Hepatocellular Carcinoma Risk in Alaska Native Children and Young Adults with Hepatitis B Virus: Retrospective Cohort Analysis.
Gounder PP , Bulkow LR , Snowball M , Negus S , Spradling PR , McMahon BJ . J Pediatr 2016 178 206-213 OBJECTIVES: To evaluate the hepatocellular carcinoma (HCC) risk in Alaska Native children and young adults with hepatitis B virus (HBV). STUDY DESIGN: Retrospective analysis of a population-based cohort of Alaska Native persons with HBV followed during 1982-2012. All individuals with HBV were offered HCC screening regardless of age using alpha-fetoprotein every 6 months; persons with an elevated alpha-fetoprotein or persons at high-risk for HCC, such as cirrhosis, family history of HCC, were offered ultrasound. We calculated the HCC incidence/1000 person-years from date of cohort entry until death, diagnosis of HCC, or attaining the age of 40 years (males) or 50 years (females). RESULTS: We followed 1083 subjects with HBV (56% male) comprising 5 genotypes (A2 [12.5%], B6 [1.7%], C [5.3%], D [49.7%], F1 [18.6%], unknown [12.4%]) for a median of 23.4 years/person. We observed 22 HCC cases (incidence/1000 person-years follow-up: 1.0); 19 HCC cases among persons with genotype F1. There was no significant difference in HCC incidence between males (1.4) and females (0.6). The HCC incidence was significantly higher for persons with genotype F1 (4.4) compared with genotype A2 (0.4) and D (0.2) and remained higher among persons with HBV genotype F1 excluding persons with HCC family history/cirrhosis (1.9). CONCLUSIONS: Alaska Native children and young adults with HBV genotype F1 are at high risk for HCC and should receive HCC surveillance. For males <40 years of age and females <50 years of age with HBV in regions of the world with a high genotype F prevalence, testing/confirming genotype F can identify persons who could benefit from HCC surveillance. |
The role of prescription medications in the association of self-reported sleep duration and obesity in U.S. adults, 2007-2012
Lawman HG , DFryar C , Gu Q , Ogden CL . Obesity (Silver Spring) 2016 24 (10) 2210-6 OBJECTIVE: Previous research has not investigated the role of prescription medication in sleep-obesity associations despite the fact that 56% of U.S. adults take at least one prescription medication. METHODS: Data from n = 16,622 adults in the National Health and Nutrition Examination Survey (2007-2012) were used to examine how the association between obesity and self-reported sleep duration varied by total number of prescription medications used in the past 30 days and by select classes of prescription medications including anxiolytics/sedatives/hypnotics, antidepressants, sleep aids, anticonvulsants, thyroid agents, and metabolic agents. RESULTS: Logistic regression analyses showed a significant inverse linear association of sleep duration and obesity, regardless of the total number of prescription medications individuals were taking. Each additional hour of sleep was associated with a 10% decrease in the odds of obesity. Results suggest that increased sleep duration is associated with lower odds of having obesity overall, even for long-duration sleepers (≥9 h), and this association does not differ for those taking antidepressants, thyroid agents, metabolic agents, and multiple prescription medications. CONCLUSIONS: The relationship between sleep duration and obesity was similar among all prescription medication users and nonusers. The potential for a nonlinear association between sleep duration and obesity may be important to examine in some specific prescription medication classes. |
Notes from the field: Splenomegaly of unknown etiology in Congolese refugees applying for resettlement to the United States - Uganda, 2015
Goers M , Ope MO , Samuels A , Gitu N , Akandwanaho S , Nabwami G , Nyoka R , Cetron MS , Dalal W , Conroy AL , Cantey P , John C , Naoum M , Weinberg M , Marano N , Stauffer W . MMWR Morb Mortal Wkly Rep 2016 65 (35) 943-944 Approximately 70,000-90,000 refugees are resettled to the United States each year, and during the next 5 years, 50,000 Congolese refugees are expected to arrive in the United States. The International Organization for Migration (IOM) performs refugee medical examinations overseas for the U.S. Refugee Resettlement Program. In 2014, IOM reported that a large number of U.S.-bound Congolese refugees from Uganda had spleens that were enlarged on examination. During two evaluations of refugee populations in western Uganda in March and July 2015, refugees with splenomegaly on physical examination were offered additional assessment and treatment, including abdominal ultrasonography and laboratory testing. Among 987 persons screened, 145 (14.7%) had splenomegaly and received further testing. Among the 145 patients with splenomegaly, 63.4% were aged 5-17 years (median = 14.8 years). There was some evidence of family clustering, with 33 (22.7%) of the 145 cases occurring in families. |
Do program implementation factors or fidelity affect chronic disease self-management education programs' outcomes?
Brady TJ , Murphy LB , O'Colmain BJ , Hobson RD . Am J Health Promot 2016 31 (5) 422-425 PURPOSE: To evaluate whether implementation factors or fidelity moderate chronic disease self-management education program outcomes. DESIGN: Meta-analysis of 34 Arthritis Self-Management Program and Chronic Disease Self-Management Program studies. SETTING: Community. PARTICIPANTS: N = 10 792. MEASURES: Twelve implementation factors: program delivery fidelity and setting and leader and participant characteristics. Eighteen program outcomes: self-reported health behaviors, physical health status, psychological health status, and health-care utilization. ANALYSIS: Meta-analysis using pooled effect sizes. RESULTS: Modest to moderate statistically significant differences for 4 of 6 implementation factors; these findings were counterintuitive with better outcomes when leaders and participants were unpaid, leaders had less than minimum training, and implementation did not meet fidelity requirements. CONCLUSION: Exploratory study findings suggest that these interventions tolerate some variability in implementation factors. Further work is needed to identify key elements where fidelity is essential for intervention effectiveness. |
Prevention of sexual transmission of Ebola in Liberia through a national semen testing and counselling programme for survivors: an analysis of Ebola virus RNA results and behavioural data.
Soka MJ , Choi MJ , Baller A , White S , Rogers E , Purpura LJ , Mahmoud N , Wasunna C , Massaquoi M , Abad N , Kollie J , Dweh S , Bemah PK , Christie A , Ladele V , Subah OC , Pillai S , Mugisha M , Kpaka J , Kowalewski S , German E , Stenger M , Nichol S , Stroher U , Vanderende KE , Zarecki SM , Green HH , Bailey JA , Rollin P , Marston B , Nyenswah TG , Gasasira A , Knust B , Williams D . Lancet Glob Health 2016 4 (10) e736-43 BACKGROUND: Ebola virus has been detected in semen of Ebola virus disease survivors after recovery. Liberia's Men's Health Screening Program (MHSP) offers Ebola virus disease survivors semen testing for Ebola virus. We present preliminary results and behavioural outcomes from the first national semen testing programme for Ebola virus. METHODS: The MHSP operates out of three locations in Liberia: Redemption Hospital in Montserrado County, Phebe Hospital in Bong County, and Tellewoyan Hospital in Lofa County. Men aged 15 years and older who had an Ebola treatment unit discharge certificate are eligible for inclusion. Participants' semen samples were tested for Ebola virus RNA by real-time RT-PCR and participants received counselling on safe sexual practices. Participants graduated after receiving two consecutive negative semen tests. Counsellors collected information on sociodemographics and sexual behaviours using questionnaires administered at enrolment, follow up, and graduation visits. Because the programme is ongoing, data analysis was restricted to data obtained from July 7, 2015, to May 6, 2016. FINDINGS: As of May 6, 2016, 466 Ebola virus disease survivors had enrolled in the programme; real-time RT-PCR results were available from 429 participants. 38 participants (9%) produced at least one semen specimen that tested positive for Ebola virus RNA. Of these, 24 (63%) provided semen specimens that tested positive 12 months or longer after Ebola virus disease recovery. The longest interval between discharge from an Ebola treatment unit and collection of a positive semen sample was 565 days. Among participants who enrolled and provided specimens more than 90 days since their Ebola treatment unit discharge, men older than 40 years were more likely to have a semen sample test positive than were men aged 40 years or younger (p=0.0004). 84 (74%) of 113 participants who reported not using a condom at enrolment reported using condoms at their first follow-up visit (p<0.0001). 176 (46%) of 385 participants who reported being sexually active at enrolment reported abstinence at their follow-up visit (p<0.0001). INTERPRETATION: Duration of detection of Ebola virus RNA by real-time RT-PCR varies by individual and might be associated with age. By combining behavioural counselling and laboratory testing, the Men's Health Screening Program helps male Ebola virus disease survivors understand their individual risk and take appropriate measures to protect their sexual partners. FUNDING: World Health Organization and the US Centers for Disease Control and Prevention. |
Resurgence of Ebola virus disease in Guinea linked to a survivor with virus persistence in seminal fluid for more than 500 days
Diallo B , Sissoko D , Loman NJ , Bah HA , Bah H , Worrell MC , Conde LS , Sacko R , Mesfin S , Loua A , Kalonda JK , Erondu NA , Dahl BA , Handrick S , Goodfellow I , Meredith LW , Cotten M , Jah U , Guetiya Wadoum RE , Rollin P , Magassouba N , Malvy D , Anglaret X , Carroll MW , Aylward RB , Djingarey MH , Diarra A , Formenty P , Keita S , Gunther S , Rambaut A , Duraffour S . Clin Infect Dis 2016 63 (10) 1353-1356 We report on an Ebola virus disease (EVD) survivor who showed Ebola virus (EBOV) in seminal fluid 531 days after onset of disease. The persisting virus was sexually transmitted in February 2016, about 470 days after onset of symptoms, and caused a new cluster of EVD in Guinea and Liberia. |
Travel- and community-based transmission of multidrug-resistant Shigella sonnei lineage among international Orthodox Jewish communities
Baker KS , Dallman TJ , Behar A , Weill FX , Gouali M , Sobel J , Fookes M , Valinsky L , Gal-Mor O , Connor TR , Nissan I , Bertrand S , Parkhill J , Jenkins C , Cohen D , Thomson NR . Emerg Infect Dis 2016 22 (9) 1545-53 Shigellae are sensitive indicator species for studying trends in the international transmission of antimicrobial-resistant Enterobacteriaceae. Orthodox Jewish communities (OJCs) are a known risk group for shigellosis; Shigella sonnei is cyclically epidemic in OJCs in Israel, and sporadic outbreaks occur in OJCs elsewhere. We generated whole-genome sequences for 437 isolates of S. sonnei from OJCs and non-OJCs collected over 22 years in Europe (the United Kingdom, France, and Belgium), the United States, Canada, and Israel and analyzed these within a known global genomic context. Through phylogenetic and genomic analysis, we showed that strains from outbreaks in OJCs outside of Israel are distinct from strains in the general population and relate to a single multidrug-resistant sublineage of S. sonnei that prevails in Israel. Further Bayesian phylogenetic analysis showed that this strain emerged approximately 30 years ago, demonstrating the speed at which antimicrobial drug-resistant pathogens can spread widely through geographically dispersed, but internationally connected, communities. |
Treatment outcomes for patients with extensively drug-resistant tuberculosis, KwaZulu-Natal and Eastern Cape Provinces, South Africa
Kvasnovsky CL , Cegielski JP , van der Walt ML . Emerg Infect Dis 2016 22 (9) 1529-36 We analyzed data for a retrospective cohort of patients treated for extensively drug-resistant tuberculosis in 2 provinces in South Africa and compared predictors of treatment outcome in HIV-positive patients who received or had not received antiretroviral drugs with those for HIV-negative patients. Overall, 220 (62.0%) of 355 patients were HIV positive. After 2 years, 34 (10.3%) of 330 patients with a known HIV status and known outcome had a favorable outcome. Multivariate analysis showed that predictors of favorable outcome were negative results for acid-fast bacilli by sputum microscopy at start of treatment and weight >50 kg. HIV-positive patients were more likely to have an unfavorable outcome. The strongest predictor of unfavorable outcome was weight <50 kg. Overall outcomes were poor. HIV status was not a predictor of favorable outcome, but HIV-positive patients were more likely to have an unfavorable outcome. These results underscore the need for timely and adequate treatment for tuberculosis and HIV infection. |
Long-term management of panuveitis and iris heterochromia in an Ebola survivor
Shantha JG , Crozier I , Varkey JB , Kraft CS , Lyon GM 3rd , Mehta AK , Carlson RD , Hill CE , Kumar G , Debiec MR , Patel PS , Olsen TW , Nussenblatt RB , Martin DF , Stroher U , Uyeki TM , Ribner BS , Smith JR , Yeh S . Ophthalmology 2016 123 (12) 2626-2628 e2 The 2013-2016 West African Ebola virus disease (EVD) outbreak has been the largest in history with 28,616 cases and 11,310 deaths in the highest transmission countries of Sierra Leone, Guinea, and Liberia.1 Reports of uveitis have emerged in EVD survivors.2-3 Herein we discuss clinical features, multimodality imaging, and long-term management of aggressive, sight-threatening panuveitis, in an EVD survivor, providing insight into the pathogenesis of this condition. |
Men who have sex with men in Kampala, Uganda: Results from a bio-behavioral respondent driven sampling survey
Hladik W , Sande E , Berry M , Ganafa S , Kiyingi H , Kusiima J , Hakim A . AIDS Behav 2016 21 (5) 1478-1490 We report on the results of a respondent-driven sampling survey among men who have sex with men (MSM) in Kampala, Uganda, where same-sex behavior is criminalized and highly stigmatized. We enrolled 608 MSM aged 18 + years and residing in greater Kampala from June 2012-November 2013. Anonymous data were collected through audio-computer assisted self-interviews; blood was tested for HIV-1 antibodies, CD4 + T cell counts, and viral load. Estimated HIV prevalence was 12.2 % (95 % confidence interval [CI] 8.0-16.1), increasing with age. One in five (19.6 %) stated knowing their HIV-positive status and a similar proportion of HIV-infected MSM were virally suppressed (19.3 %; 95 % CI 3.3-33.1). HIV-related risk behaviors included unprotected anal sex (35.8 % at last sex act), selling sex (38.5 %), having multiple steady (54.3 %) or casual (63.6 %) partners, and ever injecting drugs (31.6 %). Forty percent experienced homophobic abuse; 44.5 % ever experienced suicide ideation. HIV prevalence among MSM remains high whereas knowledge of seropositive status and suppression of viral load remains low. MSM report a wide range of high risk behaviors, frequent homophobic abuse, poor mental health, as well as low levels of testing and treatment. Better access to tailored prevention and treatment services to improve population-level viral load suppression are warranted. |
Morbidity, mortality, and seasonality of influenza hospitalizations in Egypt, November 2007-November 2014
Kandeel A , Dawson P , Labib M , Said M , El-Refai S , El-Gohari A , Talaat M . PLoS One 2016 11 (9) e0161301 BACKGROUND: Influenza typically comprises a substantial portion of acute respiratory infections, a leading cause of mortality worldwide. However, influenza epidemiology data are lacking in Egypt. We describe seven years of Egypt's influenza hospitalizations from a multi-site influenza surveillance system. METHODS: Syndromic case definitions identified individuals with severe acute respiratory infection (SARI) admitted to eight hospitals in Egypt. Standardized demographic and clinical data were collected. Nasopharyngeal and oropharyngeal swabs were tested for influenza using real-time reverse transcription polymerase chain reaction and typed as influenza A or B, and influenza A specimens subtyped. RESULTS: From November 2007-November 2014, 2,936/17,441 (17%) SARI cases were influenza-positive. Influenza-positive patients were more likely to be older, female, pregnant, and have chronic condition(s) (all p<0.05). Among them, 53 (2%) died, and death was associated with older age, five or more days from symptom onset to hospitalization, chronic condition(s), and influenza A (all p<0.05). An annual seasonal influenza pattern occurred from July-June. Each season, the proportion of the season's influenza-positive cases peaked during November-May (19-41%). CONCLUSIONS: In Egypt, influenza causes considerable morbidity and mortality and influenza SARI hospitalization patterns mirror those of the Northern Hemisphere. Additional assessment of influenza epidemiology in Egypt may better guide disease control activities and vaccine policy. |
Multidrug-resistant tuberculosis treatment failure detection depends on monitoring interval and microbiological method
Mitnick CD , White RA , Lu C , Rodriguez CA , Bayona J , Becerra MC , Burgos M , Centis R , Cohen T , Cox H , D'Ambrosio L , Danilovitz M , Falzon D , Gelmanova IY , Gler MT , Grinsdale JA , Holtz TH , Keshavjee S , Leimane V , Menzies D , Migliori GB , Milstein MB , Mishustin SP , Pagano M , Quelapio MI , Shean K , Shin SS , Tolman AW , van der Walt ML , Van Deun A , Viiklepp P . Eur Respir J 2016 48 (4) 1160-1170 Debate persists about monitoring method (culture or smear) and interval (monthly or less frequently) during treatment for multidrug-resistant tuberculosis (MDR-TB). We analysed existing data and estimated the effect of monitoring strategies on timing of failure detection.We identified studies reporting microbiological response to MDR-TB treatment and solicited individual patient data from authors. Frailty survival models were used to estimate pooled relative risk of failure detection in the last 12 months of treatment; hazard of failure using monthly culture was the reference.Data were obtained for 5410 patients across 12 observational studies. During the last 12 months of treatment, failure detection occurred in a median of 3 months by monthly culture; failure detection was delayed by 2, 7, and 9 months relying on bimonthly culture, monthly smear and bimonthly smear, respectively. Risk (95% CI) of failure detection delay resulting from monthly smear relative to culture is 0.38 (0.34-0.42) for all patients and 0.33 (0.25-0.42) for HIV-co-infected patients. Failure detection is delayed by reducing the sensitivity and frequency of the monitoring method. Monthly monitoring of sputum cultures from patients receiving MDR-TB treatment is recommended. Expanded laboratory capacity is needed for high-quality culture, and for smear microscopy and rapid molecular tests. |
Outbreak of serogroup C meningococcal disease primarily affecting men who have sex with men - Southern California, 2016
Nanduri S , Foo C , Ngo V , Jarashow C , Civen R , Schwartz B , Holguin J , Shearer E , Zahn M , Harriman K , Winter K , Kretz C , Chang HY , Meyer S , MacNeil J . MMWR Morb Mortal Wkly Rep 2016 65 (35) 939-940 During March 4-August 11, 2016, 25 outbreak-associated cases of meningococcal disease, including two deaths (8% case-fatality ratio), were reported in Southern California. Twenty-four of the cases were caused by serogroup C Neisseria meningitidis (NmC) and one by N. meningitidis with an undetermined serogroup (Figure). On June 24, 2016, in response to this increase in NmC cases, primarily among men who have sex with men (MSM) in Los Angeles County, the city of Long Beach, and Orange County, the California Department of Public Health (CDPH) issued a press release and health advisory, declaring an outbreak of NmC in Southern California. |
Persistent Bacillus cereus bacteremia in 3 persons who inject drugs, San Diego, California, USA
Schaefer G , Campbell W , Jenks J , Beesley C , Katsivas T , Hoffmaster A , Mehta SR , Reed S . Emerg Infect Dis 2016 22 (9) 1621-3 Bacillus cereus is typically considered a blood culture contaminant; however, its presence in blood cultures can indicate true bacteremia. We report 4 episodes of B. cereus bacteremia in 3 persons who inject drugs. Multilocus sequence typing showed that the temporally associated infections were caused by unrelated clones. |
Poliovirus seroprevalence before and after interruption of poliovirus transmission in Kano state, Nigeria
Iliyasu Z , Verma H , Craig KT , Nwaze E , Ahmad-Shehu A , Jibir BW , Gwarzo GD , Gajida AU , Weldon WC , Oberste SM , Takane M , Mkanda P , Muhammad AJ , Sutter RW . Vaccine 2016 34 (42) 5125-5131 INTRODUCTION: In September 2015, Nigeria was removed from the list of polio-endemic countries after more than 12months had passed since the detection of last wild poliovirus case in the country on 24 July 2014. We are presenting here a report of two polio seroprevalence surveys conducted in September 2013 and October 2014, respectively, in the Kano state of northern Nigeria. METHODS: Health facility based seroprevalence surveys were undertaken at Murtala Mohammad Specialist Hospital, Kano. Parents or guardians of children aged 6-9months, 36-47months, 5-9years and 10-14years in 2013 and 6-9months and 19-22months (corresponding to 6-9months range at the time of 2013 survey) in 2014 presenting to the outpatient department, were approached for participation, screened for eligibility and asked to provide informed consent. A questionnaire was administered and a blood sample collected for polio neutralization assay. RESULTS: Among subjects aged 6-9months in the 2013 survey, seroprevalence was 58% (95% confidence interval [CI] 51-66%) to poliovirus type 1, 42% (95% CI 34-50%) to poliovirus type 2, and 52% (95% CI 44-60%) to poliovirus type 3. Among children 36-47months and older, seroprevalence was 85% or higher for all three serotypes. In 2014, seroprevalence in 6-9month infants was 72% (95% CI 65-79%) for type 1, 59% (95% CI 52-66%) for type 2, and 65% (95% CI 57-72%) for type 3 and in 19-22months, 80% (95% CI 74-85%), 57% (49-63%) and 78% (71-83%) respectively. Seroprevalence was positively associated with history of increasing oral poliovirus vaccine doses. CONCLUSIONS: There was significant improvement in seroprevalence in 2014 over the 2013 levels indicating a positive impact of recent programmatic interventions. However the continued low seroprevalence in 6-9month age is a concern and calls for improved immunization efforts to sustain the polio-free Nigeria. |
Elevated risk for antimicrobial drug-resistant Shigella infection among men who have sex with men, United States, 2011-2015
Bowen A , Grass J , Bicknese A , Campbell D , Hurd J , Kirkcaldy RD . Emerg Infect Dis 2016 22 (9) 1613-6 Shigella spp. cause approximately 500,000 illnesses in the United States annually, and resistance to ciprofloxacin, ceftriaxone, and azithromycin is emerging. We investigated associations between transmission route and antimicrobial resistance among US shigellosis clusters reported during 2011-2015. Of 32 clusters, 9 were caused by shigellae resistant to ciprofloxacin (3 clusters), ceftriaxone (2 clusters), or azithromycin (7 clusters); 3 clusters were resistant to >1 of these drugs. We observed resistance to any of these drugs in all 7 clusters among men who have sex with men (MSM) but in only 2 of the other 25 clusters (p<0.001). Azithromycin resistance was more common among MSM-associated clusters than other clusters (86% vs. 4% of clusters; p<0.001). For adults with suspected shigellosis, clinicians should culture feces; obtain sex histories; discuss shigellosis prevention; and choose treatment, when needed, according to antimicrobial drug susceptibility. Public health interviews for enteric illnesses should encompass sex practices; health messaging for MSM must include shigellosis prevention. |
Hepatocellular carcinoma and viral hepatitis in New York City
Moore MS , Ivanina E , Bornschlegel K , Qiao B , Schymura MJ , Laraque F . Clin Infect Dis 2016 63 (12) 1577-1583 BACKGROUND: Hepatocellular carcinoma (HCC) incidence and mortality are increasing in the United States. Viral hepatitis infection is a primary risk factor for HCC. This study describes the relationship between viral hepatitis and HCC in New York City (NYC). METHODS: Viral hepatitis cases reported to the NYC Department of Health from 1999-2012 were matched to HCC cases diagnosed from 2001-2012 and reported to the New York State Cancer Registry. HCC cases were stratified by presence or absence of viral hepatitis. Demographic characteristics, factors associated with specific causes of death, and survival time were analyzed for all HCC cases. RESULTS: From 2001-2012, 8,827 NYC residents were diagnosed with HCC; 38.4% had hepatitis C (HCV) infection, 17.9% had hepatitis B (HBV) infection, and 2.2% had both infections. HCC patients were predominantly men (74.8%) and equally white non-Hispanic (28.6%) and Hispanic (28.9%). Those with HBV were primarily Asian/Pacific Islander (63.2%). The median survival time after HCC diagnosis for persons with HBV infection was 22.3 months, compared with 13.1 months for persons with HCV, and 6.9 months for non-infected persons. The five-year survival rate was 37.5% for those with HBV, 20.0% for those with HCV, 29.5% among coinfected individuals, and 16.1% for those with neither infection reported. CONCLUSION: In NYC, most persons with HCC have viral hepatitis; the majority of viral hepatitis infections are due to HCV. Survival for persons with HCC differs widely by viral hepatitis status. This study highlights the importance of viral hepatitis prevention and treatment and HCC screening. |
Influenza B virus outbreak at a religious residential school for boys in northern Bangladesh, 2011
Haque F , Sturm-Ramirez K , Homaira N , Gurley ES , Hossain MJ , Hasan SM , Chowdhury S , Sarkar S , Khan AK , Rahman M , Rahman M , Luby SP . Influenza Other Respir Viruses 2016 11 (2) 165-169 BACKGROUND: National media reported a febrile illness among dormitory residents of a boys' religious school. We investigated the outbreak to identify cause. METHODS: Individuals with fever (>100 degrees F) and cough or sore throat between 1-13 August 2011 were influenza-like-illness (ILI) case-patients. We collected histories and specimens from hospitalized case-patients, and visited campus to explore environmental context. RESULTS: All 28 case-patients were dormitory residents including 27 hospitalizations. Accommodation space per resident was <0.8 square metres. Nasal and oropharyngeal swabs from 22 case-patients were positive for influenza B virus using real-time reverse transcription polymerase chain reaction (rRT-PCR). CONCLUSIONS: Overcrowding likely facilitated transmission leading to this dormitory outbreak. |
Correlates of bacterial ulcers and acute HSV-2 infection among men with genital ulcer disease in South Africa: Age, recent sexual behaviours, and HIV
Leichliter JS , Lewis DA , Paz-Bailey G . S Afr J Infect Dis 2016 31 (2) 61-65 Data from baseline surveys and STI/HIV laboratory tests (n=615 men) were used to examine correlates of bacterial ulcers (Treponema pallidum, Haemophilus ducreyi, or Chlamydia trachomatis L1-L3 detected in ulcers) and acute HSV-2 ulcers (HSV-2 positive ulcer specimen, HSV-2 sero-negative, and negative for bacterial pathogens) versus recurrent HSV-2 ulcers (seropositive), separately. Men with bacterial ulcers had larger ulcers compared to men with recurrent HSV-2 ulcers, but were less likely to be HIV-positive; whereas, men with acute HSV-2 ulcers were younger with fewer partners. Acute HIV was higher among men with bacterial and acute HSV-2 ulcers; however, this difference was not statistically significant. |
Cross-sectional survey and surveillance for influenza viruses and MERS-CoV among Egyptian pilgrims returning from Hajj during 2012-2015
Refaey S , Amin MM , Roguski K , Azziz-Baumgartner E , Uyeki TM , Labib M , Kandeel A . Influenza Other Respir Viruses 2016 11 (1) 57-60 Among a sample of Egyptians returning from Hajj pilgrimage during 2012-2015, over 30% met the case definition for influenza-like illness, 14.4% tested positive for influenza viruses, and none tested positive for MERS-CoV. Despite Egyptian Ministry of Health and Population requirement of influenza vaccination of pilgrims, only 19.7% of pilgrims reported influenza vaccination. |
Worksite food and physical activity environments and wellness supports reported by employed adults in the United States, 2013
Onufrak SJ , Watson KB , Kimmons J , Pan L , Khan LK , Lee-Kwan SH , Park S . Am J Health Promot 2016 32 (1) 96-105 PURPOSE: To examine the workplace food and physical activity (PA) environments and wellness culture reported by employed United States adults, overall and by employer size. DESIGN: Cross-sectional study using web-based survey on wellness policies and environmental supports for healthy eating and PA. SETTING: Worksites in the United States. PARTICIPANTS: A total of 2101 adults employed outside the home. MEASURES: Survey items were based on the Centers for Disease Control and Prevention Worksite Health ScoreCard and Checklist of Health Promotion Environments and included the availability and promotion of healthy food items, nutrition education, promotion of breast-feeding, availability of PA amenities and programs, facility discounts, time for PA, stairwell signage, health promotion programs, and health risk assessments. ANALYSIS: Descriptive statistics were used to examine the prevalence of worksite environmental and facility supports by employer size (<100 or ≥100 employees). Chi-square tests were used to examine the differences by employer size. RESULTS: Among employed respondents with workplace food or drink vending machines, approximately 35% indicated the availability of healthy items. Regarding PA, 30.9% of respondents reported that their employer provided opportunities to be physically active and 17.6% reported worksite exercise facilities. Wellness programs were reported by 53.2% working for large employers, compared to 18.1% for smaller employers. CONCLUSION: Employee reports suggested that workplace supports for healthy eating, PA, and wellness were limited and were less common among smaller employers. |
Drug-induced hypothyroidism during anti-tuberculosis treatment of multidrug-resistant tuberculosis: Notes from the field
Munivenkatappa S , Anil S , Naik B , Volkmann T , Sagili KD , Akshatha JS , Buggi S , Sharada MA , Kulkarni S , Chadha VK , Moonan PK . J Tuberc Res 2016 4 (3) 105-110 We followed 188 euthyroidic persons undergoing treatment for multidrug resistant tuberculosis (MDR-TB) in the state of Karnataka, India to determine the incidence of hypothyroidism during anti-tuberculosis treatment. Overall, among MDR-TB patients with valid thyroid stimulating hormone (TSH) values, about 23% developed hypothyroidism (TSH value ≥10 mIU/ml) during anti-tuberculosis treatment; the majority (74%) occurring after 3 months of treatment. Among 133 patients who received a regimen that contained ethionamide, 42 (32%) developed hypothyroidism. Among 17 patients that received a regimen that contained para-aminosalicylate sodium, 6 (35%) developed hypothyroidism. Among 9 HIV positive patients on anti-retroviral treatment, 4 (44%) developed hypothyroidism. These results differ from previously reported 4% incidence of hypothyroidism amongst patients who passively reported thyroidal symptoms during treatment, suggesting routine serologic monitoring of TSH throughout the course of treatment for MDR-TB is warranted. |
Phthalate pregnancy exposure and male offspring growth from the intra-uterine period to five years of age
Botton J , Philippat C , Calafat AM , Carles S , Charles MA , Slama R , The Eden Mother-Child Cohort Study Group . Environ Res 2016 151 601-609 OBJECTIVE: To study associations between prenatal exposure to phthalates and fetal and postnatal growth up to age 5 years in male offspring. METHODS: Eleven phthalate metabolites were quantified in spot maternal urine samples collected during gestation among 520 women of the EDEN mother-child cohort who gave birth to a boy. Fetal growth was assessed from repeated ultrasound measurements and measurements at birth. We used repeated measures of weight and height in the first 5 years of life to model individual postnatal growth trajectories. We estimated adjusted variations in pre and postnatal growth parameters associated with an interquartile range increase in ln-transformed phthalate metabolite concentrations. RESULTS: Monocarboxyisononyl phthalate (MCNP) was positively associated with femoral length during gestation and length at birth. High molecular weight phthalate metabolites were negatively associated with estimated fetal weight throughout pregnancy. Monoethyl phthalate (MEP) showed positive association with weight growth velocity from two to five years and with body mass index at five years (beta=0.17kg/m2, 95% confidence interval, 0.04, 0.30). CONCLUSIONS: We highlighted associations between gestational exposure to some phthalates and growth in boys. The positive association between MEP and postnatal growth in boys was also reported in several previous human studies. |
Early life exposure to perfluoroalkyl substances and childhood metabolic function
Fleisch AF , Rifas-Shiman SL , Mora AM , Calafat AM , Ye X , Luttmann-Gibson H , Gillman MW , Oken E , Sagiv SK . Environ Health Perspect 2016 125 (3) 481-487 BACKGROUND: Perfluoroalkyl substances (PFASs) are synthetic chemicals that may persist in the environment and in humans. There is a possible association between early life PFAS exposure and metabolic dysfunction in later life, but data are limited. METHODS: We studied 665 mother/child pairs in Project Viva, a Boston-area cohort recruited 1999-2002. We quantified concentrations of PFASs [perfluorooctanoate (PFOA), perfluorooctane sulfonate (PFOS), perfluorononanoate (PFNA), perfluorohexane sulfonate (PFHxS), and perfluorodecanoate (PFDeA)] in maternal plasma collected at the first prenatal visit (median 9.6 weeks gestation) and in child plasma from the mid-childhood research visit (median 7.7 years). We assessed leptin, adiponectin, and homeostatic model of insulin resistance (HOMA-IR) in mid-childhood. We fit covariate-adjusted linear regression models and conducted stratified analyses by child sex. RESULTS: Children with higher PFAS concentrations had lower HOMA-IR [e.g., -10.1% (95% CI: -17.3, -2.3) per interquartile range (IQR) increment in PFOA]. This inverse association between child PFAS and HOMA-IR was more pronounced in females [e.g., PFOA: -15.6% (95% CI: -25.4, -4.6) vs. -6.1% (95% CI: -16.2, 5.2) for males]. Child PFAS plasma concentrations were not associated with leptin or adiponectin. Prenatal PFAS plasma concentrations were not associated with leptin, adiponectin, or HOMA-IR in offspring. CONCLUSIONS: We found no evidence for an adverse effect of early life PFAS exposure on metabolic function in mid-childhood. In fact, children with higher PFAS concentrations had lower insulin resistance. |
Community needs assessment after microcystin toxin contamination of a municipal water supply - Lucas County, Ohio, September 2014
McCarty CL , Nelson L , Eitniear S , Zgodzinski E , Zabala A , Billing L , DiOrio M . MMWR Morb Mortal Wkly Rep 2016 65 (35) 925-929 On August 1, 2014, routine testing at the Collins Park Water Treatment Plant in Lucas County, Ohio, revealed microcystin toxin levels in drinking water had reached 3.19 mug/L, surpassing the Ohio Environmental Protection Agency (EPA) drinking water advisory threshold of 1.0 mug/L. Microcystin is a hepatoxin released by cyanobacteria in certain harmful algal blooms. Exposure to microcystin has been associated with gastrointestinal and hepatic illness in both humans and animals (1-3). On August 2, a do-not-drink advisory was issued, warning community members not to drink, boil, or use the water for cooking or brushing teeth. Public health officials used traditional and social media outlets to disseminate public health messages to affected communities. On August 4, 2014, the advisory was lifted after multiple water samples confirmed microcystin toxin levels had dropped below the advisory threshold. To assess communication strategies, water exposure, and household needs, the Ohio Department of Health (ODH) and Toledo-Lucas County Health Department (TLCHD) conducted a Community Assessment for Public Health Emergency Response (CASPER) in Lucas County. Most households (88.1%) reported hearing about the advisory the morning it was issued, but 11% reported drinking and 21% reported brushing teeth with municipal water during the advisory. Household members reported physical (16%) and mental (10%) health concerns that they believed were related to the advisory and activity disruptions including temporarily staying outside of the home (6%) during the advisory and continued use of alternative water sources after the advisory was lifted (82%). During a do-not-drink advisory, governmental agencies and community partners need to engage in joint prevention and response efforts to decrease water exposure and prevent activity disruptions. |
A framework for monitoring progress using summary measures of health
Madans JH , Weeks JD . J Aging Health 2016 28 (7) 1299-314 OBJECTIVE: Initiatives designed to monitor health typically incorporate numerous specific measures of health and the health system to assess improvements, or lack thereof, for policy and program purposes. The addition of summary measures provides overarching information which is essential for determining whether the goals of such initiatives are met. METHOD: Summary measures are identified that relate to the individual indicators but that also reflect movement in the various parts of the system. RESULTS: A hierarchical framework that is conceptually consistent and which utilizes a succinct number of summary measures incorporating indicators of functioning and participation is proposed. DISCUSSION: While a large set of individual indicators can be useful for monitoring progress, these individual indicators do not provide an overall evaluation of health, defined broadly, at the population level. A hierarchical framework consisting of summary measures is important for monitoring the success of health improvement initiatives. |
Evaluation of efficacy, acceptability and palatability of calcium montmorillonite clay used to reduce aflatoxin B1 dietary exposure in a crossover study in Kenya
Awuor AO , Montgomery J , Yard E , Martin C , Daniel J , Zitomer N , Rybak M , Lewis L , Phillips T , Romoser A , Elmore S , Oyugi E , Amwayi S , Bii C , Vulule J . Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2016 34 (1) 93-102 Acute aflatoxin exposure can cause death and disease (aflatoxicosis) in humans. Aflatoxicosis fatality rates have been documented to be as high as 40% in Kenya. The inclusion in the diet of calcium silicate 100 (ACCS100), a calcium montmorillonite clay, may reduce aflatoxin bioavailability; thus potentially decreasing the risk of aflatoxicosis. We investigated the efficacy, acceptability, and palatability of ACCS100 in a population in Kenya with recurring aflatoxicosis outbreaks. Healthy adult participants were enrolled in this double-blinded, cross-over clinical trial in 2014. Following informed consent, participants (n=50) were randomized to receive either ACCS100 (3g/day) or placebo (3g/day) for seven days. Treatments were switched following a five-day washout period. Urine samples were collected daily and assessed for urinary aflatoxin M1 (AFM1). Blood samples were collected at the beginning and end of the trial and assessed for aflatoxin B1-lysine adducts from serum albumin (AFB1-lys). AFM1 concentrations in urine; were significantly reduced while taking ACCS100 compared to calcium carbonate placebo (beta=0.49, 95% confidence limit: 0.32-0.75). The 20 day interval included both the placebo and ACCS100 treatments as well as a washout period. There were no statistically significant differences in reported taste, aftertaste, appearance, color, or texture by treatment. There were no statistically significant differences in self-reported adverse events by treatment. Most participants would be willing to take ACCS100 (98%) and give it to their children (98%). ACCS100 was effective, acceptable, and palatable. More work is needed to test ACCS100 among vulnerable populations and to determine if ACCS100 remains effective at the levels of aflatoxin exposure that induce aflatoxicosis. |
High-Quality Genome Assembly and Annotation for Plasmodium coatneyi, Generated Using Single-Molecule Real-Time PacBio Technology.
Chien JT , Pakala SB , Geraldo JA , Lapp SA , Humphrey JC , Barnwell JW , Kissinger JC , Galinski MR . Genome Announc 2016 4 (5) Plasmodium coatneyi is a protozoan parasite species that causes simian malaria and is an excellent model for studying disease caused by the human malaria parasite, P. falciparum Here we report the complete (nontelomeric) genome sequence of P. coatneyi Hackeri generated by the application of only Pacific Biosciences RS II (PacBio RS II) single-molecule real-time (SMRT) high-resolution sequence technology and assembly using the Hierarchical Genome Assembly Process (HGAP). This is the first Plasmodium genome sequence reported to use only PacBio technology. This approach has proven to be superior to short-read only approaches for this species. |
Finishing monkeypox genomes from short reads: assembly analysis and a neural network method.
Zhao K , Wohlhueter RM , Li Y . BMC Genomics 2016 17 Suppl 5 497 BACKGROUND: Poxviruses constitute one of the largest and most complex animal virus families known. The notorious smallpox disease has been eradicated and the virus contained, but its simian sister, monkeypox is an emerging, untreatable infectious disease, killing 1 to 10 % of its human victims. In the case of poxviruses, the emergence of monkeypox outbreaks in humans and the need to monitor potential malicious release of smallpox virus requires development of methods for rapid virus identification. Whole-genome sequencing (WGS) is an emergent technology with increasing application to the diagnosis of diseases and the identification of outbreak pathogens. But "finishing" such a genome is a laborious and time-consuming process, not easily automated. To date the large, complete poxvirus genomes have not been studied comprehensively in terms of applying WGS techniques and evaluating genome assembly algorithms. RESULTS: To explore the limitations to finishing a poxvirus genome from short reads, we first analyze the repetitive regions in a monkeypox genome and evaluate genome assembly on the simulated reads. We also report on procedures and insights relevant to the assembly (from realistically short reads) of genomes. Finally, we propose a neural network method (namely Neural-KSP) to "finish" the process by closing gaps remaining after conventional assembly, as the final stage in a protocol to elucidate clinical poxvirus genomic sequences. CONCLUSIONS: The protocol may prove useful in any clinical viral isolate (regardless if a reference-strain sequence is available) and especially useful in genomes confounded by many global and local repetitive sequences embedded in them. This work highlights the feasibility of finishing real, complex genomes by systematically analyzing genetic characteristics, thus remedying existing assembly shortcomings with a neural network method. Such finished sequences may enable clinicians to track genetic distance between viral isolates that provides a powerful epidemiological tool. |
Viral deep sequencing needs an adaptive approach: IRMA, the iterative refinement meta-assembler.
Shepard SS , Meno S , Bahl J , Wilson MM , Barnes J , Neuhaus E . BMC Genomics 2016 17 (1) 708 BACKGROUND: Deep sequencing makes it possible to observe low-frequency viral variants and sub-populations with greater accuracy and sensitivity than ever before. Existing platforms can be used to multiplex a large number of samples; however, analysis of the resulting data is complex and involves separating barcoded samples and various read manipulation processes ending in final assembly. Many assembly tools were designed with larger genomes and higher fidelity polymerases in mind and do not perform well with reads derived from highly variable viral genomes. Reference-based assemblers may leave gaps in viral assemblies while de novo assemblers may struggle to assemble unique genomes. RESULTS: The IRMA (iterative refinement meta-assembler) pipeline solves the problem of viral variation by the iterative optimization of read gathering and assembly. As with all reference-based assembly, reads are included in assembly when they match consensus template sets; however, IRMA provides for on-the-fly reference editing, correction, and optional elongation without the need for additional reference selection. This increases both read depth and breadth. IRMA also focuses on quality control, error correction, indel reporting, variant calling and variant phasing. In fact, IRMA's ability to detect and phase minor variants is one of its most distinguishing features. We have built modules for influenza and ebolavirus. We demonstrate usage and provide calibration data from mixture experiments. Methods for variant calling, phasing, and error estimation/correction have been redesigned to meet the needs of viral genomic sequencing. CONCLUSION: IRMA provides a robust next-generation sequencing assembly solution that is adapted to the needs and characteristics of viral genomes. The software solves issues related to the genetic diversity of viruses while providing customized variant calling, phasing, and quality control. IRMA is freely available for non-commercial use on Linux and Mac OS X and has been parallelized for high-throughput computing. |
Epidemiology matters: peering inside the "black box" in economic evaluations of genetic testing.
Grosse SD , Khoury MJ . Genet Med 2016 18 (10) 963-5 Cost-effectiveness analyses (CEAs) of genetic testing are increasing in frequency. Such analyses can inform providers, policy makers, and payers’ coverage decisions.1 CEAs usually measure improved health outcomes in terms of either life-years gained (LYG) or quality-adjusted life-years saved (QALYs). If the cost of purchasing a LYG or QALY through the use of a new intervention (“incremental cost-effectiveness ratio”; ICER) is favorable relative to established interventions, the new intervention is considered cost-effective (i.e., good value for money). Because cost-effectiveness estimates are dependent on assumptions, it is recommended that analysts conduct sensitivity analyses to determine how sensitive cost-effectiveness conclusions are to uncertainty in the model parameters. | It can be challenging to produce reliable cost-effectiveness estimates. One reason is that the choice of a comparison intervention can significantly alter results and the inference from such analyses. For example, universal screening may appear cost-effective relative to no testing but not when compared with targeted screening strategies. Also, costs may vary greatly between countries or health systems and depend on the methods used to estimate costs. In addition, the ICER threshold below which interventions are considered cost-effective varies between and within countries. Not surprisingly, published cost-effectiveness findings for the same application often vary from cost-saving (negative total costs) to not cost-effective.2 Although most published CEAs in clinical genetics conclude that the genomic applications being evaluated are cost-effective3 because most of those genomic applications lack evidence-based guidelines, it is not clear whether the genomic applications are necessarily effective or cost-effective.4 Even for a testing application with good evidence of effectiveness, cost-effectiveness is context-dependent. |
Genetic profiles and antimicrobial resistance of Streptococcus pneumoniae non-PCV10 serotype isolates recovered from meningitis cases in Salvador, Brazil.
Azevedo J , Dos Anjos ES , Cordeiro SM , Dos Santos MS , Escobar EC , Lobo PR , Carvalho MD , Reis MG , Reis JN , Campos LC . J Med Microbiol 2016 65 (10) 1164-1170 In 2010, the 10-valent pneumococcal conjugate vaccine (PCV10) was introduced to the Brazilian childhood vaccination program. Concerns have been raised that non-vaccine serotypes could increase in prevalence and reduce the benefits of vaccination; therefore, we examined the non-PCV10 isolates recovered from meningitis during pre (January, 2008-May, 2010) and post-vaccine (June, 2010-December, 2012) periods. Surveillance for pneumococcal meningitis was established at the Reference Hospital of Infectious Diseases in Salvador, Brazil. Serotypes were determined by multiplex PCR and/or Quellung reaction. Antimicrobial susceptibility testing was conducted by E-test and broth microdilution. Genotyping employed pulsed field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). A total of 148 cases of meningitis were identified from January 2008 to December 2012, 77 (52%) of which were due to non-PCV10 isolates, with 50 (52.1%) from pre-vaccine and 27 (52%) post-vaccine periods. In the post-vaccine period, the non-PCV10 serotypes 12F (n = 6; 22.2%), 10A (n = 3; 11.1%), 15B (n = 2; 7.4%), and 18B (n = 2; 7.4%) were the most prevalent. Forty-three isolates (55.8%) were non-susceptible to one or more antibiotics. Non-susceptibility to penicillin was observed among serotypes 19A (3 isolates), 9N (1 isolate), and 12F (1 isolate). PFGE and MLST results demonstrated a wide genetic diversity among the isolates. During the early period following PCV10 introduction, no obvious emergence of a particular serotype was evident among non-PCV10 strains. This study underscores the importance of monitoring any changes among non-PCV10 cases after the introduction of PCV10. |
Rotavirus vaccine effectiveness in Hong Kong children
Yeung KH , Tate JE , Chan CC , Chan MC , Chan PK , Poon KH , Siu SL , Fung GP , Ng KL , Chan IM , Yu PT , Ng CH , Lau YL , Nelson EA . Vaccine 2016 34 (41) 4935-4942 BACKGROUND: Rotavirus is a common infectious cause of childhood hospitalisation in Hong Kong. Rotavirus vaccines have been used in the private sector since licensure in 2006 but have not been incorporated in the government's universal Childhood Immunisation Programme. This study aimed to evaluate rotavirus vaccine effectiveness against hospitalisation. METHODS: This case-control study was conducted in the 2014/2015 rotavirus season in six public hospitals. Hospitalised acute gastroenteritis patients meeting inclusion criteria were recruited and copies of their immunisation records were collected. Case-patients were defined as enrolled subjects with stool specimens obtained in the first 48h of hospitalisation that tested positive for rotavirus, whereas control-patients were those with stool specimens obtained in the first 48h of hospitalisation testing negative for rotavirus. Vaccine effectiveness for administration of at least one dose of either Rotarix(R) (GlaxoSmithKline Biologicals) or RotaTeq(R) (Merck Research Laboratories) was calculated as 1 minus the odds ratio for rotavirus vaccination history for case-patients versus control-patients. RESULTS: Among the 525 eligible subjects recruited, immunisation records were seen in 404 (77%) subjects. 31% (162/525 and 126/404) tested positive for rotavirus. In the 404 subjects assessed for vaccine effectiveness, 2.4% and 24% received at least 1 dose of either rotavirus vaccine in case- and control-patients respectively. The unmatched vaccine effectiveness against hospitalisation for administration of at least one dose of either rotavirus vaccines was 92% (95% confidence interval [CI]: 75%, 98%). The matched analyses by age only and both age and admission date showed 96% (95% CI: 72%, 100%) and 89% (95% CI: 51%, 97%) protection against rotavirus hospitalisation respectively. CONCLUSIONS: Rotavirus vaccine is highly effective in preventing hospitalisation from rotavirus disease in young Hong Kong children. |
Update on vaccine-derived polioviruses worldwide, January 2015-May 2016
Jorba J , Diop OM , Iber J , Sutter RW , Wassilak SG , Burn CC . Wkly Epidemiol Rec 2016 91 (31) 365-375 This report updates previous surveillance summaries and describes vaccine-derived polioviruses (VDPVs) detected worldwide during January 2015-May 2016. The update includes new circulating VDPV (cVDPV) outbreaks in Myanmar, Laos, Ukraine and Guinea, and sharply reduced cVDPV2 in Nigeria and Pakistan. 21 newly identified persons in 10 countries were found to excrete immunodeficiency-associated VDPVs (iVDPVs), and a patient in the UK was still excreting an iVDPV in 2015 after >29 years of chronic infection. Ambiguous VDPVs (aVDPVs) were found among immunocompetent persons and environmental samples in 19 countries. In response to the observation that the large majority of VDPV isolates are type 2, WHO coordinated the worldwide replacement of trivalent OPV (tOPV) with bivalent OPV (bOPV; types 1 and 3) in April 2016, preceded by the introduction of at least one dose of inactivated poliovirus vaccine (IPV) into routine immunization schedules in all high-risk countries. |
Acute demyelinating events following vaccines - a case centered analysis
Baxter R , Lewis E , Goddard K , Fireman B , Bakshi N , DeStefano F , Gee J , Tseng HF , Naleway AL , Klein NP . Clin Infect Dis 2016 63 (11) 1456-1462 BACKGROUND: Case reports have suggested that vaccines may trigger transverse myelitis (TM) or acute disseminated encephalomyelitis (ADEM), but the evidence for a causal association is inconclusive. We analyzed the association of immunization and subsequent development of TM or ADEM. METHODS: We identified all cases of TM and ADEM in the Vaccine Safety Datalink (VSD) population. Using a case centered method, we compared vaccination of each case to vaccination of all matched persons in the study population, who received the same type of vaccine, with respect to whether or not their vaccination occurred during a pre-determined exposure interval. We calculated a risk difference (excess risk) of TM and ADEM for each vaccine. RESULTS: Following nearly 64 million vaccine doses, only 7 cases of TM and 8 cases of ADEM were vaccinated during the primary exposure window 5-28 days prior to onset. For TM, there was no statistically significant increased risk of immunization. For ADEM, there was no statistically significant increased risk following any vaccine except for Tdap (adolescent and adult tetanus, reduced diphtheria, acellular pertussis) vaccine. Based on 2 exposed cases, the OR for Tdap exposure 5-28 days prior to ADEM onset was 15.8 (95% CI 1.2-471.6, p=0.04) and the estimated excess risk was 0.385 (-0.04-1.16) cases per million doses. CONCLUSIONS: We found no association between TM and prior immunization. There was a possible association of ADEM with Tdap vaccine, but the excess risk is not likely to be more than 1.16 cases of ADEM per million vaccines administered. |
Cessation of trivalent oral poliovirus vaccine and introduction of inactivated poliovirus vaccine - worldwide, 2016
Hampton LM , Farrell M , Ramirez-Gonzalez A , Menning L , Shendale S , Lewis I , Rubin J , Garon J , Harris J , Hyde T , Wassilak S , Patel M , Nandy R , Chang-Blanc D . MMWR Morb Mortal Wkly Rep 2016 65 (35) 934-938 Since the 1988 World Health Assembly resolution to eradicate poliomyelitis, transmission of the three types of wild poliovirus (WPV) has been sharply reduced. WPV type 2 (WPV2) has not been detected since 1999 and was declared eradicated in September 2015. Because WPV type 3 has not been detected since November 2012, WPV type 1 (WPV1) is likely the only WPV that remains in circulation. This marked progress has been achieved through widespread use of oral poliovirus vaccines (OPVs), most commonly trivalent OPV (tOPV), which contains types 1, 2, and 3 live, attenuated polioviruses and has been a mainstay of efforts to prevent polio since the early 1960s. However, attenuated polioviruses in OPV can undergo genetic changes during replication, and in communities with low vaccination coverage, can result in vaccine-derived polioviruses (VDPVs) that can cause paralytic polio indistinguishable from the disease caused by WPVs. Among the 721 polio cases caused by circulating VDPVs (cVDPVs*) detected during January 2006-May 2016, type 2 cVDPVs (cVDPV2s) accounted for >94%. Eliminating the risk for polio caused by VDPVs will require stopping all OPV use. The first stage of OPV withdrawal involved a global, synchronized replacement of tOPV with bivalent OPV (bOPV) containing only types 1 and 3 attenuated polioviruses, planned for April 18-May 1, 2016, thereby withdrawing OPV type 2 from all immunization activities. Complementing the switch from tOPV to bOPV, introduction of at least 1 dose of injectable, trivalent inactivated poliovirus vaccine (IPV) into childhood immunization schedules reduces risks from and facilitates responses to cVDPV2 outbreaks. All 155 countries and territories that were still using OPV in immunization schedules in 2015 have reported that they had ceased use of tOPV by mid-May 2016. As of August 31, 2016, 173 (89%) of 194 World Health Organization (WHO) countries included IPV in their immunization schedules. The cessation of tOPV use is a major milestone toward the global goal of eradicating polio; however, careful surveillance for polioviruses and prompt, aggressive responses to polio outbreaks are still needed to realize a polio-free world. |
The Epi Info Viral Hemorrhagic Fever (VHF) application: A resource for outbreak data management and contact tracing in the 2014-2016 West Africa Ebola epidemic
Schafer IJ , Knudsen E , McNamara LA , Agnihotri S , Rollin PE , Islam A . J Infect Dis 2016 214 S122-S136 The Epi Info Viral Hemorrhagic Fever application (Epi Info VHF) was developed in response to challenges managing outbreak data during four 2012 filovirus outbreaks. Development goals included combining case and contact data in a relational database, facilitating data-driven contact tracing, and improving outbreak data consistency and use. The application was first deployed in Guinea, when the West Africa Ebola epidemic was detected, in March 2014, and has been used in 7 African countries and 2 US states. Epi Info VHF enabled reporting of compatible data from multiple countries, contributing to international Ebola knowledge. However, challenges were encountered in accommodating the epidemic's unexpectedly large magnitude, addressing country-specific needs within 1 software product, and using the application in settings with limited Internet access and information technology support. Use of Epi Info VHF in the West Africa Ebola epidemic highlighted the fundamental importance of good data management for effective outbreak response, regardless of the software used. |
Technical packages in injury and violence prevention to move evidence into practice: Systematic reviews and beyond
Haegerich TM , David-Ferdon C , Noonan RK , Manns BJ , Billie HC . Eval Rev 2016 41 (1) 78-108 Injury and violence prevention strategies have greater potential for impact when they are based on scientific evidence. Systematic reviews of the scientific evidence can contribute key information about which policies and programs might have the greatest impact when implemented. However, systematic reviews have limitations, such as lack of implementation guidance and contextual information, that can limit the application of knowledge. "Technical packages," developed by knowledge brokers such as the federal government, nonprofit agencies, and academic institutions, have the potential to be an efficient mechanism for making information from systematic reviews actionable. Technical packages provide information about specific evidence-based prevention strategies, along with the estimated costs and impacts, and include accompanying implementation and evaluation guidance to facilitate adoption, implementation, and performance measurement. We describe how systematic reviews can inform the development of technical packages for practitioners, provide examples of technical packages in injury and violence prevention, and explain how enhancing review methods and reporting could facilitate the use and applicability of scientific evidence. |
Modeling the functional state of the reverse transcriptase of hepatitis B virus and its application to probing drug-protein interaction.
Xu X , Thai H , Kitrinos KM , Xia G , Gaggar A , Paulson M , Ganova-Raeva L , Khudyakov Y , Lara J . BMC Bioinformatics 2016 17 Suppl 8 280 BACKGROUND: Herein, the predicted atomic structures of five representative sequence variants of the reverse transcriptase protein (RT) of hepatitis B virus (HBV), sampled from patients with rapid or slow response to tenofovir disoproxil fumarate (TDF) treatment, have been examined to identify structural variations between them in order to assess structural and functional properties of HBV-RT variants associated with the differential responses to TDF treatment. RESULTS: We utilized a hybrid computational approach to model the atomistic structures of HBV-RT/DNA-RNA/dATP and HBV-RT/DNA-RNA/TFV-DP (tenofovir diphosphate) complexes with the native hybrid DNA-RNA substrate in place. Multi-nanosecond molecular dynamics (MD) simulations of HBV-RT/DNA-RNA/dATP complexes revealed strong coupling of the natural nucleotide substrate, dATP, to the active site of the RT, and the differential involvement of the two putative magnesium cations (Mg(2+)) at the active site, whereby one Mg(2+) directly bridges the interaction between dATP and HBV-RT and the other serves as a coordinator to maintain an optimal configuration of the active site. Solvated interaction energy (SIE) calculated in MD simulations of HBV-RT/DNA-RNA/TFV-DP complexes indicate no differential binding affinity between TFV-DP and HBV-RT variants identified in patients with slow or rapid response to TDF treatment. CONCLUSION: The predicted atomic structures accurately represent functional states of HBV-RT. The equivalent interaction between TFV-DP and each examined HBV-RT variants suggests that binding affinity of TFV-DP to HBV-RT is not associated with delayed viral clearance. |
Ebola Virus Disease Diagnostics, Sierra Leone: Analysis of Real-time Reverse Transcription-Polymerase Chain Reaction Values for Clinical Blood and Oral Swab Specimens.
Erickson BR , Sealy TK , Flietstra T , Morgan L , Kargbo B , Matt-Lebby VE , Gibbons A , Chakrabarti AK , Graziano J , Presser L , Flint M , Bird BH , Brown S , Klena JD , Blau DM , Brault AC , Belser JA , Salzer JS , Schuh AJ , Lo M , Zivcec M , Priestley RA , Pyle M , Goodman C , Bearden S , Amman BR , Basile A , Bergeron E , Bowen MD , Dodd KA , Freeman MM , McMullan LK , Paddock CD , Russell BJ , Sanchez AJ , Towner JS , Wang D , Zemtsova GE , Stoddard RA , Turnsek M , Guerrero LW , Emery SL , Stovall J , Kainulainen MH , Perniciaro JL , Mijatovic-Rustempasic S , Shakirova G , Winter J , Sexton C , Liu F , Slater K , Anderson R , Andersen L , Chiang CF , Tzeng WP , Crowe SJ , Maenner MJ , Spiropoulou CF , Nichol ST , Stroher U . J Infect Dis 2016 214 S258-S262 During the Ebola virus outbreak of 2013-2016, the Viral Special Pathogens Branch field laboratory in Sierra Leone tested approximately 26 000 specimens between August 2014 and October 2015. Analysis of the B2M endogenous control Ct values showed its utility in monitoring specimen quality, comparing results with different specimen types, and interpretation of results. For live patients, blood is the most sensitive specimen type and oral swabs have little diagnostic utility. However, swabs are highly sensitive for diagnostic testing of corpses. |
Biochemical and Structural Insights into the Preference of Nairoviral DeISGylases for Interferon-Stimulated Gene Product 15 Originating from Certain Species.
Deaton MK , Dzimianski JV , Daczkowski CM , Whitney GK , Mank NJ , Parham MM , Bergeron E , Pegan SD . J Virol 2016 90 (18) 8314-27 The regulation of the interferon type I (IFN-I) response has been shown to rely on posttranslational modification by ubiquitin (Ub) and Ub-like interferon-stimulated gene product 15 (ISG15) to stabilize, or activate, a variety of IFN-I signaling and downstream effector proteins. Unlike Ub, which is almost perfectly conserved among eukaryotes, ISG15 is highly divergent, even among mammals. Since zoonotic viruses rely on viral proteins to recognize, or cleave, ISG15 conjugates in order to evade, or suppress, innate immunity, the impact of ISG15 biodiversity on deISGylating proteases of the ovarian tumor family (vOTU) from nairoviruses was evaluated. The enzymatic activities of vOTUs originating from the Crimean-Congo hemorrhagic fever virus, Erve virus, and Nairobi sheep disease virus were tested against ISG15s from humans, mice, shrews, sheep, bats, and camels, which are mammalian species known to be infected by nairoviruses. This along with investigation of binding by isothermal titration calorimetry illustrated significant differences in the abilities of nairovirus deISGylases to accommodate certain species of ISG15. To investigate the molecular underpinnings of species preferences of these vOTUs, a structure was determined to 2.5 A for a complex of Erve virus vOTU protease and a mouse ISG15 domain. This structure revealed the molecular basis of Erve virus vOTU's preference for ISG15 over Ub and the first structural insight into a nonhuman ISG15. This structure also revealed key interactions, or lack thereof, surrounding three amino acids that may drive a viral deISgylase to prefer an ISG15 from one species over that of another. IMPORTANCE: Viral ovarian tumor domain proteases (vOTUs) are one of the two principal classes of viral proteases observed to reverse posttranslational modification of host proteins by ubiquitin and interferon-stimulated gene product 15 (ISG15), subsequently facilitating downregulation of IFN-I signaling pathways. Unlike the case with ubiquitin, the amino acid sequences of ISG15s from various species are notably divergent. We illustrate that vOTUs have clear preferences for ISG15s from certain species. In addition, these observations are related to the molecular insights acquired via the first X-ray structure of the vOTU from the Erve nairovirus in complex with the first structurally resolved nonhuman ISG15. This information implicates certain amino acids that drive the preference of vOTUs for ISG15s from certain species. |
Ebola Virus Replication and Disease Without Immunopathology in Mice Expressing Transgenes to Support Human Myeloid and Lymphoid Cell Engraftment.
Spengler JR , Lavender KJ , Martellaro C , Carmody A , Kurth A , Keck JG , Saturday G , Scott DP , Nichol ST , Hasenkrug KJ , Spiropoulou CF , Feldmann H , Prescott J . J Infect Dis 2016 214 S308-S318 The study of Ebola virus (EBOV) pathogenesis in vivo has been limited to nonhuman primate models or use of an adapted virus to cause disease in rodent models. Herein we describe wild-type EBOV (Makona variant) infection of mice engrafted with human hematopoietic CD34+ stem cells (Hu-NSG-SGM3 mice; hereafter referred to as SGM3 HuMice). SGM3 HuMice support increased development of myeloid immune cells, which are primary EBOV targets. In SGM3 HuMice, EBOV replicated to high levels, and disease was observed following either intraperitoneal or intramuscular inoculation. Despite the high levels of viral antigen and inflammatory cell infiltration in the liver, the characteristic histopathology of Ebola virus disease was not observed, and this absence of severe immunopathology may have contributed to the recovery and survival of some of the animals. Future investigations into the underlying mechanisms of the atypical disease presentation in SGM3 HuMice will provide additional insights into the immunopathogenesis of severe EBOV disease. |
Synthesis and evaluation of biotinylated bivalent histoblood group antigens for capturing human noroviruses
Dhawane AN , Diez-Valcarce M , Gurale BP , Dinh H , Vinje J , Iyer SS . Bioconjug Chem 2016 27 (8) 1822-9 A panel of biotinylated bivalent H-type glycans that have been reported as binding ligands for human noroviruses were synthesized using a modular synthetic strategy. These glycoconjugates were attached to streptavidin-coated magnetic beads and used to recover human norovirus from fecal samples using a magnetic bead-based assay. The biotinylated bivalent glycans synthesized for this study exhibited similar or better capturing ability when compared to commercial biotinylated glycopolymers. |
Miniature differential mobility analyzer for compact field-portable spectrometers
Qi C , Kulkarni P . Aerosol Sci Technol 2016 50 (11) 1145-1154 A low-flow miniature differential mobility analyzer (mDMA) has been developed for compact field-portable mobility spectrometers to classify the submicrometer aerosol. The mDMA was designed for an ultra-low aerosol flow rate of 0.05 L/min. At a sheath flow rate of 0.2 L/min, the mDMA's upper size limit was estimated to be about 921 nm. The mDMA has a classification zone of 2.54 cm long, an outer diameter of 2.54 cm, and an inner diameter of 1.778 cm. The design allows low-cost fabrication and easy assembly. Tandem DMA measurements were carried out to evaluate the performance of the mDMA. Its transfer function was described using Stolzenburg's model. The experimentally measured transfer function shows close agreement with the theory. The transmission efficiency was comparable to that of the Knutson–Whitby DMA for particles in the range of 10–1000 nm. The mobility resolution was comparable to that of the TSI 3085 nanoDMA at the same aerosol flow rate. The design features and performance of the mDMA make it suitable for compact field portable mobility size spectrometers for measurement of nanoparticles and submicrometer aerosol. © 2016 This article not subject to U.S. copyright law |
Non-human primate antibody response to mosquito salivary proteins: Implications for dengue virus transmission in Puerto Rico
Hemme RR , Poole-Smith BK , Hunsperger EA , Felix GE , Horiuchi K , Biggerstaff BJ , Lopez-Ortiz R , Barrera R . Acta Trop 2016 164 369-374 An important step to incriminate a mosquito as a vector of a disease pathogen is finding evidence of direct contact between the mosquito and humans. Typically, this is accomplished through landing/biting catches, or host blood meal analysis in engorged mosquitoes via immunologic assays. An alternate approach is to identify the presence of specific mosquito anti-saliva protein antibodies in the blood of exposed hosts. Following the discovery of dengue infected, free roaming non-human primates in Puerto Rico, we investigated which mosquito species had bitten these primates using a serologic assay. Serum samples from 20 patas monkeys (Erythrocebus patas) and two rhesus macaques (Macaca mulatta) were used to evaluate mosquito bite exposure to Aedes aegypti, Aedes mediovittatus, Aedes taeniorhynchus, and Culex quinquefasciatus mosquitoes. Of 22 non-human primates examined 20 (90%), 17 (77%), 13 (59%), and 7 (31%) were positive for exposure to Ae. mediovittatus, Cx. quinquefasciatus, Ae. taeniorhynchus, and Ae. aegypti, respectively. Our findings indicated that free-roaming primates in Puerto Rico were exposed to the bites of one proven dengue vector, Ae. aegypti and one potential dengue vector, Ae. mediovittatus. |
Plasmodium cynomolgi infections in rhesus macaques display clinical and parasitological features pertinent to modelling vivax malaria pathology and relapse infections
Joyner C , Moreno A , Meyer EV , Cabrera-Mora M , Kissinger JC , Barnwell JW , Galinski MR . Malar J 2016 15 (1) 451 BACKGROUND: Plasmodium vivax infections in humans or in new world monkeys pose research challenges that necessitate the use of alternative model systems. Plasmodium cynomolgi is a closely related species that shares genetic and biological characteristics with P. vivax, including relapses. Here, the haematological dynamics and clinical presentation of sporozoite-initiated P. cynomolgi infections in Macaca mulatta (rhesus macaques) are evaluated over a 100-day period. METHODS: Five M. mulatta were inoculated with 2000 P. cynomolgi B strain sporozoites. Parasitological and haematological data were collected daily to study the clinical presentations of primary infections and relapses. Peripheral blood and bone marrow aspirates were collected at specific time points during infection for future and retrospective systems biology analyses. RESULTS: Patent infections were observed between days 10 and 12, and the acute, primary infection consisted of parasitaemias ranging from 269,962 to 1,214,842 parasites/microl (4.42-19.5 % parasitaemia). All animals presented with anaemia, ranging from moderate (7-10 g/dl) to severe (<7 g/dl), based on peripheral haemoglobin concentrations. Minimum haemoglobin levels coincided with the clearance of parasites and peripheral reticulocytosis was evident at this time. Mild thrombocytopaenia (<150,000 platelets/microl) was observed in all animals, but unlike haemoglobin, platelets were lowest whenever peripheral parasitaemia peaked. The animals' conditions were classified as non-severe, severe or lethal (in one case) based upon their clinical presentation. The lethal phenotype presented uniquely with an exceptionally high parasitaemia (19.5 %) and lack of a modest reticulocyte release, which was observed in the other animals prior to acute manifestations. One or two relapses were observed in the four surviving animals, and these were characterized by significantly lower parasitaemias and minimal changes in clinical parameters compared to pre-infection values. CONCLUSIONS: Rhesus macaque infections initiated by P. cynomolgi B strain sporozoites recapitulated pathology of human malaria, including anaemia and thrombocytopaenia, with inter-individual differences in disease severity. Importantly, this study provides an in-depth assessment of clinical and parasitological data, and shows that unlike the primary infections, the relapses did not cause clinical malaria. Notably, this body of research has provided experimental plans, large accessible datasets, and blood and bone marrow samples pertinent for ongoing and iterative systems biology investigations. |
Gaps in adolescent engagement in antenatal care and prevention of mother-to-child HIV transmission services in Kenya
Ronen K , McGrath CJ , Langat AC , Kinuthia J , Omolo D , Singa B , Katana AK , Ng'Ang ALw , John-Stewart G . J Acquir Immune Defic Syndr 2016 74 (1) 30-37 BACKGROUND: Rates of pregnancy and HIV infection are high among adolescents. However, their engagement in prevention of mother-to-child HIV transmission (PMTCT) services is poorly characterized. We compared engagement in the PMTCT cascade between adult and adolescent mothers in Kenya. METHODS: We conducted a nationally representative cross-sectional survey of mother-infant pairs attending 120 maternal child health clinics selected by probability-proportionate-to-size-sampling, with a secondary survey oversampling HIV-positive mothers in 30 clinics. ANC attendance, HIV testing and ARV use were compared between adolescent (age ≤19) and adult mothers using Chi-square tests and logistic regression. RESULTS: Among 2521 mothers, 278 (12.8%) were adolescents. Adolescents were less likely than adults to be employed (16.5% vs. 37.9%), married (66.1% vs. 88.3%), have intended pregnancy (40.5% vs. 58.6%), or have disclosed their HIV status (77.5% vs. 90.7%) (p<0.01 for all). Adolescents were less likely than adults to attend ≥4 ANC visits (35.2% vs. 45.6%, p=0.002). This effect remained significant when adjusting for employment, household crowding, pregnancy intention, gravidity and HIV status (aOR[95% CI]=0.54[0.37-0.97], p=0.001). Among 2359 women without previous HIV testing, 96.1% received testing during pregnancy; testing levels did not differ between adolescents and adults. Among 288 HIV-positive women not on ART prior to pregnancy, adolescents were less likely than adults to be on ARVs (65.0% vs. 85.8%, p=0.01) or to have infants on ARVs (85.7% vs. 97.7%, p=0.005). CONCLUSIONS: Adolescent mothers had poorer ANC attendance and uptake of ARVs for PMTCT. Targeted interventions are needed to improve retention of this vulnerable population in the PMTCT cascade. |
Respirator use in a hospital setting: Establishing surveillance metrics
Yarbrough MI , Ficken ME , Lehmann CU , Talbot TR , Swift MD , McGown PW , Wheaton RF , Bruer M , Little SW , Oke CA . J Int Soc Respir Prot 2016 33 (1) 1-11 Information that details use and supply of respirators in acute care hospitals is vital to prevent disease transmission, assure the safety of health care personnel, and inform national guidelines and regulations. OBJECTIVE: To develop measures of respirator use and supply in the acute care hospital setting to aid evaluation of respirator programs, allow benchmarking among hospitals, and serve as a foundation for national surveillance to enhance effective Personal Protective Equipment (PPE) use and management. METHODS: We identified existing regulations and guidelines that govern respirator use and supply at Vanderbilt University Medical Center (VUMC). Related routine and emergency hospital practices were documented through an investigation of hospital administrative policies, protocols, and programs. Respirator dependent practices were categorized based on hospital workflow: Prevention (preparation), patient care (response), and infection surveillance (outcomes). Associated data in information systems were extracted and their quality evaluated. Finally, measures representing major factors and components of respirator use and supply were developed. RESULTS: Various directives affecting multiple stakeholders govern respirator use and supply in hospitals. Forty-seven primary and secondary measures representing factors of respirator use and supply in the acute care hospital setting were derived from existing information systems associated with the implementation of these directives. CONCLUSION: Adequate PPE supply and effective use that limit disease transmission and protect health care personnel are dependent on multiple factors associated with routine and emergency hospital practices. We developed forty-seven measures that may serve as the basis for a national PPE surveillance system, beginning with standardized measures of respirator use and supply for collection across different hospital types, sizes, and locations to inform hospitals, government agencies, manufacturers, and distributors. Despite involvement of multiple hospital stakeholders, regulatory guidance prescribes workplace practices that are likely to result in similar workflows across hospitals. Future work will explore the feasibility of implementing the collection and reporting of standardized measures in multiple facilities. |
Low back pain among office workers in three Spanish-speaking countries: Findings from the CUPID study
Campos-Fumero A , Delclos GL , Douphrate DI , Felknor SA , Vargas-Prada S , Serra C , Coggon D , Gimeno Ruiz de Porras D . Inj Prev 2016 23 (3) 158-164 OBJECTIVES: To assess the differences in the prevalence and incidence of low back pain (LBP) and associated disability among office workers in Costa Rica, Nicaragua and Spain. METHODS: Data were collected at baseline (n=947, 93% response) in November 2007 and at follow-up after 12 months (n=853, 90% response). Six outcome measures were examined: baseline prevalence of (1) LBP in the past 12 months, (2) LBP in the past month and (3) disabling LBP in the past month; and at follow-up: (4) incidence of new LBP in the past month, (5) new disabling LBP and (6) persistent LBP. Differences in prevalence by country were characterised by ORs with 95% CIs, before and after adjustment for covariates. RESULTS: Prevalence of LBP in the past month among office employees in Costa Rica (46.0%) and Nicaragua (44.2%) was higher than in Spain (33.6%). Incidence of new LBP was 37.0% in Nicaragua (OR=2.49; 95% CI 1.57 to 3.95), 14.9% in Costa Rica (OR=0.74; 95% CI 0.41 to 1.34) and 19.0% in Spain (reference). Incidence of new disabling LBP was higher in Nicaragua (17.2%; OR=2.49; 95% CI 1.43 to 4.34) and Costa Rica (13.6%; OR=1.89; 95% CI 1.03 to 3.48) than Spain (7.7%), while persistence of LBP was higher only in Nicaragua. CONCLUSIONS: Prevalence of LBP and disabling LBP was higher in Costa Rican and Nicaraguan office workers than in Spain, but the incidence was higher mainly in Nicaragua. Measured sociodemographic, job-related and health-related variables only partly explained the differences between countries, and further research is needed to explore reasons for the remaining differences. |
Jackleg drill injuries
Clark CC , Benton DJ , Seymour JB , Martin LA . Min Eng 2016 68 (8) 57-62 The U.S. National Institute for Occupational Safety and Health (NIOSH) is conducting research on jackleg use and related accidents in underground metal mines. This paper provides an analysis and overview of jackleg drill usage, accidents, operational characteristics and alternatives, based on information from injury reports, legacy research, stakeholder input and published literature. The results indicate that jackleg drills are involved in more groundfall accidents in underground metal mines than any other drill, and jackleg-drill-related injuries are most prevalent at the face in the course of installing initial ground support. Practical mechanized alternatives to jackleg drills for drilling and bolting under incomplete support in narrow underground openings have not yet been realized. Small, versatile mechanized bolting equipment needs to be developed to address jackleg-drill-related accidents and improve safety at mines where jackleg drills are being used. Metallurgy and Exploration. |
Pathways to program success: A qualitative comparative analysis (QCA) of communities putting prevention to work case study programs
Kane H , Hinnant L , Day K , Council M , Tzeng J , Soler R , Chambard M , Roussel A , Heirendt W . J Public Health Manag Pract 2016 23 (2) 104-111 OBJECTIVE: To examine the elements of capacity, a measure of organizational resources supporting program implementation that result in successful completion of public health program objectives in a public health initiative serving 50 communities. DESIGN: We used crisp set Qualitative Comparative Analysis (QCA) to analyze case study and quantitative data collected during the evaluation of the Communities Putting Prevention to Work (CPPW) program. SETTING: CPPW awardee program staff and partners implemented evidence-based public health improvements in counties, cities, and organizations (eg, worksites, schools). PARTICIPANTS: Data came from case studies of 22 CPPW awardee programs that implemented evidence-based, community- and organizational-level public health improvements. INTERVENTION: Program staff implemented a range of evidence-based public health improvements related to tobacco control and obesity prevention. MAIN OUTCOME MEASURE: The outcome measure was completion of approximately 60% of work plan objectives. RESULTS: Analysis of the capacity conditions revealed 2 combinations for completing most work plan objectives: (1) having experience implementing public health improvements in combination with having a history of collaboration with partners; and (2) not having experience implementing public health improvements in combination with having leadership support. CONCLUSION: Awardees have varying levels of capacity. The combinations identified in this analysis provide important insights into how awardees with different combinations of elements of capacity achieved most of their work plan objectives. Even when awardees lack some elements of capacity, they can build it through strategies such as hiring staff and engaging new partners with expertise. In some instances, lacking 1 or more elements of capacity did not prevent an awardee from successfully completing objectives. IMPLICATIONS FOR POLICY & PRACTICE: These findings can help funders and practitioners recognize and assemble different aspects of capacity to achieve more successful programs; awardees can draw on extant organizational strengths to compensate when other aspects of capacity are absent. |
Perspectives on the strategic uses of concept mapping to address public health challenges
Anderson LA , Slonim A . Eval Program Plann 2016 60 194-201 We examine the adaptation of approaches used to plan and implement the steps of concept mapping to meet specialized needs and requirements in several public health projects. Seven published concept mapping projects are detailed to document how each of the phases were modified to meet the specific aims of each project. Concept mapping was found to be a useful tool to complement public health roles such as assessment, program development, and priority setting. The phases of concept mapping allow for a blending of diverse perspectives, which is critical to public health efforts. The adaptability of concept mapping permits the use of multiple modalities such as the addition of face-to-face brainstorming; use of qualitative methods, including structured interviews; and review and use of published literature and guidelines. Another positive aspect of concept mapping for public health practice is its ability to identify program elements, provide a visual map of generated ideas and their relationships to one another, and assist in identifying priorities. Our reflections on the adaptability should help inform another generation in designing concept mapping projects and related products that may benefit from unique adaptations and the rapidly expanding social media technology and platforms. |
CDC's "flexible" epidemiologist: A strategy for enhancing health department infectious disease epidemiology capacity
Chung C , Fischer LS , O'Connor A , Shultz A . J Public Health Manag Pract 2016 23 (3) 295-301 CONTEXT: CDC's Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) Cooperative Agreement aims to help health departments strengthen core epidemiology capacity needed to respond to a variety of emerging infectious diseases. In fiscal year 2014, $6 million was awarded to 41 health departments for flexible epidemiologists (FEs). FEs were intended to help meet health departments' unique needs and support unanticipated events that could require the diversion of resources to specific emerging or reemerging diseases. OBJECTIVE: Explore multiple perspectives to characterize how FEs are utilized and to understand the perceived value of this strategy from the health department perspective. DESIGN, SETTING, AND PARTICIPANTS: We conducted 14 in-depth interviews using a semistructured questionnaire with a heterogeneous sample of 8 state health departments; 2 different instruments were administered to ELC principal investigators (PIs) or supervisors, and FEs. The team produced a codebook consisting of both structural and data-driven codes to prepare for a thematic analysis of the data. RESULTS: Three major patterns emerged to describe how FEs are being used in health departments; most commonly, FEs were used to support priorities and gaps across a range of infectious diseases, with an emphasis on enteric diseases. Almost all of the health departments utilized FEs to assist in investigating and responding to outbreaks, maintaining and upgrading surveillance systems, and coordinating and collaborating with partners. Both PIs and supervisors highly valued the flexibility it offered to their programs because FEs were cross-trained and could be used to help with situations where additional staff members were needed. CONCLUSION: ELC enhances epidemiology capacity in health departments by providing flexible personnel that help sustain areas with losses in capacity, addressing programmatic gaps, and supporting unanticipated events. Our findings support the notion that flexible personnel could be an effective model for strengthening epidemiology capacity among health departments. IMPLICATIONS FOR POLICY & PRACTICE: Our findings have practical implications for addressing the overall decline in the public health workforce, as well as the current context and environment of public health funding at both state and federal levels. |
Removing medical barriers to contraception - evidence-based recommendations from the Centers for Disease Control and Prevention, 2016
Curtis KM , Tepper NK , Jatlaoui TC , Whiteman MK . Contraception 2016 94 (6) 579-581 Good news! For the first time in three decades, the unintended pregnancy rate in the United States has dropped — from over 50% during 1981–2008 to 45% between 2008 and 2011 [1]. The US teen pregnancy rate has been falling for some time and is at a historic low [2]. At the same time, overall contraceptive use in the United States has remained fairly steady at about 60% among all females ages 15–44 years, but recently, use of the most effective, long-acting, reversible methods (LARCs) — intrauterine devices (IUDs) and implants — has been increasing [3], [4], [5]. Several large projects, including the Contraceptive Choice Project, family planning initiatives in Colorado and Iowa, and a randomized cluster trial of a clinical training intervention, have demonstrated success in increasing the use of contraception overall, including the most effective methods, and most importantly, decreasing unintended pregnancy and abortion rates [6], [7], [8], [9]. Finally, the Affordable Care Act requires most health plans to cover certain preventive services for women, including contraceptive methods and counseling [10], [11]. |
Urinary concentrations of cyclohexane-1,2-dicarboxylic acid monohydroxy isononyl ester, a metabolite of the non-phthalate plasticizer di(isononyl)cyclohexane-1,2-dicarboxylate (DINCH), and markers of ovarian response among women attending a fertility center
Minguez-Alarcon L , Souter I , Chiu YH , Williams PL , Ford JB , Ye X , Calafat AM , Hauser R . Environ Res 2016 151 595-600 Di(isononyl)cyclohexane-1,2-dicarboxylate (DINCH), a non-phthalate plasticizer, was introduced commercially in 2002 as an alternative to ortho-phthalate esters because of its favorable toxicological profile. However, the potential health effects from DINCH exposure remain largely unknown. We explored the associations between urinary concentrations of metabolites of DINCH on markers of ovarian response among women undergoing in vitro fertilization (IVF) treatments. Between 2011 and 2015, 113 women enrolled a prospective cohort study at the Massachusetts General Hospital Fertility Center and provided up to two urine samples prior to oocyte retrieval. The urinary concentrations of two DINCH metabolites, cyclohexane-1,2-dicarboxylic acid monohydroxy isononyl ester (MHiNCH) and cyclohexane-1,2-dicarboxylic acid monocarboxyisooctyl ester (MCOCH), were quantified by isotope dilution tandem mass spectrometry. We used generalized linear mixed models to evaluate the association between urinary metabolite concentrations and markers of ovarian response, accounting for multiple IVF cycles per woman via random intercepts. On average, women with detectable urinary MHiNCH concentrations, as compared to those below LOD, had a lower estradiol levels (-325 pmol/l, p=0.09) and number of retrieved oocytes (-1.8, p=0.08), with a stronger association among older women. However, urinary MHiNCH concentrations were unrelated to mature oocyte yield and endometrial wall thickness. In conclusion, we found suggestive negative associations between urinary MHiNCH concentrations and peak estradiol levels and number of total oocyte yields. This is the first study evaluating the effect of DINCH exposure on human reproductive health and raises the need for further experimental and epidemiological studies to better understand the potential effects of this chemical on health. |
National and state-specific attitudes toward smoke-free parks among U.S. adults
Kruger J , Jama A , Kegler M , Marynak K , King B . Int J Environ Res Public Health 2016 13 (9) Outdoor places, such as parks, remain a source of secondhand smoke (SHS) exposure. We assessed attitudes toward smoke-free parks among U.S. adults. Data came from the 2009-2010 National Adult Tobacco Survey, a landline and cellular telephone survey of noninstitutionalized adults aged ≥18 in the 50 U.S. states and D.C. Descriptive statistics and logistic regression were used to assess the prevalence and sociodemographic correlates of attitudes toward smoke-free parks, overall and by current tobacco use. Overall, 38.5% of adults reported favorable attitudes toward complete smoke-free parks; prevalence ranged from 29.2% in Kentucky to 48.2% in Maine. Prevalence of favorable attitudes toward smoke-free parks was higher among nonusers of tobacco (44.6%) and noncombustible-only users (30.0%) than any combustible users (21.3%). The adjusted odds of having a favorable attitude were higher among: women; Hispanics and Black non-Hispanics, American Indian and Alaska Native non-Hispanics, and other non-Hispanics; those with an unspecified sexual orientation; and those with children aged ≤17 in the household, relative to each characteristics respective referent group. Odds were lower among: any combustible tobacco and noncombustible-only tobacco users; adults aged 45-64; and those with some college or an undergraduate degree. Opportunities exist to educate the public about the benefits of smoke-free outdoor environments. |
Attitudes toward prohibiting tobacco sales in pharmacy stores among U.S. adults
Wang TW , Agaku IT , Marynak KL , King BA . Am J Prev Med 2016 51 (6) 1038-1043 INTRODUCTION: Pharmacy stores are positioned to cultivate health and wellness among patrons. This study assessed attitudes toward prohibiting tobacco product sales in pharmacy stores among U.S. adults. METHODS: Data from the 2014 Summer Styles, an Internet survey of U.S. adults aged ≥18 years (n=4,269), were analyzed in 2015. Respondents were asked: Do you favor or oppose banning the sale of all tobacco products in retail pharmacy stores? Responses were: strongly favor, somewhat favor, somewhat oppose, and strongly oppose. Prevalence ratios were calculated using multivariate Poisson regression to determine sociodemographic correlates of favorability (strongly or somewhat). RESULTS: Among all adults, 66.1% "strongly" or "somewhat" favored prohibiting tobacco product sales in pharmacy stores. Favorability was 46.5% among current cigarette smokers, 66.3% among former smokers, and 71.8% among never smokers. Favorability was 47.8% among current non-cigarette tobacco users, 63.2% among former users, and 71.4% among never users. Following adjustment, favorability was more likely among women compared with men (p<0.05). Conversely, favorability was less likely among the following: adults aged 25-44 years and 45-64 years compared with those aged ≥65 years, those with annual household income of $15,000-$24,999 compared with ≥$60,000, current cigarette smokers compared with never smokers, and current and former non-cigarette tobacco users compared with never tobacco users (p<0.05). CONCLUSIONS: Most U.S. adults favor prohibiting tobacco sales in retail pharmacy stores. Eliminating tobacco product sales in these settings may reinforce pharmacy stores' efforts to promote wellness, and further cultivate social climates that reduce the desirability, acceptability, and accessibility of tobacco. |
Raccoon roundworm infection associated with central nervous system disease and ocular disease - six states, 2013-2015
Sircar AD , Abanyie F , Blumberg D , Chin-Hong P , Coulter KS , Cunningham D , Huskins WC , Langelier C , Reid M , Scott BJ , Shirley DA , Babik JM , Belova A , Sapp SG , McAuliffe I , Rivera HN , Yabsley MJ , Montgomery SP . MMWR Morb Mortal Wkly Rep 2016 65 (35) 930-933 Baylisascaris procyonis, predominantly found in raccoons, is a ubiquitous roundworm found throughout North America. Although raccoons are typically asymptomatic when infected with the parasite, the larval form of Baylisascaris procyonis can result in fatal human disease or severe neurologic outcomes if not treated rapidly. In the United States, Baylisascaris procyonis is more commonly enzootic in raccoons in the midwestern and northeastern regions and along the West Coast. However, since 2002, infections have been documented in other states (Florida and Georgia) and regions. Baylisascariasis is not a nationally notifiable disease in the United States, and little is known about how commonly it occurs or the range of clinical disease in humans. Case reports of seven human baylisascariasis cases in the United States diagnosed by Baylisascaris procyonis immunoblot testing at CDC are described, including review of clinical history and laboratory data. Although all seven patients survived, approximately half were left with severe neurologic deficits. Prevention through close monitoring of children at play, frequent handwashing, and clearing of raccoon latrines (communal sites where raccoons defecate) are critical interventions in curbing Baylisascaris infections. Early treatment of suspected cases is critical to prevent permanent sequelae. |
Interagency and commercial collaboration during an investigation of chikungunya and dengue among returning travelers to the United States
Jentes ES , Millman AJ , Decenteceo M , Klevos A , Biggs HM , Esposito DH , McPherson H , Sullivan C , Voorhees D , Watkins J , Anzalone FL , Gaul L , Flores S , Brunette GW , Sotir MJ . Am J Trop Med Hyg 2016 96 (2) 265-267 Public health investigations can require intensive collaboration between numerous governmental and nongovernmental organizations. We describe an investigation involving several governmental and nongovernmental partners that was successfully planned and performed in an organized, comprehensive, and timely manner with several governmental and nongovernmental partners. |
Knowledge and use of prevention measures for chikungunya virus among visitors - Virgin Islands National Park, 2015
Cherry CC , Beer KD , Fulton C , Wong D , Buttke D , Staples JE , Ellis EM . Travel Med Infect Dis 2016 14 (5) 475-480 BACKGROUND: In June 2014, the mosquito-borne chikungunya virus (CHIKV) emerged in the U.S. Virgin Islands (USVI), a location where tourists comprise the majority of the population during peak season (January-April). Limited information is available concerning visitors' CHIKV awareness and prevention measures. METHODS: We surveyed a convenience sample of Virgin Islands National Park visitors aged ≥18 years. Respondents completed a questionnaire assessing CHIKV knowledge, attitudes, and practices; health information-seeking practices; and demographics. RESULTS: Of 783 persons contacted, 443 (57%) completed the survey. Fewer than half (208/441 [47%]) were aware of CHIKV. During trip preparation, 28% of respondents (126/443) investigated USVI-specific health concerns. Compared with persons unaware of CHIKV, CHIKV-aware persons were more likely to apply insect repellent (134/207 [65%] versus 111/231 [48%]; p < 0.001), wear long-sleeves and long pants (84/203 [41%] versus 57/227 [25%]; p < 0.001), and wear insect repellent-treated clothing (36/204 [18%] versus 22/227 [10%]; p = 0.02). CONCLUSIONS: The majority of visitors surveyed did not research destination-related health concerns and were unaware of CHIKV. However, CHIKV awareness was associated with using multiple prevention measures to reduce disease risk. These findings underscore the importance of providing tourists with disease education upon destination arrival. |
Bunyaviruses are common in male and female Ixodes scapularis ticks in central Pennsylvania
Sakamoto JM , Ng TF , Suzuki Y , Tsujimoto H , Deng X , Delwart E , Rasgon JL . PeerJ 2016 4 e2324 The blacklegged tick Ixodes scapularis is widely distributed in the United States and transmits multiple pathogens to humans, wildlife and domestic animals. Recently, several novel viruses in the family Bunyaviridae (South Bay virus (SBV) and Blacklegged tick phlebovirus (BTPV)) were identified infecting female I. scapularis ticks collected in New York State. We used metagenomic sequencing to investigate the distribution of viruses infecting male and female I. scapularis ticks collected in Centre County, Pennsylvania. We identified both SBV and BTPV in both male and female ticks from all collection locations. The role of male I. scapularis in pathogen epidemiology has been overlooked because they rarely bite and are not considered important pathogen vectors. However, males may act as reservoirs for pathogens that can then be transmitted to females during mating. Our data highlight the importance of examining all potential avenues of pathogen maintenance and transmission throughout the vector-pathogen life cycle in order to understand the epidemiology of tick-borne pathogens. |
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