Strategic planning for chronic disease prevention in rural America: looking through a PRISM lens
Honeycutt AA , Wile K , Dove C , Hawkins J , Orenstein D . J Public Health Manag Pract 2014 21 (4) 392-9 CONTEXT: Community-level strategic planning for chronic disease prevention. OBJECTIVE: To share the outcomes of the strategic planning process used by Mississippi Delta stakeholders to prevent and reduce the negative impacts of chronic disease in their communities. A key component of strategic planning was participants' use of the Prevention Impacts Simulation Model (PRISM) to project the reduction, compared with the status quo, in deaths and costs from implementing interventions in Mississippi Delta communities. DESIGN: Participants in Mississippi Delta strategic planning meetings used PRISM, a user-friendly, evidence-based simulation tool that includes 22 categories of policy, systems, and environmental change interventions, to pose what-if questions that explore the likely short- and long-term effects of an intervention or any desired combination of the 22 categories of chronic disease intervention programs and policies captured in PRISM. These categories address smoking, air pollution, poor nutrition, and lack of physical activity. Strategic planning participants used PRISM outputs to inform their decisions and actions to implement interventions. SETTING: Rural communities in the Mississippi Delta. PARTICIPANTS: A diverse group of 29 to 34 local chronic disease prevention stakeholders, known as the Mississippi Delta Strategic Alliance. MAIN OUTCOME MEASURE(S): Community plans and actions that were developed and implemented as a result of local strategic planning. RESULTS: Existing strategic planning efforts were complemented by the use of PRISM. The Mississippi Delta Strategic Alliance decided to implement new interventions to improve air quality and transportation and to expand existing interventions to reduce tobacco use and increase access to healthy foods. They also collaborated with the Department of Transportation to raise awareness and use of the current transportation network. CONCLUSIONS: The Mississippi Delta Strategic Alliance strategic planning process was complemented by the use of PRISM as a tool for strategic planning, which led to the implementation of new and strengthened chronic disease prevention interventions and policies in the Mississippi Delta. |
Strengthening breast and cervical cancer control through partnerships: American Indian and Alaska Native Women and the National Breast and Cervical Cancer Early Detection Program
Espey D , Castro G , Flagg T , Landis K , Henderson JA , Benard VB , Royalty JE . Cancer 2014 120 Suppl 16 2557-65 The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) has played a critical role in providing cancer screening services to American Indian and Alaska Native (AI/ANs) women and strengthening tribal screening capacity. Since 1991, the NBCCEDP has funded states, tribal nations, and tribal organizations to develop and implement organized screening programs. The ultimate goal is to deliver breast and cervical cancer screening to women who do not have health insurance and cannot afford to pay for these services. The delivery of clinical services is supported through complementary program efforts such as professional development, public education and outreach, and patient navigation. This article seeks to describe the growth of NBCCEDP's tribal commitment and the unique history and aspects of serving the AI/AN population. The article describes: 1) how this program has demonstrated success in improving screening of AI/AN women; 2) innovative partnerships with the Indian Health Service, state programs, and other organizations that have improved tribal public health infrastructure; and 3) the evolution of Centers for Disease Control and Prevention work with tribal communities. |
Trends in outpatient visits for insomnia, sleep apnea, and prescriptions for sleep medications among US adults: findings from the National Ambulatory Medical Care Survey 1999-2010
Ford ES , Wheaton AG , Cunningham TJ , Giles WH , Chapman DP , Croft JB . Sleep 2014 37 (8) 1283-93 STUDY OBJECTIVE: To examine recent national trends in outpatient visits for sleep related difficulties in the United States and prescriptions for sleep medications. DESIGN: Trend analysis. SETTING: Data from the National Ambulatory Medical Care Survey from 1999 to 2010. PARTICIPANTS: Patients age 20 y or older. MEASUREMENTS AND RESULTS: The number of office visits with insomnia as the stated reason for visit increased from 4.9 million visits in 1999 to 5.5 million visits in 2010 (13% increase), whereas the number with any sleep disturbance ranged from 6,394,000 visits in 1999 to 8,237,000 visits in 2010 (29% increase). The number of office visits for which a diagnosis of sleep apnea was recorded increased from 1.1 million visits in 1999 to 5.8 million visits in 2010 (442% increase), whereas the number of office visits for which any sleep related diagnosis was recorded ranged from 3.3 million visits in 1999 to 12.1 million visits in 2010 (266% increase). The number of prescriptions for any sleep medication ranged from 5.3 in 1999 to 20.8 million in 2010 (293% increase). Strong increases in the percentage of office visits resulting in a prescription for nonbenzodiazepine sleep medications ( approximately 350%), benzodiazepine receptor agonists ( approximately 430%), and any sleep medication ( approximately 200%) were noted. CONCLUSIONS: Striking increases in the number and percentage of office visits for sleep related problems and in the number and percentage of office visits accompanied by a prescription for a sleep medication occurred from 1999-2010. |
The National Breast and Cervical Cancer Early Detection Program in the era of health reform: A vision forward
Plescia M , Wong F , Pieters J , Joseph D . Cancer 2014 120 Suppl 16 2620-4 For the last 22 years, the Centers for Disease Control and Prevention (CDC) National Breast and Cervical Cancer Early Detection Program (NBCCEDP) has provided high quality breast and cervical cancer screening to women who do not have health insurance or who have inadequate insurance. As the health care landscape changes, it is time for CDC to address new identified needs and opportunities to increase cancer screening and to further explore new or expanded roles for the program looking to the future. The NBCCEDP is well positioned to build upon its experience, established clinical and community partnerships, and success in serving disadvantaged and diverse populations to address important barriers to cancer screening that will persist as health reform is implemented. Additionally, the program can adapt its extensive experience with establishing and managing an organized system of delivering cancer screening and apply it to promote a more organized approach to screening through health care systems on a population level. Emphasis is placed on the implementation of evidenced-based interventions proven effective in increasing cancer screening rates, promising practices and other organizational policy and health systems interventions. |
Preventing infections during cancer treatment: development of an interactive patient education website
Dunbar A , Tai E , Nielsen DB , Shropshire S , Richardson LC . Clin J Oncol Nurs 2014 18 (4) 426-31 Despite advances in oncology care, infections from both community and healthcare settings remain a major cause of hospitalization and death among patients with cancer receiving chemotherapy. Neutropenia (low white blood cell count) is a common and potentially dangerous side effect in patients receiving chemotherapy treatments and may lead to higher risk of infection. Preventing infection during treatment can result in significant decreases in morbidity and mortality for patients with cancer. As part of the Centers for Disease Control and Prevention's (CDC's) Preventing Infections in Cancer Patients public health campaign, a public-private partnership was formed between the CDC Foundation and Amgen, Inc. The CDC's Division of Cancer Prevention and Control developed and launched an interactive website, www.PreventCancerInfections.org, designed for patients with cancer undergoing chemotherapy. The site encourages patients to complete a risk assessment for developing neutropenia during their treatment. After completing the assessment, patients receive information about how to lower the risk for infection and keep themselves healthy while receiving chemotherapy. |
Expanding efforts to address Alzheimer's disease: the Healthy Brain Initiative
Anderson LA , Egge R . Alzheimers Dement 2014 10 S453-6 The growing burden of Alzheimer's disease underscores the importance of enhancing current public health efforts to address dementia. Public health organizations and entities have substantial opportunities to contribute to efforts underway and to add innovations to the field. The Alzheimer's Association and the Centers for Disease Control and Prevention worked with a 15-member leadership committee and hundreds of stakeholders to create The Healthy Brain Initiative: The Public Health Road Map for State and National Partnerships, 2013-2018 (Road Map). The actions in the Road Map provide a foundation for the public health community to anticipate and respond to emerging innovations and developments. It will be a challenge to harness the increasingly complex nature of public- and private-sector collaborations. We must strengthen the capacity of public health agencies, leverage partnerships, and find new ways to integrate cognitive functioning into public health efforts. |
Females with FVIII and FIX deficiency have reduced joint range of motion
Sidonio RF , Mili FD , Li T , Miller CH , Hooper WC , DeBaun MR , Soucie M . Am J Hematol 2014 89 (8) 831-6 Little is known about rates of joint bleeding among females with FVIII/FIX deficiency or hemophilia carriers. In a cross-sectional study, we tested the hypothesis that females with FVIII or FIX deficiency enrolled in the Universal Data Collection (UDC) project had a reduced mean overall joint range of motion (ROM) compared with historic controls from the Normal Joint Study. Demographics, clinical characteristics, and joint ROM measurements on 303 females without a bleeding disorder and 148 females with FVIII and FIX deficiency, respectively, between the ages of 2-69 years and a body mass index (BMI) ≤ 35 were compared. Multivariate linear regression was performed with the overall joint ROM (sum of the right and left ROM measurements of five joints) as the dependent variable and FVIII or FIX activity as the independent variable adjusting for age, race, BMI, and number of joint bleeds reported over the last 6 months. As FVIII and FIX activity decreased, the mean overall joint ROM became reduced and in most cases was significantly lower than that of the controls regardless of age and clinical hemophilia severity. Further investigation of reduced joint ROM as evidence of subclinical joint bleeding in females with FVIII and FIX deficiency is warranted. |
From cancer screening to treatment: service delivery and referral in the National Breast and Cervical Cancer Early Detection Program
Miller JW , Hanson V , Johnson GD , Royalty JE , Richardson LC . Cancer 2014 120 Suppl 16 2549-56 The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides breast and cervical cancer screening and diagnostic services to low-income and underserved women through a network of providers and health care organizations. Although the program serves women 40-64 years old for breast cancer screening and 21-64 years old for cervical cancer screening, the priority populations are women 50-64 years old for breast cancer and women who have never or rarely been screened for cervical cancer. From 1991 through 2011, the NBCCEDP provided screening and diagnostic services to more than 4.3 million women, diagnosing 54,276 breast cancers, 2554 cervical cancers, and 123,563 precancerous cervical lesions. A critical component of providing screening services is to ensure that all women with abnormal screening results receive appropriate and timely diagnostic evaluations. Case management is provided to assist women with overcoming barriers that would delay or prevent follow-up care. Women diagnosed with cancer receive treatment through the states' Breast and Cervical Cancer Treatment Programs (a special waiver for Medicaid) if they are eligible. The NBCCEDP has performance measures that serve as benchmarks to monitor the completeness and timeliness of care. More than 90% of the women receive complete diagnostic care and initiate treatment less than 30 days from the time of their diagnosis. Provision of effective screening and diagnostic services depends on effective program management, networks of providers throughout the community, and the use of evidence-based knowledge, procedures, and technologies. |
Individual, family, and community predictors of overweight and obesity among Colombian children and adolescents
Gonzalez-Casanova I , Sarmiento OL , Pratt M , Gazmararian JA , Martorell R , Cunningham SA , Stein A . Prev Chronic Dis 2014 11 E134 INTRODUCTION: Information from high-income countries is often used to design childhood obesity prevention interventions in low- and middle-income countries, even though determinants may differ greatly between settings. METHODS: We examined the associations of individual, family (household), and community (municipality) characteristics with body mass index (BMI) z scores and likelihood of overweight among children aged 5 to 18 years measured for the Colombian National Nutrition surveys of 2005 (n = 9,119) and 2010 (n = 21,520). We used 3-level hierarchical linear models with child as level 1, household as level 2, and municipality as level 3. RESULTS: The prevalence of combined overweight and obesity among Colombian children and adolescents was 15.7% in 2005 and 16.6% in 2010. The household level explained 40% in 2005 and 31% in 2010 of the variability in BMI z scores. Wealth was positively associated with BMI in 2005 (0.09 increase in z score per wealth quintile) and 2010 (0.13 increase in z score per wealth quintile) (P < .01). Children and adolescents from extended families had higher BMI z scores than those from nuclear families; BMI z scores were inversely associated with the number of family members living in the same household. The municipality level explained only between 2% and 3% of the variability in BMI. Income inequality was positively associated with BMI z scores in 2010. CONCLUSION: These patterns differ from those commonly described in high-income countries and suggest more appropriate opportunities for interventions to prevent child and adolescent obesity in Colombia and other Latin American settings and populations. |
Varicella hospitalizations in Los Angeles during the varicella vaccination era, 2003-2011: are they preventable?
Agopian A , Lopez A , Wilson D , Peralta V , Amin AN , Bialek S . Vaccine 2014 32 (41) 5353-6 Characteristics of varicella-related hospitalizations in the mature varicella vaccination era, including the proportion vaccinated and the severity of disease, are not well described. We present the vaccination status, severity and reasons for hospitalization of the hospitalized varicella cases reported to the Los Angeles County Health Department from 2003 to 2011, the period which includes the last 4 years of the mature one-dose program and the first 5 years after introduction of the routine two-dose program. A total of 158 hospitalized varicella cases were reported overall, of which 52.5% were potentially preventable and eligible for vaccination, 41.8% were not eligible for vaccination, and 5.7% were vaccinated. Most hospitalizations (72.2%) occurred among healthy persons, 54.4% occurred among persons ≥20 years of age, and 3.8% of hospitalizations resulted in death. Our data suggest that as many as half of the hospitalized varicella cases, including half of the deaths, may have been preventable given that they occurred in persons who were eligible for vaccination. More complete implementation of the routine varicella vaccination program could further reduce the disease burden of severe varicella. |
Fatal Burkholderia pseudomallei infection initially reported as a Bacillus species, Ohio, 2013
Doker TJ , Quinn CL , Salehi ED , Sherwood JJ , Benoit TJ , Elrod MG , Gee JE , Shadomy SV , Bower WA , Hoffmaster AR , Walke HT , Blaney DD , DiOrio MS . Am J Trop Med Hyg 2014 91 (4) 743-6 A fatal case of melioidosis was diagnosed in Ohio one month after culture results were initially reported as a Bacillus species. To identify a source of infection and assess risk in patient contacts, we abstracted patient charts; interviewed physicians and contacts; genetically characterized the isolate; performed a Burkholderia pseudomallei antibody indirect hemagglutination assay on household contacts and pets to assess seropositivity; and collected household plant, soil, liquid, and insect samples for culturing and real-time polymerase chain reaction testing. Family members and pets tested were seronegative for B. pseudomallei. Environmental samples were negative by real-time polymerase chain reaction and culture. Although the patient never traveled internationally, the isolate genotype was consistent with an isolated that originated in Southeast Asia. This investigation identified the fifth reported locally acquired non-laboratory melioidosis case in the contiguous United States. Physicians and laboratories should be aware of this potentially emerging disease and refer positive cultures to a Laboratory Response Network laboratory. |
Association of serum antibodies with protection against rotavirus infection and disease in South Indian children
Premkumar P , Lopman B , Ramani S , Paul A , Gladstone B , Muliyil J , Mukhopadhya I , Parashar U , Kang G . Vaccine 2014 32 Suppl 1 A55-61 Serum antibodies play an important role in natural protection from rotavirus infection and disease, but conflicting estimates of association have emerged from epidemiological studies in different geographical settings. In this study, we aim to assess the relationship between pre-existing serum immunoglobulin (Ig)G and IgA titers with protection against rotavirus infection and disease in a birth cohort of Indian children. Children were recruited at birth and followed up for 36 months. Stool samples were collected every 2 weeks and during episodes of diarrhea and serum samples were obtained at least every 6 months. The incidence rate of rotavirus infection and diarrhea was 0.9 (95% CI: 0.88, 0.99) and 0.2 (95% CI: 0.19, 0.25) episodes per child year, respectively. The risk of rotavirus infection and diarrhea decreased with age, while antibody titers (IgG and IgA) increased with age. After adjusting for age and number of previous infections, higher levels of IgG and IgA were independently associated with reduced risk of rotavirus infection. However, we did not find a clear association of IgG or IgA with rotavirus diarrhea risk or a threshold level of protection. The study supports a correlation of serum antibodies in reducing the risk of rotavirus infections, however the potential of serum antibody titer as a correlate of protection is not clear for children in lower income settings. |
West Nile virus Isolated from a Virginia opossum (Didelphis virginiana) in northwestern Missouri, USA, 2012
Bosco-Lauth A , Harmon JR , Lash RR , Weiss S , Langevin S , Savage HM , Godsey MS Jr , Burkhalter K , Root JJ , Gidlewski T , Nicholson WL , Brault AC , Komar N . J Wildl Dis 2014 50 (4) 976-8 We describe the isolation of West Nile virus (WNV; Flaviviridae, Flavivirus) from blood of a Virginia opossum (Didelphis virginiana) collected in northwestern Missouri in August 2012. Sequencing determined that the virus was related to lineage 1a WNV02 strains. We discuss the role of wildlife in WNV disease epidemiology. |
Pyrethroid susceptibility of malaria vectors in four districts of western Kenya
Ochomo E , Bayoh NM , Kamau L , Atieli F , Vulule J , Ouma C , Ombok M , Njagi K , Soti D , Mathenge E , Muthami L , Kinyari T , Subramaniam K , Kleinschmidt I , Donnelly MJ , Mbogo C . Parasit Vectors 2014 7 (1) 310 BACKGROUND: Increasing pyrethroid resistance in malaria vectors has been reported in western Kenya where long lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) are the mainstays of vector control. To ensure the sustainability of insecticide-based malaria vector control, monitoring programs need to be implemented. This study was designed to investigate the extent and distribution of pyrethroid resistance in 4 Districts of western Kenya (Nyando, Rachuonyo, Bondo and Teso). All four Districts have received LLINs while Nyando and Rachuonyo Districts have had IRS campaigns for 3-5 years using pyrethroids. This study is part of a programme aimed at determining the impact of insecticide resistance on malaria epidemiology. METHODS: Three day old adult mosquitoes from larval samples collected in the field, were used for bioassays using the WHO tube bioassay, and mortality recorded 24 hours post exposure. Resistance level was assigned based on the 2013 WHO guidelines where populations with <90% mortality were considered resistant. Once exposed, samples were identified to species using PCR. RESULTS: An. arabiensis comprised at least 94% of all An. gambiae s.l. in Bondo, Rachuonyo and Nyando. Teso was a marked contrast case with 77% of all samples being An. gambiae s.s. Mortality to insecticides varied widely between clusters even in one District with mortality to deltamethrin ranging from 45-100%, while to permethrin the range was 30-100%. Mortality to deltamethrin in Teso District was < 90% in 4 of 6 clusters tested in An arabiensis and <90% in An. gambiae s.s in 5 of 6 clusters tested. To permethrin, mortality ranged between 5.9-95%, with <90% mortality in 9 of 13 and 8 of 13 in An. arabiensis and An. gambiae s.s. respectively. Cluster specific mortality of An. arabiensis between permethin and deltamethrin were not correlated (Z = 2.9505, P = 0.2483). CONCLUSION: High levels of pyrethroid resistance were observed in western Kenya. This resistance does not seem to be associated with either species or location. Insecticide resistance can vary within small geographical areas and such heterogeneity may make it possible to evaluate the impact of resistance on malaria and mosquito parameters within similar eco-epidemiological zones. |
Cerebral Angiostrongylus cantonensis infection in a captive African pygmy falcon (Polihierax semitorquatus) in southern California
Burns RE , Bicknese EJ , Qvarnstrom Y , DeLeon-Carnes M , Drew CP , Gardiner CH , Rideout BA . J Vet Diagn Invest 2014 26 (5) 695-8 A 10-month-old, female African pygmy falcon (Polihierax semitorquatus) hatched and housed at the San Diego Zoo developed neurologic signs and died from a cerebral infection with the rat lungworm Angiostrongylus cantonensis. There was an associated mild nonsuppurative meningoencephalitis. This infection was diagnosed on histology and confirmed by detection of species-specific A. cantonensis DNA in formalin-fixed and frozen brain tissue by a polymerase chain reaction assay. To the authors' knowledge, this infection has not previously been reported in a bird in the United States and has not been known to be naturally acquired in any species in this region of the world. The source of the infection was not definitively determined but was possibly feeder geckos (Hemidactylus frenatus) imported from Southeast Asia where the parasite is endemic. |
Animal bite and rabies postexposure prophylaxis reporting - United States, 2013
Vora NM , Clippard JR , Stobierski MG , Signs K , Blanton JD . J Public Health Manag Pract 2014 21 (3) E24-7 CONTEXT: Rabies virus causes a fatal encephalitis and is typically acquired through the bite of an infected mammal. Rabies is preventable through administration of rabies postexposure prophylaxis (PEP), but this must be balanced with the need to avoid unnecessary PEP use. Though not nationally notifiable, some state health departments (SHDs) have made animal bites and use of PEP reportable within their jurisdictions. OBJECTIVE: We evaluated whether animal bites and PEP were reportable to SHDs as of 2013 for every state in the United States. DESIGN: The list of reportable conditions for each SHD as of 2013 was reviewed on the Internet for every state in the United States to determine whether animal bites or PEP were reportable. We then contacted an SHD representative (typically the State Public Health Veterinarian) to confirm data generated through Internet searches. Health departments in states where PEP was reportable were asked to complete a follow-up survey. RESULTS: Animal bites and PEP both were reportable in 9 states (18%). Another 9 states (18%) mandated animal bite reporting but not PEP reporting, while 12 states (24%) mandated PEP reporting but not animal bite reporting. These events were not reportable in 20 states (40%). The benefits reported by personnel from SHDs with PEP reporting systems varied greatly. CONCLUSIONS: Additional investigations focusing on the value of information returned by PEP reporting and identifying best practices for implementation and management are needed. The lack of standardization between current animal bite and PEP reporting systems limits completeness of reporting and comparability of outcomes. National recommendations to standardize case definitions and other data elements might help jurisdictions developing new animal bite or PEP reporting systems. |
Identification and genetic characterization of Clostridium botulinum serotype A strains from commercially pasteurized carrot juice.
Marshall KM , Nowaczyk L 2nd , Raphael BH , Skinner GE , Rukma Reddy N . Food Microbiol 2014 44 149-55 Clostridium botulinum is an important foodborne pathogen capable of forming heat resistant endospores and producing deadly botulinum neurotoxins (BoNTs). In 2006, C. botulinum was responsible for an international outbreak of botulism attributed to the consumption of commercially pasteurized carrot juice. The purpose of this study was to isolate and characterize strains of C. botulinum from the adulterated product. Carrot juice bottles retrieved from the manufacturing facility were analyzed for the presence of BoNT and BoNT-producing isolates using DIG-ELISA. Toxigenic isolates from the carrot juice were analyzed using pulsed-field gel electrophoresis (PFGE) and DNA microarray analysis to determine their genetic relatedness to the original outbreak strains CDC51348 and CDC51303. PFGE revealed that isolates CJ4-1 and CJ10-1 shared an identical pulsotype with strain CDC51303, whereas isolate CJ5-1 displayed a unique restriction banding pattern. DNA microarray analysis identified several phage related genes unique to strain CJ5-1, and Southern hybridization analysis of XhoI digested and nondigested DNA showed their chromosomal location, while a homolog to pCLI_A009 of plasmid pCLI of C. botulinum serotype Langeland F, was located on a small plasmid. The acquisition or loss of bacteriophages and other mobile genetic elements among C. botulinum strains has epidemiological and evolutionary implications. |
Public health assessment of dioxin-contaminated fish at former US airbase, Bien Hoa, Vietnam
Durant JT , Boivin TG , Pohl HR , Sinks TH . Int J Environ Health Res 2014 25 (3) 1-11 Ponds at the former US airbase at Ben Hoa, Vietnam are contaminated with Agent Orange. The ponds had been used for aquaculture, and in all likelihood, fish from those ponds have been sold to the public. We assessed human exposure to 2,3,7,8-tetrachloro-dibenzo-dioxin (2,3,7,8-TCDD) in fish samples from the ponds. For on-base tilapia, muscle concentrations 2,3,7,8-TCDD ranged from 1.4 to 32.7 pg/g. Fat concentrations ranged from 73.3 to 3990 pg/g. Estimated human exposure doses exceed international guidelines and exceed 2,3,7,8-TCDD's lowest adverse effect levels. The Bien Hoa fishponds are a completed human pathway for TCDD exposure. |
Discovery and full genome characterization of a new SIV lineage infecting red-tailed guenons (Cercopithecus ascanius schmidti) in Kibale National Park, Uganda.
Lauck M , Switzer WM , Sibley SD , Hyeroba D , Tumukunde A , Weny G , Shankar A , Greene JM , Ericsen AJ , Zheng H , Ting N , Chapman CA , Friedrich TC , Goldberg TL , O'Connor DH . Retrovirology 2014 11 (1) 55 BACKGROUND: Human immunodeficiency virus (HIV) type 1 and 2, the causative agents of acquired immunodeficiency syndrome (AIDS), emerged from African non-human primates (NHPs) through zoonotic transmission of simian immunodeficiency viruses (SIV). Among African NHPs, the Cercopithecus genus contains the largest number of species known to harbor SIV. However, our understanding of the diversity and evolution of SIVs infecting this genus is limited by incomplete taxonomic and geographic sampling, particularly in East Africa. In this study, we screened blood specimens from red-tailed guenons (Cercopithecus ascanius schmidti) from Kibale National Park, Uganda, for the presence of novel SIVs using unbiased deep-sequencing. FINDINGS: We describe and characterize the first full-length SIV genomes from wild red-tailed guenons in Kibale National Park, Uganda. This new virus, tentatively named SIVrtg_Kib, was detected in five out of twelve animals and is highly divergent from other Cercopithecus SIVs as well as from previously identified SIVs infecting red-tailed guenons, thus forming a new SIV lineage. CONCLUSIONS: Our results show that the genetic diversity of SIVs infecting red-tailed guenons is greater than previously appreciated. This diversity could be the result of cross-species transmission between different guenon species or limited gene flow due to geographic separation among guenon populations. |
Norovirus in healthcare settings
Iturriza-Gomara M , Lopman B . Curr Opin Infect Dis 2014 27 (5) 437-43 PURPOSE OF REVIEW: To provide an overview of the burden of norovirus disease in healthcare settings and the factors responsible for outbreaks in these institutions; to assess progress on interventions aimed at reducing the burden of norovirus disease. RECENT FINDINGS: Norovirus outbreaks in healthcare settings are driven by confluence of viral diversity, the built environment, and host factors. Some of these characteristics may be modifiable and the target of successful interventions. SUMMARY: Most norovirus outbreaks in hospital and residential care institutions are associated with a particular genotype, known as GII.4. The persistence of norovirus is associated with strain diversity, which is driven by immune evasion and viral adaptation to interaction with a variety of human histo-blood group antigens. The healthcare environment presents serious challenges for control, both because of the physical structure of the built space and the high levels of contact among patient populations who may have compromised hygiene. Increased vulnerability among the populations in healthcare institutions is likely to be multifactorial and may include the following: nutritional status, immunodeficiency or senescence, chronic inflammation, and microbiome alterations. Current control measures are based on general infection control principles, and treatment is mainly supportive and nonspecific. Vaccines and antiviral agents are being developed with promising results, but none are currently available. |
A compendium of strategies to prevent healthcare-associated infections in acute care hospitals: 2014 updates
Yokoe DS , Anderson DJ , Berenholtz SM , Calfee DP , Dubberke ER , Ellingson KD , Gerding DN , Haas JP , Kaye KS , Klompas M , Lo E , Marschall J , Mermel LA , Nicolle LE , Salgado CD , Bryant K , Classen D , Crist K , Deloney VM , Fishman NO , Foster N , Goldmann DA , Humphreys E , Jernigan JA , Padberg J , Perl TM , Podgorny K , Septimus EJ , VanAmringe M , Weaver T , Weinstein RA , Wise R , Maragakis LL . Am J Infect Control 2014 42 (8) 820-8 Since the publication of "A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals" in 2008, prevention of healthcare-associated infections (HAIs) has become a national priority. Despite improvements, preventable HAIs continue to occur. The 2014 updates to the Compendium were created to provide acute care hospitals with up-to-date, practical, expert guidance to assist in prioritizing and implementing their HAI prevention efforts. They are the product of a highly collaborative effort led by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise, including the Centers for Disease Control and Prevention (CDC), the Institute for Healthcare Improvement (IHI), the Pediatric Infectious Diseases Society (PIDS), the Society for Critical Care Medicine (SCCM), the Society for Hospital Medicine (SHM), and the Surgical Infection Society (SIS). |
Rotavirus disease and vaccines in India: A tremendous public health opportunity
Tate JE , Arora R , Bhan MK , Yewale V , Parashar UD , Kang G . Vaccine 2014 32 Suppl 1 vii-xii In March 2014, The Lancet reported the successful results of the efficacy and safety trial of 116E, the first Indian-manufactured rotavirus vaccine to complete phase 3 clinical testing [1]. In a multicenter study conducted in three geographically and culturally diverse cities of India – Delhi, Pune, and Vellore – despite intensive health care provision which may have modified the severity of disease, the 116E vaccine showed efficacy comparable to that of two internationally licensed rotavirus vaccines manufactured by Merck and Co. and GlaxoSmithKline. Several other indigenously manufactured rotavirus vaccines are in development in India, some of which are in late stages of clinical testing. With an effective, indigenously produced rotavirus vaccine on the near-term horizon, India, which singularly accounts for almost one fifth of the world's burden of rotavirus deaths in children [2], is poised to have a new tool in the arsenal of interventions to reduced morbidity and mortality from childhood diarrhea. To help assess the public health value of the vaccine, understanding the current rotavirus disease burden and epidemiology, circulating strains, and economic burden of rotavirus in India is important. This supplement contains papers summarizing the most up-to-date data on these issues. In addition, the supplement addresses areas relevant for post-introduction monitoring of rotavirus vaccine, including potential safety concerns associated with other rotavirus vaccines such as intussusception, a condition in which one portion of the bowel telescopes into another causing a blockage. Finally, this supplement contains papers looking at the performance of rotavirus vaccines, both the indigenous and internationally available vaccines, in India and explores strategies to improve vaccine performance. This collection of papers will help provide a complete picture of rotavirus disease in India and the potential for a rotavirus vaccination program, and also set the platform to assess the impact of vaccines post-introduction. |
Safety and immunogenicity of a recombinant live attenuated tetravalent dengue vaccine (DENVax) in flavivirus-naive healthy adults in Colombia: a randomised, placebo-controlled, phase 1 study
Osorio JE , Velez ID , Thomson C , Lopez L , Jimenez A , Haller AA , Silengo S , Scott J , Boroughs KL , Stovall JL , Luy BE , Arguello J , Beatty ME , Santangelo J , Gordon GS , Huang CY , Stinchcomb DT . Lancet Infect Dis 2014 14 (9) 830-8 BACKGROUND: Dengue virus is the most serious mosquito-borne viral threat to public health and no vaccines or antiviral therapies are approved for dengue fever. The tetravalent DENVax vaccine contains a molecularly characterised live attenuated dengue serotype-2 virus (DENVax-2) and three recombinant vaccine viruses expressing the prM and E structural genes for serotypes 1, 3, and 4 in the DENVax-2 genetic backbone. We aimed to assess the safety and immunogenicity of tetravalent DENVax formulations. METHODS: We undertook a randomised, double-blind, phase 1, dose-escalation trial between Oct 11, 2011, and Nov 9, 2011, in the Rionegro, Antioquia, Colombia. The first cohort of participants (aged 18-45 years) were randomly assigned centrally, via block randomisation, to receive a low-dose formulation of DENvax, or placebo, by either subcutaneous or intradermal administration. After a safety assessment, participants were randomly assigned to receive a high-dose DENVax formulation, or placebo, by subcutaneous or intradermal administration. Group assignment was not masked from study pharmacists, but allocation was concealed from participants, nurses, and investigators. Primary endpoints were frequency and severity of injection-site and systemic reactions within 28 days of each vaccination. Secondary endpoints were the immunogenicity of DENVax against all four dengue virus serotypes, and the viraemia due to each of the four vaccine components after immunisation. Analysis was by intention to treat for safety and per protocol for immunogenicity. Because of the small sample size, no detailed comparison of adverse event rates were warranted. The trial is registered with ClinicalTrials.gov, number NCT01224639. FINDINGS: We randomly assigned 96 patients to one of the four study groups: 40 participants (42%) received low-dose vaccine and eight participants (8%) received placebo in the low-dose groups; 39 participants (41%) received high-dose vaccine, with nine (9%) participants assigned to receive placebo. Both formulations were well tolerated with mostly mild and transient local or systemic reactions. No clinically meaningful differences were recorded in the overall incidence of local and systemic adverse events between patients in the vaccine and placebo groups; 68 (86%) of 79 participants in the vaccine groups had solicited systemic adverse events compared with 13 (76%) of 17 of those in the placebo groups. By contrast, 67 participants (85%) in the vaccine group had local solicited reactions compared with five (29%) participants in the placebo group. Immunisation with either high-dose or low-dose DENVax formulations induced neutralising antibody responses to all four dengue virus serotypes; 30 days after the second dose, 47 (62%) of 76 participants given vaccine seroconverted to all four serotypes and 73 (96%) participants seroconverted to three or more dengue viruses. Infectious DENVax viruses were detected in only ten (25%) of 40 participants in the low-dose group and 13 (33%) of 39 participants in the high-dose group. INTERPRETATION: Our findings emphasise the acceptable tolerability and immunogenicity of the tetravalent DENVax formulations in healthy, flavivirus-naive adults. Further clinical testing of DENVax in different age groups and in dengue-endemic areas is warranted. FUNDING: Takeda Vaccines. |
Vaccination against zoster remains effective in older adults who later undergo chemotherapy
Tseng HF , Tartof S , Harpaz R , Luo Y , Sy LS , Hetcher RC , Jacobsen SJ . Clin Infect Dis 2014 59 (7) 913-9 BACKGROUND: Approximately 40% of adults develop invasive cancer during their lifetimes, many of whom require chemotherapy. Herpes zoster (HZ) is common and often severe in patients undergoing chemotherapy, yet there are no data regarding whether these patients retain specific protection against HZ if they had previously received zoster vaccine. We conducted a study to determine whether zoster vaccine was effective in patients who subsequently underwent chemotherapy. METHODS: The cohort study consisted of Kaiser Permanente Southern California members aged ≥60 years treated with chemotherapy. The exposure variable was receipt of zoster vaccine prior to initiation of chemotherapy. Incident HZ cases were identified using International Classification of Diseases, Ninth Revision diagnostic codes. HZ incidence rates were calculated; hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression models. RESULTS: There were 91 and 583 HZ cases in the vaccinated and unvaccinated cohorts, respectively, yielding an incidence rate of 12.87 (95% CI, 10.48-15.80) vs 22.05 (95% CI, 20.33-23.92) per 1000 person-years. Thirty-month cumulative incidence was 3.28% in the vaccinated group and 5.34% in the unvaccinated group (P < .05). The adjusted HR for HZ was 0.58 (95% CI, .46-.73) and showed no significant variation by age, sex, or race. HZ incidence rates remained increased in the small subgroup of persons receiving zoster vaccine within 60 days before chemotherapy, but this was the only group affected by indication bias. No vaccinated patients underwent hospitalization for HZ, compared with 6 unvaccinated patients. CONCLUSIONS: Zoster vaccine continues to protect against HZ if recipients later undergo chemotherapy. Our findings provide an additional rationale for offering zoster vaccine to indicated adults while they are immunocompetent. |
Pandemic preparedness and the Influenza Risk Assessment Tool (IRAT)
Cox NJ , Trock SC , Burke SA . Curr Top Microbiol Immunol 2014 385 119-36 Influenza infections have resulted in millions of deaths and untold millions of illnesses throughout history. Influenza vaccines are the cornerstone of influenza prevention and control. Recommendations are made by the World Health Organization (WHO) 6-9 months in advance of the influenza season regarding what changes, if any, should be made in the formulation of seasonal influenza vaccines. This allows time to manufacture, test, distribute, and administer vaccine prior to the beginning of the influenza season. At the same time experts also consider which viruses not currently circulating in the human population, but with pandemic potential, pose the greatest risk to public health. Experts may conclude that one or more of these viruses are of enough concern to warrant development of a high-growth reassortant candidate vaccine virus. Subsequently, national authorities may determine that a vaccine should be manufactured, tested in clinical trials, and even stockpiled in some circumstances. The Influenza Risk Assessment Tool (IRAT) was created in an effort to develop a standardized set of elements that could be applied for decision making when evaluating pre-pandemic viruses. The tool is a simple, additive model, based on multi-attribute decision analysis . The ultimate goal is to identify an appropriate candidate vaccine virus and prepare a human vaccine before the virus adapts to infect and efficiently transmit in susceptible human populations. This pre-pandemic preparation allows production of vaccine-a strategy that could save lives and mitigate illness during a pandemic. |
Poor uptake of influenza vaccination in pregnancy in northern India
Koul PA , Bali NK , Ali S , Ahmad SJ , Bhat MA , Mir H , Akram S , Khan UH . Int J Gynaecol Obstet 2014 127 (3) 234-7 OBJECTIVE: To study the uptake of influenza vaccination among pregnant women in northern India and physicians' beliefs and practices regarding vaccination. METHODS: A questionnaire-based survey was undertaken between October 2012 and April 2013. Pregnant women attending an obstetric hospital in Srinagar, India, and healthcare personnel were asked to participate. RESULTS: Among 1000 women aged 18-41 years (13.6% first trimester, 26.8% second trimester), none had been offered or received influenza vaccination. Only 9 (10.0%) of 90 obstetricians surveyed had been vaccinated for influenza in the past 5years, although 81 (90.0%) believed that influenza could have severe consequences for themselves and their patients. The reasons cited for non-vaccination included poor knowledge about availability of vaccine and concerns about its efficacy. Sixty-six (73.3%) obstetricians believed that vaccine adverse effects are under-reported, and 79 (87.8%) believed that vaccination programs are motivated by profit. Eighty-four (93.3%) obstetricians wished to undergo vaccination in the coming flu season. CONCLUSION: Influenza vaccination among pregnant women in northern India is nonexistent. Poor uptake is rooted in misperceptions about vaccine availability, efficacy, and safety among treating physicians, few of whom are vaccinated. |
Experiences with provider and parental attitudes and practices regarding the administration of multiple injections during infant vaccination visits: lessons for vaccine introduction
Wallace AS , Mantel C , Mayers G , Mansoor O , Gindler J , Hyde TB . Vaccine 2014 32 (41) 5301-10 INTRODUCTION: An increasing proportion of childhood immunization visits include administration of multiple injections. Future introduction of vaccines to protect against multiple diseases will further increase the number of injections at routine immunization childhood visits, particularly in developing countries that are still scaling up introductions. Parental and healthcare provider attitudes toward multiple injections may affect acceptance of recommended vaccines, and understanding these attitudes may help to inform critical decisions about vaccine introduction. METHODS: We conducted a systematic review of the literature to examine factors underlying reported parental and healthcare provider concerns and practices related to administration of multiple injections during childhood vaccination visits. RESULTS: Forty-four articles were identified; 42 (95%) were from high income countries, including 27 (61%) from the USA. Providers and parents report concerns about multiple injections, which tend to increase with increasing numbers of injections. Common parental and provider concerns included apprehension about the pain experienced by the child, worry about potential side effects, and uncertainty about vaccine effectiveness. Multiple studies reported that a positive provider recommendation to the parent and a high level of concern about the severity of the target disease were significantly associated with parental acceptance of all injections. Providers often significantly overestimated parental concerns about multiple injections. DISCUSSION: Providers may play a critical role in the decision for a child to receive all recommended injections. Their overestimation of parental concerns may lead them to postpone recommended vaccinations, which may result in extra visits and delayed vaccination. More research is needed on interventions to overcome provider and parental concern about multiple injections, particularly in developing countries. |
Influenza vaccine effectiveness against medically-attended influenza illness during the 2012-2013 season in Beijing, China
Yang P , Thompson MG , Ma C , Shi W , Wu S , Zhang D , Wang Q . Vaccine 2014 32 (41) 5285-9 BACKGROUND: Influenza vaccine coverage remains low in China, and there is limited information on the preventive value of local vaccination programs. METHODS: As part of influenza virological surveillance in Beijing, China during the 2012-2013 influenza season, we assessed the vaccine effectiveness (VE) of one or more doses of trivalent inactivated influenza vaccine (IIV3) in preventing medically-attended influenza-like-illness (ILI) associated with laboratory-confirmed influenza virus infection using a test-negative case-control design. Influenza vaccination was determined based on self-report by adult patients or the parents of child patients. RESULTS: Of 1998 patients with ILI, 695 (35%) tested positive for influenza viruses, including 292 (42%) A(H3N2), 398 (57%) A(H1N1)pdm09, and 5 (1%) not (sub)typed influenza viruses. The rate of influenza vaccination among all patients was 4% (71/1998). Among influenza positive patients, 2% (57/1303) were vaccinated compared to 4% (14/695) among influenza negative patients, resulting in VE for one or more doses of vaccine (adjusted for age, sex, week, and days since illness onset) against all circulating influenza viruses of 52% (95% CI=12-74%). A significant adjusted VE for one or more doses of vaccine for all ages against A(H1N1)pdm09 of 59% (95% CI, 8-82%) was observed; however, the VE against A(H3N2) was 43% (95% CI, -30% to 75%). The point estimate of VE was 59% (95% CI, 19-79%) for those aged <60 years, but a negative VE point estimate without statistical significance was observed among those aged ≥60 years. CONCLUSIONS: IIV3 conferred moderate protection against medically-attended influenza in Beijing, China during the 2012-2013 season, especially against the A(H1N1)pdm09 strain and among those aged <60 years old. |
Insights from global data for use of rotavirus vaccines in India
Rao TS , Arora R , Khera A , Tate JE , Parashar U , Kang G . Vaccine 2014 32S1 A171-A178 Rotavirus vaccines are being introduced in several low- and middle-income countries across the world with and without support from the GAVI Alliance. India has the highest disease burden of rotavirus based on morbidity and mortality estimates and several indigenous vaccine manufacturers are developing rotavirus vaccines. One candidate has undergone phase III testing and others have completed evaluation in phase II. Global data on licensed vaccine performance in terms of impact on disease, strain diversity, safety and cost-effectiveness has been reviewed to provide a framework for decision making in India. |
Intussusception following rotavirus vaccination: an updated review of the available evidence
Rha B , Tate JE , Weintraub E , Haber P , Yen C , Patel M , Cortese MM , DeStefano F , Parashar UD . Expert Rev Vaccines 2014 13 (11) 1-10 In 1999, the first rotavirus vaccine licensed in the USA was withdrawn 9 months after introduction due to an association with intussusception that was detected in post-licensure surveillance. This association prompted large clinical trials designed to ensure the safety of two current live oral rotavirus vaccines, RotaTeq and Rotarix, which have since been recommended for use worldwide. Following their introduction, post-licensure studies have focused not only on the effectiveness and impact of these vaccines, but also on continued surveillance for intussusception. Most recent evidence from several countries shows a small increased risk of intussusception following vaccination with Rotarix and RotaTeq within the context of their demonstrated benefits. This review summarizes the available data on the safety of rotavirus vaccines with regards to intussusception. |
Distribution of rotavirus strains and strain-specific effectiveness of the rotavirus vaccine after its introduction: a systematic review and meta-analysis
Leshem E , Lopman B , Glass R , Gentsch J , Banyai K , Parashar U , Patel M . Lancet Infect Dis 2014 14 (9) 847-56 BACKGROUND: Concerns exist about whether monovalent (RV1) and pentavalent (RV5) rotavirus vaccines provide adequate protection against diverse strains and whether vaccine introduction will lead to selective pressure. We aimed to investigate the distribution of rotavirus strains and strain-specific rotavirus vaccine effectiveness after vaccine introduction. METHODS: We did a systematic review of published work to assess the strain-specific effectiveness of RV1 and RV5 rotavirus vaccines. We classified strains as homotypic, partly heterotypic, and fully heterotypic based on the amount of antigen-matching between strain and vaccine. When studies reported vaccine effectiveness against single antigens (G-type or P-type), we categorised them as either single-antigen vaccine type or single-antigen non-vaccine type. Our primary outcome was strain-specific vaccine effectiveness, comparing effectiveness of homotypic strains with fully or partly heterotypic strains. A secondary outcome was the prevalence of rotavirus strains after vaccine introduction. We estimated pooled odds ratios using random-effect regression models, stratified by country income level and vaccine type, and tested for differences in strain-specific vaccine effectiveness. We assessed strain distribution trends from surveillance reports. FINDINGS: In high-income countries, RV1 pooled vaccine effectiveness was 94% (95% CI 80-98) against homotypic strains, 71% (39-86) against partly heterotypic strains, and 87% (76-93) against fully heterotypic strains. In middle-income settings, respective pooled data were 59% (36-73), 72% (58-81), and 47% (28-61). In high-income countries, RV5 vaccine effectiveness was 83% (78-87) against homotypic strains, 82% (70-89) against single-antigen vaccine type strains, 82% (70-89) against partly heterotypic strains, and 75% (47-88) against single-antigen non-vaccine type strains. In middle-income settings, RV5 vaccine effectiveness was 70% (58-78) against single-antigen vaccine type strains, 37% (10-56) against partly heterotypic strains, and 87% (38-97) against single-antigen non-vaccine type strains. No difference was noted in vaccine effectiveness for either RV1 or RV5 in any setting (all p>0.05). Prevalent strains in countries using RV1 were G2P[4] (2198 of 4428, 50%) and G1P[8] (953, 22%), and those in countries using RV5 were G1P[8] (1280 of 3875, 33%) and G2P[4] (1169, 30%). Sustained predominance of a single strain was not recorded. INTERPRETATION: RV1 and RV5 exert similar effectiveness against homotypic and heterotypic rotavirus strains. Persistence of specific strains was not recorded, suggesting vaccine-induced selective pressure did not occur. Expansion of rotavirus surveillance efforts to low-income countries and ongoing surveillance are crucial to identify emergence of new strains and to assess strain-specific vaccine effectiveness in various settings. FUNDING: None. |
Using data to effectively manage a national screening program
Yancy B , Royalty JE , Marroulis S , Mattingly C , Benard VB , DeGroff A . Cancer 2014 120 Suppl 16 2575-83 The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) of the Centers for Disease Control and Prevention (CDC) is implemented through cooperative agreements with state health departments, US territories, and tribal health organizations (grantees). Grantees typically contract with clinicians and other providers to deliver breast and cervical cancer screening and diagnostic services. As required by the CDC, grantees report biannually a subset of patient and clinical level program data known as the Minimum Data Elements. Rigorous processes are in place to ensure the completeness and quality of program data collection. In this article, the authors describe the NBCCEDP data-collection processes and data management system and discusses how data are used for 1) program monitoring and improvement, 2) evaluation and research, and 3) policy development and analysis. They also provide 2 examples of how grantees use data to improve their performance. |
Man enough? Masculine discrepancy stress and intimate partner violence
Reidy DE , Berke DS , Gentile B , Zeichner A . Pers Individ Dif 2014 68 160-164 Research on gender roles suggests that men who strongly adhere to traditional masculine gender norms are at increased risk for the perpetration of violent and abusive acts toward their female intimate partners. Yet, gender norms alone fail to provide a comprehensive explanation of the multifaceted construct of intimate partner violence (IPV) and there is theoretical reason to suspect that men who fail to conform to masculine roles may equally be at risk for IPV. In the present study, we assessed effect of masculine discrepancy stress, a form of distress arising from perceived failure to conform to socially-prescribed masculine gender role norms, on IPV. Six-hundred men completed online surveys assessing their experience of discrepancy stress, masculine gender role norms, and history of IPV. Results indicated that masculine discrepancy stress significantly predicted men's historical perpetration of IPV independent of other masculinity related variables. Findings are discussed in terms of potential distress engendered by masculine socialization as well as putative implications of gender role discrepancy stress for understanding and intervening in partner violence perpetrated by men. |
Approach to molecular characterization of partially and completely untyped samples in an Indian rotavirus surveillance program.
Babji S , Arumugam R , Sarvanabhavan A , Gentsch JR , Kang G . Vaccine 2014 32 Suppl 1 A84-8 Surveillance networks for rotavirus document the burden of the disease using the proportion of children hospitalized with gastroenteritis positive for rotavirus by enzyme immunoassay. They also describe genotypes of circulating viruses by polymerase chain reaction for the VP7 and VP4 genes, which determine G and P types, respectively. A proportion of samples cannot be genotyped based on initial testing and laboratories need to assess further testing strategies based on resources and feasibility. To 365 samples obtained from an Indian rotavirus strain surveillance program, we applied an approach to determine the G and P types in antigen positive samples that failed to type initially with the standard laboratory protocol. Fifty-eight samples (19%) were negative for the VP6 gene, indicating that the antigen test was likely to have been false positive. Alternative extraction and priming approaches resulted in the identification of G and P types for 264 strains. The identity of one strain was determined by sequencing the first-round amplicons. Thirty-five strains were partially typed and seven strains could not be typed at all. The distribution of G and P types among strains that had initially failed to type, except one strain, did not differ from that in strains that were typed using the standard laboratory protocol. |
Validation of high throughput sequencing and microbial forensics applications.
Budowle B , Connell ND , Bielecka-Oder A , Colwell RR , Corbett CR , Fletcher J , Forsman M , Kadavy DR , Markotic A , Morse SA , Murch RS , Sajantila A , Schmedes SE , Ternus KL , Turner SD , Minot S . Investig Genet 2014 5 9 High throughput sequencing (HTS) generates large amounts of high quality sequence data for microbial genomics. The value of HTS for microbial forensics is the speed at which evidence can be collected and the power to characterize microbial-related evidence to solve biocrimes and bioterrorist events. As HTS technologies continue to improve, they provide increasingly powerful sets of tools to support the entire field of microbial forensics. Accurate, credible results allow analysis and interpretation, significantly influencing the course and/or focus of an investigation, and can impact the response of the government to an attack having individual, political, economic or military consequences. Interpretation of the results of microbial forensic analyses relies on understanding the performance and limitations of HTS methods, including analytical processes, assays and data interpretation. The utility of HTS must be defined carefully within established operating conditions and tolerances. Validation is essential in the development and implementation of microbial forensics methods used for formulating investigative leads attribution. HTS strategies vary, requiring guiding principles for HTS system validation. Three initial aspects of HTS, irrespective of chemistry, instrumentation or software are: 1) sample preparation, 2) sequencing, and 3) data analysis. Criteria that should be considered for HTS validation for microbial forensics are presented here. Validation should be defined in terms of specific application and the criteria described here comprise a foundation for investigators to establish, validate and implement HTS as a tool in microbial forensics, enhancing public safety and national security. |
Rapid and sensitive approach to simultaneous detection of genomes of hepatitis A, B, C, D and E viruses.
Kodani M , Mixson-Hayden T , Drobeniuc J , Kamili S . J Clin Virol 2014 61 (2) 260-4 BACKGROUND: Five viruses have been etiologically associated with viral hepatitis. Nucleic acid testing (NAT) remains the gold standard for diagnosis of viremic stages of infection. NAT methodologies have been developed for all hepatitis viruses; however, a NAT-based assay that can simultaneously detect all five viruses is not available. OBJECTIVES: We designed TaqMan card-based assays for detection of HAV RNA, HBV DNA, HCV RNA, HDV RNA and HEV RNA. STUDY DESIGN: The performances of individual assays were evaluated on TaqMan Array Cards (TAC) for detecting five viral genomes simultaneously. Sensitivity and specificity were determined by testing 329 NAT-tested clinical specimens. RESULTS: All NAT-positive samples for HCV (n=32), HDV (n=28) and HEV (n=14) were also found positive in TAC (sensitivity, 100%). Forty-three of 46 HAV-NAT positive samples were also positive in TAC (sensitivity, 94%), while 36 of 39 HBV-NAT positive samples were positive (sensitivity, 92%). No false-positives were detected for HBV (n=32), HCV (n=36), HDV (n=30), and HEV (n=31) NAT-negative samples (specificity 100%), while 38 of 41 HAV-NAT negative samples were negative by TAC (specificity 93%). CONCLUSIONS: TAC assay was concordant with corresponding individual NATs for hepatitis A-E viral genomes and can be used for their detection simultaneously. The TAC assay has potential for use in hepatitis surveillance, for screening of donor specimens and in outbreak situations. Wider availability of TAC-ready assays may allow for customized assays, for improving acute jaundice surveillance and for other purposes for which there is need to identify multiple pathogens rapidly. |
Multiplex qPCR assay for identification and differentiation of Amblyomma americanum, Amblyomma cajennense, and Amblyomma maculatum (Ixodida: Ixodidae) tick species in the eastern United States
Zemtsova GE , Watkins NE , Levin ML . J Med Entomol 2014 51 (4) 795-803 Many ticks of the genus Amblyomma are vectors of human pathogens, and the correct species identification is medically and epidemiologically important. Morphological identification is time-consuming and requires a high level of expertise. Identification of engorged, immature, or damaged ticks and the differentiation of closely related species remain problematic. Here, we report the development of a real-time TaqMan assay for the genomic identification and differentiation of Amblyomma americanum (L.), Amblyomma cajennense (F.), and Amblyomma maculatum (Koch), which are human-biting species found in the eastern United States. New species-specific sets of oligonucleotides for the multiplex reaction that detect and differentiate the ITS2 genomic regions of three target species were designed using Visual OMP; the previously published A. americanum oligonucleotide set was also incorporated into our assay. Specificity and sensitivity tests for two multiplex master mixes using different A. americanum sets were performed using individual and pooled samples of adult, nymphal, and larval ticks, and optimization procedures were applied. The multiplex assay successfully differentiates between genomes of three target species and does not cross-react with DNAs of ticks from other genera. Rare cases of nonspecific amplification occurred with DNAs of A. imitator and Amblyomma triste Koch misidentified as A. americanum and A. maculatum, respectively. However, this cross-reaction does not diminish the usefulness of the developed assay east of the 95th meridian, where neither A. imitator nor A. triste are found. Two master mixes incorporating the previously published or newly developed A. americanum sets are being recommended for identification of individual ticks or pooled samples, respectively. |
Human papilloma virions in the laboratory
Dunne EF , Markowitz LE , Taylor LD , Unger ER , Wheeler CM . J Clin Virol 2014 61 (2) 196-8 Carcinogenic human papillomaviruses (HPV) can cause cervical, vaginal, vulvar, penile, anal, and oropharyngeal cancers. Non-carcinogenic HPVs can cause anogenital warts and recurrent respiratory papillomatosis. Currently, few research laboratories propagate, isolate or generate papilloma virions. However, there have been questions about potential exposure and risk in this setting. In this brief note, we discuss the use of wild type and laboratory-generated virions in research laboratories, potential routes of laboratory exposure, and considerations for HPV vaccination of laboratory personnel. |
Inadequacy of IgM antibody tests for diagnosis of Rocky Mountain spotted fever
McQuiston JH , Wiedeman C , Singleton J , Carpenter LR , McElroy K , Mosites E , Chung I , Kato C , Morris K , Moncayo AC , Porter S , Dunn J . Am J Trop Med Hyg 2014 91 (4) 767-70 Among 13 suspected Rocky Mountain spotted fever (RMSF) cases identified through an enhanced surveillance program in Tennessee, antibodies to Rickettsia rickettsii were detected in 10 (77%) patients using a standard indirect immunofluorescent antibody (IFA) assay. Immunoglobulin M (IgM) antibodies were observed for 6 of 13 patients (46%) without a corresponding development of IgG, and for 3 of 10 patients (30%) at least 1 year post-onset. However, recent infection with a spotted fever group rickettsiae could not be confirmed for any patient, based on a lack of rising antibody titers in properly timed acute and convalescent serologic specimens, and negative findings by polymerase chain reaction testing. Case definitions used in national surveillance programs lack specificity and may capture cases that do not represent current rickettsial infections. Use of IgM antibodies should be reconsidered as a basis for diagnosis and public health reporting of RMSF and other spotted fever group rickettsiae in the United States. |
Bacteriophage K antimicrobial-lock technique for treatment of Staphylococcus aureus central venous catheter-related infection: a leporine model efficacy analysis
Lungren MP , Donlan RM , Kankotia R , Paxton BE , Falk I , Christensen D , Kim CY . J Vasc Interv Radiol 2014 25 (10) 1627-32 PURPOSE: To determine whether a bacteriophage antimicrobial-lock technique can reduce bacterial colonization and biofilm formation on indwelling central venous catheters in a rabbit model. MATERIALS AND METHODS: Cuffed central venous catheters were inserted into the jugular vein of female New Zealand White rabbits under image guidance. Catheters were inoculated for 24 hours with broth culture of methicillin-sensitive Staphylococcus aureus. The inoculum was aspirated, and rabbits were randomly assigned to two equal groups for 24 hours: (i) untreated controls (heparinized saline lock), (ii) bacteriophage antimicrobial-lock (staphylococcal bacteriophage K, propagated titer > 108/mL). Blood cultures were obtained via peripheral veins, and the catheters were removed for quantitative culture and scanning electron microscopy. RESULTS: Mean colony-forming units (CFU) per cm2 of the distal catheter segment, as a measure of biofilm, were significantly decreased in experimental animals compared with controls (control, 1.2 x 105 CFU/cm2; experimental, 7.6 x 103; P = .016). Scanning electron microscopy demonstrated that biofilms were present on the surface of five of five control catheters but only one of five treated catheters (P = .048). Blood culture results were not significantly different between the groups. CONCLUSIONS: In a rabbit model, treatment of infected central venous catheters with a bacteriophage antimicrobial-lock technique significantly reduced bacterial colonization and biofilm presence. Our data represent a preliminary step toward use of bacteriophage therapy for prevention and treatment of central venous catheter-associated infection. |
Development of a rapid serological assay for the diagnosis of strongyloidiasis using a novel diffraction-based biosensor technology
Pak BJ , Vasquez-Camargo F , Kalinichenko E , Chiodini PL , Nutman TB , Tanowitz HB , McAuliffe I , Wilkins P , Smith PT , Ward BJ , Libman MD , Ndao M . PLoS Negl Trop Dis 2014 8 (8) e3002 BACKGROUND: Strongyloidiasis is a persistent human parasitic infection caused by the intestinal nematode, Strongyloides stercoralis. The parasite has a world-wide distribution, particularly in tropical and subtropical regions with poor sanitary conditions. Since individuals with strongyloidiasis are typically asymptomatic, the infection can persist for decades without detection. Problems arise when individuals with unrecognized S. stercoralis infection are immunosuppressed, which can lead to hyper-infection syndrome and disseminated disease with an associated high mortality if untreated. Therefore a rapid, sensitive and easy to use method of diagnosing Strongyloides infection may improve the clinical management of this disease. METHODOLOGY/PRINCIPAL FINDINGS: An immunological assay for diagnosing strongyloidiasis was developed on a novel diffraction-based optical bionsensor technology. The test employs a 31-kDa recombinant antigen called NIE derived from Strongyloides stercoralis L3-stage larvae. Assay performance was tested using retrospectively collected sera from patients with parasitologically confirmed strongyloidiasis and control sera from healthy individuals or those with other parasitoses including schistosomiasis, trichinosis, echinococcosis or amebiasis who were seronegative using the NIE ELISA assay. If we consider the control group as the true negative group, the assay readily differentiated S. stercoralis-infected patients from controls detecting 96.3% of the positive cases, and with no cross reactivity observed in the control group These results were in excellent agreement (kappa = 0.98) with results obtained by an NIE-based enzyme-linked immunosorbent assay (ELISA). A further 44 sera from patients with suspected S. stercoralis infection were analyzed and showed 91% agreement with the NIE ELISA. CONCLUSIONS/SIGNIFICANCE: In summary, this test provides high sensitivity detection of serum IgG against the NIE Strongyloides antigen. The assay is easy to perform and provides results in less than 30 minutes, making this platform amenable to rapid near-patient screening with minimal technical expertise. |
Development of an algorithm for production of inactivated arbovirus antigens in cell culture
Goodman CH , Russell BJ , Velez JO , Laven JJ , Nicholson WL , Bagarozzi DA Jr , Moon JL , Bedi K , Johnson BW . J Virol Methods 2014 208 66-78 Arboviruses are medically important pathogens that cause human disease ranging from a mild fever to encephalitis. Laboratory diagnosis is essential to differentiate arbovirus infections from other pathogens with similar clinical manifestations. The Arboviral Diseases Branch (ADB) reference laboratory at the CDC Division of Vector-Borne Diseases (DVBD) produces reference antigens used in serological assays such as the virus-specific immunoglobulin M antibody-capture enzyme-linked immunosorbent assay (MAC-ELISA). Antigen production in cell culture has largely replaced the use of suckling mice; however, the methods are not directly transferable. The development of a cell culture antigen production algorithm for nine arboviruses from the three main arbovirus families, Flaviviridae, Togaviridae, and Bunyaviridae, is described here. Virus cell culture growth and harvest conditions were optimized, inactivation methods were evaluated, and concentration procedures were compared for each virus. Antigen performance was evaluated by the MAC-ELISA at each step of the procedure. The antigen production algorithm is a framework for standardization of methodology and quality control; however, a single antigen production protocol was not applicable to all arboviruses and needed to be optimized for each virus. |
Recognizing excellence in maternal and child health (MCH) epidemiology: the 2012 co-hosted 18th MCH Epidemiology Conference and 22nd CityMatCH Urban MCH Leadership Conference, the 25th Anniversary of the MCH Epidemiology Program, and the National MCH Epidemiology Awards
Kroelinger CD , Jones J , Barfield WD , Kogan MD . Matern Child Health J 2014 18 (7) 1553-7 In December 2012, multiple leading agencies in the field of Maternal and Child Health (MCH) partnered to co-host a national MCH Epidemiology Conference. The Conference offered opportunities for peer exchange; presentation of new scientific methodologies, programs, and policies; dialogue on changes in the MCH field; and discussion of emerging MCH issues relevant to the work of MCH professionals. During the Conference, the MCH Epidemiology Program celebrated 25 years of success and partnership, and 16 MCH agencies presented six deserving health researchers and leaders with national awards in the areas of advancing knowledge, effective practice, outstanding leadership, excellence in teaching and mentoring, and young professional achievement. In September 2014, building on knowledge gained and changes in the field of MCH, leading agencies including the Centers for Disease Control and Prevention, the Health Resources and Services Administration, CityMatCH, and the Association of MCH Programs plan to replicate the achievements of 2012 through the implementation of a fully integrated national conference: the CityMatCH Leadership and MCH Epidemiology Conference. |
Temporal trends in mortality and loss to follow-up among children enrolled in Cote d'Ivoire's national antiretroviral therapy program
Auld AF , Tuho MZ , Ekra KA , Shiraishi RW , Mohamed F , Kouakou JS , Ettiegne-Traore V , Sabatier J , Essombo J , Rivadeneira ED , Adjorlolo-Johnson G , Marlink R , Ellerbrock TV . Pediatr Infect Dis J 2014 33 (11) 1134-40 BACKGROUND: During 2004-2008, >2,000 children (<15 years old) initiated antiretroviral therapy (ART) in Cote d'Ivoire. Nationally representative outcomes, temporal trends in outcomes during 2004-2008, and site-level outcome determinants have not been investigated. METHODS: Incidence rates of death, loss to follow-up (LTFU), and attrition (death or LTFU) were evaluated in a nationally representative, retrospective cohort study among 2,110 children, who initiated ART at 29 facilities in Cote d'Ivoire during 2004-2008. RESULTS: At ART initiation, 54% were male, 1% were HIV-2-infected, and median age was 5.1 years. Median CD4% was 11%, and 61% had weight-for-age z-score (WAZ) ≤-2. Vaccination completion was documented for 9% of children. Eleven of 29 facilities had an integrated nutrition program. Over 4,585 person-years of ART, 237 children died and 427 became LTFU. Twelve-month attrition was 22% overall, but increased from 4-34% during 2004-2008, due to increases in 12-month mortality (from 3-11%) and 12-month LTFU (from 2-23%). In adjusted analysis, compared with enrollees in 2004, enrollees in 2008 had nearly four-fold higher mortality and eight-fold higher LTFU. World Health Organization stage III/IV, CD4% <10%, WAZ ≤2, and hemoglobin <8g/dL, were predictive of mortality. Incomplete vaccination was predictive of mortality and LTFU. Facilities with nutrition programs had lower LTFU and mortality rates. Clinics reporting nurse dissatisfaction with working conditions had higher LTFU rates. CONCLUSION: Investigation of causes of increasing mortality and LTFU is needed. Ensuring earlier ART initiation, vaccination completion, scale-up of site-level nutrition programs, and nurse work-environment satisfaction, could improve pediatric ART program outcomes. |
Trends in racial disparities for asthma outcomes among children 0 to 17 years, 2001-2010
Akinbami LJ , Moorman JE , Simon AE , Schoendorf KC . J Allergy Clin Immunol 2014 134 (3) 547-553 e5 BACKGROUND: Racial disparities in childhood asthma have been a long-standing target for intervention, especially disparities in hospitalization and mortality. OBJECTIVES: Describe trends in racial disparities in asthma outcomes using both traditional population-based rates and at-risk rates (based on the estimated number of children with asthma) to account for prevalence differences between race groups. METHODS: Estimates of asthma prevalence and outcomes (emergency department [ED] visits, hospitalizations, and deaths) were calculated from national data for 2001 to 2010 for black and white children. Trends were calculated using weighted loglinear regression, and changes in racial disparities over time were assessed using Joinpoint. RESULTS: Disparities in asthma prevalence between black and white children increased from 2001 to 2010; at the end of this period, black children were twice as likely as white children to have asthma. Population-based rates showed that disparities in asthma outcomes remained stable (ED visits and hospitalizations) or increased (asthma attack prevalence, deaths). In contrast, analysis with at-risk rates, which account for differences in asthma prevalence, showed that disparities in asthma outcomes remained stable (deaths), decreased (ED visits, hospitalizations), or did not exist (asthma attack prevalence). CONCLUSIONS: Using at-risk rates to assess racial disparities in asthma outcomes accounts for prevalence differences between black and white children, and adds another perspective to the population-based examination of asthma disparities. An at-risk rate analysis shows that among children with asthma, there is no disparity for asthma attack prevalence and that progress has been made in decreasing disparities in asthma ED visit and hospitalization rates. |
Epidemiology of viral-associated acute lower respiratory tract infection among children <5 years of age in a high HIV prevalence setting, South Africa, 2009-2012
Cohen C , Walaza S , Moyes J , Groome M , Tempia S , Pretorius M , Hellferscee O , Dawood H , Chhagan M , Naby F , Haffejee S , Variava E , Kahn K , Nzenze S , Tshangela A , von Gottberg A , Wolter N , Cohen AL , Kgokong B , Venter M , Madhi SA . Pediatr Infect Dis J 2014 34 (1) 66-72 BACKGROUND: Data on the epidemiology of viral-associated acute lower respiratory tract infection (LRTI) from high HIV prevalence settings are limited. We aimed to describe LRTI hospitalisations amongst South African children aged <5 years. METHODS: We prospectively enrolled hospitalized children with physician-diagnosed LRTI from 5 sites in 4 provinces from 2009-2012. Using polymerase chain reaction, nasopharyngeal aspirates were tested for ten viruses and blood for pneumococcal DNA. Incidence was estimated at one site with available population denominators. RESULTS: We enrolled 8723 children aged <5 years with LRTI, including 64% <12 months. The case-fatality ratio was 2% (150/8512). HIV prevalence among tested children was 12% (705/5964). The overall prevalence of respiratory viruses identified was 78% (6517/8393), including 37% rhinovirus, 26% respiratory syncytial virus (RSV), 7% influenza and 5% human metapneumovirus. Four percent (253/6612) tested positive for pneumococcus. The annual incidence of LRTI hospitalisation ranged from 2530-3173/100000 population and was highest in infants (8446-10532/100000). LRTI incidence was 1.1-3.0-fold greater in HIV-infected than HIV-uninfected children.In multivariable analysis, compared to HIV-uninfected children, HIV-infected children were more likely to require supplemental-oxygen (OR 1.3, 95%CI:1.1-1.7), be hospitalised >7 days (OR 3.8, 95%CI:2.8-5.0) and had a higher case-fatality ratio (4.2, 95%CI:2.6-6.8). In multivariable analysis HIV-infection (OR 3.7, 95%CI:2.2-6.1), pneumococcal co-infection (OR 2.4, 95%CI:1.1-5.6), mechanical ventilation (OR 6.9, 95%CI:2.7-17.6) and receipt of supplemental-oxygen (OR 27.3, 95%CI:13.2-55.9) were associated with death. CONCLUSIONS: HIV-infection was associated with an increased risk of LRTI hospitalisation and death. A viral pathogen, commonly RSV, was identified in a high proportion of LRTI cases. |
HIV and maternal mortality
Lathrop E , Jamieson DJ , Danel I . Int J Gynaecol Obstet 2014 127 (2) 213-5 The majority of the 17 million women globally that are estimated to be infected with HIV live in Sub-Saharan Africa. Worldwide, HIV-related causes contributed to 19 000-56 000 maternal deaths in 2011 (6%-20% of maternal deaths). HIV-infected pregnant women have two to 10 times the risk of dying during pregnancy and the postpartum period compared with uninfected pregnant women. Many of these deaths can be prevented with the implementation of high-quality obstetric care, prevention and treatment of common co-infections, and treatment of HIV with ART. The paper summarizes what is known about HIV disease progression in pregnancy, specific causes of HIV-related maternal deaths, and the potential impact of treatment with antiretroviral therapy on maternal mortality. Recommendations are proposed for improving maternal health and decreasing maternal mortality among HIV-infected women based on existing evidence. |
Cultural orientations, parental beliefs and practices, and latino adolescents' autonomy and independence
Roche KM , Caughy MO , Schuster MA , Bogart LM , Dittus PJ , Franzini L . J Youth Adolesc 2014 43 (8) 1389-403 Despite the salience of behavioral autonomy and independence to parent-child interactions during middle adolescence, little is known about parenting processes pertinent to youth autonomy development for Latino families. Among a diverse sample of 684 Latino-origin parent-adolescent dyads in Houston, Texas, this study examines how parents' cultural orientations are associated directly and indirectly, through parental beliefs, with parenting practices giving youth behavioral autonomy and independence. Informed by social domain theory, the study's parenting constructs pertain to youth behaviors in an "ambiguously personal" domain-activities that adolescents believe are up to youth to decide, but which parents might argue require parents' supervision, knowledge, and/or decision-making. Results for latent profile analyses of parents' cultural identity across various facets of acculturation indicate considerable cultural heterogeneity among Latino parents. Although 43 % of parents have a Latino cultural orientation, others represent Spanish-speaking/bicultural (21 %), bilingual/bicultural (15 %), English-speaking/bicultural (15 %), or US (6 %) cultural orientations. Structural equation modeling results indicate that bilingual/bicultural, English-speaking/bicultural, and US-oriented parents report less emphasis on the legitimacy of parental authority and younger age expectations for youth to engage in independent behaviors than do Latino-oriented parents. Parental beliefs endorsing youth's behavioral independence and autonomy, in turn, are associated with less stringent parental rules (parental report), less parental supervision (parental and youth report), and more youth autonomy in decision-making (parental and youth report). Evidence thus supports the idea that the diverse cultural orientations of Latino parents in the US may result in considerable variations in parenting processes pertinent to Latino adolescents' development. |
Precipitating circumstances of suicide among active duty U.S. Army personnel versus U.S. civilians, 2005-2010
Logan JE , Skopp NA , Reger MA , Gladden M , Smolenski DJ , Faye Floyd C , Gahm GA . Suicide Life Threat Behav 2014 45 (1) 65-77 To help understand suicide among soldiers, we compared suicide events between active duty U.S. Army versus civilian decedents to identify differences and inform military prevention efforts. We linked 141 Army suicide records from 2005 to 2010 to National Violent Death Reporting System (NVDRS) data. We described the decedents' military background and compared their precipitators of death captured in NVDRS to those of demographically matched civilian suicide decedents. Both groups commonly had mental health and intimate partner precipitating circumstances, but soldier decedents less commonly disclosed suicide intent. |
Vital Signs: fruit and vegetable intake among children - United States, 2003-2010
Kim SA , Moore LV , Galuska D , Wright AP , Harris D , Grummer-Strawn LM , Merlo CL , Nihiser AJ , Rhodes DG . MMWR Morb Mortal Wkly Rep 2014 63 (31) 671-676 BACKGROUND: Eating more fruits and vegetables adds underconsumed nutrients to diets, reduces the risks for leading causes of illness and death, and helps manage body weight. This report describes trends in the contributions of fruits and vegetables to the diets of children aged 2-18 years. METHODS: CDC analyzed 1 day of 24-hour dietary recalls from the National Health and Nutrition Examination Surveys from 2003 to 2010 to estimate trends in children's fruit and vegetable intake in cup-equivalents per 1,000 calories (CEPC) and trends by sex, age, race/ethnicity, family income to poverty ratio, and obesity status. Total fruit includes whole fruit (all fruit excluding juice) and fruit juice (from 100% juice, foods, and other beverages). Total vegetables include those encouraged in the Dietary Guidelines for Americans, 2010 (i.e., dark green, orange, and red vegetables and legumes), white potatoes, and all other vegetables. RESULTS: Total fruit intake among children increased from 0.55 CEPC in 2003-2004 to 0.62 in 2009-2010 because of significant increases in whole fruit intake (0.24 to 0.40 CEPC). Over this period, fruit juice intake significantly decreased (0.31 to 0.22 CEPC). Total vegetable intake did not change (0.54 to 0.53 CEPC). No socio-demographic group met the Healthy People 2020 target of 1.1 CEPC vegetables, and only children aged 2-5 years met the target of 0.9 CEPC fruits. CONCLUSIONS: Children's total fruit intake increased because of increases in whole fruit consumption, but total vegetable intake remained unchanged. Implications for Public Health Practice: Increased attention to the policies and food environments in multiple settings, including schools, early care and education, and homes might help continue the progress in fruit intake and improve vegetable intake. |
Minimum requirements for taxicab security cameras
Zeng S , Amandus HE , Amendola AA , Newbraugh BH , Cantis DM , Weaver D . J Transp Technol 2014 4 (3) 216-255 PROBLEM: The homicide rate of taxicab-industry is 20 times greater than that of all workers. A NIOSH study showed that cities with taxicab-security cameras experienced significant reduction in taxicab driver homicides. METHODS: Minimum technical requirements and a standard test protocol for taxicab-security cameras for effective taxicab-facial identification were determined. The study took more than 10,000 photographs of human-face charts in a simulated-taxicab with various photographic resolutions, dynamic ranges, lens-distortions, and motion-blurs in various light and cab-seat conditions. Thirteen volunteer photograph-evaluators evaluated these face photographs and voted for the minimum technical requirements for taxicab-security cameras. RESULTS: Five worst-case scenario photographic image quality thresholds were suggested: the resolution of XGA-format, highlight-dynamic-range of 1 EV, twilight-dynamic-range of 3.3 EV, lens-distortion of 30%, and shutter-speed of 1/30 second. PRACTICAL APPLICATIONS: These minimum requirements will help taxicab regulators and fleets to identify effective taxicab-security cameras, and help taxicabsecurity camera manufacturers to improve the camera facial identification capability. |
The effects of carbon nanotubes on lung and dermal cellular behaviors
Luanpitpong S , Wang L , Rojanasakul Y . Nanomedicine (Lond) 2014 9 (6) 895-912 Carbon nanotubes (CNTs) hold great promise to create new and better products, but their adverse health effect is a major concern. Human exposure to CNTs is primarily through inhalation and dermal contact, especially during the manufacturing and handling processes. Numerous animal studies have demonstrated the potential pulmonary and dermal hazards associated with CNT exposure, while in vitro studies have assessed the effects of CNT exposure on various cellular behaviors and have been used to perform mechanistic studies. In this review, we provide an overview of the pathological effects of CNTs and examine the acute and chronic effects of CNT exposure on lung and dermal cellular behaviors, beyond the generally discussed cytotoxicity. We then examine the linkage of cellular behaviors and disease pathogenesis, and discuss the pertinent mechanisms. |
Heat illness and death among workers - United States, 2012-2013
Arbury S , Jacklitsch B , Farquah O , Hodgson M , Lamson G , Martin H , Profitt A . MMWR Morb Mortal Wkly Rep 2014 63 (31) 661-665 Exposure to heat and hot environments puts workers at risk for heat stress, which can result in heat illnesses and death. This report describes findings from a review of 20122013 Occupational Safety and Health Administration (OSHA) federal enforcement cases (i.e., inspections) resulting in citations under paragraph 5(a)(1), the "general duty clause" of the Occupational Safety and Health Act of 1970. That clause requires that each employer "furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees". Because OSHA has not issued a heat standard, it must use 5(a)(1) citations in cases of heat illness or death to enforce employers' obligations to provide a safe and healthy workplace. During the 2-year period reviewed, 20 cases of heat illness or death were cited for federal enforcement under paragraph 5(a)(1) among 18 private employers and two federal agencies. In 13 cases, a worker died from heat exposure, and in seven cases, two or more employees experienced symptoms of heat illness. Most of the affected employees worked outdoors, and all performed heavy or moderate work, as defined by the American Conference of Governmental Industrial Hygienists. Nine of the deaths occurred in the first 3 days of working on the job, four of them occurring on the worker's first day. Heat illness prevention programs at these workplaces were found to be incomplete or absent, and no provision was made for the acclimatization of new workers. Acclimatization is the result of beneficial physiologic adaptations (e.g., increased sweating efficiency and stabilization of circulation) that occur after gradually increased exposure to heat or a hot environment. Whenever a potential exists for workers to be exposed to heat or hot environments, employers should implement heat illness prevention programs (including acclimatization requirements) at their workplaces. |
Impact of organizational policies and practices on workplace injuries in a hospital setting
Tveito TH , Sembajwe G , Boden LI , Dennerlein JT , Wagner GR , Kenwood C , Stoddard AM , Reme SE , Hopcia K , Hashimoto D , Shaw WS , Sorensen G . J Occup Environ Med 2014 56 (8) 802-8 OBJECTIVE: This study aimed to assess relationships between perceptions of organizational practices and policies (OPP), social support, and injury rates among workers in hospital units. METHODS: A total of 1230 hospital workers provided survey data on OPP, job flexibility, and social support. Demographic data and unit injury rates were collected from the hospitals' administrative databases. RESULTS: Injury rates were lower in units where workers reported higher OPP scores and high social support. These relationships were mainly observed among registered nurses. Registered nurses perceived coworker support and OPP as less satisfactory than patient care associates (PCAs). Nevertheless, because of the low number of PCAs at each unit, results for the PCAs are preliminary and should be further researched in future studies with larger sample sizes. CONCLUSIONS: Employers aiming to reduce injuries in hospitals could focus on good OPP and supportive work environment. |
Characterizing adoption of precautionary risk management guidance for nanomaterials, an emerging occupational hazard
Schubauer-Berigan MK , Dahm MM , Schulte PA , Hodson L , Geraci CL . J Occup Environ Hyg 2014 12 (1) 0 Exposure to engineered nanomaterials (substances with at least one dimension of 1-100 nm) has been of increased interest, with the recent growth in production and use of nanomaterials worldwide. Various organizations have recommended methods to minimize exposure to engineered nanomaterials. The purpose of this study was to evaluate available data to examine the extent to which studied U.S. companies (which represent a small fraction of all companies using certain forms of engineered nanomaterials) follow the guidelines for reducing occupational exposures to engineered nanomaterials that have been issued by the National Institute for Occupational Safety and Health (NIOSH) and other organizations. Survey data, field reports, and field notes for all NIOSH nanomaterial exposure assessments conducted between 2006 and 2011 were collected and reviewed to: (1) determine the level of adoption of precautionary guidance on engineering controls and personal protective equipment, and (2) evaluate the reliability of companies' self-reported use of engineering controls and personal protective equipment. Use of personal protective equipment was observed among 89% [95% confidence interval (CI): 76%-96%] of 46 visited companies, and use of containment-based engineering controls for at least some processes was observed among 83% (95% CI: 76%-96%). In on-site evaluations, more than 90% of the 16 engineered carbonaceous nanomaterial companies that responded to an industrywide survey were observed to be using engineering controls and personal protective equipment as reported or more stringently than reported. Since personal protective equipment use was slightly more prevalent than engineering controls, better communication may be necessary to reinforce the importance of the hierarchy of controls. These findings may also be useful in conducting exposure assessment and epidemiologic research among U.S. workers handling nanomaterials. |
Comparative impacts over 5 years of artemisinin-based combination therapies on Plasmodium falciparum polymorphisms that modulate drug sensitivity in Ugandan children.
Conrad MD , LeClair N , Arinaitwe E , Wanzira H , Kakuru A , Bigira V , Muhindo M , Kamya MR , Tappero JW , Greenhouse B , Dorsey G , Rosenthal PJ . J Infect Dis 2014 210 (3) 344-53 BACKGROUND: Artemisinin-based combination therapies, including artemether-lumefantrine (AL) and dihydroartemisinin-piperaquine (DP), are recommended to treat uncomplicated falciparum malaria. Sensitivities to components of AL and DP are impacted by polymorphisms in pfmdr1 and pfcrt. We monitored changes in prevalences of polymorphisms in Tororo, Uganda, from 2008 to 2012. METHODS: Polymorphic loci in pfmdr1 and pfcrt were characterized in samples from 312 children randomized to AL or DP for each episode of uncomplicated malaria (50 samples per arm for each 3-month interval) utilizing a fluorescent microsphere assay. Treatment outcomes and impacts of prior therapies were also characterized. RESULTS: Prevalence increased significantly over time for pfmdr1 N86 (AL: odds ratio [OR], 2.08 [95% confidence interval {CI}, 1.83-2.38]; DP: 1.41 [95% CI, 1.25-1.57]), pfmdr1 D1246 (AL: 1.46 [95% CI, 1.29-1.64]; DP: 1.36 [95% CI, 1.23-1.50]), and pfcrt K76 (AL: 3.37 [95% CI, 1.85-6.16]; DP: 5.84 [95% CI, 1.94-17.53], and decreased for pfmdr1 Y184 (AL: 0.78 [95% CI, .70-.86]; DP: 0.84 [95% CI, .76-1.50]); changes were consistently greater in the AL arm. Recent AL treatment selected for pfmdr1 N86, D1246, and 184F in subsequent episodes; DP selected for the opposite alleles. CONCLUSIONS: Genotypes with decreased sensitivity to AL components increased over time. This increase was greater in children receiving AL, suggesting that the choice of treatment regimen can profoundly influence parasite genetics and drug sensitivity. CLINICAL TRIALS REGISTRATION: NCT00527800. |
Tungiasis in Haiti: a case series of 383 patients
Louis SJ , Bronsnick T , Louis FJ , Rao B . Int J Dermatol 2014 53 (8) 999-1004 BACKGROUND: Tungiasis is endemic in poverty-stricken communities of South and Central America, Africa, Asia, and the Caribbean. This ectoparasitosis, caused by the female sand flea Tunga penetrans, is associated with considerable longterm morbidity in severely affected patients, including toe deformation and limited mobility. In Haiti, tungiasis is poorly documented but is known to occur. This study is the first formal investigation of tungiasis in Haiti. METHODS: A total of 383 patients in four regions (Belle Fontaine, Vallue, Savanette, Cerca Carvajal) were examined and interviewed to determine disease prevalence, demographics and clinical presentation, and tungiasis-related behaviors. RESULTS: Prevalences of tungiasis ranged from 10.6 to 81.8% across the four regions. The overall prevalence of tungiasis in the patients examined was 31.1%. Of the affected patients, 63% were male and 37% were female, 37% were aged 0-10 years, and 100% reported pain and pruritus. Lesions occurred on the feet in 93.3% and on the hands in 22.7% of affected patients. The most common complications observed were chronic inflammation (54.2%) and hyperkeratosis (48.2%). CONCLUSIONS: This study establishes tungiasis as endemic in four regions of Haiti and reveals disease characteristics similar to those reported previously, suggesting that there are common factors underlying this disease in various regions, which are likely to be poverty-related. These findings emphasize the need to acknowledge tungiasis as a clinically relevant public health issue in order to decrease the frequency of tungiasis-related morbidity in endemic areas. |
National Breast and Cervical Cancer Early Detection Program data validation project
Eheman CR , Leadbetter S , Benard VB , Blythe Ryerson A , Royalty JE , Blackman D , Pollack LA , Adams PW , Babcock F . Cancer 2014 120 Suppl 16 2597-603 BACKGROUND: The objectives of this study were to evaluate the quality of national data generated by the National Breast and Cervical Cancer Early Detection Program (NBCCEDP); to assess variables collected through the program that are appropriate to use for program management, evaluation, and data analysis; and to identify potential data-quality issues. METHODS: Information was abstracted randomly from 5603 medical records selected from 6 NBCCEDP-funded state programs, and 76 categorical variables and 11 text-based breast and cervical cancer screening and diagnostic variables were collected. Concordance was estimated between abstracted data and the data collected by the NBCCEDP. Overall and outcome-specific concordance was calculated for each of the key variables. Four screening performance measures also were estimated by comparing the program data with the abstracted data. RESULTS: Basic measures of program outcomes, such as the percentage of women with cancer or with abnormal screening tests, had a high concordance rate. Variables with poor or inconsistent concordance included reported breast symptoms, receipt of fine-needle aspiration, and receipt of colposcopy with biopsy. CONCLUSIONS: The overall conclusion from this comprehensive validation project of the NBCCEDP is that, with few exceptions, the data collected from individual program sites and reported to the CDC are valid and consistent with sociodemographic and clinical data within medical records. |
When performance management works: a study of the National Breast and Cervical Cancer Early Detection Program
DeGroff A , Royalty JE , Howe W , Buckman DW , Gardner J , Poister T , Hayes N . Cancer 2014 120 Suppl 16 2566-74 BACKGROUND: Little empirical evidence exists about the effectiveness of performance management systems in government. This study assessed the effectiveness of the performance management system of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and explored why it works. METHODS: Generalized estimating equation models were used to assess change in program performance after the implementation of a performance management system. In addition, qualitative case study data including observations, interviews, and document review were analyzed using inductive methods. RESULTS: Five of the 7 indicators tested had statistically significant increases in performance postimplementation. Case study results suggest that the system is characterized by high-quality data, measures viewed by grantees as meaningful and fair, and institutionalized data use. CONCLUSIONS: Several factors help to explain the system's effectiveness including characteristics of the NBCCEDP program (eg, service delivery program), qualities of the indicators (eg, process level), financial investment in the system, and a culture of data use. |
National Breast and Cervical Cancer Early Detection Program partnerships in action
Sanders LD , Larkins TL , Boyle JN , George SF , Triplett EW , Leypoldt MD . Cancer 2014 120 Suppl 16 2612-6 Since the inception of the Centers for Disease Control and Prevention (CDC) National Breast and Cervical Cancer Early Detection Program (NBCCEDP) in 1990, partnerships have played a significant role in providing breast and cervical cancer screening and early detection to uninsured and underinsured women. The state, tribal, and territorial NBCCEDP grantees have shared resources and responsibilities with a variety of partners (eg, community-based organizations, government agencies, tribes, health care systems, companies, professional organizations) to achieve common goals. National partners, such as the American Cancer Society, Susan G. Komen for the Cure, and the Avon Foundation for Women, have provided funding, lobbied for national and state funding, supported outreach and education activities, and provided treatment referral services for the programs. This article provides an overview of grantee partnerships to illustrate the effects, successes, and challenges of these partnerships and how they have affected the populations served by the program. |
Public health decisions: actions and consequences
Pohl HR , Jones DE , Holler JS , Murray HE . Regul Toxicol Pharmacol 2014 70 (1) 363-9 The goal of public health is to promote the best possible health for the whole population. Public health issues are numerous and can be unbelievably complex in form, scope, and possible consequence. Most public health decisions involve assessing several different options, weighing the respective benefits and risks of those options, and making difficult decisions that hopefully provide the greatest benefit to the affected populations. Many risk management decisions involve a variety of societal factors which modify risk assessment choices. The purpose of this paper is to point out difficulties in making decisions that impact public health. The intent of such decisions is to improve public health, but as illustrated in the paper, there can be unintended adverse consequences. Such unplanned issues require continued attention and efforts for responsible officials in the protection of environmental public health. This article presents examples of such events, when in the past, it was necessary to assess and regulate a number of potentially hazardous chemicals commonly used as insecticides, gasoline additives, and wood preservatives. |
Contraceptive counseling and postpartum contraceptive use
Zapata LB , Murtaza S , Whiteman M , Jamieson DJ , Robbins CL , Marchbanks PA , D'Angelo DV , Curtis K . Am J Obstet Gynecol 2014 212 (2) 171 e1-8 OBJECTIVE: To examine the associations between prenatal and postpartum contraceptive counseling and postpartum contraceptive use. STUDY DESIGN: Pregnancy Risk Assessment Monitoring System (PRAMS) 2004-2008 data were analyzed from Missouri, New York State, and New York City (n = 9536). We used multivariable logistic regression to assess the associations between prenatal and postpartum contraceptive counseling and postpartum contraceptive use, defined as any method and more effective methods (sterilization, intrauterine device, or hormonal methods). RESULTS: The majority of women received prenatal (78%) and postpartum (86%) contraceptive counseling; 72% received both. Compared with those who received no counseling, those counseled during 1 time period (adjusted odds ratio [AOR] 2.10, 95% confidence interval [CI] 1.65-2.67) and both time periods (AOR 2.33, 95% CI 1.87-2.89) had significantly increased odds of postpartum use of a more effective contraceptive method (32% versus 49% and 56%, respectively; P for trend < 0.0001). Results for counseling during both time periods differed by type of health insurance before pregnancy, with greater odds of postpartum use of a more effective method observed for women with no insurance (AOR 3.51, 95% CI 2.18-5.66) and Medicaid insurance (AOR 3.74, 95% CI 1.98-7.06), than for those with private insurance (AOR 1.87, 95% CI 1.44-2.43) before pregnancy. Findings were similar for postpartum use of any contraceptive method, except no differences by insurance status were detected. CONCLUSIONS: The prevalence of postpartum contraceptive use, including use of more effective methods, was highest when contraceptive counseling was provided during both prenatal and postpartum time periods. Women with Medicaid or no health insurance before pregnancy benefited the most. |
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