Targeting persons with or at high risk for chronic obstructive pulmonary disease by state-based surveillance
Pleasants RA , Heidari K , Wheaton AG , Ohar JA , Strange C , Croft JB , Liao W , Mannino DM , Kraft M . COPD 2015 12 (6) 1-10 The Behavioral Risk Factor Surveillance System (BRFSS) survey is used to estimate chronic obstructive pulmonary disease (COPD) prevalence and could be expanded to describe respiratory symptoms in the general population and to characterize persons with or at high risk for the disease. Tobacco duration and respiratory symptom questions were added to the 2012 South Carolina BRFSS. Data concerning sociodemographics, chronic illnesses, health behaviors, and respiratory symptoms were collected in 9438 adults ≥ 35 years-old. Respondents were categorized as having COPD, high risk, or low risk for the disease. High risk was defined as no self-reported COPD, ≥ 10 years' tobacco use, and ≥ 1 respiratory symptom (frequent productive cough or shortness of breath (SOB), or breathing problems affecting activities). Prevalence of self-reported and high-risk COPD were 9.1% and 8.0%, respectively. Overall, 17.3%, 10.6%, and 5.2% of all respondents reported activities limited by breathing problems, frequent productive cough, and frequent SOB, respectively. The high-risk group was more likely than the COPD group to report a productive cough and breathing problems limiting activities as well as being current smokers, male, and African-American. Health impairment was more severe in the COPD than the high-risk group, and both were worse than the low-risk group. CONCLUSIONS: Persons at high risk for COPD share many, but not all, of the characteristics of persons diagnosed with the disease. Additional questions addressing smoking duration and respiratory symptoms in the BRFSS identifies groups at high risk for having or developing COPD who may benefit from smoking cessation and case-finding interventions. |
Comorbidities, smoking status, and life expectancy among individuals eligible for lung cancer screening
Howard DH , Richards TB , Bach PB , Kegler MC , Berg CJ . Cancer 2015 121 (24) 4341-7 BACKGROUND: Lung cancer screening recommendations are based on results from the National Lung Screening Trial (NLST). The authors determined how the screening-eligible US population differs from NLST participants in terms of characteristics that affect their ability to benefit from screening. METHODS: The authors identified respondents to the 2012 Health and Retirement Study (HRS), a national survey of individuals aged ≥50 years who are eligible for screening based on US Preventive Services Task Force and Centers for Medicare and Medicaid Services criteria. Comorbidities, life expectancy, smoking history, and other characteristics were compared between the screening-eligible population and NLST participants. RESULTS: The authors estimated that in 2013, 8.4 million individuals (95% confidence interval, 7.9-8.9 million individuals) would have met the eligibility criteria for lung cancer screening established by the US Preventive Services Task Force. Compared with NLST participants, HRS screening-eligible respondents were older, more likely to be current smokers, and more likely to have been diagnosed with comorbidities. The 5-year survival rate was 87% in the HRS screening-eligible individuals versus 93% in the NLST participants (P<.001, based on a 2-sided test). Life expectancy was 18.7 years in the HRS screening-eligible individuals versus 21.2 years in the NLST participants. CONCLUSIONS: The US population eligible for lung cancer screening is probably less likely to benefit from early detection than NLST participants because they face a high risk of death from competing causes. The results of the current study highlight the need for smoking cessation interventions targeting those patients eligible for screening and tools to help clinicians determine the potential benefits of screening in individual patients. |
Population-Based Surveillance of Neisseria meningitidis Antimicrobial Resistance in the United States.
Harcourt BH , Anderson RD , Wu HM , Cohn AC , MacNeil JR , Taylor TH , Wang X , Clark TA , Messonnier NE , Mayer LW . Open Forum Infect Dis 2015 2 (3) ofv117 BACKGROUND: Antimicrobial treatment and chemoprophylaxis of patients and their close contacts is critical to reduce the morbidity and mortality and prevent secondary cases of meningococcal disease. Through the 1990's, the prevalence of antimicrobial resistance to commonly used antimicrobials among Neisseria meningitidis was low in the United States. Susceptibility testing was performed to ascertain whether the proportions of isolates with reduced susceptibility to antimicrobials commonly used for N meningitidis have increased since 2004 in the United States. METHODS: Antimicrobial susceptibility testing was performed by broth microdilution on 466 isolates of N meningitidis collected in 2004, 2008, 2010, and 2011 from an active, population-based surveillance system for susceptibility to ceftriaxone, ciprofloxacin, penicillin G, rifampin, and azithromycin. The molecular mechanism of reduced susceptibility was investigated for isolates with intermediate or resistant phenotypes. RESULTS: All isolates were susceptible to ceftriaxone and azithromycin, 10.3% were penicillin G intermediate (range, 8% in 2008-16.7% in 2010), and <1% were ciprofloxacin, rifampin, or penicillin G resistant. Of the penicillin G intermediate or resistant isolates, 63% contained mutations in the penA gene associated with reduced susceptibility to penicillin G. All ciprofloxacin-resistant isolates contained mutations in the gyrA gene associated with reduced susceptibility. CONCLUSIONS:. Resistance of N meningitidis to antimicrobials used for empirical treatment of meningitis in the United States has not been detected, and resistance to penicillin G and chemoprophylaxis agents remains uncommon. Therapeutic agent recommendations remain valid. Although periodic surveillance is warranted to monitor trends in susceptibility, routine clinical testing may be of little use. |
Systems approaches to improving rates of extragenital chlamydia and gonorrhea screening among men who have sex with men engaged in human immunodeficiency virus care
Bernstein KT . Sex Transm Dis 2015 42 (10) 599-600 In 2011, there were an estimated 1.2 million persons living with human immunodeficiency virus (HIV) in the United States, of which approximately 478,000 (40%) were engaged in HIV care.1 Among gay, bisexual, and other men who have sex with men (collectively referred to as MSM), who account for the majority of new HIV diagnoses in the United States,2 38% of 245,545 were routinely accessing HIV care.1 Although the Centers for Disease Control and Prevention recommends that all sexually active persons with HIV infection get screened for curable sexually transmitted diseases (STDs; such as chlamydia, gonorrhea, and syphilis) at least annually as part of HIV care,3 STD screening rates are suboptimal, especially extragenital chlamydia and gonorrhea screening among MSM. In a review of 8 large HIV care clinics, less than 20% of patients had at least 1 annual extragenital chlamydia or gonorrhea screening test.4 Among MSM captured in the Medical Monitoring Project surveillance platform, approximately 20% of MSM engaged in HIV care had a documented chlamydia or gonorrhea test in the prior 12 months.5 In a large cohort of HIV-infected patients engaged in regular HIV care, chlamydia and gonorrhea screening rates increased over time between 2004 and 2010, yet still remained low (39% in 2010).6 | Men who have sex with men who are engaged in HIV care are actively seeking primary care services with some regularity. Why has it been so challenging to improve STD screening rates among this population of motivated men who are routinely engaging with a provider and health care system? Two articles published in this month’s volume of Sexually Transmitted Diseases further help us to better understand this challenge. Barbee and colleagues7 evaluate current bacterial STD screening practices in a large HIV care setting in Seattle, Washington. While nearly 75% of MSM engaged in care at the Madison Clinic had a syphilis serologic test in the prior year, less than one third had either a rectal or pharyngeal chlamydia or gonorrhea screening test,7 although the majority reported some level of sexual risk that would warrant screening at exposed sites. Furthermore, while a sizable minority reported seeking STD services from the local municipal STD clinic, nearly three fourths reported that the Madison Clinic was their primary source of STD care. Surveyed Madison Clinic providers overwhelmingly believed that their patients were getting STD care elsewhere, and many were not aware of current Centers for Disease Control and Prevention recommendations for STD screening or that nucleic acid amplification test-based screening was available in their clinic. |
Tuberculosis and latent tuberculosis infection among health care workers in Kisumu, Kenya
Agaya J , Nnadi CD , Odhiambo J , Obonyo C , Obiero V , Lipke V , Okeyo E , Cain K , Oeltmann JE . Trop Med Int Health 2015 20 (12) 1797-804 OBJECTIVE: To assess prevalence and occupational risk factors of latent TB infection and history of TB disease ascribed to work in a health care setting in western Kenya. METHODS: We conducted a cross-sectional survey among health care workers in western Kenya in 2013. They were recruited from dispensaries, health centers, and hospitals that offer both TB and HIV services. School workers from the health facilities' catchment communities were randomly selected to serve as the community comparison group. Latent TB infection was diagnosed by tuberculin skin testing. HIV status of participants was assessed. Using a logistic regression model, we determined the adjusted odds of latent TB infection among health care workers compared to school workers; and among health care workers only, we assessed work-related risk factors for latent TB infection. RESULTS: We enrolled 1,005 health care workers and 411 school workers. Approximately 60% of both groups were female. 22% of 958 health care workers and 12% of 392 school workers tested HIV positive. Prevalence of self-reported history of TB disease was 7.4% among health care workers and 3.6% among school workers. Prevalence of latent TB infection was 60% among health care workers and 48% among school workers. Adjusted odds of latent TB infection were 1.5 times higher among health care workers than school workers (95% confidence interval 1.2-2.0). Health care workers at all three facility types had similar prevalence of latent TB infection, (p=0.72), but increasing years of employment was associated with increased odds of LTBI (p<0.01). CONCLUSION: Health care workers at facilities in western Kenya which offer TB and HIV services are at increased risk of latent TB infection, and the risk is similar across facility types. The WHO-recommended TB infection control measures are urgently needed in health facilities to protect health care workers. This article is protected by copyright. All rights reserved. |
The unrecognized burden of influenza in young Kenyan children, 2008-2012
McMorrow ML , Emukule GO , Njuguna HN , Bigogo G , Montgomery JM , Nyawanda B , Audi A , Breiman RF , Katz MA , Cosmas L , Waiboci LW , Duque J , Widdowson MA , Mott JA . PLoS One 2015 10 (9) e0138272 Influenza-associated disease burden among children in tropical sub-Saharan Africa is not well established, particularly outside of the 2009 pandemic period. We estimated the burden of influenza in children aged 0-4 years through population-based surveillance for influenza-like illness (ILI) and acute lower respiratory tract illness (ALRI). Household members meeting ILI or ALRI case definitions were referred to health facilities for evaluation and collection of nasopharyngeal and oropharyngeal swabs for influenza testing by real-time reverse transcription polymerase chain reaction. Estimates were adjusted for health-seeking behavior and those with ILI and ALRI who were not tested. During 2008-2012, there were 9,652 person-years of surveillance among children aged 0-4 years. The average adjusted rate of influenza-associated hospitalization was 4.3 (95% CI 3.0-6.0) per 1,000 person-years in children aged 0-4 years. Hospitalization rates were highest in the 0-5 month and 6-23 month age groups, at 7.6 (95% CI 3.2-18.2) and 8.4 (95% CI 5.4-13.0) per 1,000 person-years, respectively. The average adjusted rate of influenza-associated medically attended (inpatient or outpatient) ALRI in children aged 0-4 years was 17.4 (95% CI 14.2-19.7) per 1,000 person-years. Few children who had severe laboratory-confirmed influenza were clinically diagnosed with influenza by the treating clinician in the inpatient (0/33, 0%) or outpatient (1/109, 0.9%) settings. Influenza-associated hospitalization rates from 2008-2012 were 5-10 times higher than contemporaneous U.S. estimates. Many children with danger signs were not hospitalized; thus, influenza-associated severe disease rates in Kenyan children are likely higher than hospital-based estimates suggest. |
Use of expedited partner therapy for sexually transmitted diseases in college and university health centers in the United States, 2011-2012
Cramer R , Martinez N , Roberts C , Habel MA , Leino EV , Leichliter JS . Sex Transm Dis 2015 42 (10) 580-4 We examined expedited partner therapy for chlamydia and gonorrhea in college and university health centers by institutional and policy characteristics. Expedited partner therapy awareness and use was low (44.1% used), did not differ by institutional characteristics, and differed by policy environment. Our findings suggest missed opportunities for sexually transmitted disease prevention in college and university health centers. |
Latent tuberculosis infection among immigrant and refugee children arriving in the United States: 2010
Taylor EM , Painter J , Posey DL , Zhou W , Shetty S . J Immigr Minor Health 2015 18 (5) 966-970 Immigrants and refugees age 2-14 years entering the United States from countries with estimated tuberculosis (TB) incidence rate ≥20 per 100,000 population are screened for TB. Children with TB disease are treated before US arrival. Children with positive tuberculin skin tests (TST), but negative TB evaluation during their pre-immigration examination, are classified with latent TB infection (LTBI) and are recommended for re-evaluation post-arrival. We examined post-immigration TB evaluation and therapy for children arriving with LTBI. We reviewed medical exam data from immigrant children with medical conditions and all refugee children arriving during 2010. Medical examination data were available for 67,334 children. Of these, 8231 (12 %) had LTBI pre-immigration; 5749 (70 %) were re-evaluated for TB post-immigration, and 64 % were retested by TST or IGRA. The pre-immigration LTBI diagnosis was changed for 38 % when retested by TST and for 71 % retested by IGRA. Estimated LTBI therapy initiation and completion rates were 68 and 12 %. In this population, testing with IGRA may limit the number of children targeted for therapy. Increased pre-immigration TB screening with post-immigration follow-up evaluation leading to completion of LTBI therapy should be encouraged to prevent TB reactivation. |
Nonvolitional sex and HIV-related sexual risk behaviours among MSM in the United States
Nasrullah M , Oraka E , Chavez PR , Valverde E , Dinenno E . AIDS 2015 29 (13) 1673-80 OBJECTIVE: We estimated the prevalence of lifetime nonvolitional sex (NVS) among MSM by demographic characteristics, and characterized its association with HIV-related sexual risk behaviours among MSM in the United States. DESIGN: The National Survey of Family Growth (NSFG) is a nationally representative cross-sectional survey of the United States. METHODS: NSFG data from recent cycles 2002, and 2006-2010 were weighted and analysed for men aged 18-44 years who reported ever having anal or oral intercourse with another male. Associations of lifetime NVS (forced sex by men or women) and age of first NVS experience (<18 vs. ≥18 years), with HIV-related sexual risk behaviour outcomes in the past 12 months (i.e. sex with two or more male sex partners; exchanged sex for money or drugs; sex with IDU; sex with HIV-positive person; sex with two or more female sex partners) were assessed using adjusted prevalence ratios (aPR). RESULTS: An estimated 3 226 872 or 5.8% of men aged 18-44 years were identified as MSM with 24.6% of them reporting ever experiencing NVS. MSM reporting NVS at age 18 years or older were more likely to have had sex with an IDU [aPR = 4.40; 95% confidence interval (95% CI) 1.78-10.88] and exchanged sex for money or drugs (aPR = 2.52; 95% CI 1.17-5.43) in the past 12 months compared with those not reporting NVS. NVS for MSM less than 18 years of age was associated with exchanging sex for money or drugs. CONCLUSION: Effective interventions to raise awareness of NVS among MSM and to offer support for MSM who have experienced NVS are needed. |
Notification following new positive HIV test results
Huang YA , Hutchinson AB , Hollis ND , Sansom SL . Int J STD AIDS 2015 27 (10) 868-72 Client notification of a new HIV diagnosis is critical for timely access to treatment and reduction in behaviours associated with HIV infection. It is also an important input in HIV transmission and disease progression models. We used national, Centers for Disease Control and Prevention-funded HIV testing events data collected through the National HIV Prevention Program Monitoring and Evaluation system to update estimates of the proportion of newly identified HIV-positives notified of their status. We compared estimates from 2008 to 2010 across test technologies, settings, and HIV risk groups. In 2010, notification following a positive rapid test was 99.6% compared with 99.3% in 2008. Notification following a positive conventional test was 81.5% in 2010 compared with 80.8% in 2008. To realise the full promise of early HIV diagnosis and treatment for the prevention of additional HIV cases, efforts to ensure prompt notification following a new HIV diagnosis will be crucial. |
Outcomes of a comprehensive youth program for HIV-infected adolescents in Thailand
Chokephaibulkit K , Tarugsa J , Lolekha R , Leowsrisook P , Manaboriboon B , Naiwatanakul T , Punpanich W , Nuchanard W , Pattanasin S , Boon-Yasidhi V . J Assoc Nurses AIDS Care 2015 26 (6) 758-69 We developed an intervention program for HIV-infected Thai adolescents with two group sessions and two individual sessions, focusing on four strategies: health knowledge, coping skills, sexual risk reduction, and life goals. An audio computer-assisted self-interview (ACASI) was administered to assess knowledge, attitudes, and practices (KAP) regarding antiretroviral therapy management, reproductive health, and HIV-associated risk behavior. The program was implemented in two HIV clinics; 165 (84%) adolescents (intervention group) participated in the program; 32 (16%) completed the ACASI without participating in the group or individual sessions (nonintervention group). The median age was 14 years, and 56% were female. Baseline KAP scores of the intervention and nonintervention groups were similar. Two months after the intervention, knowledge and attitude scores increased (p < .01) in the intervention group, and the increase was sustained at 6 months. KAP scores did not change from baseline in the nonintervention group at 6 or 12 months after enrollment. |
A pregnant patient with Ebola virus disease
Oduyebo T , Pineda D , Lamin M , Leung A , Corbett C , Jamieson DJ . Obstet Gynecol 2015 126 (6) 1273-1275 BACKGROUND: Limited data suggest Ebola virus disease during pregnancy is associated with high maternal and fetal mortality. CASE: A 34-year-old woman, gravida 4 para 3, at 36 weeks of gestation was admitted to an Ebola treatment unit in Sierra Leone with Ebola virus disease confirmed by laboratory testing of maternal blood for Ebola RNA. She complained of headache, cough, and arthralgia for 7 days but was afebrile. Eleven days later, intrauterine fetal death was diagnosed; the following day, maternal blood was negative for Ebola viral RNA. Labor was induced and resulted in the vaginal delivery of a stillborn fetus. The mother recovered. Her vaginal secretions (on the day of induction), a placenta fragment, umbilical cord, and neonatal buccal swabs were positive for Ebola RNA. No exposed health care workers were infected. CONCLUSION: This case illustrates that pregnant women can survive infection with Ebola virus disease and be cared for and delivered without infection of their health care workers. |
Effects of integrated interventions on transmission risk and care continuum outcomes in persons living with HIV: meta-analysis, 1996-2014
Crepaz N , Baack BN , Higa DH , Mullins MM . AIDS 2015 29 (18) 2371-83 BACKGROUND: Reducing HIV infection and improving outcomes along the continuum of HIV care are high priorities of the US National HIV/AIDS strategy. Interventions that target multiple problem behaviors simultaneously in an integrated approach (referred to as integrated interventions) may improve prevention and care outcomes of persons living with HIV (PLWH). This systematic review and meta-analysis examines the effects of integrated interventions. METHODS: A systematic review, including both electronic and hand searches, was conducted to identify randomized controlled trials (RCTs) published between 1996 and 2014 that were designed to target at least two of the following behaviors among PLWH: HIV transmission risk behaviors, HIV care engagement, and medication adherence. Effect sizes were meta-analyzed using random-effects models. RESULTS: Fifteen RCTs met the inclusion criteria. Integrated interventions significantly reduced sex without condoms [odds ratio (OR) = 0.74, 95% confidence interval (CI) = 0.59, 0.94, P = 0.013, 13 effect sizes] and had marginally significant effects on improving medication adherence behaviors (OR = 1.35, 95% CI = 0.98, 1.85, P = 0.063, 12 effect sizes) and undetectable viral load (OR = 1.46, 95% CI = 0.93, 2.27, P = 0.098, seven effect sizes). Significant intervention effects on at least two outcomes were seen in RCTs tailored to individual needs, delivered one on one, or in settings wherein PLWH received services or care. CONCLUSION: Integrated interventions produced some favorable prevention and care continuum outcomes in PLWH. How to incorporate integrated interventions with other combination HIV prevention strategies to reach the optimal impact requires further research. |
Glycosylation analysis of engineered H3N2 influenza A virus hemagglutinins with sequentially added historically relevant glycosylation sites
An Y , McCullers JA , Alymova I , Parsons LM , Cipollo JF . J Proteome Res 2015 14 (9) 3957-69 The influenza virus surface glycoprotein hemagglutinin (HA) is the major target of host neutralizing antibodies. The oligosaccharides of HA can contribute to HA's antigenic characteristics. After a leap to humans from a zoonotic host, influenza can gain N-glycosylation sequons over time as part of its fitness strategy. This glycosylation expansion has not been studied at the structural level. Here we examine HA N-glycosylation of H3N2 virus strains that we have engineered to closely mimic glycosylation sites gained between 1968 through 2002 starting with pandemic A/Hong Kong/1/68 (H3N2: HK68). HAs studied include HK68 and engineered forms with 1, 2, and 4 added sites. We have used: nano-LC-MS(E) for glycopeptide composition, sequence and site occupancy analysis, and MALDI-TOF MS permethylation profiling for characterization of released glycans. Our study reveals that 1) the majority of N-sequons are occupied at ≥90%, 2) the class and complexity of the glycans varies by region over the landscape of the proteins, 3) Asn 165 and Asn 246, which are associated with interactions between HA and SP-D lung collectin, are exclusively high mannose type. Based on this study and previous reports we provide structural insight as to how the immune system responses may differ depending on HA glycosylation. |
High prevalence of low bone mineral density and substantial bone loss over 4 years among HIV-infected persons in the era of modern antiretroviral therapy
Escota GV , Mondy K , Bush T , Conley L , Brooks JT , Onen N , Patel P , Kojic EM , Henry K , Hammer J , Wood KC , Lichtenstein KA , Overton ET . AIDS Res Hum Retroviruses 2015 32 (1) 59-67 HIV-infected persons are living longer on combination antiretroviral therapy (cART) but experiencing more comorbidities including low bone mineral density (BMD). Using data from the Study to Understand the Natural History of HIV and AIDS in the Era of Effective Therapy (SUN Study), we determined the prevalence of low BMD (T-score below one standard deviation of the reference mean) and compared it with matched controls from the National Health and Nutrition Examination Survey (NHANES). We also assessed 4-year longitudinal BMD changes among participants virologically suppressed on cART. Of 653 participants included in this analysis (77% male, 29% black, median age 41 years, median CD4+ cell count 464 cells/mm3, 89% with HIV RNA <400 copies/ml), 51% and 10% had baseline osteopenia and osteoporosis, respectively. Low BMD at the femoral neck was significantly more prevalent than for the NHANES controls (47% versus 29%, p<0.001). Lower body mass index, nonwhite race, longer tenofovir exposure, older age, being unemployed or retired, and lower apolipoprotein E were independently associated with baseline osteoporosis. Among 170 participants virologically suppressed on cART and with longitudinal BMD data, 31% experienced substantial bone loss (≥5% BMD decline from baseline) over 4 years. Female sex, current smoking, and longer stavudine use were more common among participants who had substantial bone loss, although these variables failed to reach statistical significance. Low BMD was highly prevalent among HIV-infected persons. One-third of participants experienced substantial bone loss despite cART, suggesting the need for monitoring and potential clinical interventions. |
HIV testing and HIV service delivery to populations at high risk attending sexually transmitted disease clinics in the United States, 2011-2013
Seth P , Wang G , Sizemore E , Hogben M . Am J Public Health 2015 105 (11) e1-e8 OBJECTIVES: We evaluated HIV testing and service delivery in Centers for Disease Control and Prevention (CDC)-funded sexually transmitted disease (STD) clinics. METHODS: We assessed HIV testing, HIV positivity, receipt of HIV test results, linkage to medical care, and referral services from 61 health department jurisdictions from 2011 to 2013. RESULTS: In 2013, 18.6% (621 010) of all CDC-funded HIV-testing events were conducted in STD clinics, and 0.8% were newly identified as HIV-positive. In addition, 27.3% of all newly identified HIV-positive persons and 30.1% of all newly identified HIV-positive men who have sex with men were identified in STD clinics. Linkage to care within any time frame was 63.8%, and linkage within 90 days was 55.3%. Although there was a decrease in first-time HIV testers in STD clinics from 2011 to 2013, identification of new positives increased. CONCLUSIONS: Although linkage to care and referral to partner services could be improved, STD clinics appear successful at serving populations disproportionately affected by HIV. These clinics may reach persons who may not otherwise seek HIV testing or medical services and provide an avenue for service provision to these populations. |
Impact of a brief intervention for substance use on acquisition of sexually transmitted diseases including HIV: findings from an urban sexually transmitted disease clinic population
Rogers M , Johnson K , Yu J , Cuoco L , Blank S . Sex Transm Dis 2015 42 (10) 569-74 BACKGROUND: Unhealthy substance use is associated with increased rates of sexually transmitted diseases (STDs), including HIV. The screening, brief intervention, and referral to treatment strategy is effective at reducing substance use over time. We investigated whether STD clinic patients who received a brief intervention (BI) had lower rates of STD/HIV acquisition over time than those who did not. METHODS: A retrospective sample of 7665 patients who screened positive for substance abuse or dependence between May 1, 2008, and December 31, 2010, was matched with STD and HIV surveillance registries for a 1-year follow-up period to determine incidence of STD and HIV infection. RESULTS: Overall, 44.6% (n = 3420) received BI; 7.0% of this population acquired a bacterial STD compared with 8.8% of persons who did not receive BI (P < 0.005). In multivariate analysis, BI had a protective effect against STD infection for men (odds ratio, 0.774; 95% confidence interval [CI], 0.63-0.96), after controlling for age, race/ethnicity, and sex of partner. There were 61 new HIV infections over the follow-up period; however, we found no significant association between BI and subsequent HIV diagnosis. CONCLUSIONS: Brief intervention is associated with a reduction in STD incidence among men who screen positive for substance abuse and should be considered as an STD prevention strategy. Further study is needed to identify mechanisms through which BI may impact STD outcomes. |
Case-ascertained study of household transmission of seasonal influenza - South Africa, 2013
Iyengar P , von Mollendorf C , Tempia S , Moerdyk A , Valley-Omar Z , Hellferscee O , Martinson N , Chhagan M , McMorrow M , Gambhir M , Cauchemez S , Variava E , Masonoke K , Cohen AL , Cohen C . J Infect 2015 71 (5) 578-86 OBJECTIVES: The household is important in influenza transmission due to intensity of contact. Previous studies reported secondary attack rates (SAR) of 4-10% for laboratory-confirmed influenza in the household. Few have been conducted in middle-income countries. METHODS: We performed a case-ascertained household transmission study during May-October 2013. Index cases were patients with influenza like illness(cough and self-reported or measured fever (≥38 degrees C)) with onset in the last 3 days and no sick household contacts, at clinics in South Africa. Household contacts of index cases with laboratory-confirmed influenza were followed for 12 days. RESULTS: Thirty index cases in 30 households and 107/110 (97%) eligible household contacts were enrolled. Assuming those not enrolled were influenza negative, 21/110 household contacts had laboratory-confirmed influenza (SAR 19%); the mean serial interval was 2.1 days (SD = 0.35, range 2-3 days). Most (62/82; 76%) household contacts who completed the risk factor questionnaire never avoided contact and 43/82 (52%) continued to share a bed with the index case after illness onset. CONCLUSION: SAR for laboratory-confirmed influenza in South Africa was higher than previously reported SARs. Household contacts did not report changing behaviors to prevent transmission. These results can be used to understand and predict influenza transmission in similar middle-income settings. |
Challenges and key research questions for yaws eradication
Marks M , Mitja O , Vestergaard LS , Pillay A , Knauf S , Chen CY , Bassat Q , Martin DL , Fegan D , Taleo F , Kool J , Lukehart S , Emerson PM , Solomon AW , Ye T , Ballard RC , Mabey DC , Asiedu KB . Lancet Infect Dis 2015 15 (10) 1220-1225 Yaws is endemic in west Africa, southeast Asia, and the Pacific region. To eradicate yaws by 2020, WHO has launched a campaign of mass treatment with azithromycin. Progress has been made towards achievement of this ambitious goal, including the validation of point-of-care and molecular diagnostic tests and piloting of the strategy in several countries, including Ghana, Vanuatu, and Papua New Guinea. Gaps in knowledge need to be addressed to allow refinement of the eradication strategy. Studies exploring determinants of the spatial distribution of yaws are needed to help with the completion of baseline mapping. The finding that Haemophilus ducreyi causes lesions similar to yaws is particularly important and further work is needed to assess the effect of azithromycin on these lesions. The integration of diagnostic tests into different stages of the eradication campaign needs investigation. Finally, studies must be done to inform the optimum mass-treatment strategy for sustainable interruption of transmission. |
Children with chronic hepatitis B in the United States and Canada
Schwarz KB , Cloonan YK , Ling SC , Murray KF , Rodriguez-Baez N , Schwarzenberg SJ , Teckman J , Ganova-Raeva L , Rosenthal P . J Pediatr 2015 167 (6) 1287-1294 e2 OBJECTIVES: To test the hypothesis that children with chronic hepatitis B living in the US and Canada would have international origins and characteristic hepatitis B virus (HBV) genotypes and laboratory profiles. STUDY DESIGN: Clinical characteristics of children enrolled in the Hepatitis B Research Network were collected from 7 US and Canadian centers. RESULTS: Children (n = 343) with an age range of 1.0-17.8 years were enrolled; 78% of the children were Asian, 55% were adopted, and 97% had international origins with either the child or a parent born in 1 of 31 countries. The majority had HBV genotype B (43%) or C (32%), and the remainder had genotype A (5%), D (16%), E (4%), or multiple (<1%). Children with genotype B or C were more likely to be Asian (98% and 96%), more consistently hepatitis B envelope antigen positive (95% and 82%), had higher median HBV DNA levels (8.2 and 8.3 log10 IU/mL), and less frequently had elevated alanine aminotransferase values (43% and 57%) compared with children with other genotypes. The percentage of hepatitis B envelope antigen positivity and of those with HBV DNA ≥6 log10 IU/mL declined with age. CONCLUSIONS: The majority of children in the Hepatitis B Research Network have HBV genotypes that reflect their international origins. Clinical and laboratory data differ substantially by patient age and HBV genotype. Use of these data can help drive the development of optimal strategies to manage and treat children with chronic hepatitis B. |
Correlates of seroadaptation strategies among black men who have sex with men (MSM) in 4 US cities
Wilton L , Koblin B , Nandi V , Xu G , Latkin C , Seal D , Flores SA , Spikes P . AIDS Behav 2015 19 (12) 2333-46 We assessed associations of demographic, psychosocial, and substance use factors with seroadaptation strategies among 835 BMSM in four US cities. Seroadaptation strategies were practiced by 59.8 % of men, with 10.5 % practicing 100 % condom use, 26.5 % serosorting, 7.2 % condom serosorting, and 15.6 % seropositioning. In multivariable analyses, compared to men who used no seroadaptation strategies, serosorters were older, were less likely to be HIV infected, had fewer male sex partners, and had higher levels of social support and sexual self-efficacy. Condom serosorters had less psychological distress, were more likely to use methamphetamine, and had higher levels of sexual self-efficacy. Seropositioners were older, were less likely to be HIV infected, to have a main partner, and report alcohol/drug use with sex, while having higher levels of sexual self-efficacy. Seroadaptation practices among BMSM need to be considered to address perceived safer sex strategies and strengthen access to a broader reach of culturally-relevant prevention efforts. |
Cost-effectiveness of frequent HIV testing of high risk populations in the United States
Hutchinson AB , Farnham PG , Sansom SL , Yaylali E , Mermin JH . J Acquir Immune Defic Syndr 2015 71 (3) 323-30 PURPOSE: Data showing a high incidence of HIV infection among men who have sex with men (MSM) who had annual testing suggest that more frequent HIV testing may be warranted. Testing technology is also a consideration given the availability of sensitive testing modalities as well as the increased use of less sensitive rapid, point-of-care antibody tests. We assessed the cost-effectiveness of HIV testing of MSM and injection drug users (IDUs) at 3- and 6-month intervals using fourth-generation and rapid tests. METHODS: We used a published mathematical model of HIV transmission to evaluate testing intervals for each population using cohorts of 10,000 MSM and IDU. We incorporated HIV transmissions averted due to serostatus awareness and viral suppression. We included costs for HIV testing and treatment initiation, as well as treatment costs saved from averted transmissions. RESULTS: For MSM, HIV testing was cost-saving or cost-effective over a 1-year time period for both 6-month compared to annual testing, and quarterly compared to 6-month testing using either test. Testing IDU every 6 months compared to annually was moderately cost-effective over a 1-year time period with a fourth-generation test, while testing with rapid, point-of care tests or quarterly was not cost-effective. MSM results remained robust in sensitivity analysis, while IDU results were sensitive to changes in HIV incidence and continuum-of-care parameters. Threshold analyses on costs suggested additional implementation costs could be incurred for more frequent testing for MSM while remaining cost-effective. CONCLUSION: HIV testing of MSM as frequently as quarterly is cost-effective compared to annual testing, but testing IDU more frequently than annually is generally not cost-effective. |
Schools as potential risk sites for vector-borne disease transmission: mosquito vectors in rural schools in two municipalities in Colombia
Olano VA , Matiz MI , Lenhart A , Cabezas L , Vargas SL , Jaramillo JF , Sarmiento D , Alexander N , Stenstrom TA , Overgaard HJ . J Am Mosq Control Assoc 2015 31 (3) 212-22 Dengue and other vector-borne diseases are of great public health importance in Colombia. Vector surveillance and control activities are often focused at the household level. Little is known about the importance of nonhousehold sites, including schools, in maintaining vector-borne disease transmission. The objectives of this paper were to determine the mosquito species composition in rural schools in 2 municipalities in Colombia and to assess the potential risk of vector-borne disease transmission in school settings. Entomological surveys were carried out in rural schools during the dry and rainy seasons of 2011. A total of 12 mosquito species were found: Aedes aegypti, Anopheles pseudopunctipennis, Culex coronator, Cx. quinquefasciatus, and Limatus durhamii in both immature and adult forms; Ae. fluviatilis, Cx. nigripalpus, Cx. corniger, and Psorophora ferox in immature forms only; and Ae. angustivittatus, Haemagogus equinus, and Trichoprosopon lampropus in adult forms only. The most common mosquito species was Cx. quinquefasciatus. Classrooms contained the greatest abundance of adult female Ae. aegypti and Cx. quinquefasciatus. The most common Ae. aegypti breeding sites were containers classified as "others" (e.g., cans), followed by containers used for water storage. A high level of Ae. aegypti infestation was found during the wet season. Our results suggest that rural schools are potentially important foci for the transmission of dengue and other mosquito-borne diseases. We propose that public health programs should be implemented in rural schools to prevent vector-borne diseases. |
Assessing carbon dioxide and synthetic lure-baited traps for dengue and chikungunya vector surveillance
Harwood JF , Arimoto H , Nunn P , Richardson AG , Obenauer PJ . J Am Mosq Control Assoc 2015 31 (3) 242-7 The Aedes mosquito vectors of dengue virus (DENV) and chikungunya virus (CHIKV) are attracted to specific host cues that are not generated by traditional light traps. For this reason multiple companies have designed traps to specifically target those species. Recently the standard trap for DENV and CHIKV vectors, the BG-Sentinel (BGS) trap, has been remodeled to be more durable and better suited for use in harsh field conditions, common during military operations, and relabeled the BG-Sentinel 2 (BGS2). This new trap was evaluated against the standard Centers for Disease Control and Prevention (CDC) light trap, Zumba Trap, and BG-Mosquitito Trap to determine relative effectiveness in collecting adult Aedes aegypti and Ae. albopictus. Evaluations were conducted under semifield and field conditions in suburban areas in northeastern Florida from May to August 2014. The BGS2 trap collected more DENV and CHIKV vectors than the standard CDC light trap, Zumba Trap, and BG-Mosquitito Trap, but attracted fewer species, while the BG-Mosquitito Trap attracted the greatest number of mosquito species. |
Community-effectiveness of temephos for dengue vector control: a systematic literature review
George L , Lenhart A , Toledo J , Lazaro A , Han WW , Velayudhan R , Runge Ranzinger S , Horstick O . PLoS Negl Trop Dis 2015 9 (9) e0004006 The application of the organophosphate larvicide temephos to water storage containers is one of the most commonly employed dengue vector control methods. This systematic literature review is to the knowledge of the authors the first that aims to assess the community-effectiveness of temephos in controlling both vectors and dengue transmission when delivered either as a single intervention or in combination with other interventions. A comprehensive literature search of 6 databases was performed (PubMed, WHOLIS, GIFT, CDSR, EMBASE, Wiley), grey literature and cross references were also screened for relevant studies. Data were extracted and methodological quality of the studies was assessed independently by two reviewers. 27 studies were included in this systematic review (11 single intervention studies and 16 combined intervention studies). All 11 single intervention studies showed consistently that using temephos led to a reduction in entomological indices. Although 11 of the 16 combined intervention studies showed that temephos application together with other chemical vector control methods also reduced entomological indices, this was either not sustained over time or-as in the five remaining studies-failed to reduce the immature stages. The community-effectiveness of temephos was found to be dependent on factors such as quality of delivery, water turnover rate, type of water, and environmental factors such as organic debris, temperature and exposure to sunlight. Timing of temephos deployment and its need for reapplication, along with behavioural factors such as the reluctance of its application to drinking water, and operational aspects such as cost, supplies, time and labour were further limitations identified in this review. In conclusion, when applied as a single intervention, temephos was found to be effective at suppressing entomological indices, however, the same effect has not been observed when temephos was applied in combination with other interventions. There is no evidence to suggest that temephos use is associated with reductions in dengue transmission. |
Evaluation of contaminated drinking water and male breast cancer at Marine Corps Base Camp Lejeune, North Carolina: a case control study
Ruckart PZ , Bove FJ , Shanley E 3rd , Maslia M . Environ Health 2015 14 (1) 74 BACKGROUND: Solvents contaminated drinking water supplies at Marine Corps Base Camp Lejeune during 1950s-1985. METHODS: We conducted a case-control study among Marines to evaluate associations between residential exposure to contaminated drinking water at Camp Lejeune and male breast cancer risk. The study included 71 male breast cancer cases and 373 controls identified from the Department of Veteran's Affairs (VA) cancer registry whose military personnel records were available. Controls were selected from cancers not known to be associated with solvent exposure and included 270 skin cancers, 71 mesotheliomas, and 32 bone cancers. Base assignment and risk factor information came from military personnel and VA records. Groundwater contaminant fate/transport and distribution system models provided monthly estimated residential contaminant levels. We conducted exact logistic regression using the 50(th) percentile level among exposed controls to create low and high exposure categories. We calculated 95 % confidence intervals (CIs) to indicate precision of effect estimates. Exploratory analyses used proportional hazards methods to evaluate associations between exposures and age at diagnosis. RESULTS: After adjusting for age at diagnosis, race, and service in Vietnam, the odds ratio (OR) for ever stationed at Camp Lejeune was 1.14 (95 % CI: 0.65, 1.97). Adjusted ORs for high residential cumulative exposures to tetrachloroethylene (PCE), t-1,2 dichloroethylene (DCE), and vinyl chloride were 1.20 [95 % CI: 0.16-5.89], 1.50 [95 % CI: 0.30-6.11], 1.19 [95 % CI: 0.16-5.89], respectively, with a monotonic exposure response relationship for PCE only. However these results were based on two or three cases in the high cumulative exposure categories. Ever stationed at Camp Lejeune and high cumulative exposures to trichloroethylene (TCE), PCE, DCE and vinyl chloride were associated with earlier age at onset for male breast cancer; hazard ratios ranged from 1.4-2.7 with wide confidence intervals for cumulative exposure variables. CONCLUSION: Findings suggested possible associations between male breast cancer and being stationed at Camp Lejeune and cumulative exposure to PCE, DCE, and vinyl chloride. TCE, PCE, DCE and vinyl chloride cumulative exposures showed possible associations with earlier age at onset of male breast cancer. However, this study was limited by small numbers of cases in high exposure categories. |
Validity of the WHO cutoffs for biologically implausible values of weight, height, and BMI in children and adolescents in NHANES from 1999 through 2012
Freedman DS , Lawman HG , Skinner AC , McGuire LC , Allison DB , Ogden CL . Am J Clin Nutr 2015 102 (5) 1000-6 BACKGROUND: The WHO cutoffs to classify biologically implausible values (BIVs) for weight, height, and weight-for-height in children and adolescents are widely used in data cleaning. OBJECTIVES: We assess 1) the prevalence of these BIVs, 2) whether they were consistent with information on waist circumference, arm circumference, and leg lengths, and 3) the effect of their exclusion on the estimated prevalence of obesity in 2- to 19-y-olds in the NHANES, which is a study in which extreme values were verified when recorded. DESIGN: We conducted cross-sectional analyses in 26,480 children and adolescents in the NHANES from 1999-2000 through 2011-2012. RESULTS: The overall prevalence for a BIV for any body-size measure was 0.9% (n = 277), and almost all BIVs were due to extremely high, rather than low, values. Of 186 subjects who had a high BIV for weight or body mass index (BMI), all but one subject had both arm and waist circumferences that were greater than the sex- and age-specific 95th percentiles; 75% of subjects had circumferences greater than the 99th percentile. Of 63 subjects with a high height BIV, 75% of them had a leg length that was greater than the 95th percentile. The exclusion of children and adolescents with a BIV reduced the overall prevalence of obesity by approximately 0.5 percentage points and by 1.7% in non-Hispanic blacks. CONCLUSIONS: Most of the extremely high values of weight, height, and BMI flagged as BIVs in the NHANES are very likely correct. The increase of z score cutoffs or the use of an alternative method to detect possible errors could improve the balance between removing incorrect values and retaining extremely high, but accurate, values in other data sets. |
Outbreak of botulism after consumption of illicit prison-brewed alcohol in a maximum security prison - Arizona, 2012
Yasmin S , Adams L , Briggs G , Weiss J , Bisgard K , Anderson S , Tsang C , Henke E , Vasiq M , Komatsu K . J Correct Health Care 2015 21 (4) 327-34 The authors investigated the second botulism outbreak to occur in a maximum security prison in Arizona within a 4-month period. Botulism was confirmed in eight men aged 20 to 35 years who reported sharing a single batch of pruno made with potatoes. Initial symptoms included blurred vision, slurred speech, muscle weakness, ptosis, and dysphagia. All patients received heptavalent botulinum antitoxin, seven required mechanical ventilation, and all survived. The median incubation period was 29 hours. Sera from all patients and leftover pruno tested positive for botulinum toxin type A. Botulism should be considered among prisoners with cranial nerve palsies and descending, symmetric flaccid paralysis. Prison-brewed alcohol, particularly when made with potatoes, can be a vehicle for botulism and is associated with outbreaks of botulism in prisons. |
A qualitative inquiry about pruno, an illicit alcoholic beverage linked to botulism outbreaks in United States prisons
Walters MS , Sreenivasan N , Person B , Shew M , Wheeler D , Hall J , Bogdanow L , Leniek K , Rao A . Am J Public Health 2015 105 (11) e1-e6 OBJECTIVES: Since 2011, 3 outbreaks of botulism in US prisons have been attributed to pruno, which is an alcoholic beverage made by inmates. Following 1 outbreak, we conducted a qualitative inquiry to understand pruno brewing and its social context to inform outbreak prevention measures. METHODS: We interviewed staff, inmates, and parolees from 1 prison about pruno production methods, the social aspects of pruno, and strategies for communicating the association between botulism and pruno. RESULTS: Twenty-seven inmates and parolees and 13 staff completed interviews. Pruno is fermented from water, fruit, sugar, and miscellaneous ingredients. Knowledge of pruno making was widespread among inmates; staff were familiar with only the most common ingredients and supplies inmates described. Staff and inmates described inconsistent consequences for pruno possession and suggested using graphic health messages from organizations external to the prison to communicate the risk of botulism from pruno. CONCLUSIONS: Pruno making was frequent in this prison. Improved staff recognition of pruno ingredients and supplies might improve detection of brewing activities in this and other prisons. Consistent consequences and clear messages about the association between pruno and botulism might prevent outbreaks. |
Complete Genome Sequences of Three Neisseria gonorrhoeae Laboratory Reference Strains, Determined Using PacBio Single-Molecule Real-Time Technology.
Abrams A J , Trees D L , Nicholas RA . Genome Announc 2015 3 (5) Neisseria gonorrhoeae, the etiological agent that causes the sexually transmitted infection gonorrhea, is a significant public health concern due to the emergence of antimicrobial resistance. We report the complete genome sequences of three reference isolates with varied antimicrobial susceptibility that will aid in elucidating the genetic mechanisms that confer resistance. |
Longitudinal Detection and Persistence of Minority Drug-Resistant Populations and Their Effect on Salvage Therapy.
Nishizawa M , Matsuda M , Hattori J , Shiino T , Matano T , Heneine W , Johnson JA , Sugiura W . PLoS One 2015 10 (9) e0135941 BACKGROUND: Drug-resistant HIV are more prevalent and persist longer than previously demonstrated by bulk sequencing due to the ability to detect low-frequency variants. To clarify a clinical benefit to monitoring minority-level drug resistance populations as a guide to select active drugs for salvage therapy, we retrospectively analyzed the dynamics of low-frequency drug-resistant population in antiretroviral (ARV)-exposed drug resistant individuals. MATERIALS AND METHODS: Six HIV-infected individuals treated with ARV for more than five years were analyzed. These individuals had difficulty in controlling viremia, and treatment regimens were switched multiple times guided by standard drug resistance testing using bulk sequencing. To detect minority variant populations with drug resistance, we used a highly sensitive allele-specific PCR (AS-PCR) with detection thresholds of 0.3-2%. According to ARV used in these individuals, we focused on the following seven reverse transcriptase inhibitor-resistant mutations: M41L, K65R, K70R, K103N, Y181C, M184V, and T215F/Y. Results of AS-PCR were compared with bulk sequencing data for concordance and presence of additional mutations. To clarify the genetic relationship between low-frequency and high-frequency populations, AS-PCR amplicon sequences were compared with bulk sequences in phylogenetic analysis. RESULTS: The use of AS-PCR enabled detection of the drug-resistant mutations, M41L, K103N, Y181C, M184V and T215Y, present as low-frequency populations in five of the six individuals. These drug resistant variants persisted for several years without ARV pressure. Phylogenetic analysis indicated that pre-existing K103N and T215I variants had close genetic relationships with high-frequency K103N and T215I observed during treatment. DISCUSSION AND CONCLUSION: Our results demonstrate the long-term persistence of drug-resistant viruses in the absence of drug pressure. The rapid virologic failures with pre-existing mutant viruses detectable by AS-PCR highlight the clinical importance of low-frequency drug-resistant viruses. Thus, our results highlight the usefulness of AS-PCR and support its expanded evaluation in ART clinical management. |
Limited genomic divergence between intraspecific forms of Culex pipiens under different ecological pressures.
Gomes B , Wilding CS , Weetman D , Sousa CA , Novo MT , Savage HM , Almeida AP , Pinto J , Donnelly MJ . BMC Evol Biol 2015 15 (1) 197 BACKGROUND: Divergent selection can be a major driver of ecological speciation. In insects of medical importance, understanding the speciation process is both of academic interest and public health importance. In the West Nile virus vector Culex pipiens, intraspecific pipiens and molestus forms vary in ecological and physiological traits. Populations of each form appear to share recent common ancestry but patterns of genetic differentiation across the genome remain unknown. Here, we undertook an AFLP genome scan on samples collected from both sympatric and allopatric populations from Europe and the USA to quantify the extent of genomic differentiation between the two forms. RESULTS: The forms were clearly differentiated but each exhibited major population sub-structuring between continents. Divergence between pipiens and molestus forms from USA was higher than in both inter- and intra-continental comparisons with European samples. The proportion of outlier loci between pipiens and molestus ( approximately 3 %) was low but consistent in both continents, and similar to those observed between sibling species of other mosquito species which exhibit contemporary gene flow. Only two of the outlier loci were shared between inter-form comparisons made within Europe and USA. CONCLUSION: This study supports the molestus and pipiens status as distinct evolutionary entities with low genomic divergence. The low number of shared divergent loci between continents suggests a relatively limited number of genomic regions determining key typological traits likely to be driving incipient speciation and/or adaptation of molestus to anthropogenic habitats. |
Regulation Of Viral RNA Synthesis By The V Protein Of Parainfluenza Virus 5.
Yang Y , Zengel J , Sun M , Sleeman K , Timani KA , Aligo J , Rota P , Wu J , He B . J Virol 2015 89 (23) 11845-57 Paramyxoviruses include many important animal and human pathogens. The Parainfluenza virus 5 (PIV5), a prototypical paramyxovirus, encodes a V protein that inhibits the viral RNA synthesis. In this work, the mechanism of inhibition was investigated. Using mutational analysis and a mini-genome system, we identified regions in the N- and C- termini protein that inhibit viral RNA synthesis: one at the very N-terminus and the second at the C-terminus of V. Furthermore, we determined that residue L16 and I17 are critical for the inhibitory function of the N-terminal region of the V protein. Both regions interact with the nucleocapsid protein (NP), an essential component of the viral RNA genome complex (RNP). Mutations at L16 and I17 abolish the interaction between NP and the N-terminal domain of V. This suggests that the interaction between NP and the N-terminal domain plays a critical role in V inhibition of viral RNA synthesis by the N-terminal domain. Both the N- and C-terminal regions inhibit viral RNA replication. The C-terminus inhibits viral RNA transcription, while the N-terminal domain enhances viral RNA transcription, suggesting that the two domains affect viral RNA through different mechanisms. Interestingly, V also inhibits viral RNA synthesis of other paramyxoviruses such as Nipah virus (NiV), human parainfluenza virus 3 (HPIV3), measles virus (MeV), mumps virus (MuV) and respiratory syncytial virus (RSV). This suggests that a common host factor may be involved in replication of these paramyxoviruses. SIGNIFICANCE: We identified two regions of V that interact with NP and determined that one of these regions enhances viral RNA transcription via its interaction with NP. Our data suggest a common host factor may be involved in the regulation of paramyxovirus replication and could be a target for broad antiviral drug development. Understanding the regulation of paramyxovirus replication will enable rational design of vaccines and potential antiviral drugs. |
Genomic analysis, phenotype, and virulence of the historical Brazilian smallpox vaccine strain IOC: Implications for the origins and evolutionary relationships of vaccinia virus.
Medaglia ML , Moussatche N , Nitsche A , Dabrowski PW , Li Y , Damon IK , Lucas CG , Arruda LB , Damaso CR . J Virol 2015 89 (23) 11909-25 Smallpox was declared eradicated in 1980 after an intensive vaccination program using different strains of vaccinia virus (VACV; Poxviridae). VACV strain IOC (VACV-IOC) was the seed strain of the smallpox vaccine manufactured by the major vaccine producer in Brazil during the smallpox eradication programme. However, little is known about the biological and immunological features, as well as the phylogenetic relationships of this first-generation vaccine. In this work, we present a comprehensive characterization of two clones of VACV-IOC. Both clones had low virulence in infected mice and induced a protective immune response against a lethal infection comparable to the response of the licensed vaccine ACAM2000 and the parental strain VACV-IOC. Full genome sequencing revealed the presence of several fragmented virulence genes that are probably non-functional, e.g., F1L, B13R, C10L, K3L and C3L. Most notably, phylogenetic inference supported by the structural analysis of the genome ends provide evidence of a novel, independent cluster in VACV phylogeny formed by VACV-IOC, the Brazilian field strains Cantagalo (CTGV) and Serro 2 viruses, and horsepox virus, a VACV-like virus supposedly related to an ancestor of the VACV lineage. Our data strongly support the hypothesis that CTGV-like viruses represent feral VACV that evolved in parallel with VACV-IOC after splitting from a most recent common ancestor, probably an ancient smallpox vaccine strain related to horsepox virus. Our data, together with an interesting historical investigation, revisit the origins of VACV and propose new evolutionary relationships between ancient and extant VACV strains, mainly horsepox virus, VACV-IOC/CTGV-like viruses, and Dryvax strain. IMPORTANCE: First-generation vaccines used to eradicate smallpox had rates of adverse effects that are not acceptable by current healthcare standards. Moreover, these vaccines are genetically heterogeneous and consist of a pool of quasispecies of VACV. Therefore, the search for new-generation smallpox vaccines that combine low pathogenicity, immune protection, and genetic homogeneity is extremely important. In addition, the phylogenetic relationships and origins of VACV strains are quite nebulous. We show the characterization of two clones of VACV-IOC, a unique smallpox vaccine strain that contributed to smallpox eradication in Brazil. The immunogenicity and reduced virulence make the IOC clones good options for alternative second-generation smallpox vaccines. More importantly, this study reveals the phylogenetic relationship between VACV-IOC, feral VACV established in nature, and the ancestor-like horsepox virus. Our data expand the discussion on the origins and evolutionary connections of VACV lineages. |
Evaluation of selected Borrelia burgdorferi lp54 encoded gene products expressed during mammalian infection as antigens to improve serodiagnostic testing for early Lyme disease.
Weiner ZP , Crew RM , Brandt KS , Ullmann AJ , Schriefer ME , Molins CR , Gilmore RD . Clin Vaccine Immunol 2015 22 (11) 1176-86 Laboratory testing for the diagnosis of Lyme disease is performed primarily by serologic assays and is accurate for detection beyond the acute stage of the infection. Serodiagnostic assays to detect the early stages of infection, however, are limited in their sensitivity and improvement is warranted. We analyzed a series of Borrelia burgdorferi proteins known to be induced either within feeding ticks and/or during mammalian infection for their utility as serodiagnostic markers against a comprehensive panel of Lyme disease patient serum samples. The antigens were assayed for IgM and IgG reactivity in line immunoblots and separately by ELISA, with a focus on reactivity against early Lyme erythema migrans (EM), early disseminated Lyme neuroborreliosis, and early Lyme carditis patient serum samples. By IgM immunoblotting, we found that recombinant proteins BBA65, BBA70, and BBA73 reacted with early Lyme EM samples at levels comparable to the OspC antigen used in the current IgM blotting criteria. Additionally, these proteins reacted with serum samples from patients with early neuroborreliosis and early carditis suggesting value in detecting early stages of this disease progression. We also found serological reactivity against recombinant proteins BBA69 and BBA73 with early Lyme samples using IgG immunoblotting and ELISA. Significantly, some samples that had been scored negative by the Centers for Disease Control and Prevention recommended 2-tiered testing algorithm demonstrated positive reactivity to one or more of the antigens by IgM/IgG immunoblot and ELISA. These results suggest that incorporating additional in vivo expressed antigens in the current IgM/IgG immunoblotting tier in a recombinant protein platform assay may improve the performance of early Lyme disease serologic testing. |
Anticipated job benefits, career aspiration, and generalized self-efficacy as predictors for migration and decision-making
Hoppe A , Fujishiro K . Int J Intercult Relat 2015 47 13-27 This study aims to identify person-level factors, rather than economic situations, that influence migration decision-making and actual migration. Building on the theory of planned behavior, this study investigated potential migrants' expectations and attitudes toward migration and career (i.e., anticipated job benefits of migration, career aspiration) as well as beliefs (i.e., generalized self-efficacy) as predictors of migration decision-making conceptualized in three phases: the pre-decisional, pre-actional, and actional phases. This was examined with cross-sectional pre-migration questionnaire data from 1163 potential migrants from Spain to Germany. We also examined whether the migration decision-making phases predicted actual migration with a subsample (n=249) which provided follow-up data within twelve months. For the cross-sectional sample, multinomial logistic regressions revealed that anticipated job benefits and career aspiration are predictive for all migration phases. Self-efficacy predicts the preactional (e.g., gathering information) and actional phases (e.g., making practical arrangements). Finally, for those with low self-efficacy, anticipated job benefits play a stronger role for taking action. For the longitudinal subsample, a logistic regression revealed that being in the preactional and actional phases at baseline is predictive of actual migration within twelve months. This study expands previous research on migration intentions and behaviors by focusing on expectations, values, and beliefs as person-level predictors for migration decision-making. With a longitudinal sample, it shows that international migration is a process that involves multiple phases. |
Three Cs of translating evidence-based programs for youth and families to practice settings
Freire KE , Perkinson L , Morrel-Samuels S , Zimmerman MA . New Dir Child Adolesc Dev 2015 2015 (149) 25-39 Despite the growing number of evidence-based programs (EBPs) for youth and families, few are well-integrated in service systems or widely adopted by communities. One set of challenges to widespread adoption of EBPs relates to the transfer of programs from research and development to practice settings. This is often because program developers have limited guidance on how to prepare their programs for broad dissemination in practice settings. We describe Three Cs of Translation, which are key areas that are essential for developers to translate their EBPs from research to practice settings: (1) Communicate the underlying theory in terms easily understandable to end users, (2) Clarify fidelity and flexibility, and (3) Codify implementation lessons and examples. Program developers are in the best position to describe their interventions, to define intervention core components, to clarify fidelity and flexibility, and to codify implementation lessons from intervention studies. We note several advantages for developers to apply the Three Cs prior to intervention dissemination and provide specific recommendations for translation. |
Strain features and distributions in pneumococci from children with invasive disease before and after 13 valent conjugate vaccine implementation in the United States.
Metcalf BJ , Gertz RE Jr , Gladstone RA , Walker H , Sherwood LK , Jackson D , Li Z , Law C , Hawkins PA , Chochua S , Sheth M , Rayamajhi N , Bentley SD , Kim L , Whitney CG , McGee L , Beall B . Clin Microbiol Infect 2015 22 (1) 60 e9-60 e29 The effect of second generation pneumococcal conjugate vaccines on invasive pneumococcal disease (IPD) strain distributions have not yet been well described. We analyzed IPD isolates recovered from children <5 years of age through Active Bacterial Core surveillance before (2008-2009; n=828) and after (2011-2013; n=600) 13-valent vaccine (PCV13) implementation. We employed conventional testing, PCR/electrospray ionization mass spectrometry, and whole genome sequence (WGS) analysis to identify serotypes, resistance features, genotypes, and pilus types. PCV13, licensed in February of 2010, effectively targeted all major 19A and 7F genotypes and decreased antimicrobial resistance primarily due to removal of the 19A/ST320 complex. The strain complex contributing most to remaining beta-lactam resistance during 2011-2013 was 35B/ST558. Significant emergence of non-vaccine clonal complexes was not evident. Due to the removal of vaccine serotype strains, positivity for one or both pilus types (PI-1 and PI-2) decreased in the post PCV13 years 2011-2013 relative to 2008-2009 (decreases of 32-55% for PI-1, > 95% for PI-2 and combined PI-1 + PI-2). beta-lactam susceptibility phenotypes correlated consistently with transpeptidase region sequence combinations of the three major penicillin binding proteins (PBPs) determined through WGS. Other major resistance features were predictable by DNA signatures from WGS. Multilocus sequence data combined with PBP combinations identified progeny, serotype donors, and recipient strains in serotype switch events. PCV13 decreased all PCV13 serotype clones and concurrently decreased strain subsets with resistance and/or adherence features conducive for successful carriage. Our results serve as a reference describing key features of current pediatric IPD strains in the United States after PCV13 implementation. |
Pneumococcal vaccination coverage among persons ≥65 years - United States, 2013
O'Halloran AC , Lu PJ , Pilishvili T . Vaccine 2015 33 (42) 5503-5506 BACKGROUND: Invasive pneumococcal disease is a major cause of illness in the United States, and rates are higher among persons ≥65 years. Pneumococcal vaccination has been recommended to adults ≥65 years since 1997. METHODS: Data from the 2005-2013 Behavioral Risk Factor Surveillance System were analyzed. Weighted estimates of pneumococcal vaccination coverage were calculated by state and race/ethnicity and tests for linear trend were performed. RESULTS: In 2013, the median state vaccination coverage among adults ≥65 years was 69.5%, and coverage ranged from 61.9% in New Jersey to 75.6% in Oregon. Coverage overall among non-Hispanic whites (71.1%) was higher than coverage for non-Hispanic blacks (57.7%), Hispanics (51.9%), and non-Hispanic persons of other race (65.4%). Coverage increased from 2005 to 2013 overall and by racial/ethnic subgroups. CONCLUSION: Although pneumococcal vaccination coverage has improved in the past several years, coverage remains below the Healthy People 2020 target of 90% and racial/ethnic disparities exist. |
Preexisting immunity, more than aging, influences influenza vaccine responses
Reber AJ , Kim JH , Biber R , Talbot HK , Coleman LA , Chirkova T , Gross FL , Steward-Clark E , Cao W , Jefferson S , Veguilla V , Gillis E , Meece J , Bai Y , Tatum H , Hancock K , Stevens J , Spencer S , Chen J , Gargiullo P , Braun E , Griffin MR , Sundaram M , Belongia EA , Shay DK , Katz JM , Sambhara S . Open Forum Infect Dis 2015 2 (2) ofv052 BACKGROUND: Influenza disproportionately impacts older adults while current vaccines have reduced effectiveness in the older population. METHODS: We conducted a comprehensive evaluation of cellular and humoral immune responses of adults aged 50 years and older to the 2008-2009 seasonal trivalent inactivated influenza vaccine and assessed factors influencing vaccine response. RESULTS: Vaccination increased hemagglutination inhibition and neutralizing antibody; however, 66.3% of subjects did not reach hemagglutination inhibition titers ≥ 40 for H1N1, compared with 22.5% for H3N2. Increasing age had a minor negative impact on antibody responses, whereas prevaccination titers were the best predictors of postvaccination antibody levels. Preexisting memory B cells declined with age, especially for H3N2. However, older adults still demonstrated a significant increase in antigen-specific IgG+ and IgA+ memory B cells postvaccination. Despite reduced frequency of preexisting memory B cells associated with advanced age, fold-rise in memory B cell frequency in subjects 60+ was comparable to subjects age 50-59. CONCLUSIONS: Older adults mounted statistically significant humoral and cell-mediated immune responses, but many failed to reach hemagglutination inhibition titers ≥40, especially for H1N1. Although age had a modest negative effect on vaccine responses, prevaccination titers were the best predictor of postvaccination antibody levels, irrespective of age. |
An elaboration of theory about preventing outbreaks in homogeneous populations to include heterogeneity or preferential mixing
Feng Z , Hill AN , Smith PJ , Glasser JW . J Theor Biol 2015 386 177-87 The goal of many vaccination programs is to attain the population immunity above which pathogens introduced by infectious people (e.g., travelers from endemic areas) will not cause outbreaks. Using a simple meta-population model, we demonstrate that, if sub-populations either differ in characteristics affecting their basic reproduction numbers or if their members mix preferentially, weighted average sub-population immunities cannot be compared with the proportionally-mixing homogeneous population-immunity threshold, as public health practitioners are wont to do. Then we review the effect of heterogeneity in average per capita contact rates on the basic meta-population reproduction number. To the extent that population density affects contacts, for example, rates might differ in urban and rural sub-populations. Other differences among sub-populations in characteristics affecting their basic reproduction numbers would contribute similarly. In agreement with more recent results, we show that heterogeneous preferential mixing among sub-populations increases the basic meta-population reproduction number more than homogeneous preferential mixing does. Next we refine earlier results on the effects of heterogeneity in sub-population immunities and preferential mixing on the effective meta-population reproduction number. Finally, we propose the vector of partial derivatives of the reproduction number with respect to the sub-population immunities as a fundamentally new tool for targeting vaccination efforts. |
The Centers for Disease Control and Prevention's public health response to monitoring Tdap safety in pregnant women in the United States
Moro PL , McNeil MM , Sukumaran L , Broder KR . Hum Vaccin Immunother 2015 11 (12) 1-8 In 2010, in response to a widespread pertussis outbreak and neonatal deaths, California became the first state to recommend routine administration of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during pregnancy. In 2011, the Advisory Committee on Immunization Practices (ACIP) followed with a similar recommendation for Tdap vaccination during pregnancy for previously unvaccinated women. In 2012, this recommendation was expanded to include Tdap vaccination of every pregnant woman during each pregnancy. These recommendations were based on urgent public health needs and available evidence on the safety of other inactivated vaccines during pregnancy. However, there were limited data on the safety of Tdap during pregnancy. In response to the new ACIP recommendations, the Centers for Disease Control and Prevention (CDC) implemented ongoing collaborative studies to evaluate whether vaccination with Tdap during pregnancy adversely affects the health of mothers and their offspring and provide the committee with regular updates. The current commentary describes the public health actions taken by CDC to respond to the ACIP recommendation to study and monitor the safety of Tdap vaccines in pregnant women and describes the current state of knowledge on the safety of Tdap vaccines in pregnant women. Data from the various monitoring activities support the safety of Tdap use during pregnancy. |
IL-10 modulates antigen presentation by dendritic cells through regulation of NLRP3 inflammasome assembly during Chlamydia infection.
Omosun Y , McKeithen D , Ryans K , Kibakaya C , Blas-Machado U , Li D , Singh R , Inoue K , Xiong ZG , Eko F , Black C , Igietseme J , He Q . Infect Immun 2015 83 (12) 4662-72 Interleukin-10 (IL-10) has been implicated in the susceptibility to genital chlamydial infection and development of tubal pathologies. Also, IL-10 limitation resulted in rapid elicitation of immune responses against Chlamydia and decreased levels of IL-10 correlated with protective anti-Chlamydia immunity. To investigate the molecular basis for these effects, we compared reproductive pathology and fertility rate in Chlamydia- infected wild type and IL-10 knockout (IL10-/-) mice; we also analyzed the expression of Toll-like receptor/Interleukin-1 receptor superfamily, IL-1beta production, NLRP3 inflammasome assembly and activation, and the immunostimulatory capacity and apoptotic predilection of Chlamydia-exposed dendritic cells (DCs) from WT and IL-10-/- mice. Our results revealed that in addition to a rapid clearance of infection, genitally infected IL-10-/- mice were protected from tubal pathologies and infertility compared to WT (IL10+/+) mice. Chlamydia-pulsed IL-10-/- DCs expressed enhanced TLR4/IL1R molecules and IL-1beta production. In addition, NLRP3 inflammasome assembly was suppressed in IL-10-/- DCs through the inhibition of the P2X purinoceptor 7 (P2X7R), an ATP-gated ion channel, and a decrease in intracellular Ca2+ that inhibited DC apoptosis. Thus, the potent immunostimulatory capacity of IL-10 deficient DCs is due, at least partly, to suppression of intracellular inflammasome assembly that prevents DC apoptosis, allowing an efficient antigen presentation. The results indicate that IL-10 deficiency enabled an efficient antigen presentation by DCs for a rapid and enhanced immune activation against Chlamydia, which results in rapid microbial clearance that prevents tubal pathologies during infection. Our finding has important vaccine implication to induce protective immunity against Chlamydia and other infectious and non-infectious diseases. |
Replacement of filters for respirable quartz measurement in coal mine dust by infrared spectroscopy
Farcas D , Lee T , Chisholm WP , Soo JC , Harper M . J Occup Environ Hyg 2015 13 (2) D16-22 The objective of the present study is to compare and characterize nylon, polypropylene (PP), and polyvinyl chloride (PVC) membrane filters that might be used to replace the vinyl/acrylic co-polymer (DM-450) filter currently used in the Mine Safety and Health Administration (MSHA) P-7 method (Quartz Analytical Method) and the National Institute for Occupational Safety and Health (NIOSH) Manual of Analytical Methods 7603 method (QUARTZ in coal mine dust, by IR re-deposition). This effort is necessary because the DM-450 filters are no longer commercially available. For example, the MSHA Pittsburgh laboratory alone analyses annually approximately 15,000 samples according to the MSHA P-7 method that requires DM-450 filters. There is an impending shortage of DM-450 filters. Membrane filters suitable for on-filter analysis should have high infrared (IR) transmittance in the spectral region 600-1000 cm-1. Nylon (47 mm, 0.45 microm pore size), PP (47 mm, 0.45 microm pore size) and PVC (47 mm, 5 microm pore size) filters meet this specification. Limits of detection and limits of quantification were determined from Fourier transform infrared spectroscopy (FTIR) measurements of blank filters. The average measured quartz mass and coefficient of variation were determined from test filters spiked with respirable alpha-quartz following MSHA P-7 and NIOSH 7603 methods. Quartz was also quantified in samples of respirable coal dust on each test filter type using the MSHA and NIOSH analysis methods. The results indicate that PP and PVC filters may replace the DM-450 filters for quartz measurement in coal dust by FTIR. PVC filters of 5 microm pore size was seemed to be suitable replacement although their ability to retain small particulates should be checked by filter experiment. |
Mass spectrometric detection of bacterial protein toxins and their enzymatic activity
Kalb SR , Boyer AE , Barr JR . Toxins (Basel) 2015 7 (9) 3497-3511 Mass spectrometry has recently become a powerful technique for bacterial identification. Mass spectrometry approaches generally rely upon introduction of the bacteria into a matrix-assisted laser-desorption time-of-flight (MALDI-TOF) mass spectrometer with mass spectrometric recognition of proteins specific to that organism that form a reliable fingerprint. With some bacteria, such as Bacillus anthracis and Clostridium botulinum, the health threat posed by these organisms is not the organism itself, but rather the protein toxins produced by the organisms. One such example is botulinum neurotoxin (BoNT), a potent neurotoxin produced by C. botulinum. There are seven known serotypes of BoNT, A–G, and many of the serotypes can be further differentiated into toxin variants, which are up to 99.9% identical in some cases. Mass spectrometric proteomic techniques have been established to differentiate the serotype or toxin variant of BoNT produced by varied strains of C. botulinum. Detection of potent biological toxins requires high analytical sensitivity and mass spectrometry based methods have been developed to determine the enzymatic activity of BoNT and the anthrax lethal toxins produced by B. anthracis. This enzymatic activity, unique for each toxin, is assessed with detection of the toxin-induced cleavage of strategically designed peptide substrates by MALDI-TOF mass spectrometry offering unparalleled specificity. Furthermore, activity assays allow for the assessment of the biological activity of a toxin and its potential health risk. Such methods have become important diagnostics for botulism and anthrax. Here, we review mass spectrometry based methods for the enzymatic activity of BoNT and the anthrax lethal factor toxin. |
Measurement of impulse peak insertion loss from two acoustic test fixtures and four hearing protector conditions with an acoustic shock tube
Murphy WJ , Fackler CJ , Berger EH , Shaw PB , Stergar M . Noise Health 2015 17 (78) 364-73 Impulse peak insertion loss (IPIL) was studied with two acoustic test fixtures and four hearing protector conditions at the E-A-RCAL Laboratory. IPIL is the difference between the maximum estimated pressure for the open-ear condition and the maximum pressure measured when a hearing protector is placed on an acoustic test fixture (ATF). Two models of an ATF manufactured by the French-German Research Institute of Saint-Louis (ISL) were evaluated with high-level acoustic impulses created by an acoustic shock tube at levels of 134 decibels (dB), 150 dB, and 168 dB. The fixtures were identical except that the E-A-RCAL ISL fixture had ear canals that were 3 mm longer than the National Institute for Occupational Safety and Health (NIOSH) ISL fixture. Four hearing protection conditions were tested: Combat Arms earplug with the valve open, ETYPlugs (R) earplug, TacticalPro headset, and a dual-protector ETYPlugs earplug with TacticalPro earmuff. The IPILs measured for the E-A-RCAL fixture were 1.4 dB greater than the National Institute for Occupational Safety and Health (NIOSH) ISL ATF. For the E-A-RCAL ISL ATF, the left ear IPIL was 2.0 dB greater than the right ear IPIL. For the NIOSH ATF, the right ear IPIL was 0.3 dB greater than the left ear IPIL. |
Evaluation of nine HIV rapid test kits to develop a national HIV testing algorithm in Nigeria
Bassey O , Bond K , Adedeji A , Oke O , Abubakar A , Yakubu K , Jelpe T , Akintunde E , Ikani P , Ogundiran A , Onoja A , Kawu I , Ikwulono G , Saliu I , Nwanyawu O , Deyde V . Afr J Lab Med 2015 4 (1) BACKGROUND: Non-cold chain-dependent HIV rapid testing has been adopted in many resource-constrained nations as a strategy for reaching out to populations. HIV rapid test kits (RTKs) have the advantage of ease of use, low operational cost and short turnaround times. Before 2005, different RTKs had been used in Nigeria without formal evaluation. Between 2005 and 2007, a study was conducted to formally evaluate a number of RTKs and construct HIV testing algorithms. OBJECTIVES: The objectives of this study were to assess and select HIV RTKs and develop national testing algorithms. METHOD: Nine RTKs were evaluated using 528 well-characterised plasma samples. These comprised 198 HIV-positive specimens (37.5%) and 330 HIV-negative specimens (62.5%), collected nationally. Sensitivity and specificity were calculated with 95% confidence intervals for all nine RTKs singly and for serial and parallel combinations of six RTKs; and relative costs were estimated. RESULTS: Six of the nine RTKs met the selection criteria, including minimum sensitivity and specificity (both > 99.0%) requirements. There were no significant differences in sensitivities or specificities of RTKs in the serial and parallel algorithms, but the cost of RTKs in parallel algorithms was twice that in serial algorithms. Consequently, three serial algorithms, comprising four test kits (BundiTM, DetermineTM, Stat-Pak and Uni-GoldTM) with 100.0% sensitivity and 99.1% - 100.0% specificity, were recommended and adopted as national interim testing algorithms in 2007. CONCLUSION: This evaluation provides the first evidence for reliable combinations of RTKs for HIV testing in Nigeria. However, these RTKs need further evaluation in the field (Phase II) to re-validate their performance. |
Inhalation exposure to carbon nanotubes (CNT) and carbon nanofibers (CNF): methodology and dosimetry
Oberdorster G , Castranova V , Asgharian B , Sayre P . J Toxicol Environ Health B Crit Rev 2015 18 121-212 Carbon nanotubes (CNT) and nanofibers (CNF) are used increasingly in a broad array of commercial products. Given current understandings, the most significant life-cycle exposures to CNT/CNF occur from inhalation when they become airborne at different stages of their life cycle, including workplace, use, and disposal. Increasing awareness of the importance of physicochemical properties as determinants of toxicity of CNT/CNF and existing difficulties in interpreting results of mostly acute rodent inhalation studies to date necessitate a reexamination of standardized inhalation testing guidelines. The current literature on pulmonary exposure to CNT/CNF and associated effects is summarized; recommendations and conclusions are provided that address test guideline modifications for rodent inhalation studies that will improve dosimetric extrapolation modeling for hazard and risk characterization based on the analysis of exposure-dose-response relationships. Several physicochemical parameters for CNT/CNF, including shape, state of agglomeration/aggregation, surface properties, impurities, and density, influence toxicity. This requires an evaluation of the correlation between structure and pulmonary responses. Inhalation, using whole-body exposures of rodents, is recommended for acute to chronic pulmonary exposure studies. Dry powder generator methods for producing CNT/CNF aerosols are preferred, and specific instrumentation to measure mass, particle size and number distribution, and morphology in the exposure chambers are identified. Methods are discussed for establishing experimental exposure concentrations that correlate with realistic human exposures, such that unrealistically high experimental concentrations need to be identified that induce effects under mechanisms that are not relevant for workplace exposures. Recommendations for anchoring data to results seen for positive and negative benchmark materials are included, as well as periods for postexposure observation. A minimum data set of specific bronchoalveolar lavage parameters is recommended. Retained lung burden data need to be gathered such that exposure-dose-response correlations may be analyzed and potency comparisons between materials and mammalian species are obtained considering dose metric parameters for interpretation of results. Finally, a list of research needs is presented to fill data gaps for further improving design, analysis, and interpretation and extrapolation of results of rodent inhalation studies to refine meaningful risk assessments for humans. |
Amino acid starvation induced by protease inhibition produces differential alterations in redox status and the thiol proteome in organogenesis-stage rat embryos and visceral yolk sacs
Harris C , Jilek JL , Sant KE , Pohl J , Reed M , Hansen JM . J Nutr Biochem 2015 26 (12) 1589-98 The process of embryonic nutrition in rodent conceptuses during organogenesis has been shown to involve a dominant histiotrophic mechanism where essential developmental substrates and micronutrients are supplied as whole maternal proteins or cargoes associated with proteins. The histiotrophic nutrition pathways (HNP) responsible for uptake and initial processing of proteins across maternal-conceptal interfaces involve uptake via receptor mediated endocytosis and protein degradation via lysosomal proteolysis. Chemical inhibition of either process can lead to growth deficits and malformation in the embryo (EMB), but selective inhibition of either HNP component will elicit a different subset of developmental perturbations. In vitro, whole embryo culture exposure of GD10 or GD11 rat conceptuses to the natural protease inhibitor, leupeptin, leads to significant reductions in all measured embryonic growth parameters as well as a myriad of other effects. Leupeptin doses of 10 muM or 20 muM over a 26-h period (GD10-GD11) and 50 muM over a 3 h pulse period produced significant decreases in the clearance of FITC-albumin from culture media. The near complete loss of acid soluble fluorescence and increased total visceral yolk sac (VYS) protein content confirmed the selective inhibition of proteolysis. Inhibition of lysosomal proteolysis thus deprives the developing EMB of essential nutrient amino acids producing conditions akin to amino acid starvation, but may also cause direct effects on pathways critical for normal growth and differentiation. Following leupeptin exposure for 26 or 6 h, total glutathione (GSH) concentrations dropped significantly in the VYS, but only slightly in yolk sac (YSF) and amniotic (AF) fluids. Cys concentrations increased in VYS and EMB, but dropped in YSF and AF fluids. Redox potentials (Eh) for the glutathione disulfide (GSSG)/glutathione (GSH) redox couple trended significantly toward the positive, confirming the net oxidation of conceptual tissues following leupeptin treatment. Analysis of the thiol proteome showed few alterations to specific pathways mapped to the Kyoto Encyclopedia of Genes and Genomes Pathway database, but did reveal significant increases in concentrations of proteins associated with glycolysis/gluconeogenesis in the VYS and decreased concentrations proteins associated with ribosome biogenesis and function in the EMB. A subset of proteins elevated by >2-23-fold in the VYS were identified as serum (blood) proteins and represent the maternal-side proteins captured by the VYS and which are not degraded in the lysosomes as a result of leupeptin's inhibitory action. The observed constellation of proteins decreased in the EMB by leupeptin represent proteins from several adaptive pathways that are commonly altered in responses to amino acid starvation. These studies show clear differential responses to protease inhibition in VYS and EMB during organogenesis and suggest the possibility for additional roles of redox regulation, cellular adaptations and metabolic insufficiency caused by protease inhibition. |
Analytical evaluation of nine serological assays for diagnosis of syphilis
Malm K , Andersson S , Fredlund H , Norrgren H , Biague A , Mansson F , Ballard R , Unemo M . J Eur Acad Dermatol Venereol 2015 29 (12) 2369-76 BACKGROUND: The diagnosis of syphilis is most frequently dependent on antibody detection with serological assays. Assays for both treponemal and non-treponemal antibodies are needed to provide a sensitive and specific diagnosis. For decades, a first screening has been done with non-treponemal assays, followed by treponemal. However, in recent years, following laboratory automation, the reverse sequence screening algorithms have been developed, using a treponemal assay as the initial screening test. OBJECTIVE: To evaluate serological assays for treponemal and non-treponemal antibodies, to use in reverse algorithm screening of syphilis. MATERIAL AND METHODS: Six treponemal assays (one IgM-specific assay), two non-treponemal assays and one novel dual point-of-care (POC) assay for serological diagnosis of syphilis were evaluated. Serum samples from Guinea-Bissau and Sweden were examined, as well as two performance panels and samples from blood donors. Sensitivity and specificity were calculated for each assay, using different assays as gold standard test. RESULTS: The Macro-Vue RPR Card test was the most sensitive non-treponemal test and the TrepSure Anti-Treponema EIA Screen and the SeroDia TP-PA were the most sensitive and specific treponemal assays. Among the automated assays, both the Liaison Treponema Screen and Architect Syphilis TP showed high sensitivity, however, the former had clearly higher specificity. CONCLUSIONS: In resourced settings, where the reverse sequence algorithm is preferred for screening, an automated treponemal immunoassay for initial screening subsequently followed by the TrepSure test or TP-PA assay as a second treponemal assay appear highly effective. Finally, a quantitative highly sensitive non-treponemal assay, e.g. the Macro-Vue RPR Card test, could then be used as a supplementary test to evaluate activity of the syphilis infection. |
Building laboratory capacity to support HIV care in Nigeria: Harvard/APIN PEPFAR, 2004-2012
Hamel DJ , Sankale JL , Samuels JO , Sarr AD , Chaplin B , Ofuche E , Meloni ST , Okonkwo P , Kanki PJ . Afr J Lab Med 2015 4 (1) 190 INTRODUCTION: From 2004-2012, the Harvard/AIDS Prevention Initiative in Nigeria, funded through the US President's Emergency Plan for AIDS Relief programme, scaled up HIV care and treatment services in Nigeria. We describe the methodologies and collaborative processes developed to improve laboratory capacity significantly in a resource-limited setting. These methods were implemented at 35 clinic and laboratory locations. METHODS: Systems were established and modified to optimise numerous laboratory processes. These included strategies for clinic selection and management, equipment and reagent procurement, supply chains, laboratory renovations, equipment maintenance, electronic data management, quality development programmes and trainings. RESULTS: Over the eight-year programme, laboratories supported 160 000 patients receiving HIV care in Nigeria, delivering over 2.5 million test results, including regular viral load quantitation. External quality assurance systems were established for CD4+ cell count enumeration, blood chemistries and viral load monitoring. Laboratory equipment platforms were improved and standardised and use of point-of-care analysers was expanded. Laboratory training workshops supported laboratories toward increasing staffskills and improving overall quality. Participation in a World Health Organisation-led African laboratory quality improvement system resulted in significant gains in quality measures at five laboratories. CONCLUSIONS: Targeted implementation of laboratory development processes, during simultaneous scale-up of HIV treatment programmes in a resource-limited setting, can elicit meaningful gains in laboratory quality and capacity. Systems to improve the physical laboratory environment, develop laboratory staff, create improvements to reduce costs and increase quality are available for future health and laboratory strengthening programmes. We hope that the strategies employed may inform and encourage the development of other laboratories in resource-limited settings. |
Characterization of Puerto Rican West Nile virus isolates in mice
Caraballo EV , Hunsperger E , Martinez I . Virol J 2015 12 (1) 137 BACKGROUND: West Nile virus (WNV) is a neurotropic arbovirus that was first isolated in 1937 in the West Nile District of Uganda. The virus emerged in New York in 1999 and is now endemic in North America (2007). The first virus isolates from Puerto Rico were obtained in 2007 from a chicken (PR20wh) and a mosquito pool (PR423). Our study further characterized these viral isolates using in vitro plaque morphology assays and in vivo using a Balb/c mice pathogenesis model. METHODS AND RESULTS: In the in vitro experiments, PR WNV isolates produced significantly smaller plaques in Vero cells compared to the New York 1999 strain (NY99). For the in vivo experiments, PR WNV isolates were propagated in mammalian (Vero) and insect (C6/36) cell lines and then inoculated in Balb/c mice. When WNV was propagated in Vero cells, we observed a trend towards significance in the survival rate with PR20wh compared to NY99 (log rank, p = 0.092). Regardless of whether the viral isolates were propagated in Vero or C6/36 cells, we found a significantly greater survival in mice infected with PR20wh strain, when compared to NY99 (log rank, p = 0.04), while no statistical difference was detected between PR423 and NY99 (p = 0.84). The average survival time (AST) in mice was significantly lower in C6/36-derived PR423 when compared to C6/36-derived NY99 (t-test, p = 0.013), and Vero-derived PR423 (t-test, p < 0.001). Eight days post infection in mice the viral load in brain tissue for Vero-derived PR423 was significantly higher when compared to NY99 and PR20wh. CONCLUSIONS: These results suggest that the PR WNV isolate, PR20wh, is a less pathogenic strain in mice than NY99. Moreover, we found that PR423 is a pathogenic isolate that causes faster mortality than NY99, when propagated in C6/36. |
A comparison of carbon dioxide sources for mosquito capture in Centers for Disease Control and Prevention light traps on the Florida Gulf Coast
Hoel DF , Dunford JC , Kline DL , Irish SR , Weber M , Richardson AG , Doud CW , Wirtz RA . J Am Mosq Control Assoc 2015 31 (3) 248-57 Traditional sources of carbon dioxide (CO2), dry ice, and compressed gas, were tested against 3 combinations of food-grade reagents known to generate CO2 using a compact, lightweight generator delivery system with Centers for Disease Control and Prevention light traps. Three 6 x 6 Latin square trials were completed near the Florida Gulf Coast in the Lower Suwannee Wildlife Refuge during the summer of 2013, collecting a total of 31,632 female mosquitoes. Treatments included dry ice, compressed CO2 gas, a control trap (no CO2), citric acid + sodium bicarbonate, vinegar + sodium bicarbonate, and yeast + sugar. Decreasing order of trap collections (treatment mean number of mosquitoes per trap night +/- standard error) were dry ice 773.5 (+/-110.1) > compressed gas 440.7 (+/-42.3) > citric acid + sodium bicarbonate 197.6 (+/-30.4), yeast + sugar 153.6 (+/-27.4) > vinegar + sodium bicarbonate 109.6 (+/-16.2) > control 82.4 (+/-14.0). A 2-way Kruskal-Wallis analysis by treatment, site, and treatment x site interaction identified significant differences between all treatments. Although dry ice and compressed CO2 gas collected significantly more mosquitoes than other combinations (P < 0.05), use of citric acid and sodium bicarbonate or yeast and sugar greatly outperformed unbaited traps and offer a good alternative to dry ice and compressed gas in areas where these agents are not readily available or are difficult to obtain due to logistical constraints. An inexpensive, portable CO2 generator for use with food-grade reagents is described. |
Comparison of monkeypox virus clade kinetics and pathology within the prairie dog animal model using a serial sacrifice study design
Hutson CL , Carroll DS , Gallardo-Romero N , Drew C , Zaki SR , Nagy T , Hughes C , Olson VA , Sanders J , Patel N , Smith SK , Keckler MS , Karem K , Damon IK . Biomed Res Int 2015 2015 965710 Monkeypox virus (MPXV) infection of the prairie dog is valuable to studying systemic orthopoxvirus disease. To further characterize differences in MPXV clade pathogenesis, groups of prairie dogs were intranasally infected (8 x 103 p.f.u.) with Congo Basin (CB) or West African (WA) MPXV, and 28 tissues were harvested on days 2, 4, 6, 9, 12, 17, and 24 postinfection. Samples were evaluated for the presence of virus and gross and microscopic lesions. Virus was recovered from nasal mucosa, oropharyngeal lymph nodes, and spleen earlier in CB challenged animals (day 4) than WA challenged animals (day 6). For both groups, primary viremia (indicated by viral DNA) was seen on days 6-9 through day 17. CB MPXV spread more rapidly, accumulated to greater levels, and caused greater morbidity in animals compared to WA MPXV. Histopathology and immunohistochemistry (IHC) findings, however, were similar. Two animals that succumbed to disease demonstrated abundant viral antigen in all organs tested, except for brain. Dual-IHC staining of select liver and spleen sections showed that apoptotic cells (identified by TUNEL) tended to colocalize with poxvirus antigen. Interestingly splenocytes were labelled positive for apoptosis more often than hepatocytes in both MPXV groups. These findings allow for further characterization of differences between MPXV clade pathogenesis, including identifying sites that are important during early viral replication and cellular response to viral infection. |
Heptadecanoylcarnitine (C17) a novel candidate biomarker for newborn screening of propionic and methylmalonic acidemias
Malvagia S , Haynes CA , Grisotto L , Ombrone D , Funghini S , Moretti E , McGreevy KS , Biggeri A , Guerrini R , Yahyaoui R , Garg U , Seeterlin M , Chace D , De Jesus VR , la Marca G . Clin Chim Acta 2015 450 342-8 BACKGROUND: 3-Hydroxypalmitoleoyl-carnitine (C16:1-OH) has recently been reported to be elevated in acylcarnitine profiles of patients with propionic acidemia (PA) or methylmalonic acidemia (MMA) during expanded newborn screening (NBS). High levels of C16:1-OH, combined with other hydroxylated long chain acylcarnitines are related to long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHADD) and trifunctional protein (TFP) deficiency. METHODS: The acylcarnitine profile of two LCHADD patients was evaluated using liquid chromatography-tandem mass spectrometric method. A specific retention time was determined for each hydroxylated long chain acylcarnitine. The same method was applied to some neonatal dried blood spots (DBS) from PA and MMA patients presenting abnormal C16:1-OH concentrations. RESULTS: The retention time of the peak corresponding to C16:1-OH in LCHADD patients differed from those in MMA and PA patients. Heptadecanoylcarnitine (C17) has been identified as the novel biomarker specific for PA and MMA patients through high resolution mass spectrometry (Orbitrap) experiments. We found that 21 out of 23 neonates (22 MMA, and 1PA) diagnosed through the Tuscany region NBS program exhibited significantly higher levels of C17 compared to controls. Twenty-three maternal deficiency (21 vitamin B12 deficiency, 1 homocystinuria and 1 gastrin deficiency) samples and 82 false positive for elevated propionylcarnitine (C3) were also analyzed. CONCLUSIONS: We have characterized a novel biomarker able to detect propionate disorders during expanded newborn screening (NBS). The use of this new biomarker may improve the analytical performances of NBS programs especially in laboratories where second tier tests are not performed. |
Birth prevalence of selected external structural birth defects at four hospitals in Dar es Salaam, Tanzania, 2011-2012
Kishimba RS , Mpembeni R , Mghamba JM , Goodman D , Valencia D . J Glob Health 2015 5 (2) 020411 BACKGROUND: 94% of all birth defects (BD) and 95% of deaths due to the BD occur in low and middle income countries, many of which are preventable. In Tanzania, there is currently a paucity of BD data necessary to develop data informed prevention activities. METHODS: A cross-sectional analysis was conducted of deliveries identified with BD in the labor ward registers at four Dar es Salaam hospitals between October, 2011 and February, 2012. The birth prevalence of structural BD, case fatality proportion, and the distribution of structural defects associated deaths within total deaths were calculated. RESULTS: A total of 28 217 resident births were encountered during the study period. Overall birth prevalence of selected defects was 28.3/10 000 live births. Neural tube defects and indeterminate sex were the most and least common defects at birth (9.9 and 1.1/10 000 live births, respectively). Among stillbirths (66.7%) and deaths that occurred within less than 5 days of an affected live birth (18.5%), neural tube defects were the most frequently associated structural defect. CONCLUSION: Structural BD is common and contributes to perinatal mortality in Dar es Salaam. More than half of perinatal deaths encountered among the studied selected external structural BD are associated with neural tube defects, a birth defect with well-established evidence based prevention interventions. By establishing a population-based BD surveillance program, Tanzania would have the information about neural tube defects and other major structural BD needed to develop and monitor prevention activities. |
The relationship between livestock ownership and child stunting in three countries in Eastern Africa using national survey data
Mosites EM , Rabinowitz PM , Thumbi SM , Montgomery JM , Palmer GH , May S , Rowhani-Rahbar A , Neuhouser ML , Walson JL . PLoS One 2015 10 (9) e0136686 Livestock ownership has the potential to improve child nutrition through various mechanisms, although direct evaluations of household livestock and child stunting status are uncommon. We conducted an analysis of Demographic and Health Survey (DHS) datasets from Ethiopia (2011), Kenya (2008-2009), and Uganda (2010) among rural children under 5 years of age to compare stunting status across levels of livestock ownership. We classified livestock ownership by summing reported household numbers of goats, sheep, cattle and chickens, as well as calculating a weighted score to combine multiple species. The primary association was assessed separately by country using a log-binomial model adjusted for wealth and region, which was then stratified by child diarrheal illness, animal-source foods intake, sub-region, and wealth index. This analysis included n = 8079 children from Ethiopia, n = 3903 children from Kenya, and n = 1645 from Uganda. A ten-fold increase in household livestock ownership had significant association with lower stunting prevalence in Ethiopia (Prevalence Ratio [PR] 0.95, 95% CI 0.92-0.98) and Uganda (PR 0.87, 95% CI 0.79-0.97), but not Kenya (PR 1.01, 95% CI 0.96-1.07). The weighted livestock score was only marginally associated with stunting status. The findings varied slightly by region, but not by wealth, diarrheal disease, or animal-source food intake. This analysis suggested a slightly beneficial effect of household livestock ownership on child stunting prevalence. The small effect size observed may be related to limitations of the DHS dataset or the potentially complicated relationship between malnutrition and livestock ownership, including livestock health and productivity. |
Networking to improve nutrition policy research
Kim SA , Blanck HM , Cradock A , Gortmaker S . Prev Chronic Dis 2015 12 E148 Effective nutrition and obesity policies that improve the food environments in which Americans live, work, and play can have positive effects on the quality of human diets. The Centers for Disease Control and Prevention's (CDC's) Nutrition and Obesity Policy Research and Evaluation Network (NOPREN) conducts transdisciplinary practice-based policy research and evaluation to foster understanding of the effectiveness of nutrition policies. The articles in this special collection bring to light a set of policies that are being used across the United States. They add to the larger picture of policies that can work together over time to improve diet and health. |
Adolescent student use of school-based salad bars
Andersen L , Myers L , O'Malley K , Mundorf AR , Harris DM , Johnson CC . J Sch Health 2015 85 (10) 722-7 BACKGROUND: Childhood obesity continues to be a public health problem in the United States. Increasing consumption of fruits and vegetables (F/V) is one strategy for decreasing high consumption of energy-dense, high-fat foods, thereby improving weight status. Many Orleans Parish public schools were provided with salad bars (SBs) to augment school lunch with increased access to F/V. This study identified factors associated with student use of SBs. METHODS: Surveys examining SB use, demographics, food preference, nutrition knowledge, and social support were administered to students in the 7th to 12th grades (N = 702) in Orleans Parish (New Orleans, Louisiana). Generalized estimating equations, which incorporate clustering at the school level, helped to determine associations between independent variables and SB use. RESULTS: Sixty percent of participants were SB users. Non-African-American students were more likely to be SB users than African-American students (odds ratio [OR] = 2.35, confidence interval [CI]: 1.35-4.07) and students who had high preference for healthy food were more likely to use the SB than those who had low preference (OR = 2.41, CI: 1.44-4.01). Students who encouraged others to consume F/V were more likely to use the SB than those who did not (p = .015). CONCLUSIONS: Individual and interpersonal factors related to SB use can provide guidance in the development of school-based interventions to increase SB use and F/V consumption. |
A review of isolation gowns in healthcare: fabric and gown properties
Selcen Kilinc F . J Eng Fiber Fabr 2015 10 (3) 180-190 The threat of emerging infectious diseases including Ebola hemorrhagic fever, pandemic influenza, avian influenza, Hepatitis B, Hepatitis C, and SARS has highlighted the need for effective personal protective equipment (PPE) to protect healthcare workers (HCWs), patients, and visitors. PPE is a critical component in the hierarchy of controls used to protect HCWs from infectious hazards. HCW PPE may include gowns, respirators, face masks, gloves, eye protection, face shields, and head and shoe coverings. Important research has been conducted in certain areas, such as respirators and protective masks, but studies in other areas, particularly gowns, are scarce. Gowns are identified as the second-most-used piece of PPE, following gloves, in the healthcare setting. According to the Centers for Disease Control and Preventions Guideline for Isolation Precautions, isolation gowns should be worn to protect HCWs arms and exposed body areas during procedures and patient-care activities when anticipating contact with clothing, blood, bodily fluids, secretions and excretions. Isolation gowns currently available on the marketplace offer varying resistance to blood and other bodily fluids depending on the type of the material, its impermeability, and wear and tear. While some studies show no benefit of the routine use of isolation gowns, others demonstrate that its use is associated with a reduced infection rate. This paper reviews isolation gowns in healthcare settings, including the fabrics used, gown design and interfaces, as well as critical parameters that affect microorganism and liquid transmission through fabrics. |
Trends of occupational fatalities involving machines, United States, 1992-2010
Marsh SM , Fosbroke DE . Am J Ind Med 2015 58 (11) 1160-73 BACKGROUND: This paper describes trends of occupational machine-related fatalities from 1992-2010. We examine temporal patterns by worker demographics, machine types (e.g., stationary, mobile), and industries. METHODS: We analyzed fatalities from Census of Fatal Occupational Injuries data provided by the Bureau of Labor Statistics to the National Institute for Occupational Safety and Health. We used injury source to identify machine-related incidents and Poisson regression to assess trends over the 19-year period. RESULTS: There was an average annual decrease of 2.8% in overall machine-related fatality rates from 1992 through 2010. Mobile machine-related fatality rates decreased an average of 2.6% annually and stationary machine-related rates decreased an average of 3.5% annually. Groups that continued to be at high risk included older workers; self-employed; and workers in agriculture/forestry/fishing, construction, and mining. CONCLUSION: Addressing dangers posed by tractors, excavators, and other mobile machines needs to continue. High-risk worker groups should receive targeted information on machine safety. |
Undocumented status as a social determinant of occupational safety and health: the workers' perspective
Flynn MA , Eggerth DE , Jacobson CJ . Am J Ind Med 2015 58 (11) 1127-37 BACKGROUND: Undocumented immigration to the United States has grown dramatically over the past 25 years. This study explores undocumented status as a social determinant of occupational health by examining its perceived consequences on workplace safety of Latino immigrants. METHODS: Guided by the Theory of Work Adjustment, qualitative analysis was conducted on transcripts from focus groups and individual interviews conducted with a convenience sample of Latino immigrant workers. RESULTS: Participants reported that unauthorized status negatively impacted their safety at work and resulted in a degree of alienation that exceeded the specific proscriptions of the law. Participants overwhelming used a strategy of disengagement to cope with the challenges they face as undocumented immigrants. CONCLUSION: This study describes the complex web of consequences resulting from undocumented status and its impact on occupational health. This study presents a framework connecting the daily work experiences of immigrants, the coping strategy of disengagement, and efforts to minimize the impact of structural violence. |
Use of pooled samples to assess human exposure to parabens, benzophenone-3 and triclosan in Queensland, Australia
Heffernan AL , Baduel C , Toms LM , Calafat AM , Ye X , Hobson P , Broomhall S , Mueller JF . Environ Int 2015 85 77-83 Parabens, benzophenone-3 and triclosan are common ingredients used as preservatives, ultraviolet radiation filters and antimicrobial agents, respectively. Human exposure occurs through consumption of processed food and use of cosmetics and consumer products. The aim of this study was to provide a preliminary characterisation of exposure to selected personal care product chemicals in the general Australian population. De-identified urine specimens stratified by age and sex were obtained from a community-based pathology laboratory and pooled (n=24 pools of 100). Concentrations of free and total (sum of free plus conjugated) species of methyl, ethyl, propyl and butyl paraben, benzophenone-3 and triclosan were quantified using isotope dilution tandem mass spectrometry; with geometric means 232, 33.5, 60.6, 4.32, 61.5 and 87.7ng/mL, respectively. Age was inversely associated with paraben concentration, and females had concentrations approximately two times higher than males. Total paraben and benzophenone-3 concentrations are significantly higher than reported worldwide, and the average triclosan concentration was more than one order of magnitude higher than in many other populations. This study provides the first data on exposure of the general Australian population to a range of common personal care product chemical ingredients, which appears to be prevalent and warrants further investigation. |
Clinician beliefs and attitudes regarding use of respiratory protective devices and surgical masks for influenza
Pillai SK , Beekmann SE , Babcock HM , Pavia AT , Koonin LM , Polgreen PM . Health Secur 2015 13 (4) 274-80 While influenza transmission is thought to occur primarily by droplet spread, the role of airborne spread remains uncertain. Understanding the beliefs and attitudes of infectious disease physicians regarding influenza transmission and respiratory and barrier protection preferences can provide insights into workplace decisions regarding respiratory protection planning. Physicians participating in the Infectious Diseases Society of America's Emerging Infections Network were queried in November 2013 to determine beliefs and attitudes on influenza transmission. A subset of physicians involved in their facility's respiratory protection decision making were queried about respirator and surgical mask choices under various pandemic scenarios; availability of, and challenges associated with, respirators in their facility; and protective strategies during disposable N95 shortages. The majority of 686 respondents (98%) believed influenza transmission occurs frequently or occasionally via droplets; 44% of respondents believed transmission occurs via small particles frequently (12%) or occasionally (32%). Among the subset of respondents involved in respiratory protection planning at their facility, over 90% preferred surgical masks during provision of non-aerosol-generating patient care for seasonal influenza. However, for the same type of care during an influenza pandemic, two-thirds of respondents opted for disposable N95 filtering facepiece respirators. In settings where filtering facepiece (disposable) N95 respirators were in short supply, preferred conservation strategies included extended use and reuse of disposable N95s. Use of reusable (elastomeric facepiece) respirator types was viewed less favorably. While respondents identified droplets as the primary mode of influenza transmission, during a high-severity pandemic scenario there was increased support for devices that reduced aerosol-based transmission. Use of potentially less familiar respirator types may partially relieve shortages of disposable N95s but also may require significant education efforts so that clinicians are aware of the characteristics of alternative personal protective equipment. |
Surveillance for the safety and effectiveness of artemether-lumefantrine in patients with uncomplicated plasmodium falciparum malaria in the USA: a descriptive analysis
Gray AM , Arguin PM , Hamed K . Malar J 2015 14 (1) 349 BACKGROUND: Data from clinical studies show that artemether-lumefantrine (AL) is effective and well tolerated in adults and children with uncomplicated Plasmodium falciparum malaria. However, data on effectiveness and safety of AL in patients in non-endemic settings are limited. METHODS: A 5-year surveillance plan included all AL-treated adult and paediatric patients with confirmed or suspected P. falciparum malaria in the USA, as reported to the National Malaria Surveillance System at the Centers for Disease Control and Prevention. Descriptive analyses included demographics, baseline characteristics, clinical effectiveness, and safety. From May 2010 to April 2015, demographics and baseline characteristics were collected for 203 patients and safety data for 108 patients. Treatment effectiveness data at day 7 were collected for 117 patients and at day 28 for 98 patients. RESULTS: The majority of patients were male (58.6 %), Black (62.6 %), non-Hispanic (92.6 %), and likely malaria non-immune (80.8 %). The median age was 32 (range 1-88) years and the median body mass index was 25.5 (range 13.8-42.4) kg/m(2). All patients with effectiveness data had confirmed (n = 116) or suspected (n = 1) malaria. The overall cure rate for patients treated with AL was 91.5 % (95 % CI 84.8-95.8 %) at day 7 and 96.9 % (95 % CI 91.3-99.4 %) at day 28. Adverse events were reported in four (3.7 %) patients, and there were no new or unexpected safety signals. CONCLUSION: AL was effective and well tolerated in the treatment of likely non-immune patients with P. falciparum malaria. |
Withdrawal as pregnancy prevention and associated risk factors among US high school students: findings from the 2011 National Youth Risk Behavior Survey
Liddon N , O'Malley Olsen E , Carter M , Hatfield-Timajchy K . Contraception 2015 93 (2) 126-32 PURPOSE: Withdrawal is less effective for preventing pregnancy than other contraceptive methods and offers no protection against sexually transmitted infections including HIV. Little is known from a national perspective about adolescents who primarily use withdrawal. This study describes the prevalence of withdrawalas their primary method of pregnancy prevention at last sexual intercourse among sexually active US high school students and associations with sexual risk and substance use. METHODS: Data from the 2011 national Youth Risk Behavior Survey were used to estimate sexually active students' most recent contraceptive method. Logistic regressions examined sexual behaviors and substance use, comparing students who used withdrawal to those who used no method, a condom, and a highly effective method. RESULTS: Among 4,793 currently sexually active students, 10.2% used withdrawalonly, 12.4% used no method, 53.6% used a condom, and 23.8% used a more effective method as their primary form of pregnancy prevention during last sexual intercourse. Students who used withdrawal were less likely than those who used no method to have had sexual intercourse before age 13 years (APR=.56) and currently use cocaine (APR=.36). Among females, students who used withdrawal were more likely to engage in risky behaviors than those who used a condom and those who used a highly effective method of pregnancy prevention in a number of ways (e.g. having multiple sex partners during the past three months, current alcohol use, binge drinking, current marijuana use, drank alcohol or used drugs before last sexual intercourse). CONCLUSIONS: Approximately 1 in 10 sexually active students used withdrawal only, about the same percentage as those who used no method. Health care providers and others who serve adolescents may want to discuss its pros and cons with their clients and help ensure they have information about and access to other contraceptive methods that are more effective at preventing pregnancy and sexually transmitted infections. Health care professionals should not consider young people who use withdrawal similar in risk to those that use no method. |
Weighted multilevel models: a case study
West BT , Beer L , Gremel GW , Weiser J , Johnson CH , Garg S , Skarbinski J . Am J Public Health 2015 105 (11) e1-e2 Recent advances in statistical software have enabled public health researchers to fit multilevel models to a variety of outcome variables. Multilevel models facilitate inferences regarding unexplained variability among randomly sampled clusters of units (e.g., hospitals) in outcomes of interest and identify covariates that explain the variance in a given outcome at each level of a particular data hierarchy (e.g., patients within hospitals). Models with random intercepts enable researchers to accommodate correlations within higher-level units resulting from longitudinal or clustered study designs, and models with random coefficients enable researchers to identify higher-level covariates that explain between-cluster variance in relationships of interest. |
Trends in the average age of quitting among U.S. adult cigarette smokers
Schauer GL , Malarcher AM , Asman KJ . Am J Prev Med 2015 49 (6) 939-44 INTRODUCTION: Quitting smoking at any age confers health benefits. However, studies have suggested that quitting by age 35 years leads to mortality rates similar to never smokers. This study assessed whether the mean and median ages of past-year quitting and prevalence of past-year quit attempts and successful quitting by age group changed over time. METHODS: Data came from 113,599 adult cigarette smokers participating in the 1997-2012 National Health Interview Survey, an annual, cross-sectional household survey of U.S. adults aged ≥18 years. Mean and median ages of past-year successful abstinence (quit 6-12 months) were computed. Orthogonal polynomial logistic regression models tested for trends in quit attempts and successful quitting. Data were analyzed in 2014. RESULTS: The average age of quitting (40.0 years in 1997-1998, 39.5 years in 2011-2012, p=0.80) and median age of quitting (35.9 years in 1997-1998, 36.9 years in 2011-2012, p=0.62) did not change over time. During 1997-2012, the percentage of smokers making a past-year quit attempt increased among those aged 25-34, 35-44, and 45-64 years; the percentage of smokers who reported quitting successfully increased among those aged 25-34 and 35-44 years (p<0.001). CONCLUSIONS: Although the average age of quitting did not change over time, increases in past-year quit attempts and successful quitting occurred among adults aged 25-44 years. Proven population-level interventions-including price increases, mass media campaigns, comprehensive smoke-free policies, and health systems interventions-should be continued to further increase cessation, particularly among younger adults. |
Triple quad-ICP-MS measurement of toxic metals in mainstream cigarette smoke from Spectrum research cigarettes
Pappas RS , Gray N , Gonzalez-Jimenez N , Fresquez M , Watson CH . J Anal Toxicol 2015 40 (1) 43-8 We previously reported toxic metal concentrations in the mainstream smoke from 50 varieties of commercial cigarettes available in the USA using quadrupole inductively coupled plasma-mass spectrometry (ICP-MS). However, efforts to continue producing high quality data on select mainstream cigarette smoke constituents demand continued improvements in instrumentation and methodology and application of the methodology to cigarettes that differ in design or construction. Here we report a new application of 'triple quad'-ICP-MS instrumentation to analyze seven toxic metals in mainstream cigarette smoke from the Spectrum variable nicotine research cigarettes. The Spectrum cigarettes are available for research purposes in different configurations of low or conventional levels of nicotine, mentholated or nonmentholated, and tar delivery ranges described as 'low tar' or 'high tar'. Detailed characterizations of specific harmful or potentially harmful constituents delivered by these research cigarettes will help inform researchers using these cigarettes in exposure studies, cessation studies and studies related to nicotine addiction or compensation. |
The process of cessation among current tobacco smokers: a cross-sectional data analysis from 21 countries, Global Adult Tobacco Survey, 2009-2013
Mbulo L , Palipudi KM , Nelson-Blutcher G , Murty KS , Asma S . Prev Chronic Dis 2015 12 E151 We analyzed data from the Global Adult Tobacco Survey (GATS) from 21 countries to categorize smokers by stages of cessation and highlight interventions that could be tailored to each stage. GATS is a nationally representative household survey that measures tobacco use and other key indicators by using a standardized protocol. The distribution of smokers into precontemplation, contemplation, and preparation stages varied by country. Using the stages of change model, each country can design and implement effective interventions suitable to its cultural, social, and economic situations to help smokers advance successfully through the stages of cessation. |
Investigating implausible gestational age and high birthweight combinations
England LJ , Bulkley JE , Pazol K , Bruce FC , Kimes T , Berg CJ , Hornbrook MC , Callaghan WM . Paediatr Perinat Epidemiol 2015 29 (6) 562-6 BACKGROUND: Birth certificate data overestimate national preterm births because a high percentage of last menstrual period (LMP) dates have errors. Study goals were to determine: (i) To what extent errors in transfer of birthweight and LMP date from medical records to birth certificates contribute to implausibly high birthweight-for-gestational-age births; (ii) What percentage of implausible births would be resolved if the clinical estimate (CE) from birth certificates were used instead of LMP-based gestational age, and with what degree of certainty; and (iii) Of those not resolved, what percentage had a medical explanation. METHODS: Medical records and birth certificates for all singleton infants with implausibly high birthweight-for-gestational-age based on LMP delivered in the Kaiser Permanente Northwest system in Oregon during 1998-2007 were examined. Percentages of implausible records resolved under various scenarios were calculated. RESULTS: A total of 100 births with implausibly high birthweight-for-gestational age combinations were identified. When LMP date and birthweight from medical records were used instead of from birth certificates, 31% of births with implausible combinations were resolved. Substituting the CE on the birth certificate for the LMP date resolved 92%. Of the latter, the clinician's gestational age estimate in the medical record was obtained in early pregnancy in 72%. Five of the eight births with unresolved implausible combinations were to mothers with diabetes; the remaining three had no documented medical explanation. CONCLUSIONS: In this study, use of the birth certificate CE rather than the LMP resulted in a clinically reliable reclassification for the majority of implausible birthweight-for-gestational age deliveries. |
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