent traps followed by detection of Anopheles gambiae species, sporozoite infection, insecticide resistance and blood meal source. ITWL bioefficacy and durability will be monitored using WHO cone bioassays and household surveys, respectively. Social and cultural factors influencing community and household ITWL acceptability will be explored through focus-group discussions and in-depth interviews. Cost-effectiveness, compared between study arms, will be estimated per malaria case averted. DISCUSSION: This protocol describes the large-scale evaluation of a novel vector control product, designed to overcome some of the known limitations of existing methods. If ITWL is proven to be effective and durable under field conditions, it may warrant consideration for programmatic implementation, particularly in areas with long transmission seasons and where pyrethroid-resistant vectors predominate. Trial findings will provide crucial information for policy makers in Tanzania and other malaria-endemic countries to guide resource allocations for future control efforts. TRIAL REGISTRATION: NCT02533336 registered on 13 July 2014. |
Development of a pharmacovigilance safety monitoring tool for the rollout of single low-dose primaquine and artemether-lumefantrine to treat Plasmodium falciparum infections in Swaziland: a pilot study
Poirot E , Soble A , Ntshalintshali N , Mwandemele A , Mkhonta N , Malambe C , Vilakati S , Pan S , Darteh S , Maphalala G , Brown J , Hwang J , Pace C , Stergachis A , Vittinghoff E , Kunene S , Gosling R . Malar J 2016 15 (1) 384 BACKGROUND: Countries remain reluctant to adopt the 2012 World Health Organization recommendation for single low-dose (0.25 mg/kg) primaquine (SLD PQ) for Plasmodium falciparum transmission-blocking due to concerns over drug-related haemolysis risk, especially among glucose-6-phosphate dehydrogenase-deficient (G6PDd) people, without evidence demonstrating that it can be safely deployed in their settings. Pharmacovigilance methods provide a systematic way of collecting safety data and supporting the rollout of SLD PQ. METHODS: The Primaquine Roll Out Monitoring Pharmacovigilance Tool (PROMPT), comprising: (1) a standardized form to support the surveillance of possible adverse events following SLD PQ treatment; (2) a patient information card to enhance awareness of known adverse drug reactions of SLD PQ use; and (3) a database compiling recorded information, was developed and piloted. Data on patient characteristics, malaria diagnosis and treatment are collected. Blood samples are taken to measure haemoglobin (Hb) and test for G6PD deficiency. Active follow-up includes a repeat Hb measurement and adverse event monitoring on or near day 7. A 13-month prospective pilot study in two hospital facilities in Swaziland alongside the introduction of SLD PQ generated preliminary evidence on the feasibility and acceptability of PROMPT. RESULTS: PROMPT was well received by nurses as a simple, pragmatic approach to active surveillance of SLD PQ safety data. Of the 102 patients enrolled and administered SLD PQ, none were G6PDd. 93 (91.2 %) returned on or near day 7 for follow-up. Four (4.6 %) patients had falls in Hb ≥25 % from baseline, none of whom presented with signs or symptoms of anaemia. No patient's Hb fell below 7 g/dL and none required a blood transfusion. Of the 11 (11 %) patients who reported an adverse event over the study period, three were considered serious and included two deaths and one hospitalization; none were causally related to SLD PQ. Four non-serious adverse events were considered definitely, probably, or possibly related to SLD PQ. CONCLUSION: Improved pharmacovigilance to monitor and promote the safety of the WHO recommendation is needed. The successful application of PROMPT demonstrates its potential as an important tool to rapidly generate locally acquired safety data and support pharmacovigilance in resource-limited settings. |
Trends in long-acting reversible contraception use in adolescents and young adults: new estimates accounting for sexual experience
Pazol K , Daniels K , Romero L , Warner L , Barfield W . J Adolesc Health 2016 59 (4) 438-42 PURPOSE: The purposes of the analysis were to compare long-acting reversible contraception (LARC) use estimates that include all reproductive age women with estimates that are limited to women at risk for unintended pregnancy and to examine trends for adolescents (15-19 years) and young adults (20-24 years). METHODS: Using the 2006-2010 and 2011-2013 National Surveys of Family Growth, we compared LARC estimates for all women with estimates limited to women at risk for unintended pregnancy (those who were sexually experienced, and neither pregnant, seeking pregnancy, postpartum or infecund). We used t tests to detect differences according to the population included and to evaluate trends for adolescents and young adults. RESULTS: Among adolescents and young adults, 56% and 14%, respectively, have never had vaginal intercourse, versus 1%-4% for women aged 25-44 years. Given the high percentage of adolescents and young adults who never had vaginal intercourse, LARC estimates were higher for these age groups (p < .05), but not for women aged 25-44 years, when limited to those at risk for unintended pregnancy. Among adolescents at risk, the increase in LARC use from 2006-2008 (1.1%) to 2008-2010 (3.6%) was not significant (p = .07), and no further increase occurred from 2008-2010 to 2011-2013 (3.2%); by contrast, among young adults at risk, LARC use increased from 2006-2008 (3.2%) to 2008-2010 (6.9%) and from 2008-2010 to 2011-2013 (11.1%). CONCLUSIONS: Because many adolescents and young adult women have never had vaginal intercourse, for these groups, including all women underestimates LARC use for pregnancy prevention. Among young adults, use of LARC for pregnancy prevention has increased but remains low among adolescents. |
Trends in timing of pregnancy awareness among US women
Branum AM , Ahrens KA . Matern Child Health J 2016 21 (4) 715-726 Objectives Early pregnancy detection is important for improving pregnancy outcomes as the first trimester is a critical window of fetal development; however, there has been no description of trends in timing of pregnancy awareness among US women. Methods We examined data from the 1995, 2002, 2006-2010 and 2011-2013 National Survey of Family Growth on self-reported timing of pregnancy awareness among women aged 15-44 years who reported at least one pregnancy in the 4 or 5 years prior to interview that did not result in induced abortion or adoption (n = 17, 406). We examined the associations between maternal characteristics and late pregnancy awareness (≥7 weeks' gestation) using adjusted prevalence ratios from logistic regression models. Gestational age at time of pregnancy awareness (continuous) was regressed over year of pregnancy conception (1990-2012) in a linear model. Results Among all pregnancies reported, gestational age at time of pregnancy awareness was 5.5 weeks (standard error = 0.04) and the prevalence of late pregnancy awareness was 23 % (standard error = 1 %). Late pregnancy awareness decreased with maternal age, was more prevalent among non-Hispanic black and Hispanic women compared to non-Hispanic white women, and for unintended pregnancies versus those that were intended (p < 0.01). Mean time of pregnancy awareness did not change linearly over a 23-year time period after adjustment for maternal age at the time of conception (p < 0.16). Conclusions for Practice On average, timing of pregnancy awareness did not change linearly during 1990-2012 among US women and occurs later among certain groups of women who are at higher risk of adverse birth outcomes. |
U.S. Medical Eligibility Criteria for Contraceptive Use, 2016
Curtis KM , Tepper NK , Jatlaoui TC , Berry-Bibee E , Horton LG , Zapata LB , Simmons KB , Pagano HP , Jamieson DJ , Whiteman MK . MMWR Recomm Rep 2016 65 (3) 1-103 The 2016 U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC) comprises recommendations for the use of specific contraceptive methods by women and men who have certain characteristics or medical conditions. These recommendations for health care providers were updated by CDC after review of the scientific evidence and consultation with national experts who met in Atlanta, Georgia, during August 26-28, 2015. The information in this report updates the 2010 U.S. MEC (CDC. U.S. medical eligibility criteria for contraceptive use, 2010. MMWR 2010:59 [No. RR-4]). Notable updates include the addition of recommendations for women with cystic fibrosis, women with multiple sclerosis, and women receiving certain psychotropic drugs or St. John's wort; revisions to the recommendations for emergency contraception, including the addition of ulipristal acetate; and revisions to the recommendations for postpartum women; women who are breastfeeding; women with known dyslipidemias, migraine headaches, superficial venous disease, gestational trophoblastic disease, sexually transmitted diseases, and human immunodeficiency virus; and women who are receiving antiretroviral therapy. The recommendations in this report are intended to assist health care providers when they counsel women, men, and couples about contraceptive method choice. Although these recommendations are meant to serve as a source of clinical guidance, health care providers should always consider the individual clinical circumstances of each person seeking family planning services. This report is not intended to be a substitute for professional medical advice for individual patients. Persons should seek advice from their health care providers when considering family planning options. |
U.S. Selected Practice Recommendations for Contraceptive Use, 2016
Curtis KM , Jatlaoui TC , Tepper NK , Zapata LB , Horton LG , Jamieson DJ , Whiteman MK . MMWR Recomm Rep 2016 65 (4) 1-66 The 2016 U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR) addresses a select group of common, yet sometimes controversial or complex, issues regarding initiation and use of specific contraceptive methods. These recommendations for health care providers were updated by CDC after review of the scientific evidence and consultation with national experts who met in Atlanta, Georgia, during August 26-28, 2015. The information in this report updates the 2013 U.S. SPR (CDC. U.S. selected practice recommendations for contraceptive use, 2013. MMWR 2013;62[No. RR-5]). Major updates include 1) revised recommendations for starting regular contraception after the use of emergency contraceptive pills and 2) new recommendations for the use of medications to ease insertion of intrauterine devices. The recommendations in this report are intended to serve as a source of clinical guidance for health care providers and provide evidence-based guidance to reduce medical barriers to contraception access and use. Health care providers should always consider the individual clinical circumstances of each person seeking family planning services. This report is not intended to be a substitute for professional medical advice for individual patients. Persons should seek advice from their health care providers when considering family planning options. |
Co-administration of St. John's wort and hormonal contraceptives: A systematic review
Berry-Bibee EN , Kim MJ , Tepper NK , Riley HE , Curtis KM . Contraception 2016 94 (6) 668-677 OBJECTIVES: St. John's wort (SJW) is a known strong inducer of the cytochrome P450 (CYP) 3 A4 enzyme, and both the ethinyl estradiol and progestin components of hormonal contraceptives are substrates of CYP3A4. This systematic review examined whether the co-administration of SJW and hormonal contraceptives leads to significant safety or efficacy concerns. STUDY DESIGN: Systematic review. METHODS: PubMed and Cochrane Library databases were searched for articles of any comparative study design (clinical or pharmacokinetic) that examined potential interactions between SJW and hormonal contraceptives in women of reproductive age. RESULTS: Of the 48 identified articles, four studies met inclusion criteria and compared use of combined oral contraceptives (COCs) alone to the use of COCs co-administered with SJW. Two studies demonstrated no change in markers of ovulation, but one study demonstrated increased follicular growth and probable ovulation when COCs were co-administered with SJW. Three studies demonstrated an increased risk of breakthrough bleeding with COCs and SJW. Three studies showed changes in at least one pharmacokinetic parameter that suggested a significantly decreased exposure to hormone concentrations when COCs were co-administered with SJW. The only study that did not demonstrate any significant pharmacokinetic differences examined a SJW product containing a low amount of hypericin. CONCLUSION: Limited evidence showing increased risk of ovulation and breakthrough bleeding raises concern for decreased contraceptive efficacy when COCs are co-administered with SJW. The pharmacokinetic evidence is mixed but suggests that SJW administration may be associated with weak to moderate induction of the metabolism of COCs. |
Contraceptive use among women with multiple sclerosis: a systematic review
Zapata LB , Oduyebo T , Whiteman MK , Houtchens MK , Marchbanks PA , Curtis KM . Contraception 2016 94 (6) 612-620 BACKGROUND: Contraception is an important consideration for women with multiple sclerosis (MS), however little is known about the possible effects of hormonal contraception on disease progression or other adverse outcomes (e.g., thrombosis, low bone mineral density). OBJECTIVE: To evaluate the evidence on the safety of contraceptive use among women with MS. SEARCH STRATEGY: We searched the PubMed database for peer-reviewed articles published in any language from database inception through July 2015. SELECTION CRITERIA: We included studies that examined health outcomes among women diagnosed with MS initiating or continuing a contraceptive method. We excluded case reports and case series but included all other study designs. RESULTS: From 111 articles, we identified four studies (from 5 articles) that met our inclusion criteria. Evidence from one randomized controlled trial, two retrospective cohort studies, and one cross-sectional study suggests that use of combined oral contraceptives or oral contraceptives (type not specified) among women with MS does not worsen the clinical course of disease, defined as disability level, disease severity or progression, relapse, or number of new brain lesions on magnetic resonance imaging (body of evidence grading Level I, fair to Level II-3, poor). No studies were identified that examined the safety of other contraceptive methods or examined other outcomes of interest (venous thromboembolism, changes in bone mineral density) related to contraceptive use among women with MS. CONCLUSIONS: Limited evidence suggests that COC or OC use after MS onset does not worsen the clinical course of disease. |
Decreasing unintended pregnancy: Opportunities created by the Affordable Care Act
Fox J , Barfield W . JAMA 2016 316 (8) 815-6 The Affordable Care Act (ACA) increased access without cost to highly effective contraceptive methods, despite a legal challenge that was adjudicated by the Supreme Court, and it may help reduce unintended and teenage pregnancies.1 Unintended and teenage pregnancies are associated with delayed prenatal care, fetal exposures to tobacco and alcohol, and poorer health out-comes for newborns, as well as negative economic and social consequences for mothers and their children.2,3 Approximately 2.8 million unintended pregnancies occur in the United States each year, and, although teenage pregnancy rates have been declining for the last 2 decades, more than 430 000 pregnancies occurred among adolescents aged 15 to 19 years in the United States in 2011, including nearly 124 000 among adolescents aged 15 to 17 years.4 US teenage pregnancy rates are nearly 7 times higher than rates in some developed countries, and use of highly effective long-acting reversible contraception (LARC) remains low (<5%).3 | LARC, in particular, are effective methods of birth control; however, compared with other reversible methods, cost of LARC can be a barrier if not covered by insurance due to initial costs (including both the purchase of the contraceptive and administration by a provider), which can exceed $1000.5 When women are educated about LARC and provided with timely access, counseling, and follow-up without cost, they often choose and use these highly effective methods, which can be effective for 3 to 10 years, are associated with lower pregnancy rates, and may save insurers money over time.5 For example, in the CHOICE study, conducted from 2007 through 2011, 72% of 1404 adolescent girls and women aged 15 to 19 years chose a LARC method when provided with education and contraception at no cost compared with LARC usage rates lower than 5% among US teens.3 |
Drug interactions between hormonal contraceptives and psychotropic drugs: A systematic review
Berry-Bibee EN , Kim MJ , Simmons KB , Tepper NK , Riley HE , Pagano HP , Curtis KM . Contraception 2016 94 (6) 650-667 OBJECTIVE: To examine whether the co-administration of hormonal contraceptives (HC) and psychotropic drugs commonly used to treat anxiety and/or depression results in safety or efficacy concerns for either drug. METHODS: We searched PubMed and Cochrane libraries for clinical or pharmacokinetic [PK] studies that examined co-administration of any HC with psychotropic drugs (selective serotonin reuptake inhibitors [SSRIs], serotonin-norepinephrine reuptake inhibitors [SNRIs], tricyclic antidepressants [TCAs], oral benzodiazepines, bupropion, mirtazapine, trazadone, buspirone, hydroxyzine, monoamine oxidase inhibitors [MAOIs], or atypical antipsychotics) in reproductive aged women. RESULTS: Of 555 articles identified, 22 articles (18 studies) met inclusion criteria. We identified five studies on SSRIs, four on TCAs, one on bupropion, three on atypical antipsychotics and five on oral benzodiazepines. No articles met inclusion criteria for SNRIs, mirtazapine, trazadone, buspirone, hydroxyzine or MAOIs. Overall, clinical studies did not demonstrate differences in unintended pregnancy rates when HCs were administered with and without psychotropic drugs or in psychotropic drug treatment outcomes when psychotropic drugs were administered with and without HCs. PK studies did not demonstrate changes in drug exposure related to contraceptive safety, contraceptive effectiveness or psychotropic drug effectiveness for most classes of psychotropic drugs. However, limited PK data raise concern for HCs increasing systemic exposure of amitriptyline and imipramine (both TCAs), theoretically posing safety concerns. CONCLUSION: Limited quality and quantity evidence on use of psychotropic drugs and HCs suggests low concern for clinically significant interactions, though no data exist specifically for non-oral formulations of HC. Given the high frequency of use for both HCs and psychotropic drugs among reproductive age women in the US, this review highlights a need for further research in this area. |
Reasons for drinking as predictors of alcohol involvement one year later among HIV-infected individuals with and without hepatitis C
Elliott JC , Stohl M , Aharonovich E , O'Leary A , Hasin DS . Ann Med 2016 48 (8) 1-7 INTRODUCTION: Heavy drinking can be harmful for individuals with HIV, particularly those coinfected with hepatitis C virus (HCV). HIV patients' reasons for drinking predict short-term alcohol involvement, but whether they predict longer-term involvement is unknown. Also, it remains unknown whether these motives are differentially predictive for HIV monoinfected and HIV/HCV coinfected patients. METHOD: HIV-infected heavy drinkers (n = 254) participated in a randomized trial of brief alcohol interventions, 236 (92.9%) of whom reported on baseline motives and alcohol involvement 12 months later (77.1% male, 94.9% minority, 30.6% with HCV). RESULTS: Greater endorsement of baseline drinking to cope with negative affect predicted greater alcohol dependence symptoms at 12 months (incident rate ratio [IRR] = 1.80, p < 0.05), while greater endorsement of baseline drinking due to social pressure predicted fewer drinks consumed at 12 months (IRR = 0.67, p < 0.05). Coping and social reasons were both predictive for HIV monoinfected patients, whereas only coping reasons were predictive for HIV/HCV coinfected patients. DISCUSSION: Drinking for coping and social reasons predict alcohol involvement 12 months later; however, social reasons may only be important for HIV monoinfected patients. Understanding patient reasons for drinking may help predict patient risk up to a year later. KEY MESSAGES Among HIV patients, drinking motives predict alcohol involvement 12 months later. For HIV monoinfected patients, drinking to cope and drinking for social reasons predict 12-month alcohol involvement. For HIV/Hepatitis C coinfected patients, coping (but not social) motives predict 12-month alcohol involvement. |
Notes from the field: Kratom (Mitragyna speciosa) exposures reported to poison centers - United States, 2010-2015
Anwar M , Law R , Schier J . MMWR Morb Mortal Wkly Rep 2016 65 (29) 748-9 Kratom (Mitragyna speciosa) is a plant consumed throughout the world for its stimulant effects and as an opioid substitute. It is typically brewed into a tea, chewed, smoked, or ingested in capsules. It is also known as Thang, Kakuam, Thom, Ketum, and Biak. The Drug Enforcement Administration includes kratom on its Drugs of Concern list (substances that are not currently regulated by the Controlled Substances Act, but that pose risks to persons who abuse them), and the National Institute of Drug Abuse has identified kratom as an emerging drug of abuse. Published case reports have associated kratom exposure with psychosis, seizures, and deaths. Because deaths have been attributed to kratom in the United States, some jurisdictions have passed or are considering legislation to make kratom use a felony. CDC characterized kratom exposures that were reported to poison centers and uploaded to the National Poison Data System (NPDS) during January 2010-December 2015. The NPDS is a national database of information logged by the country's regional poison centers serving all 50 United States, the District of Columbia, and Puerto Rico and is maintained by the American Association of Poison Control Centers. NPDS case records are the result of call reports made by the public and health care providers. |
Unique Presentation of Orf Virus Infection in a Thermal Burn Patient After Receiving an Autologous Skin Graft.
Hsu CH , Rokni GR , Aghazadeh N , Brinster N , Li Y , Muehlenbachs A , Goldsmith CS , Zhao H , Petersen B , McCollum AM , Reynolds MG . J Infect Dis 2016 214 (8) 1171-4 We present a report of a burn patient who developed skin lesions on her skin-graft harvest and skin-graft recipient (burn) sites. Orf virus infection was confirmed by a combination of diagnostic assays, including molecular tests, immunohistochemistry, pathology and electron microscopy. DNA sequence analysis grouped this orf virus isolate among isolates from India. Though no definitive source of infection was determined from this case, this is the first reported case of orf virus infection in a skin graft harvest. Skin graft patients with exposures to animals may be at risk for this viral infection. |
Virulence and Evolution of West Nile Virus, Australia, 1960-2012.
Prow NA , Edmonds JH , Williams DT , Setoh YX , Bielefeldt-Ohmann H , Suen WW , Hobson-Peters J , van den Hurk AF , Pyke AT , Hall-Mendelin S , Northill JA , Johansen CA , Warrilow D , Wang J , Kirkland PD , Doggett S , Andrade CC , Brault AC , Khromykh AA , Hall RA . Emerg Infect Dis 2016 22 (8) 1353-62 Worldwide, West Nile virus (WNV) causes encephalitis in humans, horses, and birds. The Kunjin strain of WNV (WNVKUN) is endemic to northern Australia, but infections are usually asymptomatic. In 2011, an unprecedented outbreak of equine encephalitis occurred in southeastern Australia; most of the approximately 900 reported cases were attributed to a newly emerged WNVKUN strain. To investigate the origins of this virus, we performed genetic analysis and in vitro and in vivo studies of 13 WNVKUN isolates collected from different regions of Australia during 1960-2012. Although no disease was recorded for 1984, 2000, or 2012, isolates collected during those years (from Victoria, Queensland, and New South Wales, respectively) exhibited levels of virulence in mice similar to that of the 2011 outbreak strain. Thus, virulent strains of WNVKUN have circulated in Australia for >30 years, and the first extensive outbreak of equine disease in Australia probably resulted from a combination of specific ecologic and epidemiologic conditions. |
A systematic review of human bat rabies virus variant cases: Evaluating unprotected physical contact with claws and teeth in support of accurate risk assessments
Dato VM , Campagnolo ER , Long J , Rupprecht CE . PLoS One 2016 11 (7) e0159443 In the United States and Canada, the most recent documented cases of rabies have been attributed to bat rabies viruses (RABV). We undertook this systematic review in an effort to summarize and enhance understanding of the risk of infection for individuals who have been potentially exposed to a suspect or confirmed rabid bat. United States rabies surveillance summaries documented a total of 41 human bat-rabies virus variant verified non-transplant cases between 1990 and 2015. All cases were fatal. Seven (17.1%) of 41 cases reported a bite from a bat. Ten (24.3%) cases had unprotected physical contact (UPC); these included seven cases that had a bat land or crawl on them (contact with claws) and one case that touched a bat's teeth. Seven (17.1%) cases had probable UPC. Insectivorous bat teeth are extremely sharp and highly efficient for predation upon arthropod prey. Bats also have sharp claws on the end of their thumbs and feet. One of the most common bat RABV variants has an ability to replicate in non-neural cells. Questioning individuals about unprotected contact with bat teeth and claws (including a bat landing or crawling on a person) may help identify additional exposures. |
Update: interim guidance for health care providers caring for pregnant women with possible Zika virus exposure - United States, July 2016
Oduyebo T , Igbinosa I , Petersen EE , Polen KN , Pillai SK , Ailes EC , Villanueva JM , Newsome K , Fischer M , Gupta PM , Powers AM , Lampe M , Hills S , Arnold KE , Rose LE , Shapiro-Mendoza CK , Beard CB , Munoz JL , Rao CY , Meaney-Delman D , Jamieson DJ , Honein MA . MMWR Morb Mortal Wkly Rep 2016 65 (29) 739-44 CDC has updated its interim guidance for U.S. health care providers caring for pregnant women with possible Zika virus exposure, to include the emerging data indicating that Zika virus RNA can be detected for prolonged periods in some pregnant women. To increase the proportion of pregnant women with Zika virus infection who receive a definitive diagnosis, CDC recommends expanding real-time reverse transcription-polymerase chain reaction (rRT-PCR) testing. Possible exposures to Zika virus include travel to or residence in an area with active Zika virus transmission, or sex* with a partner who has traveled to or resides in an area with active Zika virus transmission without using condoms or other barrier methods to prevent infection.(dagger) Testing recommendations for pregnant women with possible Zika virus exposure who report clinical illness consistent with Zika virus disease( section sign) (symptomatic pregnant women) are the same, regardless of their level of exposure (i.e., women with ongoing risk for possible exposure, including residence in or frequent travel to an area with active Zika virus transmission, as well as women living in areas without Zika virus transmission who travel to an area with active Zika virus transmission, or have unprotected sex with a partner who traveled to or resides in an area with active Zika virus transmission). Symptomatic pregnant women who are evaluated <2 weeks after symptom onset should receive serum and urine Zika virus rRT-PCR testing. Symptomatic pregnant women who are evaluated 2-12 weeks after symptom onset should first receive a Zika virus immunoglobulin (IgM) antibody test; if the IgM antibody test result is positive or equivocal, serum and urine rRT-PCR testing should be performed. Testing recommendations for pregnant women with possible Zika virus exposure who do not report clinical illness consistent with Zika virus disease (asymptomatic pregnant women) differ based on the circumstances of possible exposure. For asymptomatic pregnant women who live in areas without active Zika virus transmission and who are evaluated <2 weeks after last possible exposure, rRT-PCR testing should be performed. If the rRT-PCR result is negative, a Zika virus IgM antibody test should be performed 2-12 weeks after the exposure. Asymptomatic pregnant women who do not live in an area with active Zika virus transmission, who are first evaluated 2-12 weeks after their last possible exposure should first receive a Zika virus IgM antibody test; if the IgM antibody test result is positive or equivocal, serum and urine rRT-PCR should be performed. Asymptomatic pregnant women with ongoing risk for exposure to Zika virus should receive Zika virus IgM antibody testing as part of routine obstetric care during the first and second trimesters; immediate rRT-PCR testing should be performed when IgM antibody test results are positive or equivocal. This guidance also provides updated recommendations for the clinical management of pregnant women with confirmed or possible Zika virus infection. These recommendations will be updated when additional data become available. |
Update: Interim guidance for prevention of sexual transmission of Zika virus - United States, July 2016
Brooks JT , Friedman A , Kachur RE , LaFlam M , Peters PJ , Jamieson DJ . MMWR Morb Mortal Wkly Rep 2016 65 (29) 745-7 Zika virus has been identified as a cause of congenital microcephaly and other serious brain defects. CDC issued interim guidance for the prevention of sexual transmission of Zika virus on February 5, 2016, with an initial update on April 1, 2016 (2). The following recommendations apply to all men and women who have traveled to or reside in areas with active Zika virus transmission and their sex partners. The recommendations in this report replace those previously issued and are now updated to reduce the risk for sexual transmission of Zika virus from both men and women to their sex partners. This guidance defines potential sexual exposure to Zika virus as having had sex with a person who has traveled to or lives in an area with active Zika virus transmission when the sexual contact did not include a barrier to protect against infection. Such barriers include male or female condoms for vaginal or anal sex and other barriers for oral sex. Sexual exposure includes vaginal sex, anal sex, oral sex, or other activities that might expose a sex partner to genital secretions. This guidance will be updated as more information becomes available. |
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