Racial differences in levels of serum lipids and effects of exposure to persistent organic pollutants on lipid levels in residents of Anniston, Alabama
Aminov Z , Haase R , Olson JR , Pavuk M , Carpenter DO . Environ Int 2014 73c 216-223 Serum lipid levels are major risk factors for cardiovascular disease. In addition to diet, exercise, genetics, age and race, serum concentrations of persistent organic pollutants (POPs) influence concentrations of serum lipids. We investigated associations between fasting concentrations of 35 polychlorinated biphenyl (PCB) congeners and nine organochlorine pesticides in relation to total serum lipids, total cholesterol, low-density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol and triglycerides in 525 Caucasian and African American residents of Anniston, Alabama, who were not on any lipid-lowering medication. In Model 1, data were adjusted for age, age quadratic, gender, BMI, alcohol consumption, smoking and exercise, while in Model 2, additional adjustment was done for other POPs. As compared to Caucasians, African Americans had lower levels of total lipids and triglycerides with higher concentrations of HDL cholesterol, but higher concentrations of PCBs and pesticides. Total pesticides were more strongly associated with elevations in serum lipids than were total PCBs, and the associations were stronger in African Americans. Total DDTs were not associated with serum lipids after adjustment for other POPs in either racial group, while the strongest positive associations were seen for hexachlorobenzene (HCB) in both racial groups. Racial differences in lipid profiles, concentrations of POPs and associations between POP concentrations and serum lipids are relevant to racial differences in rates of cardiovascular disease. |
A web-based lifestyle intervention for women with recent gestational diabetes mellitus: a randomized controlled trial
Nicklas JM , Zera CA , England LJ , Rosner BA , Horton E , Levkoff SE , Seely EW . Obstet Gynecol 2014 124 (3) 563-70 OBJECTIVE: To test the feasibility and effectiveness of a Web-based lifestyle intervention based on the Diabetes Prevention Program modified for women with recent gestational diabetes mellitus to reduce postpartum weight retention. METHODS: We randomly allocated 75 women with recent gestational diabetes mellitus to either a Web-based lifestyle program (Balance after Baby) delivered over the first postpartum year or to a control group. Primary outcomes were change in body weight at 12 months from 1) first postpartum measured weight; and 2) self-reported prepregnancy weight. RESULTS: There were no significant differences in baseline characteristics between groups including age, body mass index, race, and income status. Women assigned to the Balance after Baby program (n=36, three lost to follow-up) lost a mean of 2.8 kg (95% confidence interval -4.8 to -0.7) from 6 weeks to 12 months postpartum, whereas the control group (n=39, one lost to follow-up) gained a mean of 0.5 kg (-1.4 to +2.4) (P=.022). Women in the intervention were closer to prepregnancy weight at 12 months postpartum (mean change -0.7 kg; -3.5 to +2.2) compared with women in the control arm (+4.0 kg; +1.3 to +6.8) (P=.035). CONCLUSION: A Web-based lifestyle modification program for women with recent gestational diabetes mellitus decreased postpartum weight retention. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01158131. LEVEL OF EVIDENCE: I. |
Public education and targeted outreach to underserved women through the National Breast and Cervical Cancer Early Detection Program
Levano W , Miller JW , Leonard B , Bellick L , Crane BE , Kennedy SK , Haslage NM , Hammond W , Tharpe FS . Cancer 2014 120 Suppl 16 2591-6 The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) was established to provide low-income, uninsured, and underinsured women access to cancer screening and diagnostic services with the goal of increasing the early detection and prevention of breast and cervical cancer. Although this is a valuable resource for women who might not have the means to get screened otherwise, providing services at no cost, by itself, does not guarantee uptake of screening services. Public education and targeted outreach facilitate the critical link between public service programs and the communities they serve. The purpose of public education and outreach in the NBCCEDP is to increase the number of women who use breast and cervical cancer screening services by raising awareness, providing education, addressing barriers, and motivating women to complete screening exams and follow-up. Effective strategies focus on helping to remove structural, physical, interpersonal, financial, and cultural barriers; educate women about the importance of screening and inform women about the services available to them. This article provides an overview of the importance of public education and targeted outreach activities for cancer screening through community-based programs including examples from NBCCEDP grantees that highlight successes, challenges, and solutions, encountered when conducting these types of interventions. |
Pulmonary hypertension surveillance: United States, 2001 to 2010
George MG , Schieb LJ , Ayala C , Talwalkar A , Levant S . Chest 2014 146 (2) 476-95 Pulmonary hypertension (PH) is an uncommon but progressive condition, and much of what we know about it comes from specialized disease registries. With expanding research into the diagnosis and treatment of PH, it is important to provide updated surveillance on the impact of this disease on hospitalizations and mortality. This study, which builds on previous PH surveillance of mortality and hospitalization, analyzed mortality data from the National Vital Statistics System and data from the National Hospital Discharge Survey between 2001 and 2010. PH deaths were identified using International Classification of Diseases, Tenth Revision codes I27.0, I27.2, I27.8, or I27.9 as any contributing cause of death on the death certificate. Hospital discharges associated with PH were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes 416.0, 416.8, or 416.9 as one of up to seven listed medical diagnoses. The decline in death rates associated with PH among men from 1980 to 2005 has reversed and now shows a significant increasing trend. Similarly, the death rates for women with PH have continued to increase significantly during the past decade. PH-associated mortality rates for those aged 85 years and older have accelerated compared with rates for younger age groups. There have been significant declines in PH-associated mortality rates for those with pulmonary embolism and emphysema. Rates of hospitalization for PH have increased significantly for both men and women during the past decade; for those aged 85 years and older, hospitalization rates have nearly doubled. Continued surveillance helps us understand and address the evolving trends in hospitalization and mortality associated with PH and PH-associated conditions, especially regarding sex, age, and race/ethnicity disparities. |
Implementation of the National Breast and Cervical Cancer Early Detection Program: the beginning
Lee NC , Wong FL , Jamison PM , Jones SF , Galaska L , Brady KT , Wethers B , Stokes-Townsend GA . Cancer 2014 120 Suppl 16 2540-8 In 1990, Congress passed the Breast and Cervical Cancer Mortality Prevention Act because of increases in the number of low-income and uninsured women being diagnosed with breast cancer. This act authorized the Centers for Disease Control and Prevention (CDC) to establish the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) to provide high-quality and timely breast and cervical cancer screening and diagnostic services to low-income, uninsured women. The program started in 1991, and, in 1993, Congress amended the act to allow the CDC to fund American Indian and Alaska Native tribes and tribal organizations. By 1996, the program was providing cancer screening across the United States. To ensure appropriate delivery and monitoring of services, the program adopted detailed policies on program management, evidence-based guidelines for clinical services, a systematized clinical data system to track service quality, and key partnerships that expand the program's reach. The NBCCEDP currently funds 67 programs, including all 50 states, the District of Columbia, 5 US territories, and 11 tribes or tribal organizations. |
Acute stroke reperfusion therapy trends in the expanded treatment window era
Asaithambi G , Tong X , George MG , Tsai AW , Peacock JM , Luepker RV , Lakshminarayan K . J Stroke Cerebrovasc Dis 2014 23 (9) 2316-21 BACKGROUND: The American Heart Association/American Stroke Association (AHA/ASA) recommended an expansion of the time window for acute ischemic stroke (AIS) reperfusion with intravenous (IV) recombinant tissue plasminogen activator (rt-PA) from 3 to 4.5 hours after symptom onset. We examine rates of IV and intra-arterial (IA) reperfusion before and after the recommendations to track guideline adoption in community practice. METHODS: Patients with AIS in the Paul Coverdell National Acute Stroke Registry spanning years 2007-2012 were identified. Trends in rates of IV rt-PA versus IA therapy were examined. Outcomes included symptomatic intracerebral hemorrhage (sICH), in-hospital mortality, ability to ambulate at discharge, and discharge destination. RESULTS: From 2007 to 2012, there were 182,235 AIS patients (median age, 72 years; 51.5% women) in the database at the time of analysis. AIS patients receiving IV rt-PA increased significantly from 3.7% in 2007 to 5.1% in 2012 in the ≤3 hours time window and from .2% in 2007 to 1.3% in 2012 in the 3-4.5 hours time window (P < .001 for both). There was also a significant increase in the rate of IA therapy between 2007 and 2012 (P < .001). There was a significant decrease in the rate of sICH among patients who received any reperfusion between 2007 and 2012. CONCLUSIONS: There was a trend for increased utilization of IV rt-PA in the 0-3 hours and the 3-4.5 hours time windows, which began around the same time as the publication of AHA/ASA recommendations in 2009. This increase was associated with an increase in IA treatment rates along with a decrease in overall sICH rates for patients receiving any reperfusion. |
Body mass index categories in observational studies of weight and risk of death
Flegal KM , Kit BK , Graubard BI . Am J Epidemiol 2014 180 (3) 288-96 The World Health Organization (Geneva, Switzerland) and the National Heart, Lung, and Blood Institute (Bethesda, Maryland) have developed standard categories of body mass index (BMI) (calculated as weight (kg)/height (m)(2)) of less than 18.5 (underweight), 18.5-24.9 (normal weight), 25.0-29.9 (overweight), and 30.0 or more (obesity). Nevertheless, studies of BMI and the risk of death sometimes use nonstandard BMI categories that vary across studies. In a meta-analysis of 8 large studies that used nonstandard BMI categories and were published between 1999 and 2014 and included 5.8 million participants, hazard ratios tended to be small throughout the range of overweight and normal weight. Risks were similar between subjects of high-normal weight (BMI of approximately 23.0-24.9) and those of low overweight (BMI of approximately 25.0-27.4). In an example using national survey data, minor variations in the reference category affected hazard ratios. For example, choosing high-normal weight (BMI of 23.0-24.9) instead of standard normal weight (BMI of 18.5-24.9) as the reference category produced higher nonsignificant hazard ratios (1.05 vs. 0.97 for men and 1.06 vs. 1.02 for women) for the standard overweight category (BMI of 25.0-29.9). Use of the standard BMI groupings avoids problems of ad hoc and post hoc category selection and facilitates between-study comparisons. The ways in which BMI data are categorized and reported may shape inferences about the degree of risk for various BMI categories. |
Scale-up, retention and HIV/STI prevalence trends among female sex workers attending VICITS clinics in Guatemala
Morales-Miranda S , Jacobson JO , Loya-Montiel I , Mendizabal-Burastero R , Galindo-Arandi C , Flores C , Chen SY . PLoS One 2014 9 (8) e103455 BACKGROUND: Since 2007, Guatemala integrated STI clinical service with an HIV prevention model into four existing public health clinics to prevent HIV infection, known as the VICITS strategy. We present the first assessment of VICITS scale-up, retention, HIV and STI prevalence trends, and risk factors associated with HIV infection among Female Sex Workers (FSW) attending VICITS clinics in Guatemala. METHODS: Demographic, behavioral and clinical data were collected using a standardized form. Data was analyzed by year and health center. HIV and STI prevalence were estimated from routine visits. Retention was estimated as the percent of new users attending VICITS clinics who returned for at least one follow-up visit to any VICITS clinic within 12 months. Separate multivariate logistic regression models were conducted to investigate factors associated with HIV infection and program retention. RESULTS: During 2007-2011 5,682 FSW visited a VICITS clinic for the first-time. HIV prevalence varied from 0.4% to 5.8%, and chlamydia prevalence from 0% to 14.3%, across sites. Attending the Puerto Barrios clinic, having a current syphilis infection, working primarily on the street, and using the telephone or internet to contact clients were associated with HIV infection. The number of FSW accessing VICITS annually increased from 556 to 2,557 (361%) during the period. In 2011 retention varied across locations from 7.7% to 42.7%. Factors negatively impacting retention included current HIV diagnosis, having practiced sex work in another country, being born in Honduras, and attending Marco Antonio Foundation or Quetzaltenango clinic sites. Systematic time trends did not emerge, however 2008 and 2010 were characterized by reduced retention. CONCLUSIONS: Our data show local differences in HIV prevalence and clinic attendance that can be used to prioritize prevention activities targeting FSW in Guatemala. VICITS achieved rapid scale-up; however, a better understanding of the causes of low return rates is urgently needed. |
Notes from the field: atypical pneumonia in three members of an extended family - South Carolina and north Carolina, July-August 2013
Rhea SK , Cox SW , Moore ZS , Mays ER , Benitez AJ , Diaz MH , Winchell JM . MMWR Morb Mortal Wkly Rep 2014 63 (33) 734-5 On August 5, 2013, the South Carolina Department of Health and Environmental Control was notified of a case of acute respiratory failure in a previously healthy woman. A family interview revealed the patient's uncle and cousin had also been hospitalized with similar symptoms in North Carolina. The South Carolina Department of Health and Environmental Control and the North Carolina Division of Public Health collaborated to identify the cause of the respiratory illness cluster and to prevent additional illnesses. |
Exposure to influenza virus aerosols in the hospital setting: is routine patient care an aerosol generating procedure?
Cummings KJ , Martin SB Jr , Lindsley WG , Othumpangat S , Blachere FM , Noti JD , Beezhold DH , Roidad N , Parker JE , Weissman DN . J Infect Dis 2014 210 (3) 504-5 We read with interest the article by Bischoff et al, in which they describe detection of influenza virus in aerosols around hospitalized patients with influenza virus infection who were receiving routine care [1]. As the authors note, current World Health Organization and Centers for Disease Control and Prevention guidelines for protection of healthcare professionals from influenza virus infection rely on the supposition that, under routine conditions, most transmission occurs via large droplets, rather than via small-particle aerosols [2, 3]. Under these guidelines, aerosol transmission is presumed to be limited to certain aerosol-generating procedures (AGPs), for which higher-level respiratory protection is recommended. The designation of AGPs has been made in large part by extrapolation from epidemiologic studies of outbreaks of other respiratory infections, such as tuberculosis and SARS coronavirus infection [4]. Whether such procedures are uniquely associated with generation of potentially infectious aerosols has not been established. | As part of a pilot study, we recently enrolled patients with and those without respiratory infections who were undergoing potential AGPs at a tertiary-care hospital. All patients provided written informed consent. We included patients with documented influenza virus infection during periods when they were undergoing mechanical ventilation and/or during periods when they were breathing on their own. We sampled air within 0.91 m (3 feet) and 1.83 m (6 feet) of the patient and outside the room for 3.25 hours, using National Institute for Occupational Safety and Health 2-stage aerosol samplers [5]. Aerosol sampling was also performed for 1 to several minutes near the patient's mouth, using closed-faced filter cassettes during extubation, suctioning, and use of an incentive spirometer. Influenza virus RNA copy number was determined by polymerase chain reaction (PCR), and the mean value of 2 replicates was used in analysis. |
Influenza-like illness, the time to seek healthcare, and influenza antiviral receipt during the 2010-2011 influenza season-United States
Biggerstaff M , Jhung MA , Reed C , Fry AM , Balluz L , Finelli L . J Infect Dis 2014 210 (4) 535-44 BACKGROUND: Few data exist describing healthcare-seeking behaviors among persons with influenza-like illness (ILI) or adherence to influenza antiviral treatment recommendations. METHODS: We analyzed adult responses to the Behavioral Risk Factor Surveillance System in 31 states and the District of Columbia (DC) and pediatric responses in 25 states and DC for January-April 2011 by demographics and underlying health conditions. RESULTS: Among 75 088 adult and 15 649 child respondents, 8.9% and 33.9%, respectively, reported ILI. ILI was more frequent among adults with asthma (16%), chronic obstruction pulmonary disease (COPD; 26%), diabetes (12%), heart disease (19%), kidney disease (16%), or obesity (11%). Forty-five percent of adults and 57% of children sought healthcare for ILI. Thirty-five percent of adults sought care ≤2 days after ILI onset. Seeking care ≤2 days was more frequent among adults with COPD (48%) or heart disease (55%). Among adults with a self-reported physician diagnosis of influenza, 34% received treatment with antiviral medications. The only underlying health condition with a higher rate of treatment was diabetes (46%). CONCLUSIONS: Adults with underlying health conditions were more likely to report ILI, but the majority did not seek care promptly, missing opportunities for early influenza antiviral treatment. |
Antibiotic resistance threats in the United States: stepping back from the brink
Solomon SL , Oliver KB . Am Fam Physician 2014 89 (12) 938-41 In a recently issued report, the Centers for Disease Control and Prevention (CDC) estimated the national burden of illnesses and deaths caused by the most common and most worrisome antibiotic-resistant pathogens.1 The report focused on 16 antimicrobial-resistant bacterial pathogens, as well as Candida infections, which together account for more than 2 million illnesses and at least 23,000 deaths every year in the United States.1 The report also included information on Clostridium difficile infections, which, like antibiotic resistance, are driven by antibiotic use. C. difficile causes more than 250,000 clinical infections annually and is associated with more than 14,000 deaths every year in the United States.1 | In this report, the CDC categorized 18 pathogens (eTable A) into three groups (urgent, serious, and concerning) based on seven criteria: clinical impact, economic impact, incidence, 10-year projection of incidence, transmissibility, availability of effective antibiotics, and barriers to prevention.1 Three types of bacteria were included in the urgent category: carbapenem-resistant Enterobacteriaceae, drug-resistant Neisseria gonorrhoeae, and C. difficile. In the past, drug-resistant strains of Enterobacteriaceae and N. gonorrhoeae have shown a propensity to spread rapidly in the United States and around the world. Some strains of carbapenem-resistant Enterobacteriaceae are currently untreatable with available antibiotics, and the cephalosporin agents to which some gonococci are now showing emerging resistance are the last available drugs to effectively treat this infection. Thus, further spread of these strains constitutes a public health crisis. C. difficile infections already cause significant morbidity and mortality, and a recently emerging epidemic strain, BI/NAP1/027, appears to be more virulent. |
The burden of influenza-associated critical illness hospitalizations
Ortiz JR , Neuzil KM , Shay DK , Rue TC , Neradilek MB , Zhou H , Seymour CW , Hooper LG , Cheng PY , Goss CH , Cooke CR . Crit Care Med 2014 42 (11) 2325-32 OBJECTIVE: Influenza is the most common vaccine-preventable disease in the United States; however, little is known about the burden of critical illness due to influenza virus infection. Our primary objective was to estimate the proportion of all critical illness hospitalizations that are attributable to seasonal influenza. DESIGN: Retrospective cohort study. SETTING: Arizona, California, and Washington from January 2003 to March 2009. PATIENTS: All adults hospitalized with critical illness, defined by International Classification of Diseases, 9th Edition, Clinical Modification diagnosis and procedure codes for acute respiratory failure, severe sepsis, or in-hospital death. MEASUREMENTS AND MAIN RESULTS: We combined the complete hospitalization discharge databases for three U.S. states, regional influenza virus surveillance, and state census data. Using negative binomial regression models, we estimated the incidence rates of adult influenza-associated critical illness hospitalizations and compared them with all-cause event rates. We also compared modeled outcomes to International Classification of Diseases, 9th Edition, Clinical Modification-coded influenza hospitalizations to assess potential underrecognition of severe influenza disease. During the study period, we estimated that 26,760 influenza-associated critical illness hospitalizations (95% CI, 14,541, 47,464) occurred. The population-based incidence estimate for influenza-associated critical illness was 12.0 per 100,000 person-years (95% CI, 6.6, 21.6) or 1.3% of all critical illness hospitalizations (95% CI, 0.7%, 2.3%). During the influenza season, 3.4% of all critical illness hospitalizations (95% CI, 1.9%, 5.8%) were attributable to influenza. There were only 2,612 critical illness hospitalizations with International Classification of Diseases, 9th Edition, Clinical Modification-coded influenza diagnoses, suggesting influenza is either undiagnosed or undercoded in a substantial proportion of critical illness. CONCLUSIONS: Extrapolating our data to the 2010 U.S. population, we estimate that about 28,000 adults are hospitalized for influenza-associated critical illness annually. Influenza in many of these critically ill patients may be undiagnosed. Critical care physicians should have a high index of suspicion for influenza in the ICU, particularly when influenza is known to be circulating in their communities. |
Decline in hepatitis E virus antibody prevalence in the United States from 1988-1994 to 2009-2010
Teshale EH , Denniston MM , Drobeniuc J , Kamili S , Teo CG , Holmberg SD . J Infect Dis 2014 211 (3) 366-73 BACKGROUND: Previous population-based estimates in the United States have shown a relatively high prevalence of hepatitis E virus (HEV) antibody. We sought to determine whether changes in the prevalence of HEV antibody have occurred over time. METHODS: We analyzed data from the 2009-2010 National Health and Nutrition Examination Survey (NHANES) and NHANES III (1988-1994). Using the same serologic assay, we compared the estimated anti-HEV-IgG prevalence and risk factors for antibody positivity for the two time periods. RESULTS: The prevalence of HEV antibody among those aged>6 years declined from 10.2% (95% CI 9.1-11.4) during 1988-1994 to 6.0% (5.2-6.8%) during 2009-2010, and for those of US birth, from 9.6% (8.4-10.9) to 5.2% (4.4-6.2). Among US-born persons, the estimated HEV-antibody prevalence declined significantly for all subgroups of age , sex, region of residence, and number of persons per room in the household; significant declines also were observed for persons at or above poverty level, and persons of non-Hispanic white, non-Hispanic black and Mexican-American race/ethnicity. No clear associations with food consumption were found. CONCLUSION: Anti-HEV prevalence is declining in the US. Although the decline suggests a decrease in exposure to HEV over time, the risks associated with exposure remain unknown. |
Did CDC's 2006 revised HIV testing recommendations make a difference? Evaluation of HIV testing in the U.S. household population, 2003-2010
Woodring JV , Kruszon-Moran D , Oster AM , McQuillan G . J Acquir Immune Defic Syndr 2014 67 (3) 331-40 OBJECTIVE: To examine changes in the prevalence of HIV testing among adults following CDC's 2006 revised HIV testing recommendations. DESIGN: The 2003-2010 National Health and Nutrition Examination Survey (NHANES), a nationally representative, cross-sectional survey of the non-institutionalized U.S. population. METHODS: Weighted estimates and multivariable modeling to assess prevalence of lifetime HIV testing, outside of blood donations, based on 13,975 respondents aged 18-59 years, comparing NHANES 2003-2006 and 2007-2010. RESULTS: Overall, HIV testing was 42.1% during 2003-2006 and 44.5% during 2007-2010 (p>0.05). After adjusting for significant predictors in a multivariate model, HIV testing increased from 2003-2006 to 2007-2010 (adjusted odds ratio [aOR] 1.14, p<0.05), mostly among males (aOR 1.33, p<0.001) as compared to females (aOR 1.02, p>0.05). HIV testing also increased significantly among non-Hispanic blacks, heterosexuals, those aged 50-59 years, those without a sexually transmitted infection (STI) history, those without health insurance and those who did not access healthcare in the past year. HIV testing did not change significantly among high-risk groups, including men who have sex with men, those with a history of injection or illicit drug use and those with a STI history. CONCLUSION: In multivariate modeling, we found a modest but significant increase in HIV testing overall and among males after publication of the revised recommendations for HIV testing. The significant increase in non-high risk groups suggests an expansion in generalized HIV testing, as recommended. However, even in 2007-2010, 56% of the U.S. population has never been tested for HIV. |
Multilocus typing of Cryptosporidium spp. and Giardia duodenalis from non-human primates in China.
Karim MR , Zhang S , Jian F , Li J , Zhou C , Zhang L , Sun M , Yang G , Zou F , Dong H , Li J , Rume FI , Qi M , Wang R , Ning C , Xiao L . Int J Parasitol 2014 44 (13) 1039-47 Non-human primates (NHPs) are commonly infected with Cryptosporidium spp. and Giardia duodenalis. However, molecular characterisation of these pathogens from NHPs remains scarce. In this study, 2,660 specimens from 26 NHP species in China were examined and characterised by PCR amplification of 18S rRNA, 70kDa heat shock protein (hsp70) and 60kDa glycoprotein (gp60) gene loci for Cryptosporidium; and 1,386 of the specimens by ssrRNA, triosephosphate isomerase (tpi) and glutamate dehydrogenase (gdh) gene loci for Giardia. Cryptosporidium was detected in 0.7% (19/2660) specimens of four NHP species including rhesus macaques (0.7%), cynomolgus monkeys (1.0%), slow lorises (10.0%) and Francois' leaf monkeys (6.7%), belonging to Cryptosporidium hominis (14/19) and Cryptosporidium muris (5/19). Two C. hominis gp60 subtypes, IbA12G3 and IiA17 were observed. Based on the tpi locus, G. duodenalis was identified in 2.2% (30/1,386) of specimens including 2.1% in rhesus macaques, 33.3% in Japanese macaques, 16.7% in Assam macaques, 0.7% in white-headed langurs, 1.6% in cynomolgus monkeys and 16.7% in olive baboons. Sequence analysis of the three targets indicated that all of the Giardia-positive specimens belonged to the zoonotic assemblage B. Highest sequence polymorphism was observed at the tpi locus, including 11 subtypes: three known and eight new ones. Phylogenetic analysis of the subtypes showed that most of them were close to the so-called subtype BIV. Intragenotypic variations at the gdh locus revealed six types of sequences (three known and three new), all of which belonged to so-called subtype BIV. Three specimens had co-infection with C. hominis (IbA12G3) and G. duodenalis (BIV). The presence of zoonotic genotypes and subtypes of Cryptosporidium spp. and G. duodenalis in NHPs suggests that these animals can potentially contribute to the transmission of human cryptosporidiosis and giardiasis. |
Valley fever: finding new places for an old disease: Coccidioides immitis found in Washington State soil associated with recent human infection
Litvintseva AP , Marsden-Haug N , Hurst S , Hill H , Gade L , Driebe EM , Ralston C , Roe C , Barker BM , Goldoft M , Keim P , Wohrle R , Thompson GR 3rd , Engelthaler DM , Brandt ME , Chiller T . Clin Infect Dis 2014 60 (1) e1-3 We used real-time PCR and culture to demonstrate persistent colonization of soils by Coccidioides immitis, an agent of Valley Fever, in Washington State linked to recent human infections and located outside of the endemic range. Whole genome sequencing confirmed genetic identity between isolates from soil and one of the case-patients. |
Update on cases of delayed hemolysis after parenteral artesunate therapy for malaria - United States, 2008 and 2013
Paczkowski MM , Landman KL , Arguin PM . MMWR Morb Mortal Wkly Rep 2014 63 (34) 753-5 Parenteral artesunate, a first-line treatment for severe malaria in several countries, is associated with increased survival and has a better safety profile compared with parenteral quinine or quinidine. However, parenteral artesunate has been associated with delayed hemolysis, leading to concerns about drug toxicity. Postartemisinin delayed hemolysis (PADH) can occur 1-3 weeks after initiation of treatment with artemisinin-based antimalarials such as artesunate and is characterized by a decline in hemoglobin levels amid hemolysis. CDC conducted a literature review and identified 18 cases of PADH since 2012, mostly in European travelers. In addition, malaria case reports were reviewed retrospectively, and active surveillance was implemented in the United States, identifying two additional PADH cases, for a total of 20. A few patients with PADH required blood transfusions, but among patients where complete follow-up information was available, all made a full recovery. Results from this review suggest that PADH occurs because of delayed clearance of once-infected erythrocytes, probably as a result of a pharmacologic effect of parenteral artesunate and not drug-related toxicity. Therefore, parenteral artesunate can still be considered a safe treatment for severe malaria and should remain an option for its treatment. |
Serum PCB concentrations in residents of Calcasieu and Lafayette Parishes, Louisiana with comparison to the U.S. population
Wong LY , Uddin MS , Turner W , Ragin AD , Dearwent S . Chemosphere 2014 118c 156-162 In 2002, a cross-sectional study designed to compare the serum dioxin toxic equivalent concentrations (TEQ) of a population-based sample of Calcasieu Parish, Louisiana residents, to Lafayette Parish was conducted. The mono-ortho polychlorinated biphenyls (PCBs) were measured in order to calculate the TEQ. We compared the sum of lipid adjusted serum concentrations of 27 PCB congeners (total PCBs) in residents of these two parishes and also by their demographic characteristics. The geometric means (GM) [standard errors (SE)] of the concentrations (ngg-1 lipids) of total PCBs in participants from Calcasieu Parish and Lafayette Parish were 154 (11.8) and 168.6 (20.8) (T-test p=0.54), respectively. Various percentiles of the distribution of serum total PCB concentrations were similar in the two parishes. After adjusting by age and race in the ANCOVA regression model, the adjusted GM for the lipid adjusted total PCBs was statistically higher in the residents in Lafayette than in Calcasieu Parish regardless of age or race (P=0.007). The adjusted GM of lipid adjusted total PCBs for African Americans was significantly higher than for Whites (p<0.001). Serum total PCB levels in residents of both parishes increased linearly with age (P<0.001). The congener profiles were similar in residents of both parishes. We also compared the GMs of a sum of 8 PCBs in Calcasieu and Lafayette Parish residents to those from a representative sample of the U.S. general population in 2001-2002 and they were not significantly different between parishes or between the parish data and the U.S. general population. |
Prenatal exposure to phenols and growth in boys
Philippat C , Botton J , Calafat AM , Ye X , Charles MA , Slama R . Epidemiology 2014 25 (5) 625-35 BACKGROUND: Phenols interact with nuclear receptors implicated in growth and adipogenesis regulation. Only a few studies have explored their effects on growth in humans. OBJECTIVES: We studied the associations of maternal exposure to phenols during pregnancy with prenatal and postnatal growth of male newborns. METHODS: Within a cohort of women recruited during pregnancy, we selected 520 mother-son pairs and quantified 9 phenols in spot urine samples collected during pregnancy. We used ultrasonography during pregnancy, together with birth measurements, to assess fetal growth. We modeled individual postnatal growth trajectories from repeated measures of weight and height in the first 3 years of life. RESULTS: Triclosan concentration was negatively associated with growth parameters measured at the third ultrasound examination but not earlier in pregnancy. At birth, this phenol tended to be negatively associated with head circumference (-1.2 mm for an interquartile range [IQR] increase in ln-transformed triclosan concentration [95% confidence interval = -2.6 to 0.3]) but not with weight or height. Parabens were positively associated with weight at birth. This positive association remained for 3 years for methylparaben (beta = 193 g [-4 to 389]) for an IQR increase in ln-transformed concentrations. CONCLUSION: We relied on only 1 spot urine sample to assess exposure; because of the high variability in phenol urinary concentrations reported during pregnancy, using only 1 sample may result in exposure misclassification, in particular for bisphenol A. Our study suggested associations between prenatal exposure to parabens and triclosan and prenatal or early postnatal growth. |
Multistate foodborne disease outbreaks associated with raw tomatoes, United States, 1990-2010: a recurring public health problem
Bennett SD , Littrell KW , Hill TA , Mahovic M , Behravesh CB . Epidemiol Infect 2014 143 (7) 1-8 We examined multistate outbreaks attributed to raw tomatoes in the United States from 1990 to 2010. We summarized the demographic and epidemiological characteristics of 15 outbreaks resulting in 1959 illnesses, 384 hospitalizations, and three deaths. Most (80%) outbreaks were reported during 2000-2010; 73% occurred May-September. Outbreaks commonly affected adult (median age 34 years) women (median 58% of outbreak cases). All outbreaks were caused by Salmonella [serotypes Newport (n = 6 outbreaks), Braenderup (n = 2), Baildon, Enteritidis, Javiana, Montevideo, Thompson, Typhimurium (n = 1 each); multiple serotypes (n = 1)]. Red, round (69% of outbreaks), Roma (23%), and grape (8%) tomatoes were implicated. Most (93%) outbreaks were associated with tomatoes served predominantly in restaurants. However, traceback investigations suggested that contamination occurred on farms, at packinghouses, or at fresh-cut processing facilities. Government agencies, academia, trade associations, and the fresh tomato industry should consider further efforts to identify interventions to reduce contamination of tomatoes during production and processing. |
Multistate outbreak of Escherichia coli O157:H7 associated with bagged salad
Marder EP , Garman KN , Ingram LA , Dunn JR . Foodborne Pathog Dis 2014 11 (8) 593-5 Shiga toxin-producing Escherichia coli O157:H7 (STEC O157) is the most commonly identified serotype of STEC in the United States. An estimated 63,000 STEC O157 infections occur annually. Infection typically results in diarrhea, bloody stool, abdominal cramps, and, in some cases, hemolytic uremic syndrome. Recent outbreaks of STEC O157 have increasingly been associated with consumption of leafy greens such as lettuce and spinach. We investigated an outbreak of STEC O157 associated with the consumption of bagged salad with cases clustered in various institutional settings. A case-control study was conducted among cases from selected schools with controls matched by school and grade. Seventeen cases from three U.S. states were identified. The median age of cases was 23 years (range: 3-88) and 13 (76%) were female. Six cases were hospitalized and two died. Onset dates ranged from April 29 to May 12, 2012. The matched case-control analysis identified a single significant food service exposure: consumption of lettuce provided by a school cafeteria (median odds ratio=9.4, 95% confidence interval: 1.4-infinity, p=0.0469). The implicated bagged salad product was traced back to a single production facility. Implicated growing areas were scheduled for heightened inspection for the upcoming growing season. A combination of analytical epidemiologic studies among subclusters of cases, surveillance, and traceback implicated bagged salad in this outbreak investigation. |
Outbreaks caused by sprouts, United States, 1998-2010: lessons learned and solutions needed
Dechet AM , Herman KM , Chen Parker C , Taormina P , Johanson J , Tauxe RV , Mahon BE . Foodborne Pathog Dis 2014 11 (8) 635-44 After a series of outbreaks associated with sprouts in the mid-1990s, the U.S. Food and Drug Administration (FDA) published guidelines in 1999 for sprouts producers to reduce the risk of contamination. The recommendations included treating seeds with an antimicrobial agent such as calcium hypochlorite solution and testing spent irrigation water for pathogens. From 1998 through 2010, 33 outbreaks from seed and bean sprouts were documented in the United States, affecting 1330 reported persons. Twenty-eight outbreaks were caused by Salmonella, four by Shiga toxin-producing Escherichia coli, and one by Listeria. In 15 of the 18 outbreaks with information available, growers had not followed key FDA guidelines. In three outbreaks, however, the implicated sprouts were produced by firms that appeared to have implemented key FDA guidelines. Although seed chlorination, if consistently applied, reduces pathogen burden on sprouts, it does not eliminate the risk of human infection. Further seed and sprouts disinfection technologies, some recently developed, will be needed to enhance sprouts safety and reduce human disease. Improved seed production practices could also decrease pathogen burden but, because seeds are a globally distributed commodity, will require international cooperation. |
Genetic determinants of differential oral infection phenotypes of West Nile and St. Louis encephalitis viruses in Culex spp. mosquitoes.
Maharaj PD , Bolling BG , Anishchenko M , Reisen WK , Brault AC . Am J Trop Med Hyg 2014 91 (5) 1066-72 St. Louis encephalitis virus (SLEV) has shown greater susceptibility to oral infectivity than West Nile virus (WNV) in Culex mosquitoes. To identify the viral genetic elements that modulate these disparate phenotypes, structural chimeras (WNV-pre-membrane [prM] and envelope [E] proteins [prME]/SLEV.IC and SLEV-prME/WNV.IC) were constructed in which two of the structural proteins, the prM and E, were interchanged between viruses. Oral dose-response assessment with the chimeric/parental WNV and SLEV was performed to characterize the infection phenotypes in Culex mosquitoes by artificial oral blood meals. The median infectious dose required to infect 50% of Cx. quinquefasciatus with WNV was indistinguishable from that of the SLEV-prME/WNV.IC chimeric virus. Similarly, SLEV and WNV-prME/SLEV.IC virus exhibited an indistinguishable oral dose-response relationship in Cx. quinquefasciatus. Infection rates for WNV.IC and SLEV-prME/WNV.IC were significantly lower than SLEV.IC and WNV-prME/SLEV.IC infection rates. These results indicated that WNV and SLEV oral infectivities are not mediated by genetic differences within the prM and E proteins. |
Mass media health communication campaigns combined with health-related product distribution: a Community Guide Systematic Review
Robinson MN , Tansil KA , Elder RW , Soler RE , Labre MP , Mercer SL , Eroglu D , Baur C , Lyon-Daniel K , Fridinger F , Sokler LA , Green LW , Miller T , Dearing JW , Evans WD , Snyder LB , Kasisomayajula Viswanath K , Beistle DM , Chervin DD , Bernhardt JM , Rimer BK . Am J Prev Med 2014 47 (3) 360-371 CONTEXT: Health communication campaigns including mass media and health-related product distribution have been used to reduce mortality and morbidity through behavior change. The intervention is defined as having two core components reflecting two social marketing principles: (1) promoting behavior change through multiple communication channels, one being mass media, and (2) distributing a free or reduced-price product that facilitates adoption and maintenance of healthy behavior change, sustains cessation of harmful behaviors, or protects against behavior-related disease or injury. EVIDENCE ACQUISITION: Using methods previously developed for the Community Guide, a systematic review (search period, January 1980-December 2009) was conducted to evaluate the effectiveness of health communication campaigns that use multiple channels, including mass media, and distribute health-related products. The primary outcome of interest was use of distributed health-related products. EVIDENCE SYNTHESIS: Twenty-two studies that met Community Guide quality criteria were analyzed in 2010. Most studies showed favorable behavior change effects on health-related product use (a median increase of 8.4 percentage points). By product category, median increases in desired behaviors ranged from 4.0 percentage points for condom promotion and distribution campaigns to 10.0 percentage points for smoking-cessation campaigns. CONCLUSIONS: Health communication campaigns that combine mass media and other communication channels with distribution of free or reduced-price health-related products are effective in improving healthy behaviors. This intervention is expected to be applicable across U.S. demographic groups, with appropriate population targeting. The ability to draw more specific conclusions about other important social marketing practices is constrained by limited reporting of intervention components and characteristics. |
Increasing smoke alarm operability through theory-based health education: a randomised trial
Miller TR , Bergen G , Ballesteros MF , Bhattacharya S , Gielen AC , Sheppard MS . J Epidemiol Community Health 2014 68 (12) 1168-74 BACKGROUND: Although working smoke alarms halve deaths in residential fires, many households do not keep alarms operational. We tested whether theory-based education increases alarm operability. METHODS: Randomised multiarm trial, with a single arm randomly selected for use each day, in low-income neighbourhoods in Maryland, USA. Intervention arms: (1) Full Education combining a health belief module with a social-cognitive theory module that provided hands-on practice installing alarm batteries and using the alarm's hush button; (2) Hands-on Practice social-cognitive module supplemented by typical fire department education; (3) Current Norm receiving typical fire department education only. Four hundred and thirty-six homes recruited through churches or by knocking on doors in 2005-2008. Follow-up visits checked alarm operability in 370 homes (85%) 1-3.5 years after installation. Main outcome measures: number of homes with working alarms defined as alarms with working batteries or hard-wired and number of working alarms per home. Regressions controlled for alarm status preintervention; demographics and beliefs about fire risks and alarm effectiveness. RESULTS: Homes in the Full Education and Practice arms were more likely to have a functioning smoke alarm at follow-up (OR=2.77, 95% CI 1.09 to 7.03) and had an average of 0.32 more working alarms per home (95% CI 0.09 to 0.56). Working alarms per home rose 16%. Full Education and Practice had similar effectiveness (p=0.97 on both outcome measures). CONCLUSIONS: Without exceeding typical fire department installation time, installers can achieve greater smoke alarm operability. Hands-on practice is key. Two years after installation, for every three homes that received hands-on practice, one had an additional working alarm. TRIAL REGISTRATION NUMBER: http://www.clinicaltrials.gov number NCT00139126. |
Update on recommendations for use of herpes zoster vaccine
Hales CM , Harpaz R , Ortega-Sanchez I , Bialek SR . MMWR Morb Mortal Wkly Rep 2014 63 (33) 729-31 Herpes zoster vaccine (Zostavax [Merck & Co., Inc.]) was licensed in 2006 and recommended by the Advisory Committee on Immunization Practices (ACIP) in 2008 for prevention of herpes zoster (shingles) and its complications among adults aged ≥60 years. The Food and Drug Administration (FDA) approved the use of Zostavax in 2011 for adults aged 50 through 59 years based on a large study of safety and efficacy in this age group. ACIP initially considered the use of herpes zoster vaccine among adults aged 50 through 59 years in June 2011, but declined to recommend the vaccine in this age group, citing shortages of Zostavax and limited data on long-term protection afforded by herpes zoster vaccine. In October 2013, ACIP reviewed the epidemiology of herpes zoster and its complications, herpes zoster vaccine supply, short-term vaccine efficacy in adults aged 50 through 59 years, short- and long- term vaccine efficacy and effectiveness in adults aged ≥60 years, an updated cost-effectiveness analysis, and deliberations of the ACIP herpes zoster work group, all of which are summarized in this report. No vote was taken, and ACIP maintained its current recommendation that herpes zoster vaccine be routinely recommended for adults aged ≥60 years. Meeting minutes are available at http://www.cdc.gov/vaccines/acip/meetings/meetings-info.html. |
Vaccine-associated paralytic poliomyelitis and BCG-osis in an immigrant child with severe combined immunodeficiency syndrome - Texas, 2013
Trimble R , Atkins J , Quigg TC , Burns CC , Wallace GS , Thomas M , Mangla AT , Infante AJ . MMWR Morb Mortal Wkly Rep 2014 63 (33) 721-4 Poliovirus transmission has been eliminated in most of the world through the use of inactivated poliovirus vaccine (IPV) and live, attenuated oral poliovirus vaccine (OPV). In the United States, use of OPV was discontinued by the year 2000 because of the potential for vaccine-associated paralytic polio (VAPP); an average of eight cases were reported each year in the United States during 1980-2000. Polio eradication efforts in other parts of the world continue to rely on OPV to take advantage of transmission of poliovirus vaccine strains to unvaccinated persons in the population, lower cost, and ease of administration. In 2013, an infant aged 7 months who recently immigrated to the United States from India was referred to a hospital in San Antonio, Texas. The infant had fever, an enlarging skin lesion in the deltoid region with axillary lymphadenopathy, decreased activity, and inability to bear weight on the left leg, progressing to paralysis of the left leg over a 6-week period. Recognition of lymphopenia on complete blood count led to immune evaluation, which revealed the presence of severe combined immunodeficiency syndrome (SCIDS), an inherited disorder. A history of OPV and bacille Calmette-Guerin (BCG) vaccination in India led to the diagnoses of VAPP and BCG-osis, which were confirmed microbiologically. This report demonstrates the importance of obtaining a comprehensive clinical history in a child who has recently immigrated to the United States, with recognition that differing vaccine practices in other countries might require additional consideration of potential etiologies. |
National, state, and selected local area vaccination coverage among children aged 19-35 months - United States, 2013
Elam-Evans LD , Yankey D , Singleton JA , Kolasa M . MMWR Morb Mortal Wkly Rep 2014 63 (34) 741-8 In the United States, among children born during 1994-2013, vaccination will prevent an estimated 322 million illnesses, 21 million hospitalizations, and 732,000 deaths during their lifetimes. Since 1994, the National Immunization Survey (NIS) has monitored vaccination coverage among children aged 19-35 months in the United States. This report describes national, regional, state, and selected local area vaccination coverage estimates for children born January 2010-May 2012, based on results from the 2013 NIS. In 2013, vaccination coverage achieved the 90% national Healthy People 2020 target* for ≥1 dose of measles, mumps, and rubella vaccine (MMR) (91.9%); ≥3 doses of hepatitis B vaccine (HepB) (90.8%); ≥3 doses of poliovirus vaccine (92.7%); and ≥1 dose of varicella vaccine (91.2%). Coverage was below the Healthy People 2020 targets for ≥4 doses of diphtheria, tetanus, and pertussis vaccine (DTaP) (83.1%; target 90%); ≥4 doses of pneumococcal conjugate vaccine (PCV) (82.0%; target 90%); the full series of Haemophilus influenzae type b vaccine (Hib) (82.0%; target 90%); ≥2 doses of hepatitis A vaccine (HepA) (54.7%; target 85%); rotavirus vaccine (72.6%; target 80%); and the HepB birth dose (74.2%; target 85%). Coverage remained stable relative to 2012 for all of the vaccinations with Healthy People 2020 objectives except for increases in the HepB birth dose (by 2.6 percentage points) and rotavirus vaccination (by 4.0 percentage points). The percentage of children who received no vaccinations remained below 1.0% (0.7%). Children living below the federal poverty level had lower vaccination coverage compared with children living at or above the poverty level for many vaccines, with the largest disparities for ≥4 doses of DTaP (by 8.2 percentage points), full series of Hib (by 9.5 percentage points), ≥4 doses of PCV (by 11.6 percentage points), and rotavirus (by 12.6 percentage points). MMR coverage was below 90% for 17 states. Reaching and maintaining high coverage across states and socioeconomic groups is needed to prevent resurgence of vaccine-preventable diseases. |
Effectiveness of primary care-public health collaborations in the delivery of influenza vaccine: a cluster-randomized pragmatic trial
Kempe A , Albright K , O'Leary S , Kolasa M , Barnard J , Kile D , Lockhart S , Dickinson LM , Shmueli D , Babbel C , Barrow J . Prev Med 2014 69 110-6 OBJECTIVE: To assess effectiveness and feasibility of public-private collaboration in delivering influenza immunization to children. METHODS: Four pediatric and four family medicine (FM) practices in Colorado with a common public health department (PHD) were randomized at the beginning of baseline year (10/2009) to Intervention (joint community clinics and PHD nurses aiding in delivery at practices); or control involving usual care without PHD. Generalized estimating equations compared changes in rates over baseline between intervention and control practices at end of 2nd intervention year (Y2=5/2011). Barriers to collaboration were examined using qualitative methods. RESULTS: Overall, rates increased from baseline to Y2 by 9.2% in intervention and 3.2% in control (p<.0001), with significant increases in both pediatric and FM practices. The largest increases were seen among school-aged and adolescent children (p<.0001 for both), with differences for 6-month-old to 5-year-old children and for children with high-risk conditions not reaching significance. Barriers to collaboration included uncertainty regarding the delivery of vaccine supplies, concerns about using up all purchased vaccine by practices, and concerns about documentation of vaccination if collaboration occurred. CONCLUSIONS: In spite of barriers, public-private collaboration resulted in significantly higher influenza immunization rates, particularly for older, healthy children who visit providers less frequently. |
Human papillomavirus vaccination: recommendations of the Advisory Committee on Immunization Practices (ACIP)
Markowitz LE , Dunne EF , Saraiya M , Chesson HW , Curtis CR , Gee J , Bocchini JA , Unger ER . MMWR Recomm Rep 2014 63 1-30 This report summarizes the epidemiology of human papillomavirus (HPV) and associated diseases, describes the licensed HPV vaccines, provides updated data from clinical trials and postlicensure safety studies, and compiles recommendations from CDC's Advisory Committee on Immunization Practices (ACIP) for use of HPV vaccines. Persistent infection with oncogenic HPV types can cause cervical cancer in women as well as other anogenital and oropharyngeal cancers in women and men. HPV also causes genital warts. Two HPV vaccines are licensed in the United States. Both are composed of type-specific HPV L1 protein, the major capsid protein of HPV. Expression of the L1 protein using recombinant DNA technology produces noninfectious virus-like particles (VLPs). Quadrivalent HPV vaccine (HPV4) contains four HPV type-specific VLPs prepared from the L1 proteins of HPV 6, 11, 16, and 18. Bivalent HPV vaccine (HPV2) contains two HPV type-specific VLPs prepared from the L1 proteins of HPV 16 and 18. Both vaccines are administered in a 3-dose series. ACIP recommends routine vaccination with HPV4 or HPV2 for females aged 11 or 12 years and with HPV4 for males aged 11 or 12 years. Vaccination also is recommended for females aged 13 through 26 years and for males aged 13 through 21 years who were not vaccinated previously. Males aged 22 through 26 years may be vaccinated. ACIP recommends vaccination of men who have sex with men and immunocompromised persons (including those with HIV infection) through age 26 years if not previously vaccinated. As a compendium of all current recommendations for use of HPV vaccines, information in this report is intended for use by clinicians, vaccination providers, public health officials, and immunization program personnel as a resource. ACIP recommendations are reviewed periodically and are revised as indicated when new information and data become available. |
Assessing and mitigating the risks for polio outbreaks in polio-free countries - Africa, 2013-2014
Andre M , Wolff CG , Tangermann RH , Chenoweth P , Tallis G , Kamgang JB , Wassilak SG . MMWR Morb Mortal Wkly Rep 2014 63 (34) 756-61 Since 1988, when the Global Polio Eradication Initiative (GPEI) began, the annual number of polio cases has decreased by >99%. Only three countries remain that have never interrupted wild poliovirus (WPV) transmission: Afghanistan, Nigeria, and Pakistan. Since 2001, outbreaks have occurred in 31 formerly polio-free counties in Africa, with outbreaks in 25 countries caused by WPV originating in Nigeria (2-4). After the declaration of the World Health Assembly of polio eradication as a programmatic emergency in 2012, efforts to identify areas at high risk for importation-associated outbreaks and to reduce that risk have been intensified. This report updates the 2013 assessment of the risk for outbreaks attributable to importation of poliovirus in 33 countries in Africa, using indicators of childhood susceptibility to poliovirus and proximity to countries currently affected by polio . From January 2013 to August 12, 2014, outbreaks occurred in five African countries. Four of the five (Cameroon, Equatorial Guinea, Ethiopia, and Somalia) have had recent transmission (cases within the previous 12 months). Based on the current risk assessment, 15 countries are considered to be at high risk for WPV outbreaks, five at moderate-to-high risk, seven at moderate risk, and six at low risk. In 15 of the 33 countries, less than half of the population resides in areas where surveillance performance indicators have met minimum targets. Enhanced, coordinated activities to raise childhood immunity are underway in 2014 to prevent additional WPV spread. Although substantial progress toward polio eradication has occurred in Nigeria, all African countries remain at risk for outbreaks as long as WPV continues to circulate anywhere on the continent. |
Determination of accuracy of polycythemia vera diagnoses and use of the JAK2V617F test in the diagnostic scheme.
Roda P , Ferrari A , Tang X , Erlich P , Eisenhower C , Patel MD , Irvin-Barnwell EA . Ann Hematol 2014 93 (9) 1467-72 In 2005, three independent research groups described the presence of a specific mutation in the JAK2 gene, JAK2V617F, in patients with a Philadelphia chromosome-negative myeloproliferative neoplasm (MPN). The percentage of patients with the mutation varied according to specific disease with >98 % of polycythemia vera (PV) patients having the mutation. In 2008, the World Health Organization issued new diagnostic criteria for PV including use of the JAK2V617F test as a major diagnostic criterion. The goal of the present study is to determine the accuracy of diagnosing PV in a community practice and reporting of PV to cancer registries, as well as assessing the integration of molecular testing into diagnostic paradigms. Using Geisinger Medical Center's electronic medical records (EMR), patients with a PV diagnosis being seen by a hematologist/oncologist during 2004-2009 were identified. Records were reviewed by a single hematologist/oncologist to determine accuracy of the treating physician's diagnosis and use of the molecular test for the JAK2V617F mutation. There was a diagnosis of PV from the treating physicians in 121 of the 204 evaluable patients (59 %) and another MPN in 21 (10 %). However, we confirmed a PV diagnosis in only 90 patients (44 %). Of the 90 confirmed PV patients, 64 were JAK2V617F-mutation positive while 24 were not tested. While JAK2V617F testing has made a major impact in facilitating the successful delineation of the type of polycythemia (PV versus secondary polycythemia) in patients evaluated in a large, community-based Hematology/Oncology practice, physician usage of other critical tests is inconsistent leading to errors in diagnosis. JAK2V617F mutation testing in combination with other diagnostic criteria may help reduce diagnostic errors. |
Oxidative stress and reduced responsiveness of challenged circulating leukocytes following pulmonary instillation of metal-rich particulate matter in rats
Erdely A , Antonini JM , Young SH , Kashon ML , Gu JK , Hulderman T , Salmen R , Meighan T , Roberts JR , Zeidler-Erdely PC . Part Fibre Toxicol 2014 11 (1) 34 Welding fume is an exposure that consists of a mixture of metal-rich particulate matter with gases (ozone, carbon monoxide) and/or vapors (VOCs). Data suggests that welders are immune compromised. Given the inability of pulmonary leukocytes to properly respond to a secondary infection in animal models, the question arose whether the dysfunction persisted systemically. Our aim was to evaluate the circulating leukocyte population in terms of cellular activation, presence of oxidative stress, and functionality after a secondary challenge, following welding fume exposure. Rats were intratracheally instilled (ITI) with PBS or 2 mg of welding fume collected from a stainless steel weld. Rats were sacrificed 4 and 24 h post-exposure and whole blood was collected. Whole blood was used for cellular differential counts, RNA isolation with subsequent microarray and Ingenuity Pathway Analysis, and secondary stimulation with LPS utilizing TruCulture technology. In addition, mononuclear cells were isolated 24 h post-exposure to measure oxidative stress by flow cytometry and confocal microscopy. Welding fume exposure had rapid effects on the circulating leukocyte population as identified by relative mRNA expression changes. Instillation of welding fume reduced inflammatory protein production of circulating leukocytes when challenged with the secondary stimulus LPS. The effects were not related to transcription, but were observed in conjunction with oxidative stress. These findings support previous studies of an inadequate pulmonary immune response following a metal-rich exposure and extend those findings showing leukocyte dysfunction occurs systemically. |
Plasmodium falciparum parasites lacking histidine-rich protein 2 and 3: a review and recommendations for accurate reporting
Cheng Q , Gatton ML , Barnwell J , Chiodini P , McCarthy J , Bell D , Cunningham J . Malar J 2014 13 (1) 283 Malaria rapid diagnostic tests (RDTs) play a critical role in malaria case management, surveillance and case investigations. Test performance is largely determined by design and quality characteristics, such as detection sensitivity, specificity, and thermal stability. However, parasite characteristics such as variable or absent expression of antigens targeted by RDTs can also affect RDT performance. Plasmodium falciparum parasites lacking the PfHRP2 protein, the most common target antigen for detection of P. falciparum, have been reported in some regions. Therefore, accurately mapping the presence and prevalence of P. falciparum parasites lacking pfhrp2 would be an important step so that RDTs targeting alternative antigens, or microscopy, can be preferentially selected for use in such regions. Herein the available evidence and molecular basis for identifying malaria parasites lacking PfHRP2 is reviewed, and a set of recommended procedures to apply for future investigations for parasites lacking PfHRP2, is proposed. |
H1PVAT is a novel and potent early-stage inhibitor of poliovirus replication that targets VP1
Tijsma A , Thibaut HJ , Spieser SA , De Palma A , Koukni M , Rhoden E , Oberste S , Purstinger G , Volny-Luraghi A , Martin J , Marchand A , Chaltin P , Neyts J , Leyssen P . Antiviral Res 2014 110c 1-9 A novel small molecule, H1PVAT, was identified as a potent and selective inhibitor of the in vitro replication of all three poliovirus serotypes, whereas no activity was observed against other enteroviruses. Time-of-drug-addition studies revealed that the compound interfered with an early stage of virus replication. Four independently-selected H1PVAT-resistant virus variants uniformly carried the single amino acid substitution I194F in the VP1 capsid protein. Poliovirus type 1 strain Sabin, reverse-engineered to contain this substitution, proved to be completely insensitive to the antiviral effect of H1PVAT and was cross-resistant to the capsid-binding inhibitors V-073 and pirodavir. The VP1 I194F mutant had a smaller plaque phenotype than wild-type virus, and the amino acid substitution rendered the virus more susceptible to heat inactivation. Both for the wild-type and VP1 I194F mutant virus, the presence of H1PVAT increased the temperature at which the virus was inactivated, providing evidence that the compound interacts with the viral capsid, and that capsid stabilization and antiviral activity are not necessarily correlated. Molecular modeling suggested that H1PVAT binds with high affinity in the pocket underneath the floor of the canyon that is involved in receptor binding. Introduction of the I194F substitution in the model of VP1 induced a slight concerted rearrangement of the core beta-barrel in this pocket, which disfavors binding of the compound. Taken together, the compound scaffold, to which H1PVAT belongs, may represent another promising class of poliovirus capsid-binding inhibitors next to V-073 and pirodavir. Potent antivirals against poliovirus will be essential in the poliovirus eradication end-game. |
Assessment of two portable real-time particle monitors used in nanomaterial workplace exposure evaluations
Liu Y , Beaucham CC , Pearce TA , Zhuang Z . PLoS One 2014 9 (8) e105769 BACKGROUND: Nanoparticle emission assessment technique was developed to semi-quantitatively evaluate nanomaterial exposures and employs a combination of filter based samples and portable real-time particle monitors, including a condensation particle counter (CPC) and an optical particle counter (OPC), to detect nanomaterial releases. This laboratory study evaluated the results from CPC and OPC simultaneously measuring a polydisperse aerosol to assess their variability and accuracy. METHODS AND RESULTS: Two CPCs and two OPCs were used to evaluate a polydisperse sodium chloride aerosol within an enclosed chamber. The measurement results for number concentration versus time were compared between paired particle monitors of the same type, and to results from the Scanning Mobility Particle Spectrometer (SMPS) which was widely used to measure concentration of size-specific particles. According to analyses by using the Bland-Altman method, the CPCs displayed a constant mean percent difference of -3.8% (95% agreement limits: -9.1 to 1.6%; range of 95% agreement limit: 10.7%) with the chamber particle concentration below its dynamic upper limit (100,000 particles per cubic centimeter). The mean percent difference increased from -3.4% to -12.0% (range of 95% agreement limits: 7.1%) with increasing particle concentrations that were above the dynamic upper limit. The OPC results showed the percent difference within 15% for measurements in particles with size ranges of 300 to 500 and 500 to 1000 regardless of the particle concentration. Compared with SMPS measurements, the CPC gave a mean percent difference of 22.9% (95% agreement limits: 10.5% to 35.2%); whereas the measurements from OPC were not comparable. CONCLUSIONS: This study demonstrated that CPC and OPC are useful for measuring nanoparticle exposures but the results from an individual monitor should be interpreted based upon the instrument's technical parameters. Future research should challenge these monitors with particles of different sizes, shapes, or composition, to determine measurement comparability and accuracy across various workplace nanomaterials. |
Characterization of a novel insect-specific flavivirus from Brazil: potential for inhibition of infection of arthropod cells with medically important flaviviruses
Kenney JL , Solberg OD , Langevin SA , Brault AC . J Gen Virol 2014 95 2796-2808 In the past decade there has been an upsurge in the number of newly described insect-specific flaviviruses isolated pan-globally. We recently described the isolation of a novel flavivirus (tentatively designated "Nhumirim virus"; NHUV) (Pauvolid-Correa et al., in review) that represents an example of a unique subset of apparently insect-specific viruses that phylogenetically affiliate with dual-host mosquito-borne flaviviruses despite appearing to be limited to replication in mosquito cells. We characterized the in vitro growth potential, 3' UTR sequence homology with alternative flaviviruses, and evaluated the virus's capacity to suppress replication of representative Culex spp. vectored pathogenic flaviviruses in mosquito cells. Only mosquito cell lines such as C6/36, C710, and Culex quinquefasciatus cells, were found to support NHUV replication, further reinforcing the insect-specific phenotype of this virus. Analysis of the sequence and predicted RNA secondary structures of the 3' UTR indicate NHUV to be most similar to viruses within the yellow fever serogroup, Japanese encephalitis serogroup, and viruses in the tick-borne flavivirus clade. Interestingly, NHUV was found to share the fewest conserved sequence elements when compared to traditional insect-specific flaviviruses. This suggests that, despite being apparently insect-specific, this virus likely diverged from an ancestral mosquito-borne flavivirus. Co-infection experiments indicated that prior or concurrent infection of mosquito cells with NHUV resulted in significant reduction in viral production of West Nile virus (WNV), St. Louis encephalitis virus (SLEV) and Japanese encephalitis virus (JEV). The inhibitory effect was most effective against WNV and SLEV with over a million-fold and 10,000-fold reduction in peak titers, respectively. These data indicate the potential modulatory effect of flaviviral mosquito co-infections in the field and serve to identify a potential target for blocking mosquito infection with medically important flaviviruses. |
Comparison of hepatitis C virus testing strategies: birth cohort versus elevated alanine aminotransferase levels
Smith BD , Yartel AK . Am J Prev Med 2014 47 (3) 233-41 BACKGROUND: Hepatitis C virus (HCV) infection is unidentified in an estimated 40%-85% of infected adults. Surveillance and modeling data have found significant increases in HCV-associated morbidity and mortality. PURPOSE: To compare two HCV antibody (anti-HCV) testing strategies based on (1) elevated alanine aminotransferase levels (ALT) and (2) a birth cohort approach for people born during 1945-1965. METHODS: Data from 19,055 adults aged 20-70 years who completed the National Health and Nutrition Examination Survey in 1999-2008 were analyzed in 2013. Two independent models were evaluated, based on membership in the 1945-1965 birth cohort or elevated ALT, to compare the number of identified anti-HCV-positive (anti-HCV+) individuals; proportion of total identified cases; and the number of people that would be tested using either strategy. RESULTS: The prevalence of anti-HCV among adults aged 20-70 years was estimated at 2.0% (95% CI=1.8%, 2.3%), representing about 3.6 million people. The birth cohort strategy would result in testing about 85.4 million people and identifying nearly 2.8 million anti-HCV+ people with a sensitivity of 76.6%. The ALT strategy would test about 21.5 million adults and identify approximately 1.8 million anti-HCV+ people with a sensitivity of 50.0%. Implementing both strategies concurrently would identify 87.3% of anti-HCV+ adults. CONCLUSIONS: The birth cohort strategy, which is recommended by both the CDC and the U.S. Preventive Services Task Force, would identify 1 million more anti-HCV+ people than the elevated ALT approach. Concurrent implementation would identify an even larger number of individuals ever infected. |
Distinguishing highly-related outbreak-associated Clostridium botulinum type A(B) strains
Raphael BH , Shirey TB , Luquez C , Maslanka SE . BMC Microbiol 2014 14 192 BACKGROUND: In the United States, most Clostridium botulinum type A strains isolated during laboratory investigations of human botulism demonstrate the presence of an expressed type A botulinum neurotoxin (BoNT/A) gene and an unexpressed BoNT/B gene. These strains are designated type A(B). The most common pulsed-field gel electrophoresis (PFGE) pattern in the C. botulinum PulseNet database is composed of A(B) strains. The purpose of this study was to evaluate the ability of genome sequencing and multi-loci variable number of tandem repeat analysis (MLVA) to differentiate such strains. RESULTS: The genome sequences of type A(B) strains evaluated in this study are closely related and cluster together compared to other available C. botulinum Group I genomes. In silico multilocus sequence typing (MLST) analysis (7-loci) was unable to differentiate any of the type A(B) strains isolated from seven different outbreak investigations evaluated in this study. A 15-locus MLVA scheme demonstrated an improved ability to differentiate these strains, however, repeat unit variation among the strains was restricted to only two loci. Reference-free single nucleotide polymorphism (SNP) analysis demonstrated the ability to differentiate strains from all of the outbreaks examined and a non-outbreak associated strain. CONCLUSIONS: This study confirms that type A(B) strains that share the same PFGE pattern also share closely-related genome sequences. The lack of a complete type A(B) strain representative genome sequence hinders the ability to assemble genomes by reference mapping and analysis of SNPs at pre-identified sites. However, compared to other methods evaluated in this study, a reference-free SNP analysis demonstrated optimal subtyping utility for type A(B) strains using de novo assembled genome sequences. |
Racial disparities in access to maternity care practices that support breastfeeding - United States, 2011
Lind JN , Perrine CG , Li R , Scanlon KS , Grummer-Strawn LM . MMWR Morb Mortal Wkly Rep 2014 63 (33) 725-8 Despite the well documented health benefits of breastfeeding, initiation of breastfeeding and breastfeeding duration rates among black infants in the United States are approximately 16% lower than among whites. Although many factors play a role in a woman's ability to breastfeed, experiences during the childbirth hospitalization are critical for establishing breastfeeding. To analyze whether the implementation by maternity facilities of practices that support breastfeeding varied depending on the racial composition of the area surrounding the facility, CDC linked data from its 2011 Maternity Practices in Infant Nutrition and Care (mPINC) survey to U.S. Census data on the percentage of blacks living within the zip code area of each facility. The results of that analysis indicated that facilities in zip code areas where the percentage of black residents was >12.2% (the national average during 2007-2011) were less likely than facilities in zip code areas where the percentage was ≤12.2% to meet five of 10 mPINC indicators for recommended practices supportive of breastfeeding and more likely to implement one practice; differences for the other four practices were not statistically significant. Comparing facilities in areas with >12.2% black residents with facilities in areas with ≤12.2% black residents, the largest differences were in the percentage of facilities that implemented recommended practices related to early initiation of breastfeeding (46.0% compared with 59.9%), limited use of breastfeeding supplements (13.1% compared with 25.8%), and rooming-in (27.7% compared with 39.4%). These findings suggest there are racial disparities in access to maternity care practices known to support breastfeeding. |
Strength and body weight in US children and adolescents
Ervin RB , Fryar CD , Wang CY , Miller IM , Ogden CL . Pediatrics 2014 134 (3) e782-9 BACKGROUND AND OBJECTIVES: Regular aerobic and muscle-strengthening physical activity in youth has been positively associated with health and may help prevent obesity. The purpose of this study is to provide reference values on 4 core, upper, and lower body measures of muscle strength among US children and adolescents and to investigate the association between these measures of strength and weight status. METHODS: We assessed muscular strength using 4 different tests (plank, modified pull-up, knee extension, and grip strength) in 1224 youth aged 6 to 15 years collected during the 2012 National Health and Nutrition Examination Survey National Youth Fitness Survey. Mean and median estimates are provided by gender, age, and weight status. Weight status was defined based on standard categories of obesity, overweight, normal weight, and underweight using the gender-specific BMI-for-age Centers for Disease Control and Prevention growth charts. RESULTS: There were significant positive trends with age for each of the strength tests (P < .001) except the modified pull-up among girls. The length of time the plank was held decreased as weight status increased for both girls and boys (P < .001). As weight status increased the number of modified pull-ups decreased (P < .001 boys and girls). Scores on the knee extension increased as weight status increased (P < .01). Grip strength increased as weight status increased (P < .01). CONCLUSIONS: Increasing weight status had a negative association with measures of strength that involved lifting the body, but was associated with improved performances on tests that did not involve lifting the body. |
Medication use during pregnancy
Cragan JD . BMJ 2014 349 g5252 Medication use during pregnancy is remarkably common. In the linked paper in this issue (doi:10.1136/bmj.g5159), Bech and colleagues assess the risk of spontaneous abortion and stillbirth after antiepileptic drug use during pregnancy, utilizing national health registers in Denmark from 1997 to 2008.1 The findings are largely reassuring, but studying the effects of drug use in pregnancy is always a challenge and confident conclusions about safety are rarely possible. | Estimates of prescription drug use including vitamins and minerals during the first trimester have ranged from 33% to 69% in developed countries.2 The average number of over the counter and prescription drugs used by pregnant women in the United States increased from 2.5 in 1976-78 to 4.2 in 2006-08.3 And yet the quantity and quality of information about the risk to the fetus of medication use during pregnancy remains poor. A review of 172 medications approved by the US Food and Drug Administration between 2000 and 2010 found that for 97.7% the teratogenic risk in human pregnancy was undetermined; for 73.3% there were no available data about the risk in pregnancy.4 However, because many pregnancies occur unintentionally, women who take medications can be exposed in the early weeks of gestation before realizing they are pregnant.5 In addition, many acute and chronic conditions must be treated during pregnancy to ensure the health of both mother and fetus. Use of antiepileptic drugs is critical in many cases to control epilepsy, and such medications are used increasingly to treat non-epilepsy disorders.6 Some of these disorders, such as migraine, are more common than epilepsy. |
Closure of varicella-zoster virus-containing vaccines pregnancy registry - United States, 2013
Marin M , Willis ED , Marko A , Rasmussen SA , Bialek SR , Dana A . MMWR Morb Mortal Wkly Rep 2014 63 (33) 732-3 Vaccines that contain live attenuated varicella-zoster virus (VZV) (Varivax, ProQuad, and Zostavax [all products of Merck & Co., Inc.]) are contraindicated during pregnancy. To monitor the pregnancy outcomes of women inadvertently vaccinated with VZV-containing vaccines immediately before or during pregnancy, Merck and CDC established the Merck/CDC Pregnancy Registry for VZV-Containing Vaccines in 1995. This report updates previously published summaries of registry data, provides the rationale for the closure of the registry, and describes plans for continued monitoring of the safety of these vaccines when inadvertently administered to pregnant women or immediately before pregnancy. From inception of the registry in 1995 through March 2012, no cases of congenital varicella syndrome and no increased prevalence of other birth defects have been detected among women vaccinated within 3 months before or during pregnancy. Although a small risk for congenital varicella syndrome cannot be ruled out, the number of exposures being registered each year (approximately two varicella-susceptible women exposed during the high-risk period for congenital varicella syndrome) is now too low to improve on the current estimate of the risk. |
Self-reported advertising exposure to sugar-sweetened beverages among US youth
Kumar G , Onufrak S , Zytnick D , Kingsley B , Park S . Public Health Nutr 2014 18 (7) 1-7 OBJECTIVE: According to the Federal Trade Commission, in 2009, the top food category with teen-directed marketing expenditures was sugar-sweetened beverages (SSB). The present study reports on exposure to SSB advertisements using self-report data from adolescents. DESIGN: Cross-sectional study design using descriptive statistics to assess self-reported frequency of exposure to SSB advertisements and multivariable logistic regression to examine associations between frequency of SSB advertising exposure and sociodemographic variables. SETTING: Online survey conducted at home. SUBJECTS: US adolescents aged 12-17 years (n 847). RESULTS: Among the surveyed adolescents, 42 % to 54 % reported seeing/hearing SSB advertisements ≥1 time/d. Those aged 14-15 years were more likely to report seeing/hearing soda, sports drink and energy drink advertisements ≥1 time/d than 16- to 17-year-olds. Males were more likely to report seeing/hearing sports drink advertising ≥1 time/d than females. Non-Hispanic black adolescents were more likely to report seeing/hearing fruit drink and sports drink advertisements ≥1 time/d than non-Hispanic white adolescents. Adolescents whose parents had high-school education or less were more likely to report seeing/hearing soda, fruit drink and energy drink advertisements ≥1 time/d than adolescents whose parents were college graduates. CONCLUSIONS: Almost half of the adolescents sampled reported daily SSB advertising exposure, with higher exposure among African Americans and adolescents with less educated parents. These data can help inform potential actions that decision makers might take, such as education of adolescents and their caregivers on the potential impact of beverage advertising, especially among groups at higher risk for obesity. |
Caffeine and diuresis during rest and exercise: a meta-analysis
Zhang Y , Coca A , Casa DJ , Antonio J , Green JM , Bishop PA . J Sci Med Sport 2014 18 (5) 569-74 OBJECTIVES: Although ergogenic, acute caffeine ingestion may increase urine volume, prompting concerns about fluid balance during exercise and sport events. This meta-analysis evaluated caffeine induced diuresis in adults during rest and exercise. DESIGN: Meta-analysis. METHODS: A search of three databases was completed on November 1, 2013. Only studies that involved healthy adults and provided sufficient information concerning the effect size (ES) of caffeine ingestion on urine volume were included. Sixteen studies met the inclusion criteria, providing a total of 28 ESs for the meta-analysis. Heterogeneity was assessed using a random-effects model. RESULTS: The median caffeine dosage was 300mg. The overall ES of 0.29 (95% confidence interval (CI)=0.11-0.48, p=0.001) corresponds to an increase in urine volume of 109+/-195mL or 16.0+/-19.2% for caffeine ingestion vs. non-caffeine conditions. Subgroup meta-analysis confirmed exercise as a strong moderator: active ES=0.10, 95% CI=-0.07 to 0.27, p=0.248 vs. resting ES=0.54, 95% CI=0.22-0.85, p=0.001 (Cochran's Q, p=0.019). Females (ES=0.75, 95% CI=0.38-1.13, p<0.001) were more susceptible to diuretic effects than males (ES=0.13, 95% CI=-0.05 to 0.31, p=0.158) (Cochran's Q, p=0.003). CONCLUSIONS: Caffeine exerted a minor diuretic effect which was negated by exercise. Concerns regarding unwanted fluid loss associated with caffeine consumption are unwarranted particularly when ingestion precedes exercise. |
Reproductive health risks associated with occupational exposures to antineoplastic drugs in health care settings: a review of the evidence
Connor TH , Lawson CC , Polovich M , McDiarmid MA . J Occup Environ Med 2014 56 (9) 901-10 OBJECTIVES: Antineoplastic drugs are known reproductive and developmental toxicants. Our objective was to review the existing literature of reproductive health risks to workers who handle antineoplastic drugs. METHODS: A structured literature review of 18 peer-reviewed, English language publications of occupational exposure and reproductive outcomes was performed. RESULTS: Although effect sizes varied with study size and population, occupational exposure to antineoplastic drugs seems to raise the risk of both congenital malformations and miscarriage. Studies of infertility and time to pregnancy also suggested an increased risk for subfertility. CONCLUSIONS: Antineoplastic drugs are highly toxic in patients receiving treatment, and adverse reproductive effects have been well documented in these patients. Health care workers with long-term, low-level occupational exposure to these drugs also seem to have an increased risk of adverse reproductive outcomes. Additional precautions to prevent exposure should be considered. |
Injury rates on new and old technology oil and gas rigs operated by the largest United States onshore drilling contractor
Blackley DJ , Retzer KD , Hubler WG , Hill RD , Laney AS . Am J Ind Med 2014 57 (10) 1188-92 BACKGROUND: Occupational fatality rates among oil and gas extraction industry and specifically among drilling contractor workers are high compared to the U.S. all-industry average. There is scant literature focused on non-fatal injuries among drilling contractors, some of which have introduced engineering controls to improve rig efficiency and reduce injury risk. METHODS: We compared injury rates on new and old technology rigs operated by the largest U.S. drilling contractor during 2003-2012, stratifying by job type and grouping outcomes by injury severity and body part affected. RESULTS: Six hundred seventy-one injuries were recorded over 77.4 million person-hours. The rate on new rigs was 66% of that on old rigs. Roughnecks had lower injury rates on new rigs, largely through reduced limb injury rates. New rigs had lower rates in each non-fatal injury severity category. CONCLUSIONS: For this company, new technology rigs appear to provide a safer environment for roughnecks. Future studies could include data from additional companies. |
Chemotherapy: current and emerging issues in safe handling of antineoplastic and other hazardous drugs
Roussel C , Connor TH . Oncol Pharm 2014 7 (4) 14-17 This is the last article of a 4-part series on the toxic effects and safe handling of hazardous drugs by Roussel and Connor.1-3 The previous 3 articles have covered the adverse health effects of hazardous drugs, contamination of the workplace, and biomarkers of effect and exposure. The present article addresses several emerging issues that healthcare providers will need to be aware of, including hazardous drug assessment, use of antineoplastic drugs in nonon- cology settings, oral chemotherapy, decontamination/cleaning, state legislative activities, and US Pharmacopeial Convention (USP) Chapter 800.4 |
Soil-transmitted helminths in pre-school-aged and school-aged children in an urban slum: a cross-sectional study of prevalence, distribution, and associated exposures
Davis SM , Worrell CM , Wiegand RE , Odero KO , Suchdev PS , Ruth LJ , Lopez G , Cosmas L , Neatherlin J , Njenga SM , Montgomery JM , Fox LM . Am J Trop Med Hyg 2014 91 (5) 1002-10 Soil-transmitted helminths (STHs) are controlled by regular mass drug administration. Current practice targets school-age children (SAC) preferentially over pre-school age children (PSAC) and treats large areas as having uniform prevalence. We assessed infection prevalence in SAC and PSAC and spatial infection heterogeneity, using a cross-sectional study in two slum villages in Kibera, Nairobi. Nairobi has low reported STH prevalence. The SAC and PSAC were randomly selected from the International Emerging Infections Program's surveillance platform. Data included residence location and three stools tested by Kato-Katz for STHs. Prevalences among 692 analyzable children were any STH: PSAC 40.5%, SAC 40.7%; Ascaris: PSAC 24.1%, SAC 22.7%; Trichuris: PSAC 24.0%, SAC 28.8%; hookworm < 0.1%. The STH infection prevalence ranged from 22% to 71% between sub-village sectors. The PSAC have similar STH prevalences to SAC and should receive deworming. Small areas can contain heterogeneous prevalences; determinants of STH infection should be characterized and slums should be assessed separately in STH mapping. |
Loss and dysfunction of Vdelta2+ gammadelta T cells are associated with clinical tolerance to malaria
Jagannathan P , Kim CC , Greenhouse B , Nankya F , Bowen K , Eccles-James I , Muhindo MK , Arinaitwe E , Tappero JW , Kamya MR , Dorsey G , Feeney ME . Sci Transl Med 2014 6 (251) 251ra117 Although clinical immunity to malaria eventually develops among children living in endemic settings, the underlying immunologic mechanisms are not known. The Vdelta2(+) subset of gammadelta T cells have intrinsic reactivity to malaria antigens, can mediate killing of Plasmodium falciparum merozoites, and expand markedly in vivo after malaria infection in previously naive hosts, but their role in mediating immunity in children repeatedly exposed to malaria is unclear. We evaluated gammadelta T cell responses to malaria among 4-year-old children enrolled in a longitudinal study in Uganda. We found that repeated malaria was associated with reduced percentages of Vdelta2(+) gammadelta T cells in peripheral blood, decreased proliferation and cytokine production in response to malaria antigens, and increased expression of immunoregulatory genes. Further, loss and dysfunction of proinflammatory Vdelta2(+) gammadelta T cells were associated with a reduced likelihood of symptoms upon subsequent P. falciparum infection. Together, these results suggest that repeated malaria infection during childhood results in progressive loss and dysfunction of Vdelta2(+) gammadelta T cells that may facilitate immunological tolerance of the parasite. |
Prevalence of Strongyloides stercoralis antibodies among a rural Appalachian population - Kentucky, 2013
Russell ES , Bosserman E , Marshall RE , Davis S , Beaudoin A , Handali S , McAuliffe I , Davis C , Woodhall D . Am J Trop Med Hyg 2014 91 (5) 1000-1 We investigated whether Strongyloides infection remains endemic in rural Kentucky's Appalachian regions; 7 of 378 (1.9%) participants tested positive for Strongyloides antibodies. We identified no statistically significant association between a positive test and travel to a known endemic country (P = 0.58), indicating that transmission in rural Kentucky might be ongoing. |
U.S. adults' participation in specific activities, Behavioral Risk Factor Surveillance System - 2011
Watson KB , Frederick GM , Harris CD , Carlson SA , Fulton JE . J Phys Act Health 2014 12 Suppl 1 S3-10 BACKGROUND: There is little information on national estimates for participation in types of aerobic activities among U.S. adults. Current estimates are important to develop appropriate and effective interventions to promote physical activity and interpret bias for some activities measured with devices. METHODS: The percentage of adults participating in specific aerobic activities was estimated overall and by demographic subgroups. The 2011 Behavioral Risk Factor Surveillance System respondents (N = 446,216) reported up to two aerobic activities they spent the most time doing during the past month. RESULTS: Overall, walking (47%) was the most common activity reported and was reported more by women (54%) than men (41%). Participation in most activities declined with increasing age (P < 0.006). There were a number of differences in participation between race/ethnic subgroups. Participation increased with more education (P for trend < 0.006) for all activities. Participation in most activities was different (P < 0.002) across BMI subgroups. CONCLUSIONS: Walking is the most common activity, overall and among most subgroups. Other activity profiles differ by demographic subgroup. Physical activity promotion strategies that focus on identifying and addressing personal and environmental barriers and understanding demographic subgroup differences could lead to more tailored interventions and public health programs. |
Walking for transportation: what do U.S. adults think is a reasonable distance and time?
Watson KB , Carlson SA , Humbert-Rico T , Carroll DD , Fulton JE . J Phys Act Health 2014 12 Suppl 1 S53-61 BACKGROUND: Less than one-third of U.S. adults walk for transportation. Public health strategies to increase transportation walking would benefit from knowing what adults think is a reasonable distance to walk. Our purpose was to determine (1) what adults think is a reasonable distance and amount of time to walk and (2) whether there were differences in minutes spent transportation walking by what adults think is reasonable. METHODS: Analyses used a cross-sectional nationwide adult sample (n=3,653) participating in the 2010 Summer ConsumerStyles mail survey. RESULTS: Most adults (>90%) think transportation walking is reasonable. However, less than half (43%) think walking a mile or more or for 20 minutes or more is reasonable. What adults think is reasonable is similar across most demographic subgroups, except for older adults (≥ 65 years) who think shorter distances and times are reasonable. Trend analysis that adjust for demographic characteristics indicates adults who think longer distances and times are reasonable walk more. CONCLUSIONS: Walking for short distances is acceptable to most U.S. adults. Public health programs designed to encourage longer distance trips may wish to improve supports for transportation walking to make walking longer distances seem easier and more acceptable to most U.S. adults. |
Characteristics of the built environment in relation to objectively measured physical activity among Mexican adults, 2011
Salvo D , Reis RS , Stein AD , Rivera J , Martorell R , Pratt M . Prev Chronic Dis 2014 11 E147 INTRODUCTION: The built environment correlates of physical activity are documented in high-income countries but have yet to be studied among Mexican adults. Our objectives were to assess the associations between characteristics of the built environment and physical activity among adults in Cuernavaca, Mexico, and to examine potential moderation by perceived park and neighborhood safety. METHODS: We conducted a population-based study of adults in Cuernavaca, Mexico, in 2011 (N = 677). Participants wore Actigraph GT3X accelerometers for 7 days. We used geographic information systems (GIS) to generate 500-m- and 1-km-buffer-based measures of net residential density, proportion of commercial land use, land-use mix, connectivity, walkability, and number of parks and transit routes. We also obtained data on distance to the nearest park with GIS. Perceived neighborhood and park safety were self-reported. We created quartile-based categories for all built environment characteristics and ran linear regression models to estimate the association between each characteristic and total weekly moderate-to-vigorous physical activity (MVPA) and MVPA within 10-minute bouts. RESULTS: Walkability was inversely related to total weekly minutes of MVPA (1-km buffer, -46.9 [standard error, 20.0]; P = .03) and weekly minutes of MVPA within bouts (500-m buffer, -31.5 [12.9]; P = .02). The number of transit routes in the 500-m buffer was inversely related to total weekly minutes of MVPA (-23.8 [10.6]; P = .04). Perception of park safety moderated the association between physical activity and having a park intersect the 500-m buffer. CONCLUSION: Our findings contrast with those from high-income countries, suggesting that environmental programs and policies to increase physical activity in Mexican cities cannot be adapted from high-income countries without considering the local context. |
Evaluating application of knowledge and skills: the use of consensus expert review to assess conference abstracts of Field Epidemiology Training participants
Volkov B , MacDonald G , Herrera-Guibert D , Jones D , Patel M . J Multidiscip Eval 2014 10 (23) 44-50 Background: Often evaluations of training programs are limited - with many focusing on the aspects that are easy to measure (e.g., reaction of trainees) without addressing the important outcomes of training, such as how trainees applied their new knowledge, skills, and attitudes. Numerous evaluations fail to measure training’s effect on job performance because few effective methods are available to do so. Particularly difficult is the problem of evaluating multisite training programs that vary considerably in structure and implementation from one site to another. Research Design: We devised a method of a consensus expert review to evaluate the quality of conference abstracts submitted by participants in Field Epidemiology Training Programs - an approach that can provide useful information on how well trainees apply knowledge and skills gained in training, complementing data obtained from other sources and methods. This method is practical, minimally intrusive, and resource-efficient, and it may prove useful for evaluation practice in diverse fields that require training. |
Quality assurance through quality improvement and professional development in the National Breast and Cervical Cancer Early Detection Program
Siegl EJ , Miller JW , Khan K , Harris SE . Cancer 2014 120 Suppl 16 2584-90 Quality assurance (QA) is the process of providing evidence that the outcome meets the established standards. Quality improvement (QI), by contrast, is the act of methodically developing ways to meet acceptable quality standards and evaluating current processes to improve overall performance. In the case of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), the desired outcome is the delivery of quality health care services to program clients. The NBCCEDP provides professional development to ensure that participating providers have current knowledge of evidence-based clinical standards regarding breast and cervical cancer screening and diagnosis and are monitoring women with abnormal screening results for timely follow-up. To assess the quality of clinical care provided to NBCCEDP clients, performance data are collected by NBCCEDP grantees and compared against predetermined Centers for Disease Control and Prevention (CDC) benchmarks known as Data Quality Indicator Guides. In this article, the authors describe 1) the development and use of indicators for QI in the NBCCEDP and 2) the professional development activities implemented to improve clinical outcomes. QA identifies problems, whereas QI systematically corrects them. The quality of service delivery and improved patient outcomes among NBCCEDP grantees has enhanced significantly because of continuous monitoring of performance and professional development. By using QA, NBCCEDP grantees can maximize the quality of patient screening, diagnostic services, and follow-up. Examples of grantee activities to maintain quality of care are also described in this report. |
A probability model for evaluating the bias and precision of influenza vaccine effectiveness estimates from case-control studies
Haber M , An Q , Foppa IM , Shay DK , Ferdinands JM , Orenstein WA . Epidemiol Infect 2014 143 (7) 1-10 As influenza vaccination is now widely recommended, randomized clinical trials are no longer ethical in many populations. Therefore, observational studies on patients seeking medical care for acute respiratory illnesses (ARIs) are a popular option for estimating influenza vaccine effectiveness (VE). We developed a probability model for evaluating and comparing bias and precision of estimates of VE against symptomatic influenza from two commonly used case-control study designs: the test-negative design and the traditional case-control design. We show that when vaccination does not affect the probability of developing non-influenza ARI then VE estimates from test-negative design studies are unbiased even if vaccinees and non-vaccinees have different probabilities of seeking medical care against ARI, as long as the ratio of these probabilities is the same for illnesses resulting from influenza and non-influenza infections. Our numerical results suggest that in general, estimates from the test-negative design have smaller bias compared to estimates from the traditional case-control design as long as the probability of non-influenza ARI is similar among vaccinated and unvaccinated individuals. We did not find consistent differences between the standard errors of the estimates from the two study designs. |
Effect of religiosity and dysfunctional dating attitudes on youth substance use
Tharp AT , DeWall CN , Richman SB , Noonan RK . J Addict 2014 2014 143709 The current investigation examined the interactive effect of dysfunctional dating attitudes and religiosity on substance use in a large sample of youth (N = 1,357) from the YouthStyles survey. Based on past research, we explored the possibility that religiosity buffered the association between dysfunctional dating attitudes and substance use. Because age was significantly associated with all study variables, we included age in our analyses. In support of our hypothesis we found an attitude by religiosity by age interaction among youth with moderate levels of dysfunctional dating attitudes. Among these youth, the buffering effect of religiosity increased with age. For youth with low and high dysfunctional dating attitudes, religiosity did not buffer the association. The results of this study are in line with past work that suggests that the association between relationship characteristics and substance use is complex. It also identifies religiosity as a protective factor for the effect of dating attitudes on substance use but suggests that these effects may be the most important for youth with moderate levels of dysfunctional dating attitudes. |
Acute kidney injury associated with smoking synthetic cannabinoid
Buser GL , Gerona RR , Horowitz BZ , Vian KP , Troxell ML , Hendrickson RG , Houghton DC , Rozansky D , Su SW , Leman RF . Clin Toxicol (Phila) 2014 52 (7) 664-73 CONTEXT AND OBJECTIVES: Synthetic cannabinoids are illegal drugs of abuse known to cause adverse neurologic and sympathomimetic effects. They are an emerging health risk: 11% of high school seniors reported smoking them during the previous 12 months. We describe the epidemiology of a toxicologic syndrome of acute kidney injury associated with synthetic cannabinoids, review the toxicologic and public health investigation of the cluster, and describe clinical implications of the cluster investigation. MATERIALS AND METHODS: Case series of nine patients affected by the toxicologic syndrome in Oregon and southwestern Washington during May-October 2012. Cases were defined as acute kidney injury (creatinine > 1.3 mg/dL) among persons aged 13-40 years without known renal disease who reported smoking synthetic cannabinoids. Toxicology laboratories used liquid chromatography and time-of-flight mass spectrometry to test clinical and product specimens for synthetic cannabinoids, their metabolites, and known nephrotoxins. Public health alerts informed clinicians, law enforcement, and the community about the cluster and the need to be alert for toxidromes associated with emerging drugs of abuse. RESULTS: Patients were males aged 15-27 years (median, 18 years), with intense nausea and flank or abdominal pain, and included two sets of siblings. Peak creatinine levels were 2.6-17.7 mg/dL (median, 6.6 mg/dL). All patients were hospitalized; one required dialysis; none died. No alternate causes of acute kidney injury or nephrotoxins were identified. Patients reported easily purchasing synthetic cannabinoids at convenience, tobacco, and adult bookstores. One clinical and 2 product samples contained evidence of a novel synthetic cannabinoid, XLR-11 ([1-(5-fluoropentyl)-1H-indol-3-yl](2,2,3,3-tetramethylcyclopropyl)methanone). DISCUSSION AND CONCLUSION: Whether caused by direct toxicity, genetic predisposition, or an as-yet unidentified nephrotoxin, this association between synthetic cannabinoid exposure and acute kidney injury reinforces the need for vigilance to detect new toxicologic syndromes associated with emerging drugs of abuse. Liquid chromatography and time-of-flight mass spectrometry are useful tools in determining the active ingredients in these evolving products and evaluating them for toxic contaminants. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Disease Reservoirs and Vectors
- Drug Safety
- Environmental Health
- Food Safety
- Genetics and Genomics
- Health Communication and Education
- Immunity and Immunization
- Laboratory Sciences
- Maternal and Child Health
- Nutritional Sciences
- Occupational Safety and Health
- Parasitic Diseases
- Physical Activity
- Program Evaluation
- Public Health Leadership and Management
- Statistics as Topic
- Substance Use and Abuse
About
CDC Science Clips is an online, continuously updated, searchable database of scientific literature published by CDC authors. Each article features an Altmetric Attention Score to track social and mainstream media mentions. If you are aware of a CDC-authored publication that does not appear in this database, please let us know.
- Page last reviewed:Feb 1, 2024
- Page last updated:Sep 03, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure