The Cancer Epidemiology Descriptive Cohort Database: A Tool to Support Population-Based Interdisciplinary Research.
Kennedy AE , Khoury MJ , Ioannidis JP , Brotzman M , Miller A , Lane C , Lai GY , Rogers SD , Harvey C , Elena JW , Seminara D . Cancer Epidemiol Biomarkers Prev 2016 25 (10) 1392-1401 BACKGROUND: We report on the establishment of a web-based Cancer Epidemiology Descriptive Cohort Database (CEDCD). The CEDCD's goals are to: enhance awareness of resources, facilitate interdisciplinary research collaborations, and support existing cohorts for the study of cancer-related outcomes. METHODS: Comprehensive descriptive data were collected from large cohorts established to study cancer as primary outcome, using a newly developed questionnaire. These included an inventory of baseline and follow-up data, biospecimens, genomics, policies and protocols. Additional descriptive data extracted from publicly available sources were also collected. This information was entered in a querable and publicly accessible database. We summarized the descriptive data across cohorts and reported the characteristics of this resource. RESULTS: As of December 2015, the CEDCD includes data from 46 cohorts representing more than 6.5 million individuals (29% ethnic/racial minorities). Overall, 78% of the cohorts have collected blood at least once, 57% at multiple time points, and 46% collected tissue samples. Genotyping has been performed by 67% of the cohorts, while 46% have performed whole genome or exome sequencing in subsets of enrolled individuals. Information on medical conditions other than cancer have been collected in over 50% of the cohorts. More than 600,000 incident cancer cases and over 40,000 prevalent cases are reported, with 24 cancer sites represented. CONCLUSIONS: The CEDCD assembles detailed descriptive information on a large number of cancer cohorts in a searchable database. IMPACT: Information from the CEDCD may assist the interdisciplinary research community by facilitating identification of well-established population resources and large-scale collaborative and integrative research. |
Racial and ethnic differences in health behaviors and preventive health services among prostate cancer survivors in the United States
Li J , Thompson TD , Richards TB , Steele CB . Prev Chronic Dis 2016 13 E95 INTRODUCTION: Little is known about how health behaviors and receipt of preventive health care differ by race and ethnicity among prostate cancer survivors. The purpose of this study was to identify differences in the prevalence of 7 modifiable factors related to prostate cancer: smoking, alcohol consumption, physical inactivity, weight, colorectal cancer screening, influenza vaccination, and pneumococcal vaccination. METHODS: We used data from the 2010 Behavioral Risk Factor Surveillance System to calculate the racial/ethnic prevalence of sociodemographic and health-related characteristics, health behaviors, and preventive health care among prostate cancer survivors. Adjusted prevalence estimates were calculated by using multivariable logistic regression. RESULTS: We identified 8,016 men with a history of prostate cancer. Multivariable analyses indicated that more black men reported being obese (29.9%; 95% confidence interval [CI], 24.5%-35.9%) than white men (22.8%; 95% CI, 21.1%-24.6%). More white men (3.6%; 95% CI, 2.9%-4.5%) reported consuming more than 2 alcoholic drinks per day than black men (0.9%; 95% CI, 0.4%-2.0%). More white men aged 65 or older reported receiving pneumococcal vaccine (74.2%; 95% CI, 72.2%-76.1%) than black men of the same age (63.2%; 95% CI, 54.8%-70.8%).We did not observe any differences in the prevalence of health behaviors and preventive health care between white men and men in Hispanic or other race categories. CONCLUSION: Differences in alcohol consumption, obesity, and receipt of pneumococcal vaccination existed only between black and white prostate cancer survivors. These differences underscore the need to develop culturally appropriate, evidence-based interventions to reduce excessive alcohol consumption, maintain a healthy weight, and promote pneumococcal vaccination among prostate cancer survivors. |
Use of pharmacy sales data to assess changes in prescription- and payment-related factors that promote adherence to medications commonly used to treat hypertension, 2009 and 2014
Ritchey M , Tsipas S , Loustalot F , Wozniak G . PLoS One 2016 11 (7) e0159366 BACKGROUND: Effective hypertension management often necessitates patients' adherence to the blood pressure (BP)-lowering medication regimen they are prescribed. Patients' adherence to that regimen can be affected by prescription- and payment-related factors that are typically controlled by prescribers, filling pharmacies, pharmacy benefit managers, and/or patients' health insurance plans. This study describes patterns and changes from 2009 to 2014 in factors that the literature reports are associated with increased adherence to BP-lowering medication. METHODS AND FINDINGS: We use a robust source of United States prescription sales data-IMS Health's National Prescription Audit-to describe BP-lowering medication fill counts and spending in 2009 compared with 2014. Moreover, we describe patterns and changes in adherence-promoting factors across age groups, payment sources, and medication classes. From 2009 to 2014, the BP-lowering medication prescription fill count increased from 613.7 million to 653.0 million. Encouraging changes in adherence-promoting factors included: the share of generic fills increased from 82.5% to 95.0%; average days' supply per fill increased from 45.9 to 51.8 days; and average total (patient contribution) spending per years' supply decreased from $359 ($54) to $311 ($37). Possibly undesirable changes included: the percentage of fills for fixed-dose combinations decreased from 17.1% to 14.2% and acquired via mail order decreased from 10.7% to 8.2%. In 2014: 653.0 million fills occurred accounting for $28.81B in spending; adults aged 45-64 years had the highest percentage of fixed-dose combinations fills (16.9%); and fills with Medicaid as the payment source had the lowest average patient spending per fill ($1.19). CONCLUSIONS: We identified both encouraging and possibly undesirable patterns and changes from 2009 to 2014 in factors that promote adherence to BP-lowering medications during this period. Continued tracking of these metrics using pharmacy sales data can help identify areas that can be addressed by clinical and policy interventions to improve adherence for medications commonly used to treat hypertension. |
Molecular Typing of Treponema pallidum in Ocular Syphilis.
Oliver S , Sahi SK , Tantalo LC , Godornes C , Neblett Fanfair R , Markowitz LE , Lukehart SA , Marra CM . Sex Transm Dis 2016 43 (8) 524-7 BACKGROUND: Syphilis can have many clinical manifestations, including eye involvement, or "ocular syphilis." In 2015, an increase in reported cases of ocular syphilis and potential case clusters raised concern for an oculotropic strain of Treponema pallidum, the infectious agent of syphilis. Molecular typing was used to examine strains found in cases of ocular syphilis in the United States. METHODS: In 2015, after a clinical advisory issued by the Centers for Disease Control and Prevention, pretreatment clinical specimens from US patients with ocular syphilis were sent to a research laboratory for molecular analysis of T. pallidum DNA. Molecular typing was conducted on these specimens, and results were compared with samples collected from Seattle patients diagnosed with syphilis, but without ocular symptoms. RESULTS: Samples were typed from 18 patients with ocular syphilis and from 45 patients with syphilis, but without ocular symptoms. Clinical data were available for 14 ocular syphilis patients: most were men, human immunodeficiency virus-infected, and had early syphilis. At least 5 distinct strain types of Treponema pallidum were identified in these patients, and 9 types were identified in the Seattle nonocular patients. 14d/g was the most common type in both groups. An unusual strain type was detected in a small cluster of ocular syphilis patients in Seattle. CONCLUSIONS: Ocular syphilis is a serious sequela of syphilis. In this preliminary study, clear evidence of a predominant oculotropic strain causing ocular syphilis was not detected. Identification of cases and prompt treatment is critical in the management of ocular syphilis. |
Antiretroviral Therapy for the Prevention of HIV-1 Transmission.
Cohen MS , Chen YQ , McCauley M , Gamble T , Hosseinipour MC , Kumarasamy N , Hakim JG , Kumwenda J , Grinsztejn B , Pilotto JH , Godbole SV , Chariyalertsak S , Santos BR , Mayer KH , Hoffman IF , Eshleman SH , Piwowar-Manning E , Cottle L , Zhang XC , Makhema J , Mills LA , Panchia R , Faesen S , Eron J , Gallant J , Havlir D , Swindells S , Elharrar V , Burns D , Taha TE , Nielsen-Saines K , Celentano DD , Essex M , Hudelson SE , Redd AD , Fleming TR . N Engl J Med 2016 375 (9) 830-9 Background An interim analysis of data from the HIV Prevention Trials Network (HPTN) 052 trial showed that antiretroviral therapy (ART) prevented more than 96% of genetically linked infections caused by human immunodeficiency virus type 1 (HIV-1) in serodiscordant couples. ART was then offered to all patients with HIV-1 infection (index participants). The study included more than 5 years of follow-up to assess the durability of such therapy for the prevention of HIV-1 transmission. Methods We randomly assigned 1763 index participants to receive either early or delayed ART. In the early-ART group, 886 participants started therapy at enrollment (CD4+ count, 350 to 550 cells per cubic millimeter). In the delayed-ART group, 877 participants started therapy after two consecutive CD4+ counts fell below 250 cells per cubic millimeter or if an illness indicative of the acquired immunodeficiency syndrome (i.e., an AIDS-defining illness) developed. The primary study end point was the diagnosis of genetically linked HIV-1 infection in the previously HIV-1-negative partner in an intention-to-treat analysis. Results Index participants were followed for 10,031 person-years; partners were followed for 8509 person-years. Among partners, 78 HIV-1 infections were observed during the trial (annual incidence, 0.9%; 95% confidence interval [CI], 0.7 to 1.1). Viral-linkage status was determined for 72 (92%) of the partner infections. Of these infections, 46 were linked (3 in the early-ART group and 43 in the delayed-ART group; incidence, 0.5%; 95% CI, 0.4 to 0.7) and 26 were unlinked (14 in the early-ART group and 12 in the delayed-ART group; incidence, 0.3%; 95% CI, 0.2 to 0.4). Early ART was associated with a 93% lower risk of linked partner infection than was delayed ART (hazard ratio, 0.07; 95% CI, 0.02 to 0.22). No linked infections were observed when HIV-1 infection was stably suppressed by ART in the index participant. Conclusions The early initiation of ART led to a sustained decrease in genetically linked HIV-1 infections in sexual partners. (Funded by the National Institute of Allergy and Infectious Diseases; HPTN 052 ClinicalTrials.gov number, NCT00074581). |
The World Health Organization measles programmatic risk assessment tool-Romania, 2015
Kriss JL , Stanescu A , Pistol A , Butu C , Goodson JL . Risk Anal 2016 37 (6) 1096-1107 Despite global improvement in annual measles incidence and mortality since 2000, progress toward elimination goals has slowed. The World Health Organization (WHO) European Region (EUR) established a regional goal for measles and rubella elimination by 2015. Romania is one of 13 EUR countries in which measles remains endemic. To identify barriers to meeting programmatic targets and to aid in prioritizing efforts to strengthen measles elimination strategy implementation, the WHO and U.S. Centers for Disease Control and Prevention developed a measles programmatic risk assessment tool that uses routinely collected data to estimate district-level risk scores. The WHO measles programmatic risk assessment tool was used to identify high-risk areas in order to guide measles elimination program activities in Romania. Of the 42 districts in Romania, 27 (64%) were categorized as very high or high risk. Many of the very-high-risk districts were clustered in the western part of the country or were clustered around the capital Bucharest in the southeastern part of the country. The overall risk scores in the very-high-risk districts were driven primarily by poor surveillance quality and suboptimal population immunity. The measles risk assessment conducted in Romania was the first assessment to be completed in a European country. Annual assessments using the programmatic risk tool could provide valuable information for immunization program and surveillance staff at the national level and in each district to guide activities to enhance measles elimination efforts, such as strengthening routine immunization services, improving immunization campaign planning, and intensifying surveillance. |
Neisseria gonorrhoeae antimicrobial susceptibility surveillance - the Gonococcal Isolate Surveillance Project, 27 Sites, United States, 2014
Kirkcaldy RD , Harvey A , Papp JR , Del Rio C , Soge OO , Holmes KK , Hook EW 3rd , Kubin G , Riedel S , Zenilman J , Pettus K , Sanders T , Sharpe S , Torrone E . MMWR Surveill Summ 2016 65 (7) 1-19 PROBLEM/CONDITION: Gonorrhea is the second most commonly reported notifiable disease in the United States; 350,062 gonorrhea cases were reported in 2014. Sexually transmitted infections caused by Neisseria gonorrhoeae are a cause of pelvic inflammatory disease in women, which can lead to serious reproductive complications including tubal infertility, ectopic pregnancy, and chronic pelvic pain. Prevention of sequelae and of transmission to sexual partners relies largely on prompt detection and effective antimicrobial treatment. However, treatment has been compromised by the absence of routine antimicrobial susceptibility testing in clinical care and evolution of antimicrobial resistance to the antibiotics used to treat gonorrhea. PERIOD COVERED: 2014. DESCRIPTION OF THE SYSTEM: The Gonococcal Isolate Surveillance Project (GISP) was established in 1986 as a sentinel surveillance system to monitor trends in antimicrobial susceptibilities of N. gonorrhoeae strains in the United States. Each month, N. gonorrhoeae isolates are collected from up to the first 25 men with gonococcal urethritis attending each of the participating sexually transmitted disease (STD) clinics at 27 sites. The number of participating sites has varied over time (21-30 per year). Selected demographic and clinical data are abstracted from medical records. Isolates are tested for antimicrobial susceptibility using agar dilution at one of five regional laboratories. RESULTS: A total of 5,093 isolates were collected in 2014. Of these, 25.3% were resistant to tetracycline, 19.2% to ciprofloxacin, and 16.2% to penicillin (plasmid-based, chromosomal, or both). Reduced azithromycin susceptibility (Azi-RS) (defined as minimum inhibitory concentration [MIC] ≥2.0 microg/mL) increased from 0.6% in 2013 to 2.5% in 2014. The increase occurred in all geographic regions, but was greatest in the Midwest, and among all categories of sex of sex partners (men who have sex with men [MSM], men who have sex with men and women [MSMW], and men who have sex with women [MSW]). No Azi-RS isolates exhibited reduced cefixime or ceftriaxone susceptibility (Cfx-RS and Cro-RS, respectively). The prevalence of Cfx-RS (MIC ≥0.25 microg/mL) increased from 0.1% in 2006 to 1.4% in both 2010 and 2011, decreased to 0.4% in 2013, and increased to 0.8% in 2014. Cro-RS (MIC ≥0.125 microg/mL) increased following a similar pattern but at lesser percentages (increased from 0.1% in 2008 to 0.4% in 2011 and decreased to 0.1% in 2013 and 2014). The percentage of isolates resistant to tetracycline, ciprofloxacin, penicillin, or all three antimicrobials, was greater in isolates from MSM than from MSW. INTERPRETATION: This is the first report to present comprehensive surveillance data from GISP and summarize gonococcal susceptibility over time, as well as underscore the history and public health implications of emerging cephalosporin resistance. Antimicrobial susceptibility patterns vary by geographic region within the United States and by sex of sex partner. Because dual therapy with ceftriaxone plus azithromycin is the only recommended gonorrhea treatment, increases in azithromycin and cephalosporin MICs are cause for concern that resistance to these antimicrobial agents might be emerging. It is unclear whether increases in the percentage of isolates with Azi-RS mark the beginning of a trend. The percentage of isolates with elevated cefixime MICs increased during 2009-2010, then decreased during 2012-2013 after treatment recommendations were changed in 2010 to recommend dual therapy (with a cephalosporin and a second antibiotic) and a higher dosage of ceftriaxone. Subsequently, the treatment recommendations were changed again in 2012 to no longer recommend cefixime as part of first-line therapy (leaving ceftriaxone-based dual therapy as the only recommended therapy). Despite the MIC decrease (i.e., trend of improved cefixime susceptibility) during 2012-2013, the increase in the number of strains with Cfx-RS in 2014 underscores the potential threat of cephalosporin-resistant N. gonorrhoeae. PUBLIC HEALTH ACTION: The National Strategy for Combating Antibiotic-Resistant Bacteria identifies prevention, rapid detection, and control of outbreaks of ceftriaxone-resistant N. gonorrhoeae infection as a priority for U.S. PUBLIC HEALTH ACTION: Antimicrobial susceptibility surveillance is conducted to guide development of treatment recommendations for effective therapy and prevention of complications from and transmission of gonorrhea. Federal agencies can use GISP data to develop national treatment recommendations and set research and prevention priorities. Local and state health departments can use GISP data to determine allocation of STD prevention services and resources, guide prevention planning, and communicate best treatment practices to health care providers. Continued surveillance, appropriate treatment, development of new antibiotics, and prevention of transmission remain the best strategies to reduce gonorrhea incidence and morbidity. |
Notes from the field: meningococcal disease in an international traveler on eculizumab therapy - United States, 2015
Applegate AO , Fong VC , Tardivel K , Lippold SA , Zarate S . MMWR Morb Mortal Wkly Rep 2016 65 (27) 696-7 On June 2, 2015, CDC was notified that a male airline passenger, aged 41 years, with a fever of 105.4 degrees F, headache, nausea, photophobia, diarrhea, and vomiting, which began approximately 3 hours after departure, was arriving to San Francisco, California, on a flight from Frankfurt, Germany. His symptoms reportedly started with neck stiffness 1 day earlier. Upon arrival, the patient was immediately transported to a local hospital, where he was in septic shock, which was followed by multisystem organ failure. Cerebrospinal fluid, obtained approximately 12 hours after initiation of treatment, was Gram stain- and culture-negative. Blood cultures, which were drawn before antibiotic treatment, were positive for Neisseria meningitides of indeterminate serogroup. A review of the patient's medical records revealed a history of paroxysmal nocturnal hemoglobinuria and current biweekly eculizumab (Soliris) therapy. |
Impact of the Centers for Disease Control's HIV preexposure prophylaxis guidelines for men who have sex with men in the United States
Jenness SM , Goodreau SM , Rosenberg E , Beylerian EN , Hoover KW , Smith DK , Sullivan P . J Infect Dis 2016 214 (12) 1800-1807 BACKGROUND: Preexposure prophylaxis (PrEP) is effective for preventing human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) within trial settings. Population impact will depend on clinical indications for PrEP initiation, coverage levels, and drug adherence. No modeling studies have estimated the impact of clinical practice guidelines for PrEP issued by the Centers for Disease Control and Prevention (CDC). METHODS: Mathematical models of HIV transmission among MSM were used to estimate the percentage of infections averted (PIA) and the number needed to treat (NNT) under behavioral indications of the CDC's PrEP guidelines. We modeled the contribution of these indications while varying treatment coverage and adherence. RESULTS: At 40% coverage of indicated MSM over the next decade, application of CDC guidelines would avert 1162 infections per 100 000 person-years, 33.0% of expected infections. The predicted NNT for the guidelines would be 25. Increasing coverage and adherence jointly raise the PIA, but reductions to the NNT were associated with better adherence only. CONCLUSIONS: Implementation of CDC PrEP guidelines would result in strong and sustained reductions in HIV incidence among MSM in the United States. The guidelines strike a good balance between epidemiological impact (PIA) and efficiency (NNT) at plausible scale-up levels. Adherence counseling could maximize public health investment in PrEP by decreasing the NNT. |
The importance of school staff referrals and follow-up in connecting high school students to HIV and STD testing
Rasberry CN , Liddon N , Adkins SH , Lesesne CA , Hebert A , Kroupa E , Rose I , Morris E . J Sch Nurs 2016 33 (2) 143-153 This study examined predictors of having received HIV and sexually transmitted disease (STD) testing and having been referred by school staff for HIV/STD testing. In 2014, students in seven high schools completed paper-and-pencil questionnaires assessing demographic characteristics, sexual behavior, referrals for HIV/STD testing, and HIV/STD testing. The analytic sample (n = 11,303) was 50.7% female, 40.7% Hispanic/Latino, 34.7% Black/African American (non-Hispanic), and mean age was 15.86 (SD = 1.22). After controlling for demographic characteristics, significant predictors of reporting having been tested for HIV or STDs were reporting having received a referral for HIV/STD testing (odds ratio [OR] = 3.18; 95% CI = [2.14, 4.70]) and reporting staff following-up on the referral (OR = 3.29; 95% CI = [1.31, 8.23]). Students reporting referrals had significantly higher odds of being male (OR = 2.49; 95% CI = [1.70, 3.65]), "other" or multiracial (non-Hispanic; compared to White, non-Hispanic; OR = 2.72; 95% CI = [1.35, 5.46]), sexual minority (OR = 3.80; 95% CI = [2.57, 5.62]), and sexually experienced (OR = 2.58; 95% CI = [1.76, 3.795]). School staff referrals with follow-up may increase HIV/STD testing among students. |
Increased hepatitis C virus (HCV) detection in women of childbearing age and potential risk for vertical transmission - United States and Kentucky, 2011-2014
Koneru A , Nelson N , Hariri S , Canary L , Sanders KJ , Maxwell JF , Huang X , Leake JA , Ward JW , Vellozzi C . MMWR Morb Mortal Wkly Rep 2016 65 (28) 705-710 Hepatitis C virus (HCV) infection is a leading cause of liver-related morbidity and mortality (1). Transmission of HCV is primarily via parenteral blood exposure, and HCV can be transmitted vertically from mother to child. Vertical transmission occurs in 5.8% (95% confidence interval = 4.2%-7.8%) of infants born to women who are infected only with HCV and in up to twice as many infants born to women who are also infected with human immunodeficiency virus (HIV) (2) or who have high HCV viral loads (3,4); there is currently no recommended intervention to prevent transmission of infection from mother to child (3). Increased reported incidence of HCV infection among persons aged ≤30 years (5,6) with similar increases among women and men in this age group (6), raises concern about increases in the number of pregnant women with HCV infection, and in the number of infants who could be exposed to HCV at birth. Data from one large commercial laboratory and birth certificate data were used to investigate trends in HCV detection among women of childbearing age,* HCV testing among children aged ≤2 years, and the proportions of infants born to HCV-infected women nationally and in Kentucky, the state with the highest incidence of acute HCV infection during 2011-2014 (6). During 2011-2014, commercial laboratory data indicated that national rates of HCV detection (antibody or RNA positivitydagger) among women of childbearing age increased 22%, and HCV testing (antibody or RNA) among children aged ≤2 years increased 14%; birth certificate data indicated that the proportion of infants born to HCV-infected mothers increased 68%, from 0.19% to 0.32%. During the same time in Kentucky, the HCV detection rate among women of childbearing age increased >200%, HCV testing among children aged ≤2 years increased 151%, and the proportion of infants born to HCV-infected women increased 124%, from 0.71% to 1.59%. Increases in the rate of HCV detection among women of childbearing age suggest a potential risk for vertical transmission of HCV. These findings highlight the importance of following current CDC recommendations to identify, counsel, and test persons at risk for HCV infection (1,7), including pregnant women, as well as consider developing public health policies for routine HCV testing of pregnant women, and expanding current policies for testing and monitoring children born to HCV-infected women. Expansion of HCV reporting and surveillance requirements will enhance case identification and prevention strategies. |
Addressing infection prevention and control in the first U.S. community hospital to care for patients with Ebola virus disease: context for national recommendations and future strategies
Cummings KJ , Choi MJ , Esswein EJ , de Perio MA , Harney JM , Chung WM , Lakey DL , Liddell AM , Rollin PE . Ann Intern Med 2016 165 (1) 41-49 Health care personnel (HCP) caring for patients with Ebola virus disease (EVD) are at increased risk for infection with the virus. In 2014, a Texas hospital became the first U.S. community hospital to care for a patient with EVD; 2 nurses were infected while providing care. This article describes infection control measures developed to strengthen the hospital's capacity to safely diagnose and treat patients with EVD. After admission of the first patient with EVD, a multidisciplinary team from the Centers for Disease Control and Prevention (CDC) joined the hospital's infection preventionists to implement a system of occupational safety and health controls for direct patient care, handling of clinical specimens, and managing regulated medical waste. Existing engineering and administrative controls were strengthened. The personal protective equipment (PPE) ensemble was standardized, HCP were trained on donning and doffing PPE, and a system of trained observers supervising PPE donning and doffing was implemented. Caring for patients with EVD placed substantial demands on a community hospital. The experiences of the authors and others informed national policies for the care of patients with EVD and protection of HCP, including new guidance for PPE, a rapid system for deploying CDC staff to assist hospitals ("Ebola Response Team"), and a framework for a tiered approach to hospital preparedness. The designation of regional Ebola treatment centers and the establishment of the National Ebola Training and Education Center address the need for HCP to be prepared to safely care for patients with EVD and other high-consequence emerging infectious diseases. |
Adherence to concurrent tuberculosis treatment and antiretroviral treatment among co-infected persons in South Africa, 2008-2010
Webb Mazinyo E , Kim L , Masuku S , Lancaster JL , Odendaal R , Uys M , Podewils LJ , Van der Walt ML . PLoS One 2016 11 (7) e0159317 BACKGROUND: Adherence to tuberculosis (TB) treatment and antiretroviral therapy (ART) reduces morbidity and mortality among persons co-infected with TB/HIV. We measured adherence and determined factors associated with non-adherence to concurrent TB treatment and ART among co-infected persons in two provinces in South Africa. METHODS: A convenience sample of 35 clinics providing integrated TB/HIV care was included due to financial and logistic considerations. Retrospective chart reviews were conducted among persons who received concurrent TB treatment and ART and who had a TB treatment outcome recorded during 1 January 2008-31 December 2010. Adherence to concurrent TB and HIV treatment was defined as: (1) taking ≥80% of TB prescribed doses by directly observed therapy (DOT) as noted in the patient card; and (2) taking >90% ART doses as documented in the ART medical record during the concurrent treatment period (period of time when the patient was prescribed both TB treatment and ART). Risk ratios (RRs) and 95% confidence intervals (CIs) were used to identify factors associated with non-adherence. RESULTS: Of the 1,252 persons receiving concurrent treatment, 138 (11.0%) were not adherent. Non-adherent persons were more likely to have extrapulmonary TB (RR: 1.71, 95% CI: 1.12 to 2.60) and had not disclosed their HIV status (RR: 1.96, 95% CI: 1.96 to 3.76). CONCLUSIONS: The majority of persons with TB/HIV were adherent to concurrent treatment. Close monitoring and support of persons with extrapulmonary TB and for persons who have not disclosed their HIV status may further improve adherence to concurrent TB and antiretroviral treatment. |
Assessing progress, impact, and next steps in rolling out voluntary medical male circumcision for HIV prevention in 14 priority countries in eastern and southern Africa through 2014
Kripke K , Njeuhmeli E , Samuelson J , Schnure M , Dalal S , Farley T , Hankins C , Thomas AG , Reed J , Stegman P , Bock N . PLoS One 2016 11 (7) e0158767 BACKGROUND: In 2007, the World Health Organization and the Joint United Nations Programme on HIV/AIDS (UNAIDS) identified 14 priority countries across eastern and southern Africa for scaling up voluntary medical male circumcision (VMMC) services. Several years into this effort, we reflect on progress. METHODS: Using the Decision Makers' Program Planning Tool (DMPPT) 2.1, we assessed age-specific impact, cost-effectiveness, and coverage attributable to circumcisions performed through 2014. We also compared impact of actual progress to that of achieving 80% coverage among men ages 15-49 in 12 VMMC priority countries and Nyanza Province, Kenya. We populated the models with age-disaggregated VMMC service statistics and with population, mortality, and HIV incidence and prevalence projections exported from country-specific Spectrum/Goals files. We assumed each country achieved UNAIDS' 90-90-90 treatment targets. RESULTS: More than 9 million VMMCs were conducted through 2014: 43% of the estimated 20.9 million VMMCs required to reach 80% coverage by the end of 2015. The model assumed each country reaches the UNAIDS targets, and projected that VMMCs conducted through 2014 will avert 240,000 infections by the end of 2025, compared to 1.1 million if each country had reached 80% coverage by the end of 2015. The median estimated cost per HIV infection averted was $4,400. Nyanza Province in Kenya, the 11 priority regions in Tanzania, and Uganda have reached or are approaching MC coverage targets among males ages 15-24, while coverage in other age groups is lower. Across all countries modeled, more than half of the projected HIV infections averted were attributable to circumcising 10- to 19-year-olds. CONCLUSIONS: The priority countries have made considerable progress in VMMC scale-up, and VMMC remains a cost-effective strategy for epidemic impact, even assuming near-universal HIV diagnosis, treatment coverage, and viral suppression. Examining circumcision coverage by five-year age groups will inform countries' decisions about next steps. |
Centers for Disease Control and Prevention-funded human immunodeficiency virus testing, positivity, and service delivery among newly diagnosed women in 61 health department jurisdictions, United States, 2014
Seth P , Figueroa A , Wang G . Womens Health Issues 2016 26 (5) 496-503 BACKGROUND: More than 1.2 million persons are living with human immunodeficiency virus (HIV) in the United States; at the end of 2011, 23% of them were women. Minority women are disproportionately affected by HIV, and new infections are higher among older women. HIV testing and service delivery among women funded by the U.S. Centers for Disease Control and Prevention (CDC) is examined. METHODS: Data were submitted by 61 health department jurisdictions. HIV testing, HIV-positive tests, new HIV diagnoses among women, and linkage and referral services among newly diagnosed women are described. Differences across demographic characteristics for HIV diagnoses, linkage, and referral services were assessed. Diagnoses were identified as new when women who tested HIV positive were not found to be reported previously in the jurisdiction's HIV surveillance system; when jurisdictions could not verify prior test results in their surveillance systems, new diagnoses were identified by self-report. RESULTS: Of CDC-funded testing events in 2014, 1,484,902 (48.7%) were among women, and they accounted for 19.5% of all HIV-positive testing events. Among women tested, 0.4% were HIV positive, and 0.1% had new HIV diagnoses. Women aged 40 and older and Black women were more likely to test HIV positive (0.7% and 0.5%, respectively). Among newly diagnosed women, 62.8% were linked within any timeframe, 57.1% were linked within 90 days, 74.1% were referred to partner services, 57.5% were interviewed for partner services, and 55.5% were referred to HIV risk reduction services. CONCLUSIONS: Among all women receiving CDC-funded HIV testing, Black women and older women were more likely to have HIV-positive tests and new diagnoses. Although women overall may not be at the highest risk for HIV, Black women in this sample are disproportionately affected. Additionally, linkage, referral, and interview services for women need improvement. Targeted testing approaches may ensure effective test and treat strategies for women. |
Contribution of contact sampling in increasing sensitivity of poliovirus detection during a polio outbreak - Somalia, 2013
Moturi E , Mahmud A , Kamadjeu R , Mbaeyi C , Farag N , Mulugeta A , Gary H Jr , Ehrhardt D . Open Forum Infect Dis 2016 3 (2) ofw111 Background. In May 2013, a wild poliovirus type 1 (WPV1) outbreak reported in Somalia provided an opportunity to examine the contribution of testing contacts to WPV detection. Methods. We reviewed acute flaccid paralysis (AFP) case-patients and linked contacts reported in the Somalia Surveillance Database from May 9 to December 31, 2013. We restricted our analysis to AFP case-patients that had ≥3 contacts and calculated the contribution of each contact to case detection. Results. Among 546 AFP cases identified, 328 AFP cases had ≥3 contacts. Among the 328 AFP cases with ≥3 contacts, 93 WPV1 cases were detected: 58 cases (62%; 95% confidence interval [CI], 52%-72%) were detected through testing stool specimens from AFP case-patients; and 35 cases (38%; 95% CI, 28%-48%) were detected through testing stool specimens from contacts, including 19 cases (20%; 95% CI, 14%-30%) from the first contact, 11 cases (12%; 95% CI, 7%-20%) from the second contact, and 5 cases (5%; 95% CI, 2%-12%) from the third contact. Among the 103 AFP cases with ≥4 contacts, 3 (6%; 95% CI, 2%-16%) of 52 WPV1 cases were detected by testing the fourth contact. No additional WPV1 cases were detected by testing >4 contacts. Conclusions. Stool specimens from 3 to 4 contacts of persons with AFP during polio outbreaks are needed to maximize detection of WPV cases. |
Diphtheria outbreak in Lao People's Democratic Republic, 2012-2013
Sein C , Tiwari T , Macneil A , Wannemuehler K , Soulaphy C , Souliphone P , Reyburn R , Ramirez Gonzalez A , Watkins M , Goodson JL . Vaccine 2016 34 (36) 4321-6 BACKGROUND: Diphtheria is a vaccine-preventable disease. When vaccination coverage and population immunity are low, outbreaks can occur. We investigated a diphtheria outbreak in Lao People's Democratic Republic that occurred during 2012-2013 and highlighted challenges in immunization services delivery to children in the country. METHODS: We reviewed diphtheria surveillance data from April 1, 2012-May 31, 2013. A diphtheria case was defined as a respiratory illness consisting of pharyngitis, tonsillitis, or laryngitis, and an adherent tonsillar or nasopharyngeal pseudomembrane. To identify potential risk factors for diphtheria, we conducted a retrospective case-control study with two aged-matched neighborhood controls per case-patient in Houaphan Province, using bivariate analysis to calculate matched odds ratio (mOR) with 95% confidence intervals (CI). Reasons for non-vaccination among unvaccinated persons were assessed. RESULTS: Sixty-two clinical cases of diphtheria and 12 diphtheria-related deaths were reported in seven of 17 provinces. Among case-patients, 43 (69%) were <15years old, five (8%) reported receiving three DTP doses (DTP3), 21 (34%) had received no DTP doses, and 35 (56%) had unknown vaccination status. For the case-control study, 42 of 52 diphtheria case-patients from Houaphan province and 79 matched-controls were enrolled. Five (12%) case-patients and 20 (25%) controls had received DTP3 (mOR=0.4, CI=0.1-1.7). No diphtheria toxoid-containing vaccine was received by 20 (48%) case-patients and 38 (46%) controls. Among case-patients and controls with no DTP dose, 43% of case-patients and 40% of controls lacked access to routine immunization services. CONCLUSION: Suboptimal DTP3 coverage likely caused the outbreak. To prevent continued outbreaks, access to routine immunization services should be strengthened, outreach visits need to be increased, and missed opportunities need to be minimized. In the short term, to rapidly increase population immunity, three rounds of DTP immunization campaign should be completed, targeting children aged 0-14years in affected provinces. |
Urinary antimony and leukocyte telomere length: An analysis of NHANES 1999-2002
Scinicariello F , Buser MC . Environ Res 2016 150 513-518 Telomeres are repetitive DNA sequences (TTAGGG) at the end of chromosomes. Cells with critically short telomeres enter replicative senescence and apoptosis. Several in vitro studies report that antimony causes cell apoptosis in human leukocyte cell lines. The goal of this analysis was to investigate whether there is an association between antimony exposure and leukocyte telomere length (LTL) among US adults aged 20 and older based on the National Health and Nutrition Examination Survey (NHANES) 1999-2002. We used multivariate linear regression to analyze the association of urinary antimony with LTL. LTL was log-natural transformed and the results were re-transformed and presented as percent differences. After adjustment for potential confounders, individuals in the 3rd and 4th quartiles of urinary antimony had statistically significantly shorter LTL (-4.78%, 95% CI: -8.42,-0.90; and -6.11%, 95% CI: -11.04,-1.00, respectively) compared to the lowest referent quartile, with evidence of a dose-response relationship (p-value for trend =0.03). Shorter LTL with antimony was driven by middle aged (40-59 years) and older (60-85 years) adult groups. The association may be biologically plausible because of reported oxidative stress and apoptosis effects of antimony on blood cells, effects known to shorten telomere length. |
Notes from the field: Acute sulfuryl fluoride poisoning in a family - Florida, August 2015
Mulay PR , Clark G , Jackson WL , Calvert GM . MMWR Morb Mortal Wkly Rep 2016 65 (27) 698-9 On August 19, 2015, the Florida Department of Health (FDOH) was notified by the Florida Poison Information Center Network and a local hospital of possible sulfuryl fluoride poisonings affecting a family in Martin County, in southeastern Florida. Sulfuryl fluoride is a highly toxic (toxicity category I) gas fumigant used for termite control of homes and buildings. FDOH personnel in Martin County commenced an investigation and identified a family of five (a grandmother, mother, father, son, and daughter) exposed to sulfuryl fluoride after their house was fumigated. The Florida Department of Agriculture and Consumer Services (FDACS), and the U.S. Environmental Protection Agency (EPA) Criminal Investigation Division also conducted an investigation after being notified by FDOH. Medical records were reviewed, and the father was interviewed by FDOH. |
Perchlorate exposure through water and milk in Istanbul
Can O , Blount B , Valentin-Blasini L , Erdemgil Y , Uzunoglu D , Aksoy M , Coskun A , Serteser M , Unsal I , Ozpinar A . Bull Environ Contam Toxicol 2016 97 (3) 439-45 Perchlorate is a chemical pollutant that inhibits iodide uptake and may possibly impair thyroid function. Our previous study found widespread perchlorate exposure in non-pregnant, non-lactating, healthy women residing in Istanbul. The aim of this study is to assess the relative amounts of perchlorate exposure attributable to consumption of municipal water, bottled water and boxed milk available in Istanbul. Only trace levels of perchlorate were found in treated municipal water (58 % detectable, mean = 0.13 microg/L, maximum = 0.75 microg/L) and bottled water (7.4 % detectable, mean = <LOD, maximum = 0.19 microg/L). Conversely, all 30 boxed milk samples contained measurable levels of perchlorate (mean = 4.53 microg/L; maximum = 6.21 microg/L). Median perchlorate exposure attributable to water and milk (0.007 microg/kg/day) is small compared both to the reference dose (0.7 microg/kg/day) and to total perchlorate exposure (0.13 microg/kg/day) in Istanbul. Therefore, additional studies are needed to identify the major sources of perchlorate exposure in Istanbul. |
CONSISE statement on the reporting of seroepidemiologic studies for influenza (ROSES-I statement): an extension of the STROBE statement
Horby PW , Laurie KL , Cowling BJ , Engelhardt OG , Sturm-Ramirez K , Sanchez JL , Katz JM , Uyeki TM , Wood J , Van Kerkhove MD , CONSISE Steering Committee . Influenza Other Respir Viruses 2016 11 (1) 2-14 BACKGROUND: Population-based serologic studies are a vital tool for understanding the epidemiology of influenza and other respiratory viruses, including the early assessment of the transmissibility and severity of the 2009 influenza pandemic, and MERS-CoV. However, interpretation of the results of serologic studies have been hampered by the diversity of approaches and the lack of standardized methods and reporting. OBJECTIVE: The objective of the CONSISE ROSES-I statement is to improve the quality and transparency of reporting of influenza seroepidemiologic studies and facilitate assessment of the validity and generalizability of published results. METHODS: The ROSES-I statement was developed as an expert consensus of the CONSISE epidemiology and laboratory working groups. The recommendations are presented in the familiar format of a reporting guideline. Since seroepidemiologic studies are a specific type of observational epidemiology study, the ROSES-I statement is built upon the STROBE guidelines. As such the ROSES-I statement should be seen as an extension of the STROBE guidelines. RESULTS: The ROSES-I statement presents 42 items that can be used as a checklist of the information that should be included in the results of published seroepidemiologic studies, and which can also serve as a guide to the items that need to be considered during study design and implementation. CONCLUSIONS: We hope that the ROSES-I Statement will contribute to improving the quality of reporting of seroepidemiologic studies. This article is protected by copyright. All rights reserved. |
Chromosome and Linear Plasmid Sequences of a 2015 Human Isolate of the Tick-Borne Relapsing Fever Spirochete, Borrelia turicatae.
Kingry LC , Batra D , Replogle A , Sexton C , Rowe L , Stermole BM , Christensen AM , Schriefer ME . Genome Announc 2016 4 (4) The sequences of the complete linear chromosome and 7 linear plasmids of the relapsing fever spirochete Borrelia turicatae are presented in this report. The 925,547 bp of chromosome and 380,211 bp of plasmid sequence were predicted to contain a total of 1,131 open reading frames, with an average G+C content of 29.7%. |
Employment implications of informal cancer caregiving
de Moor JS , Dowling EC , Ekwueme DU , Guy GP Jr , Rodriguez J , Virgo KS , Han X , Kent EE , Li C , Litzelman K , McNeel TS , Liu B , Yabroff KR . J Cancer Surviv 2016 11 (1) 48-57 PURPOSE: Previous research describing how informal cancer caregiving impacts employment has been conducted in small samples or a single disease site. This paper provides population-based estimates of the effect of informal cancer caregiving on employment and characterizes employment changes made by caregivers. METHODS: The samples included cancer survivors with a friend or family caregiver, participating in either the Medical Expenditure Panel Survey Experiences with Cancer Survivorship Survey (ECSS) (n = 458) or the LIVESTRONG 2012 Survey for People Affected by Cancer (SPAC) (n = 4706). Descriptive statistics characterized the sample of survivors and their caregivers' employment changes. Multivariable logistic regression identified predictors of caregivers' extended employment changes, comprising time off and changes to hours, duties, or employment status. RESULTS: Among survivors with an informal caregiver, 25 % from the ECSS and 29 % from the SPAC reported that their caregivers made extended employment changes. Approximately 8 % of survivors had caregivers who took time off from work lasting ≥2 months. Caregivers who made extended employment changes were more likely to care for survivors: treated with chemotherapy or transplant; closer to diagnosis or end of treatment; who experienced functional limitations; and made work changes due to cancer themselves compared to caregivers who did not make extended employment changes. CONCLUSIONS: Many informal cancer caregivers make employment changes to provide care during survivors' treatment and recovery. IMPLICATIONS FOR CANCER SURVIVORS: This study describes cancer caregiving in a prevalent sample of cancer survivors, thereby reflecting the experiences of individuals with many different cancer types and places in the cancer treatment trajectory. |
Letter in response to "questionable validity of the catheter-associated urinary tract infection metric used for value-based purchasing"
Halpin AL , Sinkowitz-Cochran R , Allen-Bridson K , Edwards JR , Pollock D , McDonald LC , Gould CV . Am J Infect Control 2016 44 (3) 369-70 Calderon et al. compares the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) catheter-associated urinary tract infection (CAUTI) metric and the Agency for Healthcare Research and Quality (AHRQ) CAUTI metric. CAUTIs are a major source of morbidity among US hospital patients, leading to unnecessary antibiotic use, secondary bacteremia, and increased length of stay. Many private and public sector organizations have led and continue to lead efforts aimed at preventing CAUTIs, including initiatives spearheaded by Federal agencies: AHRQ, CDC, and the Centers for Medicare & Medicaid Services. To monitor progress in CAUTI prevention, several metrics have been developed. While the CDC metric relies on self-reports of CAUTI events and urinary catheter use by facilities, the NHSN protocol specifies criteria and reporting rules for the purposes of objectivity and standardization. Further, the changes to the definition made in 2015 (Allen-Bridson, Pollock, et al.) likely will improve objectivity and comparability across facilities and enhance the clinical credibility of the CAUTIs reported (e.g., by excluding yeast). In addition, the potential for underreporting will be minimized over time through ongoing and expanding validation efforts and eventual transition to electronic reporting. |
Methicillin-resistant Staphylococcus aureus recovered from healthcare- and community-associated infections in Egypt
Abdel-Maksoud M , El-Shokry M , Ismail G , Hafez S , El-Kholy A , Attia E , Talaat M . Int J Bacteriol 2016 2016 5751785 Background. Methicillin-resistant Staphylococcus aureus (MRSA) has created significant epidemiological, infection-control, and therapeutic management challenges during the past three decades. Aim. To analyze the pattern of resistance of healthcare- and community-associated MRSA in Egypt and the trend of resistance of HA-MRSA over time (2005-2013). Methods. MRSA isolates were recovered from healthcare-associated (HA) and community-associated (CA) Staphylococcus aureus (S. aureus) infections. They were tested against 11 antimicrobial discs and the minimal inhibitory concentration (MIC) of vancomycin was determined. Inducible clindamycin resistance (iMLSB) was also screened using D-test. Findings. Of 631 S. aureus, MRSA was identified in 343 (76.6%) and 21 (11.5%) of HA and CA S. aureus isolates, respectively. The proportion of HA-MRSA increased significantly from 48.6% in 2005 to 86.8% in 2013 (p value < 0.001). Multidrug resistance (MDR) was observed in 85.8% of HA-MRSA and 48.6% of CA-MRSA. Vancomycin intermediate resistant S. aureus (VISA) was detected in 1.2% of HA-MRSA and none was detected in CA-MRSA. Among HA-MRSA strains, 5.3% showed iMLSB compared to 9.5% among CA-MRSA. Conclusion. The upsurge of the prevalence rates of HA-MRSA over time is alarming and urges for an effective infection control strategy and continuous monitoring of antimicrobial use. |
Is there room for prevention? Examining the effect of outpatient facility type on the risk of surgical site infection
Parikh R , Pollock D , Sharma J , Edwards J . Infect Control Hosp Epidemiol 2016 37 (10) 1-7 OBJECTIVE We compared risk for surgical site infection (SSI) following surgical breast procedures among 2 patient groups: those whose procedures were performed in ambulatory surgery centers (ASCs) and those whose procedures were performed in hospital-based outpatient facilities. DESIGN Cohort study using National Healthcare Safety Network (NHSN) SSI data for breast procedures performed from 2010 to 2014. METHODS Unconditional multivariate logistic regression was used to examine the association between facility type and breast SSI, adjusting for American Society of Anesthesiologists (ASA) Physical Status Classification, patient age, and duration of procedure. Other potential adjustment factors examined were wound classification, anesthesia use, and gender. RESULTS Among 124,021 total outpatient breast procedures performed between 2010 and 2014, 110,987 procedure reports submitted to the NHSN provided complete covariate data and were included in the analysis. Breast procedures performed in ASCs carried a lower risk of SSI compared with those performed in hospital-based outpatient settings. For patients aged ≤51 years, the adjusted risk ratio was 0.36 (95% CI, 0.25-0.50) and for patients >51 years old, the adjusted risk ratio was 0.32 (95% CI, 0.21-0.49). CONCLUSIONS SSI risk following breast procedures was significantly lower among ASC patients than among hospital-based outpatients. These findings should be placed in the context of study limitations, including the possibility of incomplete ascertainment of SSIs and shortcomings in the data available to control for differences in patient case mix. Additional studies are needed to better understand the role of procedural settings in SSI risk following breast procedures and to identify prevention opportunities. |
A concise set of structure and process indicators to assess and compare antimicrobial stewardship programs among EU and US hospitals: Results from a multinational expert panel
Pollack LA , Plachouras D , Sinkowitz-Cochran R , Gruhler H , Monnet DL , Weber JT . Infect Control Hosp Epidemiol 2016 37 (10) 1-11 OBJECTIVES To develop common indicators, relevant to both EU member states and the United States, that characterize and allow for meaningful comparison of antimicrobial stewardship programs among different countries and healthcare systems. DESIGN Modified Delphi process. PARTICIPANTS A multinational panel of 20 experts in antimicrobial stewardship. METHODS Potential indicators were rated on the perceived feasibility to implement and measure each indicator and clinical importance for optimizing appropriate antimicrobial prescribing. RESULTS The outcome was a set of 33 indicators developed to characterize the infrastructure and activities of hospital antimicrobial stewardship programs. Among them 17 indicators were considered essential to characterize an antimicrobial stewardship program and therefore were included in a core set of indicators. The remaining 16 indicators were considered optional indicators and included in a supplemental set. CONCLUSIONS The integration of these indicators in public health surveillance and special studies will lead to a better understanding of best practices in antimicrobial stewardship. Additionally, future studies can explore the association of hospital antimicrobial stewardship programs to antimicrobial use and resistance. |
Modeling and managing the risks of measles and rubella: A global perspective, part I
Thompson KM , Cochi SL . Risk Anal 2016 36 (7) 1288-96 Over the past 50 years, the use of vaccines led to significant decreases in the global burdens of measles and rubella, motivated at least in part by the successive development of global control and elimination targets. The Global Vaccine Action Plan (GVAP) includes specific targets for regional elimination of measles and rubella in five of six regions of the World Health Organization by 2020. Achieving the GVAP measles and rubella goals will require significant immunization efforts and associated financial investments and political commitments. Planning and budgeting for these efforts can benefit from learning some important lessons from the Global Polio Eradication Initiative (GPEI). Following an overview of the global context of measles and rubella risks and discussion of lessons learned from the GPEI, we introduce the contents of the special issue on modeling and managing the risks of measles and rubella. This introduction describes the synthesis of the literature available to support evidence-based model inputs to support the development of an integrated economic and dynamic disease transmission model to support global efforts to optimally manage these diseases globally using vaccines. |
Antibody-dependent cell-mediated cytotoxicity to hemagglutinin of influenza A viruses after influenza vaccination in humans
Zhong W , Liu F , Wilson JR , Holiday C , Li ZN , Bai Y , Tzeng WP , Stevens J , York IA , Levine MZ . Open Forum Infect Dis 2016 3 (2) ofw102 Background. Detection of neutralizing antibodies (nAbs) to influenza A virus hemagglutinin (HA) antigens by conventional serological assays is currently the main immune correlate of protection for influenza vaccines However, current prepandemic avian influenza vaccines are poorly immunogenic in inducing nAbs despite considerable protection conferred. Recent studies show that Ab-dependent cell-mediated cytotoxicity (ADCC) to HA antigens are readily detectable in the sera of healthy individuals and patients with influenza infection. Methods. Virus neutralization and ADCC activities of serum samples from individuals who received either seasonal or a stock-piled H5N1 avian influenza vaccine were evaluated by hemagglutination inhibition assay, microneutralization assay, and an improved ADCC natural killer (NK) cell activation assay. Results. Immunization with inactivated seasonal influenza vaccine led to strong expansion of both nAbs and ADCC-mediating antibodies (adccAbs) to H3 antigen of the vaccine virus in 24 postvaccination human sera. In sharp contrast, 18 individuals vaccinated with the adjuvanted H5N1 avian influenza vaccine mounted H5-specific antibodies with strong ADCC activities despite moderate virus neutralization capacity. Strength of HA-specific ADCC activities is largely associated with the titers of HA-binding antibodies and not with the fine antigenic specificity of anti-HA nAbs. Conclusions. Detection of both nAbs and adccAbs may better reflect protective capacity of HA-specific antibodies induced by avian influenza vaccines. |
Risk profiles of women experiencing initial and repeat incarcerations: implications for prevention programs
Herbst JH , Branscomb-Burgess O , Gelaude DJ , Seth P , Parker S , Fogel CI . AIDS Educ Prev 2016 28 (4) 299-311 Incarcerated women experience myriad individual, interpersonal, and structural factors leading to arrest and rearrest. This study examined risk profiles of women experiencing initial and repeat incarcerations. The sample included 521 women recruited from two prisons in North Carolina and enrolled in a HIV/STD risk-reduction intervention trial. Variables included socio-demographics, structural/economic factors, sexual and substance use behaviors, STDs, victimization history, and depressive symptoms. Bivariate and multivariable analyses identified risk differences. Compared to women incarcerated for the first time, women with repeat incarcerations reported significantly greater economic instability, substance use and sexual risk behaviors, laboratory-confirmed STDs, and victimization during childhood and adulthood. Multivariable logistic regression found women with repeat incarcerations experienced greater unstable housing, injection drug use, crack cocaine use, concurrent sex partners, and childhood sexual victimization. Findings can inform the development of prevention programs by addressing economic instability, sexual risk, and substance use among women prisoners. |
Mandating treatment based on interlock performance: Evidence for effectiveness
Voas RB , Tippetts AS , Bergen G , Grosz M , Marques P . Alcohol Clin Exp Res 2016 40 (9) 1953-60 BACKGROUND: Vehicle alcohol ignition interlocks reduce alcohol-impaired driving recidivism while installed, but recidivism reduction does not continue after removal. It has been suggested that integrating alcohol use disorder (AUD) treatment with interlock programs might extend the effectiveness of interlocks in reducing recidivism beyond their removal. This study evaluated the first implementation of a Florida policy mandating AUD treatment for driving under the influence (DUI) offenders on interlocks. Treatment was required when the offender accumulated 3 violations (defined as 2 "lockouts" within 4 hours; a lockout occurs when the device prevents a drinking driver from starting the vehicle). METHODS: Cox regression was used to compare alcohol-impaired driving recidivism during the 48 months following the interlock removal between 2 groups: (i) 640 multiple DUI offenders who received AUD treatment while interlocks were installed; and (ii) 806 matched offenders not mandated to treatment while interlocks were installed. RESULTS: The ignition interlock plus treatment group experienced 32% lower recidivism, 95% confidence interval [9, 49], following the removal of the interlock during the 12 to 48 months in which they were compared with the nontreatment group. We estimated that this decline in recidivism would have prevented 41 rearrests, 13 crashes, and almost 9 injuries in crashes involving the 640 treated offenders over the period following interlock removal. CONCLUSIONS: This study provides strong support for the inclusion of AUD treatment for offenders in interlock programs based on the number of times they are "locked out." The offenders required to attend treatment demonstrated a one-third lower DUI recidivism following their time on the interlock compared to similar untreated offenders. |
Handheld solar light use, durability, and retention among women and girls in internally displaced persons camps in Haiti - 2013-2014
Dynes M , Rosenthal M , Hulland E , Hardy C , Torre L , Tomczyk B . Int J Disaster Risk Reduct 2016 18 162-170 During conflict and disasters, women and girls are at increased risk of gender based violence. International humanitarian guidelines call for the distribution of individual lighting to meet women and girls' basic needs and to reduce risk of violence; however, little evidence exists to support these guidelines. This paper presents an evaluation of handheld solar light use, retention, and durability among women and girls living in two internally displaced persons camps in Port-au-Prince, Haiti. Data was gathered prospectively via five household surveys from August 2013 to April 2014; a total of 754 females participated in the study. Women reported going outside at night more frequently at the end of the study than at the beginning. The handheld solar lights were the most common source of lighting at endline, whereas candle and gas lamp use declined significantly over time. Results from a Life-Table survival analysis estimated that households had an 83% probability of still owning a functioning light after seven months. Given the frequent use, acceptable durability, and retention of the lights, donors and humanitarian organizations should consider supporting light distribution to women and girls in internally displaced persons camps to help meet their basic needs. © 2016. |
Reversion of Cold-adapted Live Attenuated Influenza Vaccine into a Pathogenic Virus.
Zhou B , Meliopoulos VA , Wang W , Lin X , Stucker KM , Halpin RA , Stockwell TB , Schultz-Cherry S , Wentworth DE . J Virol 2016 90 (19) 8454-63 The only licensed live attenuated influenza A vaccines (LAIVs) in the United States (FluMist(R)) are created using internal protein coding gene segments from the cold-adapted temperature sensitive master donor virus A/Ann Arbor/6/1960 and HA/NA gene segments from circulating viruses. During serial passage of A/Ann Arbor/6/1960 at low temperatures to select the desired attenuating phenotypes, multiple cold-adaptive mutations and temperature-sensitive mutations arose. A substantial amount of scientific and clinical evidence has proven that FluMist is safe and effective. Nevertheless, no study has been conducted specifically to determine if the attenuating temperature sensitive phenotype can revert, and if so, the type of substitutions that will emerge (i.e., compensatory substitutions versus reversion of existing attenuating mutations). Serial passage of the monovalent FluMist 2009 H1N1 pandemic vaccine at increasing temperatures in vitro generated a variant that replicated efficiently at higher temperatures. Sequencing of the variant identified seven nonsynonymous mutations including PB1-E51K, PB1-I171V, PA-N350K, PA-L366I, NP-N125Y, NP-V186I, and NS2-G63E. None occurred at positions previously reported to affect temperature sensitivity of influenza A viruses. Synthetic genomics technology was used to synthesize the whole genome of the virus, and the role of individual mutations was characterized by assessing their effects on RNA polymerase activity and virus replication kinetics at various temperatures. The revertant also regained virulence and caused significant disease in mice, with severity comparable to that caused by a wild type 2009 H1N1 pandemic virus. IMPORTANCE: The live attenuated influenza vaccine FluMist(R) has been proven safe and effective and are widely used in the USA. The phenotype and genotype of the vaccine virus are believed to be very stable and mutants that cause disease in animals or humans have never been reported. By propagating the virus under well-controlled laboratory conditions, we found that the FluMist vaccine backbone could regain virulence to cause severe disease in mice. The identification of the responsible substitutions and elucidation of the underlying mechanisms provide unique insights on the attenuation of influenza virus, which is important to basic research on vaccines, attenuation reversion, and replication. In addition, this study suggests that the safety of LAIVs should be closely monitored after mass vaccination and novel strategies to continue to improve LAIV vaccine safety should be investigated. |
Sensitive and specific nested PCR assay for detection of rotavirus A in samples with a low viral load.
Mijatovic-Rustempasic S , Esona MD , Williams AL , Bowen MD . J Virol Methods 2016 236 41-46 Techniques such as the real-time reverse transcription-polymerase chain reaction (qRT-PCR) can detect RNA in samples with a low viral load. However, these amplicons typically are either too short or at insufficient concentrations for use in subsequent sequencing reactions for genotyping and detection confirmation. The assay developed in this study detects rotavirus G genotypes and P genotypes with viral loads as low as 6.2 and 8.2 copies per reaction, respectively. The assay was validated using a panel of 91 stool samples, 32 reference rotavirus strains, and 6 non-target enteric virus samples. |
Vapor pressure and predicted stability of American Contact Dermatitis Society Core Allergens
Jou PC , Siegel PD , Warshaw EM . Dermatitis 2016 27 (4) 193-201 BACKGROUND: Accurate patch testing is reliant on proper preparation of patch test allergens. The stability of patch test allergens is dependent on several factors including vapor pressure (VP). OBJECTIVE: This investigation reviews the VP of American Contact Dermatitis Society Core Allergens and compares stability predictions based on VP with those established through clinical testing. METHODS: Standard references were accessed for determining VP in millimeters of mercury and associated temperature in degrees celsius. If multiple values were listed, VP at temperatures that most approximate indoor storage conditions (20 degrees C and 25 degrees C) were chosen. For mixes, the individual component with the highest VP was chosen as the overall VP, assuming that the most volatile substance would evaporate first. Antigens were grouped into low (≤0.001 mm Hg), moderate (<1 to >0.001 mm Hg), and high (≥1 mm Hg) volatility using arbitrary cutoff values. CONCLUSIONS: This review is consistent with previously reported data on formaldehyde, acrylates, and fragrance material instability. Given lack of testing data, VP can be useful in predicting patch test compound stability. Measures such as air-tight multidose reagent containers, sealed single-application dispensers, preparation of patches immediately before application, and storage at lower temperatures may remedy some of these issues. |
Method for the determination of ammonia in mainstream cigarette smoke using ion chromatography
Watson CV , Feng J , Valentin-Blasini L , Stanelle R , Watson CH . PLoS One 2016 11 (7) e0159126 Ammonia in mainstream smoke is present in both the particulate and vapor phases. The presence of ammonia in the cigarette filler material and smoke is of significance because of the potential role ammonia could have in raising the "smoke pH." An increased smoke pH could shift a fraction of total nicotine to free-base nicotine, which is reportedly more rapidly absorbed by the smoker. Methods measuring ammonia in smoke typically employ acid filled impingers to trap the smoke. We developed a fast, reliable method to measure ammonia in mainstream smoke without the use of costly and time consuming impingers to examine differences in ammonia delivery. The method uses both a Cambridge filter pad and a Tedlar bag to capture particulate and vapor phases of the smoke. We quantified ammonia levels in the mainstream smoke of 50 cigarette brands from 5 manufacturers. Ammonia levels ranged from approximately 1mcg to 23mcg per cigarette for ISO smoking conditions and 38mug to 67mcg per cigarette for Canadian intense smoking conditions and statistically significance differences were observed between brands and manufacturers. Our findings suggest that ammonia levels vary by brand and are higher under Canadian intense smoking conditions. |
Open-source LIMS in Vietnam: the path toward sustainability and host country ownership
Landgraf KM , Kakkar R , Meigs M , Jankauskas PT , Phan TT , Nguyen VN , Nguyen DT , Duong TT , Nguyen TH , Bond KB . Int J Med Inform 2016 93 92-102 OBJECTIVE: The objectives of this case report are as follows: to describe the process of establishing a national laboratory information management system (LIMS) program for clinical and public health laboratories in Vietnam; to evaluate the outcomes and lessons learned; and to present a model for sustainability based on the program outcomes that could be applied to diverse laboratory programs. METHODS: This case report comprises a review of program documentation and records, including planning and budgetary records of the donor, monthly reports from the implementer, direct observation, and ad-hoc field reports from technical advisors and governmental agencies. Additional data on program efficacy and user acceptance were collected from routine monitoring of laboratory policies and operational practices. RESULTS: LIMS software was implemented at 38 hospital, public health and HIV testing laboratories in Vietnam. This LIMS was accepted by users and program managers as a useful tool to support laboratory processes. Implementation cost per laboratory and average duration of deployment decreased over time, and project stakeholders initiated transition of financing (from the donor to local institutions) and of system maintenance functions (from the implementer to governmental and site-level staff). Collaboration between the implementer in Vietnam and the global LIMS user community was strongly established, and knowledge was successfully transferred to staff within Vietnam. CONCLUSION: Implementing open-sourced LIMS with local development and support was a feasible approach towards establishing a sustainable laboratory informatics program that met the needs of health laboratories in Vietnam. Further effort to institutionalize IT support capacity within key government agencies is ongoing. |
Potent inhibitors of acetyltransferase Eis overcome kanamycin resistance in Mycobacterium tuberculosis
Willby MJ , Green KD , Gajadeera CS , Hou C , Tsodikov OV , Posey JE , Garneau-Tsodikova S . ACS Chem Biol 2016 11 (6) 1639-46 A major cause of tuberculosis (TB) resistance to the aminoglycoside kanamycin (KAN) is the Mycobacterium tuberculosis (Mtb) acetyltransferase Eis. Upregulation of this enzyme is responsible for inactivation of KAN through acetylation of its amino groups. A 123000-compound high-throughput screen (HTS) yielded several small-molecule Eis inhibitors that share an isothiazole S,S-dioxide heterocyclic core. These were investigated for their structure-activity relationships. Crystal structures of Eis in complex with two potent inhibitors show that these molecules are bound in the conformationally adaptable aminoglycoside binding site of the enzyme, thereby obstructing binding of KAN for acetylation. Importantly, we demonstrate that several Eis inhibitors, when used in combination with KAN against resistant Mtb, efficiently overcome KAN resistance. This approach paves the way toward development of novel combination therapies against aminoglycoside-resistant TB. |
Incident infection and resistance mutation analysis of dried blood spots collected in a field study of HIV risk groups, 2007-2010
Wei X , Smith AJ , Forrest DW , Cardenas GA , Beck DW , LaLota M , Metsch LR , Sionean C , Owen SM , Johnson JA . PLoS One 2016 11 (7) e0159266 OBJECTIVE: To assess the utility of cost-effective dried blood spot (DBS) field sampling for incidence and drug resistance surveillance of persons at high risk for HIV infection. METHODS: We evaluated DBS collected in 2007-2010 in non-clinical settings by finger-stick from HIV-positive heterosexuals at increased risk of HIV infection (n = 124), men who have sex with men (MSM, n = 110), and persons who inject drugs (PWID, n = 58). Relative proportions of recent-infection findings among risk groups were assessed at avidity index (AI) cutoffs of ≤25%, ≤30%, and ≤35%, corresponding to an infection mean duration of recency (MDR) of 220.6, 250.4, and 278.3 days, respectively. Drug resistance mutation prevalence was compared among the risk groups and avidity indices. RESULTS: HIV antibody avidity testing of all self-reported ARV-naive persons (n = 186) resulted in 9.7%, 11.3% and 14.0% with findings within the 221, 250, and 278-day MDRs, respectively. The proportion of ARV-naive MSM, heterosexuals, and PWID reporting only one risk category who had findings below the suggested 30% AI was 23.1%, 6.9% and 3.6% (p<0.001), respectively. MSM had the highest prevalence of drug resistance and the only cases of transmitted multi-class resistance. Among the ARV-experienced, MSM had disproportionately more recent-infection results than did heterosexuals and PWID. CONCLUSIONS: The disproportionately higher recent-infection findings for MSM as compared to PWID and heterosexuals increased as the MDR window increased. Unreported ARV use might explain greater recent-infection findings and drug resistance in this MSM population. DBS demonstrated utility in expanded HIV testing; however, optimal field handling is key to accurate recent-infection estimates. |
Changes in the antibiotic susceptibility of anaerobic bacteria from 2007-2009 to 2010-2012 based on the CLSI methodology
Hastey CJ , Boyd H , Schuetz AN , Anderson K , Citron DM , Dzink-Fox J , Hackel M , Hecht DW , Jacobus NV , Jenkins SG , Karlsson M , Knapp CC , Koeth LM , Wexler H , Roe-Carpenter DE . Anaerobe 2016 42 27-30 Antimicrobial susceptibility testing of anaerobic isolates was conducted at four independent sites from 2010 to 2012 and compared to results from three sites during the period of 2007-2009. This data comparison shows significant changes in antimicrobial resistance in some anaerobic groups. Therefore, we continue to recommend institutions regularly perform susceptibility testing when anaerobes are cultured from pertinent sites. Annual generation of an institutional-specific antibiogram is recommended for tracking of resistance trends over time. |
Racial and ethnic differences in receipt of pressure equalization tubes among US children, 2014
Simon AE , Boss EF , Zelaya CE , Hoffman HJ . Acad Pediatr 2016 17 (1) 88-94 OBJECTIVES: Pressure equalization tube (PET) placement (also referred to as tympanostomy tube placement) is among the most common ambulatory surgical procedures performed on U.S. children. Over twenty years ago, differences by race/ethnicity in the national prevalence of having had PETs placed were documented. Whether these differences persist is unknown. METHODS: We used data from the 2014 National Health Interview Survey to examine the percentage of children 0-17 years of age that have ever undergone PET placement. Unadjusted logistic regression with predictive margins was used to assess the relationship between having received PETs and race/ethnicity, as well as other clinical, socioeconomic, and geographic factors. Multivariable logistic regression was used to determine whether other factors could account for any observed differences by race/ethnicity. RESULTS: Overall, 8.9% of children 0 to 17 years of age had undergone PET surgery. By race/ethnicity, 12.6% of non-Hispanic white children received PETs, which was significantly greater than the 4.8% of non-Hispanic black, 4.4% of Hispanic, and 5.6% of non-Hispanic other/multiple race children that had this surgery (p<0.001 for all comparisons). In multivariable analysis, the adjusted prevalence for non-Hispanic white children (10.8%) was greater than for non-Hispanic black (5.4%) and Hispanic (5.8%) children (p<0.001 for both comparisons). CONCLUSION: Nearly 9% of U.S. children have had PETs placed. Non-Hispanic white children still have a greater prevalence of PET placement compared with non-Hispanic black and Hispanic children. These differences could not be fully explained by other demographic, clinical, socioeconomic, or geographic differences between racial/ethnic groups. |
The relationship between physical activity and diet and young children's cognitive development: A systematic review
Tandon PS , Tovar A , Jayasuriya AT , Welker E , Schober DJ , Copeland K , Dev DA , Murriel AL , Amso D , Ward DS . Prev Med Rep 2016 3 379-90 OBJECTIVE: Given the high prevalence of suboptimal nutrition and low activity levels in children, we systematically reviewed the literature on the relationship between physical activity and dietary patterns and cognitive development in early childhood (six months to five years). METHODS: In February 2016, we conducted two different searches of MEDLINE, PsycINFO, and ERIC. Each search included either physical activity (including gross motor skills) or diet terms, and neurocognitive development outcome terms. Included studies were in English, published since 2005, and of any study design in which the physical activity or diet measure occurred prior to age five. RESULTS: For physical activity, twelve studies (5 cross-sectional, 3 longitudinal and 4 experimental) were included. Eleven studies reported evidence suggesting that physical activity or gross motor skills are related to cognition or learning. Both acute bouts and longer term exposures showed benefit. For diet, eight studies were included consisting of secondary analyses from longitudinal cohort studies. A healthier dietary pattern was associated with better cognitive outcomes in all studies, although some of the reported associations were weak and the measures used varied across the studies. CONCLUSIONS: Physical activity and healthy diets in early childhood are associated with better cognitive outcomes in young children. The paucity of literature and the variability in the type and quality of measures used highlight the need for more rigorous research. Given that the early childhood years are critical for both obesity prevention and neurocognitive development, evidence that the same healthy behaviors could promote both should inform future interventions. |
Provision of non-breast milk supplements to healthy breastfed newborns in U.S. hospitals, 2009 to 2013
Nelson JM , Perrine CG , Scanlon KS , Li R . Matern Child Health J 2016 20 (11) 2228-2232 Introduction Breastfed newborns are often given non-breast milk supplements in the hospital, which can negatively impact breastfeeding outcomes. Efforts to improve maternity care practices include reducing supplementation of breastfed newborns. Methods The Maternity Practices in Infant Nutrition and Care (mPINC) survey is administered every 2 years to all hospitals in the United States and territories with registered maternity beds. We examined provision of non-breast milk supplements to healthy, full-term breastfed newborns from 2009 to 2013. Results Hospitals that provided non-breast milk supplements to at least 50 % of breastfed newborns decreased from 31.5 % in 2009 to 23.3 % in 2013. Among hospitals providing any supplements, there was no change in the percent that supplemented with infant formula; whereas, supplementing with water declined from 8.8 % in 2009 to 4.2 % in 2013 and with glucose water from 23.4 % to 12.5 %, respectively. In 2013, 64.9 % of breastfed infants were supplemented with formula for "mother's choice," 25.0 % for "doctor's orders," and 8.7 % for "nurse's recommendation." Discussion Despite improvements in maternity care practices, nearly one-fourth of hospitals are still providing at least 50 % of healthy, full-term breastfed newborns with non-breast milk supplements. While there has been no change in the proportion of hospitals providing infant formula supplements, the proportion supplementing with water and glucose water have declined. Additional education and support of mothers during the early post-partum period and training of physicians may address reasons breastfed infants are supplemented. |
Estimating benzathine penicillin need for the treatment of pregnant women diagnosed with syphilis during antenatal care in high-morbidity countries
Taylor MM , Nurse-Findlay S , Zhang X , Hedman L , Kamb ML , Broutet N , Kiarie J . PLoS One 2016 11 (7) e0159483 BACKGROUND: Congenital syphilis continues to be a preventable cause of global stillbirth and neonatal morbidity and mortality. Shortages of injectable penicillin, the only recommended treatment for pregnant women and infants with syphilis, have been reported by high-morbidity countries. We sought to estimate current and projected annual needs for benzathine penicillin in antenatal care settings for 30 high morbidity countries that account for approximately 33% of the global burden of congenital syphilis. METHODS: Proportions of antenatal care attendance, syphilis screening coverage in pregnancy, syphilis prevalence among pregnant women, and adverse pregnancy outcomes due to untreated maternal syphilis reported to WHO were applied to 2012 birth estimates for 30 high syphilis burden countries to estimate current and projected benzathine penicillin need for prevention of congenital syphilis. RESULTS: Using current antenatal care syphilis screening coverage and seroprevalence, we estimated the total number of women requiring treatment with at least one injection of 2.4 MU of benzathine penicillin in these 30 countries to be 351,016. Syphilis screening coverage at or above 95% for all 30 countries would increase the number of women requiring treatment with benzathine penicillin to 712,030. Based on WHO management guidelines, 351,016 doses of weight-based benzathine penicillin would also be needed for the live-born infants of mothers who test positive and are treated for syphilis in pregnancy. Assuming availability of penicillin and provision of treatment for all mothers diagnosed with syphilis, an estimated 95,938 adverse birth outcomes overall would be prevented including 37,822 stillbirths, 15,814 neonatal deaths, and 34,088 other congenital syphilis cases. CONCLUSION: Penicillin need for maternal and infant syphilis treatment is high among this group of syphilis burdened countries. Initiatives to ensure a stable and adequate supply of benzathine penicillin for treatment of maternal syphilis are important for congenital syphilis prevention, and will be increasingly critical in the future as more countries move toward elimination targets. |
Importance of performance measurement and MCH epidemiology leadership to quality improvement initiatives at the national, state and local levels
Rankin KM , Gavin L , Moran JW Jr , Kroelinger CD , Vladutiu CJ , Goodman DA , Sappenfield WM . Matern Child Health J 2016 20 (11) 2239-2246 Purpose In recognition of the importance of performance measurement and MCH epidemiology leadership to quality improvement (QI) efforts, a plenary session dedicated to this topic was presented at the 2014 CityMatCH Leadership and MCH Epidemiology Conference. This paper summarizes the session and provides two applications of performance measurement to QI in MCH. Description Performance measures addressing processes of care are ubiquitous in the current health system landscape and the MCH community is increasingly applying QI processes, such as Plan-Do-Study-Act (PDSA) cycles, to improve the effectiveness and efficiency of systems impacting MCH populations. QI is maximally effective when well-defined performance measures are used to monitor change. Assessment MCH epidemiologists provide leadership to QI initiatives by identifying population-based outcomes that would benefit from QI, defining and implementing performance measures, assessing and improving data quality and timeliness, reporting variability in measures throughout PDSA cycles, evaluating QI initiative impact, and translating findings to stakeholders. MCH epidemiologists can also ensure that QI initiatives are aligned with MCH priorities at the local, state and federal levels. Two examples of this work, one highlighting use of a contraceptive service performance measure and another describing QI for peripartum hemorrhage prevention, demonstrate MCH epidemiologists' contributions throughout. Challenges remain in applying QI to complex community and systems-level interventions, including those aimed at improving access to quality care. Conclusion MCH epidemiologists provide leadership to QI initiatives by ensuring they are data-informed and supportive of a common MCH agenda, thereby optimizing the potential to improve MCH outcomes. |
A systematic review of reported exposure to engineered nanomaterials
Debia M , Bakhiyi B , Ostiguy C , Verbeek JH , Brouwer DH , Murashov V . Ann Occup Hyg 2016 60 (8) 916-35 BACKGROUND: Engineered nanomaterials (ENMs) have a large economic impact in a range of fields, but the concerns about health and safety of occupational activities involving nanomaterials have not yet been addressed. Monitoring exposure is an important step in risk management. Hence, the interest for reviewing studies that reported a potential for occupational exposure. METHODS: We systematically searched for studies published between January 2000 and January 2015. We included studies that used a comprehensive method of exposure assessment. Studies were grouped by nanomaterial and categorized as carbonaceous, metallic, or nanoclays. We summarized data on task, monitoring strategy, exposure outcomes, and controls in a narrative way. For each study, the strength of the exposure assessment was evaluated using predetermined criteria. Then, we identified all exposure situations that reported potential occupational exposure based on qualitative or quantitative outcomes. Results were synthesized and general conclusion statements on exposure situations were formulated. The quality of evidence for the conclusion statements was rated as low, moderate, or high depending on the number of confirmed exposure situations, the strength of the exposure assessment, and the consistency of the results. RESULTS: From the 6403 references initially identified, 220 were selected for full-text screening. From these, 50 studies describing 306 exposure situations in 72 workplaces were eligible for inclusion (27 industrial-scale plants and 45 research or pilot-scale units). There was a potential for exposure to ENMs in 233 of the exposure situations. Exposure occurred in 83% (N = 107) of the situations with carbonaceous ENMs, in 73% (N = 120) of those with metallic ENMs and in 100% (N = 6) of those with nanoclay. Concentrations of elemental carbon in the workers' breathing zone ranged from not detected (ND) to 910 microg m-3 with local engineering controls (LEC), and from ND to 1000 microg m-3 without those controls. For carbon nanofibres (CNFs), particle counts ranged from ND to 1.61 CNF structures cm-3 with LEC, and from 0.09 to 193 CNF structures cm-3 without those controls. The mass concentrations of aluminium oxide, titanium dioxide, silver, and iron nanoparticles (NPs) were ND, 10-150, 0.24-0.43, and 32 microg m-3 with LEC, while they were <0.35, non-applicable, 0.09-33, and 335 microg m-3 without those controls, respectively. CONCLUSIONS: Regarding the potential of exposure in the workplace, we found high-quality evidence for multiwalled carbon nanotubes (CNTs), single-walled CNTs, CNFs, aluminium oxide, titanium dioxide, and silver NPs; moderate-quality evidence for non-classified CNTs, nanoclays, and iron and silicon dioxide NPs; low-quality evidence for fullerene C60, double-walled CNTs, and zinc oxide NPs; and no evidence for cerium oxide NPs. We found high-quality evidence that potential exposure is most frequently due to handling tasks, that workers are mostly exposed to micro-sized agglomerated NPs, and that engineering controls considerably reduce workers' exposure. There was moderate-quality evidence that workers are exposed in secondary manufacturing industrial-scale plants. There was low-quality evidence that workers are exposed to airborne particles with a size <100nm. There were no studies conducted in low- and middle-income countries. |
Tool-specific performance of vibration-reducing gloves for attenuating fingers-transmitted vibration
Welcome DE , Dong RG , Xu XS , Warren C , McDowell TW . Occup Ergon 2016 13 (1) 23-44 BACKGROUND: Fingers-transmitted vibration can cause vibration-induced white finger. The effectiveness of vibration reducing (VR) gloves for reducing hand transmitted vibration to the fingers has not been sufficiently examined. OBJECTIVE: The objective of this study is to examine tool-specific performance of VR gloves for reducing finger-transmitted vibrations in three orthogonal directions (3D) from powered hand tools. METHODS: A transfer function method was used to estimate the tool-specific effectiveness of four typical VR gloves. The transfer functions of the VR glove fingers in three directions were either measured in this study or during a previous study using a 3D laser vibrometer. More than seventy vibration spectra of various tools or machines were used in the estimations. RESULTS: When assessed based on frequency-weighted acceleration, the gloves provided little vibration reduction. In some cases, the gloves amplified the vibration by more than 10%, especially the neoprene glove. However, the neoprene glove did the best when the assessment was based on unweighted acceleration. The neoprene glove was able to reduce the vibration by 10% or more of the unweighted vibration for 27 out of the 79 tools. If the dominant vibration of a tool handle or workpiece was in the shear direction relative to the fingers, as observed in the operation of needle scalers, hammer chisels, and bucking bars, the gloves did not reduce the vibration but increased it. CONCLUSIONS: This study confirmed that the effectiveness for reducing vibration varied with the gloves and the vibration reduction of each glove depended on tool, vibration direction to the fingers, and finger location. VR gloves, including certified anti-vibration gloves do not provide much vibration reduction when judged based on frequency-weighted acceleration. However, some of the VR gloves can provide more than 10% reduction of the unweighted vibration for some tools or workpieces. Tools and gloves can be matched for better effectiveness for protecting the fingers. |
Mediating pathways and gender differences between shift work and subjective cognitive function
Wong IS , Smith PM , Ibrahim S , Mustard CA , Gignac MA . Occup Environ Med 2016 73 (11) 753-760 OBJECTIVES: Increased injury risk among shift workers is often attributed to cognitive function deficits that come about as a result of sleep disruptions. However, little is known about the intermediate influences of other factors (eg, work stress, health) which may affect this relationship. In addition, gender differences in these the complex relationships have not been fully explored. The purpose of this study is to (1) identify the extent to which work and non-work factors mediate the relationship between shift work, sleep and subsequent subjective cognitive function; and (2) determine if the mediating pathways differ for men and women. METHODS: Data from the 2010 National Population Health Survey was used to create a cross-sectional sample of 4255 employed Canadians. Using path modelling, we examined the direct and indirect relationships between shift work, sleep duration, sleep quality and subjective cognitive function. Multigroup analyses tested for significantly different pathways between men and women. Potential confounding effects of age and self-reported health and potential mediating effects of work stress were simultaneously examined. RESULTS: Work stress and sleep quality significantly mediated the effects of shift work on cognition. Age and health confounded the relationship between sleep quality and subjective cognition. No differences were found between men and women. CONCLUSIONS: Occupational health and safety programmes are needed to address stress and health factors, in addition to sleep hygiene, to effectively address cognitive function among shift workers. |
Small airway dysfunction and abnormal exercise responses. A study in coal miners
Petsonk EL , Stansbury RC , Beeckman-Wagner LA , Long JL , Wang ML . Ann Am Thorac Soc 2016 13 (7) 1076-80 RATIONALE: Coal mine dust exposure can cause symptoms and loss of lung function from multiple mechanisms, but the roles of each disease process are not fully understood. OBJECTIVES: We investigated the implications of small airway dysfunction for exercise physiology among a group of workers exposed to coal mine dust. METHODS: Twenty coal miners performed spirometry, first breathing air and then helium-oxygen, single-breath diffusing capacity, and computerized chest tomography, and then completed cardiopulmonary exercise testing. MEASUREMENTS AND MAIN RESULTS: Six participants meeting criteria for small airway dysfunction were compared with 14 coal miners who did not. At submaximal workload, miners with small airway dysfunction used a higher proportion of their maximum voluntary ventilation and had higher ventilatory equivalents for both O2 and CO2. Regression modeling indicated that inefficient ventilation was significantly related to small airway dysfunction but not to FEV1 or diffusing capacity. At the end of exercise, miners with small airway dysfunction had 27% lower O2 consumption. CONCLUSIONS: Small airway abnormalities may be associated with important inefficiency of exercise ventilation. In dust-exposed individuals with only mild abnormalities on resting lung function tests or chest radiographs, cardiopulmonary exercise testing may be important in defining causes of exercise intolerance. |
Exploring virtual mental practice in maintenance task training
Bauerle T , Brnich MJ , Navoyski J . J Workplace Learn 2016 28 (5) 294-306 Purpose: This paper aims to contribute to a general understanding of mental practice by investigating the utility of and participant reaction to a virtual reality maintenance training among underground coal mine first responders. Design/methodology/approach: Researchers at the National Institute for Occupational Safety and Health’s Office of Mine Safety and Health Research (OMSHR) developed software to provide opportunities for mine rescue team members to learn to inspect, assemble and test their closed-circuit breathing apparatus and to practice those skills. In total, 31 mine rescue team members utilized OMSHR’s BG 4 Benching Trainer software and provided feedback to the development team. After training, participants completed a brief post-training questionnaire, which included demographics, perceived training climate and general training evaluation items. Findings: The results overall indicate a generally positive reaction to and high perceived utility of the BG 4 benching software. In addition, the perceived training climate appears to have an effect on the perceived utility of the mental practice virtual reality game, with benchmen from mines with more positive training climates reporting greater perceived efficacy in the training’s ability to prepare trainees for real emergencies. Originality/value: This paper helps to broaden current applications of mental practice and is one of the few empirical investigations into a non-rehabilitation virtual reality extension of mental practice. This paper also contributes to the growing literature advocating for greater usage of accurate and well-informed mental practice techniques, tools and methodologies, especially for occupational populations with limitations on exposure to hands-on training. © 2016, © Emerald Group Publishing Limited. |
Plasmodium falciparum Drug-Resistant Haplotypes and Population Structure in Postearthquake Haiti, 2010.
Morton LC , Huber C , Okoth SA , Griffing S , Lucchi N , Ljolje D , Boncy J , Oscar R , Townes D , McMorrow M , Chang MA , Udhayakumar V , Barnwell JW . Am J Trop Med Hyg 2016 95 (4) 811-816 Chloroquine (CQ) remains the first-line treatment of malaria in Haiti. Given the challenges of conducting in vivo drug efficacy trials in low-endemic settings like Haiti, molecular surveillance for drug resistance markers is a reasonable approach for detecting resistant parasites. In this study, 349 blood spots were collected from suspected malaria cases in areas in and around Port-au-Prince from March to July 2010. Among them, 121 samples that were Plasmodium falciparum positive by polymerase chain reaction were genotyped for drug-resistant pfcrt, pfdhfr, pfdhps, and pfmdr1 alleles. Among the 108 samples that were successfully sequenced for CQ resistant markers in pfcrt, 107 were wild type (CVMNK), whereas one sample carried a CQ-resistant allele (CVIET). Neutral microsatellite genotyping revealed that the CQ-resistant isolate was distinct from all other samples in this study. Furthermore, the remaining parasite specimens appeared to be genetically distinct from other reported Central and South American populations. |
Adherence to national guidelines for the diagnosis and management of severe malaria: a nationwide, cross-sectional survey in Malawi, 2012
Shah MP , Briggs-Hagen M , Chinkhumba J , Bauleni A , Chalira A , Moyo D , Dodoli W , Luhanga M , Sande J , Ali D , Gutman J , Mathanga DP , Lindblade KA . Malar J 2016 15 (1) 369 BACKGROUND: Severe malaria has a case fatality rate of 10-20 %; however, few studies have addressed the quality of severe malaria case management. This study evaluated the diagnostic and treatment practices of malaria patients admitted to inpatient health facilities (HF) in Malawi. METHODS: In July-August 2012, a nationwide, cross-sectional survey of severe malaria management was conducted in 36 HFs selected with equal probability from all eligible public sector HFs in Malawi. Patient records from all admissions during October 2011 and April 2012 (low and high season, respectively) were screened for an admission diagnosis of malaria or prescription of any anti-malarial. Eligible records were stratified by age (< 5 or ≥ 5 years). A maximum of eight records was randomly selected within each age and month stratum. Severe malaria was defined by admission diagnosis or documentation of at least one sign or symptom of severe malaria. Treatment with intravenous (IV) quinine or artesunate was considered correct. Patients without documentation of severe malaria were analysed as uncomplicated malaria patients; treatment with an artemisinin-based combination therapy (ACT) or oral quinine based on malaria test results was considered correct. All analyses accounted for HF level clustering and sampling weights. RESULTS: The analysis included 906 records from 35 HFs. Among these, 42 % (95 % confidence interval [CI] 35-49) had a severe malaria admission diagnosis and 50 % (95 % CI 44-57) had at least one severe malaria sign or symptom documented. Severe malaria patients defined by admission diagnosis (93, 95 % CI 86-99) were more likely to be treated correctly compared to patients defined by a severe sign (82, 95 % CI 75-89) (p < 0.0001). Among uncomplicated malaria patients, 26 % (95 % CI 18-35) were correctly treated and 53 % (95 % CI 42-64) were adequately treated with IV quinine alone or in combination with an ACT or oral quinine. CONCLUSIONS: A majority of patients diagnosed with severe malaria received the recommended IV therapy in accordance with national treatment guidelines. However, the inconsistencies between diagnosis of severe malaria and documentation of severe signs and symptoms highlight the need to improve healthcare worker recognition and documentation of severe signs and symptoms. |
Safety of intrauterine devices in breastfeeding women: a systematic review
Berry-Bibee EN , Tepper NK , Jatlaoui TC , Whiteman MK , Jamieson DJ , Curtis KM . Contraception 2016 94 (6) 725-738 OBJECTIVES: To investigate levonorgestrel (LNG)-releasing and copper-bearing (Cu) intrauterine device (IUD) safety among breastfeeding women and, for Cu-IUD use, breastfeeding performance and infant health. STUDY DESIGN: Systematic review METHODS: We searched PubMed, Embase, Cochrane Library and clinicaltrials.gov for articles through January 2016. We included studies of Cu-IUD or LNG-IUD users comparing IUD-specific (perforation, expulsion) and other contraceptive-related (infection, removal/cessation due to bleeding/pain, and other adverse events) outcomes for breastfeeding versus non-breastfeeding women. We also included studies of breastfeeding women comparing contraceptive-related outcome for IUD-users versus other contraceptive-method users. Finally, we included studies comparing breastfeeding outcomes among Cu-IUD users to users of other non-hormonal contraceptives or no contraception. RESULTS: Of 548 articles identified, 23 (16 studies) met inclusion criteria. Two studies suggested the risk of IUD perforation was 6-10 times higher among breastfeeding versus non-breastfeeding women. Seven studies suggested risks for other adverse events were similar or lower among breastfeeding versus non-breastfeeding women. Three studies among breastfeeding women found no increased risk of adverse events in IUD users versus non-users. Breastfeeding performance and infant growth were similar for Cu-IUD users and users of other non-hormonal methods or no contraception. CONCLUSION: Overall, risks for adverse events among IUD users, including expulsion, pain and removals were similar or lower for breastfeeding women versus non-breastfeeding women. Uterine perforation with IUDs, while rare, appeared more frequent among breastfeeding women. No evidence indicated Cu-IUD use in breastfeeding women influences breastfeeding performance or infant growth. |
Factors predicting double embryo implantation following double embryo transfer in assisted reproductive technology: implications for elective single embryo transfer
Martin C , Chang J , Boulet S , Jamieson DJ , Kissin D . J Assist Reprod Genet 2016 33 (10) 1343-1353 PURPOSE: The aim of this study was to identify factors associated with double embryo implantation following double embryo transfer (DET) during assisted reproductive technology (ART) procedures and to evaluate the implications of findings in selecting candidates for elective single embryo transfer (eSET). METHODS: Factors predicting double embryo implantation, defined as embryo transfers with two or more heartbeats on 6-week ultrasound following DET, were assessed using the US National ART Surveillance System data from 2000 to 2012 (n = 1,793,067 fresh, autologous transfers). Adjusted risk ratios (aRRs) were estimated after stratifying by prognosis. Favorable prognosis was defined as first-time ART with supernumerary embryo(s) cryopreserved. Average prognosis was defined as first-time ART without supernumerary embryo(s) cryopreserved, prior unsuccessful ART with supernumerary embryo(s) cryopreserved, or prior ART with previous birth(s) conceived with ART or naturally. Rates and factors associated with double embryo implantation were compared with single embryo implantation following DET among both prognosis groups. RESULTS: Double embryo implantation was positively associated with blastocyst (versus cleavage) transfer in favorable (aRR = 1.58 (1.51-1.65)) and average (aRR = 1.67 (1.60-1.75)) prognosis groups and negatively associated with age >35 years in both prognosis groups. For average prognosis patients, double embryo implantation was associated with retrieving >10 oocytes (aRR = 1.22 (1.18-1.24)). CONCLUSIONS: Regardless of prognosis, patients aged <35 years with blastocyst-stage embryos and average prognosis patients from whom >10 oocytes were retrieved may be good candidates for eSET. Physicians may consider using these data to counsel patients on eSET, which would reduce multiple gestations and associated complications. |
Characteristics of women screened for a contraceptive intravaginal ring study in Kisumu, Kenya, 2014
McLellan-Lemal E , Gust DA , Gvetadze R , Furtado M , Otieno FO , Desai M , Zeh C , Samandari T , Nyagol B , Makanga EM . Res J Womens Health 2016 3 (1) BACKGROUND: HIV antiretroviral-based intravaginal rings with and without co-formulated contraception hold promise for increasing HIV prevention options for women. Acceptance of and ability to correctly and consistently use this technology may create challenges for future ring-based microbicide trials in settings where this technology has not been introduced. We examined baseline factors associated with enrolling in a contraceptive intravaginal ring study in Kisumu, Kenya and describe notional acceptability (willingness to switch to a contraceptive ring based solely on information received about it). METHODS: Demographic, psychosocial, and behavioral eligibility screening of women 18-34 years was undertaken. Testing for pregnancy, HIV, and other sexually transmitted infections (STIs) was also conducted. We compared enrollment status across groups of categorical predictors using prevalence ratios (PR) and 95% confidence interval (CI) estimates obtained from a log-binomial regression model. RESULTS: Out of 692 women pre-screened April to November 2014, 463 completed screening, and 302 women were enrolled. Approximately 97% of pre-screened women were willing to switch from their current contraceptive method to use the intravaginal ring exclusively for the 6-month intervention period. Pregnancy, HIV, and STI prevalence were 1.7%, 14.5%, and 70.4% respectively for the 463 women screened. Women 18-24 (PR=1.47, CI 1.15-1.88) were more likely to be enrolled than those 30-34 years of age, as were married/cohabitating women (PR=1.62, CI 1.22-2.16) compared to those separated, divorced, or widowed. In adjusted analyses, sexual debut at less than 17 years of age, one lifetime sexual partner, abnormal vaginal bleeding in the past 12 months, condomless vaginal or anal sex in the past 3 months, and not having a sexual partner of unknown HIV status in the past 3 months were predictive of enrollment. CONCLUSION: High notional acceptability suggests feasibility for contraceptive intravaginal ring use. Factors associated with ring use initiation and 6-month use will need to be assessed. |
Dietary folate intake and modification of the association of urinary bisphenol A concentrations with in vitro fertilization outcomes among women from a fertility clinic
Minguez-Alarcon L , Gaskins AJ , Chiu YH , Souter I , Williams PL , Calafat AM , Hauser R , Chavarro JE . Reprod Toxicol 2016 65 104-112 Experimental data in rodents suggest that the effects of bisphenol A (BPA) on oocyte development may be modified by dietary methyl donors. Whether the same interaction exists in humans is unknown. We evaluated whether intake of methyl donors modified the associations between urinary BPA concentrations and treatment outcomes among 178 women who underwent 248 IVF cycles at a fertility center in Boston between 2007 and 2012. Participants completed a validated food frequency questionnaire and provided up to two urine samples per treatment cycle. High urinary BPA concentrations were associated with a 66% lower probability of implantation (p=0.007) among women who consumed <400mug/day of food folate, but not among women consuming ≥400mug/day (21% higher probability of implantation, p=0.18) (p,interaction=0.04). A similar pattern was observed for probability of clinical pregnancy (p,interaction=0.07) and live birth (p,interaction=0.16). These results are consistent with previous animal data but further evaluation in other human populations is needed. |
A methodological approach to small area estimation for the Behavioral Risk Factor Surveillance System
Pierannunzi C , Xu F , Wallace RC , Garvin W , Greenlund KJ , Bartoli W , Ford D , Eke P , Town GM . Prev Chronic Dis 2016 13 E91 Public health researchers have used a class of statistical methods to calculate prevalence estimates for small geographic areas with few direct observations. Many researchers have used Behavioral Risk Factor Surveillance System (BRFSS) data as a basis for their models. The aims of this study were to 1) describe a new BRFSS small area estimation (SAE) method and 2) investigate the internal and external validity of the BRFSS SAEs it produced. The BRFSS SAE method uses 4 data sets (the BRFSS, the American Community Survey Public Use Microdata Sample, Nielsen Claritas population totals, and the Missouri Census Geographic Equivalency File) to build a single weighted data set. Our findings indicate that internal and external validity tests were successful across many estimates. The BRFSS SAE method is one of several methods that can be used to produce reliable prevalence estimates in small geographic areas. |
Tobacco product use among adults - United States, 2013-2014
Hu SS , Neff L , Agaku IT , Cox S , Day HR , Holder-Hayes E , King BA . MMWR Morb Mortal Wkly Rep 2016 65 (27) 685-91 While significant declines in cigarette smoking have occurred among U.S. adults during the past 5 decades, the use of emerging tobacco products has increased in recent years (1-3). To estimate tobacco use among U.S. adults aged ≥18 years, CDC and the Food and Drug Administration (FDA) analyzed data from the 2013-2014 National Adult Tobacco Survey (NATS). During 2013-2014, 21.3% of U.S. adults used a tobacco product every day or some days, and 25.5% of U.S. adults used a tobacco product every day, some days, or rarely. Despite progress in reducing cigarette smoking, during 2013-2014, cigarettes remained the most commonly used tobacco product among adults. Young adults aged 18-24 years reported the highest prevalence of use of emerging tobacco products, including water pipes/hookahs and electronic cigarettes (e-cigarettes). Furthermore, racial/ethnic and sociodemographic differences in the use of any tobacco product were observed, with higher use reported among males; non-Hispanic whites, non-Hispanic blacks, and non-Hispanics of other races(dagger); persons aged <45 years; persons living in the Midwest or South; persons with a General Educational Development (GED) certificate; persons who were single/never married/not living with a partner or divorced/separated/widowed; persons with annual household income <$20,000; and persons who were lesbian, gay, or bisexual (LGB). Population-level interventions that focus on all forms of tobacco product use, including tobacco price increases, high-impact anti-tobacco mass media campaigns, comprehensive smoke-free laws, and enhanced access to help quitting tobacco use, in conjunction with FDA regulation of tobacco products, are critical to reducing tobacco-related diseases and deaths in the United States. |
Tobacco use, secondhand smoke, and smoke-free home rules in multiunit housing
Nguyen KH , Gomez Y , Homa DM , King BA . Am J Prev Med 2016 51 (5) 682-692 INTRODUCTION: Multiunit housing (MUH) residents are particularly susceptible to involuntary secondhand smoke (SHS) exposure in their home, which can enter their living units from nearby units and shared areas where smoking occurs. To date, no study has assessed non-cigarette tobacco use among MUH residents. This study assessed the prevalence and sociodemographic correlates of tobacco use (combustible, noncombustible, any tobacco use including electronic cigarettes), smoke-free home rules, and SHS incursions among U.S. MUH residents. METHODS: Data came from the 2013-2014 National Adult Tobacco Survey, a telephone survey of U.S. adults aged ≥18 years. Analyses were conducted in 2015. Prevalence of current tobacco use and smoke-free home rules were assessed overall and by sociodemographics, stratified by housing type (single family versus MUH). Prevalence and adjusted odds of SHS incursions among MUH residents with smoke-free home rules were assessed. RESULTS: Tobacco use was higher among adults living in MUH (24.7%) than those in single-family housing (18.9%, p<0.05). Smoke-free home rules were higher among adults living in single-family housing (86.7%) than those in MUH (80.9%, p<0.05). Among MUH residents with smoke-free homes, 34.4% experienced SHS incursions. Adjusted odds of SHS incursions were greater among women, younger adults, non-Hispanic blacks, Hispanics, and those with lower income. CONCLUSIONS: One quarter of MUH residents use tobacco, and one third of MUH residents with smoke-free rules experience SHS incursions. Interventions are warranted to promote tobacco cessation and smoke-free building policies to protect all MUH residents, employees, and visitors from the dangers of tobacco use and SHS. |
Multivariate statistical analysis of cigarette design feature influence on ISO TNCO yields
Agnew-Heard KA , Lancaster VA , Bravo R , Watson C , Walters MJ , Holman MR . Chem Res Toxicol 2016 29 (6) 1051-63 The aim of this study is to explore how differences in cigarette physical design parameters influence tar, nicotine, and carbon monoxide (TNCO) yields in mainstream smoke (MSS) using the International Organization of Standardization (ISO) smoking regimen. Standardized smoking methods were used to evaluate 50 U.S. domestic brand cigarettes and a reference cigarette representing a range of TNCO yields in MSS collected from linear smoking machines using a nonintense smoking regimen. Multivariate statistical methods were used to form clusters of cigarettes based on their ISO TNCO yields and then to explore the relationship between the ISO generated TNCO yields and the nine cigarette physical design parameters between and within each cluster simultaneously. The ISO generated TNCO yields in MSS are 1.1-17.0 mg tar/cigarette, 0.1-2.2 mg nicotine/cigarette, and 1.6-17.3 mg CO/cigarette. Cluster analysis divided the 51 cigarettes into five discrete clusters based on their ISO TNCO yields. No one physical parameter dominated across all clusters. Predicting ISO machine generated TNCO yields based on these nine physical design parameters is complex due to the correlation among and between the nine physical design parameters and TNCO yields. From these analyses, it is estimated that approximately 20% of the variability in the ISO generated TNCO yields comes from other parameters (e.g., filter material, filter type, inclusion of expanded or reconstituted tobacco, and tobacco blend composition, along with differences in tobacco leaf origin and stalk positions and added ingredients). A future article will examine the influence of these physical design parameters on TNCO yields under a Canadian Intense (CI) smoking regimen. Together, these papers will provide a more robust picture of the design features that contribute to TNCO exposure across the range of real world smoking patterns. |
Perceived effectiveness of antismoking ads and association with quit attempts among smokers: evidence from the Tips From Former Smokers Campaign
Davis KC , Duke J , Shafer P , Patel D , Rodes R , Beistle D . Health Commun 2016 32 (8) 1-8 BACKGROUND: Measures of perceived effectiveness (PE) of ads have been validated to predict changes in cognitive precursors of quit attempts, but a relationship between PE and actual quit attempts has not been shown in population-based studies. We analyzed smokers' PE ratings of ads from the national Tips From Former Smokers (Tips) campaign to (1) establish the validity of PE in predicting quit attempts in a large, nationally representative sample of smokers; (2) identify behavioral and demographic correlates of PE among respondents; and (3) examine whether PE is influenced by matching the race/ethnicity of ad participants with that of the ad viewer. METHODS: We used survey data from two waves (baseline and follow-up) of a longitudinal online cohort of adult U.S. cigarette smokers. Respondents were shown one or more of 14 Tips campaign ads and were asked to assess each ad in terms of PE. We used multivariate models to estimate the association between baseline PE and prospective quit attempts; cross-sectional associations between PE and various respondent characteristics, including race/ethnicity, desire to quit, and health conditions; and the association between race/ethnicity of respondents and Tips ad participants. RESULTS: Higher PE at baseline was associated with increased odds of a quit attempt at follow-up. Higher PE scores were associated with non-Hispanic black race, Hispanic ethnicity, higher desire to quit, presence of a chronic health condition, and presence of a mental health condition. There was no relationship between PE scores and matched race/ethnicity of the respondent and Tips ad participants. CONCLUSIONS: This is the first study to demonstrate an association between PE scores for antismoking ads and prospective quit attempts in a large, nationally representative sample of smokers. Our findings also provide strong evidence that racial/ethnic minority subpopulations, including non-Hispanic blacks and Hispanics, react more favorably to Tips campaign ads irrespective of race/ethnicity of the ad participant. This suggests that message characteristics (e.g., graphic visuals and emotional content) may play a more important role in PE than race/ethnicity of ad participants. |
Tick-Borne Relapsing Fever Outbreak Among a High School Football Team at an Outdoor Education Camping Trip, Arizona, 2014.
Jones JM , Hranac CR , Schumacher M , Horn K , Lee DM , Terriquez J , Engelthaler DM , Peoples M , Corrigan J , Replogle A , Souders N , Komatsu KK , Nieto NC . Am J Trop Med Hyg 2016 95 (3) 546-50 During August 2014, five high school students who had attended an outdoor education camp were hospitalized with a febrile illness, prompting further investigation. Ten total cases of tick-borne relapsing fever (TBRF) were identified-six cases confirmed by culture or visualization of spirochetes on blood smear and four probable cases with compatible symptoms (attack rate: 23%). All patients had slept in the campsite's only cabin. Before the camp, a professional pest control company had rodent proofed the cabin, but no acaricides had been applied. Cabin inspection after the camp found rodents and Ornithodoros ticks, the vector of TBRF. Blood samples from a chipmunk trapped near the cabin and from patients contained Borrelia hermsii with identical gene sequences (100% over 630 base pairs). Health departments in TBRF endemic areas should consider educating cabin owners and pest control companies to apply acaricides during or following rodent proofing, because ticks that lack rodents for a blood meal might feed on humans. |
Zika virus infection associated with severe thrombocytopenia
Sharp TM , Munoz-Jordan J , Perez-Padilla J , Bello-Pagan MI , Rivera A , Pastula DM , Salinas JL , Martinez Mendez JH , Mendez M , Powers AM , Waterman S , Rivera-Garcia B . Clin Infect Dis 2016 63 (9) 1198-1201 We report two patients who developed severe thrombocytopenia after Zika virus infection. The first had 1,000 platelets/mm3, and died following multiple hemorrhages. The second had 2,000 platelets/mm3, melena, ecchymoses, and recovered after receiving intravenous immunoglobulin. Physicians should be aware that Zika virus may be associated with immune-mediated severe thrombocytopenia. |
Notes from the field: Rickettsia parkeri rickettsiosis - Georgia, 2012-2014
Straily A , Feldpausch A , Ulbrich C , Schell K , Casillas S , Zaki SR , Denison AM , Condit M , Gabel J , Paddock CD . MMWR Morb Mortal Wkly Rep 2016 65 (28) 718-719 During 2012-2014, five cases of Rickettsia parkeri rickettsiosis were identified by a single urgent care practice in Georgia, located approximately 40 miles southwest of Atlanta. Symptom onset occurred during June-October, and all patients had a known tick bite. Patients ranged in age from 27 to 72 years (median = 53 years), and all were male. The most commonly reported initial signs were erythema (n = 3) and swelling (n = 2) at the site of the bite. Two patients reported fever and a third patient reported a rash and lymphadenopathy without fever. Other symptoms included myalgia (n = 3), chills (n = 3), fatigue (n = 2), arthralgia (n = 2), and headache (n = 2). Eschar biopsy specimens were collected from each patient using a 4-mm or 5-mm punch and placed in 10% neutral buffered formalin or sterile saline. These specimens were tested by immunohistochemical (IHC) stains, quantitative polymerase chain reaction (qPCR) assays, or cell culture isolation to determine if there was evidence of infection with a Rickettsia species (1). IHC evidence of spotted fever group rickettsiae was found in the eschar biopsy specimens in all five cases. In four cases, the biopsy specimens were also positive for R. parkeri by qPCR. The fifth case (specimen positive only by IHC testing) was considered a probable R. parkeri case based on clinical signs and symptoms. R. parkeri was grown in cell culture from one specimen from which isolation was attempted. All patients were treated with oral doxycycline (100 mg twice daily) for a minimum of 10 days, and all recovered. |
A performance management initiative for local health department vector control programs
Gerding J , Kirshy M , Moran JW , Bialek R , Lamers V , Sarisky J . Environ Health Insights 2016 10 113-8 Local health department (LHD) vector control programs have experienced reductions in funding and capacity. Acknowledging this situation and its potential effect on the ability to respond to vector-borne diseases, the U.S. Centers for Disease Control and Prevention and the Public Health Foundation partnered on a performance management initiative for LHD vector control programs. The initiative involved 14 programs that conducted a performance assessment using the Environmental Public Health Performance Standards. The programs, assisted by quality improvement (QI) experts, used the assessment results to prioritize improvement areas that were addressed with QI projects intended to increase effectiveness and efficiency in the delivery of services such as responding to mosquito complaints and educating the public about vector-borne disease prevention. This article describes the initiative as a process LHD vector control programs may adapt to meet their performance management needs. This study also reviews aggregate performance assessment results and QI projects, which may reveal common aspects of LHD vector control program performance and priority improvement areas. LHD vector control programs interested in performance assessment and improvement may benefit from engaging in an approach similar to this performance management initiative. |
Projected Zika virus importation and subsequent ongoing transmission after travel to the 2016 Olympic and Paralympic Games - country-specific assessment, July 2016
Grills A , Morrison S , Nelson B , Miniota J , Watts A , Cetron MS . MMWR Morb Mortal Wkly Rep 2016 65 (28) 711-715 Zika virus belongs to the genus Flavivirus of the family Flaviviridae; it is transmitted to humans primarily through the bite of an infected Aedes species mosquito (e.g., Ae. aegypti and Ae. albopictus) (1). Zika virus has been identified as a cause of congenital microcephaly and other serious brain defects (2). As of June 30, 2016, CDC had issued travel notices for 49 countries and U.S. territories across much of the Western hemisphere (3), including Brazil, where the 2016 Olympic and Paralympic Games (Games of the XXXI Olympiad, also known as Rio 2016; Games) will be hosted in Rio de Janeiro in August and September 2016. During the Games, mosquito-borne Zika virus transmission is expected to be low because August and September are winter months in Brazil, when cooler and drier weather typically reduces mosquito populations (4). CDC conducted a risk assessment to predict those countries susceptible to ongoing Zika virus transmission resulting from introduction by a single traveler to the Games. Whereas all countries are at risk for travel-associated importation of Zika virus, CDC estimated that 19 countries currently not reporting Zika outbreaks have the environmental conditions and population susceptibility to sustain mosquito-borne transmission of Zika virus if a case were imported from infection at the Games. For 15 of these 19 countries, travel to Rio de Janeiro during the Games is not estimated to increase substantially the level of risk above that incurred by the usual aviation travel baseline for these countries. The remaining four countries, Chad, Djibouti, Eritrea, and Yemen, are unique in that they do not have a substantial number of travelers to any country with local Zika virus transmission, except for anticipated travel to the Games. These four countries will be represented by a projected, combined total of 19 athletes (plus a projected delegation of about 60 persons), a tiny fraction of the 350,000-500,000 visitors expected at the Games.* Overall travel volume to the Games represents a very small fraction (<0.25%) of the total estimated 2015 travel volume to Zika-affected countries,dagger highlighting the unlikely scenario that Zika importation would be solely attributable to travel to the Games. To prevent Zika virus infection and its complications among athletes and visitors to the Games and importation of Zika virus into countries that could sustain local transmission, pregnant women should not travel to the Games, mosquito bites should be avoided while traveling and for 3 weeks after returning home, and measures should be taken to prevent sexual transmission (Box). |
Evidence for personal protective measures to reduce human contact with blacklegged ticks and for environmentally based control methods to suppress host-seeking blacklegged ticks and reduce infection with Lyme disease spirochetes in tick vectors and rodent reservoirs
Eisen L , Dolan MC . J Med Entomol 2016 53 (5) 1063-1092 In the 1980s, the blacklegged tick, Ixodes scapularis Say, and rodents were recognized as the principal vector and reservoir hosts of the Lyme disease spirochete Borrelia burgdorferi in the eastern United States, and deer were incriminated as principal hosts for I. scapularis adults. These realizations led to pioneering studies aiming to reduce the risk for transmission of B. burgdorferi to humans by attacking host-seeking ticks with acaricides, interrupting the enzootic transmission cycle by killing immatures infesting rodent reservoirs by means of acaricide-treated nesting material, or reducing deer abundance to suppress tick numbers. We review the progress over the past three decades in the fields of: 1) prevention of human-tick contact with repellents and permethrin-treated clothing, and 2) suppression of I. scapularis and disruption of enzootic B. burgdorferi transmission with environmentally based control methods. Personal protective measures include synthetic and natural product-based repellents that can be applied to skin and clothing, permethrin sprays for clothing and gear, and permethrin-treated clothing. A wide variety of approaches and products to suppress I. scapularis or disrupt enzootic B. burgdorferi transmission have emerged and been evaluated in field trials. Application of synthetic chemical acaricides is a robust method to suppress host-seeking I. scapularis ticks within a treated area for at least 6-8 wk. Natural product-based acaricides or entomopathogenic fungi have emerged as alternatives to kill host-seeking ticks for homeowners who are unwilling to use synthetic chemical acaricides. However, as compared with synthetic chemical acaricides, these approaches appear less robust in terms of both their killing efficacy and persistence. Use of rodent-targeted topical acaricides represents an alternative for homeowners opposed to open distribution of acaricides to the ground and vegetation on their properties. This host-targeted approach also provides the benefit of the intervention impacting the entire rodent home range. Rodent-targeted oral vaccines against B. burgdorferi and a rodent-targeted antibiotic bait have been evaluated in laboratory and field trials but are not yet commercially available. Targeting of deer-via deer reduction or treatment of deer with topical acaricides-can provide area-wide suppression of host-seeking I. scapularis These two deer-targeted approaches combine great potential for protection that impacts the entire landscape with severe problems relating to public acceptance or implementation logistics. Integrated use of two or more methods has unfortunately been evaluated in very few published studies, but additional field evaluations of integrated tick and pathogen strategies are underway. |
Experiences with insecticide-treated curtains: a qualitative study in Iquitos, Peru
Paz-Soldan VA , Bauer KM , Lenhart A , Cordova Lopez JJ , Elder JP , Scott TW , McCall PJ , Kochel TJ , Morrison AC . BMC Public Health 2016 16 582 BACKGROUND: Dengue is an arthropod-borne viral disease responsible for approximately 400 million infections annually; the only available method of prevention is vector control. It has been previously demonstrated that insecticide treated curtains (ITCs) can lower dengue vector infestations in and around houses. As part of a larger trial examining whether ITCs could reduce dengue transmission in Iquitos, Peru, the objective of this study was to characterize the participants' experience with the ITCs using qualitative methods. METHODS: Knowledge, attitudes, and practices (KAP) surveys (at baseline, and 9 and 27 months post-ITC distribution, with n = 593, 595 and 511, respectively), focus group discussions (at 6 and 12 months post-ITC distribution, with n = 18 and 33, respectively), and 11 one-on-one interviews (at 12 months post-distribution) were conducted with 605 participants who received ITCs as part of a cluster-randomized trial. RESULTS: Focus groups at 6 months post-ITC distribution revealed that individuals had observed their ITCs to function for approximately 3 months, after which they reported the ITCs were no longer working. Follow up revealed that the ITCs required re-treatment with insecticide at approximately 1 year post-distribution. Over half (55.3 %, n = 329) of participants at 9 months post-ITC distribution and over a third (34.8 %, n = 177) at 27 months post-ITC distribution reported perceiving a decrease in the number of mosquitoes in their home. The percentage of participants who would recommend ITCs to their family or friends in the future remained high throughout the study (94.3 %, n = 561 at 9 months and 94.6 %, n = 488 at 27 months post-distribution). When asked why, participants reported that ITCs were effective at reducing mosquitoes (81.6 and 37.8 %, at 9 and 27 months respectively), that they prevent dengue (5.7 and 51.2 %, at 9 and 27 months), that they are "beautiful" (5.9 and 3.1 %), as well as other reasons (6.9 and 2.5 %). CONCLUSION: ITCs have substantial potential for long term dengue vector control because they are liked by users, both for their perceived effectiveness and for aesthetic reasons, and because they require little proactive behavioral effort on the part of the users. Our results highlight the importance of gathering process (as opposed to outcome) data during vector control studies, without which researchers would not have become aware that the ITCs had lost effectiveness early in the trial. |
Insights into Borrelia miyamotoi infection from an untreated case demonstrating relapsing fever, monocytosis and a positive C6 Lyme serology
Sudhindra P , Wang G , Schriefer ME , McKenna D , Zhuge J , Krause PJ , Marques AR , Wormser GP . Diagn Microbiol Infect Dis 2016 86 (1) 93-6 We describe a patient from the United States with PCR- and serology-confirmed Borrelia miyamotoi infection who recovered without antibiotics. Our findings suggest that B. miyamotoi infection may cause relapsing fever, blood monocytosis and antibody reactivity to the C6 peptide. Further studies are required to better define the spectrum of clinical and laboratory findings for this emerging tick-transmitted infection. |
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