Spinal glia and chronic pain
O'Callaghan JP , Miller DB . Metabolism 2010 59 Suppl 1 S21-6 Therapeutic management of chronic pain has not been widely successful owing to a lack of understanding of factors that initiate and maintain the chronic pain condition. Efforts to delineate the mechanisms underlying pain long have focused on neuronal elements of pain pathways, and both opiate- and non-opiate-based therapeutics are thought largely to target neurons. Abnormal neuronal activity at the level of spinal cord "pain centers" in the dorsal horn leads to hypersensitivity or a hyperalgesic response subsequent to the initial painful stimulus. Only recently has the experimental literature implicated nonneuronal elements in pain because of the realization that glial-derived signaling molecules can contribute to and modulate pain signaling in the spinal cord. Most notably, glial proinflammatory mediators within the dorsal horn of the spinal cord appear to contribute to self-perpetuating pain. Chronic pain is modeled experimentally through a variety of manipulations of sensory nerves including cutting, crushing, resection, and ligation. The cellular and molecular responses in the spinal cord due to these manipulations often reveal activation of 2 types of glia: microglia and astrocytes. The activation states of both microglia and astrocytes are complex and may be driven by underlying chronic neuropathology and/or a chronically "primed" condition that accounts for their contribution to chronic pain. Recent evidence even suggests that opioid tolerance and withdrawal hyperalgesia may be initiated and maintained via actions of microglia and astroglia. Together, these recent findings suggest that glia will serve as novel therapeutic targets for the treatment of chronic pain. To fully exploit glia as novel therapeutic targets will require a greater understanding of glial biology, as well as the identification of agents able to control the glial reactions involved in chronic pain, without interfering with beneficial glial functions. |
Prevalence of monoclonal B-cell lymphocytosis: a systematic review
Shim YK , Middleton DC , Caporaso NE , Rachel JM , Landgren O , Abbasi F , Raveche ES , Rawstron AC , Orfao A , Marti GE , Vogt RF . Cytometry B Clin Cytom 2010 78 Suppl 1 S10-8 BACKGROUND: Individuals with monoclonal B-cell lymphocytosis (MBL) have been identified in clinic outpatients, in unaffected relatives of patients with chronic lymphocytic leukemia (CLL), and in general populations. MBL and its relationship with CLL have been actively investigated over the last decade. This report systematically reviews the prevalence of MBL in the context of the populations studied and the evolution of laboratory methods used to define MBL. METHODS: To identify published studies that have assessed the prevalence of MBL, we systematically searched the MEDLINE databases and consulted with members of the International MBL Study Group. We reviewed the 10 articles that were identified by this process. We abstracted information on study populations, laboratory tests, criteria for designating MBL, and the reported frequencies. RESULTS: Three of the ten studies were published in 2009, three between 2007 and 2008, and four between 2002 and 2004. Reported prevalences varied widely, ranging from 0.12 to 18.2%. This variability was clearly associated with both the laboratory methods and the populations studied. MBL was more common among older individuals and kindred of persons with CLL. The most common MBL subtype was CLL-like MBL. CONCLUSIONS: Large population-based studies of MBL that employ standardized laboratory methods with a consensus case definition are needed to assess prevalence and establish risk factors. These studies should include prospective follow-up of MBL cases to determine the relationship between MBL and CLL. Data from original studies should be reported in sufficient detail to allow future synthesis of information from multiple studies, such as meta-analysis. |
Recovery of a multidrug-resistant strain of pandemic influenza A 2009 (H1N1) virus carrying a dual H275Y/I223R mutation from a child after prolonged treatment with Oseltamivir
Nguyen HT , Fry AM , Loveless PA , Klimov AI , Gubareva LV . Clin Infect Dis 2010 51 (8) 983-4 Resistance to oseltamivir in strains of the pandemic influenza A 2009 (H1N1) virus, although rare, has been reported worldwide [1]. The oseltamivir resistance is caused by a single mutation, H275Y, in the neuraminidase, which does not affect susceptibility to zanamivir. Here we report an influenza A 2009 (H1N1) virus strain with 2 neuraminidase mutations (H275Y and I223R) with laboratory evidence for multidrug resistance. | The patient, a 14-year-old girl with systemic lupus erythematosus, systemic vasculitis, and chronic pancreatitis who was receiving immune-suppressing medications, was hospitalized with respiratory failure and tested positive for influenza A 2009 (H1N1) on 13 October 2009. Oseltamivir was administered in dosages of 60 mg twice daily (13–16 October) and 150 mg twice daily (16–23 October) and was restarted at a dosage of 120 mg twice daily (1–14 November) for fever. During the period 23–28 November, she was treated with intravenous zanamivir (420 mg twice daily) because of persistent influenza A 2009 (H1N1) detection and suspicion of oseltamivir resistance. She died of complications on 26 December. |
Hepatitis delta: seek and ye shall find
Holmberg SD , Ward JW . J Infect Dis 2010 202 (6) 822-4 Hepatitis delta virus (HDV) was discovered in 1977 by Rizzetto and colleagues [1], and—as he expressed it 30 years later—HDV “would have possibly died away as another odd antigenic subtype” of hepatitis B virus (HBV) had it not been for an international collaboration among investigators from Turin, Italy, the National Institutes of Health, and Georgetown University [2]. Chimpanzee experiments demonstrated that the delta antigen, rather than being a component of HBV, was its own defective form that required HBV for its infection and replication, a “virus's virus.” Dual HBV-HDV infection was quickly recognized to have worldwide distribution, to be associated with more severe and rapidly progressive hepatitis, and to be especially resistant to treatment. | In the past few decades, remarkable strides in understanding the complex interplay between HBV and HDVat the molecular level have been achieved [3]. But many mysteries remain when these insights are applied to human disease, in which levels of HBV DNA and HDV RNA may fluctuate in relation to each other or not at all in individual patients [4]. Furthermore, some of the groups with HBVHDV coinfection, such as injection drug users, also have hepatitis C virus (HCV) and human immunodeficiency virus (HIV) coinfections. Unrecognized coinfections with these viruses—ie, before the availability of reliable screening tests for HIV (1985) or HCV (1992)—may have confounded early observations of the clinical course of patients with HBV-HDV coinfections. Indeed, one of the helpful observations of the article by Kucirka and colleagues [5] in the current issue of the Journal is the still very high infection rate found among a sample of injection drug users from 2005 to 2006 when tested for HCV (92%) or HIV (38%). |
Community-level incentives to increase the use of vaccination services in developing countries: an idea whose time has come?
Behl AS , Vijayaraghavan M , Nordin JD , Maciosek MV , Strebel PM . Vaccine 2010 28 (38) 6123-4 Elinor Ostrom is the co-recipient of the 2009 Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel “for her analysis of economic governance, especially the commons” [1], making this an opportune time to propose a strategy to improve immunization coverage based on the concept of “commons”, which refers to collectively owned resources. | In September 2000, building upon a decade of major United Nations conferences and summits, world leaders adopted the United Nations Millennium Declaration, committing their nations to a new global partnership to reduce extreme poverty and setting out a series of time-bound targets with a deadline of 2015, that have become known as the Millennium Development Goals (MDGs) [2]. The fourth goal (MDG 4) aims to reduce mortality among children less than 5 years of age by two-thirds, between 1990 and 2015. Although deaths among children under 5 years of age declined by 28% between 1990 and 2008, an estimated 8.8 million children under the age of five died in 2008, of which nearly a quarter were attributable to diseases preventable by vaccines [3], [4]. To set priorities based on costs and benefits of solutions to confront ten great global challenges, for the Copenhagen Consensus 2008, a panel of economic experts comprising eight of the world's most distinguished economists ranked expanded immunization coverage for children as one of the most cost-effective solutions to confront diseases at the global level [5]. |
Prescription drug use continues to increase: U.S. prescription drug data for 2007-2008
Gu Q , Dillon CF , Burt VL . NCHS Data Brief 2010 (42) 1-8 KEY FINDINGS: Over the last 10 years, the percentage of Americans who took at least one prescription drug in the past month increased from 44% to 48%. The use of two or more drugs increased from 25% to 31%. The use of five or more drugs increased from 6% to 11%. In 2007-2008, 1 out of every 5 children and 9 out of 10 older Americans reported using at least one prescription drug in the past month. Those who were without a regular place for health care, health insurance, or prescription drug benefit had less prescription drug use compared with those who had these benefits. The most commonly used types of drugs included: asthma medicines for children, central nervous system stimulants for adolescents, antidepressants for middle-aged adults, and cholesterol lowering drugs for older Americans. |
Rate constants for the gas-phase reactions of nitrate radicals with geraniol, citronellol, and dihydromyrcenol
Harrison JC , Ham JE . Int J Chem Kinet 2010 42 (11) 669-675 Terpenes and terpene alcohols are prevalent compounds found in a wide variety of consumer products including soaps, flavorings, perfumes, and air fresheners used in the indoor environment. Knowing the reaction rate of these chemicals with the nitrate radical is an important factor in determining their fate indoors. In this study, the bimolecular rate constants of k[NO3+geraniol] (16.6 +/- 4.2) × 10(−12), k[NO3+citronellol] 12.1 +/- 3) × 10(−12), and k[NO3+dihydromyrcenol] (2.3 +/- 0.6) × 10(−14) cm(3) molecule(−1) s(−1) were measured using the relative rate technique for the reaction of the nitrate radical (NO3) with 2,6-dimethyl-2,6-octadien-8-ol (geraniol), 3,7-dimethyl-6-octen-1-ol (citronellol), and 2,6-dimethyl-7-octen-2-ol (dihydromyrcenol) at (297 +/- 3) K and 1 atmosphere total pressure. Using the geraniol, citronellol, or dihydromyrcenol + NO3 rate constants reported here, pseudo-first-order rate lifetimes (k') of 1.5, 1.1, and 0.002 h(−1) were determined, respectively. © 2010 Wiley Periodicals, Inc. |
Studying associations between urinary metabolites of polycyclic aromatic hydrocarbons (PAHs) and cardiovascular diseases in the United States
Xu X , Cook RL , Ilacqua VA , Kan H , Talbott EO , Kearney G . Sci Total Environ 2010 408 (21) 4943-8 The association between background, enduring environmental exposure to polycyclic aromatic hydrocarbons (PAHs) and cardiovascular diseases has not been well studied in the general population. In this study, we used the National Health and Nutrition Examination Survey (NHANES) 2001-2004 to investigate the associations between eight monohydroxy PAHs (OH-PAHs) and self-report CVD. In a logistic regression model adjusting for cigarette smoking and other covariates, phenanthrene metabolite, 2-hydroxyphennathrene (2-PHEN), was significantly associated with self-report CVD. Compared to subjects within the lowest tertile of 2-PHEN, subjects within the middle and highest tertiles had higher self-report CVD (the 2nd tertile: AOR=1.29, 95%CI: 0.97-1.72; the 3rd tertile: AOR=1.45, 95%CI: 1.01-2.07; p for trend=0.04). In addition, fluorene metabolite (i.e. 2-hydroxyfluorene) also showed a marginally significant linear trend with self-report CVD (p for trend=0.07). Further studies are necessary to explore the associations between these highly prevalent pollutants and CVD. |
Acute illnesses associated with exposure to fipronil - surveillance data from 11 states in the United States, 2001-2007
Lee SJ , Mulay P , Diebolt-Brown B , Lackovic MJ , Mehler LN , Beckman J , Waltz J , Prado JB , Mitchell YA , Higgins SA , Schwartz A , Calvert GM . Clin Toxicol (Phila) 2010 48 (7) 737-44 INTRODUCTION: Fipronil is a broad-spectrum phenylpyrazole insecticide widely used to control residential pests and is also commonly used for flea and tick treatment on pets. It is a relatively new insecticide and few human toxicity data exist on fipronil. OBJECTIVE: This paper describes the magnitude and characteristics of acute illnesses associated with fipronil exposure. METHODS: Illness cases associated with exposure to fipronil-containing products from 2001 to 2007 were identified from the Sentinel Event Notification System for Occupational Risks (SENSOR)-Pesticides Program and the California Department of Pesticide Regulation. RESULTS: A total of 103 cases were identified in 11 states. Annual case counts increased from 5 in 2001 to 30 in 2007. Of the cases, 55% were female, the median age was 37 years, and 11% were <15 years old. The majority (76%) had exposure in a private residence, 37% involved the use of pet-care products, and 26% had work-related exposures. Most cases (89%) had mild, temporary health effects. Neurological symptoms (50%) such as headache, dizziness, and paresthesia were the most common, followed by ocular (44%), gastrointestinal (28%), respiratory (27%), and dermal (21%) symptoms/signs. Exposures usually occurred from inadvertent spray/splash/spill of products or inadequate ventilation of the treated area before re-entry. CONCLUSIONS: Our findings indicate that exposure to fipronil can pose a risk for mild, temporary health effects in various body systems. Precautionary actions should be reinforced to prevent fipronil exposure to product users. |
The emergence of translational epidemiology: from scientific discovery to population health impact.
Khoury MJ , Gwinn M , Ioannidis JP . Am J Epidemiol 2010 172 (5) 517-24 Recent emphasis on translational research (TR) is highlighting the role of epidemiology in translating scientific discoveries into population health impact. The authors present applications of epidemiology in TR through 4 phases designated T1-T4, illustrated by examples from human genomics. In T1, epidemiology explores the role of a basic scientific discovery (e.g., a disease risk factor or biomarker) in developing a "candidate application" for use in practice (e.g., a test used to guide interventions). In T2, epidemiology can help to evaluate the efficacy of a candidate application by using observational studies and randomized controlled trials. In T3, epidemiology can help to assess facilitators and barriers for uptake and implementation of candidate applications in practice. In T4, epidemiology can help to assess the impact of using candidate applications on population health outcomes. Epidemiology also has a leading role in knowledge synthesis, especially using quantitative methods (e.g., meta-analysis). To explore the emergence of TR in epidemiology, the authors compared articles published in selected issues of the Journal in 1999 and 2009. The proportion of articles identified as translational doubled from 16% (11/69) in 1999 to 33% (22/66) in 2009 (P = 0.02). Epidemiology is increasingly recognized as an important component of TR. By quantifying and integrating knowledge across disciplines, epidemiology provides crucial methods and tools for TR. |
Use of an immunization information system to assess the effectiveness of pentavalent rotavirus vaccine in US children
Sahni LC , Boom JA , Patel MM , Baker CJ , Rench MA , Parashar UD , Tate JE . Vaccine 2010 28 (38) 6314-7 Immunization information systems (IISs) are accessible sources of immunization data. We validated immunization information from a local IIS against provider records and assessed the system's utility in evaluating vaccine effectiveness against rotavirus disease using a case-control study. Among the 91% of case and control patients with immunization records, 49% were in the IIS, and 97% had a provider record. Good agreement was observed across record sources (k=0.65). Vaccine effectiveness (VE) was 82% using IIS data compared to 82-88% using provider data. Controls identified through the IIS provided VE estimates similar to hospital control patients. IISs could represent a valuable source of data for effectiveness evaluations. |
Epidemiology of HIV infection in large urban areas in the United States
Hall HI , Espinoza L , Benbow N , Hu YW . PLoS One 2010 5 (9) e12756 BACKGROUND: While the U.S. HIV epidemic continues to be primarily concentrated in urban area, local epidemiologic profiles may differ and require different approaches in prevention and treatment efforts. We describe the epidemiology of HIV in large urban areas with the highest HIV burden. METHODS/PRINCIPAL FINDINGS: We used data from national HIV surveillance for 12 metropolitan statistical areas (MSAs) to determine disparities in HIV diagnoses and prevalence and changes over time. Overall, 0.3% to 1% of the MSA populations were living with HIV at the end of 2007. In each MSA, prevalence was >1% among blacks; prevalence was >2% in Miami, New York, and Baltimore. Among Hispanics, prevalence was >1% in New York and Philadelphia. The relative percentage differences in 2007 HIV diagnosis rates, compared to whites, ranged from 239 (San Francisco) to 1239 (Baltimore) for blacks and from 15 (Miami) to 413 (Philadelphia) for Hispanics. The epidemic remains concentrated, with more than 50% of HIV diagnoses in 2007 attributed to male-to-male sexual contact in 7 of the 12 MSAs; heterosexual transmission surpassed or equaled male-to-male sexual transmission in Baltimore, Philadelphia, and Washington, DC. Yet in several MSAs, including Baltimore and Washington, DC, AIDS diagnoses increased among men-who-have sex with men in recent years. CONCLUSIONS/SIGNIFICANCE: These data are useful to identify local drivers of the epidemic and to tailor public health efforts for treatment and prevention services for people living with HIV. |
Human Salmonella infections linked to contaminated dry dog and cat food, 2006-2008
Behravesh CB , Ferraro A , Deasy M 3rd , Dato V , Moll M , Sandt C , Rea NK , Rickert R , Marriott C , Warren K , Urdaneta V , Salehi E , Villamil E , Ayers T , Hoekstra RM , Austin JL , Ostroff S , Williams IT . Pediatrics 2010 126 (3) 477-83 OBJECTIVE: Human Salmonella infections associated with dry pet food have not been previously reported. We investigated such an outbreak of Salmonella Schwarzengrund and primarily affecting young children. PATIENTS AND METHODS: Two multistate case-control studies were conducted to determine the source and mode of infections among case-patients with the outbreak strain. Study 1 evaluated household exposures to animals and pet foods, and study 2 examined risk factors for transmission among infant case-patients. Environmental investigations were conducted. RESULTS: Seventy-nine case-patients in 21 states were identified; 48% were children aged 2 years or younger. Case-households were significantly more likely than control households to report dog contact (matched odds ratio [mOR]: 3.6) and to have recently purchased manufacturer X brands of dry pet food (mOR: 6.9). Illness among infant case-patients was significantly associated with feeding pets in the kitchen (OR: 4.4). The outbreak strain was isolated from opened bags of dry dog food produced at plant X, fecal specimens from dogs that ate manufacturer X dry dog food, and an environmental sample and unopened bags of dog and cat foods from plant X. More than 23,000 tons of pet foods were recalled. After additional outbreak-linked illnesses were identified during 2008, the company recalled 105 brands of dry pet food and permanently closed plant X. CONCLUSIONS: Dry dog and cat foods manufactured at plant X were linked to human illness for a 3-year period. This outbreak highlights the importance of proper handling and storage of pet foods in the home to prevent human illness, especially among young children. |
A plausible causal model of HAART-efficacy beliefs, HIV/AIDS complacency, and HIV-acquisition risk behavior among young men who have sex with men
Mackellar DA , Hou SI , Whalen CC , Samuelsen K , Valleroy LA , Secura GM , Behel S , Bingham T , Celentano DD , Koblin BA , Lalota M , Shehan D , Thiede H , Torian LV . AIDS Behav 2010 15 (4) 788-804 Despite considerable research, the causal relationship remains unclear between HIV/AIDS complacency, measured as reduced HIV/AIDS concern because of highly active antiretroviral therapy (HAART), and HIV risk behavior. Understanding the directionality and underpinnings of this relationship is critical for programs that target HIV/AIDS complacency as a means to reduce HIV incidence among men who have sex with men (MSM). This report uses structural equation modeling to evaluate a theory-based, HIV/AIDS complacency model on 1,593 MSM who participated in a venue-based, cross-sectional survey in six U.S. cities, 1998-2000. Demonstrating adequate fit and stability across geographic samples, the model explained 15.0% of the variance in HIV-acquisition behavior among young MSM. Analyses that evaluated alternative models and models stratified by perceived risk for HIV infection suggest that HIV/AIDS complacency increases acquisition behavior by mediating the effects of two underlying HAART-efficacy beliefs. New research is needed to assess model effects on current acquisition risk behavior, and thus help inform prevention programs designed to reduce HIV/AIDS complacency and HIV incidence among young MSM. |
Self-examination behaviors for syphilis symptoms among HIV-infected men
Taylor MM , Peterson B , Post J , Williams C , Vanig T , Winscott M . J Acquir Immune Defic Syndr 2010 55 (2) 284-5 Sexual risk–taking behavior among HIV-infected men who have sex with men (MSM) has been reflected in the increases in co-infection with syphilis in multiple urban areas in the United States.1 Increases in the cotransmission of HIV and syphilis have been demonstrated in these regions as well.2 Efforts to reduce transmission of syphilis among MSM with and without HIV have relied on symptom recognition by providers, routine syphilis testing, and partner notification efforts.3 Patient recognition of syphilis symptoms has been emphasized in media campaigns in some regions.4 | Although patients may be aware of sexual risk reduction techniques proven to decrease HIV transmission, they may not be aware that some of these behaviors (such as oral sex) efficiently transmit syphilis.5 In addition, patients may not be aware of the typical symptoms that occur during the 2 infectious stages: primary (painless genital, rectal, or oral chancres) and secondary (generalized body rash, palmar/plantar rash, condyloma lata). These syphilis lesions may go undetected in MSM particularly, when located in the mouth or rectal area.6 Self examination and detection of syphilis lesions by men may result in earlier presentation for care, diagnosis, treatment, and partner referral. | Provider instruction on other preventative self-examination behaviors such as breast, skin, and testicular exams have been incorporated into clinical care encounters.7–9 We evaluated the impact of an intervention in which medical providers used clinical pictures of syphilis, sexual risk assessments, and loss-framed messages to increase patient self examination of their oral and rectal regions for syphilis ulcers. |
Latino men who have sex with men and HIV in the rural south-eastern USA: findings from ethnographic in-depth interviews
Rhodes SD , Hergenrather KC , Aronson RE , Bloom FR , Felizzola J , Wolfson M , Vissman AT , Alonzo J , Boeving Allen A , Montano J , McGuire J . Cult Health Sex 2010 12 (7) 797-812 A community-based participatory research partnership explored HIV risk and potentially effective intervention characteristics to reduce exposure and transmission among immigrant Latino men who have sex with men living in the rural south-eastern USA. Twenty-one participants enrolled and completed a total of 62 ethnographic in-depth interviews. Mean age was 31 (range 18-48) years and English-language proficiency was limited; 18 participants were from Mexico. Four participants reported having sex with men and women during the past three months; two participants self-identified as male-to-female transgender. Qualitative themes that emerged included a lack of accurate information about HIV and prevention; the influence of social-political contexts to sexual risk; and barriers to healthcare services. We also identified eight characteristics of potentially effective interventions for HIV prevention. Our findings suggest that socio-political contexts must be additional targets of change to reduce and eliminate HIV health disparities experienced by immigrant Latino men who have sex with men. |
Educating teenagers about sex in the United States
Martinez G , Abma J , Copen C . NCHS Data Brief 2010 (44) 1-8 KEY FINDINGS: Most teenagers received formal sex education before they were 18 (96% of female and 97% of male teenagers). Female teenagers were more likely than male teenagers to report first receiving instruction on birth control methods in high school (47% compared with 38%). Younger female teenagers were more likely than younger male teenagers to have talked to their parents about sex and birth control. Nearly two out of three female teenagers talked to their parents about "how to say no to sex" compared with about two out of five male teenagers. |
Methodology and measurement of the effectiveness of Haemophilus influenzae type b vaccine: systematic review
O'Loughlin RE , Edmond K , Mangtani P , Cohen AL , Shetty S , Hajjeh R , Mulholland K . Vaccine 2010 28 (38) 6128-36 The use of the highly effective Haemophilus influenzae type b (Hib) conjugate vaccine has increased globally. We review the benefits and limitations of studies measuring Hib vaccine effectiveness (VE). We critically examine the case-control approach by assessing the similarities and differences in methodology and findings and discuss the need for future Hib VE studies. In the absence of good surveillance data, vaccine effectiveness studies can play an important role, particularly with the increasing use of pneumococcal vaccine that has not been well tested under field conditions in less developed countries. However, the effectiveness of Hib vaccine has been well documented so the need for future VE Hib studies is minimal. |
HPV vaccine for adolescent males: acceptability to parents post-vaccine licensure
Reiter PL , McRee AL , Gottlieb SL , Brewer NT . Vaccine 2010 28 (38) 6292-7 We examined mothers' willingness to get their adolescent sons HPV vaccine. In December 2009, 2 months after approval of HPV vaccine for males, we surveyed a national sample of mothers with sons aged 9-18 (n=406). More mothers were definitely or probably willing to get their sons HPV vaccine if the vaccine were free (47%) than if it cost $400 out of pocket (11%). The importance of HPV vaccine possibly protecting their sons' future female partners from HPV-related disease was the strongest correlate of willingness. These findings are important to increasing acceptability to parents of HPV vaccine for their sons. |
Human papillomavirus vaccination practices: a survey of US physicians 18 months after licensure
Daley MF , Crane LA , Markowitz LE , Black SR , Beaty BL , Barrow J , Babbel C , Gottlieb SL , Liddon N , Stokley S , Dickinson LM , Kempe A . Pediatrics 2010 126 (3) 425-33 OBJECTIVES: The objectives of this study were to assess, in a nationally representative network of pediatricians and family physicians, (1) human papillomavirus (HPV) vaccination practices, (2) perceived barriers to vaccination, and (3) factors associated with whether physicians strongly recommended HPV vaccine to 11- to 12-year-old female patients. METHODS: In January through March 2008, a survey was administered to 429 pediatricians and 419 family physicians. RESULTS: Response rates were 81% for pediatricians and 79% for family physicians. Ninety-eight percent of pediatricians and 88% of family physicians were administering HPV vaccine in their offices (P<.001). Among those physicians, fewer strongly recommended HPV vaccination for 11- to 12-year-old female patients than for older female patients (pediatricians: 57% for 11- to 12-year-old patients and 90% for 13- to 15-year-old patients; P<.001; family physicians: 50% and 86%, respectively; P<.001). The most-frequently reported barriers to HPV vaccination were financial, including vaccine costs and insurance coverage. Factors associated with not strongly recommending HPV vaccine to 11- to 12-year-old female patients included considering it necessary to discuss sexuality before recommending HPV vaccine (risk ratio: 1.27 [95% confidence interval: 1.07-1.51]) and reporting more vaccine refusals among parents of younger versus older adolescents (risk ratio: 2.09 [95% confidence interval: 1.66-2.81]). CONCLUSIONS: Eighteen months after licensure, the vast majority of pediatricians and family physicians reported offering HPV vaccine. Fewer physicians strongly recommended the vaccine for younger adolescents than for older adolescents, and physicians reported financial obstacles to vaccination. |
Induction of broadly neutralizing H1N1 influenza antibodies by vaccination
Wei CJ , Boyington JC , McTamney PM , Kong WP , Pearce MB , Xu L , Andersen H , Rao S , Tumpey TM , Yang ZY , Nabel GJ . Science 2010 329 (5995) 1060-4 The rapid dissemination of the 2009 pandemic influenza virus underscores the need for universal influenza vaccines that elicit protective immunity to diverse viral strains. Here, we show that vaccination with plasmid DNA encoding H1N1 influenza hemagglutinin (HA) and boosting with seasonal vaccine or replication-defective adenovirus 5 vector encoding HA stimulated the production of broadly neutralizing influenza antibodies. This prime/boost combination increased the neutralization of diverse H1N1 strains dating from 1934 to 2007 as compared to either component alone and conferred protection against divergent H1N1 viruses in mice and ferrets. These antibodies were directed to the conserved stem region of HA and were also elicited in nonhuman primates. Cross-neutralization of H1N1 subtypes elicited by this approach provides a basis for the development of a universal influenza vaccine for humans. |
Adverse events following influenza A (H1N1) 2009 monovalent vaccines reported to the vaccine adverse events reporting system, United States, October 1, 2009-January 31, 2010
Vellozzi C , Broder KR , Haber P , Guh A , Nguyen M , Cano M , Lewis P , McNeil MM , Bryant M , Singleton J , Martin D , Destefano F . Vaccine 2010 28 (45) 7248-55 The United States (US) influenza A (H1N1) 2009 monovalent (2009-H1N1) vaccination program began in October 2009. Reports to the vaccine adverse event reporting system (VAERS), a US spontaneous reporting system, were reviewed to identify potential rare events or unusual adverse event (AE) patterns after 2009-H1N1 vaccination. The adverse event profile after 2009-H1N1 vaccine in VAERS (over 10,000 reports) was consistent with that of seasonal influenza vaccines, although the reporting rate was higher after 2009-H1N1 than seasonal influenza vaccines, this may be, at least in part, a reflection of stimulated reporting. Death, Guillain-Barre syndrome and anaphylaxis reports after 2009-H1N1 vaccination were rare (each <2 per million doses administered). |
Bicycle helmet use among children in the United States: the effects of legislation, personal and household factors
Dellinger AM , Kresnow MJ . J Safety Res 2010 41 (4) 375-80 INTRODUCTION: Children ages 5-14 years have the highest rate of bicycle-related injuries in the country. Bicycle helmets can prevent head and brain injuries, which represent the most serious type of bicycle-related injury. OBJECTIVES: This paper compares children's bicycle helmet use to that estimated from an earlier study, and explores regional differences in helmet use by existing helmet legislation. METHODS: This study was a cross-sectional, list-assisted random-digit-dial telephone survey. Interviews were completed by 9,684 respondents during 2001-2003. The subset with at least one child in the household age 5-14 years (2,409 respondents) answered questions about bicycle helmet use for a randomly selected child in their household. RESULTS: Almost half (48%) of the children always wore their helmet, 23% sometimes wore their helmet, and 29% never wore their helmet. Helmet wearing was significantly associated with race, ethnicity, and child age but was not associated with the sex of the child. Other significant predictors of use included household income, household education, census region, and bicycle helmet law status. Statewide laws were more effective than laws covering smaller areas. The proportion of children who always wore a helmet increased from 25% in 1994 to 48% in 2001-2002. Significant increases in helmet use from 20% to 26% were seen among both sexes, younger (5-9 years) and older (10-14 years) children, and in all four regions of the country. CONCLUSIONS: While there has been substantial progress in the number of children who always wear their helmets, more than half do not. Further progress will require using a combination of methods that have been shown to successfully promote consistent helmet use. IMPACT ON INDUSTRY: minimal. |
Scaling up HIV rapid testing in developing countries: comprehensive approach for implementing quality assurance
Parekh BS , Kalou MB , Alemnji G , Ou CY , Gershy-Damet GM , Nkengasong JN . Am J Clin Pathol 2010 134 (4) 573-84 In the last few years, the use of HIV rapid testing has expanded worldwide in response to the call for universal access to prevention, care, and treatment by UNAIDS and the World Health Organization. HIV rapid testing is performed by people with varied skills in laboratory and nonlaboratory settings. Accurate HIV diagnostic testing is the first step to identifying infected persons for follow-up referral and care. However, there are several challenges related to test kit quality, test selection, testing algorithms, training, quality assurance (QA), quality of new lots, and postmarket performance. We highlight various issues that impact the quality of HIV rapid testing and provide solutions to monitor and improve test accuracy, especially in resource-limited settings. These include the use of validated kits, training with emphasis on QA, use of a standardized log book, dried-tube specimen-based proficiency testing, new kit lot verification, and postmarket surveillance. Systematic implementation of these tools should greatly enhance the quality of HIV rapid testing. |
Laboratory testing practices for West Nile virus in the United States
Janusz KB , Lehman JA , Panella AJ , Fischer M , Staples E . Vector Borne Zoonotic Dis 2010 11 (5) 597-9 We surveyed state public health and commercial diagnostic reference laboratories regarding current testing practices for West Nile virus (WNV). The majority of WNV testing is now performed in commercial diagnostic reference laboratories using commercially available Food and Drug Administration-cleared kits labeled for the presumptive diagnosis of WNV. However, only 25% of surveyed state public health or commercial diagnostic reference laboratories currently have the capacity to perform the recommended confirmatory testing. These findings indicate the need for both manufacturers and laboratories to monitor the performance of these WNV test kits. Further, clinicians should be aware of the limitations of these kits and the need for additional testing to confirm a diagnosis of WNV disease. |
Particle size distributions from laboratory-scale biomass fires using fast response instruments
Hosseini S , Li Q , Cocker D , Weise D , Miller A , Shrivastava M , Miller JW , Mahalingam S , Princevac M , Jung H . Atmos Chem Phys 2010 10 (16) 8065-8076 Particle size distribution from biomass combustion is an important parameter as it affects air quality, climate modelling and health effects. To date, particle size distributions reported from prior studies vary not only due to difference in fuels but also difference in experimental conditions. This study aims to report characteristics of particle size distributions in well controlled repeatable lab scale biomass fires for southwestern United States fuels with focus on chaparral. The combustion laboratory at the United States Department of Agriculture-Forest Service's Fire Science Laboratory (USDA-FSL), Missoula, MT provided a repeatable combustion and dilution environment ideal for measurements. For a variety of fuels tested the major mode of particle size distribution was in the range of 29 to 52 nm, which is attributable to dilution of the fresh smoke. Comparing mass size distribution from FMPS and APS measurement 51-68% of particle mass was attributable to the particles ranging from 0.5 to 10 mu m for PM10. Geometric mean diameter rapidly increased during flaming and gradually decreased during mixed and smoldering phase combustion. Most fuels produced a unimodal distribution during flaming phase and strong biomodal distribution during smoldering phase. The mode of combustion (flaming, mixed and smoldering) could be better distinguished using the slopes in MCE (Modified Combustion Efficiency) vs. geometric mean diameter than only using MCE values. |
A quality management systems approach for CD4 testing in resource-poor settings
Westerman LE , Kohatsu L , Ortiz A , McClain B , Kaplan J , Spira T , Marston B , Jani IV , Nkengasong J , Parsons LM . Am J Clin Pathol 2010 134 (4) 556-67 Quality assurance (QA) is a systematic process to monitor and improve clinical laboratory practices. The fundamental components of a laboratory QA program include providing a functional and safe laboratory environment, trained and competent personnel, maintained equipment, adequate supplies and reagents, testing of appropriate specimens, internal monitoring of quality, accurate reporting, and external quality assessments. These components are necessary to provide accurate and precise CD4 T-cell counts, an essential test to evaluate start of and monitor effectiveness of antiretroviral therapy for HIV-infected patients. In recent years, CD4 testing has expanded dramatically in resource-limited settings. Information on a CD4 QA program as described in this article will provide guidelines not only for clinical laboratory staff but also for managers of programs responsible for supporting CD4 testing. All agencies involved in implementing CD4 testing must understand the needs of the laboratory and provide advocacy, guidance, and financial support to established CD4 testing sites and programs. This article describes and explains the procedures that must be put in place to provide reliable CD4 determinations in a variety of settings. |
Ensuring the quality of HIV rapid testing in resource-poor countries using a systematic approach to training
Yao K , Wafula W , Bile EC , Cheignsong R , Howard S , Demby A , Nkengasong J . Am J Clin Pathol 2010 134 (4) 568-72 HIV rapid testing is a key tool in the fight against the HIV/AIDS epidemic; it enables the rapid expansion of prevention and treatment programs in resource-limited countries. Meeting the goals of these programs means that millions of people will need testing annually. Accuracy and reliability of these tests are critical to the success of these programs. Given the enormous number of rapid tests that are performed each year, even a low error rate of 0.5% applied to 100 million people will result in 500,000 erroneous results. Ensuring the quality of HIV rapid testing presents unique challenges in that testing is often performed in various settings by personnel without formal laboratory training. This article describes the development and implementation of a generic HIV rapid test training package using a systems approach in an effort to standardize training and ensure the quality of rapid tests. It also highlights achievements from Uganda, Haiti, and Botswana. |
Evaluating the BED capture enzyme immunoassay to estimate HIV incidence among adults in three countries in Sub-Saharan Africa
Kim AA , McDougal JS , Hargrove J , Rehle T , Pillay-Van Wyk V , Puren A , Ekra A , Borget-Alloue MY , Adje-Toure C , Abdullahi AS , Odawo L , Marum L , Parekh BS . AIDS Res Hum Retroviruses 2010 26 (10) 1051-61 Serological assays for estimating HIV-1 incidence are prone to misclassification, limiting the accuracy of the incidence estimate. Adjustment factors have been developed and recommended for estimating assay-based HIV-1 incidence in cross-sectional settings. We evaluated the performance of the recommended adjustment factors for estimating incidence in national HIV surveys in three countries in sub-Saharan Africa. The BED-capture enzyme immunoassay was applied to stored blood specimens from (1) pregnant women aged 15-49 years attending antenatal clinics in Cote d'Ivoire (1998-2004), (2) adults aged 15-49 years participating in a demographic health survey in Kenya (2003), and (3) adults aged 15-49 years participating in a national household serosurvey in South Africa (2005). Assay-derived incidence estimates were corrected for misclassification using recommended adjustment factors and, where possible, were compared to mathematically modeled incidence in the same populations. Trends in HIV prevalence were compared to trends in assay-derived incidence to assess plausibility in the assay-derived trends. Unadjusted incidence was 3.8% [95% confidence interval (CI) 3.3-4.5] in Cote d'Ivoire, 3.5% (2.7-4.3) in Kenya, and 4.4% (CI 2.3-6.5]) in South Africa. Adjusted incidence was 2.9% (CI 2.1-3.7) in Cote d'Ivoire, 2.6% (CI 2.0-3.2) in Kenya, and 2.4% (CI 1.7-3.1) in South Africa. After adjustment, peak incidence shifted from older to younger age groups in Cote d'Ivoire and South Africa. Modeled HIV incidence was 1.0% (CI 1.02-1.08) in Kenya and 2.0% (CI 1.7-2.4) in South Africa. After applying the recommended adjustments factors, adjusted assay-derived estimates remained implausibly high in two of three populations evaluated. For more accurate measures of assay-derived population incidence, adjustment factors must be locally derived and validated. Until improved assays are available, caution should be applied in the use and interpretation of data from incidence assays. |
Age exaggerates proinflammatory cytokine signaling and truncates signal transducers and activators of transcription 3 signaling following ischemic stroke in the rat
Dinapoli VA , Benkovic SA , Li X , Kelly KA , Miller DB , Rosen CL , Huber JD , O'Callaghan JP . Neuroscience 2010 170 (2) 633-44 Neuroinflammation is associated with glial activation following a variety of brain injuries, including stroke. While activation of perilesional astrocytes and microglia following ischemic brain injury is well documented, the influence of age on these cellular responses after stroke is unclear. This study investigated the influence of advanced age on neuronal degeneration, neuroinflammation, and glial activation in female Sprague-Dawley rats after reversible embolic occlusion of the middle cerebral artery (MCAO). Results indicate that in comparison to young adult rats (3 months), aged rats (18 months) showed enhanced neuronal degeneration, altered microglial response, and a markedly increased expression of proinflammatory cytokines/chemokines following MCAO. In addition, the time-course for activation of signal transducers and activators of transcription 3 (STAT3), the signaling mechanism that regulates astrocyte reactivity, was truncated in the aged rats after MCAO. Moreover, the expression of suppressor of cytokine signaling 3 (SOCS3), which is associated with termination of astrogliosis, was enhanced as a function of age after MCAO. These findings are suggestive of an enhanced proinflammatory response and a truncated astroglial response as a function of advanced age following MCAO. These data provide further evidence of the prominent role played by age in the molecular and cellular responses to ischemic stroke and suggest that astrocytes may represent targets for future therapies aimed at improving stroke outcome. |
Application and validation of PFGE for serovar identification of Leptospira clinical isolates
Galloway RL , Levett PN . PLoS Negl Trop Dis 2010 4 (9) Serovar identification of clinical isolates of Leptospira is generally not performed on a routine basis, yet the identity of an infecting serovar is valuable from both epidemiologic and public health standpoints. Only a small number of reference laboratories worldwide have the capability to perform the cross agglutinin absorption test (CAAT), the reference method for serovar identification. Pulsed-field gel electrophoresis (PFGE) is an alternative method to CAAT that facilitates rapid identification of leptospires to the serovar level. We employed PFGE to evaluate 175 isolates obtained from humans and animals submitted to the Centers for Disease Control and Prevention (CDC) between 1993 and 2007. PFGE patterns for each isolate were generated using the NotI restriction enzyme and compared to a reference database consisting of more than 200 reference strains. Of the 175 clinical isolates evaluated, 136 (78%) were identified to the serovar level by the database, and an additional 27 isolates (15%) have been identified as probable new serovars. The remaining isolates yet to be identified are either not represented in the database or require further study to determine whether or not they also represent new serovars. PFGE proved to be a useful tool for serovar identification of clinical isolates of known serovars from different geographic regions and a variety of different hosts and for recognizing potential new serovars. |
Chemical-specific screening criteria for interpretation of biomonitoring data for volatile organic compounds (VOCs)--application of steady-state PBPK model solutions
Aylward LL , Kirman CR , Blount BC , Hays SM . Regul Toxicol Pharmacol 2010 58 (1) 33-44 The National Health and Nutrition Examination Survey (NHANES) generates population-representative biomonitoring data for many chemicals including volatile organic compounds (VOCs) in blood. However, no health or risk-based screening values are available to evaluate these data from a health safety perspective or to use in prioritizing among chemicals for possible risk management actions. We gathered existing risk assessment-based chronic exposure reference values such as reference doses (RfDs), reference concentrations (RfCs), tolerable daily intakes (TDIs), cancer slope factors, etc. and key pharmacokinetic model parameters for 47 VOCs. Using steady-state solutions to a generic physiologically-based pharmacokinetic (PBPK) model structure, we estimated chemical-specific steady-state venous blood concentrations across chemicals associated with unit oral and inhalation exposure rates and with chronic exposure at the identified exposure reference values. The geometric means of the slopes relating modeled steady-state blood concentrations to steady-state exposure to a unit oral dose or unit inhalation concentration among 38 compounds with available pharmacokinetic parameters were 12.0 microg/L per mg/kg-d (geometric standard deviation [GSD] of 3.2) and 3.2 microg/L per mg/m(3) (GSD=1.7), respectively. Chemical-specific blood concentration screening values based on non-cancer reference values for both oral and inhalation exposure range from 0.0005 to 100 microg/L; blood concentrations associated with cancer risk-specific doses at the 1E-05 risk level ranged from 5E-06 to 6E-02 microg/L. The distribution of modeled steady-state blood concentrations associated with unit exposure levels across VOCs may provide a basis for estimating blood concentration screening values for VOCs that lack chemical-specific pharmacokinetic data. The screening blood concentrations presented here provide a tool for risk assessment-based evaluation of population biomonitoring data for VOCs and are most appropriately applied to central tendency estimates for such datasets. |
Correlates of seasonal influenza vaccine coverage among pregnant women in Georgia and Rhode Island
Ahluwalia IB , Jamieson DJ , Rasmussen SA , D'Angelo D , Goodman D , Kim H . Obstet Gynecol 2010 116 (4) 949-955 OBJECTIVE: To identify facilitators of and barriers to pregnant women being vaccinated against seasonal influenza by identifying factors associated with influenza vaccination during pregnancy among women who had recently given birth to a live infant. METHODS: We analyzed pooled data from Georgia (n=2,692) and Rhode Island (n=2,732) participants in the 2006 and 2007 surveys of the Pregnancy Risk Assessment and Monitoring System, which conducts cross-sectional surveys of women with live births. SUDAAN software was used for analysis to account for complex survey design. We estimated rates of seasonal influenza vaccination among pregnant women in Georgia and Rhode Island and identified factors associated with being vaccinated. RESULTS: The prevalence of immunization for seasonal influenza in 2006 and 2007 combined was 18.4% (95% confidence interval [CI]: 15.9-21.1) in Georgia and 31.9% (95% CI 29.8-34.0) in Rhode Island. Multivariable analyses showed that in Georgia, multiparous women were significantly less likely to have been vaccinated than primiparous women (adjusted odds ratio [OR] 0.60; 95% CI 0.40-0.89). In Georgia, among those not vaccinated, 43% indicated that their health care providers did not mention anything about the seasonal influenza vaccination. In Rhode Island, women whose health care provider encouraged them to be vaccinated (adjusted OR 56.62; 95% CI 37.43-85.63) and those who did not smoke cigarettes (adjusted OR 1.92; 95% CI 1.25-2.94) were significantly more likely to be vaccinated. CONCLUSION: Our findings indicate a need for strategies to promote seasonal influenza vaccine use among pregnant women. Health care providers can play a significant role in increasing influenza vaccination coverage rates among pregnant women by advising women to be vaccinated and by addressing their concerns about vaccine safety. LEVEL OF EVIDENCE: III. |
Racial and ethnic disparities in work-related injuries and socio-economic resources among nursing assistants employed in US nursing homes
Tak S , Alterman T , Baron S , Calvert GM . Am J Ind Med 2010 53 (10) 951-9 BACKGROUND: We aimed to estimate the proportion of nursing assistants (NAs) in the US with work-related injuries and insufficient socio-economic resources by race/ethnicity. METHODS: Data from the 2004 National Nursing Assistant Survey (NNAS), a nationally representative sample survey of NAs employed in United States nursing homes, were analyzed accounting for the complex survey design. RESULTS: Among 2,880 participants, 44% reported "scratch, open wounds, or cuts" followed by "back injuries" (17%), "black eyes or other types of bruising" (16%), and "human bites" (12%). When compared to non-Hispanic white NAs, the adjusted rate ratio (RR) for wound/cut was 0.74 for non-Hispanic black NAs (95% confidence interval [CI]: 0.65-0.85). RRs for black eyes/bruises were 0.18 for non-Hispanic black NAs (95% CI: 0.12-0.26), and 0.55 for Hispanic NAs (95% CI: 0.37-0.82). CONCLUSIONS: Minority racial and ethnic groups were less likely to report having experienced injuries compared with non-Hispanic white NAs. Future research should focus on identifying preventable risk factors, such as differences by race and ethnicity in the nature of NA jobs and the extent of their engagement in assisting patients with activities of daily living. Am. J. Ind. Med. 53:951-959, 2010. (c) 2010 Wiley-Liss, Inc. |
Exposure to flour dust and sensitization among bakery employees
Page EH , Dowell CH , Mueller CA , Biagini RE , Heederik D . Am J Ind Med 2010 53 (12) 1225-32 BACKGROUND: The National Institute for Occupational Safety and Health conducted a study to determine prevalences of sensitization to bakery-associated antigens (BAAs) and work-related respiratory symptoms at a large commercial bakery. METHODS: The following measurements were carried out: personal breathing zone (PBZ) and general area (GA) monitoring for inhalable flour dust, alpha-amylase and wheat, a questionnaire, and blood tests for IgE specific to flour dust, wheat, alpha-amylase, and common aeroallergens. RESULTS: Of 186 bakery employees present during our site visit, 161completed the questionnaire and 96 allowed their blood to be drawn. The geometric mean PBZ and GA inhalable flour dust concentrations for the lower-exposure group was 0.235 mg/m(3), and for the higher-exposure group was 3.01 mg/m(3). Employees in the higher-exposure group had significantly higher prevalences of work-related wheezing, runny nose, stuffy nose, and frequent sneezing than the lower-exposure group. The prevalence of IgE specific to wheat was significantly higher among employees who ever had a job in the higher-exposure group or in production at another bakery at both the ≥ 0.10 kU/L and the ≥ 0.35 kU/L cutoffs, and to flour dust and alpha-amylase at the ≥ 0.10 kU/L cutoff, compared to the lower-exposure group. CONCLUSIONS: Despite knowledge of the risks of exposure to flour being available for centuries, U.S. employees are still at risk of sensitization and respiratory symptoms from exposure to high levels of BAA. Am. J. Ind. Med. (c) 2010 Wiley-Liss, Inc. |
Evaluation of targeted influenza vaccination strategies via population modeling
Glasser J , Taneri D , Feng Z , Chuang JH , Tull P , Thompson W , Mason McCauley M , Alexander J . PLoS One 2010 5 (9) BACKGROUND: Because they can generate comparable predictions, mathematical models are ideal tools for evaluating alternative drug or vaccine allocation strategies. To remain credible, however, results must be consistent. Authors of a recent assessment of possible influenza vaccination strategies conclude that older children, adolescents, and young adults are the optimal targets, no matter the objective, and argue for vaccinating them. Authors of two earlier studies concluded, respectively, that optimal targets depend on objectives and cautioned against changing policy. Which should we believe? METHODS AND FINDINGS: In matrices whose elements are contacts between persons by age, the main diagonal always predominates, reflecting contacts between contemporaries. Indirect effects (e.g., impacts of vaccinating one group on morbidity or mortality in others) result from off-diagonal elements. Mixing matrices based on periods in proximity with others have greater sub- and super-diagonals, reflecting contacts between parents and children, and other off-diagonal elements (reflecting, e.g., age-independent contacts among co-workers), than those based on face-to-face conversations. To assess the impact of targeted vaccination, we used a time-usage study's mixing matrix and allowed vaccine efficacy to vary with age. And we derived mortality rates either by dividing observed deaths attributed to pneumonia and influenza by average annual cases from a demographically-realistic SEIRS model or by multiplying those rates by ratios of (versus adding to them differences between) pandemic and pre-pandemic mortalities. CONCLUSIONS: In our simulations, vaccinating older children, adolescents, and young adults averts the most cases, but vaccinating either younger children and older adults or young adults averts the most deaths, depending on the age distribution of mortality. These results are consistent with those of the earlier studies. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Community Health Services
- Drug Safety
- Environmental Health
- Epidemiology and Surveillance
- Food Safety
- Health Behavior and Risk
- Health Communication and Education
- Immunity and Immunization
- Injury and Violence
- Laboratory Sciences
- Maternal and Child Health
- Occupational Safety and Health
- Program Evaluation
About
CDC Science Clips is an online, continuously updated, searchable database of scientific literature published by CDC authors. Each article features an Altmetric Attention Score to track social and mainstream media mentions. If you are aware of a CDC-authored publication that does not appear in this database, please let us know.
- Page last reviewed:Feb 1, 2024
- Page last updated:Sep 03, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure