Adjusted fluoride concentrations and control ranges in 34 states - 2006-2010 and 2015
Barker LK , Duchon KK , Lesaja S , Robison VA , Presson SM . J Am Water Works Assoc 2017 109 (8) 13-25 To inform selection of a control range around the Public Health Service's recommended 0.7 mg/L drinking water fluoride concentration to prevent tooth decay, the Centers for Disease Control and Prevention's Water Fluoridation Reporting System data for 2006-2010 and 2015 were analyzed. Monthly average concentration data from 4,251 fluoride-adjusted community water systems for 191,266 of 255,060 system-months (2006-2010) were compared with control ranges 0.6 mg/L to 0.2 mg/L wide. Percentages of system-months within control ranges ≥0.4 mg/L wide (e.g., +/-0.2 mg/L) were >83% versus 68% for 0.2 mg/L wide (+/-0.1 mg/L). In 2015, 70% of adjusted systems maintained averages within +/-0.1 mg/L of their system's annual average for nine of 12 months, 67% used the 0.7 mg/L target and 45% used it with a +/-0.1 mg/L control range. Adoption of the 0.7 mg/L target was underway but not completed in 2015. Control ranges narrower than +/-0.2 mg/L may be feasible for monthly average fluoride concentration. |
BRCA Genetic Testing and Receipt of Preventive Interventions Among Women Aged 18-64 Years with Employer-Sponsored Health Insurance in Nonmetropolitan and Metropolitan Areas - United States, 2009-2014.
Kolor K , Chen Z , Grosse SD , Rodriguez JL , Green RF , Dotson WD , Bowen MS , Lynch JA , Khoury MJ . MMWR Surveill Summ 2017 66 (15) 1-11 PROBLEM/CONDITION: Genetic testing for breast cancer 1 (BRCA1) and breast cancer 2 (BRCA2) gene mutations can identify women at increased risk for breast and ovarian cancer. These testing results can be used to select preventive interventions and guide treatment. Differences between nonmetropolitan and metropolitan populations in rates of BRCA testing and receipt of preventive interventions after testing have not previously been examined. PERIOD COVERED: 2009-2014. DESCRIPTION OF SYSTEM: Medical claims data from Truven Health Analytics MarketScan Commercial Claims and Encounters databases were used to estimate rates of BRCA testing and receipt of preventive interventions after BRCA testing among women aged 18-64 years with employer-sponsored health insurance in metropolitan and nonmetropolitan areas of the United States, both nationally and regionally. RESULTS: From 2009 to 2014, BRCA testing rates per 100,000 women aged 18-64 years with employer-sponsored health insurance increased 2.3 times (102.7 to 237.8) in metropolitan areas and 3.0 times (64.8 to 191.3) in nonmetropolitan areas. The relative difference in BRCA testing rates between metropolitan and nonmetropolitan areas decreased from 37% in 2009 (102.7 versus 64.8) to 20% in 2014 (237.8 versus 191.3). The relative difference in BRCA testing rates between metropolitan and nonmetropolitan areas decreased more over time in younger women than in older women and decreased in all regions except the West. Receipt of preventive services 90 days after BRCA testing in metropolitan versus nonmetropolitan areas throughout the period varied by service: the percentage of women who received a mastectomy was similar, the percentage of women who received magnetic resonance imaging of the breast was lower in nonmetropolitan areas (as low as 5.8% in 2014 to as high as 8.2% in 2011) than metropolitan areas (as low as 7.3% in 2014 to as high as 10.3% in 2011), and the percentage of women who received mammography was lower in nonmetropolitan areas in earlier years but was similar in later years. INTERPRETATION: Possible explanations for the 47% decrease in the relative difference in BRCA testing rates over the study period include increased access to genetic services in nonmetropolitan areas and increased demand nationally as a result of publicity. The relative differences in metropolitan and nonmetropolitan BRCA testing rates were smaller among women at younger ages compared with older ages. PUBLIC HEALTH ACTION: Improved data sources and surveillance tools are needed to gather comprehensive data on BRCA testing in the United States, monitor adherence to evidence-based guidelines for BRCA testing, and assess receipt of preventive interventions for women with BRCA mutations. Programs can build on the recent decrease in geographic disparities in receipt of BRCA testing while simultaneously educating the public and health care providers about U.S. Preventive Services Task Force recommendations and other clinical guidelines for BRCA testing and counseling. |
Vital Signs: Recent trends in stroke death rates - United States, 2000-2015
Yang Q , Tong X , Schieb L , Vaughan A , Gillespie C , Wiltz JL , King SC , Odom E , Merritt R , Hong Y , George MG . MMWR Morb Mortal Wkly Rep 2017 66 (35) 933-939 INTRODUCTION: The prominent decline in U.S. stroke death rates observed for more than 4 decades has slowed in recent years. CDC examined trends and patterns in recent stroke death rates among U.S. adults aged ≥35 years by age, sex, race/ethnicity, state, and census region. METHODS: Trends in the rates of stroke as the underlying cause of death during 2000-2015 were analyzed using data from the National Vital Statistics System. Joinpoint software was used to identify trends in stroke death rates, and the excess number of stroke deaths resulting from unfavorable changes in trends was estimated. RESULTS: Among adults aged ≥35 years, age-standardized stroke death rates declined 38%, from 118.4 per 100,000 persons in 2000 to 73.3 per 100,000 persons in 2015. The annual percent change (APC) in stroke death rates changed from 2000 to 2015, from a 3.4% decrease per year during 2000-2003, to a 6.6% decrease per year during 2003-2006, a 3.1% decrease per year during 2006-2013, and a 2.5% (nonsignificant) increase per year during 2013-2015. The last trend segment indicated a reversal from a decrease to a statistically significant increase among Hispanics (APC = 5.8%) and among persons in the South Census Region (APC = 4.2%). Declines in stroke death rates failed to continue in 38 states, and during 2013-2015, an estimated 32,593 excess stroke deaths might not have occurred if the previous rate of decline could have been sustained. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Prior declines in stroke death rates have not continued in recent years, and substantial variations exist in timing and magnitude of change by demographic and geographic characteristics. These findings suggest the importance of strategically identifying opportunities for prevention and intervening in vulnerable populations, especially because effective and underused interventions to prevent stroke incidence and death are known to exist. |
Healthcare access and cancer screening among victims of intimate partner violence
Massetti GM , Townsend JS , Thomas CC , Basile KC , Richardson LC . J Womens Health (Larchmt) 2017 27 (5) 607-614 BACKGROUND: Intimate partner violence (IPV) victims often experience substantial and persistent mental and physical health problems, including increased risk for chronic disease and barriers to healthcare access. This study investigated the association between IPV and cancer screening. MATERIALS AND METHODS: Behavioral Risk Factor Surveillance System data from the eight states and one U.S. territory that administered the optional IPV module in 2006 were analyzed to examine demographic characteristics, health behaviors, health status, healthcare coverage, use of health services, and cancer screening among men and women who reported IPV victimization compared with those among men and women who did not. IPV victimization included physical violence, threats, and sexual violence. RESULTS: In the nine jurisdictions that administered the IPV module, 23.6% of women and 11.3% of men experienced IPV. Fewer women and men reporting IPV victimization had health insurance, a personal doctor or healthcare provider, or regular checkups within the past 2 years than nonvictims. More male and female IPV victims were current tobacco users and engaged in binge drinking in the past month. IPV victims of both sexes also had poorer health status, lower life satisfaction, less social and emotional support, and more days with poor physical and mental health in the past month than nonvictims. IPV victimization was associated with lower rates of mammography and colorectal cancer screening but not cervical cancer screening in women and was not associated with colorectal cancer screening in men. In multivariable logistic regression results presented as adjusted proportions controlling for demographics, health status, and healthcare access, only the association with mammography screening remained significant, and the magnitude of this association was modest. CONCLUSIONS: There were consistent differences between IPV victims and nonvictims in nearly every measure of healthcare access, health status, and preventive service use. Much of this association seems explained by population characteristics associated with both IPV and lower use of preventive service use, including differences in demographic characteristics, health status, and healthcare access. Healthcare providers could take steps to identify populations at high risk for lack of access or use of preventive services and IPV victimization. |
Differences in bleeding phenotype and provider interventions in postmenarchal adolescents when compared to adult women with bleeding disorders and heavy menstrual bleeding
Srivaths LV , Zhang QC , Byams VR , Dietrich JE , James AH , Kouides PA , Kulkarni R . Haemophilia 2017 24 (1) 63-69 INTRODUCTION: Due to lack of patient/health care provider awareness causing delayed diagnosis, the bleeding phenotype and provider interventions in adolescents with heavy menstrual bleeding (HMB) and bleeding disorders (BD) may be different when compared to adults. AIM: The aim of this study was to compare/characterize bleeding phenotype and provider interventions in postmenarchal adolescents < 18 years and premenopausal adults ≥ 18 years with HMB and BD. METHODS: Patient demographics, BD, and provider interventions/therapy details for HMB were compared between both age groups enrolled in the Centers for Disease Control and Prevention (CDC) Female Universal Data Collection (UDC) surveillance project in United States hemophilia treatment centres. Cross-sectional descriptive analyses including frequency distributions, summary statistics, bivariate and logistic regression analyses were performed. RESULTS: Of 269 females (79 adolescents; median age 16 years, interquartile range (IQR) = 2; 190 adults; median age 27 years, IQR = 13) evaluated, BD distribution was similar in both groups. Compared to adolescents, adults more often had family history of bleeding (Adjusted odds ratios [AOR] = 2.6, 1.3-5.6), delay in diagnosis (AOR = 2.5, 1.2-4.9), bleeding with dental procedures (AOR = 2.0, 1.0-4.0), gastrointestinal bleeding (AOR = 4.6, 1.0-21.9), anaemia (AOR = 2.7, 1.4-5.2), utilized desmopressin less often (AOR = 0.4, 0.2-0.8) and underwent gynaecologic procedure/surgery more frequently (AOR = 5.9, 1.3-27.3). CONCLUSION: Bleeding phenotypes of adolescents and adults with HMB and BD were different with more frequent bleeding complications, anaemia, gynaecologic procedures/surgeries, less desmopressin use and more delay in diagnosing BD in adults. Longitudinal studies are needed to determine whether improved patient/provider awareness and education will translate to early diagnosis and timely management of BD/HMB in adolescents that may prevent/reduce future haematologic/gynaecologic complications. |
Determining the Seasonality of Respiratory Syncytial Virus in the United States: The Impact of Increased Molecular Testing.
Midgley CM , Haynes AK , Baumgardner JL , Chommanard C , Demas SW , Prill MM , Abedi GR , Curns AT , Watson JT , Gerber SI . J Infect Dis 2017 216 (3) 345-355 Background: In the United States, the seasonality of respiratory syncytial virus (RSV) has traditionally been defined on the basis of weeks during which antigen-based tests detect RSV in >10% of specimens (hereafter, the "10% threshold"). Because molecular testing has become more widely used, we explored the extent of polymerase chain reaction (PCR)-based RSV testing and its impact on determining the seasonality of RSV. Methods: We assessed antigen- and PCR-based RSV reports submitted to the National Respiratory and Enteric Virus Surveillance System during July 2005-June 2015. To characterize RSV seasons by using PCR-based reports, we assessed the traditional 10% threshold; subsequently, we developed 3 methods based on either PCR-based detections or the percentage of positive test results. Results: The annual number of PCR-based reports increased 200-fold during 2005-2015, while the annual number of antigen-based reports declined. The weekly percentage of specimens positive for RSV by PCR was less than that for antigen-detection tests; accordingly, the 10% threshold excluded detections by PCR and so was imprecise for characterizing RSV seasons. Among our PCR-specific approaches, the most sensitive and consistent method captured 96%-98% of annual detections within a season, compared with 82%-94% captured using the traditional method. Conclusions: PCR-based reports are increasingly relevant for RSV surveillance and determining the seasonality of RSV. These PCR-specific methods provide a more comprehensive understanding of RSV trends, particularly in settings where testing and reporting are most active. Diagnostic practices will vary by locality and should be understood before choosing which method to apply. |
Reported cases of neurosyphilis among early syphilis cases - United States, 2009 to 2015
de Voux A , Kidd S , Torrone EA . Sex Transm Dis 2017 45 (1) 39-41 The surveillance of neurosyphilis, an uncommon but severe consequence of syphilis, is complex; surveillance classification of neurosyphilis requires a lumbar puncture and cerebrospinal fluid analysis. We examined the prevalence of reported neurosyphilis among primary, secondary, and early latent syphilis cases reported in the United States from 2009 to 2015. Overall, the prevalence of reported neurosyphilis from 2009 to 2015 was low (0.84%); however, this is likely an underestimate of the true burden in the United States. |
The spatial association between federally qualified health centers and county-level reported sexually transmitted infections: A spatial regression approach
Owusu-Edusei K Jr , Gift TL , Leichliter JS , Romaguera RA . Sex Transm Dis 2017 45 (2) 81-86 BACKGROUND: The number of categorical sexually transmitted disease (STD) clinics is declining in the United States. Federally qualified health centers (FQHCs) have the potential to supplement the needed sexually transmitted infection (STI) services. In this study, we describe the spatial distribution of FQHC sites and determine if reported county-level nonviral STI morbidity were associated with having FQHC(s) using spatial regression techniques. METHODS: We extracted map data from the Health Resources and Services Administration data warehouse on FQHCs (ie, geocoded health care service delivery [HCSD] sites) and extracted county-level data on the reported rates of chlamydia, gonorrhea and, primary and secondary (P&S) syphilis (2008-2012) from surveillance data. A 3-equation seemingly unrelated regression estimation procedure (with a spatial regression specification that controlled for county-level multiyear (2008-2012) demographic and socioeconomic factors) was used to determine the association between reported county-level STI morbidity and HCSD sites. RESULTS: Counties with HCSD sites had higher STI, poverty, unemployment, and violent crime rates than counties with no HCSD sites (P < 0.05). The number of HCSD sites was associated (P < 0.01) with increases in the temporally smoothed rates of chlamydia, gonorrhea, and P&S syphilis, but there was no significant association between the number of HCSD per 100,000 population and reported STI rates. CONCLUSIONS: There is a positive association between STI morbidity and the number of HCSD sites; however, this association does not exist when adjusting by population size. Further work may determine the extent to which HCSD sites can meet unmet needs for safety net STI services. |
Syphilis screening and treatment: integration with HIV services
Taylor MM , Kamb M , Wu D , Hawkes S . Bull World Health Organ 2017 95 (9) 610-610a Syphilis transmitted from mother to child is second only to malaria as a leading cause of preventable stillbirth.1 An estimated 930 000 pregnant women experience 350 000 adverse pregnancy outcomes annually due to syphilis. Over half of these affected pregnancies end in stillbirth or neonatal death.2 Elimination of mother-to-child transmission of syphilis relies on reducing the background prevalence of syphilis in pregnant women as well as within general populations. Screening and treatment of high-risk populations and pregnant women are critical strategies that can rapidly reduce morbidity and mortality related to this infection. However, while countries frequently have well-resourced programmes for human immunodeficiency virus (HIV) prevention and care, syphilis control is seldom centralized and often falls within the responsibilities, but outside the priorities, of HIV programmes or antenatal care. Advocacy, policy implementation and resource allocation for syphilis testing and treatment are often deficient, particularly in countries with high syphilis burden.3 | The World Health Organization (WHO) strategy for the elimination of congenital syphilis prioritized commitment and advocacy at the highest levels, alongside promoting increased access to and quality of maternal and newborn health services, improved coverage of syphilis testing and treatment in pregnancy and ongoing surveillance, monitoring and evaluation of targets.4 In 2014, regional and country-led initiatives as well as encouragement by external partners led WHO to promote integrating programmes for dual elimination of mother-to-child transmission of both HIV and syphilis, recognizing that harmonized approaches improved efficiency and quality of maternal and newborn health services and improved health outcomes for mothers and infants. The resulting WHO global guidance on elimination of mother-to-child transmission of HIV and syphilis set corresponding process criteria for country validation of (i) at least 95% coverage of antenatal care; (ii) 95% testing coverage of pregnant women for HIV and syphilis; and (iii) 95% treatment coverage for those pregnant women testing positive for HIV or syphilis.5 In addition to antenatal-care-specific targets, the global guidance also calls for enhanced access for the general population to syphilis prevention and control interventions. |
Measuring progress on preventing pneumonia deaths: are we there yet?
Whitney CG . Lancet Infect Dis 2017 17 (11) 1100-1101 In The Lancet Infectious Diseases, the GBD 2015 LRI Collaborators provide estimates of the burden of illnesses and deaths from lower respiratory tract infections as a group and specific numbers for four common aetiologies—Streptococcus pneumoniae (pneumococcal pneumonia), Haemophilus influenzae type b (Hib), influenza, and respiratory syncytial virus (RSV).1 According to the models presented, lower respiratory tract infections remain a top cause of mortality for all ages—the fifth leading cause of deaths overall and second in children younger than 5 years. The burden of lower respiratory tract infections is immense, with 2·7 million deaths in 2015 alone, including 704 000 deaths in children younger than 5 years. Clearly, the need to press ahead on multiple fronts to reduce this burden is great. | Progress is being made. The new estimates show that deaths due to respiratory infections decreased between 2005 and 2015, in particular in young children. However, the authors' models show how the poorest countries in sub-Saharan Africa and south Asia still have the largest burden of deaths from respiratory infections, with three of every four deaths from respiratory infections worldwide occurring in these two regions. Additionally, estimated reductions in pneumonia mortality over the past decade were smaller in sub-Saharan Africa (21·4%, 95% UI 11·0–30·8) than the overall worldwide reductions (36·9%, 31·6–42·0). WHO and UNICEF lead a global effort to reduce childhood deaths from pneumonia, with key strategies summarised in the integrated Global Action Plan for Pneumonia and Diarrhoea (GAPPD).2 The GAPPD highlights adequate nutrition, access to appropriate treatment, reducing indoor air pollution, and vaccination as interventions crucial to reducing pneumonia mortality in children. The models presented by the GBD 2015 LRI Collaborators1 show that decreases in exposure to air pollution and child undernutrition contributed strongly to the reductions in years of life lost from pneumonia over the past decade, with decreases in respiratory infection DALYs of 8·9% attributed to reductions in undernutrition and 4·3% attributed to reductions in air pollution. In future models, making similar estimates that quantify the benefits seen from the introduction of the pneumococcal conjugate vaccine and Hib vaccine would be useful. |
Misdiagnosis of HIV infection during a South African community-based survey: implications for rapid HIV testing
Kufa T , Kharsany AB , Cawood C , Khanyile D , Lewis L , Grobler A , Chipeta Z , Bere A , Glenshaw M , Puren A . J Int AIDS Soc 2017 20 35-43 INTRODUCTION: We describe the overall accuracy and performance of a serial rapid HIV testing algorithm used in community-based HIV testing in the context of a population-based household survey conducted in two sub-districts of uMgungundlovu district, KwaZulu-Natal, South Africa, against reference fourth-generation HIV-1/2 antibody and p24 antigen combination immunoassays. We discuss implications of the findings on rapid HIV testing programmes. METHODS: Cross-sectional design: Following enrolment into the survey, questionnaires were administered to eligible and consenting participants in order to obtain demographic and HIV-related data. Peripheral blood samples were collected for HIV-related testing. Participants were offered community-based HIV testing in the home by trained field workers using a serial algorithm with two rapid diagnostic tests (RDTs) in series. In the laboratory, reference HIV testing was conducted using two fourth-generation immunoassays with all positives in the confirmatory test considered true positives. Accuracy, sensitivity, specificity, positive predictive value, negative predictive value and false-positive and false-negative rates were determined. RESULTS: Of 10,236 individuals enrolled in the survey, 3740 were tested in the home (median age 24 years (interquartile range 19-31 years), 42.1% males and HIV positivity on RDT algorithm 8.0%). From those tested, 3729 (99.7%) had a definitive RDT result as well as a laboratory immunoassay result. The overall accuracy of the RDT when compared to the fourth-generation immunoassays was 98.8% (95% confidence interval (CI) 98.5-99.2). The sensitivity, specificity, positive predictive value and negative predictive value were 91.1% (95% CI 87.5-93.7), 99.9% (95% CI 99.8-100), 99.3% (95% CI 97.4-99.8) and 99.1% (95% CI 98.8-99.4) respectively. The false-positive and false-negative rates were 0.06% (95% CI 0.01-0.24) and 8.9% (95% CI 6.3-12.53). Compared to true positives, false negatives were more likely to be recently infected on limited antigen avidity assay and to report antiretroviral therapy (ART) use. CONCLUSIONS: The overall accuracy of the RDT algorithm was high. However, there were few false positives, and the sensitivity was lower than expected with high false negatives, despite implementation of quality assurance measures. False negatives were associated with recent (early) infection and ART exposure. The RDT algorithm was able to correctly identify the majority of HIV infections in community-based HIV testing. Messaging on the potential for false positives and false negatives should be included in these programmes. |
Prevalence of gonorrhea and chlamydia testing by anatomical site among men who have sex with men in HIV medical care, United States, 2013-2014
Patel MR , Brooks JT , Tie Y , Garg S , Bradley H . Sex Transm Dis 2017 45 (1) 25-27 Fewer than one-third of men who have sex with men were tested for Neisseria gonorrhoeae or Chlamydia trachomatis as part of HIV medical care in the United States in 2013 to 2014, and only 11.6% were tested for either sexually transmitted disease at an extragenital site. |
Evaluation of Project RISE, an HIV prevention intervention for black bisexual men using an ecosystems approach
Lauby J , Milnamow M , Joseph HA , Hitchcock S , Carson L , Pan Y , Mendoza M , Millett G . AIDS Behav 2017 22 (1) 164-177 Black men who have sex with men and women (MSMW) are among the populations at highest risk for HIV infection. We describe the evaluation of Project RISE, a six-session individual-level intervention developed for black MSMW using an ecosystems approach. A randomized controlled trial was used to test the effect of the intervention on sexual risk outcomes. Eligibility criteria included having both male and female sex partners in the past 12 months. Complete data at 5-month follow-up were collected from 86.7% of the 165 participants. In analyses controlling for HIV status, age, and baseline risk, intervention participants were found to have significantly greater reductions in number of female partners (p < 0.05) and total male and female partners (p < 0.05) at follow-up, compared to the control group. Intervention participants also were significantly more likely to report a reduction in number of sex episodes without a condom with female partners (p < 0.05) and with all partners (p < 0.02) at follow-up, compared to the control group. |
High rates of loss to follow-up during the first year of pre-antiretroviral therapy for HIV patients at sites providing pre-ART care in Nigeria, 2004-2012
Agolory SG , Auld AF , Odafe S , Shiraishi RW , Dokubo EK , Swaminathan M , Dalhatu I , Onotu D , Abiri O , Debem H , Bashorun A , Ellerbrock TV . PLoS One 2017 12 (9) e0183823 BACKGROUND: With about 3.4 million HIV-infected persons, Nigeria has the second highest number of people living with HIV (PLHIV) in the world. However, antiretroviral treatment (ART) coverage in Nigeria remains low with only 748,846 (22%) of PLHIV on ART by the end of 2014. Retention of HIV-infected patients in pre-ART care is essential to ensure timely ART initiation. We assessed outcomes of patients enrolled in Nigeria's pre-ART program during 2004-2012. METHODS: We conducted a nationally representative retrospective cohort study among adults (≥15 years old), enrolling in pre-ART programs supported by the U.S. President's Emergency Plan for AIDS Relief in Nigeria. A total of 35 sites enrolling ≥50 patients in pre-ART were selected using probability proportional-to-size sampling; 2,415 eligible medical records at these sites were randomly selected for abstraction. Determinants of loss to follow-up (LTFU) and mortality during pre-ART care were estimated using Cox proportional hazards regression models. RESULTS: The median age at enrollment was 32 years (interquartile range (IQR) 27-40). A total of 1,216 (51.4%) initiated ART by the time of data abstraction. Among the remaining 1,199 patients, 898 (74.9%) had been LTFU, 180 (15.0%) were alive and in pre-ART care, 71 (5.9%) had died, 50 (4.2%) had transferred out or stopped care. Baseline markers of advanced disease, including weight <45 kg (adjusted hazard ration (AHR) = 4.23; 95% confidence interval (CI): 1.51-15.58) and more advanced WHO disease stage, were predictive of pre-ART mortality. Compared with patients aged 15-24, patients aged 35-44 (AHR = 0.67; 95% CI: 1.0.47-0.95) and age 45-54 (AHR = 0.66; 95% CI: 0.48-0.91) had lower LTFU rates. Compared with attending facilities in North Central geopolitical zone, attending facility locations in South East (AHR = 0.44; 95% CI: 0.24-0.83) was protective against LTFU. CONCLUSIONS: About half of patients enrolling in HIV program during 2004-2012 in Nigeria had not initiated ART by 2013. Key strategies to improve early ART initiation among pre-ART enrollees include implementation of the WHO test and treat guidelines, earlier HIV testing, and better monitoring to improve ART initiation rates. Further research to understand regional variations in pre-ART outcomes is warranted. |
Human immunodeficiency virus, chlamydia, and gonorrhea testing in New York Medicaid-enrolled adolescents
Wang LY , Chang MH , Burstein G , Hocevar Adkins S . Sex Transm Dis 2017 45 (1) 14-18 BACKGROUND: Although growing public health efforts have been expended on increasing adolescents' access to human immunodeficiency virus (HIV) and sexually transmitted infection (STI) testing, little is known about the current utilization of those services in clinical settings. METHODS: Using 2010 to 2012 New York State Center for Medicare and Medicaid Services Medicaid Analytic eXtract data, we estimated the annual percentage of 13- to 19-year-olds who were tested for HIV, chlamydia (CT), and gonorrhea (GC). A regression analysis was performed to identify factors independently associated with testing utilization. We further examined testing utilization in all adolescent females with 1 or more health care encounter, pregnant females, and adolescents at increased risk for HIV/STI. RESULTS: From 2010 to 2012, HIV, CT, and GC testing rates increased in the overall study population and in most demographic subgroups. Female adolescents, black and Hispanic adolescents, at-risk adolescents, and adolescents with 6 months or longer of enrollment were significantly more likely to be tested. Among adolescent females with 1 or more health care encounter, 19.2% were tested for CT and 16.9% tested for GC in 2012. Among pregnant females, 35.2%, 53.9%, and 46.1% were tested for HIV, CT, and GC, respectively. Among at-risk adolescents, 39.9%, 63.7%, and 54.4% were tested for HIV, CT, and GC, respectively. CONCLUSIONS: Although progress had been made by New York State providers to adhere to recommended testing for adolescents, there was a clear gap between the recommended level of testing and the actual level of utilization among sexually active females, pregnant females, and at-risk adolescents. Opportunities exist for community provider and public health collaboration to increase adolescent HIV and STI testing. |
Influenza
Uyeki TM . Ann Intern Med 2017 167 (5) Itc33-itc48 Influenza is an acute viral respiratory disease that affects persons of all ages and is associated with millions of medical visits, hundreds of thousands of hospitalizations, and thousands of deaths during annual winter epidemics of variable severity in the United States. Elderly persons have the highest influenza-associated hospitalization and mortality rates. The primary method of prevention is annual vaccination. Early antiviral treatment has the greatest clinical benefit; otherwise, management includes adherence to recommended infection prevention and control measures as well as supportive care of complications. |
Comparison of ICD-9 codes for depression and alcohol misuse to survey instruments suggests these codes should be used with caution
Boscarino JA , Moorman AC , Rupp LB , Zhou Y , Lu M , Teshale EH , Gordon SC , Spradling PR , Schmidt MA , Trinacty CM , Zhong Y , Holmberg SD , Holtzman D . Dig Dis Sci 2017 62 (10) 2704-2712 BACKGROUND: Research suggests depression and alcohol misuse are highly prevalent among chronic hepatitis C (CHC) patients, which is of clinical concern. AIMS: To compare ICD-9 codes for depression and alcohol misuse to validated survey instruments. METHODS: Among CHC patients, we assessed how well electronic ICD-9 codes for depression and alcohol misuse predicted these disorders using validated instruments. RESULTS: Of 4874 patients surveyed, 56% were male and 52% had a history of injection drug use. Based on the PHQ-8, the prevalence of depression was 30% compared to 14% based on ICD-9 codes within 12 months of survey, 37% from ICD-9 codes any time before or within 12 months after survey, and 48% from ICD-9 codes any time before or within 24 months after survey. ICD-9 codes predicting PHQ-8 depression had a sensitivity ranging from 59 to 88% and a specificity ranging from 33 to 65%. Based on the AUDIT-C, the prevalence of alcohol misuse was 21% compared to 3-23% using ICD-9 codes. The sensitivity of ICD-9 codes to predict AUDIT-C score ranged from 9 to 35% and specificity from 80 to 98%. Overall 39% of patients reported ever binge drinking, with a sensitivity of ICD-9 to predict binge drinking ranging from 7 to 33% and a specificity from 84 to 98%. More than half of patients had either an ICD-9 code for depression, a survey score indicating depression, or both (59%); more than one-third had the same patterns for alcohol misuse (36%). CONCLUSIONS: ICD-9 codes were limited in predicting current depression and alcohol misuse, suggesting that caution should be exercised when using ICD-9 codes to assess depression or alcohol misuse among CHC patients. |
Cryptococcal antigen screening by lay cadres using a rapid test at the point of care: A feasibility study in rural Lesotho
Rick F , Niyibizi AA , Shroufi A , Onami K , Steele SJ , Kuleile M , Muleya I , Chiller T , Walker T , Van Cutsem G . PLoS One 2017 12 (9) e0183656 INTRODUCTION: Cryptococcal meningitis is one of the leading causes of death among people with HIV in Africa, primarily due to delayed presentation, poor availability and high cost of treatment. Routine cryptococcal antigen (CrAg) screening of patients with a CD4 count less than 100 cells/mm3, followed by pre-emptive therapy if positive, might reduce mortality in high prevalence settings. Using the cryptococcal antigen (CrAg) lateral flow assay (LFA), screening is possible at the point of care (POC). However, critical shortages of health staff may limit adoption. This study investigates the feasibility of lay counsellors conducting CrAg LFA screening in rural primary care clinics in Lesotho. METHODS: From May 2014 to June 2015, individuals who tested positive for HIV were tested for CD4 count and those with CD4 <100 cells/mm3 were screened with CrAg LFA. All tests were performed by lay counsellors. CrAg-positive asymptomatic patients received fluconazole, while symptomatic patients were referred to hospital. Lay counsellors were trained and supervised by a laboratory technician and counsellor activity supervisor. Additionally, nurses and doctors were trained on CrAg screening and appropriate treatment. RESULTS: During the study period, 1,388 people were newly diagnosed with HIV, of whom 129 (9%) presented with a CD4 count <100 cells/mm3. Of these, 128 (99%) were screened with CrAg LFA and 14/128 (11%) tested positive. Twelve of the 14 (86%) were asymptomatic, and received outpatient fluconazole. All commenced ART with a median time to initiation of 15.5 days [IQR: 14-22]. Of the asymptomatic patients, nine (75%) remained asymptomatic after a median time of 5 months [IQR; 3-6] of follow up. One (8%) became co-infected with tuberculosis and died and two were transferred out. The two patients with symptomatic cryptococcal meningitis (CM) were referred to hospital, where they later died. CONCLUSIONS: CrAg LFA screening by lay counsellors followed by pre-emptive fluconazole treatment for asymptomatic cases, or referral to hospital for symptomatic cases, proved feasible. However, regular follow-up to ensure proper management of cryptococcal disease was needed. These early results support the wider use of CrAg LFA screening in remote primary care settings where upper cadres of healthcare staff may be in short supply. |
Response: The geographic distribution of Ixodes scapularis (Acari: Ixodidae) revisited: The importance of assumptions about error balance
Hahn MB , Jarnevich CS , Monaghan AJ , Eisen RJ . J Med Entomol 2017 54 (5) 1104-1106 The black-legged tick, Ixodes scapularis Say, is the primary vector in the eastern United States of the Lyme disease spirochetes Borrelia burgdorferi sensu stricto and B. mayonii, as well as Anaplasma phagocytophilum (anaplasmosis), Ehrlichia muris-like agent (ehrlichiosis), Babesia microti (babesiosis), and Powassan encephalitis virus (Goodman et al. 2005; Pritt et al. 2011, 2016). The documented distribution of this medically important tick has expanded substantially over the past two decades, paralleling the increase in the number and geographic distribution of reported human Lyme disease cases in the United States (Kugeler et al. 2015, Mead 2015, Eisen et al. 2016). Although these findings highlight the need for continued vector surveillance, resources for such work are often very limited. | Habitat suitability models can be useful for identifying areas of potential future expansion and thus aid in targeting limited public health resources. To better define the leading edge of the tick’s ongoing geographic expansion, recently we published a distribution map that identified counties that were classified as suitable by at least two statistical models, but where I. scapularis has not yet been documented to be established (Hahn et al. 2016). Peterson and Raghavan (2017) critiqued the distribution based on the cut-point used to dichotomize a continuous probability into a binary suitability surface. The authors used a simplified version of the Hahn et al. (2016) model to demonstrate a well-known outcome that arises when continuous probabilities are dichotomized into a binary response (Fielding and Bell 1997). That is, when the probability threshold is reduced, a broader geographic area is classified as suitable and model sensitivity increases. Indeed, when Peterson and Raghavan (2017) increased sensitivity from 78% (Hahn et al. 2016) to 99% (1% omission threshold), the predicted distribution of suitable I. scapularis habitat increased significantly; most areas east of 98.4° W longitude were considered suitable for I. scapularis (Peterson and Raghavan 2017). Ixodes scapularis, a primarily woodland-associated tick, is remarkably well-suited to survive a broad range of climatic conditions (Eisen et al. 2015, 2016), and it is likely that if introduced, could survive at low abundance in most of the eastern United States. However, the distribution map presented by Peterson and Raghavan (2017) provides little guidance on which counties are most likely to be suitable for I. scapularis to establish. |
Transmission of the Lyme disease spirochete Borrelia mayonii in relation to duration of attachment by nymphal Ixodes scapularis (Acari: Ixodidae)
Dolan MC , Breuner NE , Hojgaard A , Boegler KA , Hoxmeier JC , Replogle AJ , Eisen L . J Med Entomol 2017 54 (5) 1360-1364 The recently recognized Lyme disease spirochete, Borrelia mayonii, has been detected in host-seeking Ixodes scapularis Say ticks and is associated with human disease in the Upper Midwest. Although experimentally shown to be vector competent, studies have been lacking to determine the duration of time from attachment of a single B. mayonii-infected I. scapularis nymph to transmission of spirochetes to a host. If B. mayonii spirochetes were found to be transmitted within the first 24 h after tick attachment, in contrast to Borrelia burgdorferi spirochetes (>24 h), then current recommendations for tick checks and prompt tick removal as a way to prevent transmission of Lyme disease spirochetes would need to be amended. We therefore conducted a study to determine the probability of transmission of B. mayonii spirochetes from single infected nymphal I. scapularis ticks to susceptible experimental mouse hosts at three time points postattachment (24, 48, and 72 h) and for a complete feed (>72-96 h). No evidence of infection with or exposure to B. mayonii occurred in mice that were fed upon by a single infected nymph for 24 or 48 h. The probability of transmission by a single infected nymphal tick was 31% after 72 h of attachment and 57% for a complete feed. In addition, due to unintended simultaneous feeding upon some mice by two B. mayonii-infected nymphs, we recorded a single occasion in which feeding for 48 h by two infected nymphs resulted in transmission and viable infection in the mouse. We conclude that the duration of attachment of a single infected nymphal I. scapularis tick required for transmission of B. mayonii appears to be similar to that for B. burgdorferi: transmission is minimal for the first 24 h of attachment, rare up to 48 h, but then increases distinctly by 72 h postattachment. |
Updated reported distribution of Aedes (Stegomyia) aegypti and Aedes (Stegomyia) albopictus (Diptera: Culicidae) in the United States, 1995-2016
Hahn MB , Eisen L , McAllister J , Savage HM , Mutebi JP , Eisen RJ . J Med Entomol 2017 54 (5) 1420-1424 Aedes (Stegomyia) aegypti (L.) and Aedes (Stegomyia) albopictus (Skuse) are potential vectors of Zika, dengue, and chikungunya viruses in the United States. A Zika virus outbreak in Florida in the summer of 2016, driven by Ae. aegypti and resulting in > 200 locally acquired cases of human illness, underscored the need for up-to-date information on the geographic distribution of Ae. aegypti and Ae. albopictus in the United States. In early 2016, we conducted a survey and literature review to compile county records for presence of Ae. aegypti and Ae. albopictus in the United States from 1995 to 2016. Surveillance for these vectors was intensified across the United States during the summer and fall of 2016. At the end of 2016, we therefore conducted a follow-up survey of mosquito control agencies, university researchers, and state and local health departments to document new collection records for Ae. aegypti and Ae. albopictus. The repeated survey at the end of the year added Ae. aegypti collection records from 38 new counties and Ae. albopictus collection records from 127 new counties, representing a 21 and 10 percent increase, respectively, in the number of counties with reported presence of these mosquitoes compared with the previous report. Moreover, through our updated survey, 40 and 183 counties, respectively, added additional years of collection records for Ae. aegypti and Ae. albopictus from 1995 to 2016. Our findings underscore the continued need for systematic surveillance of Ae. aegypti and Ae. albopictus. |
Immunization of mice with Borrelia burgdorferi lp54 gene encoded recombinant proteins does not provide protection against tick transmitted infectious challenge
Brandt KS , Gilmore RD . Vaccine 2017 35 (40) 5310-5313 The Borrelia burgdorferi outer surface membrane proteins BBA65, BBA66, BBA69, BBA70, and BBA73 were tested for their ability to confer protection against B. burgdorferi infection challenge. Mice were immunized with recombinant forms of the proteins singly or in combinations. Following initial protein inoculation and booster injections, seroconversion was confirmed prior to B. burgdorferi challenge by tick bite. Despite mice having high antibody titers for each antigen, no significant protections against the challenge infections were observed. These results demonstrate that these recombinant proteins were not protective and reflects the challenges confronted to identify effective novel vaccine candidates for Lyme disease. |
Arboviruses isolated from mosquitoes collected in Uganda, 2008-2012
Mossel EC , Crabtree MB , Mutebi JP , Lutwama JJ , Borland EM , Powers AM , Miller BR . J Med Entomol 2017 54 (5) 1403-1409 A large number of arthropod-borne viruses are endemic to East Africa. As a part of the process of undertaking a systematic characterization of the mosquito fauna of Uganda, we examined mosquitoes collected from 2008 through early 2012 for known and novel viruses. In all, 8,288 mosquito pools containing 157,554 mosquitoes were tested. Twenty-nine isolations of 11 different viruses were made from mosquitoes of nine distinct species and from pools identified only to genus Culex. Identified viruses were from family Togaviridae, alphaviruses Sindbis and Babanki viruses; family Rhabdoviridae, hapaviruses Mossuril and Kamese viruses; family Flaviviridae, flaviviruses West Nile and Usutu viruses; family Phenuiviridae, phlebovirus Arumowot virus; and family Peribunyaviridae, orthobunyaviruses Witwatersrand, Pongola, and Germiston viruses. In addition, a novel orthobunyavirus, provisionally named Mburo virus, was isolated from Coquillettidia metallica (Theobald). This is the first report of Babanki, Arumowot, and Mossuril virus isolation from Uganda. |
Cryptosporidium infecting wild cricetid rodents from the subfamilies Arvicolinae and Neotominae
Stenger BLS , Horcickova M , Clark ME , Kvac M , Condlova S , Khan E , Widmer G , Xiao L , Giddings CW , Pennil C , Stanko M , Sak B , McEvoy JM . Parasitology 2017 145 (3) 1-9 We undertook a study on Cryptosporidium spp. in wild cricetid rodents. Fecal samples were collected from meadow voles (Microtus pennsylvanicus), southern red-backed voles (Myodes gapperi), woodland voles (Microtus pinetorum), muskrats (Ondatra zibethicus) and Peromyscus spp. mice in North America, and from bank voles (Myodes glareolus) and common voles (Microtus arvalis) in Europe. Isolates were characterized by sequence and phylogenetic analyses of the small subunit ribosomal RNA (SSU) and actin genes. Overall, 33.2% (362/1089) of cricetids tested positive for Cryptosporidium, with a greater prevalence in cricetids from North America (50.7%; 302/596) than Europe (12.1%; 60/493). Principal Coordinate analysis separated SSU sequences into three major groups (G1-G3), each represented by sequences from North American and European cricetids. A maximum likelihood tree of SSU sequences had low bootstrap support and showed G1 to be more heterogeneous than G2 or G3. Actin and concatenated actin-SSU trees, which were better resolved and had higher bootstrap support than the SSU phylogeny, showed that closely related cricetid hosts in Europe and North America are infected with closely related Cryptosporidium genotypes. Cricetids were not major reservoirs of human pathogenic Cryptosporidium spp. |
Chemical-induced asthma and the role of clinical, toxicological, exposure and epidemiological research in regulatory and hazard characterization approaches
Vincent MJ , Bernstein JA , Basketter D , LaKind JS , Dotson GS , Maier A . Regul Toxicol Pharmacol 2017 90 126-132 Uncertainties in understanding all potential modes-of-action for asthma induction and elicitation hinders design of hazard characterization and risk assessment methods that adequately screen and protect against hazardous chemical exposures. To address this challenge and identify current research needs, the University of Cincinnati and the American Cleaning Institute hosted a webinar series to discuss the current state-of-science regarding chemical-induced asthma. The general consensus is that the available database, comprised of data collected from routine clinical and validated toxicological tests, is inadequate for predicting or determining causal relationships between exposures and asthma induction for most allergens. More research is needed to understand the mechanism of asthma induction and elicitation in the context of specific chemical exposures and exposure patterns, and the impact of population variability and patient phenotypes. Validated tools to predict respiratory sensitization and to translate irritancy assays to asthma potency are needed, in addition to diagnostic biomarkers that assess and differentiate allergy versus irritant-based asthmatic responses. Diagnostic methods that encompass the diverse etiologies of asthmatic responses and incorporate robust exposure measurements capable of capturing different temporal patterns of complex chemical mixtures are needed. In the absence of ideal tools, risk assessors apply hazard-based safety assessment methods, in conjunction with active risk management, to limit potential asthma concerns, proactively identify new concerns, and ensure deployment of approaches to mitigate asthma-related risks. |
Comparison of wildfire smoke estimation methods and associations with cardiopulmonary-related hospital admissions
Gan RW , Ford B , Lassman W , Pfister G , Vaidyanathan A , Fischer E , Volckens J , Pierce JR , Magzamen S . Geohealth 2017 1 (3) 122-136 Climate forecasts predict an increase in frequency and intensity of wildfires. Associations between health outcomes and population exposure to smoke from Washington 2012 wildfires were compared using surface monitors, chemical-weather models, and a novel method blending three exposure information sources. The association between smoke particulate matter ≤2.5 mum in diameter (PM2.5) and cardiopulmonary hospital admissions occurring in Washington from 1 July to 31 October 2012 was evaluated using a time-stratified case-crossover design. Hospital admissions aggregated by ZIP code were linked with population-weighted daily average concentrations of smoke PM2.5 estimated using three distinct methods: a simulation with the Weather Research and Forecasting with Chemistry (WRF-Chem) model, a kriged interpolation of PM2.5 measurements from surface monitors, and a geographically weighted ridge regression (GWR) that blended inputs from WRF-Chem, satellite observations of aerosol optical depth, and kriged PM2.5. A 10 mug/m3 increase in GWR smoke PM2.5 was associated with an 8% increased risk in asthma-related hospital admissions (odds ratio (OR): 1.076, 95% confidence interval (CI): 1.019-1.136); other smoke estimation methods yielded similar results. However, point estimates for chronic obstructive pulmonary disease (COPD) differed by smoke PM2.5 exposure method: a 10 mug/m3 increase using GWR was significantly associated with increased risk of COPD (OR: 1.084, 95%CI: 1.026-1.145) and not significant using WRF-Chem (OR: 0.986, 95%CI: 0.931-1.045). The magnitude (OR) and uncertainty (95%CI) of associations between smoke PM2.5 and hospital admissions were dependent on estimation method used and outcome evaluated. Choice of smoke exposure estimation method used can impact the overall conclusion of the study. |
Identification and quantification of carbonyl-containing alpha-pinene ozonolysis products using O-tert-butylhydroxylamine hydrochloride
Jackson SR , Ham JE , Harrison JC , Wells JR . J Atmos Chem 2016 2016 (3) 1-14 The yields of carbonyl-containing reaction products from the ozonolysis of alpha-pinene have been investigated using concentrations of ozone found in the indoor environment ([O3] ≤ 100 ppb). An impinger was used to collect gas-phase oxidation products in water, where the derivatization agent O-tert-butylhydroxylamine hydrochloride (TBOX) and gas chromatography-mass spectrometry were used to identify carbonyl-containing species. Seven carbonyl-containing products were observed. The yield of the primary product, pinonaldehyde was measured to be 76 %. Using cyclohexane as a hydroxyl radical (OH) scavenger, the yield of pinonaldehyde decreased to 46 %, indicating the influence secondary OH radicals have on alpha-pinene ozonolysis products. Furthermore, the use of TBOX, a small molecular weight derivatization agent, allowed for the acquisition of the first mass spectral data of oxopinonaldehyde, a tricarbonyl reaction product of alpha-pinene ozonolysis. The techniques described herein allow for an effective method for the collection and identification of terpene oxidation products in the indoor environment. |
The WHO global reference list of 100 core health indicators: The example of Sierra Leone
Kaiser R , Johnson N , Jalloh MF , Dafae F , Redd JT , Hersey S , Jambai A . Pan Afr Med J 2017 27 (246) The global reference list of 100 core health indicators is a standard set of indicators published by the World Health Organization in 2015. We reviewed core health indicators in the public domain and in-country for Sierra Leone, the African continent and globally. Review objectives included assessing available sources, accessibility and feasibility of obtaining data and informing efforts to monitor program progress. Our search strategy was guided by feasibility considerations targeting mainly national household surveys in Sierra Leone and topic-specific and health statistics reports published annually by WHO. We also included national, regional and worldwide health indicator estimates published with open access in the literature and compared them with cumulative annual indicators from the weekly national epidemiological bulletin distributed by the Sierra Leone Ministry of Health and Sanitation. We obtained 70 indicators for Sierra Leone from Internet sources and 2 (maternal mortality and malaria incidence) from the national bulletin. Of the 70 indicators, 14 (20%) were modified versions of WHO indicators and provided uncertainty intervals. Maternal mortality showed considerable differences between 2 international sources for 2015 and the most recent national bulletin. We were able to obtain the majority of core indicators for Sierra Leone. Some indicators were similar but not identical, uncertainty intervals were limited and estimates differed for the same year between sources. Current efforts to improve health and mortality surveillance in Sierra Leone will improve availability and quality of reporting in the future. A centralized core indicator reporting website should be considered. |
Notes from the Field: Clostridium perfringens outbreak at a catered lunch - Connecticut, September 2016
Leung VH , Phan Q , Costa CE , Nishimura C , Pung K , Horn L , Sosa L . MMWR Morb Mortal Wkly Rep 2017 66 (35) 940-941 In September 2016, the Connecticut Department of Public Health was notified of a cluster of gastrointestinal illnesses among persons who shared a catered lunch. The Connecticut Department of Public Health worked with the local health department to investigate the outbreak and recommend control measures. Information about symptoms and foods eaten was gathered using an online survey. A case was defined as the onset of abdominal pain or diarrhea in a lunch attendee <24 hours after the lunch. Risk ratios (RRs), 95% confidence intervals (CIs), and Fisher’s exact p-values were calculated for all food and beverages consumed. Associations of food exposures with illness were considered statistically significant at p<0.05. | Among approximately 50 attendees, 30 (60%) completed the survey; 19 (63%) respondents met the case definition. The majority of commonly reported symptoms included diarrhea (17 of 18), abdominal pain (15 of 16), and headache (7 of 15). The median interval from lunch to illness onset was 5.3 hours (range = 0.4–15.5 hours) for any symptom and 7 hours (range = 2.5–13 hours) for diarrhea. Analysis of food exposures reported by 16 ill and 10 well respondents (four respondents did not provide food exposure information) found illness to be associated with the beef dish (RR = undefined; CI = 1.06–∞; p = 0.046) (Table). All 16 ill respondents reported eating the beef. Coffee was also associated with illness; however, all 13 coffee drinkers who became ill also ate the beef. Eating cake approached significance (p = 0.051); all 10 cake eaters who became ill also ate the beef. |
High-Quality Draft Genome Sequences for Four Drug-Resistant or Outbreak-Associated Shigella sonnei Strains Generated with PacBio Sequencing and Whole-Genome Maps.
Lindsey RL , Batra D , Rowe L , Loparev V N , Juieng P , Garcia-Toledo L , Bicknese A , Stripling D , Martin H , Chen J , Strockbine N , Trees E . Genome Announc 2017 5 (35) Drug-resistant Shigella sonnei poses a clinical and public health challenge. We report here the high-quality draft whole-genome sequences of four outbreak-associated S. sonnei isolates; three were resistant to two or more antibiotics, and one was resistant to streptomycin only. |
Complete Genome Sequence of Vibrio sp. Strain 2521-89, a Close Relative of Vibrio cholerae Isolated from Lake Water in New Mexico, USA.
Liang K , Orata FD , Winkjer NS , Rowe LA , Tarr CL , Boucher Y . Genome Announc 2017 5 (35) Vibrio sp. strain 2521-89 is an environmental isolate from lake water in New Mexico, USA. Average nucleotide identity, in silico DNA-DNA hybridization, and core genome single-nucleotide polymorphism (SNP)-based phylogenetic analysis suggest that this may be a potentially novel species that is closely related to Vibrio cholerae. |
Health-related behaviors and academic achievement among high school students - United States, 2015
Rasberry CN , Tiu GF , Kann L , McManus T , Michael SL , Merlo CL , Lee SM , Bohm MK , Annor F , Ethier KA . MMWR Morb Mortal Wkly Rep 2017 66 (35) 921-927 Studies have shown links between educational outcomes such as letter grades, test scores, or other measures of academic achievement, and health-related behaviors. However, as reported in a 2013 systematic review, many of these studies have used samples that are not nationally representative, and quite a few studies are now at least 2 decades old (1). To update the relevant data, CDC analyzed results from the 2015 national Youth Risk Behavior Survey (YRBS), a biennial, cross-sectional, school-based survey measuring health-related behaviors among U.S. students in grades 9-12. Analyses assessed relationships between academic achievement (i.e., self-reported letter grades in school) and 30 health-related behaviors (categorized as dietary behaviors, physical activity, sedentary behaviors, substance use, sexual risk behaviors, violence-related behaviors, and suicide-related behaviors) that contribute to leading causes of morbidity and mortality among adolescents in the United States (5). Logistic regression models controlling for sex, race/ethnicity, and grade in school found that students who earned mostly A's, mostly B's, or mostly C's had statistically significantly higher prevalence estimates for most protective health-related behaviors and significantly lower prevalence estimates for most health-related risk behaviors than did students with mostly D's/F's. These findings highlight the link between health-related behaviors and education outcomes, suggesting that education and public health professionals can find their respective education and health improvement goals to be mutually beneficial. Education and public health professionals might benefit from collaborating to achieve both improved education and health outcomes for youths. |
Translating economic evidence for public health: Knowledge brokers and the interactive systems framework
Puddy RW , Hall DM . Am J Prev Med 2017 53 (5) e185-e189 The May 2016 special issue of the American Journal of Preventive Medicine on using economics to inform U.S. public health policy highlighted several ways that economics has been used in public health and suggested additional opportunities to accelerate public health impact.1 This special issue was a first of its kind, and was much needed, long overdue, and highlighted the contributions of economics in informing public health policy. Furthering this work requires sustained momentum and a broader application of economics to U.S. public health decision making. Even though high-quality economic evidence exists, there is limited knowledge on how best to ensure its use in public health decision making. This paper discusses this all too familiar application gap and outlines a proposed integrated approach (knowledge brokers in the Interactive Systems Framework) for increasing the uptake of economic evidence to inform public health decision making. Here economic evidence is defined broadly and means any kind of cost information that is relevant and of interest to decision makers. |
Strengthening infection prevention and control and systematic surveillance of healthcare associated infections in India
Swaminathan S , Prasad J , Dhariwal AC , Guleria R , Misra MC , Malhotra R , Mathur P , Walia K , Gupta S , Sharma A , Ohri V , Jain S , Gupta N , Laserson K , Malpiedi P , Velayudhan A , Park B , Srikantiah P . BMJ 2017 358 j3768 Establishing and expanding government led networks to strengthen infection prevention and control and healthcare associated infection surveillance are essential to effectively tackle antimicrobial resistance. Soumya Swaminathan and colleagues discuss the progress in India |
Text4baby influenza messaging and influenza vaccination among pregnant women
Bushar JA , Kendrick JS , Ding H , Black CL , Greby SM . Am J Prev Med 2017 53 (6) 845-853 INTRODUCTION: Pregnant women are at risk for severe influenza-related complications; however, only 52% reported receiving an influenza vaccination during the 2013-2014 influenza season. Text4baby, a free national text service, provides influenza vaccination education and reminders to pregnant women. This study examined reported influenza vaccination during pregnancy among Text4baby participants who reported receiving influenza messages and women who reported never participating in Text4baby. METHODS: Opt-in Internet Panel Surveys (April 2013 and 2014) of pregnant women collected demographic and other characteristics; influenza vaccination knowledge, attitudes, and behaviors; and Text4baby participation. Women aged 18-49 years, pregnant anytime from October to January (N=3,321) were included. Text4baby influenza message recallers reported receiving Text4baby influenza messages during their current/most recent pregnancy (n=377). Text4baby non-participants reported never receiving Text4baby messages (n=2,824). Multivariable logistic regression was performed (2014-2016) controlling for demographic and other characteristics, high-risk conditions, and provider recommendation and offer to vaccinate. Adjusted prevalence ratios (APRs) were calculated. Random sampling was assumed for this non-probability sample. RESULTS: Text4baby recallers were more likely than non-participants to report influenza vaccination regardless of receipt of provider recommendation and/or offer to vaccinate (provider recommendation/offer APR=1.29, 95% CI=1.21, 1.37, provider recommendation/no offer APR=1.52, 95% CI=1.07, 2.17). Among women receiving neither a provider recommendation nor offer to vaccinate, Text4baby recallers were more than three times as likely to report influenza vaccination compared with non-participants (APR=3.39, 95% CI=2.03, 5.67). CONCLUSIONS: Text4baby status was associated with higher influenza vaccination, especially among women whose provider did not recommend or offer the vaccine. Encouraging Text4baby enrollment may help ensure influenza vaccination is given to protect mothers and infants. |
Letter in response to commentary by Small and Cronin
Grohskopf L , Foppa I , Flannery B , Fry A . Vaccine 2017 35 (39) 5225 The commentary by Small and Cronin [1] on the Advisory Committee on Immunization Practices (ACIP) recommendation that live attenuated influenza vaccine (LAIV) not be used during the 2016–17 influenza season [2] contains misconceptions concerning the basis of the ACIP recommendation and aspects of the test negative case-control (TNCC) design. Contrary to the statement that the recommendation was based upon CDC data that showed no protection against H1N1 viruses during the last influenza season (2015–16), the decision was reached following consideration of data for children aged 2 through 17 years from three U.S. studies (from CDC, the U.S. Department of Defense, and MedImmune) over three consecutive seasons [3]. These studies noted lack of significant effectiveness against H1N1pdm09 during the 2013–14 and 2015–16 seasons; during the latter season, despite replacement of the LAIV H1N1 vaccine virus to address the putative cause. During 2013–14 and 2015–16, inactivated influenza vaccines (IIVs) were significantly effective, with a higher point estimate than that for LAIV. Additional analysis of CDC data from the 2010–11 season revealed similarly low effectiveness of LAIV against H1N1pdm09 relative to IIV [4]. The authors note that previous “extensive studies demonstrate superior efficacy of LAIV in young children for both homologous and drifted viruses.” However, these studies were conducted prior to the 2009 pandemic, and the emergence of H1N1pdm09. Moreover, during the 2014–15 season, LAIV performed no better than IIVs against the predominant antigeni-cally-drifted H3N2 viruses, contrasting with observations from pre-pandemic trials [5]. |
Naturally acquired immunity against rotavirus infection and gastroenteritis in children: Paired reanalyses of birth cohort studies
Lewnard JA , Lopman BA , Parashar UD , Bar-Zeev N , Samuel P , Guerrero ML , Ruiz-Palacios GM , Kang G , Pitzer VE . J Infect Dis 2017 216 (3) 317-326 Background: Observational studies in socioeconomically distinct populations have yielded conflicting conclusions about the strength of naturally acquired immunity against rotavirus gastroenteritis (RVGE), mirroring vaccine underperformance in low-income countries. We revisited birth cohort studies to understand naturally acquired protection against rotavirus infection and RVGE. Methods: We reanalyzed data from 200 Mexican and 373 Indian children followed from birth to 2 and 3 years of age, respectively. We reassessed protection against RVGE, decomposing the incidence rate into the rate of rotavirus infection and the risk of RVGE given infection, and tested for serum antibody correlates of protection using regression models. Results: Risk for primary, secondary, and subsequent infections to cause RVGE decreased per log-month of age by 28% (95% confidence interval [CI], 12%-41%), 69% (95% CI, 30%-86%), and 64% (95% CI, -186% to 95%), respectively, in Mexico City, and by 10% (95% CI, -1% to 19%), 51% (95% CI, 41%-59%) and 67% (95% CI, 57%-75%), respectively, in Vellore. Elevated serum immunoglobulin A and immunoglobulin G titers were associated with partial protection against rotavirus infection. Associations between older age and reduced risk for RVGE or moderate-to-severe RVGE given infection persisted after controlling for antibody levels. Conclusions: Dissimilar estimates of protection against RVGE may be due in part to age-related, antibody-independent risk for rotavirus infections to cause RVGE. |
Overseas hepatitis B vaccinations among newly arrived Cubans in Texas-2010-2015
Lee D , Montour J , Fulton AC , Benoit SR , Nelson NP , Liu Y . J Immigr Minor Health 2017 20 (3) 755-758 We assessed hepatitis B virus (HBV) serologic results among newly arrived Cubans with vaccination documentation. We matched the post-arrival health assessment HBV serologic results of Cubans who arrived during 2010-2015 in Texas with their overseas hepatitis B (HepB) vaccination records in the CDC's Electronic Disease Notification database and calculated the proportion of those immune due to HepB vaccinations. Among 2123 who had overseas HepB vaccination and serologic results, 1072 (50.5%) had three valid documented doses of HepB. Of these 1072, 441 (41.1%) were immune due to HepB vaccination, 24 (2.2%), immune due to natural infection, 599 (55.9%), susceptible to HBV, and 8 (0.7%), HBV infected. Stratified by age, 21 (87.5%) of 24 children <5 years of age showed protection, and the antibody to HepB surface antigen (anti-HBs) decreased as age increased. Our findings concurred with previous observations that anti-HBs serologic results wane over time. Many newly arrived Cubans with complete HepB vaccination records on the U.S. Department of State overseas vaccination forms might be immune despite <10 mIU/mL anti-HBs response levels. |
Pneumococcal conjugate vaccines and hospitalization of children for pneumonia: a time-series analysis, South Africa, 2006-2014
Izu A , Solomon F , Nzenze SA , Mudau A , Zell E , O'Brien KL , Whitney CG , Verani J , Groome M , Madhi SA . Bull World Health Organ 2017 95 (9) 618-628 OBJECTIVE: To assess the impact of immunization with pneumococcal conjugate vaccines on all-cause pneumonia hospitalizations among children in Soweto, South Africa. METHODS: We used data collected at the Chris Hani Baragwanath Hospital in Soweto between 2006 and 2014 - i.e. before and after April 2009, when a pneumococcal conjugate vaccine was first included in South Africa's routine immunization programme. Using a Bayesian generalized seasonal autoregressive moving-average model and the data collected in 2006-2008, we estimated the numbers of children that would have been hospitalized for pneumonia between 2010 and 2014 if no pneumococcal conjugate vaccines had been used. These estimates were then compared with the corresponding numbers of hospitalizations observed. FINDINGS: Between 2006 and 2014, 26 778 children younger than five years - including 3388 known to be infected with human immunodeficiency virus (HIV) - were admitted to the study hospital for pneumonia. We estimated that, for the children known to be infected with HIV and for the other children, pneumococcal conjugate vaccines reduced the numbers of hospitalizations for pneumonia in 2014 by 33% (50% credible interval, CrI: 6 to 52) and 39% (50% CrI: 24 to 50), respectively. In the study hospital in 2012-2014, as a result of immunizations with these vaccines, there were an estimated 3100 fewer pneumonia hospitalizations of children younger than five years. CONCLUSION: In our study hospital, following the introduction of pneumococcal conjugate vaccines into the national immunization programme, there were significant reductions in pneumonia hospitalizations among children. |
The effect of probiotics and zinc supplementation on the immune response to oral rotavirus vaccine: A randomized, factorial design, placebo-controlled study among Indian infants
Lazarus RP , John J , Shanmugasundaram E , Rajan AK , Thiagarajan S , Giri S , Babji S , Sarkar R , Kaliappan PS , Venugopal S , Praharaj I , Raman U , Paranjpe M , Grassly NC , Parker EPK , Parashar UD , Tate JE , Fleming JA , Steele AD , Muliyil J , Abraham AM , Kang G . Vaccine 2017 36 (2) 273-279 BACKGROUND: Strategies are needed to improve oral rotavirus vaccine (RV), which provides suboptimal protection in developing countries. Probiotics and zinc supplementation could improve RV immunogenicity by altering the intestinal microbiota and immune function. METHODS: Infants 5weeks old living in urban Vellore, India were enrolled in a randomized, double-blind, placebo-controlled trial with a 4-arm factorial design to assess the effects of daily zinc (5mg), probiotic (1010Lactobacillus rhamnosus GG) or placebo on the immunogenicity of two doses of RV (Rotarix(R), GlaxoSmithKline Biologicals) given at 6 and 10weeks of age. Infants were eligible for participation if healthy, available for the study duration and without prior receipt of RV or oral poliovirus vaccine other than the birth dose. The primary outcome was seroconversion to rotavirus at 14weeks of age based on detection of VP6-specific IgA at ≥20U/ml in previously seronegative infants or a fourfold rise in concentration. RESULTS: The study took place during July 2012 to February 2013. 620 infants were randomized equally between study arms and 551 (88.9%) completed per protocol. Seroconversion was recorded in 54/137 (39.4%), 42/136 (30.9%), 40/143 (28.0%), and 37/135 (27.4%) infants receiving (1) probiotic and zinc, (2) probiotic and placebo, (3) placebo and zinc, (4) two placebos. Seroconversion showed a modest improvement among infants receiving probiotic (difference between groups 1, 2 and 3, 4 was 7.5% (97.5% Confidence Interval (CI): -1.4%, 16.2%), p=0.066) but not zinc (difference between groups 1, 3 and 2, 4 was 4.4% (97.5% CI: -4.4%, 13.2%), p=0.272). 16 serious adverse events were recorded, none related to study interventions. CONCLUSIONS: Zinc or probiotic supplementation did not significantly improve the low immunogenicity of rotavirus vaccine given to infants in a poor urban community in India. A modest effect of combined supplementation deserves further investigation. TRIAL REGISTRATION: The trial was registered in India (CTRI/2012/05/002677). |
Effectiveness of a third dose of MMR vaccine for mumps outbreak control
Cardemil CV , Dahl RM , James L , Wannemuehler K , Gary HE , Shah M , Marin M , Riley J , Feikin DR , Patel M , Quinlisk P . N Engl J Med 2017 377 (10) 947-956 BACKGROUND: The effect of a third dose of the measles-mumps-rubella (MMR) vaccine in stemming a mumps outbreak is unknown. During an outbreak among vaccinated students at the University of Iowa, health officials implemented a widespread MMR vaccine campaign. We evaluated the effectiveness of a third dose for outbreak control and assessed for waning immunity. METHODS: Of 20,496 university students who were enrolled during the 2015-2016 academic year, mumps was diagnosed in 259 students. We used Fisher's exact test to compare unadjusted attack rates according to dose status and years since receipt of the second MMR vaccine dose. We used multivariable time-dependent Cox regression models to evaluate vaccine effectiveness, according to dose status (three vs. two doses and two vs. no doses) after adjustment for the number of years since the second dose. RESULTS: Before the outbreak, 98.1% of the students had received at least two doses of MMR vaccine. During the outbreak, 4783 received a third dose. The attack rate was lower among the students who had received three doses than among those who had received two doses (6.7 vs. 14.5 cases per 1000 population, P<0.001). Students had more than nine times the risk of mumps if they had received the second MMR dose 13 years or more before the outbreak. At 28 days after vaccination, receipt of the third vaccine dose was associated with a 78.1% lower risk of mumps than receipt of a second dose (adjusted hazard ratio, 0.22; 95% confidence interval, 0.12 to 0.39). The vaccine effectiveness of two doses versus no doses was lower among students with more distant receipt of the second vaccine dose. CONCLUSIONS: Students who had received a third dose of MMR vaccine had a lower risk of mumps than did those who had received two doses, after adjustment for the number of years since the second dose. Students who had received a second dose of MMR vaccine 13 years or more before the outbreak had an increased risk of mumps. These findings suggest that the campaign to administer a third dose of MMR vaccine improved mumps outbreak control and that waning immunity probably contributed to propagation of the outbreak. (Funded by the Centers for Disease Control and Prevention.). |
Influenza epidemiology and immunization during pregnancy: Final report of a World Health Organization working group
Fell DB , Azziz-Baumgartner E , Baker MG , Batra M , Beaute J , Beutels P , Bhat N , Bhutta ZA , Cohen C , De Mucio B , Gessner BD , Gravett MG , Katz MA , Knight M , Lee VJ , Loeb M , Luteijn JM , Marshall H , Nair H , Pottie K , Salam RA , Savitz DA , Serruya SJ , Skidmore B , Ortiz JR . Vaccine 2017 35 (43) 5738-5750 From 2014 to 2017, the World Health Organization convened a working group to evaluate influenza disease burden and vaccine efficacy to inform estimates of maternal influenza immunization program impact. The group evaluated existing systematic reviews and relevant primary studies, and conducted four new systematic reviews. There was strong evidence that maternal influenza immunization prevented influenza illness in pregnant women and their infants, although data on severe illness prevention were lacking. The limited number of studies reporting influenza incidence in pregnant women and infants under six months had highly variable estimates and underrepresented low- and middle-income countries. The evidence that maternal influenza immunization reduces the risk of adverse birth outcomes was conflicting, and many observational studies were subject to substantial bias. The lack of scientific clarity regarding disease burden or magnitude of vaccine efficacy against severe illness poses challenges for robust estimation of the potential impact of maternal influenza immunization programs. |
A scoping review to address the culture of concussion in youth and high school sports
Sarmiento K , Donnell Z , Hoffman R . J Sch Health 2017 87 (10) 790-804 BACKGROUND: In 2013, the National Academy of Sciences emphasized the need to develop, implement, and evaluate effective large-scale educational strategies to improve the culture of concussion in youth and high school sports. In support of this recommendation, in this article we summarize research on factors that contribute to the culture of concussion. METHODS: We conducted the literature search using 7 electronic databases. We used a scoping review method to identify studies that addressed knowledge, attitudes, behaviors, use of educational resources, and interventions related to concussion among young athletes, coaches, and parents. RESULTS: Of the 33 articles identified, most focused on concussion education (N = 15), followed by knowledge (N = 13), behaviors (N = 13), and attitudes (N = 5). Three studies addressed multiple study populations. CONCLUSIONS: The rapid spread of concussion education and awareness efforts has outpaced research on effective strategies to improve knowledge, attitudes, and behaviors that contribute to the culture of concussion. Further research is critical to inform the development and implementation of large-scale educational efforts. This research should incorporate rigorous study designs; be inclusive of diverse ages, socioeconomic status, and racial/ethnic groups; and examine opportunities to improve behavioral outcomes around concussion prevention, reporting, and management. |
A non-invasive specimen collection method and a novel simian foamy virus (SFV) DNA quantification assay in New World primates reveal aspects of tissue tropism and improved SFV detection.
Muniz CP , Zheng H , Jia H , Cavalcante LTF , Augusto AM , Fedullo LP , Pissinatti A , Soares MA , Switzer WM , Santos AF . PLoS One 2017 12 (9) e0184251 Simian foamy viruses (SFVs) co-evolved with a wide range of Old World and New World primates (OWPs and NWPs, respectively) and occasionally transmit to humans. Previous studies of OWPs showed that the predominant site of SFV replication is the oral mucosa. However, very little is known about SFV viral loads (VLs) in the oral mucosa or blood of NWPs. NWPs have smaller body sizes, limiting collection of sufficient whole blood volumes to molecularly detect and quantify SFV. Our study evaluated the use of noninvasively collected buccal swabs to detect NWP SFV compared with detection in blood using a new NWP SFV quantitative PCR (qPCR) assay. Buccal and blood samples were collected from 107 captive NWPs in Brazil comprising eleven distinct genera at the Primate Center of Rio de Janeiro (n = 58) and at Fundacao Jardim Zoologico da Cidade do Rio Janeiro (n = 49). NWP SFV western blot (WB) testing was performed on a subset of animals for comparison with PCR results. The qPCR assay was validated using distinct SFV polymerase sequences from seven NWP genera (Callithrix, Sapajus, Saimiri, Ateles, Alouatta, Cacajao and Pithecia). Assay sensitivity was 20 copies/106 cells, detectable in 90% of replicates. SFV DNA VLs were higher in buccal swabs (5 log copies/106 cells) compared to peripheral blood mononuclear cells (PBMCs) (3 log copies/106 cells). The qPCR assay was also more sensitive than nested PCR for detection of NWP SFV infection and identified an additional 27 SFV-infected monkeys of which 18 (90%) were WB-positive and three that were WB-negative. We show the utility of using both blood and buccal swabs and our new qPCR assay for detection and quantification of diverse NWP SFV, which will assist a better understanding of the epidemiology of SFV in NWPs and any potential zoonotic infection risk for humans exposed to NWPs. |
Novel graphene-based biosensor for early detection of Zika virus infection
Afsahi S , Lerner MB , Goldstein JM , Lee J , Tang X , Bagarozzi DA Jr , Pan D , Locascio L , Walker A , Barron F , Goldsmith BR . Biosens Bioelectron 2017 100 85-88 We have developed a cost-effective and portable graphene-enabled biosensor to detect Zika virus with a highly specific immobilized monoclonal antibody. Field Effect Biosensing (FEB) with monoclonal antibodies covalently linked to graphene enables real-time, quantitative detection of native Zika viral (ZIKV) antigens. The percent change in capacitance in response to doses of antigen (ZIKV NS1) coincides with levels of clinical significance with detection of antigen in buffer at concentrations as low as 450pM. Potential diagnostic applications were demonstrated by measuring Zika antigen in a simulated human serum. Selectivity was validated using Japanese Encephalitis NS1, a homologous and potentially cross-reactive viral antigen. Further, the graphene platform can simultaneously provide the advanced quantitative data of nonclinical biophysical kinetics tools, making it adaptable to both clinical research and possible diagnostic applications. The speed, sensitivity, and selectivity of this first-of-its-kind graphene-enabled Zika biosensor make it an ideal candidate for development as a medical diagnostic test. |
Assessment of half-mask elastomeric respirator and powered air-purifying respirator reprocessing for an influenza pandemic
Lawrence C , Harnish DA , Sandoval-Powers M , Mills D , Bergman M , Heimbuch BK . Am J Infect Control 2017 45 (12) 1324-1330 BACKGROUND: Health care facilities are considering the use of reusable respiratory protective devices (RPDs) to mitigate a potential N95 filtering facepiece respirator shortage caused by an influenza pandemic. US regulators are also considering stockpiling reusable RPDs for pandemic preparedness, but limited data exist on the effectiveness of cleaning and disinfection of these devices. This study defines reprocessing protocols and evaluates their effectiveness against a pandemic influenza strain in a laboratory setting. METHODS: Five half-mask elastomeric respirator models and 3 powered air-purifying respirator models were contaminated with influenza virus and artificial skin oil on multiple surfaces. RPDs were then manually treated with 1 of 2 methods: cleaned or cleaned and disinfected. Presence of viable influenza was determined via swab sampling and a median tissue culture infectious dose assay. RESULTS: Across 41 RPD surfaces, a mean log reduction in viable influenza of 4.54 +/- 0.97 log10 median tissue culture infectious dose was achieved for all treated surfaces, which included both cleaned and cleaned and disinfected surfaces. CONCLUSIONS: The methods defined as part of this study are effective for eliminating viable influenza in the presence of artificial skin oil on most of the RPD surfaces tested. Material type and RPD design should be considered when implementing RPD reprocessing protocols. |
Calibration and performance of synchronous SIM/scan mode for simultaneous targeted and discovery (non-targeted) analysis of exhaled breath samples from firefighters
Geer Wallace MA , Pleil JD , Mentese S , Oliver KD , Whitaker DA , Fent KW . J Chromatogr A 2017 1516 114-124 Traditionally, gas chromatography-mass spectrometry (GC/MS) analysis has used a targeted approach called selected ion monitoring (SIM) to quantify specific compounds that may have adverse health effects. Due to method limitations and the constraints of preparing duplicate samples, the information that could be obtained from separately collecting the full scan chromatogram of the sample has often been sacrificed. However, the hybrid technique called synchronous SIM/scan mode alternates between the two acquisition modes, maintaining the accuracy and sensitivity of SIM for targeted analysis while also providing the full scan chromatogram for discovery of non-target compounds. This technology was assessed using calibration data and real-world breath samples from a joint EPA/NIOSH collaboration that investigated the safety of firefighters' protective gear during controlled structure burns. Collecting field samples is costly and must be performed strategically to ensure that time points and replicates are accurate and representative of the intended population. This is difficult to accomplish with firefighters who are working under volatile conditions. The synchronous SIM/scan method decreases the number of field samples that need to be collected by half and reduces error in trying to recreate time points since a breath sample from a single sorbent tube can be used to collect both the SIM and scan data simultaneously. As a practical demonstration of the method, we investigate thirty-six firefighter breath samples, document organic compounds of interest, and identify additional non-target compounds. |
Crimean-Congo hemorrhagic fever virus suppresses innate immune responses via a ubiquitin and ISG15 specific protease
Scholte FEM , Zivcec M , Dzimianski JV , Deaton MK , Spengler JR , Welch SR , Nichol ST , Pegan SD , Spiropoulou CF , Bergeron E . Cell Rep 2017 20 (10) 2396-2407 Antiviral responses are regulated by conjugation of ubiquitin (Ub) and interferon-stimulated gene 15 (ISG15) to proteins. Certain classes of viruses encode Ub- or ISG15-specific proteases belonging to the ovarian tumor (OTU) superfamily. Their activity is thought to suppress cellular immune responses, but studies demonstrating the function of viral OTU proteases during infection are lacking. Crimean-Congo hemorrhagic fever virus (CCHFV, family Nairoviridae) is a highly pathogenic human virus that encodes an OTU with both deubiquitinase and deISGylase activity as part of the viral RNA polymerase. We investigated CCHFV OTU function by inactivating protease catalytic activity or by selectively disrupting its deubiquitinase and deISGylase activity using reverse genetics. CCHFV OTU inactivation blocked viral replication independently of its RNA polymerase activity, while deubiquitinase activity proved critical for suppressing the interferon responses. Our findings provide insights into viral OTU functions and support the development of therapeutics and vaccines. |
Primary Care Provider Management of Congenital Hypothyroidism Identified Through Newborn Screening.
Rosenthal NA , Bezar E , Mann S , Bachrach LK , Banerjee S , Geffner ME , Gottschalk M , Shapira SK , Hasegawa L , Feuchtbaum L . Ann Thyroid Res 2017 3 (1) 95-101 OBJECTIVE: To assess Primary Congenital Hypothyroidism (CH) management patterns and feasibility of providing long-term care for patients with CH identified through newborn screening by Primary Care Providers (PCPs) in California and Hawaii. STUDY DESIGN: A survey was mailed to all physicians (N=823) listed as the referral doctor for confirmed patients with CH identified through newborn screening programs in both states between 01/01/2009-12/31/2013. Information was collected on CH management patterns, barriers to providing care, and knowledge on CH treatment. Descriptive statistics and bivariate logistic regression results were reported. RESULTS: 206 PCPs completed the survey. Among these, 78% currently have patients with CH and 91% indicated willingness to provide long-term care to new patients with CH. Among PCPs currently caring for patients with CH, 17% managed CH by themselves with limited assistance from endocrinologists; 63% were involved in managing CH but endocrinologists played a larger role than PCPs; 19% were not involved in CH care. Only 49% of PCPs correctly answered questions regarding recommended follow-up frequencies and 23% knew the correct age for a trial off levothyroxine for suspected transient CH. Top two perceived barriers to providing long-term care included "need guidance or support from endocrinologists" (61%) and "not familiar with CH treatment guidelines" (28%). CONCLUSION: The majority of PCPs surveyed are willing to provide long-term care to patients with CH, but need support from endocrinologists and increased knowledge about current treatment guidelines. |
Prenatal alcohol exposure in relation to autism spectrum disorder: Findings from the Study to Explore Early Development (SEED)
Singer AB , Aylsworth AS , Cordero C , Croen LA , DiGuiseppi C , Fallin MD , Herring AH , Hooper SR , Pretzel RE , Schieve LA , Windham GC , Daniels JL . Paediatr Perinat Epidemiol 2017 31 (6) 573-582 BACKGROUND: Prenatal alcohol exposure can affect neurodevelopment, but few studies have examined associations with autism spectrum disorder (ASD). METHODS: We assessed the association between maternal alcohol use and ASD in the Study to Explore Early Development, a multi-site case-control study of children born between September 2003 and August 2006 in the US Regression analyses included 684 children with research clinician-confirmed ASD, 869 children with non-ASD developmental delays or disorders (DDs), and 962 controls ascertained from the general population (POP). Maternal alcohol exposure during each month from 3 months prior to conception until delivery was assessed by self-report. RESULTS: Mothers of POP children were more likely to report any prenatal alcohol use than mothers of children with ASD or DD. In trimester one, 21.2% of mothers of POP children reported alcohol use compared with 18.1% and 18.2% of mothers of children with ASD or DD, respectively (adjusted OR for ASD vs. POP 0.8, 95% confidence interval 0.6, 1.1). During preconception and the first month of pregnancy, one to two drinks on average per week was inversely associated with ASD risk. CONCLUSIONS: These results do not support an adverse association between low-level alcohol exposure and ASD, although these findings were based on retrospective self-reported alcohol use. Unmeasured confounding or exposure misclassification may explain inverse associations with one to two drinks per week. Pregnant or potentially pregnant women should continue to follow recommendations to avoid alcohol use because of other known effects on infant health and neurodevelopment. |
Eradicating hepatitis B virus: The critical role of preventing perinatal transmission
Stevens CE , Toy P , Kamili S , Taylor PE , Tong MJ , Xia GL , Vyas GN . Biologicals 2017 50 3-19 Prevention of hepatitis B virus (HBV) transmission from infected mothers to their newborns is critical to HBV control and eventual eradication. Mother-to-child perinatal transmission causes the highest chronic carrier rate (>85%) with a high rate of subsequent chronic liver disease and hepatocellular carcinoma. This risk is reduced by 90% with HBV vaccine given along with hepatitis B immune globulin (HBIG) starting at birth. New analyses of our data from US trials of HBIG and HBV vaccine in high-risk infants revealed better efficacy with yeast-recombinant vaccine than plasma-derived vaccine, especially in preventing late onset infections, with evidence that vaccine prevented transmission of maternal HBV infection with the glycine to arginine mutation in surface antigen codon 145 (sG145R). Most late infections with sG145R were in vaccine non-responders, suggesting escape from HBIG rather than from vaccine-induced antibody. Our findings also help explain survey results from Taiwan following universal childhood immunization implemented in the mid-1980s. We conclude that current vaccines will remain effective against surface antigen mutants. Anti-viral drugs in high-risk pregnant women, in combination with newborn HBIG and vaccine, show promise for eliminating residual breakthrough neonatal infections, critical to meeting WHO 2030 goals and for eradicating HBV. |
Homogeneous subgroups of young children with autism improve phenotypic characterization in the Study to Explore Early Development
Wiggins LD , Tian LH , Levy SE , Rice C , Lee LC , Schieve L , Pandey J , Daniels J , Blaskey L , Hepburn S , Landa R , Edmondson-Pretzel R , Thompson W . J Autism Dev Disord 2017 47 (11) 3634-3645 The objective of this study was to identify homogenous classes of young children with autism spectrum disorder (ASD) to improve phenotypic characterization. Children were enrolled in the Study to Explore Early Development between 2 and 5 years of age. 707 children were classified with ASD after a comprehensive evaluation with strict diagnostic algorithms. Four classes of children with ASD were identified from latent class analysis: mild language delay with cognitive rigidity, mild language and motor delay with dysregulation, general developmental delay, and significant developmental delay with repetitive motor behaviors. We conclude that a four-class phenotypic model of children with ASD best describes our data and improves phenotypic characterization of young children with ASD. Implications for screening, diagnosis, and research are discussed. |
An analysis of injuries to front-end loader operators during ingress and egress
Nasarwanji MF , Pollard J , Porter W . Int J Ind Ergon 2017 65 84-92 Slips, trips, and falls from mobile mining equipment have been documented for decades. However, little research has been conducted to determine the events precipitating these incidents during ingress or egress. This study examined slips, trips, and falls sustained during ingress or egress from front-end loaders to determine the frequencies of factors that may contribute to injuries. Non-fatal injuries, when getting on or off of front-end wheel loaders specifically, were identified, coded, and analyzed from the Mine Safety and Health Administration's accidents, injuries, and illnesses database. Overall trends, events that precipitated the injury, injuries sustained, contributing factors, location of the individual, and equipment characteristics were analyzed. More incidents occurred during egress (63%); and egress is believed to be more hazardous than ingress. Foot slips were the most common event that precipitated the incident and the leading cause of these was contaminants on the equipment. Misstep, loss of footing, and step on/in related incidents were more common during egress and are likely due to the operator's reduced visibility when descending a ladder facing the equipment, limiting their ability to detect hazards. Egress also makes an operator less capable of avoiding unsafe ground conditions as indicated by the significant number of step on/in injuries occurring on the ground during egress. Most of the front-end loaders associated with the incidents were found to have bottom rungs with flexible rails, which may also increase fall risk during egress due to inconsistent rung heights and lengthy transition areas from the ground, through the flexible-railed rungs, to the rungs with rigid rails. Recommendations are provided to reduce the risk for slips, trips, and falls from mobile mining equipment. |
Mozambique field epidemiology and laboratory training program: A pathway for strengthening human resources in applied epidemiology
Baltazar CS , Taibo C , Sacarlal J , Gujral L , Salomao C , Doyle T . Pan Afr Med J 2017 27 (233) Introduction: in the last decades, Mozambique has been undergoing demographic, epidemiological, economic and social transitions, which have all had a notable impact on the National Health System. New challenges have emerged, causing a need to expand the preparation and response to emerging disease threats and public health emergencies. Methods: We describe the structure and function of the Mozambique Field Epidemiology Training Program (MZ-FELTP) and the main outputs achieved during the first 6 years of program implementation (consisting of 3 cohorts). We also outline the contribution of the program to the National Health System and assess the retention of the graduates. Results: The MZ-FELTP is a post-graduate in-service training program, based on the acquisition of skills, within two tracks: applied epidemiology and laboratory management. The program was established in 2010, with the objective of strengthening capacity in applied epidemiology and laboratory management, so that events of public health importance can be detected and investigated in a timely and effective manner. The program is in its seventh year, having successfully trained 36 health professionals in the advanced course. During the first six years of the program, more than 40 outbreaks were investigated, 37 surveillance system evaluations were conducted and 39 descriptive data analyses were performed. Surveillance activities were implemented for mass events and emergency situations. In addition, more than 100 oral and poster presentations were given by trainees at national and international conferences. Conclusion: The MZ-FELTP has helped provide the Ministry of Health with the human and technical resources and operational capacity, to rapidly and effectively respond to major public health challenges in the country. The continuous involvement of key stakeholders is necessary for the continuation, expansion and ongoing sustainability of the program. |
Rapid and accurate interpretation of dengue diagnostics in the context of dengue vaccination implementation: Viewpoints and guidelines issued from an experts group consultation
Hunsperger EA , Duarte Dos Santos CN , Vu HTQ , Yoksan S , Deubel V . PLoS Negl Trop Dis 2017 11 (9) e0005719 There are 4 serologically distinct dengue viruses (DENVs), which contemporarily cocirculate in a majority of countries of the tropical and subtropical belt in Latin America, Asia-Pacific, and Africa [1]. DENVs are members of the Flavivirus genus, related to other medically important mosquito-borne viruses such as yellow fever virus (YFV), Japanese encephalitis virus (JEV), and Zika virus (ZIKV). A chimeric YF-DEN tetravalent dengue vaccine CYD-TDV (Dengvaxia) has now been licensed in 13 countries [2]. A phase IIb trial in Thailand and 2 phase III large-scale efficacy trials in 10 countries in Asia and Latin America have been conducted [2]. The vaccine clinical monitoring and careful diagnosis of the vaccinated and unvaccinated populations enrolled in these studies have provided valuable information that is useful for the later stage of vaccination implementation and its monitoring [2]. A recent study of the validity of the serological diagnosis of dengue immunoglobulin G (IgG) and immunoglobulin M (IgM) by ELISA according to WHO recommendations [3] in acute febrile and in convalescent individuals vaccinated and unvaccinated (Placebo), and virologically confirmed or not, showed a high sensitivity (97.1%) but a low specificity (85.1%) in the IgM ELISA due to the presence of residual IgM from previous vaccination or subclinical undetected dengue, which may introduce a diagnostic bias [4]. The proportion of false positives IgM in the CYD-TDV vaccinated group (17.4%) was higher than in the control group (10.1%), particularly within the 2 months following vaccination. Therefore, it was necessary to review and redefine a reliable diagnostic testing algorithm in light of false dengue positives, which would be used by healthcare professionals to confirm suspected dengue cases in vaccinees and to evaluate the effectiveness of the CYD-TDV vaccine in the vaccinated populations. Here, a group of experts in the diagnosis and monitoring of DENV and other flaviviruses has considered key questions regarding sensitive and specific dengue diagnostics and their application for dengue surveillance in countries where the CYD-TDV vaccine has been implemented. |
Update: Increase in human infections with novel Asian lineage avian influenza A(H7N9) viruses during the fifth epidemic - China, October 1, 2016-August 7, 2017
Kile JC , Ren R , Liu L , Greene CM , Roguski K , Iuliano AD , Jang Y , Jones J , Thor S , Song Y , Zhou S , Trock SC , Dugan V , Wentworth DE , Levine MZ , Uyeki TM , Katz JM , Jernigan DB , Olsen SJ , Fry AM , Azziz-Baumgartner E , Davis CT . MMWR Morb Mortal Wkly Rep 2017 66 (35) 928-932 Among all influenza viruses assessed using CDC's Influenza Risk Assessment Tool (IRAT), the Asian lineage avian influenza A(H7N9) virus (Asian H7N9), first reported in China in March 2013, is ranked as the influenza virus with the highest potential pandemic risk. During October 1, 2016-August 7, 2017, the National Health and Family Planning Commission of China; CDC, Taiwan; the Hong Kong Centre for Health Protection; and the Macao CDC reported 759 human infections with Asian H7N9 viruses, including 281 deaths, to the World Health Organization (WHO), making this the largest of the five epidemics of Asian H7N9 infections that have occurred since 2013. This report summarizes new viral and epidemiologic features identified during the fifth epidemic of Asian H7N9 in China and summarizes ongoing measures to enhance pandemic preparedness. Infections in humans and poultry were reported from most areas of China, including provinces bordering other countries, indicating extensive, ongoing geographic spread. The risk to the general public is very low and most human infections were, and continue to be, associated with poultry exposure, especially at live bird markets in mainland China. Throughout the first four epidemics of Asian H7N9 infections, only low pathogenic avian influenza (LPAI) viruses were detected among human, poultry, and environmental specimens and samples. During the fifth epidemic, mutations were detected among some Asian H7N9 viruses, identifying the emergence of high pathogenic avian influenza (HPAI) viruses as well as viruses with reduced susceptibility to influenza antiviral medications recommended for treatment. Furthermore, the fifth-epidemic viruses diverged genetically into two separate lineages (Pearl River Delta lineage and Yangtze River Delta lineage), with Yangtze River Delta lineage viruses emerging as antigenically different compared with those from earlier epidemics. Because of its pandemic potential, candidate vaccine viruses (CVV) were produced in 2013 that have been used to make vaccines against Asian H7N9 viruses circulating at that time. CDC is working with partners to enhance surveillance for Asian H7N9 viruses in humans and poultry, to improve laboratory capability to detect and characterize H7N9 viruses, and to develop, test and distribute new CVV that could be used for vaccine production if a vaccine is needed. |
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