Shared use agreements between municipalities and public schools in the United States, 2014
Omura JD , Carlson SA , Paul P , Sliwa S , Onufrak SJ , Fulton JE . Prev Med 2016 95 Suppl S53-S59 Shared use agreements allow public use of school facilities during non-school hours. Such agreements can cover outdoor facilities alone or may be more comprehensive by also including indoor facilities. Our aim was to: 1) estimate the prevalence of shared use agreements and facility types covered among U.S. municipalities and 2) identify differences in prevalence by municipality characteristics. The 2014 National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living is a representative survey of US municipalities (n=2029). Data were analyzed using survey weights to create national estimates. Logistic and multinomial regression models determined odds ratios adjusting for municipality characteristics. Among 1930 municipalities with a school, 41.6% had a shared use agreement as reported by a local official, 45.6% did not, and 12.8% did not know. Significant differences in prevalence existed by population size, rural/urban status, poverty prevalence, median education level, and census region; however, after adjustment for other municipality characteristics significant differences remained only by population size, median education level, and census region. Among municipalities with a shared use agreement, 59.6% covered both outdoor and indoor facilities, 5.5% covered indoor facilities only, and 34.9% covered outdoor facilities only. Opportunities exist to expand the use of shared use agreements particularly in municipalities with small populations, lower education levels, and in the South, and to promote more comprehensive shared use agreements that include both indoor and outdoor facilities. |
Total and regional adiposity measured by dual-energy X-ray absorptiometry and mortality in NHANES 1999-2006
Zong G , Zhang Z , Yang Q , Wu H , Hu FB , Sun Q . Obesity (Silver Spring) 2016 24 (11) 2414-2421 OBJECTIVE: Associations of overall and regional body fat measured by dual-energy X-ray absorptiometry with total and cause-specific mortality in the National Health and Nutrition Examination Survey (NHANES) 1999-2006 were investigated. METHODS: This study included 9,471 participants (≥20 years) free of major chronic diseases at baseline. Death information was obtained from the National Death Index (mean follow-up duration: 8.8 years). RESULTS: A total of 682 participants died after 12 months since baseline, with 206 and 170 deaths attributed to cardiovascular diseases (CVD) and cancer, respectively. The second quartile of fat mass percentages (FM%) was used as the reference to account for potential nonlinearity. In the multivariate-adjusted model, participants in the highest quartile of total FM% had increased total mortality; hazard ratio (HR; 95% confidence interval, 95% CI) was 1.48 (1.07-2.04; P < 0.05). Higher total and trunk FM%, but not leg FM%, were significantly associated with an increased CVD mortality; HRs (95% CIs) in the highest quartiles of total, trunk, and leg FM% were 2.24 (1.17-4.31), 1.93 (1.02-3.66), and 1.50 (0.77-2.94), respectively. CONCLUSIONS: Higher total body fat was associated with increased total mortality in U.S. adults. Higher total and trunk fat contents were also associated with increased CVD mortality, although fat accumulation in the lower body was not an independent predictor of mortality. |
Education and disability trends of older Americans, 2000-2014
Tsai Y . J Public Health (Oxf) 2016 39 (3) 447-454 BACKGROUND: Trends in disability among older Americans has declined since the 1980s. The study examines whether the trend continues to decline and whether educational disparities exist in the prevalence of functional limitations. METHODS: I used the 2000-2014 National Health Interview Survey and included adults aged ≥65 years. Functional limitations was measured by three outcomes: the need for help with activities of daily living (ADLs) or instrumental activities of daily living (IADLs) and physical function limitations. I used a set of logistic models to estimate the average annual change rate of functional limitations. I examined whether the annual rate of change differed by education, age group and sex. RESULTS: During 2000-2014, the annual increase rate of ADL limitations was 1.7% (P < 0.001) and was 2.0% (P < 0.001) for physical function limitations; IADL limitation did not change significantly. All subgroups experienced an increase in ADL and physical function limitations except for adults with a more than high school education. The lower-educated group had a higher proportion and a higher annual rate of increase in all outcomes. Increasing trends in chronic conditions may contribute to the increasing trend in functional limitations. CONCLUSIONS: The study highlighted a large educational disparity in late-life disability among older Americans. |
Factors influencing time to case registration for youth with type 1 and type 2 diabetes: SEARCH for Diabetes in Youth Study
Crume TL , Hamman RF , Isom S , Talton J , Divers J , Mayer-Davis EJ , Zhong VW , Liese AD , Saydah S , Standiford DA , Lawrence JM , Pihoker C , Dabelea D . Ann Epidemiol 2016 26 (9) 631-7 PURPOSE: The development of a sustainable pediatric diabetes surveillance system for the United States requires a better understanding of issues related to case ascertainment. METHODS: Using the SEARCH for Diabetes in Youth registry, we examined whether time from diabetes diagnosis to case registration differed by diabetes type, patient demographics, and the type of provider reporting the case to the study. Plots for time from diagnosis to registration were developed, and differences by key variables were examined using the log-rank test. RESULTS: Compared with time to registration for type 1 cases, it took 2.6 (95% confidence interval [CI], 2.5-2.6) times longer to register 50% of type 2 diabetes cases, and 2.3 (95% CI, 2.0-2.5) times longer to register 90% of type 2 cases. For type 1 diabetes cases, a longer time to registration was associated with older age, minority race/ethnicity, and cases, where the referring provider was not an endocrinologist. For type 2 diabetes cases, older age, non-Hispanic white race/ethnicity, and cases reported by providers other than an endocrinologist took longer to identify and register. CONCLUSIONS: These findings highlight the need for continued childhood diabetes surveillance to identify future trends and influences on changes in prevalence and incidence. |
Adults with one or more functional disabilities - United States, 2011-2014
Stevens AC , Carroll DD , Courtney-Long EA , Zhang QC , Sloan ML , Griffin-Blake S , Peacock G . MMWR Morb Mortal Wkly Rep 2016 65 (38) 1021-1025 Nearly 40 million persons in the United States have a disability, as defined by responses to six questions recommended by the U.S. Department of Health and Human Services as the national standard for identifying disabilities in population-based health surveys. Although these questions have been used to estimate prevalence of functional disabilities overall, as well as types of functional disabilities (disability type), no study has yet investigated the characteristics of U.S. adults by number of disability types. Knowing the characteristics of persons living with multiple disability types is important for understanding the overall functional status of these persons. CDC analyzed data from the family component of the National Health Interview Survey (NHIS) for the years 2011-2014 to estimate the percentage of adults aged 18-64 years with one, two, three, or four or more disability types, by selected demographic and socioeconomic characteristics. Overall, 22.6 million (11.9%) working-age adults were found to have any disability, and in this population, most (12.8 million) persons had only one disability type. A generally consistent pattern between increasing indicators of low socioeconomic status and the number of disability types was observed. Understanding the demographic and socioeconomic characteristics of working-age adults with disabilities, including those with multiple disability types, might help to further the inclusion of persons with disabilities in public health programs and policies. |
A call to action and a lifecourse strategy to address the global burden of raised blood pressure on current and future generations: the Lancet Commission on hypertension
Olsen MH , Angell SY , Asma S , Boutouyrie P , Burger D , Chirinos JA , Damasceno A , Delles C , Gimenez-Roqueplo AP , Hering D , Lopez-Jaramillo P , Martinez F , Perkovic V , Rietzschel ER , Schillaci G , Schutte AE , Scuteri A , Sharman JE , Wachtell K , Wang JG . Lancet 2016 388 (10060) 2665-2712 Elevated blood pressure is the strongest modifi able risk | factor for cardiovascular disease worldwide. Despite | extensive knowledge about ways to prevent as well as to | treat hypertension, the global incidence and prevalence | of hypertension and, more importantly, its cardiovascular | complications are not reduced—partly because of | inadequacies in prevention, diagnosis, and control of the | disorder in an ageing world. | The aim of the Lancet Commission on hypertension | is to identify key actions to improve the management of | blood pressure both at the population and the individual | level, and to generate a campaign to adopt the suggested | actions at national levels to reduce the impact of | elevated blood pressure globally. The fi rst task of the | Commission is this report, which briefl y reviews the | available evidence for prevention, identifi cation, and | treatment of elevated blood pressure, hypertension, | and its cardiovascular complications. The report | focuses on how as-yet unsolved issues might be tackled | using approaches with population-wide impact and | new methods for patient evaluation and education in | the broadest sense (some of which are not always | strictly evidence based) to manage blood pressure | worldwide. |
Decisions about renal replacement therapy in patients with advanced kidney disease in the US Department of Veterans Affairs, 2000-2011
Wong SP , Hebert PL , Laundry RJ , Hammond KW , Liu CF , Burrows NR , O'Hare AM . Clin J Am Soc Nephrol 2016 11 (10) 1825-1833 BACKGROUND AND OBJECTIVES: It is not known what proportion of United States patients with advanced CKD go on to receive RRT. In other developed countries, receipt of RRT is highly age dependent and the exception rather than the rule at older ages. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a retrospective study of a national cohort of 28,568 adults who were receiving care within the US Department of Veteran Affairs and had a sustained eGFR <15 ml/min per 1.73 m2 between January 1, 2000 to December 31, 2009. We used linked administrative data from the US Renal Data System, US Department of Veteran Affairs, and Medicare to identify cohort members who received RRT during follow-up through October 1, 2011 (n=19,165). For a random 25% sample of the remaining 9403 patients, we performed an in-depth review of their VA-wide electronic medical records to determine the treatment status of their CKD. RESULTS: Two thirds (67.1%) of cohort members received RRT on the basis of administrative data. On the basis of the results of chart review, we estimate that an additional 7.5% (95% confidence interval, 7.2% to 7.8%) of cohort members had, in fact, received dialysis, that 10.9% (95% confidence interval, 10.6% to 11.3%) were preparing for and/or discussing dialysis but had not started dialysis at most recent follow-up, and that a decision had been made not to pursue dialysis in 14.5% (95% confidence interval, 14.1% to 14.9%). The percentage of cohort members who received or were preparing to receive RRT ranged from 96.2% (95% confidence interval, 94.4% to 97.4%) for those <45 years old to 53.3% (95% confidence interval, 50.7% to 55.9%) for those aged ≥85 years old. Results were similar after stratification by tertile of Gagne comorbidity score. CONCLUSIONS: In this large United States cohort of patients with advanced CKD, the majority received or were preparing to receive RRT. This was true even among the oldest patients with the highest burden of comorbidity. |
Unmet needs for ancillary services among men who have sex with men and who are receiving HIV medical care - United States, 2013-2014
DeGroote NP , Korhonen LC , Shouse RL , Valleroy LA , Bradley H . MMWR Morb Mortal Wkly Rep 2016 65 (37) 1004-1007 Gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by human immunodeficiency virus (HIV) in the United States (1). Ancillary services, defined as services that support retention in HIV medical care and assist with day-to-day living, can improve the health of HIV-infected MSM and help them achieve viral suppression (2). To assess the unmet needs for ancillary services among MSM receiving outpatient HIV medical care during 2013-2014, CDC used data from the Medical Monitoring Project (MMP), a surveillance system designed to assess clinical and behavioral characteristics of adults receiving HIV care, to obtain nationally representative estimates of, and identify reasons for, unmet needs (3). Based on self-reported needs of persons responding to the MMP survey, the most prevalent unmet needs were for non-HIV medical care services: approximately 23% had an unmet need for dental care, and 19% had an unmet need for eye or vision care. Unmet needs were most prevalent among young, non-Hispanic black, and Hispanic/Latino MSM. State and local health departments, community-based organizations, and health care providers might improve the health of MSM living with HIV by promoting access to ancillary services using strategies that increase patient awareness of how to obtain these services, especially among young, non-Hispanic black, and Hispanic/Latino MSM. |
Update: Influenza activity - United States and worldwide, May 22-September 10, 2016
Budd A , Blanton L , Kniss K , Smith S , Mustaquim D , Davlin SL , Kramer N , Flannery B , Fry AM , Grohskopf LA , Olsen SJ , Bresee J , Sessions W , Garten R , Xu X , Elal AI , Gubareva L , Barnes J , Wentworth DE , Burns E , Katz J , Jernigan D , Brammer L . MMWR Morb Mortal Wkly Rep 2016 65 (37) 1008-1014 During May 22-September 10, 2016, the United States experienced typical low levels of seasonal influenza activity overall; beginning in late August, clinical laboratories reported a slight increase in influenza positive test results and CDC received reports of a small number of localized influenza outbreaks caused by influenza A (H3N2) viruses. Influenza A (H1N1)pdm09, influenza A (H3N2), and influenza B viruses were detected during May-September in the United States and worldwide. The majority of the influenza viruses collected from the United States and other countries during that time have been characterized antigenically or genetically or both as being similar to the reference viruses representing vaccine components recommended for the 2016-17 Northern Hemisphere vaccine. During May 22-September 10, 2016, 20 influenza variant virusdagger infections were reported; two were influenza A (H1N2) variant (H1N2v) viruses (Minnesota and Wisconsin) and 18 were influenza A (H3N2) variant (H3N2v) viruses (12 from Michigan and six from Ohio). |
Notes from the field: Measles outbreak of unknown source - Shelby County, Tennessee, April-May 2016
Fill MA , Sweat D , Morrow H , Haushalter A , Martin JC , Zerwekh T , Chakraverty T , Kmet J , Morris K , Moore K , Kainer M , Murphree R , Dunn JR , Schaffner W , Jones TF . MMWR Morb Mortal Wkly Rep 2016 65 (38) 1039-1040 On April 15, 2016, local public health officials in Shelby County, Tennessee, were notified of a positive measles immunoglobulin M (IgM) test for a male aged 18 months (patient A). On April 18, 2016, a second positive measles IgM test was reported for a man aged 50 years (patient B). Both patients had rash onset on April 9, 2016. The Shelby County Health Department initiated an investigation, and confirmatory testing for measles virus on oropharyngeal swabs by polymerase chain reaction (PCR) at CDC was positive for both patients. On April 21, 2016, public health officials were notified of a third suspected measles case in a female aged 7 months (patient C) who had developed a rash on April 14; PCR testing was positive. Genotyping conducted at CDC identified genotype B3 measles virus in all three cases. Genotype B3 is known to be circulating globally and has previously been associated with imported cases in the United States. |
Operating characteristics of a tuberculosis screening tool for people living with HIV in out-patient HIV care and treatment services, Rwanda
Turinawe K , Vandebriel G , Lowrance DW , Uwinkindi F , Mutwa P , Boer KR , Mutembayire G , Tugizimana D , Nsanzimana S , Pevzner E , Howard AA , Gasana M . PLoS One 2016 11 (9) e0163462 BACKGROUND: The World Health Organization (WHO) 2010 guidelines for intensified tuberculosis (TB) case finding (ICF) among people living with HIV (PLHIV) includes a recommendation that PLHIV receive routine TB screening. Since 2005, the Rwandan Ministry of Health has been using a five-question screening tool. Our study objective was to assess the operating characteristics of the tool designed to identify PLHIV with presumptive TB as measured against a composite reference standard, including bacteriologically confirmed TB. METHODS: In a cross-sectional study, the TB screening tool was routinely administered at enrolment in outpatient HIV care and treatment services at seven public health facilities. From March to September 2011, study enrollees were examined for TB disease irrespective of TB screening outcome. The examination consisted of a chest radiograph (CXR), three sputum smears (SS), sputum culture (SC) and polymerase chain reaction line-probe assay (Hain test). PLHIV were classified as having "laboratory-confirmed TB" with positive results on SS for acid-fast bacilli, SC on Lowenstein-Jensen medium, or a Hain test. RESULTS: Overall, 1,767 patients were enrolled and screened of which; 1,017 (57.6%) were female, median age was 33 (IQR, 27-41), and median CD4+ cell count was 385 (IQR, 229-563) cells/mm3. Of the patients screened, 138 (7.8%) were diagnosed with TB of which; 125 (90.5%) were laboratory-confirmed pulmonary TB. Of 404 (22.9%) patients who screened positive and 1,363 (77.1%) who screened negative, 79 (19.5%) and 59 (4.3%), respectively, were diagnosed with TB. For laboratory-confirmed TB, the tool had a sensitivity of 54.4% (95% CI 45.3-63.3), specificity of 79.5% (95% CI 77.5-81.5), PPV of 16.8% and NPV of 95.8%. CONCLUSION: TB prevalence among PLHIV newly enrolling into HIV care and treatment was 65 times greater than the overall population prevalence. However, the performance of the tool was poorer than the predicted performance of the WHO recommended TB screening questions. |
The epidemiology of meningitis among adults in a South African province with a high HIV prevalence, 2009-2012
Britz E , Perovic O , von Mollendorf C , von Gottberg A , Iyaloo S , Quan V , Chetty V , Sriruttan C , Ismail NA , Nanoo A , Musekiwa A , Reddy C , Viljoen K , Cohen C , Govender NP . PLoS One 2016 11 (9) e0163036 INTRODUCTION: Meningitis is a major cause of mortality in southern Africa. We aimed to describe the aetiologies and frequencies of laboratory-confirmed fungal and bacterial meningitis among adults in a South African province with an 11% HIV prevalence, over 4 years. METHODS: We conducted a retrospective, observational study of secondary laboratory data, extracted on all cerebrospinal fluid (CSF) specimens submitted to public-sector laboratories in Gauteng province from 2009 through 2012. We calculated cause-specific incidence rates in the general and HIV-infected populations and used Poisson regression to determine if trends were significant. RESULTS: We identified 11,891 (10.7%) incident cases of meningitis from 110,885 CSF specimens. Cryptococcal meningitis, tuberculous meningitis and pneumococcal meningitis accounted for 62.3% (n = 7,406), 24.6% (n = 2,928) and 10.1% (n = 1,197) of cases over the four-year period. The overall incidence (cases per 100,000 persons) of cryptococcal meningitis declined by 23% from 24.4 in 2009 to 18.7 in 2012 (p <0.001) and decreased by 19% among HIV-infected persons from 178.2 to 144.7 (p <0.001). Tuberculous meningitis decreased by 40% from 11.3 in 2009 to 6.8 in 2012 (p <0.001) and decreased by 36% among HIV-infected persons from 54.4 to 34.9 (p <0.001). Pneumococcal meningitis decreased by 41% from 4.2 in 2009 to 2.5 in 2012 (p <0.001) and decreased by 38% among HIV-infected persons from 28.0 to 17.5 (p <0.001). Among cases of other bacterial meningitis (248/11,891, 2.1%), Neisseria meningitidis (n = 93), Escherichia coli (n = 72) and Haemophilus influenzae (n = 20) were the most common organisms identified. CONCLUSIONS: In this high HIV-prevalence province, cryptococcal meningitis was the leading cause of laboratory-confirmed meningitis among adults. Over a 4-year period, there was a significant decrease in incidence of cryptococcal, tuberculous and pneumococcal meningitis. This coincided with expansion of the national antiretroviral treatment programme, enhanced tuberculosis control programme and routine childhood immunisation with pneumococcal conjugate vaccines. |
Evaluating Google flu trends in Latin America: Important lessons for the next phase of digital disease detection
Pollett S , Boscardin WJ , Azziz-Baumgartner E , Tinoco YO , Soto G , Romero C , Kok J , Biggerstaff M , Viboud C , Rutherford GW . Clin Infect Dis 2016 64 (1) 34-41 BACKGROUND: Latin America has a substantial burden of influenza and rising Internet access and could thus benefit from real-time influenza epidemic prediction web-tools such as Google Flu Trends (GFT) to assist in risk communication and resource allocation during epidemics. However, there has never been a published assessment of GFT's accuracy in most of the Latin American countries nor in any low-middle income country. We aimed to evaluate GFT in Argentina, Bolivia, Brazil, Chile, Mexico, Paraguay, Peru and Uruguay. METHODS: Weekly influenza-test positive proportions for the eight countries were obtained from FluNet for the period January 2011 - December 2014. Concurrent weekly Google-predicted influenza activity in the same countries were abstracted from GFT. Pearson correlation coefficients between observed and Google-predicted influenza activity trends were determined for each country. Permutation tests were used to examine background seasonal correlation between FluNet and GFT by country. RESULTS: There were frequent GFT prediction errors, with correlation ranging from r=-0.53 to 0.91. GFT-predicted influenza activity best correlated with FluNet data in Mexico follow by Uruguay, Argentina, Chile, Brazil, Peru, Bolivia and Paraguay. Correlation was generally highest in the more temperate countries with more regular influenza seasonality and lowest in tropical regions. A substantial amount of autocorrelation was noted, suggestive that GFT is not fully specific of influenza virus activity. CONCLUSIONS: We note substantial inaccuracies with GFT-predicted influenza activity compared to FluNet throughout Latin America, particularly among tropical countries with irregular influenza seasonality. Our findings offer valuable lessons for future internet-based biosurveillance tools. |
First isolation of nocardia grenadensis from a clinical sample
Ercibengoa M , Bell M , Vicente D , Marimon JM . JMM Case Rep 2016 3 (2) Introduction: Nocardia species have a worldwide distribution and are commonly found as saprophytes of soil or water. However, they can cause human disease especially in immunocompromised patients, with respiratory infection being the most frequent clinical manifestation of the disease. The aim of the present work was to describe the first clinical isolation of Nocardia grenadensis from the sputum of a patient from the north of Spain suspected of having tuberculosis. Case Presentation: In November 2012, a chest X-ray showed a mass in the left upper lobe of the lung of a 75-year-old man with persistent cough with bloody expectoration. The patient was sent to the outpatient pulmonology consultation for further studies. In the sputum sent for mycobacterial study, a Nocardia isolate was present that was identified by sequencing a 1440 bp fragment of the 16S rRNA gene as N. grenadensis at the Special Bacteriology Reference Laboratory at the Centers for Disease Control and Prevention (USA). Conclusion: The clinical significance of N. grenadensis in the sputum of this patient was uncertain, as symptoms of persistent cough with haemoptysis in the absence of other identified causes suggested the possible involvement of N. grenadensis in a bronchial lung infection. However, the spontaneous resolution of symptoms without specific antimicrobial treatment pointed to the possibility of a transient colonization. To the best of our knowledge, this is the first evidence in the literature of the isolation of N. grenadensis in humans. |
The Health, Enlightenment, Awareness, and Living (HEAL) Intervention: Outcome of an HIV and hepatitis B and C risk reduction intervention
Henry-Akintobi T , Laster N , Trotter J , Jacobs D , Johnson T , King Gordon T , Miller A . Int J Environ Res Public Health 2016 13 (10) African American women have among the highest HIV/AIDS and hepatitis B and C incidence rates in the United States, especially among those homeless or incarcerated. The objective of this study was to evaluate the Health Enlightenment, Awareness and Living Intervention, designed to decrease HIV/AIDS, hepatitis and related risky behaviors. The thirteen-session intervention was implemented among homeless and formerly incarcerated low-income African American women, ages 18 to 55, in Atlanta, Georgia from 2006 to 2010. A single group repeated measures study design was employed and consisted of a pre-test (n = 355) group, an immediate post-test (n = 228) group with a response rate of 64%, and a six-month follow up (n = 110) group with response rate of 48%, completing a 135-item survey. Paired-sample t-tests, McNemar tests, and repeated measures ANOVA were applied to compare survey results. Participants demonstrated statistically significant increases in hepatitis B and C knowledge over time (p < 0.001). Statistically significant decreases were also reported for unprotected sex in exchange for money, drugs or shelter (p = 0.008), and sex under the influence of drugs or alcohol (p < 0.001). Reported substance use decreased with statistical significance for alcohol (p = 0.011), marijuana (p = 0.011), illegal drugs (p = 0.002), and crack/cocaine (p = 0.003). Findings broaden the evidence base related to the effectiveness of HIV/AIDS and hepatitis risk reduction interventions designed for homeless and previously incarcerated African American women. |
Hepatitis B Virus (HBV) Load Response to 2 Antiviral Regimens, Tenofovir/Lamivudine and Lamivudine, in HIV/ HBV-Coinfected Pregnant Women in Guangxi, China: The Tenofovir in Pregnancy (TiP) Study
Wang L , Wiener J , Bulterys M , Wei X , Chen L , Liu W , Liang S , Shepard C , Wang L , Wang A , Zhang F , Kourtis AP . J Infect Dis 2016 214 (11) 1695-1699 BACKGROUND: There is limited information on HBV-antiviral therapy among HIV/HBV co-infected pregnant women. METHODS: Phase II randomized controlled trial of a regimen containing tenofovir (TDF) /lamivudine (3TC), versus 3TC, in HIV/HBV co-infected pregnant women in China. The HBV virological response was compared in study arms (Clinical Trials registration: #NCT01125696). RESULTS: Median decline of HBV DNA was 2.60 log10 copies/ml in the TDF-3TC arm; 2.24 log10 copies/ml in the 3TC arm (p=0.41). All women achieved delivery HBV DNA levels <6 log10 copies/ml. CONCLUSIONS: Initiation of either regimen led to achieving HBV DNA levels below the threshold associated with perinatal HBV transmission. |
HIV testing experience before HIV diagnosis among men who have sex with men - 21 jurisdictions, United States, 2007-2013
Linley L , An Q , Song R , Valverde E , Oster AM , Qian X , Hernandez AL . MMWR Morb Mortal Wkly Rep 2016 65 (37) 999-1003 Gay, bisexual, and other men who have sex with men (MSM) continue to be the population most affected by human immunodeficiency virus (HIV) in the United States. In 2014, 81% of diagnoses of HIV infection were among adult and adolescent males, and among these, 83% of infections were attributable to male-to-male sexual contact (1). Since 2006, CDC has recommended HIV testing at least annually for sexually active MSM to foster early detection of HIV infection and prevent HIV transmission (2,3). Several initiatives and strategies during the past decade have aimed to expand HIV testing among MSM to increase early diagnosis and treatment and reduce transmission. To better understand HIV testing patterns among MSM with diagnosed HIV infection, CDC analyzed data for 2007-2013 from jurisdictions conducting HIV incidence surveillance as part of CDC's National HIV Surveillance System (NHSS). Findings from this analysis suggest that increasing percentages of MSM have had a negative HIV test during the 12 months before diagnosis (48% in 2007, 56% in 2013, among those with a known date of previous negative HIV test), indicating a trend toward increased HIV testing and earlier HIV diagnosis among persons most at risk for HIV. |
A case cluster of variant Creutzfeldt-Jakob disease linked to the Kingdom of Saudi Arabia
Coulthart MB , Geschwind MD , Qureshi S , Phielipp N , Demarsh A , Abrams JY , Belay E , Gambetti P , Jansen GH , Lang AE , Schonberger LB . Brain 2016 139 2609-2616 As of mid-2016, 231 cases of variant Creutzfeldt-Jakob disease-the human form of a prion disease of cattle, bovine spongiform encephalopathy-have been reported from 12 countries. With few exceptions, the affected individuals had histories of extended residence in the UK or other Western European countries during the period (1980-96) of maximum global risk for human exposure to bovine spongiform encephalopathy. However, the possibility remains that other geographic foci of human infection exist, identification of which may help to foreshadow the future of the epidemic. We report results of a quantitative analysis of country-specific relative risks of infection for three individuals diagnosed with variant Creutzfeldt-Jakob disease in the USA and Canada. All were born and raised in Saudi Arabia, but had histories of residence and travel in other countries. To calculate country-specific relative probabilities of infection, we aligned each patient's life history with published estimates of probability distributions of incubation period and age at infection parameters from a UK cohort of 171 variant Creutzfeldt-Jakob disease cases. The distributions were then partitioned into probability density fractions according to time intervals of the patient's residence and travel history, and the density fractions were combined by country. This calculation was performed for incubation period alone, age at infection alone, and jointly for incubation and age at infection. Country-specific fractions were normalized either to the total density between the individual's dates of birth and symptom onset ('lifetime'), or to that between 1980 and 1996, for a total of six combinations of parameter and interval. The country-specific relative probability of infection for Saudi Arabia clearly ranked highest under each of the six combinations of parameter x interval for Patients 1 and 2, with values ranging from 0.572 to 0.998, respectively, for Patient 2 (age at infection x lifetime) and Patient 1 (joint incubation and age at infection x 1980-96). For Patient 3, relative probabilities for Saudi Arabia were not as distinct from those for other countries using the lifetime interval: 0.394, 0.360 and 0.378, respectively, for incubation period, age at infection and jointly for incubation and age at infection. However, for this patient Saudi Arabia clearly ranked highest within the 1980-96 period: 0.859, 0.871 and 0.865, respectively, for incubation period, age at infection and jointly for incubation and age at infection. These findings support the hypothesis that human infection with bovine spongiform encephalopathy occurred in Saudi Arabia. |
Classification and Regression Tree (CART) analysis to predict influenza in primary care patients
Zimmerman RK , Balasubramani GK , Nowalk MP , Eng H , Urbanski L , Jackson ML , Jackson LA , McLean HQ , Belongia EA , Monto AS , Malosh RE , Gaglani M , Clipper L , Flannery B , Wisniewski SR . BMC Infect Dis 2016 16 (1) 503 BACKGROUND: The use of neuraminidase-inhibiting anti-viral medication to treat influenza is relatively infrequent. Rapid, cost-effective methods for diagnosing influenza are needed to enable appropriate prescribing. Multi-viral respiratory panels using reverse transcription polymerase chain reaction (PCR) assays to diagnose influenza are accurate but expensive and more time-consuming than low sensitivity rapid influenza tests. Influenza clinical decision algorithms are both rapid and inexpensive, but most are based on regression analyses that do not account for higher order interactions. This study used classification and regression trees (CART) modeling to estimate probabilities of influenza. METHODS: Eligible enrollees ≥ 5 years old (n = 4,173) who presented at ambulatory centers for treatment of acute respiratory illness (≤7 days) with cough or fever in 2011-2012, provided nasal and pharyngeal swabs for PCR testing for influenza, information on demographics, symptoms, personal characteristics and self-reported influenza vaccination status. RESULTS: Antiviral medication was prescribed for just 15 % of those with PCR-confirmed influenza. An algorithm that included fever, cough, and fatigue had sensitivity of 84 %, specificity of 48 %, positive predictive value (PPV) of 23 % and negative predictive value (NPV) of 94 % for the development sample. CONCLUSIONS: The CART algorithm has good sensitivity and high NPV, but low PPV for identifying influenza among outpatients ≥5 years. Thus, it is good at identifying a group who do not need testing or antivirals and had fair to good predictive performance for influenza. Further testing of the algorithm in other influenza seasons would help to optimize decisions for lab testing or treatment. |
Contraception for HIV-infected adolescents
Kourtis AP , Mirza A . Pediatrics 2016 138 (3) Access to high-quality reproductive health care is important for adolescents and young adults with HIV infection to prevent unintended pregnancies, sexually transmitted infections, and secondary transmission of HIV to partners and children. As perinatally HIV-infected children mature into adolescence and adulthood and new HIV infections among adolescents and young adults continue to occur in the United States, medical providers taking care of such individuals often face issues related to sexual and reproductive health. Challenges including drug interactions between several hormonal methods and antiretroviral agents make decisions regarding contraceptive options more complex for these adolescents. Dual protection, defined as the use of an effective contraceptive along with condoms, should be central to ongoing discussions with HIV-infected young women and couples wishing to avoid pregnancy. Last, reproductive health discussions need to be integrated with discussions on HIV care, because a reduction in plasma HIV viral load below the level of detection (an "undetectable viral load") is essential for the individual's health as well as for a reduction in HIV transmission to partners and children. |
Unintentional administration of insulin instead of influenza vaccine: a case study and review of reports to US vaccine and drug safety monitoring systems
Clogston J , Hudanick L , Suragh TA , Jankosky C , Lewis P , Martin D , Schembri C , Zinderman C , Maslov Y , Mistry M , Pippins JR , Vee S , Wyeth J , Shimabukuro TT , Leighton J . Drugs Ther Perspect 2016 32 (10) 439-446 Introduction: There have been isolated case reports of medication product mix-ups involving insulin unintentionally given to patients when the intent was to administer vaccines. Information on how and why these types of errors occur is limited. Objective: To describe incidents of unintentional administration of insulin instead of influenza vaccine and identify possible causes for errors. Methods: We describe a 2014 investigation of an apparent mix-up where a cluster of five adult patients unintentionally received insulin instead of influenza vaccine. We also searched Centers for Disease Control and Prevention (CDC) and US Food and Drug Administration (FDA) vaccine and drug safety monitoring databases from January 2005 to April 2015 in order to identify other incidents. We classified cases as either ‘highly suggestive’ or ‘suggestive’ of insulin and influenza vaccine mix-ups. Results: Investigation of the primary cluster incident revealed deviations from recommended practices for storage, handling, preparation, and administration of drugs and vaccines; the five cases were classified as highly suggestive of insulin and influenza vaccine mix-ups. Our search of CDC and FDA vaccine and drug safety monitoring databases identified an additional two highly suggestive and 15 suggestive cases, for a total of 22 cases (7 highly suggestive and 15 suggestive) during the 10-year study period. Conclusion: Insulin and vaccine mix-ups have the potential to cause serious harm to patients, and are preventable with proper training and application of standards. Our investigation indicated that improper storage—including inadequate segregation of insulin and influenza vaccine products in clearly labeled containers or bins—lack of standardized procedures for confirming the contents of vials, and decreased vigilance in preparation and administration likely contributed to the primary cluster incident. |
Measuring appropriate antimicrobial use: Attempts at opening the black box
Spivak ES , Cosgrove SE , Srinivasan A . Clin Infect Dis 2016 63 (12) 1639-1644 Indiscriminate antimicrobial use has plagued medicine since antibiotics were first introduced into clinical practice more than seventy years ago. Infectious diseases physicians and public health officials have advocated for preservation of these life-saving drugs for many years. With rising burden of antimicrobial resistant organisms and Clostridium difficile infections, halting unnecessary antimicrobial use has become one of the largest public health concerns of our time. Inappropriate antimicrobial use has been quantified in various settings using numerous definitions; however, no established reference standard exists. With mounting national efforts to improve antimicrobial use, a consensus definition and standard method of measuring appropriate antimicrobial use is imperative. We review existing literature on systematic approaches to define and measure appropriate antimicrobial use, and describe a collaborative effort at developing standardized audit tools for assessing the quality of antimicrobial prescribing. |
Respiratory effects of indoor heat and the interaction with air pollution in COPD
McCormack MC , Belli AJ , Waugh D , Matsui EC , Peng RD , Williams D , Paulin L , Saha A , Aloe CM , Diette GB , Breysse PN , Hansel NN . Ann Am Thorac Soc 2016 13 (12) 2125-2131 RATIONALE: There is limited evidence of the effect of exposure to heat on COPD morbidity and the interactive effect between indoor heat and air pollution has not been established. OBJECTIVES: To determine the effect of indoor and outdoor heat exposure on COPD morbidity and to determine whether air pollution concentrations modify the effect of temperature. METHODS: Sixty-nine participants with COPD were enrolled in a longitudinal cohort study and data from the 601 participant days that occurred during the warm weather season were included in the analysis. Participants completed home environmental monitoring with measurement of temperature, relative humidity, and indoor air pollutants and simultaneous daily assessment of respiratory health with questionnaires and portable spirometry. MEASUREMENTS AND MAIN RESULTS: Participants had moderate to severe COPD and spent the majority of their time indoors. Increases in maximum indoor temperature were associated with worsening of daily Breathlessness, Cough, and Sputum Scores (BCSS) and increases in rescue inhaler use. The effect was detected on the same day and lags of 1 and 2 days. The detrimental effect of temperature on these outcomes increased with higher concentrations of indoor fine particulate matter and nitrogen dioxide (p<0.05 for interaction terms). On days that participants went outdoors, increases in maximum daily outdoor temperature were associated with increases in BCSS scores after adjusting for outdoor pollution concentrations. CONCLUSIONS: For patients with COPD that spend the majority of their time indoors, indoor heat exposure during warmer months represents a modifiable environmental exposure that may contribute to respiratory morbidity. In the context of climate change, adaptive strategies that include optimization of indoor environmental conditions are needed to protect this high risk group from adverse health effects of heat. |
Anniston Community Health Survey: Follow-up and dioxin analyses (ACHS-II) - methods
Birnbaum LS , Dutton ND , Cusack C , Mennemeyer ST , Pavuk M . Environ Sci Pollut Res Int 2016 23 (3) 2014-21 High serum concentrations of polychlorinated biphenyls (PCBs) have been reported previously among residents of Anniston, Alabama, where a PCB production facility was located in the past. As the second of two cross-sectional studies of these Anniston residents, the Anniston Community Health Survey: Follow-Up and Dioxin Analyses (ACHS-II) will yield repeated measurements to be used to evaluate changes over time in ortho-PCB concentrations and selected health indicators in study participants. Dioxins, non-ortho PCBs, other chemicals, heavy metals, and a variety of additional clinical tests not previously measured in the original ACHS cohort will be examined in ACHS-II. The follow-up study also incorporates a questionnaire with extended sections on diet and occupational history for a more comprehensive assessment of possible exposure sources. Data collection for ACHS-II from 359 eligible participants took place in 2014, 7 to 9 years after ACHS. |
Biomonitoring human exposure to household air pollution and association with self-reported health symptoms - A stove intervention study in Peru
Li Z , Commodore A , Hartinger S , Lewin M , Sjodin A , Pittman E , Trinidad D , Hubbard K , Lanata CF , Gil AI , Mausezahl D , Naeher LP . Environ Int 2016 97 195-203 BACKGROUND: Household air pollution (HAP) from indoor biomass stoves contains harmful pollutants, such as polycyclic aromatic hydrocarbons (PAHs), and is a leading risk factor for global disease burden. We used biomonitoring to assess HAP exposure and association with self-reported symptoms in 334 non-smoking Peruvian women to evaluate the efficacy of a stove intervention program. METHODS: We conducted a cross-sectional study within the framework of a community randomized control trial. Using urinary PAH metabolites (OH-PAHs) as the exposure biomarkers, we investigated whether the intervention group (n=155, with new chimney-equipped stoves) were less exposed to HAP compared to the control group (n=179, with mostly open-fire stoves). We also estimated associations between the exposure biomarkers, risk factors, and self-reported health symptoms, such as recent eye conditions, respiratory conditions, and headache. RESULTS: We observed reduced headache and ocular symptoms in the intervention group than the control group. Urinary 2-naphthol, a suggested biomarker for inhalation PAH exposure, was significantly lower in the intervention group (GM with 95% CI: 13.4 [12.3, 14.6] mug/g creatinine) compared to control group (16.5 [15.0, 18.0] mug/g creatinine). Stove type and/or 2-naphthol was associated with a number of self-reported symptoms, such as red eye (adjusted OR with 95% CI: 3.80 [1.32, 10.9]) in the past 48h. CONCLUSIONS: Even with the improved stoves, the biomarker concentrations in this study far exceeded those of the general populations and were higher than a no-observed-genotoxic-effect-level, indicating high exposure and a potential for increased cancer risk in the population. |
Case diagnosis and characterization of suspected paralytic shellfish poisoning in Alaska.
Knaack JS , Porter KA , Jacob JT , Sullivan K , Forester M , Wang RY , Trainer VL , Morton S , Eckert G , McGahee E , Thomas J , McLaughlin J , Johnson RC . Harmful Algae 2016 57 45-50 Clinical cases of paralytic shellfish poisoning (PSP) are common in Alaska, and result from human consumption of shellfish contaminated with saxitoxin (STX) and its analogues. Diagnosis of PSP is presumptive and based on recent ingestion of shellfish and presence of manifestations consistent with symptoms of PSP; diagnosis is confirmed by detection of paralytic shellfish toxins in a clinical specimen or food sample. A clinical diagnostic analytical method using high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) was used to evaluate the diagnosis of saxitoxin-induced PSP (STX-PSP) in 11 Alaskan patients using urine specimens collected between June 2010 and November 2011. Concentrations of urinary STX were corrected for creatinine concentrations to account for dilution or concentration of urine from water intake or restriction, respectively. Of the 11 patients with suspected PSP, four patients were confirmed to have STX-PSP by urine testing (24-364 ng STX/g creatinine). Five patients had clinical manifestations of PSP though no STX was detected in their urine. Two patients were ruled out for STX-PSP based on non-detected urinary STX and the absence of clinical findings. Results revealed that dysphagia and dysarthria may be stronger indicators of PSP than paresthesia and nausea, which are commonly used to clinically diagnose patients with PSP. PSP can also occur from exposure to a number of STX congeners, such as gonyautoxins, however their presence in urine was not assessed in this investigation. In addition, meal remnants obtained from six presumptive PSP cases were analyzed using the Association of Official Analytical Chemists' mouse bioassay. All six samples tested positive for PSP toxins. In the future, the clinical diagnostic method can be used in conjunction with the mouse bioassay or HPLC-MS/MS to assess the extent of STX-PSP in Alaska where it has been suggested that PSP is underreported. |
Characteristics of clusters of Salmonella and Escherichia coli O157 detected by pulsed-field gel electrophoresis that predict identification of outbreaks
Jones TF , Sashti N , Ingram A , Phan Q , Booth H , Rounds J , Nicholson CS , Cosgrove S , Crocker K , Gould LH . Foodborne Pathog Dis 2016 13 (12) 674-678 INTRODUCTION: Molecular subtyping of pathogens is critical for foodborne disease outbreak detection and investigation. Many clusters initially identified by pulsed-field gel electrophoresis (PFGE) are not confirmed as point-source outbreaks. We evaluated characteristics of clusters that can help prioritize investigations to maximize effective use of limited resources. MATERIALS AND METHODS: A multiagency collaboration (FoodNet) collected data on Salmonella and Escherichia coli O157 clusters for 3 years. Cluster size, timing, extent, and nature of epidemiologic investigations were analyzed to determine associations with whether the cluster was identified as a confirmed outbreak. RESULTS: During the 3-year study period, 948 PFGE clusters were identified; 849 (90%) were Salmonella and 99 (10%) were E. coli O157. Of those, 192 (20%) were ultimately identified as outbreaks (154 [18%] of Salmonella and 38 [38%] of E. coli O157 clusters). Successful investigation was significantly associated with larger cluster size, more rapid submission of isolates (e.g., for Salmonella, 6 days for outbreaks vs. 8 days for nonoutbreaks) and PFGE result reporting to investigators (16 days vs. 29 days, respectively), and performance of analytic studies (completed in 33% of Salmonella outbreaks vs. 1% of nonoutbreaks) and environmental investigations (40% and 1%, respectively). Intervals between first and second cases in a cluster did not differ significantly between outbreaks and nonoutbreaks. CONCLUSIONS: Molecular subtyping of pathogens is a rapidly advancing technology, and successfully identifying outbreaks will vary by pathogen and methods used. Understanding criteria for successfully investigating outbreaks is critical for efficiently using limited resources. |
Genomic Analysis Reveals Novel Diversity among the 1976 Philadelphia Legionnaires' Disease Outbreak Isolates and Additional ST36 Strains.
Mercante JW , Morrison SS , Desai HP , Raphael BH , Winchell JM . PLoS One 2016 11 (9) e0164074 Legionella pneumophila was first recognized as a cause of severe and potentially fatal pneumonia during a large-scale outbreak of Legionnaires' disease (LD) at a Pennsylvania veterans' convention in Philadelphia, 1976. The ensuing investigation and recovery of four clinical isolates launched the fields of Legionella epidemiology and scientific research. Only one of the original isolates, "Philadelphia-1", has been widely distributed or extensively studied. Here we describe the whole-genome sequencing (WGS), complete assembly, and comparative analysis of all Philadelphia LD strains recovered from that investigation, along with L. pneumophila isolates sharing the Philadelphia sequence type (ST36). Analyses revealed that the 1976 outbreak was due to multiple serogroup 1 strains within the same genetic lineage, differentiated by an actively mobilized, self-replicating episome that is shared with L. pneumophila str. Paris, and two large, horizontally-transferred genomic loci, among other polymorphisms. We also found a completely unassociated ST36 strain that displayed remarkable genetic similarity to the historical Philadelphia isolates. This similar strain implies the presence of a potential clonal population, and suggests important implications may exist for considering epidemiological context when interpreting phylogenetic relationships among outbreak-associated isolates. Additional extensive archival research identified the Philadelphia isolate associated with a non-Legionnaire case of "Broad Street pneumonia", and provided new historical and genetic insights into the 1976 epidemic. This retrospective analysis has underscored the utility of fully-assembled WGS data for Legionella outbreak investigations, highlighting the increased resolution that comes from long-read sequencing and a sequence type-matched genomic data set. |
A Bacillus anthracis Genome Sequence from the Sverdlovsk 1979 Autopsy Specimens.
Sahl JW , Pearson T , Okinaka R , Schupp JM , Gillece JD , Heaton H , Birdsell D , Hepp C , Fofanov V , Noseda R , Fasanella A , Hoffmaster A , Wagner DM , Keim P . mBio 2016 7 (5) Anthrax is a zoonotic disease that occurs naturally in wild and domestic animals but has been used by both state-sponsored programs and terrorists as a biological weapon. A Soviet industrial production facility in Sverdlovsk, USSR, proved deficient in 1979 when a plume of spores was accidentally released and resulted in one of the largest known human anthrax outbreaks. In order to understand this outbreak and others, we generated a Bacillus anthracis population genetic database based upon whole-genome analysis to identify all single-nucleotide polymorphisms (SNPs) across a reference genome. Phylogenetic analysis has defined three major clades (A, B, and C), B and C being relatively rare compared to A. The A clade has numerous subclades, including a major polytomy named the trans-Eurasian (TEA) group. The TEA radiation is a dominant evolutionary feature of B. anthracis, with many contemporary populations having resulted from a large spatial dispersal of spores from a single source. Two autopsy specimens from the Sverdlovsk outbreak were deep sequenced to produce draft B. anthracis genomes. This allowed the phylogenetic placement of the Sverdlovsk strain into a clade with two Asian live vaccine strains, including the Russian Tsiankovskii strain. The genome was examined for evidence of drug resistance manipulation or other genetic engineering, but none was found. The Soviet Sverdlovsk strain genome is consistent with a wild-type strain from Russia that had no evidence of genetic manipulation during its industrial production. This work provides insights into the world's largest biological weapons program and provides an extensive B. anthracis phylogenetic reference. IMPORTANCE: The 1979 Russian anthrax outbreak resulted from an industrial accident at the Soviet anthrax spore production facility in the city of Sverdlovsk. Deep genomic sequencing of two autopsy specimens generated a draft genome and phylogenetic placement of the Soviet Sverdlovsk anthrax strain. While it is known that Soviet scientists had genetically manipulated Bacillus anthracis with the potential to evade vaccine prophylaxis and antibiotic therapeutics, there was no genomic evidence of this from the Sverdlovsk production strain genome. The whole-genome SNP genotype of the Sverdlovsk strain was used to precisely identify it and its close relatives in the context of an extensive global B. anthracis strain collection. This genomic identity can now be used for forensic tracking of this weapons material on a global scale and for future anthrax investigations. |
Massive dispersal of coxiella burnetii among cattle across the United States
Olivas S , Hornstra H , Priestley RA , Kaufman E , Hepp C , Sonderegger DL , Handady K , Massung RF , Keim P , Kersh GJ , Pearson T . Microb Genom 2016 2 (8) e000068 Q-fever is an underreported disease caused by the bacterium Coxiella burnetii, which is highly infectious and has the ability to disperse great distances. It is a completely clonal pathogen with low genetic diversity and requires whole-genome analysis to identify discriminating features among closely related isolates. C. burnetii, and in particular one genotype (ST20), is commonly found in cow's milk across the entire dairy industry of the USA. This single genotype dominance is suggestive of host-specific adaptation, rapid dispersal and persistence within cattle. We used a comparative genomic approach to identify SNPs for high-resolution and high-throughput genotyping assays to better describe the dispersal of ST20 across the USA. We genotyped 507 ST20 cow milk samples and discovered three subgenotypes, all of which were present across the entire country and over the complete time period studied. Only one of these sub-genotypes was observed in a single dairy herd. The temporal and geographic distribution of these sub-genotypes is consistent with a model of large-scale, rapid, frequent and continuous dissemination on a continental scale. The distribution of subgenotypes is not consistent with wind-based dispersal alone, and it is likely that animal husbandry and transportation practices, including pooling of milk from multiple herds, have also shaped the patterns. On the scale of an entire country, there appear to be few barriers to rapid, frequent and large-scale dissemination of the ST20 subgenotypes. |
Economic evidence for US asthma self-management education and home-based interventions
Hsu J , Wilhelm N , Lewis L , Herman E . J Allergy Clin Immunol Pract 2016 4 (6) 1123-1134 e27 The health and economic burden of asthma in the United States is substantial. Asthma self-management education (AS-ME) and home-based interventions for asthma can improve asthma control and prevent asthma exacerbations, and interest in health care-public health collaboration regarding asthma is increasing. However, outpatient AS-ME and home-based asthma intervention programs are not widely available; economic sustainability is a common concern. Thus, we conducted a narrative review of existing literature regarding economic outcomes of outpatient AS-ME and home-based intervention programs for asthma in the United States. We identified 9 outpatient AS-ME programs and 17 home-based intervention programs with return on investment (ROI) data. Most programs were associated with a positive ROI; a few programs observed positive ROIs only among selected populations (eg, higher health care utilization). Interpretation of existing data is limited by heterogeneous ROI calculations. Nevertheless, the literature suggests promise for sustainable opportunities to expand access to outpatient AS-ME and home-based asthma intervention programs in the United States. More definitive knowledge about how to maximize program benefit and sustainability could be gained through more controlled studies of specific populations and increased uniformity in economic assessments. |
Can anaerobes be acid fast? A novel, clinically relevant acid fast anaerobe
Navas ME , Jump R , Canaday DH , Wnek MD , SenGupta DJ , McQuiston JR , Bell M . JMM Case Rep 2016 3 (4) e005036 Introduction: Anaerobic acid fast bacilli (AFB) have not been previously reported in clinical microbiology. This is the second case report of a novel anaerobic AFB causing disease in humans. Case presentation: An anaerobic AFB was isolated from an abdominal wall abscess in a 64- year-old Caucasian diabetic male, who underwent distal pancreatectomy and splenectomy for resection of a pancreatic neuroendocrine tumour. The isolated bacteria were gram-variable and acid-fast, consisting of small irregular rods. The 16S rRNA gene sequence analysis showed that the isolate is a novel organism described in the literature only once before. The organism was studied at the CDC (Centers for Disease Control and Prevention) by the same group that worked with the isolates from the previous report; their findings suggest that the strain belongs to the suborder Corynebacterineae. Conclusion: This is the fifth reported case of an anaerobic AFB involved in clinical disease; its microbiological features and 16S RNA sequence are identical to previously reported cases. Clinical disease with this organism seems to be associated with recent history of surgery and abscess formation in deep soft tissues. Acquisition from surgical material is uncertain but seems unlikely. |
Trends in compliance with two-dose influenza vaccine recommendations in children aged 6 months through 8 years, 2010-2015
Lin X , Fiebelkorn AP , Pabst LJ . Vaccine 2016 34 (46) 5623-5628 BACKGROUND: Children aged 6 months through 8 years may require two doses of influenza vaccine for adequate immune response against the disease. However, poor two-dose compliance has been reported in the literature. METHODS: We analyzed data for >2.6million children from six immunization information system (IIS) sentinel sites, and assessed full vaccination coverage and two-dose compliance in the 2010-2015 influenza vaccination seasons. Full vaccination was defined as having received at least the recommended number of influenza vaccine doses (one or two), based on recommendations from the Advisory Committee on Immunization Practices. Two-dose compliance was defined as the percentage of children during each season who received at least two doses of influenza vaccine among those who required two doses and initiated the series. RESULTS: Across seasons, 1-dose influenza vaccination coverage was mainly unchanged among 6-23montholds (range: 60.9-66.6%), 2-4yearolds (range: 44.8-47.4%), and 5-8yearolds (range: 34.5-38.9%). However, full vaccination coverage showed increasing trends from 2010-11 season to 2014-15 season (6-23months: 43.0-46.5%; 2-4yearolds: 26.3-39.7%; 5-8yearolds, 18.5-33.9%). Across seasons, two-dose compliance remained modest in children 6-23months (range: 63.3-67.6%) and very low in older children (range: 11.6-18.7% in children 2-4yearsand6.8-13.3% in children 5-8years). In the 2014-15 season, among children who required and received 2 doses, only half completed the two-dose series before influenza activity peaked. CONCLUSIONS: Improved messaging of the two-dose influenza vaccine recommendations is needed for providers and parents. Providers are encouraged to determine a child's eligibility for two doses of influenza vaccine using the child's vaccination history, and to vaccinate children early in the season so that two-dose series are completed before influenza peaks. |
Measuring adolescent human papillomavirus vaccine coverage: a match of sexually transmitted disease clinic and Immunization Registry data
Pathela P , Jamison K , Papadouka V , Kabir R , Markowitz LE , Dunne EF , Schillinger JA . J Adolesc Health 2016 59 (6) 710-715 PURPOSE: Human papillomavirus (HPV) vaccine is recommended for adolescents. By the end of 2013, 64% of female and 40% of male New York City residents aged 13-18 years had received ≥1 HPV vaccine dose. Adolescents attending sexually transmitted disease (STD) clinics are at high risk for HPV exposure and could benefit from vaccination. Our objective was to estimate HPV vaccination coverage for this population. METHODS: We matched records of New York City's STD clinic patients aged 13-18 years during 2010-2013 with the Citywide Immunization Registry. We assessed HPV vaccine initiation (≥1 dose) and series completion (≥3 doses among those who initiated) as of clinic visit date and by patient demographics. We compared receipt of ≥1 dose for HPV, tetanus-diphtheria-acellular pertussis, and meningococcal conjugate vaccine. RESULTS: Eighty-two percent of clinic attendees (13,505/16,364) had records in the Citywide Immunization Registry. Receipt of ≥1 HPV dose increased during 2010-2013 (females: 57.6%-69.7%; males: 1.5%-36.3%). Among females, ≥1-dose coverage was lowest among whites (53.4%) and highest among Hispanics (73.3%); among males, ≥1-dose coverage was lowest among whites (6.9%) and highest among Asians (20.9%). Series completion averaged 57.7% (females) and 28.0% (males), with little variation by race/ethnicity or poverty level. Receipt of ≥1 dose was 59.7% for HPV, 82% for tetanus-diphtheria-acellular pertussis, and 76% for meningococcal conjugate vaccines. CONCLUSIONS: HPV vaccine initiation and completion were low among adolescent STD clinic patients; coverage was lower compared with other recommended vaccines. STD clinics may be good venues for delivering HPV vaccine, thereby enhancing efforts to improve HPV vaccination. |
Population-based incidence rates of cervical intraepithelial neoplasia in the human papillomavirus vaccine era
Benard VB , Castle PE , Jenison SA , Hunt WC , Kim JJ , Cuzick J , Lee JH , Du R , Robertson M , Norville S , Wheeler CM . JAMA Oncol 2016 3 (6) 833-837 Importance: A substantial effect of human papillomavirus (HPV) vaccines on reducing HPV-related cervical disease is essential before modifying clinical practice guidelines in partially vaccinated populations. Objective: To determine the population-based cervical intraepithelial neoplasia (CIN) trends when adjusting for changes in cervical screening practices that overlapped with HPV vaccination implementation. Design, Setting, and Participants: The New Mexico HPV Pap Registry, which captures population-based estimates of both cervical screening prevalence and CIN, was used to compute CIN trends from January 1, 2007, to December 31, 2014. Under New Mexico Administrative Code, the New Mexico HPV Pap Registry, a statewide public health surveillance program, receives mandatory reporting of all cervical screening (cytologic and HPV testing) and any cervical, vulvar, and vaginal histopathological findings for all women residing in New Mexico irrespective of outcome. Main Outcome Measures: Prespecified outcome measures included low-grade CIN (grade 1 [CIN1]) and high-grade CIN (grade 2 [CIN2] and grade 3 [CIN3]). Results: From 2007 to 2014, a total of 13520 CIN1, 4296 CIN2, and 2823 CIN3 lesions were diagnosed among female individuals 15 to 29 years old. After adjustment for changes in cervical screening across the period, reductions in the CIN incidence per 100000 women screened were significant for all grades of CIN among female individuals 15 to 19 years old, dropping from 3468.3 to 1590.6 for CIN1 (annual percentage change [APC], -9.0; 95% CI, -12.0 to -5.8; P < .001), from 896.4 to 414.9 for CIN2 (APC, -10.5; 95% CI, -18.8 to -1.2; P = .03), and from 240.2 to 0 for CIN3 (APC, -41.3; 95% CI, -65.7 to 0.3; P = .05). Reductions in the CIN2 incidence were also significant for women 20 to 24 years old, dropping from 1027.7 to 627.1 (APC, -6.3; 95% CI, -10.9 to -1.4; P = .02). Conclusions and Relevance: Population-level decreases in CIN among cohorts partially vaccinated for HPV may be considered when clinical practice guidelines for cervical cancer screening are reassessed. Evidence is rapidly growing to suggest that further increases in raising the age to start screening are imminent, one step toward integrating screening and vaccination. |
Influenza vaccination coverage among health care personnel - united states, 2015-16 influenza season
Black CL , Yue X , Ball SW , Donahue SM , Izrael D , de Perio MA , Laney AS , Williams WW , Lindley MC , Graitcer SB , Lu PJ , DiSogra C , Devlin R , Walker DK , Greby SM . MMWR Morb Mortal Wkly Rep 2016 65 (38) 1026-1031 The Advisory Committee on Immunization Practices recommends annual influenza vaccination for all health care personnel to reduce influenza-related morbidity and mortality among both health care personnel and their patients (1-4). To estimate influenza vaccination coverage among U.S. health care personnel for the 2015-16 influenza season, CDC conducted an opt-in Internet panel survey of 2,258 health care personnel during March 28-April 14, 2016. Overall, 79.0% of survey participants reported receiving an influenza vaccination during the 2015-16 season, similar to the 77.3% coverage reported for the 2014-15 season (5). Coverage in long-term care settings increased by 5.3 percentage points compared with the previous season. Vaccination coverage continued to be higher among health care personnel working in hospitals (91.2%) and lower among health care personnel working in ambulatory (79.8%) and long-term care settings (69.2%). Coverage continued to be highest among physicians (95.6%) and lowest among assistants and aides (64.1%), and highest overall among health care personnel who were required by their employer to be vaccinated (96.5%). Among health care personnel working in settings where vaccination was neither required, promoted, nor offered onsite, vaccination coverage continued to be low (44.9%). An increased percentage of health care personnel reporting a vaccination requirement or onsite vaccination availability compared with earlier influenza seasons might have contributed to the overall increase in vaccination coverage during the past 6 influenza seasons. |
Breastfeeding linked to the reduction of both rotavirus shedding and IgA levels after Rotarix(R) immunization in Mexican infants
Bautista-Marquez A , Velasquez DE , Esparza-Aguilar M , Luna-Cruz M , Ruiz-Moran T , Sugata K , Jiang B , Parashar U , Patel M , Richardson V . Vaccine 2016 34 (44) 5284-5289 We examined potential risk factors on vaccine virus shedding and antibody seroresponse to human rotavirus vaccine (Rotarix) in Mexican infants. Two doses of Rotarix were administered to infants during the first two visits for their routine childhood immunization ( approximately 8 and 15weeks of age) in Mexico City. Infant's characteristics and socioeconomic indicators were obtained, including history of long-term feeding practices (exclusively/predominantly breastfed and exclusively/predominantly non-breastfed). Two serum specimens were collected, one during the second rotavirus vaccine visit and one 7weeks later. Stool specimens were collected between days 4-7 after each of the two rotavirus vaccine doses. Rotavirus IgA and IgG titers in serum were determined by enzyme immunoassays (EIA) and rotavirus shedding in stool was assessed by EIA and confirmed by RT-PCR. The overall rotavirus IgA geometric mean titers (GMT) increased significantly post dose 2 from post dose 1 [176 (95%CI: 113-273) to 335 (238-471); p=0.020). Infants who were exclusively/predominantly breastfed were less likely to shed vaccine virus in stool than those who were formula-fed (22% vs. 43%, p=0.016). Infants who were breastfed had lower rotavirus IgA titers than those who were formula-fed after dose 1 [GMT: 145 (84-250) vs. 267 (126-566) p=0.188] and dose 2 [236 (147-378) vs.578 (367-910), p=0.007]. Infants who shed vaccine virus post dose 1 had significantly higher serum IgA GMT than those who did not shed [425 (188-965) vs. 150 (84-266), p=0.038]. Breastfeeding was linked with the reduction of both stool vaccine shedding, and IgA seroresponse. The reduced rotavirus replication in the gut and shedding after dose 1 may explain in part the lower IgA response in serum. |
Combining biomedical preventions for HIV: Vaccines with pre-exposure prophylaxis, microbicides or other HIV preventions
McNicholl JM . Hum Vaccin Immunother 2016 12 (12) 0 Biomedical preventions for HIV, such as vaccines, microbicides or pre-exposure prophylaxis (PrEP) with antiretroviral drugs, can each only partially prevent HIV-1 infection in most human trials. Oral PrEP is now FDA approved for HIV-prevention in high risk groups, but partial adherence reduces efficacy. If combined as biomedical preventions (CBP) an HIV vaccine could provide protection when PrEP adherence is low and PrEP could prevent vaccine breakthroughs. Other types of PrEP or microbicides may also be partially protective. When licensed, first generation HIV vaccines are likely to be partially effective. Individuals at risk for HIV may receive an HIV vaccine combined with other biomedical preventions, in series or in parallel, in clinical trials or as part of standard of care, with the goal of maximally increasing HIV prevention. In human studies, it is challenging to determine which preventions are best combined, how they interact and how effective they are. |
Accomplishments and opportunities in biosurveillance
Thomas MJ . J Public Health Manag Pract 2016 22 Suppl 6, Public Health Informatics S81-s82 This commentary discusses the accomplishments and opportunities in biosurveillance to guide public health action, planning, and prioritization. | Surveillance is the cornerstone of public health. Robust surveillance data and their analysis meaningfully impact public health action, planning, and prioritization. However, as Dr Alexander Langmuir stated in his 1962 Cutter Lecture on Preventive Medicine at the Harvard School of Public Health, “Good surveillance does not necessarily ensure making the right decisions, but it reduces the chances of wrong ones.”1(p191) Over the past 50 years, the application of computer and information science has improved efficiency and effectiveness of public health surveillance by changing the way we collect, process, and analyze vast and disparate data for research, decision making, and learning. One example is the development of syndromic surveillance systems. What began as an experiment in a few large cities 20 years ago to track over-the-counter sales of antidiarrhea medications as an early warning of outbreaks of gastrointestinal illness expanded substantially after the terrorist attacks of 2001. Today the model has expanded to include many additional sources of real-time or near real-time data and broader uses of those data. Health departments are using data collected from emergency department visits that they receive from hospitals for monitoring conditions for which there are no surveillance systems (eg, opioid overdoses and carbon monoxide poisonings) and for improving public health situational awareness. These syndromic-based systems can continue to improve as additional text fields from the electronic health record (EHR) become part of the data stream. These additional data along with advanced natural-language processing and statistical learning methods may enhance the use of other coded and free-text contextual information. Over time, adaptive machine learning methods could make possible the detection of syndromes that were not prespecified, which could enhance overall surveillance and improve early event detection. |
Relationship characteristics associated with teen dating violence perpetration
Vivolo-Kantor AM , Massetti G , Niolon P , Foshee V , McNaughton-Reyes L . J Aggress Maltreat Trauma 2016 25 (9) 1-19 Teen dating violence (TDV) is unstable across dating relationships, suggesting that characteristics of the relationship could be related to TDV. Few empirical studies have examined these links. This study examined associations between relationship characteristics and TDV perpetration among teens and sex differences in those associations. Relationship characteristics examined include tactics used to manipulate partners; ways of responding to relationship problems; relationship duration; exclusivity of the relationship; age difference between partners; and history of sexual intercourse with partner. Data were drawn from 667 teens in a current relationship (62.5% female and 81.4% white) enrolled in the 11th or 12th grade in 14 public schools in a rural US state. Bivariate and multivariable regression analyses examined proposed associations. 30.1% and 8.2% of teens reported controlling and physical TDV perpetration, respectively. In multivariable models, frequent use manipulation tactics increased risk for controlling or physical TDV perpetration. Teens dating a partner two or more years younger were at significantly increased risk for both controlling and physical perpetration. A significant interaction emerged between sex and exit/neglect accommodation for physical TDV. Characteristics of a current dating relationship play an important role in determining risk for controlling and physical TDV perpetration. |
Mediating and moderating effects of social support in the study of child abuse and adult physical and mental health
Herrenkohl TI , Jung H , Klika JB , Mason WA , Brown EC , Leeb RT , Herrenkohl RC . Am J Orthopsychiatry 2016 86 (5) 573-83 A number of cross-sectional and a few longitudinal studies have shown a developmental relationship between child abuse and adult physical and mental health. Published findings also suggest that social support can lessen the risk of adverse outcomes for some abused children. However, few studies have investigated whether social support mediates or moderates the relationship between child abuse and adult physical and mental health. Structural equation modeling was used to examine data on these topics from a longitudinal study of more than 30 years. While a latent construct of physical and emotional child abuse did not predict adult health outcomes directly, child abuse did predict outcomes indirectly through social support. A test of variable moderation for child abuse and social support was nonsignificant. Results suggest that social support may help explain the association between child abuse and health outcomes at midlife. Implications of the findings for prevention and treatment are discussed. |
Falls and fall injuries among adults aged ≥65 years - United States, 2014
Bergen G , Stevens MR , Burns ER . MMWR Morb Mortal Wkly Rep 2016 65 (37) 993-998 Falls are the leading cause of fatal and nonfatal injuries among adults aged ≥65 years (older adults). During 2014, approximately 27,000 older adults died because of falls; 2.8 million were treated in emergency departments for fall-related injuries, and approximately 800,000 of these patients were subsequently hospitalized.* To estimate the numbers, percentages, and rates of falls and fall injuries among older adults by selected characteristics and state, CDC analyzed data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) survey. In 2014, 28.7% of older adults reported falling; the estimated 29.0 million falls resulted in 7.0 million injuries. Known effective strategies for reducing the number of older adult falls include a multifactorial clinical approach (e.g., gait and balance assessment, strength and balance exercises, and medication review). Health care providers can play an important role in fall prevention by screening older adults for fall risk, reviewing and managing medications linked to falls, and recommending vitamin D supplements to improve bone, muscle, and nerve health and reduce the risk for falls. |
Use of quantitative molecular diagnostic methods to identify causes of diarrhoea in children: a reanalysis of the GEMS case-control study.
Liu J , Platts-Mills JA , Juma J , Kabir F , Nkeze J , Okoi C , Operario DJ , Uddin J , Ahmed S , Alonso PL , Antonio M , Becker SM , Blackwelder WC , Breiman RF , Faruque AS , Fields B , Gratz J , Haque R , Hossain A , Hossain MJ , Jarju S , Qamar F , Iqbal NT , Kwambana B , Mandomando I , McMurry TL , Ochieng C , Ochieng JB , Ochieng M , Onyango C , Panchalingam S , Kalam A , Aziz F , Qureshi S , Ramamurthy T , Roberts JH , Saha D , Sow SO , Stroup SE , Sur D , Tamboura B , Taniuchi M , Tennant SM , Toema D , Wu Y , Zaidi A , Nataro JP , Kotloff KL , Levine MM , Houpt ER . Lancet 2016 388 (10051) 1291-301 BACKGROUND: Diarrhoea is the second leading cause of mortality in children worldwide, but establishing the cause can be complicated by diverse diagnostic approaches and varying test characteristics. We used quantitative molecular diagnostic methods to reassess causes of diarrhoea in the Global Enteric Multicenter Study (GEMS). METHODS: GEMS was a study of moderate to severe diarrhoea in children younger than 5 years in Africa and Asia. We used quantitative real-time PCR (qPCR) to test for 32 enteropathogens in stool samples from cases and matched asymptomatic controls from GEMS, and compared pathogen-specific attributable incidences with those found with the original GEMS microbiological methods, including culture, EIA, and reverse-transcriptase PCR. We calculated revised pathogen-specific burdens of disease and assessed causes in individual children. FINDINGS: We analysed 5304 sample pairs. For most pathogens, incidence was greater with qPCR than with the original methods, particularly for adenovirus 40/41 (around five times), Shigella spp or enteroinvasive Escherichia coli (EIEC) and Campylobactor jejuni o C coli (around two times), and heat-stable enterotoxin-producing E coli ([ST-ETEC] around 1.5 times). The six most attributable pathogens became, in descending order, Shigella spp, rotavirus, adenovirus 40/41, ST-ETEC, Cryptosporidium spp, and Campylobacter spp. Pathogen-attributable diarrhoeal burden was 89.3% (95% CI 83.2-96.0) at the population level, compared with 51.5% (48.0-55.0) in the original GEMS analysis. The top six pathogens accounted for 77.8% (74.6-80.9) of all attributable diarrhoea. With use of model-derived quantitative cutoffs to assess individual diarrhoeal cases, 2254 (42.5%) of 5304 cases had one diarrhoea-associated pathogen detected and 2063 (38.9%) had two or more, with Shigella spp and rotavirus being the pathogens most strongly associated with diarrhoea in children with mixed infections. INTERPRETATION: A quantitative molecular diagnostic approach improved population-level and case-level characterisation of the causes of diarrhoea and indicated a high burden of disease associated with six pathogens, for which targeted treatment should be prioritised. FUNDING: Bill & Melinda Gates Foundation. |
Mono- and quadri-subtype virus-like particles (VLPs) containing H10 subtype elicit protective immunity to H10 influenza in a ferret challenge model
Pushko P , Sun X , Tretyakova I , Hidajat R , Pulit-Penaloza JA , Belser JA , Maines TR , Tumpey TM . Vaccine 2016 34 (44) 5235-5242 Avian-origin influenza represents a global public health concern. In 2013, the H10N8 virus caused documented human infections for the first time. Currently, there is no approved vaccine against H10 influenza. Recombinant virus-like particles (VLPs) represent a promising vaccine approach. In this study, we evaluated H10 VLPs containing hemagglutinin from H10N8 virus as an experimental vaccine in a ferret challenge model. In addition, we evaluated quadri-subtype VLPs co-localizing H5, H7, H9 and H10 subtypes. Both vaccines elicited serum antibody that reacted with the homologous H10 derived from H10N8 virus and cross-reacted with the heterologous H10N1 virus. Quadri-subtype vaccine also elicited serum antibody to the homologous H5, H7, and H9 antigens and cross-reacted with multiple clades of H5N1 virus. After heterologous challenge with the H10N1 virus, all vaccinated ferrets showed significantly reduced titers of replicating virus in the respiratory tract indicating protective effect of vaccination with either H10 VLPs or with quadri-subtype VLPs. |
On-column trypsin digestion coupled with LC-MS/MS for quantification of apolipoproteins
Toth CA , Kuklenyik Z , Jones JI , Parks BA , Gardner MS , Schieltz DM , Rees JC , Andrews ML , McWilliams LG , Pirkle JL , Barr JR . J Proteomics 2016 150 258-267 Apolipoproteins measured in plasma or serum are potential biomarkers for assessing metabolic irregularities that are associated with the development of cardiovascular disease (CVD). LC-MS/MS allows quantitative measurement of multiple apolipoproteins in the same sample run.However, the accuracy and precision of the LC-MS/MS measurement depends on the reproducibility of the enzymatic protein digestion step. With the application of an immobilized enzyme reactor (IMER), the reproducibility of the trypsin digestion can be controlled with high precision via flow rate, column volume and temperature. In this report, we demonstrate the application of an integrated IMER-LC-MS/MS platform for the simultaneous quantitative analysis of eight apolipoproteins. Using a dilution series of a characterized serum pool as calibrator, the method was validated by repeated analysis of pooled sera and individual serum samples with a wide range of lipid profiles, all showing intra-assay CV<4.4% and inter-assay CV<8%. In addition, the method was compared with traditional homogeneous digestion coupled LC-MS/MS for the quantification of apoA-I and apoB-100. Applied in large scale human population studies, this method can serve the translation of a wider panel of apolipoprotein biomarkers from research to clinical application. SIGNIFICANCE: Currently, the translation of apolipoprotein biomarkers to clinical application is impaired because of the high cost of large cohort studies using traditional single-analyte immunoassays. The application of on-line tryptic digestion coupled with LC-MS/MS analysis is an effective way to address this problem. In this work we demonstrate a high throughput, multiplexed, automated proteomics workflow for the simultaneous analysis of multiple proteins. |
Pathogenesis and transmission assessments of two H7N8 influenza A viruses recently isolated from turkey farms in Indiana using mouse and ferret models
Sun X , Belser JA , Pulit-Penaloza JA , Zeng H , Lewis A , Shieh WJ , Tumpey TM , Maines TR . J Virol 2016 90 (23) 10936-10944 Avian influenza A H7 viruses have caused multiple outbreaks in domestic poultry throughout North America, resulting in occasional human infections in close contact. In early 2016, the presence of H7N8 highly pathogenic avian influenza (HPAI) viruses and closely related H7N8 low pathogenic avian influenza (LPAI) viruses were confirmed in commercial turkey farms in Indiana. These H7N8 viruses represent the first isolation of this subtype in domestic poultry in North America, with their virulence in mammalian hosts and the potential risk for human infection largely unknown. In this study, we assessed the ability of H7N8 HPAI and LPAI viruses to replicate in vitro in human airway cells and in vivo in mouse and ferret models. Both H7N8 viruses replicated efficiently in vitro and in vivo, but exhibited substantial differences in disease severity in mammals. In mice, while the H7N8 LPAI virus largely remained avirulent, the H7N8 HPAI virus exhibited greater infectivity, virulence, and lethality. Both H7N8 viruses replicated similarly in ferrets, but only the H7N8 HPAI virus caused moderate weight loss, lethargy, and mortality. The H7N8 LPAI virus displayed limited transmissibility in ferrets placed in direct contact, while no transmission of H7N8 HPAI virus was detected. Our results indicate that the H7N8 avian influenza viruses from Indiana are able to replicate in mammals and cause severe disease, but with limited transmission. The recent appearance of H7N8 viruses in domestic poultry highlights the need for continued influenza surveillance in wild birds and close monitoring of the potential risk to human health. IMPORTANCE: H7 influenza viruses circulate in wild birds in the U.S., but when the virus emerges in domestic poultry populations, the frequency of human exposure and the potential for human infections increases. An H7N8 highly pathogenic avian influenza (HPAI) and an H7N8 low pathogenic avian influenza (LPAI) viruses were recently isolated from commercial turkey farms in Indiana. To determine the risk that these influenza viruses pose to humans, we assessed the pathogenesis and transmission in vitro and in mammalian models. We found that the H7N8 HPAI virus exhibited enhanced virulence and, although transmission was only observed with the H7N8 LPAI virus, the ability of this H7 virus to transmit in a mammalian host and quickly evolve to a more virulent strain is cause for concern. Our findings offer important insight into the potential for emerging H7 avian influenza viruses to acquire the ability to cause disease and transmit among mammals. |
Interlaboratory analytical comparison of fatty acid concentrations in serum or plasma
Schantz MM , Powers CD , Schleicher RL , Betz JM , Wise SA . Clin Chim Acta 2016 462 148-152 BACKGROUND: There are a large number of clinical studies focusing on the measurement of individual fatty acids in serum or plasma; however, few studies have focused on the interlaboratory comparisons of these measurements. The National Institutes of Standards and Technology (NIST), in collaboration with the National Institutes of Health Office of Dietary Supplements (NIH-ODS) and the Centers for Disease Control and Prevention (CDC), has initiated a quality assurance program for assessing and improving the comparability of individual fatty acid measurements in serum and plasma. METHODS: This is a performance-based study so participants are encouraged to use their laboratory's methods for the quantification of the individual fatty acids that they typically measure in the unknown serum or plasma samples along with a control material. The control materials used to date are SRM 1950 Metabolites in Human Plasma and SRM 2378 Fatty Acids in Frozen Human Serum. RESULTS: To date, two studies of the Fatty Acid Quality Assurance Program (FAQAP) have been completed with 11 and 14 participants, respectively. The agreement among the laboratories for individual fatty acids was within 20% for 70% of the data submitted. Laboratories were also requested to run triplicate analyses for each unknown sample. The precision of the individual laboratory data was generally good, with relative standard deviations <20%. CONCLUSIONS: The results from the first two exercises indicate the need for additional assessment of the comparability among laboratories doing these measurements. Future studies will be conducted with the goals of increasing the number of participating laboratories, increasing awareness of the need to use control materials, and improving the comparability among laboratories. |
Neurobehavioral disorder associated with prenatal alcohol exposure
Hagan JF Jr , Balachova T , Bertrand J , Chasnoff I , Dang E , Fernandez-Baca D , Kable J , Kosofsky B , Senturias YN , Singh N , Sloane M , Weitzman C , Zubler J . Pediatrics 2016 138 (4) Children and adolescents affected by prenatal exposure to alcohol who have brain damage that is manifested in functional impairments of neurocognition, self-regulation, and adaptive functioning may most appropriately be diagnosed with neurobehavioral disorder associated with prenatal exposure. This Special Article outlines clinical implications and guidelines for pediatric medical home clinicians to identify, diagnose, and refer children regarding neurobehavioral disorder associated with prenatal exposure. Emphasis is given to reported or observable behaviors that can be identified as part of care in pediatric medical homes, differential diagnosis, and potential comorbidities. In addition, brief guidance is provided on the management of affected children in the pediatric medical home. Finally, suggestions are given for obtaining prenatal history of in utero exposure to alcohol for the pediatric patient. |
Do social resources protect against lower quality of life among diverse young adolescents?
Scott Sarah M , Wallander Jan L , Elliott Marc N , Grunbaum Jo Anne , Chien Alyna T , Tortolero Susan , Cuccaro Paula , Schuster Mark A . J Early Adolesc 2016 36 (6) 754-782 We examined whether social resources from the family and the community moderate the risk associated with low socioeconomic status (SES) for reduced quality of life (QL) among youth across racial/ethnic groups. Data were from 4,824 fifth-grade youth (age X = 11.1, SD = 0.6; 49% females) in the Healthy PassagesTM study (2004-2006) located in Birmingham, Alabama; Los Angeles County, California; and Houston, Texas. Youth reported their QL using the Pediatric Quality of Life Inventory Version 4.0 and the Global Self-Worth subscale of the Self-Perception Profile and their status for hypothesized protective social mechanisms. Overall, family cohesion, parental nurturance, other adult, and peer support were positively associated with QL across racial/ethnic groups. There were few significant interactions, but all suggested that higher SES youth benefited more than lower SES youth. In fact, family cohesion among African American youth and other adult support among Hispanic youth differentiated QL at higher, but not lower SES. Further research should examine other risk contexts and seek to inform targeted prevention efforts. |
Applying inappropriate cutoffs leads to misinterpretation of folate status in the US population
Pfeiffer CM , Sternberg MR , Hamner HC , Crider KS , Lacher DA , Rogers LM , Bailey RL , Yetley EA . Am J Clin Nutr 2016 104 (6) 1607-1615 BACKGROUND: Folate cutoffs for risk of deficiency compared with possible deficiency were originally derived differently (experimental compared with epidemiologic data), and their interpretations are different. The matching of cutoffs derived from one assay with population-based data derived from another assay requires caution. OBJECTIVE: We assessed the extent of folate-status misinterpretation with the use of inappropriate cutoffs. DESIGN: In the cross-sectional NHANES, serum and red blood cell (RBC) folate were first measured with the use of a radioprotein-binding assay (RPBA) (1988-2006) and, afterwards, with the use of a microbiologic assay (2007-2010). We compared prevalence estimates for assay-matched cutoffs (e.g., with the use of an RPBA cutoff with RPBA data) and assay-mismatched cutoffs (e.g., with the use of microbiologic assay cutoff with RPBA data) for risk of deficiency on the basis of megaloblastic anemia as a hematologic indicator in persons ≥4 y of age (e.g., serum folate concentration <7 nmol/L and RBC folate concentration <305 nmol/L derived with the use of a microbiologic assay), possible deficiency on the basis of rising homocysteine as a metabolic indicator in persons ≥4 y of age (e.g., serum folate concentration <10 nmol/L and RBC folate concentration <340 nmol/L derived with the use of an RPBA), and insufficiency on the basis of elevated risk of neural tube defects in women 12-49 y old (e.g., RBC folate concentration <906 nmol/L derived with the use of a microbiologic assay). RESULTS: Pre-folic acid fortification (1988-1994), risks of deficiency for assay-matched compared with assay-mismatched cutoffs were 5.6% compared with 16% (serum folate), respectively, and 7.4% compared with 28% (RBC folate), respectively; risks declined postfortification (1999-2006) to <1% compared with <1% (serum folate), respectively, and to <1% compared with 2.5% (RBC folate), respectively. Prefortification (1988-1994), risks of possible deficiency for assay-matched compared with assay-mismatched cutoffs were 35% compared with 56% (serum folate), respectively, and 37% compared with 84% (RBC folate), respectively; risks declined postfortification (1999-2006) to 1.9% compared with 7.0% (serum folate), respectively, and to 4.8% compared with 53% (RBC folate), respectively. Postfortification (2007-2010), risks of insufficiency were 3% (assay matched) compared with 39% (assay mismatched), respectively. CONCLUSIONS: The application of assay-mismatched cutoffs leads to a misinterpretation of folate status. This confusion likely applies to clinical assays because no comparability data are available, to our knowledge. |
Comparing 2 national organization-level workplace health promotion and improvement tools, 2013-2015
Meador A , Lang JE , Davis WD , Jones-Jack NH , Mukhtar Q , Lu H , Acharya SD , Molloy ME . Prev Chronic Dis 2016 13 E136 Creating healthy workplaces is becoming more common. Half of employers that have more than 50 employees offer some type of workplace health promotion program. Few employers implement comprehensive evidence-based interventions that reach all employees and achieve desired health and cost outcomes. A few organization-level assessment and benchmarking tools have emerged to help employers evaluate the comprehensiveness and rigor of their health promotion offerings. Even fewer tools exist that combine assessment with technical assistance and guidance to implement evidence-based practices. Our descriptive analysis compares 2 such tools, the Centers for Disease Control and Prevention's Worksite Health ScoreCard and Prevention Partners' WorkHealthy America, and presents data from both to describe workplace health promotion practices across the United States. These tools are reaching employers of all types (N = 1,797), and many employers are using a comprehensive approach (85% of those using WorkHealthy America and 45% of those using the ScoreCard), increasing program effectiveness and impact. |
Development of methods for using workers' compensation data for surveillance and prevention of occupational injuries among state-insured private employers in Ohio
Wurzelbacher SJ , Al-Tarawneh IS , Meyers AR , Bushnell PT , Lampl MP , Robins DC , Tseng CY , Wei C , Bertke SJ , Raudabaugh JA , Haviland TM , Schnorr TM . Am J Ind Med 2016 59 (12) 1087-1104 BACKGROUND: Workers' compensation (WC) claims data may be useful for identifying high-risk industries and developing prevention strategies. METHODS: WC claims data from private-industry employers insured by the Ohio state-based workers' compensation carrier from 2001 to 2011 were linked with the state's unemployment insurance (UI) data on the employer's industry and number of employees. National Labor Productivity and Costs survey data were used to adjust UI data and estimate full-time equivalents (FTE). Rates of WC claims per 100 FTE were computed and Poisson regression was used to evaluate differences in rates. RESULTS: Most industries showed substantial claim count and rate reductions from 2001 to 2008, followed by a leveling or slight increase in claim count and rate from 2009 to 2011. Despite reductions, there were industry groups that had consistently higher rates. CONCLUSION: WC claims data linked to employment data could be used to prioritize industries for injury research and prevention activities among State-insured private employers. |
Development of portable aerosol mobility spectrometer for personal and mobile aerosol measurement
Kulkarni P , Qi C , Fukushima N . Aerosol Sci Technol 2016 50 (11) 1167-1179 We describe development of a portable aerosol mobility spectrometer (PAMS) for size distribution measurement of submicrometer aerosol. The spectrometer is designed for use in personal or mobile aerosol characterization studies and measures approximately 22.5×22.5×15 cm and weighs about 4.5 kg including the battery. PAMS uses electrical mobility technique to measure number-weighted particle size distribution of aerosol in the 10–855 nm range. Aerosol particles are electrically charged using a dual-corona bipolar corona charger, followed by classification in a cylindrical miniature differential mobility analyzer. A condensation particle counter is used to detect and count particles. The mobility classifier was operated at an aerosol flow rate of 0.05 L/min, and at two different user-selectable sheath flows of 0.2 L/min (for wider size range 15–855 nm) and 0.4 L/min (for higher size resolution over the size range of 10.6–436 nm). The instrument was operated in voltage stepping mode to retrieve the size distribution in approximately 1–2 min. Sizing accuracy and resolution were probed and found to be within the 25% limit of NIOSH criterion for direct-reading instruments. Comparison of size distribution measurements from PAMS and other commercial mobility spectrometers showed good agreement. The instrument offers unique measurement capability for on-person or mobile size distribution measurement of ultrafine and nanoparticle aerosol. |
Prevalence and trends of leisure-time physical activity by occupation and industry in U.S. workers: the National Health Interview Survey 2004-2014
Gu JK , Charles LE , Ma CC , Andrew ME , Fekedulegn D , Hartley TA , Violanti JM , Burchfiel CM . Ann Epidemiol 2016 26 (10) 685-692 PURPOSE: Studies describing prevalence and trends of physical activity among workers in the United States are scarce. We aimed to estimate prevalence and trends of "sufficient" leisure-time physical activity (LTPA) during the 2004-2014 time period among U.S. workers. METHODS: Data were collected for U.S. workers in the National Health Interview Survey. LTPA was categorized as sufficiently active (moderate intensity, ≥150 minutes per week), insufficiently active (10-149 minutes per week), and inactive (<10 minutes per week). Prevalence of LTPA was adjusted for age using 2010 U.S. working population as a standardized age distribution. RESULTS: Prevalence trends of "sufficient" LTPA significantly increased from 2004 to 2014 (45.6% to 54.8%; P < .001). Among industry groups, the highest prevalence of "sufficient" LTPA was observed among workers in Professional/Scientific/Technical Services (62.1%). The largest increases were observed among workers in Public Administration (51.3%-63.4%). Among occupational groups, "sufficient" LTPA prevalence was lowest in farming/fishing/forestry (30.8%) and highest in life/physical/social science (66.4%). Prevalence of LTPA significantly increased from 2004 to 2014 in most occupational and industry groups. CONCLUSIONS: Among U.S. workers, trends of "sufficient" LTPA significantly increased between 2004 and 2014. Overall, a larger proportion of white-collar compared to blue-collar workers were engaged in "sufficient" LTPA. |
Efficacy and mediation of a theory-based physical activity intervention for African American men who have sex with men: A randomized controlled trial
Zhang J , Jemmott JB 3rd , O'Leary A , Stevens R , Jemmott LS , Icard LD , Hsu J , Rutledge SE . Ann Behav Med 2016 51 (1) 106-116 BACKGROUND: Few trials have tested physical-activity interventions among sexual minorities, including African American men who have sex with men (MSM). PURPOSE: We examined the efficacy and mediation of the Being Responsible for Ourselves (BRO) physical-activity intervention among African American MSM. METHOD: African American MSM were randomized to the physical-activity intervention consisting of three 90-min one-on-one sessions or an attention-matched control intervention and completed pre-intervention, immediately post-intervention, and 6- and 12-month post-intervention audio computer-based surveys. RESULTS: Of the 595 participants, 503 completed the 12-month follow-up. Generalized estimating equation models revealed that the intervention increased self-reported physical activity compared with the control intervention, adjusted for pre-intervention physical activity. Mediation analyses suggested that the intervention increased reasoned action approach variables, subjective norm and self-efficacy, increasing intention immediately post-intervention, which increased physical activity during the follow-up period. CONCLUSIONS: Interventions targeting reasoned action approach variables may contribute to efforts to increase African American MSM's physical activity. CLINICAL TRIAL REGISTRATION: The trial was registered with the ClinicalTrials.gov Identifier NCT02561286 . |
Implementing health impact assessment programs in state health agencies: Lessons learned from pilot programs, 2009-2011
Goff N , Wyss K , Wendel A , Jarris P . J Public Health Manag Pract 2016 22 (6) E8-e13 CONTEXT: Health Impact Assessment (HIA) has emerged as a promising tool to integrate health considerations into decision making. The growth and success of HIA practice in the United States will be dependent on building the capacity of practitioners. OBJECTIVE: This article seeks to identify the role of state health agencies (SHAs) in building capacity for conducting HIAs and the key components of initiatives that produced effective HIAs and HIA programs. The authors proposed to answer 3 research questions: (1) What can be the role of the SHA in HIA? (2) What are the characteristics of successful state HIA programs? and (3) What are some effective strategies for building capacity for HIA in SHAs and local health departments? DESIGN: The authors reviewed program reports from the ASTHO's pilot state health agencies (California, Minnesota, Oregon, and Wisconsin) that, between 2009 and 2011, created HIA programs to provide HIA training, conduct HIAs, and build practitioner networks. MAIN OUTCOME MEASURES: Program reports were examined for shared themes on the role of SHAs in a statewide HIA initiative, the characteristics of successful programs, and effective strategies for building capacity. RESULTS: Despite differences among the programs, many shared themes existed. These include stressing the importance of a basic, sustained infrastructure for HIA practice; leveraging existing programs and networks; and working in partnership with diverse stakeholders. CONCLUSIONS: SHAs can build capacity for HIA, and SHAs can both lead and support the completion of individual HIAs. States and territories interested in starting comprehensive statewide HIA initiatives could consider implementing the strategies identified by the pilot programs. |
State and local policies related to sexual orientation in the United States
Cramer R , Hexem S , LaPollo A , Cuffe KM , Chesson HW , Leichliter JS . J Public Health Policy 2016 Poorer health suffered by lesbian, gay, and bisexual (LGB) populations may be associated with public policies. We collected the laws that in 2013 prohibited discrimination based on sexual orientation from 50 United States (US) states, the District of Columbia (Washington, DC or DC), and the 30 most populous US metropolitan areas. To facilitate future research, we coded certain aspects of these laws to create a dataset. We generated descriptive statistics by jurisdiction type and tested for regional differences in state law using Chi-square tests. Sixteen (31.4 per cent) states prohibited discrimination by all employers based on sexual orientation, 25 states (49.0 per cent) in public employment, 18 states (35.3 per cent) in government contracting, and 21 states (41.2 per cent) in private employment. Twenty-one states prohibited discrimination (41.2 per cent) in housing practices (selling and renting), and 17 (33.3 per cent) in public accommodations. Local (county/city) laws prohibiting discrimination were less common. State laws differed significantly by US census region - West, Midwest, Northeast, and South. Future analyses of these data could examine the impact of these laws on various outcomes, including health among LGB populations. |
State public health enabling authorities: Results of a fundamental activities assessment examining core and essential services
Hoss A , Menon A , Corso L . J Public Health Manag Pract 2016 22 (6) 529-36 CONTEXT: Public health enabling authorities establish the legal foundation for financing, organizing, and delivering public health services. State laws vary in terms of the content, depth, and breadth of these fundamental public health activities. Given this variance, the Institute of Medicine has identified state public health laws as an area that requires further examination. To respond to this call for further examination, the Centers for Disease Control and Prevention's Public Health Law Program conducted a fundamental activities legal assessment on state public health laws. OBJECTIVE: The goal of the legal assessment was to examine state laws referencing frameworks representing public health department fundamental activities (ie, core and essential services) in an effort to identify, catalog, and describe enabling authorities of state governmental public health systems. DESIGN: In 2013, Public Health Law Program staff compiled a list of state statutes and regulations referencing different commonly-recognized public health frameworks of fundamental activities. The legal assessment included state fundamental activities laws available on WestlawNext as of July 2013. The results related to the 10 essential public health services and the 3 core public health functions were confirmed and updated in June 2016. RESULTS: Eighteen states reference commonly-recognized frameworks of fundamental activities in their laws. Thirteen states have listed the 10 essential public health services in their laws. Eight of these states have also referenced the 3 core public health functions in their laws. Five states reference only the core public health functions. CONCLUSIONS: Several states reference fundamental activities in their state laws, particularly through use of the essential services framework. Further work is needed to capture the public health laws and practices of states that may be performing fundamental activities but without reference to a common framework. |
One Health core competency domains
Frankson R , Hueston W , Christian K , Olson D , Lee M , Valeri L , Hyatt R , Annelli J , Rubin C . Front Public Health 2016 4 192 The emergence of complex global challenges at the convergence of human, animal, and environmental health has catalyzed a movement supporting "One Health" approaches. Despite recognition of the importance of One Health approaches to address these complex challenges, little effort has been directed at identifying the seminal knowledge, skills, and attitudes necessary for individuals to successfully contribute to One Health efforts. Between 2008 and 2011, three groups independently embarked on separate initiatives to identify core competencies for professionals involved with One Health approaches. Core competencies were considered critically important for guiding curriculum development and continuing professional education, as they describe the knowledge, skills, and attitudes required to be effective. A workshop was convened in 2012 to synthesize the various strands of work on One Health competencies. Despite having different mandates, participants, and approaches, all of these initiatives identified similar core competency domains: management; communication and informatics; values and ethics; leadership; teams and collaboration; roles and responsibilities; and systems thinking. These core competency domains have been used to develop new continuing professional education programs for One Health professionals and help university curricula prepare new graduates to be able to contribute more effectively to One Health approaches. |
Development and usefulness of a district health systems tool for performance improvement in essential public health functions in Botswana and Mozambique
Bishai D , Sherry M , Pereira CC , Chicumbe S , Mbofana F , Boore A , Smith M , Nhambi L , Borse NN . J Public Health Manag Pract 2016 22 (6) 586-96 INTRODUCTION: This study describes the development of a self-audit tool for public health and the associated methodology for implementing a district health system self-audit tool that can provide quantitative data on how district governments perceive their performance of the essential public health functions. METHODS: Development began with a consensus-building process to engage Ministry of Health and provincial health officers in Mozambique and Botswana. We then worked with lists of relevant public health functions as determined by these stakeholders to adapt a self-audit tool describing essential public health functions to each country's health system. We then piloted the tool across districts in both countries and conducted interviews with district health personnel to determine health workers' perception of the usefulness of the approach. RESULTS: Country stakeholders were able to develop consensus around 11 essential public health functions that were relevant in each country. Pilots of the self-audit tool enabled the tool to be effectively shortened. Pilots also disclosed a tendency to upcode during self-audits that was checked by group deliberation. Convening sessions at the district enabled better attendance and representative deliberation. Instant feedback from the audit was a feature that 100% of pilot respondents found most useful. CONCLUSION: The development of metrics that provide feedback on public health performance can be used as an aid in the self-assessment of health system performance at the district level. Measurements of practice can open the door to future applications for practice improvement and research into the determinants and consequences of better public health practice. The current tool can be assessed for its usefulness to district health managers in improving their public health practice. The tool can also be used by the Ministry of Health or external donors in the African region for monitoring the district-level performance of the essential public health functions. |
Extremities of body mass index and their association with pregnancy outcomes in women undergoing in vitro fertilization in the United States
Kawwass JF , Kulkarni AD , Hipp HS , Crawford S , Kissin DM , Jamieson DJ . Fertil Steril 2016 106 (7) 1742-1750 OBJECTIVE: To investigate the associations among underweight body mass index (BMI), pregnancy, and obstetric outcomes among women using assisted reproductive technology (ART). DESIGN: Retrospective cohort study using national data and log binomial regression. SETTING: Not applicable. PATIENT(S): Women undergoing IVF in the United States from 2008 to 2013. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Pregnancy outcomes (intrauterine pregnancy, live birth rates) per transfer, miscarriage rate per pregnancy, and low birth weight and preterm delivery rates among singleton and twin pregnancies. RESULT(S): For all fresh autologous in vitro fertilization (IVF) cycles in the United States from 2008 to 2013 (n = 494,097 cycles, n = 402,742 transfers, n = 180,855 pregnancies) reported to the national ART Surveillance System, compared with normal weight women, underweight women had a statistically significant decreased chance of intrauterine pregnancy (adjusted risk ratio [aRR] 0.97; 95% confidence interval [CI], 0.96-0.99) and live birth (aRR 0.95; 95% CI, 0.93-0.98) per transfer. Obese women also had a statistically decreased likelihood of both (aRR 0.94; 95% CI, 0.94-0.95; aRR 0.87; 95% CI, 0.86-0.88, respectively). Among cycles resulting in singleton pregnancy, both underweight and obese statuses were associated with increased risk of low birth weight (aRR 1.39; 95% CI, 1.25-1.54, aRR 1.26; 95% CI, 1.20-1.33, respectively) and preterm delivery (aRR 1.12; 95% CI, 1.01-1.23, aRR 1.42; 95% CI, 1.36-1.48, respectively). The association between underweight status and miscarriage was not statistically significant (aRR 1.04; 95% CI, 0.98-1.11). In contrast, obesity was associated with a statistically significantly increased miscarriage risk (aRR 1.23; 95% CI, 1.20-1.26). CONCLUSION(S): Among women undergoing IVF, prepregnancy BMI affects pregnancy and obstetric outcomes. Underweight status may have a limited impact on pregnancy and live-birth rates, but it is associated with increased preterm and low-birth-weight delivery risk. Obesity negatively impacts all ART and obstetric outcomes investigated. |
A second order cone formulation of continuous CTA model
Lesaja G , Castro J , Oganian A . Priv Stat Databases 2016 9867 41-53 In this paper we consider a minimum distance Controlled Tabular Adjustment (CTA) model for statistical disclosure limitation (control) of tabular data. The goal of the CTA model is to find the closest safe table to some original tabular data set that contains sensitive information. The measure of closeness is usually measured using 1or 2norm; with each measure having its advantages and disadvantages. Recently, in [4] a regularization of the 1-CTA using Pseudo-Huber function was introduced in an attempt to combine positive characteristics of both 1-CTA and 2-CTA. All three models can be solved using appropriate versions of Interior-Point Methods (IPM). It is known that IPM in general works better on well structured problems such as conic optimization problems, thus, reformulation of these CTA models as conic optimization problem may be advantageous. We present reformulation of Pseudo-Huber-CTA, and 1-CTA as Second-Order Cone (SOC) optimization problems and test the validity of the approach on the small example of two-dimensional tabular data set. |
Propensity score based conditional group swapping for disclosure limitation of strata-defining variables
Oganian A , Lesaja G . Priv Stat Databases 2016 6896 69-80 In this paper we propose a method for statistical disclosure limitation of categorical variables that we call Conditional Group Swapping. This approach is suitable for design and strata-defining variables, the cross-classification of which leads to the formation of important groups or subpopulations. These groups are considered important because from the point of view of data analysis it is desirable to preserve analytical characteristics within them. In general data swapping can be quite distorting [13,16,20], especially for the relationships between the variables not only within the subpopulations but for the overall data. To reduce the damage incurred by swapping, we propose to choose the records for swapping using conditional probabilities which depend on the characteristics of the exchanged records. In particular, our approach exploits the results of propensity scores methodology for the computation of swapping probabilities. The experimental results presented in the paper show good utility properties of the method. |
Evaluating targeted interventions via meta-population models with multi-level mixing
Feng Z , Hill AN , Curns AT , Glasser JW . Math Biosci 2016 287 93-104 Among the several means by which heterogeneity can be modeled, Levins' (1969) meta-population approach preserves the most analytical tractability, a virtue to the extent that generality is desirable. When model populations are stratified, contacts among their respective sub-populations must be described. Using a simple meta-population model, Feng et al. (2015) showed that mixing among sub-populations, as well as heterogeneity in characteristics affecting sub-population reproduction numbers, must be considered when evaluating public health interventions to prevent or control infectious disease outbreaks. They employed the convex combination of preferential within- and proportional among-group contacts first described by Nold (1980) and subsequently generalized by Jacquez et al. (1988). As the utility of meta-population modeling depends on more realistic mixing functions, the authors added preferential contacts between parents and children and among co-workers (Glasser et al., 2012). Here they further generalize this function by including preferential contacts between grandparents and grandchildren, but omit workplace contacts. They also describe a general multi-level mixing scheme, provide three two-level examples, and apply two of them. In their first application, the authors describe age- and gender-specific patterns in face-to-face conversations (Mossong et al., 2008), proxies for contacts by which respiratory pathogens might be transmitted, that are consistent with everyday experience. This suggests that meta-population models with inter-generational mixing could be employed to evaluate prolonged school-closures, a proposed pandemic mitigation measure that could expose grandparents, and other elderly surrogate caregivers for working parents, to infectious children. In their second application, the authors use a meta-population SEIR model stratified by 7 age groups and 50 states plus the District of Columbia, to compare actual with optimal vaccination during the 2009-2010 influenza pandemic in the United States. They also show that vaccination efforts could have been adjusted month-to-month during the fall of 2009 to ensure maximum impact. Such applications inspire confidence in the reliability of meta-population modeling in support of public health policymaking. |
Supporting rabies control in India
Mansfield KL , Banyard AC , Fooks AR , Franka R , Isloor S , Rahman A . Vet Rec 2016 179 (12) 296-7 Earlier this year, Tony Fooks and colleagues described how, under a laboratory twinning project run by the World Organisation for Animal Health (OIE), the UK's OIE Reference Laboratory for rabies, based at the APHA in Weybridge, had been working with the Changchun Veterinary Research Institute in the People's Republic of China to help the institute develop into an OIE Reference Laboratory itself (VR, March 5, 2016, vol 178, pp 231-232). Now, the APHA is taking part in a further three-year project to build rabies diagnosis capability in Bangalore, India, as he and his colleagues explain below. |
Zika virus in semen: Lessons from Ebola
Purpura LJ , Choi MJ , Rollin PE . Lancet Infect Dis 2016 16 (10) 1107-8 The largest Ebola virus disease epidemic in history, the 2014 west African outbreak, left more than 17 000 survivors. Previously, Ebola virus RNA has been detected in semen by RT-PCR up to 101 days and infectious particles via culture up to 82 days after illness onset.1 As such, all male survivors of Ebola virus disease were advised to abstain from sex or use condoms for 3 months after recovery. In May 2015, genomic and epidemiological data provided evidence of sexual transmission of Ebola virus from a Liberian man who had detectable virus RNA 199 days after illness onset.2 This led WHO to recommend semen testing for all male survivors or safe sex practices for at least 6 months after illness onset if semen testing is not available.3 More recently, ongoing semen testing programmes in west Africa and USA have detected virus RNA in semen up to 290 days after disease onset and up to 565 days after disease recovery.4, 5 | Like Ebola virus disease, Zika virus has been found to persist in semen—RT-PCR has identified presence of virus 93 days after symptom onset,5 as has virus isolation 24 days after.6 As with Ebola virus, reported sexual transmission of Zika virus has led to changes in recommendations for safe sex practices. Condom use is recommended for asymptomatic men for 8 weeks after return from an area with ongoing local Zika virus transmission, and for symptomatic men, use for 6 months after onset of symptoms is advised.7 |
Local mosquito-borne transmission of Zika virus - Miami-Dade and Broward Counties, Florida, June-August 2016
Likos A , Griffin I , Bingham AM , Stanek D , Fischer M , White S , Hamilton J , Eisenstein L , Atrubin D , Mulay P , Scott B , Jenkins P , Fernandez D , Rico E , Gillis L , Jean R , Cone M , Blackmore C , McAllister J , Vasquez C , Rivera L , Philip C . MMWR Morb Mortal Wkly Rep 2016 65 (38) 1032-1038 During the first 6 months of 2016, large outbreaks of Zika virus disease caused by local mosquito-borne transmission occurred in Puerto Rico and other U.S. territories, but local mosquito-borne transmission was not identified in the continental United States. As of July 22, 2016, the Florida Department of Health had identified 321 Zika virus disease cases among Florida residents and visitors, all occurring in either travelers from other countries or territories with ongoing Zika virus transmission or sexual contacts of recent travelers.* During standard case investigation of persons with compatible illness and laboratory evidence of recent Zika virus infection (i.e., a specimen positive by real-time reverse transcription-polymerase chain reaction [rRT-PCR], or positive Zika immunoglobulin M [IgM] with supporting dengue serology [negative for dengue IgM antibodies and positive for dengue IgG antibodies], or confirmation of Zika virus neutralizing antibodies by plaque reduction neutralization testing [PRNT]), four persons were identified in Broward and Miami-Dade counties whose infections were attributed to likely local mosquito-borne transmission. Two of these persons worked within 120 meters (131 yards) of each other but had no other epidemiologic connections, suggesting the possibility of a local community-based outbreak. Further epidemiologic and laboratory investigations of the worksites and surrounding neighborhood identified a total of 29 persons with laboratory evidence of recent Zika virus infection and likely exposure during late June to early August, most within an approximate 6-block area. In response to limited impact on the population of Aedes aegypti mosquito vectors from initial ground-based mosquito control efforts, aerial ultralow volume spraying with the organophosphate insecticide naled was applied over a 10 square-mile area beginning in early August and alternated with aerial larviciding with Bacillus thuringiensis subspecies israelensis (Bti), a group biologic control agent, in a central 2 square-mile area. No additional cases were identified after implementation of this mosquito control strategy. No increases in emergency department (ED) patient visits associated with aerial spraying were reported, including visits for asthma, reactive airway disease, wheezing, shortness of breath, nausea, vomiting, or diarrhea. Local and state health departments serving communities where Ae. aegypti, the primary vector of Zika virus, is found should continue to actively monitor for local transmission of the virus. |
Prioritizing zoonotic diseases in Ethiopia using a one health approach
Pieracci EG , Hall AJ , Gharpure R , Haile A , Walelign E , Deressa A , Bahiru G , Kibebe M , Walke H , Belay E . One Health 2016 2 131-135 Background Ethiopia has the second largest human population in Africa and the largest livestock population on the continent. About 80% of Ethiopians are dependent on agriculture and have direct contact with livestock or other domestic animals. As a result, the country is vulnerable to the spread of zoonotic diseases. As the first step of the country's engagement in the Global Health Security Agenda, a zoonotic disease prioritization workshop was held to identify significant zoonotic diseases of mutual concern for animal and human health agencies. Methods A semi-quantitative tool developed by the US CDC was used for prioritization of zoonotic diseases. Workshop participants representing human, animal, and environmental health ministries were selected as core decision-making participants. Over 300 articles describing the zoonotic diseases considered at the workshop were reviewed for disease specific information on prevalence, morbidity, mortality, and DALYs for Ethiopia or the East Africa region. Committee members individually ranked the importance of each criterion to generate a final group weight for each criterion. Results Forty-three zoonotic diseases were evaluated. Criteria selected in order of importance were: 1)severity of disease in humans, 2)proportion of human disease attributed to animal exposure, 3)burden of animal disease, 4)availability of interventions, and 5)existing inter-sectoral collaboration. Based on the results from the decision tree analysis and subsequent discussion, participants identified the following five priority zoonotic diseases: rabies, anthrax, brucellosis, leptospirosis, and echinococcosis. Discussion Multi-sectoral collaborations strengthen disease surveillance system development in humans and animals, enhance laboratory capacity, and support implementation of prevention and control strategies. To facilitate this, the creation of a One Health-focused Zoonotic Disease Unit is recommended. Enhancement of public health and veterinary laboratories, joint outbreak and surveillance activities, and intersectoral linkages created to tackle the prioritized zoonotic diseases will undoubtedly prepare the country to effectively address newly emerging zoonotic diseases. |
Evaluating the performance of infectious disease forecasts: A comparison of climate-driven and seasonal dengue forecasts for Mexico
Johansson MA , Reich NG , Hota A , Brownstein JS , Santillana M . Sci Rep 2016 6 33707 Dengue viruses, which infect millions of people per year worldwide, cause large epidemics that strain healthcare systems. Despite diverse efforts to develop forecasting tools including autoregressive time series, climate-driven statistical, and mechanistic biological models, little work has been done to understand the contribution of different components to improved prediction. We developed a framework to assess and compare dengue forecasts produced from different types of models and evaluated the performance of seasonal autoregressive models with and without climate variables for forecasting dengue incidence in Mexico. Climate data did not significantly improve the predictive power of seasonal autoregressive models. Short-term and seasonal autocorrelation were key to improving short-term and long-term forecasts, respectively. Seasonal autoregressive models captured a substantial amount of dengue variability, but better models are needed to improve dengue forecasting. This framework contributes to the sparse literature of infectious disease prediction model evaluation, using state-of-the-art validation techniques such as out-of-sample testing and comparison to an appropriate reference model. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Drug Safety
- Environmental Health
- Food Safety
- Genetics and Genomics
- Health Economics
- Healthcare Associated Infections
- Immunity and Immunization
- Informatics
- Injury and Violence
- Laboratory Sciences
- Maternal and Child Health
- Nutritional Sciences
- Occupational Safety and Health
- Physical Activity
- Program Evaluation
- Public Health Law
- Public Health Leadership and Management
- Reproductive Health
- Statistics as Topic
- Zoonotic and Vectorborne Diseases
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