The "Million Hearts" initiative - preventing heart attacks and strokes
Frieden TR , Berwick DM . N Engl J Med 2011 365 (13) e27 Each year, more than 2 million Americans have a heart attack or stroke, and more than 800,000 of them die; cardiovascular disease is the leading cause of death in the United States and the largest cause of lower life expectancy among blacks. Related medical costs and productivity losses approach $450 billion annually, and inflation-adjusted direct medical costs are projected to triple over the next two decades if present trends continue.(1) To reduce this burden, the Department of Health and Human Services (DHHS), other federal, state, and local government agencies, and a broad range of private-sector partners are today launching a . . . |
Nonsteroidal anti-inflammatory drug use among persons with chronic kidney disease in the United States
Plantinga L , Grubbs V , Sarkar U , Hsu CY , Hedgeman E , Robinson B , Saran R , Geiss L , Burrows NR , Eberhardt M , Powe N . Ann Fam Med 2011 9 (5) 423-430 PURPOSE: Because avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs) is recommended for most individuals with chronic kidney disease (CKD), we sought to characterize patterns of NSAID use among persons with CKD in the United States. METHODS: A total of 12,065 adult (aged 20 years or older) participants in the cross-sectional National Health and Nutrition Examination Survey (1999-2004) responded to a questionnaire regarding their use of over-the-counter and prescription NSAIDs. NSAIDs (excluding aspirin and acetaminophen) were defined by self-report. CKD was categorized as no CKD, mild CKD (stages 1 and 2; urinary albumin-creatinine ratio of ≥30 mg/g) and moderate to severe CKD (stages 3 and 4; estimated glomerular filtration rate of 15-59 mL/min/1.73 m(2)). Adjusted prevalence was calculated using multivariable logistic regression with appropriate population-based weighting. RESULTS: Current use (nearly every day for 30 days or longer) of any NSAID was reported by 2.5%, 2.5%, and 5.0% of the US population with no, mild, and moderate to severe CKD, respectively; nearly all of the NSAIDs used were available over-the-counter. Among those with moderate to severe CKD who were currently using NSAIDs, 10.2% had a current NSAID prescription and 66.1% had used NSAIDs for 1 year or longer. Among those with CKD, disease awareness was not associated with reduced current NSAID use: (3.8% vs 3.9%, aware vs unaware; P=.979). CONCLUSIONS: Physicians and other health care clinicians should be aware of use of NSAIDs among those with CKD in the United States and evaluate NSAID use in their CKD patients. |
Oxidative stress is associated with impaired arterial elasticity
Patel RS , Al Mheid I , Morris AA , Ahmed Y , Kavtaradze N , Ali S , Dabhadkar K , Brigham K , Hooper WC , Alexander RW , Jones DP , Quyyumi AA . Atherosclerosis 2011 218 (1) 90-5 AIMS: Arterial stiffening may lead to hypertension, greater left ventricular after-load and adverse clinical outcomes. The underlying mechanisms influencing arterial elasticity may involve oxidative injury to the vessel wall. We sought to examine the relationship between novel markers of oxidative stress and arterial elastic properties in healthy humans. METHODS AND RESULTS: We studied 169 subjects (mean age 42.6+/-14 years, 51.6% male) free of traditional cardiovascular risk factors. Indices of arterial stiffness and wave reflections measured included carotid-femoral Pulse Wave Velocity (PWV), Augmentation Index (Aix) and Pulse Pressure Amplification (PPA). Non-free radical oxidative stress was assessed as plasma oxidized and reduced amino-thiol levels (cysteine/cystine, glutathione/GSSG) and their ratios (redox potentials), and free radical oxidative stress as derivatives of reactive oxygen metabolites (dROMs). Inflammation was assessed as hsCRP and interleukin-6 levels. The non-free radical marker of oxidative stress, cystine was significantly correlated with all arterial indices; PWV (r=0.38, p<0.001), Aix (r=0.35, p<0.001) and PPA (r=-0.30, p<0.001). Its redox potential, was also associated with PWV (r=0.22, p=0.01), while the free radical marker of oxidative stress dROMS was associated with Aix (r=0.25, p<0.01). After multivariate adjustment for age, gender, arterial pressure, height, weight, heart rate and CRP, of these oxidative stress markers, only cystine remained independently associated with PWV (p=0.03), Aix (p=0.01) and PPA (p=0.05). CONCLUSIONS: In healthy subjects without confounding risk factors or significant systemic inflammation, a high cystine level, reflecting extracellular oxidant burden, is associated with increased arterial stiffness and wave reflections. This has implications for understanding the role of oxidant burden in pre-clinical vascular dysfunction. |
Diabetes, impaired glucose tolerance, and metabolic biomarkers in individuals with normal glucose tolerance are inversely associated with lung function: the Jackson Heart Study
Hickson DA , Burchfiel CM , Liu J , Petrini MF , Harrison K , White WB , Sarpong DF . Lung 2011 189 (4) 311-21 The objectives of this study were to test the hypothesis that diabetes and impaired glucose tolerance (IGT), diabetes control and diabetes duration, and metabolic biomarkers in adults with normal glucose tolerance (NGT) are inversely associated with spirometry-measured lung function. We conducted a cross-sectional observational cohort study that included nonsmoking African American adults (n = 2,945; mean age = 52.5 +/- 12.6 years; 69.2% female), who were free of cardiovascular disease, from the Jackson Heart Study. The interventions were diabetes, metabolic biomarkers and lung function. We measured the associations of glycemia with forced expiratory volume (FEV) in 1 s, FEV in 6 s, and vital capacity. Multivariable adjusted mean lung function values were lower among adults with diabetes and IGT (in women only, but not after adjustment for waist circumference) than adults with NGT. Among adults with diabetes, no associations were observed between lung function and diabetes control or duration. In women with NGT, lower lung function was consistently associated with higher glucose levels and less consistently with higher insulin levels and insulin resistance. Lower lung function was consistently associated with higher insulin levels and insulin resistance and less consistently associated with insulin and hemoglobin A1c in men with NGT. Overall, our findings generally support the hypothesis that diabetes, IGT, and increased levels of metabolic biomarkers in individuals with NGT are inversely associated with lung function in African Americans, independent of adiposity. |
Laboratory confirmed case of yaws in a 10 year-old boy from the Republic of the Congo
Pillay A , Chen CY , Reynolds MG , Mombouli JV , Castro AC , Louvouezo D , Steiner B , Ballard RC . J Clin Microbiol 2011 49 (11) 4013-5 We report a case of yaws in a patient with puritic cutaneous eruption who was initially suspected of infection with monkeypox. The diagnosis was established by real-time PCR and sequencing of specific treponemal DNA sequences. This is the first report describing the use of DNA sequencing to identify T. pallidum subsp. pertenue-specific sequences in a patient with active yaws. |
Lethal factor toxemia and anti-protective antigen antibody activity in naturally acquired cutaneous anthrax
Boyer AE , Quinn CP , Beesley CA , Gallegos-Candela M , Marston CK , Cronin LX , Lins RC , Stoddard RA , Li H , Schiffer J , Hossain MJ , Chakraborty A , Rahman M , Luby SP , Shieh WJ , Zaki S , Barr JR , Hoffmaster AR . J Infect Dis 2011 204 (9) 1321-7 Cutaneous anthrax outbreaks occurred in Bangladesh from August to October 2009. As part of the epidemiological response and to confirm anthrax diagnoses, serum samples were collected from suspected case patients with observed cutaneous lesions. Anthrax lethal factor (LF), anti-protective antigen (anti-PA) immunoglobulin G (IgG), and anthrax lethal toxin neutralization activity (TNA) levels were determined in acute and convalescent serum of 26 case patients with suspected cutaneous anthrax from the first and largest of these outbreaks. LF (0.005-1.264 ng/mL) was detected in acute serum from 18 of 26 individuals. Anti-PA IgG and TNA were detected in sera from the same 18 individuals and ranged from 10.0 to 679.5 mcg/mL and 27 to 593 units, respectively. Seroconversion to serum anti-PA and TNA was found only in case patients with measurable toxemia. This is the first report of quantitative analysis of serum LF in cutaneous anthrax and the first to associate acute stage toxemia with subsequent antitoxin antibody responses. |
No rebound in tuberculosis in the United States in 2010
Winston CA , Navin TR , Becerra JE , LoBue PA . Int J Tuberc Lung Dis 2011 15 (9) 1272 In a recent article in this Journal, Holland et al. correlate TB incidence in the United States since 1952 with time, immigration, and HIV in the late 1980s and early 1990s.1 The authors also correlate proportional decreases in TB incidence in 2008–2009 with increases in unemployment in 2009–2010 in a separate linear regression in which lagged unemployment explains about 10% of state variance in TB incidence (R2 = 0.10). Given the disparities in TB incidence trends comparing US-born versus foreign-born persons in the United States,2 these models may be enhanced by considering origin of birth as an explanatory or stratification variable. | Provisional national surveillance data as of 26 February 2011 show a continued decline in TB case counts, to 11 181 cases in 2010 compared with 11 531 cases in 2009.3 In provisional data, the proportion of all TB patients with cavitary disease was 26% in 2009 and 25% in 2010, while 2% of patients were dead at diagnosis in both years. Despite the aberrant decline in 2009, these data suggest no increase in the number or severity of cases in 2010. As the 2010 case count data are finalized, we continue to investigate and be vigilant for any resurgence in TB. To date, none has been observed. |
Patterns of chlamydia/gonorrhea positivity among voluntarily screened New York City public high school students
Han JS , Rogers ME , Nurani S , Rubin S , Blank S . J Adolesc Health 2011 49 (3) 252-7 PURPOSE: Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) are common sexually transmitted infections that disproportionately affect adolescents. Annual screening for CT for sexually active female adolescents is recommended. In 2006, New York City began conducting CT/GC education, screening, and treatment in public high schools. We examine 3-year programmatic outcomes and the relationship between sexual activity, screening, and CT/GC positivity. METHODS: We describe the epidemiology of students who screened and those infected with CT/GC. Univariate, bivariate, and multivariate logistic regression analyses were performed to assess relationships between sex, race/ethnicity, age, sexual activity, and screening status; and the relationship between sexually transmitted infection positivity and sexual activity. RESULTS: Between July 2006 and June 2009, we educated 57,418 students and screened 27,353 (47.6%) for CT/GC; 1,736 (6.3%) students were reported to be infected with either organism. Students who screened positive were more likely to be females (8.9%), report black race (8.3%) and be ≥16 years of age (6.6%-9.7%). Screening rates were 70.6% for students who were sexually active, 27.9% for those who had never had sex, and 47.3% for those who did not respond to the sexual activity question; CT/GC positivity was 7.2%, 1.4%, and 6.1%, respectively. CONCLUSIONS: Black, older adolescent females were most likely to screen positive for CT/GC in this population. A large proportion of students who did not answer the sexual activity question chose to screen for CT/GC and screened positive. School screening programs should offer screening to all students regardless of reported sexual activity. Programs should target females and older adolescents. |
Preventing deaths from cryptococcal meningitis: from bench to bedside
Roy M , Chiller T . Expert Rev Anti Infect Ther 2011 9 (9) 715-7 Cryptococcal meningitis (CM), a fungal disease caused by Cryptococcus spp., is the most common form of meningitis and a leading cause of death among persons with HIV/AIDS in sub-Saharan Africa. Detection of cryptococcal antigen, which is present several weeks before overt signs of meningitis develop, provides an opportunity to detect infection early. Screening persons with HIV for cryptococcal infection when they access healthcare can identify asymptomatic infected patients allowing for prompt treatment and prevention of death. A newly developed point-of-care assay for cryptococcal antigen, as well as growing evidence supporting the utility and cost-effectiveness of screening, are further reasons to consider broad implementation of cryptococcal screening in countries with a high burden of cryptococcal disease. |
Feasibility of selected prophylactic barriers in arrestance of airborne bacterial vegetative cells and endospores
Davidson CS , Green CF , Gibbs SG , Panlilio AL , Jensen PA , Jin Y , Scarpino PV . Am J Infect Control 2011 39 (7) 581-6 BACKGROUND: Transmission of infection by airborne agents is a risk for health care personnel, patients, and visitors. This risk is heightened in regions without access to environmental controls and personal protective equipment. The ability of 2 prophylactic barriers (ie, semitransparent netting for insect control) to arrest bioaerosols was assessed for potential use within the malarial zones. METHODS: Barriers (pore sizes of 0.8 mm and 0.25 mm) were challenged with bioaerosols of vegetative cells and endospores of Bacillus anthracis strain Sterne 34F2 using a bioaerosol chamber. Barriers were also challenged with airborne inert polystyrene latex particles of known diameters (0.1, 0.43, 0.6, 1.3, 3.2, and 8.0 mcm), and the arrestance provided by barrier with the 0.25 mm pore size was expressed as a function of aerodynamic diameter of challenge aerosols. RESULTS: Barrier with the 0.8 mm pore size provided no significant arrestance of aerosols, whereas the barrier with the 0.25 mm pore size provided an 8% arrestance of vegetative cells and a 13% arrestance of endospores. No arrestance at or below the 0.6 mcm particle size was observed. CONCLUSION: The level of arrestance provided by these prophylactic barriers does not justify their use as a sole method of preventing transmission. |
International spread of an epidemic population of Salmonella enterica serotype Kentucky ST198 resistant to ciprofloxacin
Le Hello S , Hendriksen RS , Doublet B , Fisher I , Nielsen EM , Whichard JM , Bouchrif B , Fashae K , Granier SA , Jourdan-Da Silva N , Cloeckaert A , Threlfall EJ , Angulo FJ , Aarestrup FM , Wain J , Weill FX . J Infect Dis 2011 204 (5) 675-84 National Salmonella surveillance systems from France, England and Wales, Denmark, and the United States identified the recent emergence of multidrug-resistant isolates of Salmonella enterica serotype Kentucky displaying high-level resistance to ciprofloxacin. A total of 489 human cases were identified during the period from 2002 (3 cases) to 2008 (174 cases). These isolates belonged to a single clone defined by the multilocus sequence type ST198, the XbaI-pulsed-field gel electrophoresis cluster X1, and the presence of the Salmonella genomic island 1 variant SGI1-K. This clone was probably selected in 3 steps in Egypt during the 1990s and the early 2000s and has now spread to several countries in Africa and, more recently, in the Middle East. Poultry has been identified as a potential major vehicle for infection by this clone. Continued surveillance and appropriate control measures should be implemented by national and international authorities to limit the spread of this strain. (See the editorial commentary by Hedberg, on pages 665-6.) |
Acceptability of Carraguard vaginal microbicide gel among HIV-infected women in Chiang Rai, Thailand
Whitehead SJ , McLean C , Chaikummao S , Braunstein S , Utaivoravit W , van de Wijgert JH , Mock PA , Siraprapasiri T , Friedland BA , Kilmarx PH , Markowitz LE . PLoS One 2011 6 (9) e14831 BACKGROUND: Few studies of microbicide acceptability among HIV-infected women have been done. We assessed Carraguard(R) vaginal gel acceptability among participants in a randomized, controlled, crossover safety trial in HIV-infected women in Thailand. METHODOLOGY/PRINCIPAL FINDINGS: Participants used each of 3 treatments (Carraguard gel, methylcellulose placebo gel, and no product) for 7 days, were randomized to one of six treatment sequences, and were blinded to the type of gel they received in the two gel-use periods. After both gel-use periods, acceptability was assessed by face-to-face interview. Responses were compared to those of women participating in two previous Carraguard safety studies at the same study site. Sixty women enrolled with a median age of 34 years; 25% were sexually active. Self-reported adherence (98%) and overall satisfaction rating of the gels (87% liked "somewhat" or "very much") were high, and most (77%) considered the volume of gel "just right." For most characteristics, crossover trial participants evaluated the gels more favorably than women in the other two trials, but there were few differences in the desired characteristics of a hypothetical microbicide. Almost half (48%) of crossover trial participants noticed a difference between Carraguard and placebo gels; 33% preferred Carraguard while 12% preferred placebo (p = 0.01). CONCLUSIONS/SIGNIFICANCE: Daily Carraguard vaginal gel use was highly acceptable in this population of HIV-infected women, who assessed the gels more positively than women in two other trials at the site. This may be attributable to higher perceived need for protection among HIV-infected women, as well as to study design differences. This trial was registered in the U.S. National Institutes of Health clinical trials registry under registration number NCT00213044. |
Air sickness: vomiting and environmental transmission of norovirus on aircraft
Lopman B . Clin Infect Dis 2011 53 (6) 521-2 Vomiting is a common—perhaps the defining—feature of norovirus gastroenteritis. Indeed, the syndrome was once known as “winter vomiting disease.” Vomiting often occurs with no prodromic forewarning; thus, public vomiting appears to be the spark that starts the rapid spread of many outbreaks. Both classic outbreak investigations [1] and sophisticated modeling studies [2] have demonstrated the role of vomiting in direct transmission. This suggests a role for vomitus-oral transmission through droplets, more frequently associated with transmission of respiratory pathogens. Cases occurring through this mode of transmission occur within 1 incubation period (<48 hours for norovirus) from the time of the vomiting incident. In addition, after being aerosolized by vomiting, norovirus settles on surfaces and may persist and remain infectious, from which cases may occur days or even weeks later. | After a public vomiting incident aboard a long haul flight on a Boeing 777-200, 27 flight attendants who worked on the aircraft on 8 flight sectors over 6 days suffered symptoms of gastroenteritis consistent with norovirus infection [3]. The evidence that these illnesses were a result of a common exposure to norovirus is circumstantial, but compelling nonetheless. Aside from the crew on the first flight sector on which the vomiting incident occurred, there was no apparent opportunity for direct transmission from symptomatic crew to each other. No flight attendants worked on the aircraft while ill or within 48 hours after they recovered. Although both pre- and postsymptomatic transmission of norovirus have been documented in other studies [4], this is not likely to have played a major role in this situation. Two flight attendants from different sectors had laboratory-confirmed infections with the rare genogroup 1 genotype 6 (G1.6) norovirus. The chances that both individuals were infected with this particular norovirus strain and were not part of the same chain of transmission are improbably small. The long-standing norovirus sequence database of the viruses causing outbreaks in New Zealand and worldwide [5] was crucial to making this molecular epidemiological inference. |
The contribution of HIV-discordant relationships to new HIV infections in Rakai, Uganda
Grabbe KL , Medley A , Bachanas P , Bock N , Marum E . AIDS 2011 25 (15) 1931-2 In their recent research letter entitled ‘The contribution of HIV-discordant relationships to new HIV infections in Rakai, Uganda’, Gray et al. [1] argue that targeting HIV testing and counseling efforts to HIV serodiscordant couples will have limited impact for HIV prevention. We disagree with this argument for several reasons. | Gray et al. [1] underestimate the true contribution to overall HIV incidence from serodiscordant couples in two ways. First, they focus only on study participants identified as both married and serodiscordant. Yet approximately one-third of married couples had a partner of unknown HIV status (36 and 33% in the pre- and post-antiretroviral therapy (ART) intervals, respectively). It is likely that some of these couples were in fact HIV serodiscordant. Likewise, among those who were not currently married, some were likely in long-term serodiscordant relationships. Thus, the number of infections that occurred among serodiscordant couples is unknown but likely higher than could be reported with the available data. | Second, although the authors state that acceptance of couples counseling has been low in their cohort, it is unclear from the letter what proportion of the couples identified as serodiscordant in the database were actually aware of their serodiscordant status or had received couples HIV testing and counseling (CHTC). Thus, the contribution of serodiscordant couples to new HIV infections may have been low because of mutual disclosure of HIV status or other effective interventions that reduce sexual risk behaviors and transmission [2–7]. |
Urinary concentrations of dialkylphosphate metabolites of organophosphorus pesticides: National Health and Nutrition Examination Survey 1999-2004
Barr DB , Wong LY , Bravo R , Weerasekera G , Odetokun M , Restrepo P , Kim DG , Fernandez C , Whitehead RD Jr , Perez J , Gallegos M , Williams BL , Needham LL . Int J Environ Res Public Health 2011 8 (8) 3063-98 Organophosphorus (OP) insecticides were among the first pesticides that EPA reevaluated as part of the Food Quality Protection Act of 1996. Our goal was to assess exposure to OP insecticides in the U.S. general population over a six-year period. We analyzed 7,456 urine samples collected as part of three two-year cycles of the National Health and Nutrition Examination Survey (NHANES) from 1999-2004. We measured six dialkylphosphate metabolites of OP pesticides to assess OP pesticide exposure. In NHANES 2003-2004, dimethylthiophosphate was detected most frequently with median and 95th percentile concentrations of 2.03 and 35.3 mcg/L, respectively. Adolescents were two to three times more likely to have diethylphosphate concentrations above the 95th percentile estimate of 15.5 mcg/L than adults and senior adults. Conversely, for dimethyldithiophosphate, senior adults were 3.8 times and 1.8 times more likely to be above the 95th percentile than adults and adolescents, respectively, while adults were 2.1 times more likely to be above the 95th percentile than the adolescents. Our data indicate that the most vulnerable segments of our population-children and older adults-have higher exposures to OP pesticides than other population segments. However, according to DAP urinary metabolite data, exposures to OP pesticides have declined during the last six years at both the median and 95th percentile levels. |
Potential immunotoxicological health effects following exposure to COREXIT 9500A during cleanup of the Deepwater Horizon oil spill
Anderson SE , Franko J , Lukomska E , Meade BJ . J Toxicol Environ Health A 2011 74 (21) 1419-30 Workers involved in the Deepwater Horizon oil spill cleanup efforts reported acute pulmonary and dermatological adverse health effects. These studies were undertaken to assess the immunotoxicity of COREXIT 9500A, the primary dispersant used in cleanup efforts, as a potential causative agent. COREXIT 9500A and one of its active ingredients, dioctyl sodium sulfosuccinate (DSS), were evaluated using murine models for hypersensitivity and immune suppression, including the local lymph node assay (LLNA), phenotypic analysis of draining lymph node cells (DLN), mouse ear swelling test (MEST), total serum immunoglobulin E (IgE), and the plaque-forming cell (PFC) assay. Dermal exposure to COREXIT 9500A and DSS induced dose-responsive increases in dermal irritation and lymphocyte proliferation. The EC3 values for COREXIT 9500A and DSS were 0.4% and 3.9%, respectively, resulting in a classification of COREXIT 9500A as a potent sensitizer and DSS as a moderate sensitizer. A T-cell-mediated mechanism underlying the LLNA was supported by positive responses in the MEST assay for COREXIT and DSS, indicated by a significant increase in ear swelling 48 h post challenge. There were no marked alterations in total serum IgE or B220+/IgE+ lymph-node cell populations following exposure to COREXIT 9500A. Significant elevations in interferon (IFN)-gamma but not interleukin (IL)-4 protein were also observed in stimulated lymph node cells. The absence of increases in IgE and IL-4 in the presence of enhanced lymphocyte proliferation, positive MEST responses, and elevations in IFN-gamma suggest a T-cell-mediated mechanism. COREXIT 9500A did not induce immunosuppression in the murine model. |
Association of low-level blood lead and blood pressure in NHANES 1999-2006
Scinicariello F , Abadin HG , Murray HE . Environ Res 2011 111 (8) 1249-57 This study investigated whether low blood-lead levels (≤10mcg/dL) were associated with blood pressure (BP) outcomes. The authors analyzed data from National Health and Nutrition Examination Survey 1999-2006 and participants aged 20 years or older. Outcome variables were systolic and diastolic BP measurements, pulse pressure, and hypertension status. Multivariable linear and logistic regressions stratified by race/ethnicity and gender were performed. Blood lead levels (BLL) were significantly correlated with higher systolic BP among black men and women, but not white or Mexican-American participants. BLLs were significantly associated with higher diastolic BPs among white men and women and black men, whereas, a negative association was observed in Mexican-American men that had, also, a wider pulse pressure. Black men in the 90th percentile of blood lead distribution (BLL≥3.50mcg/dL) compared to black men in the 10th percentile of blood lead distribution (BLL≤0.7mcg/dL) had a significant increase of risk of having hypertension (adjusted POR=2.69; 95% CI: 1.08-6.72). In addition, blood cadmium was significantly associated with hypertension and systolic and diastolic blood. This study found that, despite the continuous decline in blood lead in the U.S. population, lead exposure disparities among race and gender still exist. |
Seasonality - still confusing
Dowell SF . Epidemiol Infect 2011 140 (1) 1-4 Annual peaks in incidence are almost universal features of infectious disease epidemiology, yet a consistent explanation for this phenomenon remains elusive. The article by Murray and colleagues [Reference Murray1] adds rigorously collected and analysed data and proposes household crowding as an explanation, but there are internal inconsistencies in this study as there are throughout the infectious disease seasonality literature. What exists are models that explain only a subset of the data, or proposed drivers for seasonality that correlate with the seasonal variation for one pathogen in one geographical area, but break down for the same pathogen in another location, or correlate well for several years and then fail to do so consistently over time. And yet a regular annual variation in the incidence of acute respiratory infections is among the most undeniable patterns in infectious disease epidemiology, almost begging for a simple explanation. | The study by Murray and colleagues begins by acknowledging a contradiction. The authors note that a recent laboratory study identified cold, dry air as more conducive to the aerosol transmission of influenza viruses in guinea pigs [Reference Lowen2], but that such an explanation could not be the reason for the seasonal increase in Bangladesh, because that peak occurs during the hottest, wettest time of the year. They go on to describe an elegant study exploring the hypothesis that household crowding during the rainy season is the explanation. Indeed, during a single 3-month period respiratory infections were significantly more likely to be associated with rainy days than were control periods. Their explanation that people were crowded indoors during the rains, increasing the transmission of influenza and other respiratory viruses, appears to have been substantiated by a stronger association for homes with >3 inhabitants. |
Patterns of illness in travelers visiting Mexico and Central America: the GeoSentinel experience
Flores-Figueroa J , Okhuysen PC , von Sonnenburg F , Dupont HL , Libman MD , Keystone JS , Hale DC , Burchard G , Han PV , Wilder-Smith A , Freedman DO . Clin Infect Dis 2011 53 (6) 523-531 BACKGROUND: Mexico and Central America are important travel destinations for North American and European travelers. There is limited information on regional differences in travel related morbidity. METHODS: We describe the morbidity among 4779 ill travelers returned from Mexico and Central America who were evaluated at GeoSentinel network clinics during December 1996 to February 2010. RESULTS: The most frequent presenting syndromes included acute and chronic diarrhea, dermatologic diseases, febrile systemic illness, and respiratory disease. A higher proportion of ill travelers from the United States had acute diarrhea, compared with their Canadian and European counterparts (odds ratio, 1.9; P < .0001). During the 2009 H1N1 influenza outbreak from March 2009 through February 2010, the proportionate morbidity (PM) associated with respiratory illnesses in ill travelers increased among those returned from Mexico, compared with prior years (196.0 cases per 1000 ill returned travelers vs 53.7 cases per 1000 ill returned travelers; P < .0001); the PM remained constant in the rest of Central America (57.3 cases per 1000 ill returned travelers). We identified 50 travelers returned from Mexico and Central America who developed influenza, including infection due to 2009 H1N1 strains and influenza-like illness. The overall risk of malaria was low; only 4 cases of malaria were acquired in Mexico (PM, 2.2 cases per 1000 ill returned travelers) in 13 years, compared with 18 from Honduras (PM, 79.6 cases per 1000 ill returned travelers) and 14 from Guatemala (PM, 34.4 cases per 1000 ill returned travelers) during the same period. Plasmodium vivax malaria was the most frequent malaria diagnosis. CONCLUSIONS: Travel medicine practitioners advising and treating travelers visiting these regions should dedicate special attention to vaccine-preventable illnesses and should consider the uncommon occurrence of acute hepatitis A, leptospirosis, neurocysticercosis, acute Chagas disease, onchocerciasis, mucocutaneous leishmaniasis, neurocysticercosis, HIV, malaria, and brucellosis. |
Probabilistic linkage of assisted reproductive technology information with vital records, Massachusetts 1997-2000
Zhang Y , Cohen B , Macaluso M , Zhang Z , Durant T , Nannini A . Matern Child Health J 2011 16 (8) 1703-8 To assess the validity of probabilistic linkage (PL) in combining national surveillance data on assisted reproductive technology (ART) with Massachusetts birth and infant death data, for the purpose of monitoring maternal and child health outcomes of ART. A study conducted in 2006 utilized direct identifiers to match Massachusetts birth records with records on ART procedures performed to Massachusetts residents in fertility clinics located in Massachusetts and Rhode Island, achieving a linkage rate of 87.5%. The present study employed PL using the program Link Plus, without access to direct identifiers. The primary linking variables were maternal and infant dates of birth, and plurality. Ancillary variables such as maternal ZIP code and gravidity helped resolve duplicate matches and capture additional matches. PL linked 5,390 (87.8%) of 6,139 deliveries, correctly identifying 96.4% of the matches previously obtained using deterministic linkage methods. PL yielded a high linkage rate with satisfactory validity; this method may be applied in other states to help monitor the maternal and child health outcomes of ART. |
Effect of incorporating adaptive functioning scores on the prevalence of intellectual disability
Obi O , Van Naarden Braun K , Baio J , Drews-Botsch C , Devine O , Yeargin-Allsopp M . Am J Intellect Dev Disabil 2011 116 (5) 360-70 Surveillance and epidemiologic research on intellectual disability often do not incorporate adaptive functioning (AF) data. Exclusion of AF data leads to overestimation of the prevalence of intellectual disability, the extent of which is not known. In this study, the authors evaluated the effect of incorporating AF data on overall intellectual disability prevalence according to sociodemographic, economic, and severity characteristics. Between 2002 and 2006, the Metropolitan Atlanta Developmental Disabilities Surveillance Program identified 1,595 8-year-old children who met the study's intellectual disability surveillance-case definition of IQ ≤ 70. AF scores were not available for 9.2% of the case children, specifically those with mild intellectual disability and low socioeconomic backgrounds. Prevalence estimates showed few substantive changes when incorporating AF data. The authors conclude that use of IQ data alone appears to be appropriate for measuring population intellectual disability prevalence. |
Epidemiology of syphilis in Kenya: results from a nationally representative serological survey
Otieno-Nyunya B , Bennett E , Bunnell R , Dadabhai S , Gichangi AA , Mugo N , Wanyungu J , Baya I , Kaiser R . Sex Transm Infect 2011 87 (6) 521-525 OBJECTIVES: The authors used data from the Kenya AIDS Indicator Survey (KAIS) 2007 to determine the prevalence of syphilis and associated risk factors among adults aged 15-64 years. METHODS: KAIS was a nationally representative population-based sero-survey that examined demographic and behavioural indicators and serological testing for syphilis, HIV and herpes simplex virus type 2 (HSV-2) in adults aged 15-64 years. The authors analysed data from 8935 women and 6727 men with complete syphilis results. Logistic regression models stratified by sex were used to assess potential factors associated with syphilis sero-prevalence. RESULTS: Overall, 262 adults tested positive for syphilis (1.8%, 95% CI 1.5% to 2.1%); sero-prevalence was similar among women and men (1.7%, 95% CI 1.3% to 2.0% and 1.9%, 95% CI 1.5% to 2.3%, respectively). Syphilis prevalence was the highest among men with HIV (6.4%, 95% CI 3.1% to 9.7%) and HSV-2 (4.5%, 95% CI 3.4% to 5.7%) infection. Independent risk factors for syphilis included HIV (men only, adjusted OR (AOR) 3.4, 95% CI 1.6% to 7.1%), HSV-2 (women, AOR 3.5, 95% CI 2.1% to 5.8%; men AOR 2.2, 95% CI 1.3% to 3.7%), lack of male circumcision (AOR 2.2, 95% CI 1.3% to 3.7%), poorest or poorer versus richest wealth index (women, AOR 2.0, 95% CI 1.0% to 4.2%; men AOR 2.5, 95% CI 1.4% to 4.9%) and no primary versus secondary or more education in men (AOR 4.8, 95% CI 2.0% to 11.7%). CONCLUSIONS: Syphilis prevalence in the general population in Kenya is relatively low and eradication could be possible but would require intensified syphilis prevention and control efforts, including routine screening in HIV, sexually transmitted infection and antenatal care clinics as well as in family planning and male circumcision settings. |
HCV screening practices and prevalence in an MCO, 2000-2007
Roblin DW , Smith BD , Weinbaum CM , Sabin ME . Am J Manag Care 2011 17 (8) 548-55 BACKGROUND/OBJECTIVE: The Centers for Disease Control and Prevention recommends routine screening for the hepatitis C virus antibody (anti- HCV) among persons most likely to be infected. Little is known about anti-HCV screening and prevalence in routine practice settings. We studied anti-HCV screening rates, anti-HCV positivity, and demographic and risk factors associated with increased likelihood of anti-HCV screening or positivity in a managed care organization (MCO). METHODS: This was a retrospective observational study of 17-to-74-year-old MCO enrollees from 2000 to 2007 (N = 557,056; 1,949,499 enrollee years). The primary outcome measures were likelihood of anti-HCV screening and HCV positivity (both in the total population and among those screened). Independent variables were: birth cohort, gender, HCV risk factors, and socioeconomic status (SES) and race of residents' neighborhoods. Likelihood of each outcome as a function of the independent variables was estimated using logistic regression. RESULTS: Over the 8-year period, 4.31% of the total population received anti-HCV screening; 0.22% had a positive HCV result. Among those screened, HCV positivity was 5.15%. HCV screening and positivity rates increased over time. Both likelihood of HCV screening and HCV positivity were highest (P <0.05) among persons born during 1945-1964, males, those with HCV risk factors, and residents of neighborhoods of lower SES or with higher percentages of African Americans. CONCLUSIONS: Although HCV screening and detection improved in this MCO over an 8-year period, anti-HCV screening was lower than expected. Many persons at risk for HCV remained unscreened. Strategies for improving anti-HCV screening in routine practice are recommended for patients at increased risk. |
Assessing Google Flu Trends performance in the United States during the 2009 influenza virus A (H1N1) pandemic
Cook S , Conrad C , Fowlkes AL , Mohebbi MH . PLoS One 2011 6 (8) e23610 BACKGROUND: Google Flu Trends (GFT) uses anonymized, aggregated internet search activity to provide near-real time estimates of influenza activity. GFT estimates have shown a strong correlation with official influenza surveillance data. The 2009 influenza virus A (H1N1) pandemic [pH1N1] provided the first opportunity to evaluate GFT during a non-seasonal influenza outbreak. In September 2009, an updated United States GFT model was developed using data from the beginning of pH1N1. METHODOLOGY/PRINCIPAL FINDINGS: We evaluated the accuracy of each U.S. GFT model by comparing weekly estimates of ILI (influenza-like illness) activity with the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet). For each GFT model we calculated the correlation and RMSE (root mean square error) between model estimates and ILINet for four time periods: pre-H1N1, Summer H1N1, Winter H1N1, and H1N1 overall (Mar 2009-Dec 2009). We also compared the number of queries, query volume, and types of queries (e.g., influenza symptoms, influenza complications) in each model. Both models' estimates were highly correlated with ILINet pre-H1N1 and over the entire surveillance period, although the original model underestimated the magnitude of ILI activity during pH1N1. The updated model was more correlated with ILINet than the original model during Summer H1N1 (r = 0.95 and 0.29, respectively). The updated model included more search query terms than the original model, with more queries directly related to influenza infection, whereas the original model contained more queries related to influenza complications. CONCLUSIONS: Internet search behavior changed during pH1N1, particularly in the categories "influenza complications" and "term for influenza." The complications associated with pH1N1, the fact that pH1N1 began in the summer rather than winter, and changes in health-seeking behavior each may have played a part. Both GFT models performed well prior to and during pH1N1, although the updated model performed better during pH1N1, especially during the summer months. |
Convergent genomic studies identify association of GRIK2 and NPAS2 with chronic fatigue syndrome.
Smith AK , Fang H , Whistler T , Unger ER , Rajeevan MS . Neuropsychobiology 2011 64 (4) 183-94 BACKGROUND: There is no consistent evidence of specific gene(s) or molecular pathways that contribute to the pathogenesis, therapeutic intervention or diagnosis of chronic fatigue syndrome (CFS). While multiple studies support a role for genetic variation in CFS, genome-wide efforts to identify associated loci remain unexplored. We employed a novel convergent functional genomics approach that incorporates the findings from single-nucleotide polymorphism (SNP) and mRNA expression studies to identify associations between CFS and novel candidate genes for further investigation. METHODS: We evaluated 116,204 SNPs in 40 CFS and 40 nonfatigued control subjects along with mRNA expression of 20,160 genes in a subset of these subjects (35 CFS subjects and 27 controls) derived from a population-based study. RESULTS: Sixty-five SNPs were nominally associated with CFS (p < 0.001), and 165 genes were differentially expressed (≥4-fold; p ≤ 0.05) in peripheral blood mononuclear cells of CFS subjects. Two genes, glutamate receptor, ionotropic, kinase 2 (GRIK2) and neuronal PAS domain protein 2 (NPAS2), were identified by both SNP and gene expression analyses. Subjects with the G allele of rs2247215 (GRIK2) were more likely to have CFS (p = 0.0005), and CFS subjects showed decreased GRIK2 expression (10-fold; p = 0.015). Subjects with the T allele of rs356653 (NPAS2) were more likely to have CFS (p = 0.0007), and NPAS2 expression was increased (10-fold; p = 0.027) in those with CFS. CONCLUSION: Using an integrated genomic strategy, this study suggests a possible role for genes involved in glutamatergic neurotransmission and circadian rhythm in CFS and supports further study of novel candidate genes in independent populations of CFS subjects. |
Monitoring the safety of quadrivalent human papillomavirus vaccine: findings from the Vaccine Safety Datalink
Gee J , Naleway A , Shui I , Baggs J , Yin R , Li R , Kulldorff M , Lewis E , Fireman B , Daley MF , Klein NP , Weintraub ES . Vaccine 2011 29 (46) 8279-84 BACKGROUND: In 7 large managed care organizations (MCOs), we performed a post-licensure safety assessment of quadrivalent human papillomavirus vaccine (HPV4) among 9-26 year-old female vaccine recipients between August 2006 and October 2009. METHODS: Sequential analyses were conducted weekly to detect associations between HPV4 exposure and pre-specified outcomes. The pre-specified outcomes identified by ICD-9 codes using computerized data at the participating MCOs included: Guillan-Barre Syndrome (GBS), stroke, venous thromboembolism (VTE), appendicitis, seizures, syncope, allergic reactions, and anaphylaxis. For rare outcomes, historical background rates were used as the comparison group. For more common outcomes, a concurrent unexposed comparison group was utilized. A standardized review of medical records was conducted for all cases of GBS, VTE, and anaphylaxis. RESULTS: A total of 600,558 HPV4 doses were administered during the study period. We found no statistically significant increased risk for the outcomes studied. However, a non-statistically significant relative risk (RR) for VTE ICD-9 codes following HPV4 vaccination of 1.98 was detected among females age 9-17 years. Medical record review of all 8 vaccinated cases in this age group revealed that 5 met the standard case definition for VTE and all cases had known risk factors for VTE (oral contraceptive use, coagulation disorders, smoking, obesity or prolonged hospitalization). CONCLUSIONS: In a study of over 600,000 HPV4 vaccine doses administered, no statistically significant increased risk for any of the pre-specified adverse events after vaccination was detected. Further study of a possible association with VTE following HPV4 vaccination is warranted. |
Monovalent rotavirus vaccine provides protection against an emerging fully heterotypic G9P[4] rotavirus strain in Mexico
Yen C , Figueroa JR , Uribe ES , Carmen-Hernandez LD , Tate JE , Parashar UD , Patel MM , Richardson Lopez-Collado V . J Infect Dis 2011 204 (5) 783-6 After the introduction of monovalent rotavirus vaccine (RV1) in Mexico in 2006-2007, diarrhea mortality and morbidity declined substantially among Mexican children under 5 years of age. In January 2010, surveillance identified the emergence of a novel G9P[4] rotavirus strain nationwide. We conducted a case-control study to assess the field effectiveness of RV1 against severe rotavirus gastroenteritis caused by this unusual strain and to determine whether the G9P[4] emergence was related to vaccine failure or failure to vaccinate. RV1 was 94% effective (95% confidence interval, 16%-100%) against G9P[4] rotavirus-related hospitalization, indicating that its emergence was likely unrelated to vaccine pressure. |
Childhood diarrhea deaths after rotavirus vaccination in Mexico
Richardson V , Parashar U , Patel M . N Engl J Med 2011 365 (8) 772-3 The World Health Organization (WHO) recommends the use of rotavirus vaccines for all children worldwide to control severe rotavirus disease, which causes 527,000 childhood deaths annually. After the phased national introduction of rotavirus vaccine in Mexico in 2006 and 2007, we showed a marked reduction in the rate of death from childhood diarrhea during the rotavirus season (December to May) of 2007–2008 and 2008–2009 (Jan. 28, 2010, issue).1 However, because of year-to-year variations in diarrhea rates, cautious interpretation was warranted with regard to whether rotavirus vaccination had a causal role in this reduction. In addition, emerging evidence from Africa, Asia, and poor settings of Latin America suggests the possibility of waning vaccine efficacy after the first year of life.2-4 To address these concerns, we continued to monitor diarrhea-related deaths in Mexican children and compared diarrhea-related mortality during a 3-year period after the introduction of the vaccine (2008–2010) with mortality during rotavirus seasons in baseline years (2003–2006), excluding the transition year (2007). | Number of Diarrhea-Related Deaths among Children 59 Months of Age or Younger from July 2002 through December 2010 in Mexico, According to Age Group. | We found a sustained reduction in diarrhea-related mortality for children under the age of 5 years for 3 full years (Figure 1). As compared with baseline, diarrhea mortality fell by 56% (95% confidence interval [CI], 49 to 63) during rotavirus seasons after vaccination. Reductions were primarily among children under 1 year of age in the 2007–2008 season and extended to older ages in subsequent seasons. Annual diarrhea-related mortality among children under the age of 5 years dropped by 46% (95% CI, 42 to 50) from an average of 18 deaths per 100,000 in 2003–2006 to 9 deaths per 100,000 in 2008–2010 (P<0.001). These findings translate to an annual reduction of approximately 880 deaths related to childhood diarrhea. Overall, most of the reduction was among children under 2 years of age, who accounted for approximately 90% of the diarrhea-related mortality among children under the age of 5 years. |
Update of the NIOSH life table analysis system: a person-years analysis program for the windows computing environment
Schubauer-Berigan MK , Hein MJ , Raudabaugh WM , Ruder AM , Silver SR , Spaeth S , Steenland K , Petersen MR , Waters KM . Am J Ind Med 2011 54 (12) 915-24 BACKGROUND: Person-years analysis is a fundamental tool of occupational epidemiology. A life table analysis system (LTAS), previously developed by the National Institute for Occupational Safety and Health, was limited by its platform and analysis and reporting capabilities. We describe the updating of LTAS for the Windows operating system (LTAS.NET) with improved properties. SOFTWARE DEVELOPMENT PROCESS: A group of epidemiologists, programmers, and statisticians developed software, platform, and computing requirements. Statistical methods include the use of (indirectly) standardized mortality ratios, (directly) standardized rate ratios, confidence intervals, and P values based on the normal approximation and exact Poisson methods, and a trend estimator for linear exposure-response associations. SOFTWARE FEATURES: We show examples using LTAS.NET to stratify and analyze multiple fixed and time-dependent variables. Data import, stratification, and reporting options are highly flexible. Users may export stratified data for Poisson regression modeling. CONCLUSIONS: LTAS.NET incorporates improvements that will facilitate more complex person-years analysis of occupational cohort data. |
Multi-locus variable number tandem repeat analysis for investigation of the genetic association of Clostridium difficile isolates from food, food animals and humans.
Marsh JW , Tulenko MM , Shutt KA , Thompson AD , Weese JS , Songer JG , Limbago BM , Harrison LH . Anaerobe 2011 17 (4) 156-60 Clostridium difficile is the primary known cause of antibiotic-associated diarrhea. Diarrheal disease in food animals due to C. difficile infection has been well documented. Recently, reports of C. difficile infections in patients with no known risk factors for disease have raised concern of community acquisition through food animals and food. In this study, multi-locus variable number tandem repeat analysis (MLVA) was performed on a collection of 97C. difficile isolates of human, animal and food origin belonging to either the North American pulsed-field type (NAP) 1 or NAP7/NAP8. MLVA discriminated between NAP1 and NAP7/NAP8 populations. Three clusters of food, food animal and human NAP1 isolates were highly related by MLVA. These data suggest the possibility of either laboratory contamination or widespread distribution of clonal C. difficile populations. Community-associated NAP1 isolates were unrelated to NAP1 food and food animal isolates. Two MLVA loci were absent and 1 was invariant in all NAP7/NAP8 isolates. Therefore, MLVA discrimination was not sufficient to make assessments regarding the genetic associations among food, food animal and human isolates belonging to the NAP7/NAP8 pulsovar. Rigorous epidemiologic and laboratory investigations that employ highly discriminatory genotyping methods are necessary to compare C. difficile isolates from food and food animals to those from humans. |
Characterization of Helicobacter pylori cagA and vacA genotypes among Alaskans and their correlation with clinical disease.
Miernyk K , Morris J , Bruden D , McMahon B , Hurlburt D , Sacco F , Parkinson A , Hennessy T , Bruce M . J Clin Microbiol 2011 49 (9) 3114-21 Helicobacter pylori infection is common in Alaska. The development of severe H. pylori disease is partially determined by the virulence of the infecting strain. Here we present vacA and cagA genotype data for H. pylori strains isolated from Alaskans and their correlation with clinical disease. We enrolled patients scheduled for esophagogastroduodenoscopy and positive for H. pylori infection. Gastric biopsy specimens from the stomach antrum and fundus were cultured. We performed PCR analysis of the H. pylori vacA gene and for the presence of the cagA gene and cagA empty site. We genotyped 515 H. pylori samples from 220 Native and 66 non-Native Alaskans. We detected the cagA gene in 242/286 (85%) persons; of 222 strains that could be subtyped, 95% (212) were non-Asian cagA and 3% (6) were East Asian cagA. After removing mixed infections (n = 17), 83% of H. pylori strains had either the vacA s1m1 (120/269) or s2m2 (103/269) genotype. Sixty-six percent (68/103) of H. pylori strains with the vacA s2m2 genotype also contained the cagA gene. Infection with an H. pylori strain having the cagA gene or vacA s1m1 genotype (compared with s1m2 and s2m2) was associated with a decreased risk of esophagitis (P = 0.003 and 0.0003, respectively). Infection with an H. pylori strain having the vacA s1m1 genotype (compared with s1m2 and s2m2) was associated with an increased risk of peptic ulcer disease (PUD) (P = 0.003). The majority of H. pylori strains in this study carried the non-Asian cagA gene and either the vacA s1m1 or s2m2 genotype. A majority of H. pylori strains with the vacA s2m2 genotype also contained the cagA gene. There was an association of H. pylori genotype with esophagitis and PUD. |
Molecular detection and identification of Bartonella species in Xenopsylla cheopis fleas (Siphonaptera: Pulicidae) collected from Rattus norvegicus rats in Los Angeles, California.
Billeter SA , Gundi VA , Rood MP , Kosoy MY . Appl Environ Microbiol 2011 77 (21) 7850-2 Of 200 individual Xenopsylla cheopis fleas removed from Rattus norvegicus trapped in downtown Los Angeles, California, 190 (95%) were positive for the presence of Bartonella DNA. Ninety-one amplicons were sequenced: B. rochalimae-like DNA was detected in 66 examined fleas and B. tribocorum-like DNA was identified in 25 fleas. The data obtained from this study demonstrates an extremely high prevalence of Bartonella DNA in rat-associated fleas. |
Tissue binding affects the kinetics of theophylline diffusion through the stratum corneum barrier layer of skin
Frasch HF , Barbero AM , Hettick JM , Nitsche JM . J Pharm Sci 2011 100 (7) 2989-95 New data sets on both (i) equilibrium theophylline (TH) partitioning/binding in stratum corneum and (ii) transient TH diffusion through human epidermis are explained by an extended partition-diffusion model with reversible binding. Data conform to a linear binding isotherm within the tested concentration range (0-2000 mcg/mL) with an equilibrium ratio of bound-to-free solute of approximately 1.4. The permeability coefficient for TH is 4.86 x 10(-5) cm/h, and the lag time is 20.1 h. Binding occurs as a slow process, significantly affecting the kinetics of dermal penetration. |
Mycobacterium tuberculosis testing practices in hospital, commercial and state laboratories in the New England states
Livingston KA , Lobato MN , Sosa LE , Budnick GE , Bernardo J , Downing R , Crosby J , Brookes D , Sharnprapai S , Han L , Sweeney M , Fournier J , Temple B , Froeliger E , Shoenfeld S , Metchock B . Int J Tuberc Lung Dis 2011 15 (9) 1218-1222 SETTING: The mycobacterial laboratory is assuming an increasingly important role in tuberculosis (TB) control in the United States today. OBJECTIVE: To assess mycobacterial laboratory capacity and practices in the New England states, USA. DESIGN: We surveyed 143 hospital and commercial laboratories and five of the six state public health laboratories in New England that offer testing services for Mycobacterium tuberculosis. The survey captured information on types of services offered and volume of testing, use of state laboratories for testing, and promptness of reporting results to TB control programs. RESULTS: State laboratories perform the majority of testing services, particularly for more specialized tests. All state laboratories surveyed perform species identification of acid-fast isolates, culture and first-line drug susceptibility testing. Less than 20% of hospital and commercial laboratories offer these services, and 78.6% of hospitals and commercial laboratories refer specimens to state laboratories for culture. CONCLUSION: Surveys of M. tuberculosis testing capacities in a region can help decision makers ensure maintenance of essential services. Hospital and commercial laboratories with lower testing volume might increase efficiency by referring more specimens to state laboratories. State health departments might consider organizing regional laboratory service networks to monitor the provision of services, improve efficiency and oversee quality improvement initiatives. 2011 The Union. |
National prevalence estimates for cytomegalovirus IgM and IgG avidity and association between high IgM antibody titer and low IgG avidity
Dollard SC , Staras SA , Amin MM , Schmid DS , Cannon MJ . Clin Vaccine Immunol 2011 18 (11) 1895-9 Primary cytomegalovirus (CMV) infection of the mother during pregnancy presents risk of CMV infection of the fetus with resulting permanent disability. CMV IgM antibody is generated following primary CMV infection but also can appear during non-primary CMV infection and is thus of limited diagnostic use by itself. In contrast, the presence of low CMV IgG avidity has been shown to be a unique and reliable serologic indicator of primary CMV infection. We measured CMV IgG, IgM, and IgG avidity antibody in sera from a population sample of 6,067 U.S. women ages 12-49 years old from NHANES (National Health and Nutrition Examination Survey). The CMV IgG prevalence was 58% overall and increased strongly with age. The CMV IgM prevalence was 3.0 % overall and remained relatively flat across age groups. The prevalence of low IgG avidity was 2.0% overall, decreased sharply with age, and was seen mainly among IgM-positive sera. Fourteen to eighteen percent of the CMV IgM-positive sera were low IgG avidity presumably representing primary CMV infection. High CMV IgM antibody titer was a strong predictor of low IgG avidity. The ability to reliably identify primary CMV infection during pregnancy is important for management of the pregnancy including possible treatment options for the fetus. Both IgM and IgG avidity measurements provide useful clinical information for evaluating primary CMV infection, although commercial tests for CMV IgG avidity are not yet widely available in the US. |
Neutralizing human monoclonal antibodies to severe acute respiratory syndrome coronavirus: target, mechanism of action, and therapeutic potential
Coughlin MM , Prabhakar BS . Rev Med Virol 2011 22 (1) 2-17 The emergence of Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) led to a rapid response not only to contain the outbreak but also to identify possible therapeutic interventions, including the generation of human monoclonal antibodies (hmAbs). hmAbs may be used therapeutically without the drawbacks of chimeric or animal Abs. Several different methods have been used to generate SARS-CoV specific neutralizing hmAbs including the immunization of transgenic mice, cloning of small chain variable regions from naive and convalescent patients, and the immortalization of convalescent B cells. Irrespective of the techniques used, the majority of hmAbs specifically reacted with the receptor binding domain (RBD) of the spike (S) protein and likely prevented receptor binding. However, several hmAbs that can bind to epitopes either within the RBD, located N terminal of the RBD or in the S2 domain, and neutralize the virus with or without inhibiting receptor binding have been identified. Therapeutic utility of hmAbs has been further elucidated through the identification of potential combinations of hmAbs that could neutralize viral variants including escape mutants selected using hmAbs. These results suggest that a cocktail of hmAbs that can bind to unique epitopes and have different mechanisms of action might be of clinical utility against SARS-CoV infection, and indicate that a similar approach may be applied to treat other viral infections. Copyright (c) 2011 John Wiley & Sons, Ltd. |
Pulmonary effects after acute inhalation of oil dispersant (COREXIT EC9500A) in rats
Roberts JR , Reynolds JS , Thompson JA , Zaccone EJ , Shimko MJ , Goldsmith WT , Jackson M , McKinney W , Frazer DG , Kenyon A , Kashon ML , Piedimonte G , Castranova V , Fedan JS . J Toxicol Environ Health A 2011 74 (21) 1381-96 COREXIT EC9500A (COREXIT) was used to disperse crude oil during the 2010 Deepwater Horizon oil spill. While the environmental impact of COREXIT has been examined, the pulmonary effects are unknown. Investigations were undertaken to determine whether inhaled COREXIT elicits airway inflammation, alters pulmonary function or airway reactivity, or exerts pharmacological effects. Male rats were exposed to COREXIT (mean 27 mg/m(3), 5 h). Bronchoalveolar lavage was performed on d 1 and 7 postexposure. Lactate dehydrogenase (LDH) and albumin were measured as indices of lung injury; macrophages, neutrophils, lymphocytes, and eosinophils were quantified to evaluate inflammation; and oxidant production by macrophages and neutrophils was measured. There were no significant effects of COREXIT on LDH, albumin, inflammatory cell levels or oxidant production at either time point. In conscious animals, neither breathing frequency nor specific airway resistance were altered at 1 hr, 1 d and 7 d postexposure. Airway resistance responses to methacholine (MCh) aerosol in anesthetized animals were unaffected at 1 and 7 d postexposure, while dynamic compliance responses were decreased after 1 d but not 7 d. In tracheal strips, in the presence or absence of MCh, low concentrations of COREXIT (0.001% v/v) elicited relaxation; contraction occurred at 0.003-0.1% v/v. In isolated, perfused trachea, intraluminally applied COREXIT produced similar effects but at higher concentrations. COREXIT inhibited neurogenic contractile responses of strips to electrical field stimulation. Our findings suggest that COREXIT inhalation did not initiate lung inflammation, but may transiently increase the difficulty of breathing. |
Experimental infection of Swiss Webster mice with four rat bartonella strains: host specificity, bacteremia kinetics, dose dependent response, and histopathology
Colton L , Zeidner N , Kosoy MY . Comp Immunol Microbiol Infect Dis 2011 34 (6) 465-73 Groups of Swiss Webster outbred mice were each inoculated with one of four bartonella strains originally isolated from Rattus spp. at doses ranging from 10(1) to 10(7) bacteria per mouse. One strain, Rn1691yn (Bartonella coopersplainensis-like), infected mice and produced bacteremias at levels up to 10(5) bacteria/ml of blood and from 3 to 8 weeks duration. A dose dependent response was also observed with differing proportions of mice bacteremic following inoculation at different doses. In addition weeks-to-months long lags in bacteremia manifestation occurred following lower dose exposures. The possibility of bacterial transmission from bacteremic mice to uninfected cagemates was assessed and no naive mice became infected from contacts with infected mice. Finally, a subset of bacteremic mice inoculated with high doses of Rn1691yn were examined histopathologically and multifocal, granulomatous lesions were detected in both liver and kidneys. The host specificity and infectivity of the strains is discussed in relation to their potential for zoonotic transmission to incidental hosts. |
Acute effects of COREXIT EC9500A on cardiovascular functions in rats
Krajnak K , Kan H , Waugh S , Miller GR , Johnson C , Roberts JR , Goldsmith WT , Jackson M , McKinney W , Frazer D , Kashon ML , Castranova V . J Toxicol Environ Health A 2011 74 (21) 1397-404 These studies characterized cardiovascular responses after an acute inhalation exposure to COREXIT EC9500A, the oil dispersant used in the Deepwater Horizon oil spill. Male Sprague-Dawley rats underwent a single 5-h inhalation exposure to COREXIT EC9500A (average exposure level 27.12 mg/m(3)) or air. On d 1 and 7 following the exposure, rats were implanted with indwelling catheters and changes in heart rate and blood pressure were assessed in response to increasing levels of adrenoreceptor agonists. A separate group of rats was euthanized at the same time points, ventral tail arteries were dissected, and vascular tone along with dose-dependent responses to vasoconstricting and dilating factors were assessed in vitro. Agonist-induced dose-dependent increases in heart rate and blood pressure were greater in COREXIT EC9500A-exposed than in air-exposed rats at 1 d but not 7 d after the exposure. COREXIT EC9500A exposure also induced a rise in basal tone and reduced responsiveness of tail arteries to acetylcholine-induced vasodilation at 1 d but not 7 d following the exposure. These findings demonstrate that an acute exposure to COREXIT EC9500A exerts transient effects on cardiovascular and peripheral vascular functions. |
Comparison of innate immune responses to pathogenic and putative non-pathogenic hantaviruses in vitro
Shim SH , Park MS , Moon S , Park KS , Song JW , Song KJ , Baek LJ . Virus Res 2011 160 367-73 Hantaviruses are human pathogens that cause hemorrhagic fever with renal syndrome or hantavirus cardiopulmonary syndrome. The mechanisms accounting for the differences in virulence between pathogenic and non-pathogenic hantaviruses are not well known. We have examined the pathogenesis of different hantavirus groups by comparing the innate immune responses induced in the host cell following infection by pathogenic (Sin Nombre, Hantaan, and Seoul virus) and putative non-pathogenic (Prospect Hill, Tula, and Thottapalayam virus) hantaviruses. Pathogenic hantaviruses were found to replicate more efficiently in interferon-competent A549 cells than putative non-pathogenic hantaviruses. The former also suppressed the expression of the interferon-beta and myxovirus resistance protein genes, while the transcription level of both genes increased rapidly within 24h post-infection in the latter. In addition, the induction level of interferon correlated with the activation level of interferon regulatory factor-3. Taken together, these results suggest that the observed differences are correlated with viral pathogenesis and further indicate that pathogenic and putative non-pathogenic hantaviruses differ in terms of early interferon induction via activation of the interferon regulatory factor-3 in infected host cells. |
Maternal smokeless tobacco use in Alaska Native women and singleton infant birth size
England LJ , Kim SY , Shapiro-Mendoza CK , Wilson HG , Kendrick JS , Satten GA , Lewis CA , Whittern P , Tucker MJ , Callaghan WM . Acta Obstet Gynecol Scand 2011 91 (1) 93-103 OBJECTIVE: To examine the effects of maternal prenatal smokeless tobacco use on infant birth size. DESIGN: A retrospective medical record review of 502 randomly selected deliveries. POPULATION: Singleton deliveries to Alaska Native women residing in a defined geographical region in western Alaska, 1997-2005. MATERIAL AND METHODS: A regional medical center's electronic records were used to identify singleton deliveries. Data on maternal tobacco exposure and pregnancy outcomes were abstracted from medical records. Logistic models were used to estimate adjusted mean birthweight, length, and head circumference for deliveries to women who used no tobacco (n=121), used smokeless tobacco (n=237), or smoked cigarettes (n=59). Differences in mean birthweight, length, and head circumference, 95% confidence intervals, and p-values were calculated using non-users as the reference group. MAIN OUTCOME MEASURES: Infant birthweight, crown-heel length, and head circumference. RESULTS: After adjustment for gestational age and other potential confounders, the mean birthweight of infants of smokeless tobacco users was reduced by 78g compared with that of infants of non-users (p=0.18), and by 331g in infants of smokers (p<0.01). No association was found between maternal smokeless tobacco use and infant length or infant head circumference. CONCLUSIONS: We found a modest but non-significant reduction in the birthweight of infants of smokeless tobacco users compared with infants of tobacco non-users. Because smokeless tobacco contains many toxic compounds that could affect other pregnancy outcomes, results of this study should not be construed to mean that smokeless tobacco use is safe during pregnancy. |
Low-fat milk consumption among children and adolescents in the United States, 2007-2008
Kit BK , Carroll MD , Ogden CL . NCHS Data Brief 2011 75 (75) 1-8 Milk and milk products are recommended in Dietary Guidelines for Americans, 2010 because of their positive contribution to dietary intake of calcium, vitamin D, and other nutrients. Milk consumption during childhood is particularly important for achieving optimal lifetime bone health. To obtain the nutritional benefits of milk while limiting caloric and fat intake, low-fat milk and milk products are recommended by Dietary Guidelines for Americans, 2010 and the American Academy of Pediatrics for all individuals aged 2 years and over. This report presents recent national data on the frequency and type of milk consumed by youth in the United States. |
Study design and methods to investigate inhalation and dermal exposure to polycyclic aromatic compounds and urinary metabolites from asphalt paving workers: research conducted through partnership
Kriech AJ , Osborn LV , Snawder JE , Olsen LD , Herrick RF , Cavallari Jr M , McClean MD , Blackburn GR . Polycycl Aromat Compd 2011 31 (4) 243-269 Innovations in science may require crossing traditional boundaries between industry, unions, government, and academia. While such collaborations have the potential to be highly beneficial and productive, opportunities for such collaborations are often missed due to some of the inherent challenges. This collaborative research effort demonstrates an example of how a successful partnership can optimize the ability to answer complicated scientific questions. Specifically, these researchers collaborated to investigate inhalation and dermal exposures to polycyclic aromatic compounds and related urinary metabolites in hot-mix asphalt paving workers. Reported here are details of the partnership process used to create the study design, the review processes, and details of the analytical methodologies employed to help attain the study goals related to the identification of the nature, source, pathway, and biological relevance of exposure during hot-mix asphalt paving operations. The actual results of the study are being prepared for future publications. |
World Trade Center disaster: assessment of responder occupations, work locations, and job tasks
Woskie SR , Kim H , Freund A , Stevenson L , Park BY , Baron S , Herbert R , de Hernandez MS , Teitelbaum S , de la Hoz RE , Wisnivesky JP , Landrigan P . Am J Ind Med 2011 54 (9) 681-695 BACKGROUND: To date there have been no comprehensive reports of the work performed by 9/11 World Trade Center responders. METHODS: 18,969 responders enrolled in the WTC Medical Monitoring and Treatment Program were used to describe workers' pre-9/11 occupations, WTC work activities and locations from September 11, 2001 to June 2002. RESULTS: The most common pre-9/11 occupation was protective services (47%); other common occupations included construction, telecommunications, transportation, and support services workers. 14% served as volunteers. Almost one-half began work on 9/11 and >80% reported working on or adjacent to the "pile'' at Ground Zero. Initially, the most common activity was search and rescue but subsequently, the activities of most responders related to their pre-9/11 occupations. Other major activities included security; personnel support; buildings and grounds cleaning; and telecommunications repair. CONCLUSIONS: The spatial, temporal, occupational, and task-related taxonomy reported here will aid the development of a job-exposure matrix, assist in assessment of disease risk, and improve planning and training for responders in future urban disasters. Am. J. Ind. Med. 54:681-695, 2011. (C) 2011 Wiley-Liss, Inc. |
Neurotoxicity following acute inhalation exposure to the oil dispersant COREXIT EC9500A
Sriram K , Lin GX , Jefferson AM , Goldsmith WT , Jackson M , McKinney W , Frazer DG , Robinson VA , Castranova V . J Toxicol Environ Health A 2011 74 (21) 1405-18 Consequent to the 2010 Deepwater Horizon oil spill in the Gulf of Mexico, there is an emergent concern about the short- and long-term adverse health effects of exposure to crude oil, weathered-oil products, and oil dispersants among the workforce employed to contain and clean up the spill. Oil dispersants typically comprise of a mixture of solvents and surfactants that break down floating oil to micrometer-sized droplets within the water column, thus preventing it from reaching the shorelines. As dispersants are generally sprayed from the air, workers are at risk for exposure primarily via inhalation. Such inhaled fractions might potentially permeate or translocate to the brain via olfactory or systemic circulation, producing central nervous system (CNS) abnormalities. To determine whether oil dispersants pose a neurological risk, male Sprague-Dawley rats were exposed by whole-body inhalation exposure to a model oil dispersant, COREXIT EC9500A (CE; approximately 27 mg/m(3) x 5 h/d x 1 d), and various molecular indices of neural dysfunction were evaluated in discrete brain areas, at 1 or 7 d postexposure. Exposure to CE produced partial loss of olfactory marker protein in the olfactory bulb. CE also reduced tyrosine hydroxylase protein content in the striatum. Further, CE altered the levels of various synaptic and neuronal intermediate filament proteins in specific brain areas. Reactive astrogliosis, as evidenced by increased expression of glial fibrillary acidic protein, was observed in the hippocampus and frontal cortex following exposure to CE. Collectively, these findings are suggestive of disruptions in olfactory signal transduction, axonal function, and synaptic vesicle fusion, events that potentially result in an imbalance in neurotransmitter signaling. Whether such acute molecular aberrations might persist and produce chronic neurological deficits remains to be ascertained. |
Periodic spirometry in occupational setting: improving quality, accuracy, and precision
Hnizdo E , Hakobyan A , Fleming JL , Beeckman-Wagner LA . J Occup Environ Med 2011 53 (10) 1205-9 OBJECTIVE: Effectiveness of periodic spirometry in medical monitoring depends on spirometry quality. We describe an intervention on spirometry quality and its impact on accuracy and precision of longitudinal measurements. METHODS: The intervention was conducted from 2005 to 2010 in a monitoring program involving approximately 2500 firefighters. Intervention supported adherence to 2005 American Thoracic Society/European Respiratory Society recommendations through monitoring of spirometry quality and longitudinal data precision, technician training, change of spirometer, and quality control. RESULTS: The percentage of forced vital capacity tests meeting the American Thoracic Society/European Respiratory Society criteria increased from 60% to 95% and the mean longitudinal forced expiratory volume in 1 second within-person variation decreased from 6% to 4%. The increased accuracy and precision of measurements and estimated rates of forced expiratory volume in 1 second decline were statistically significant. CONCLUSION: Monitoring of quality and data precision helped to recognize the need for intervention. The intervention improved accuracy and precision of spirometry measurements and their usefulness. |
Pilot study for the investigation of personal breathing zone and dermal exposure using levels of polycyclic aromatic compounds (PAC) and PAC metabolites in the urine of hot-mix asphalt paving workers
Osborn LV , Snawder JE , Olsen LD , Kriech AJ , Cavallari JM , Herrick RF , McClean MD , Blackburn GR . Polycycl Aromat Compd 2011 31 (4) 173-200 As part of the design of a comprehensive study of hot-mix asphalt paving workers to investigate the relative contribution of personal breathing zone and dermal exposures to polycyclic aromatic compounds, a two-part pilot (Phase I) was performed. The pilot study was important to examine the sources of exposure, the chemical nature of these exposures, and their biological relevance through analysis of biomarkers in urine. Existing, modified, and new sampling and analytical techniques, used in concert with each other, were evaluated to help design the full-scale study (Phase II). Although subject numbers were limited, the air, dermal, and urine sampling, analytical results and field experience provided valuable guidance in the design and implementation of Phase II. An overview of methods used and developed from this study is provided. More details of those methods selected for Phase II are presented in complementary manuscripts. Results of Phase II will be the subject of future publications. |
Protective facemask impact on human thermoregulation: an overview
Roberge RJ , Kim JH , Coca A . Ann Occup Hyg 2011 56 (1) 102-12 The use of protective facemasks (PFMs) negatively impacts respiratory and dermal mechanisms of human thermoregulation through impairment of convection, evaporation, and radiation processes. The relatively minor reported increases in core temperature directly attributable to the wearing of PFMs suggest that associated perceptions of increased body temperature may have a significant psychological component or that regional or global brain temperature changes are involved. Modifications in PFM structure, components, and materials might allow for improved heat dissipation and enhanced compliance with use. |
AORN Ergonomic Tool 7: Pushing, Pulling, and Moving Equipment on Wheels
Waters T , Lloyd JD , Hernandez E , Nelson A . AORN J 2011 94 (3) 254-60 Pushing and pulling equipment in and around the OR can place high shear force demands on perioperative team members' shoulder and back muscles and joints. These high forces may lead to work-related musculoskeletal disorders. AORN Ergonomic Tool 7: Pushing, Pulling, and Moving Equipment on Wheels can help perioperative team members assess the risk of pushing and pulling tasks in the perioperative setting. The tool provides evidence-based suggestions about when assistive devices should be used for these tasks and is based on current ergonomic safety concepts, scientific evidence, and knowledge of effective technology and procedures, including equipment and devices for safe patient handling. |
Assessment of exposure to PACs in asphalt workers: measurement of urinary PACs and their metabolites with an ELISA kit
Smith JP , Biagini RE , Johnson BC , Olsen LD , Mackenzie BA , Robertson SA , Sammons DL , Striley CAF , Walker CV , Snawder JE . Polycycl Aromat Compd 2011 31 (4) 270-285 An enzyme-linked immunosorbent assay (ELISA) kit made for determination of polycyclic aromatic compounds (PACs) in water was adapted for measuring PACs and their metabolites in urine. This method was then applied to a pilot asphalt worker PAC exposure study. Currently, liquid-liquid extraction with gas chromatography/isotope dilution high-resolution mass spectrometry (GC/HRMS) is the preferred method to determine urinary PAC metabolites. Although sensitive and specific, GC/HRMS is time consuming and costly. The ELISA method had a range from 14-720 ng/ml 1-hydroxypyrene equivalents with a lower limit of detection (LOD) of 14 ng/ml urine. ELISA and GC/HRMS PAC metabolite measurements had a statistically significant correlation and the PAC ELISA results were indicative of potential asphalt exposure. PAC ELISA is promising as a more rapid and less costly routine method for determining worker exposure to PACs in asphalt emissions. |
Atrazine and cancer incidence among pesticide applicators in the Agricultural Health Study (1994-2007)
Freeman LEB , Rusiecki JA , Hoppin JA , Lubin JH , Koutros S , Andreotti G , Zahm SH , Hines CJ , Coble JB , Barone-Adesi F , Sloan J , Sandler DP , Blair A , Alavanja MC . Environ Health Perspect 2011 119 (9) 1253-9 BACKGROUND: Atrazine is a triazine herbicide used widely in the United States. Although it is an animal carcinogen, the mechanism in rodents does not appear to operate in humans. Few epidemiologic studies have provided evidence for an association. METHODS: The Agricultural Health Study (AHS) is a prospective cohort that includes 57,310 licensed pesticide applicators. In this report, we extend a previous AHS analysis of cancer risk associated with self-reported atrazine use with six additional years of follow-up and more than twice as many cancer cases. Using Poisson regression, we calculated relative risk estimates and 95% confidence intervals for lifetime use of atrazine and intensity-weighted lifetime days, which accounts for factors that impact exposure. RESULTS: Overall, 36,357 (68%) of applicators reported using atrazine, among whom there were 3,146 cancer cases. There was no increase among atrazine users in overall cancer risk or at most cancer sites in the higher exposure categories compared with the lowest. Based on 29 exposed cases of thyroid cancer, there was a statistically significant risk in the second and fourth quartiles of intensity-weighted lifetime days. There was a similar pattern for lifetime days, but neither the risk estimates nor the trend were statistically significant and for neither metric was the trend monotonic. CONCLUSIONS: Overall, there was no consistent evidence of an association between atrazine use and any cancer site. There was a suggestion of increased risk of thyroid cancer, but these results are based on relatively small numbers and minimal supporting evidence. |
A computer-controlled whole-body inhalation exposure system for the oil dispersant COREXIT EC9500A
Goldsmith WT , McKinney W , Jackson M , Law B , Bledsoe T , Siegel P , Cumpston J , Frazer D . J Toxicol Environ Health A 2011 74 (21) 1368-80 An automated whole-body inhalation exposure system capable of exposing 12 individually housed rats was designed to examine the potential adverse health effects of the oil dispersant COREXIT EC9500A, used extensively during the Deepwater Horizon oil spill. A computer-controlled syringe pump injected the COREXIT EC9500A into an atomizer where droplets and vapor were formed and mixed with diluent air. The aerosolized COREXIT EC9500A was passed into a customized exposure chamber where a calibrated light-scattering instrument estimated the real-time particle mass concentration of the aerosol in the chamber. Software feedback loops controlled the chamber aerosol concentration and pressure throughout each exposure. The particle size distribution of the dispersant aerosol was measured and shown to have a count median aerodynamic diameter of 285 nm with a geometric standard deviation of 1.7. The total chamber concentration (particulate + vapor) was determined using a modification of the acidified methylene blue spectrophotometric assay for anionic surfactants. Tests were conducted to show the effectiveness of closed loop control of chamber concentration and to verify chamber concentration homogeneity. Five automated 5-h animal exposures were performed that produced controlled and consistent COREXIT EC9500A concentrations (27.1 +/- 2.9 mg/m(3), mean +/- SD). |
Malaria rapid diagnostic tests in elimination settings-can they find the last parasite?
McMorrow ML , Aidoo M , Kachur SP . Clin Microbiol Infect 2011 17 (11) 1624-31 Rapid diagnostic tests (RDTs) for malaria have improved the availability of parasite-based diagnosis throughout the malaria-endemic world. Accurate malaria diagnosis is essential for malaria case management, surveillance, and elimination. RDTs are inexpensive, simple to perform, and provide results in 15-20 min. Despite high sensitivity and specificity for Plasmodium falciparum infections, RDTs have several limitations that may reduce their utility in low-transmission settings: they do not reliably detect low-density parasitaemia (≤200 parasites/mcL), many are less sensitive for Plasmodium vivax infections, and their ability to detect Plasmodium ovale and Plasmodium malariae is unknown. Therefore, in elimination settings, alternative tools with higher sensitivity for low-density infections (e.g. nucleic acid-based tests) are required to complement field diagnostics, and new highly sensitive and specific field-appropriate tests must be developed to ensure accurate diagnosis of symptomatic and asymptomatic carriers. As malaria transmission declines, the proportion of low-density infections among symptomatic and asymptomatic persons is likely to increase, which may limit the utility of RDTs. Monitoring malaria in elimination settings will probably depend on the use of more than one diagnostic tool in clinical-care and surveillance activities, and the combination of tools utilized will need to be informed by regular monitoring of test performance through effective quality assurance. |
Characteristics of users of intrauterine devices and other reversible contraceptive methods in the United States
Xu X , Macaluso M , Frost J , Anderson JE , Curtis K , Grosse SD . Fertil Steril 2011 96 (5) 1138-44 OBJECTIVE: To evaluate the determinants of intrauterine device (IUD) use and reasons for choosing IUDs over other reversible contraceptive methods. DESIGN AND SETTING: Descriptive statistics and multinomial logistic regression were used to assess multiple factors associated with IUD use and the use of other reversible methods in the United States. PATIENT(S): Women at risk of pregnancy from the 2006 to 2008 National Survey of Family Growth and a 2004 Guttmacher Institute survey. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Sociodemographic and reproductive characteristics, family background, and health insurance coverage. RESULT(S): IUD use was positively associated with women's parity and the highest education level of respondent's mother; it was less common among women who had ≥4 sexual partners in the last 12 months and those who were widowed, divorced, or separated. IUD users reported pregnancy prevention, provider recommendation, and no interruption of sex as the most important reasons for choosing the method and reported a high level of satisfaction. CONCLUSION(S): IUD users differed substantially from users of other reversible contraceptives. IUD use was especially uncommon among nulliparae. Most current IUD users were satisfied with their choice. |
Statistical methodology for the evaluation of vaccine efficacy in a phase III multi-centre trial of the RTS,S/AS01 malaria vaccine in African children
Lievens M , Aponte JJ , Williamson J , Mmbando B , Mohamed A , Bejon P , Leach A . Malar J 2011 10 222 BACKGROUND: There has been much debate about the appropriate statistical methodology for the evaluation of malaria field studies and the challenges in interpreting data arising from these trials. METHODS: The present paper describes, for a pivotal phase III efficacy of the RTS, S/AS01 malaria vaccine, the methods of the statistical analysis and the rationale for their selection. The methods used to estimate efficacy of the primary course of vaccination, and of a booster dose, in preventing clinical episodes of uncomplicated and severe malaria, and to determine the duration of protection, are described. The interpretation of various measures of efficacy in terms of the potential public health impact of the vaccine is discussed. CONCLUSIONS: The methodology selected to analyse the clinical trial must be scientifically sound, acceptable to regulatory authorities and meaningful to those responsible for malaria control and public health policy. TRIAL REGISTRATION: Clinicaltrials.gov NCT00866619. |
Resting pulse rate reference data for children, adolescents, and adults: United States, 1999-2008
Ostchega Y , Porter KS , Hughes J , Dillon CF , Nwankwo T . Natl Health Stat Report 2011 (41) 1-16 OBJECTIVE: This report presents national reference data on resting pulse rate (RPR), for all ages of the U.S. population, from 1999-2008. METHODS: During 1999-2008, 49,114 persons were examined. From this, a normative sample comprising 35,302 persons was identified as those who did not have a current medical condition or use a medication that would affect the RPR. RPR was obtained after the participant had been seated and had rested quietly for approximately 4 minutes. RESULTS: RPR is inversely associated with age. There is a mean RPR of 129 beats per minute (standard error, or SE, 0.9) at less than age 1 year, which decreases to a mean RPR of 96 beats/min (SE 0.5) by age 5, and further decreases to 78 beats/min (SE 0.3) in early adolescence. The mean RPR in adulthood plateaus at 72 beats/min (SE 0.2) (p < 0.05 for trend). In addition, there is a significant gender difference, with the male pulse rate plateauing in early adulthood, while the female resting pulse plateaus later when middle-aged. There are two exceptions, that is, infants under age 1 year and adults aged 80 and over, when the mean RPR is statistically and significantly higher in females than in males (females under age 20 have an RPR of 90 beats/min, SE 0.3, and males under age 20 have an RPR of 86 beats/min, SE 0.3, p <0.05; females aged 20 and over have an RPR of 74 beats/min, SE 0.2, and males aged 20 and over have an RPR of 71 beats/min, SE 0.3, p <0.05). After controlling for age effects, non-Hispanic black males have a significantly (p <0.001) lower mean RPR (74 beats/min) than non-Hispanic white males (77 beats/min) and Mexican-American males (76 beats/min). Among females, non-Hispanic black females (79 beats/min) and Mexican-American females (79 beats/min) had statistically and significantly (p < 0.01) lower mean RPRs compared with non-Hispanic white females (80 beats/min). Among males, the prevalence of clinically defined tachycardia (abnormally fast heart rate, RPR 100 beats/min) is 1.3% (95% CI = 1.1-1.7), and the prevalence of clinically defined bradycardia (abnormally slow heart rate, RPR < 60 beats/min) is 15.2% (95% CI = 14.1-16.4). For adult females, these prevalences are 1.9% (95% CI = 1.6-2.3) for clinical tachycardia and 6.9% (95% CI = 6.2-7.8) for clinical bradycardia. Controlling for age, males have higher odds (2.43, 95% CI = 2.09-2.83) of having bradycardia, and notably lower odds (0.71, 95% CI = 0.52-0.97) of having tachycardia than women. CONCLUSIONS: The data provides current, updated population-based percentiles of RPR, which is one of the key vital signs routinely measured in clinical practice. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Environmental Health
- Epidemiology and Surveillance
- Genetics and Genomics
- Immunity and Immunization
- Informatics
- Laboratory Sciences
- Maternal and Child Health
- Nutritional Sciences
- Occupational Safety and Health
- Parasitic Diseases
- Reproductive Health
- Statistics as Topic
- Vital Statistics
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:Apr 29, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure