Prevalence of past-year dental visit among US adults, 1999-2010: Comparison of trends and estimates between the Behavioral Risk Factor Surveillance System and three national surveys
Lin M , Li CH , Wei L , Naavaal S , Kolavic Gray S , Manz MC , Barker L . J Public Health Dent 2016 77 (2) 105-114 OBJECTIVES: To compare estimated prevalence of past-year dental visit (PPYDV) among US adults aged ≥18 years from the Behavioral Risk Factor Surveillance System (BRFSS) to estimates from the Medical Expenditure Panel Survey (MEPS), National Health Interview Survey (NHIS), and National Health and Nutrition Examination Survey (NHANES). METHODS: We estimated PPYDV adjusted for covariates (age, race/ethnicity, education level, poverty status, edentulism) using BRFSS, MEPS, and NHIS 1999-2010, and NHANES 1999-2004. We tested trend in overall PPYDV for BRFSS, MEPS, and NHIS from 1999-2010. For 2002 and 2010, we calculated absolute differences (AD) and 95% confidence intervals (CI) in PPYDV between BRFSS and each of the other surveys overall and among subpopulations defined by covariates. We pooled NHANES 1999-2004 data for comparison with BRFSS 2002. RESULTS: From 1999 to 2010, BRFSS (68.5% vs. 67.5%), MEPS (43.5% vs. 39.7%), and NHIS (63.3% vs. 59.7%) showed small but significant decreases in overall PPYDV. In 2002, estimates for overall PPYDV were highest for BRFSS (70.0%) and lowest for MEPS (43.9%) with estimates for NHIS (61.5%) and NHANES (1999-2004: 58.1%) in between; the largest AD (26.2%, 95% CI: 25.0%-27.3%) was between BRFSS and MEPS. ADs were consistent in 2002 and 2010, overall and by covariates, except among edentate persons, where PPYDV estimates from BRFSS and NHIS were similar. CONCLUSIONS: Estimates of PPYDV from BRFSS were notably higher than estimates from MEPS, NHIS, or NHANES except among the edentate. Trends in PPYDV over time, however, were consistent across all surveys. |
Prevalence of severe joint pain among adults with doctor-diagnosed arthritis - United States, 2002-2014
Barbour KE , Boring M , Helmick CG , Murphy LB , Qin J . MMWR Morb Mortal Wkly Rep 2016 65 (39) 1052-1056 In the United States, arthritis is a leading cause of disability (1,2); arthritis affected an estimated 52.5 million (22.7%) adults in 2010-2012 and has been projected to affect 78.4 million adults by 2040 (3). Severe joint pain (SJP) can limit function and seriously compromise quality of life (4,5). To determine the prevalence of SJP among adults with doctor-diagnosed arthritis, and the trend in SJP from 2002 to 2014, CDC analyzed data from the National Health Interview Survey. In 2014, approximately one fourth of adults with arthritis had SJP (27.2%). Within selected groups, the age-standardized prevalence of SJP was higher among women (29.2%), non-Hispanic blacks (42.3%), Hispanics (35.8%), and persons with a disability (45.6%), and those who were unable to work (51.9%); prevalence also was higher among those who had fair or poor health (49.1%), obesity (31.7%), heart disease (34.1%), diabetes (40.9%), or serious psychological distress (56.3%). From 2002 to 2014, the age-standardized prevalence of SJP among adults with arthritis did not change (p = 0.14); however, the number of adults with SJP was significantly higher in 2014 (14.6 million) than in 2002 (10.5 million). A strategy to improve pain management (e.g., the 2016 National Pain Strategy*) has been developed, and more widespread dissemination of evidence-based interventions that reduce joint pain in adults with arthritis might reduce the prevalence of SJP. |
A Novel Rapidly Growing Mycobacterium Species Causing an Abdominal Cerebrospinal Fluid Pseudocyst Infection.
Hussain CK , de Man TJ , Toney NC , Kamboj K , Balada-Llasat JM , Wang SH . Open Forum Infect Dis 2016 3 (3) ofw146 Nontuberculous mycobacteria (NTM) are a rare cause of ventriculoperitoneal shunt infections. We describe the isolation and identification of a novel, rapidly growing, nonpigmented NTM from an abdominal cerebrospinal fluid pseudocyst. The patient presented with fevers, nausea, and abdominal pain and clinically improved after shunt removal. NTM identification was performed by amplicon and whole-genome sequencing. |
Clinical Impact on Tuberculosis Treatment Outcomes of Discordance Between Molecular and Growth-Based Assays for Rifampin Resistance, California 2003-2013.
Shah NS , Grace Lin SY , Barry PM , Cheng YN , Schecter G , Desmond E . Open Forum Infect Dis 2016 3 (3) ofw150 Background. Data from international settings suggest that isolates of Mycobacterium tuberculosis with rpoB mutations testing phenotypically susceptible to rifampin (RIF) may have clinical significance. We analyzed treatment outcomes of California patients with discordant molecular-phenotypic RIF results. Methods. We included tuberculosis (TB) patients, during 2003-2013, whose specimens tested RIF susceptible phenotypically but had a rpoB mutation determined by pyrosequencing. Demographic data were abstracted from the California TB registry. Phenotypic drug-susceptibility testing, medical history, treatment, and outcomes were abstracted from medical records. Results. Of 3330 isolates tested, 413 specimens had a rpoB mutation (12.4%). Of these, 16 (3.9%) had molecular-phenotypic discordant RIF results. Seven mutations were identified: 511Pro, 516Phe, 526Asn, 526Ser (AGC and TCC), 526Cys, and 533Pro. Fourteen (88%) had isoniazid (INH) resistance, 6 of whom were also phenotypically resistant to ethambutol (EMB) and/or pyrazinamide (PZA). Five patients (25%), 1 with 511Pro and 4 with 526Asn, relapsed or failed treatment. The initial regimen for 3 patients was RIF, PZA, and EMB; 1 patient received RIF, PZA, EMB, and a fluoroquinolone (FQN); and 1 patient received RIF, EMB, FQN, and some second-line medications. Upon retreatment with an expanded regimen, 3 (75%) patients completed treatment, 1 patient moved before treatment completion, and 1 patient continues on treatment. The remaining 11 patients had a successful outcome with 9 having received a FQN and/or a rifamycin. Conclusions. Rifampin molecular-phenotypic discordance was rare, and most isolates had INH resistance. Patients who did not receive an expanded regimen had poor outcomes. These mutations may have clinical importance, and expanded treatment regimens should be considered. |
Comparison of norovirus genogroup I, II and IV seroprevalence among children in the Netherlands, 1963, 1983 and 2006.
van Beek J , de Graaf M , Xia M , Jiang X , Vinje J , Beersma M , de Bruin E , van de Vijver D , Holwerda M , van Houten M , Buisman AM , van Binnendijk R , Osterhaus AD , van der Klis F , Vennema H , Koopmans MP . J Gen Virol 2016 97 (9) 2255-64 Noroviruses are a major cause of acute gastroenteritis worldwide and are a genetically diverse group of viruses. Since 2002, an increasing number of norovirus outbreaks have been reported globally, but it is not clear whether this increase has been caused by a higher awareness or reflects the emergence of new genogroup II genotype 4 (GII.4) variants. The hypothesis that norovirus prevalence has increased post-2002 and is related to the emergence of GII.4 is tested in this study. Sera collected from children aged <5 years of three Dutch cross-sectional population based cohorts in 1963, 1983 and 2006/2007 (n=143, n=130 and n=376, respectively) were tested for specific serum IgG by protein array using antigens to GII.4 and a range of other antigens representing norovirus GI, GII and GIV genotypes. The protein array was validated by paired sera of norovirus infected patients and supernatants of B-cell cultures with single epitope specificity. Evidence for norovirus infection was found to be common among Dutch children in each cohort, but the prevalence towards different genotypes changed over time. At the genogroup level, GI seroprevalence decreased significantly between 1963 and 2006/2007, while a significant increase of GII and, in particular, specific antibodies of the genotype GII.4 was detected in the 2006/2007 cohort. There were no children with only GII.4 antibodies in the 1963 cohort. This study shows that the high GII.4 norovirus incidence in very young children is a recent phenomenon. These findings are of importance for vaccine development and trials that are currently focusing mostly on GII.4 viruses. |
Secondary infections with Ebola virus in rural communities, Liberia and Guinea, 2014-2015
Lindblade KA , Nyenswah T , Keita S , Diallo B , Kateh F , Amoah A , Nagbe TK , Raghunathan P , Neatherlin JC , Kinzer M , Pillai SK , Attfield KR , Hajjeh R , Dweh E , Painter J , Barradas DT , Williams SG , Blackley DJ , Kirking HL , Patel MR , Dea M , Massoudi MS , Barskey AE , Zarecki SL , Fomba M , Grube S , Belcher L , Broyles LN , Maxwell TN , Hagan JE , Yeoman K , Westercamp M , Mott J , Mahoney F , Slutsker L , DeCock KM , Marston B , Dahl B . Emerg Infect Dis 2016 22 (9) 1653-5 Persons who died of Ebola virus disease at home in rural communities in Liberia and Guinea resulted in more secondary infections than persons admitted to Ebola treatment units. Intensified monitoring of contacts of persons who died of this disease in the community is an evidence-based approach to reduce virus transmission in rural communities. |
Self-reported illness among Boston-area international travelers: A prospective study
Chen LH , Han PV , Wilson ME , Stoney RJ , Jentes ES , Benoit C , Ooi WW , Barnett ED , Hamer DH . Travel Med Infect Dis 2016 14 (6) 604-613 BACKGROUND: The Boston Area Travel Medicine Network surveyed travelers on travel-related health problems. METHODS: Travelers were recruited 2009-2011 during pre-travel consultation at three clinics. The investigation included pre-travel data, weekly during-travel diaries, and a post-travel questionnaire. We analyzed demographics, trip characteristics, health problems experienced, and assessed the relationship between influenza vaccination, influenza prevention advice, and respiratory symptoms. RESULTS: Of 987 enrolled travelers, 628 (64%) completed all surveys, of which 400 (64%) reported health problems during and/or after travel; median trip duration was 12 days. Diarrhea affected the most people during travel (172) while runny/stuffy nose affected the most people after travel (95). Of those with health problems during travel, 25% stopped or altered plans; 1% were hospitalized. After travel, 21% stopped planned activities, 23% sought physician or other health advice; one traveler was hospitalized. Travelers who received influenza vaccination and influenza prevention advice had lower rates of respiratory symptoms than those that received influenza prevention advice alone (18% vs 28%, P = 0.03). CONCLUSIONS: A large proportion of Boston-area travelers reported health problems despite pre-travel consultation, resulting in inconveniences. The combination of influenza prevention advice and influenza immunization was associated with fewer respiratory symptoms than those who received influenza prevention advice alone. |
Sporotrichosis-associated hospitalizations, United States, 2000-2013
Gold JA , Derado G , Mody RK , Benedict K . Emerg Infect Dis 2016 22 (10) 1817-20 To determine frequency and risk for sporotrichosis-associated hospitalizations, we analyzed the US 2000-2013 National (Nationwide) Inpatient Sample. An estimated 1,471 hospitalizations occurred (average annual rate 0.35/1 million persons). Hospitalizations were associated with HIV/AIDS, immune-mediated inflammatory diseases, and chronic obstructive pulmonary disease. Although rare, severe sporotrichosis should be considered for at-risk patients. |
Successful treatment of disseminated Anncaliia algerae microsporidial infection with combination fumagillin and albendazole
Boileau M , Ferreira J , Ahmad I , Lavallee C , Qvarnstrom Y , Dufresne SF . Open Forum Infect Dis 2016 3 (3) ofw158 Anncaliia algerae myositis is a life-threatening, emerging microsporidiosis among immunocompromised hosts. We report a case of disseminated A algerae infection in a man previously treated with alemtuzumab. Due to failure of albendazole-based therapy, fumagillin was added as a novel approach to management, with a good clinical response and patient survival. |
What community-based HIV prevention organizations say about their role in biomedical HIV prevention
Smith DK , Maier E , Betts J , Gray S , Kolodziejski B , Hoover KW . AIDS Educ Prev 2016 28 (5) 426-439 Community-based organizations (CBOs) are critical to delivery of effective HIV prevention because of their reach to key populations. This online survey of a national sample of CBOs assessed their awareness of, interest in, and resources needed to provide nonoccupational postexposure prophylaxis (nPEP), preexposure prophylaxis (PrEP), and HIV treatment as prevention (TasP). One hundred seventy-five CBOs participated: 87 clinical and 88 nonclinical CBOs. For nPEP, PrEP, and TasP, program managers reported that awareness was high (94%, 90%, 85%), meeting current client need was low (20%, 13%, 18%), and the likelihood of increasing their current provision with additional resources was somewhat high (62%, 64%, 62%). Clinical CBOs were more prepared to support expansion of these biomedical interventions than nonclinical CBOs. Meeting the information, training, and resource needs of CBOs is critical for effective collaboration to reduce the number of new HIV infections through expanded delivery of PrEP, nPEP, and TasP. |
Legionnaires' disease outbreak at a resort in Cozumel, Mexico
Hampton LM , Garrison L , Kattan J , Brown E , Kozak-Muiznieks NA , Lucas C , Fields B , Fitzpatrick N , Sapian L , Martin-Escobar T , Waterman S , Hicks LA , Alpuche-Aranda C , Lopez-Gatell H . Open Forum Infect Dis 2016 3 (3) ofw170 Background. A Legionnaires' disease (LD) outbreak at a resort on Cozumel Island in Mexico was investigated by a joint Mexico-United States team in 2010. This is the first reported LD outbreak in Mexico, where LD is not a reportable disease. Methods. Reports of LD among travelers were solicited from US health departments and the European Working Group for Legionella Infections. Records from the resort and Cozumel Island health facilities were searched for possible LD cases. In April 2010, the resort was searched for possible Legionella exposure sources. The temperature and total chlorine of the water at 38 sites in the resort were measured, and samples from those sites were tested for Legionella. Results. Nine travelers became ill with laboratory-confirmed LD within 2 weeks of staying at the resort between May 2008 and April 2010. The resort and its potable water system were the only common exposures. No possible LD cases were identified among resort workers. Legionellae were found to have extensively colonized the resort's potable water system. Legionellae matching a case isolate were found in the resort's potable water system. Conclusions. Medical providers should test for LD when treating community-acquired pneumonia that is severe or affecting patients who traveled in the 2 weeks before the onset of symptoms. When an LD outbreak is detected, the source should be identified and then aggressively remediated. Because LD can occur in tropical and temperate areas, all countries should consider making LD a reportable disease if they have not already done so. |
A measles outbreak in an underimmunized Amish community in Ohio
Gastanaduy PA , Budd J , Fisher N , Redd SB , Fletcher J , Miller J , McFadden DJ 3rd , Rota J , Rota PA , Hickman C , Fowler B , Tatham L , Wallace GS , de Fijter S , Parker Fiebelkorn A , DiOrio M . N Engl J Med 2016 375 (14) 1343-1354 Background Although measles was eliminated in the United States in 2000, importations of the virus continue to cause outbreaks. We describe the epidemiologic features of an outbreak of measles that originated from two unvaccinated Amish men in whom measles was incubating at the time of their return to the United States from the Philippines and explore the effect of public health responses on limiting the spread of measles. Methods We performed descriptive analyses of data on demographic characteristics, clinical and laboratory evaluations, and vaccination coverage. Results From March 24, 2014, through July 23, 2014, a total of 383 outbreak-related cases of measles were reported in nine counties in Ohio. The median age of case patients was 15 years (range, <1 to 53); a total of 178 of the case patients (46%) were female, and 340 (89%) were unvaccinated. Transmission took place primarily within households (68% of cases). The virus strain was genotype D9, which was circulating in the Philippines at the time of the reporting period. Measles-mumps-rubella (MMR) vaccination coverage with at least a single dose was estimated to be 14% in affected Amish households and more than 88% in the general (non-Amish) Ohio community. Containment efforts included isolation of case patients, quarantine of susceptible persons, and administration of the MMR vaccine to more than 10,000 persons. The spread of measles was limited almost exclusively to the Amish community (accounting for 99% of case patients) and affected only approximately 1% of the estimated 32,630 Amish persons in the settlement. Conclusions The key epidemiologic features of a measles outbreak in the Amish community in Ohio were transmission primarily within households, the small proportion of Amish people affected, and the large number of people in the Amish community who sought vaccination. As a result of targeted containment efforts, and high baseline coverage in the general community, there was limited spread beyond the Amish community. (Funded by the Ohio Department of Health and the Centers for Disease Control and Prevention.). |
Penicillin use in meningococcal disease management: Active Bacterial Core surveillance sites, 2009
Blain AE , Mandal S , Wu H , MacNeil JR , Harrison LH , Farley MM , Lynfield R , Miller L , Nichols M , Petit S , Reingold A , Schaffner W , Thomas A , Zansky SM , Anderson R , Harcourt BH , Mayer LW , Clark TA , Cohn AC . Open Forum Infect Dis 2016 3 (3) ofw152 In 2009, in the Active Bacterial Core surveillance sites, penicillin was not commonly used to treat meningococcal disease. This is likely because of inconsistent availability of antimicrobial susceptibility testing and ease of use of third-generation cephalosporins. Consideration of current practices may inform future meningococcal disease management guidelines. |
Persistence of antibodies against Middle East Respiratory Syndrome coronavirus
Payne DC , Iblan I , Rha B , Alqasrawi S , Haddadin A , Al Nsour M , Alsanouri T , Ali SS , Harcourt J , Miao C , Tamin A , Gerber SI , Haynes LM , Al Abdallat MM . Emerg Infect Dis 2016 22 (10) 1824-6 To determine how long antibodies against Middle East respiratory syndrome coronavirus persist, we measured long-term antibody responses among persons serologically positive or indeterminate after a 2012 outbreak in Jordan. Antibodies, including neutralizing antibodies, were detectable in 6 (86%) of 7 persons for at least 34 months after the outbreak. |
Estimation of severe Middle East Respiratory Syndrome cases in the Middle East, 2012-2016
O'Hagan JJ , Carias C , Rudd JM , Pham HT , Haber Y , Pesik N , Cetron MS , Gambhir M , Gerber SI , Swerdlow DL . Emerg Infect Dis 2016 22 (10) 1797-9 Using data from travelers to 4 countries in the Middle East, we estimated 3,250 (95% CI 1,300-6,600) severe cases of Middle East respiratory syndrome occurred in this region during September 2012-January 2016. This number is 2.3-fold higher than the number of laboratory-confirmed cases recorded in these countries. |
HIV testing and human rights: the right to the right test
Nkengasong JN , Parekh BS , Hader SL . Lancet HIV 2016 3 (10) e457-8 In September, 2015, Stefano Vella published an important commentary in The Lancet HIV on addressing barriers to end the HIV epidemic by 2030.1 An additional barrier that needs to be addressed is to ensure the quality of HIV diagnostic testing as programmes are scaled up. About 150 million children and adults in 129 low-income and middle-income countries reportedly received HIV testing services in 2014.2 Optimistically assuming a 1% error rate (ie, 99% accuracy), a large number of individuals could be wrongly initiated on antiretroviral therapy (ART) as we enter the test-and-treat era while others who need therapy would not receive it. In fact, although diagnostic tests have high sensitivity and specificity, some studies have reported misdiagnosis rates of 2·6–4·8% that occur in HIV testing programme settings.3, 4 | Almost 20 years ago, in 1998, the Office of the High Commissioner for Human Rights (OHCHR) and the Joint UN Programme on HIV/AIDS (UNAIDS) issued the International Guidelines on HIV/AIDS and Human Rights.5 The guidelines emphasised the need for countries to take steps to protect human rights in the context of HIV/AIDS. The epidemic is ever evolving at a rapid pace, and much has happened since the guidelines were adopted: at the time, fewer than 50 000 people with HIV were receiving life-saving ART in developing countries, now more than 17 million are estimated to be on treatment.6 As the global community responds to the prospects of ending the HIV/AIDS epidemic by 2030, UNAIDS has set an ambitious target of 90% of infected individuals being diagnosed, 90% of those being on ART, and 90% of those achieving viral load suppression by 2020.7 |
Association between parent-adolescent communication about sex-related topics and HIV testing, United States. 2006-2013
Balaji AB , Oraka E , Fasula AM , Jayne PE , Carry MG , Raiford JL . AIDS Care 2016 29 (3) 1-6 Adolescents need information about sex-related topics in order to reduce risk behavior and engage in healthy sexual decision-making. Parents have the potential to be an important source of this information. Using the 2006-2010 and 2011-2013 National Survey of Family Growth, we examined associations between parent-adolescent communication before age 18 about sex-related topics and HIV testing among respondents aged 18-24 that ever had sexual intercourse (women = 3893; men = 3359). Analyses showed that for both men and women, discussing how to prevent HIV/AIDS and how to use a condom with a parent before age 18 were positively associated with HIV testing. Among women only, discussions about methods of birth control, where to get birth control, and STDs were positively associated with HIV testing. Developing strategies and interventions to facilitate parent-adolescent communication about sex-related topics, particularly HIV prevention and condom use, may be important to increase HIV testing among young women and men. |
Associations and trends in cause-specific rates of death among persons reported with HIV infection, 23 U.S. jurisdictions, through 2011
Adih WK , Selik RM , Hall HI , Babu AS , Song R . Open AIDS J 2016 10 144-157 BACKGROUND: Published death rates for persons with HIV have not distinguished deaths due to HIV from deaths due to other causes. Cause-specific death rates would allow better assessment of care needs. METHODS: Using data reported to the US national HIV surveillance system, we examined a) associations between selected decedent characteristics and causes of death during 2007-2011, b) trends in rates of death due to underlying causes among persons with AIDS during 1990-2011, and among all persons with diagnosed HIV infection (with or without AIDS) during 2000-2011. RESULTS: During 2007-2011, non-HIV-attributable causes of death with the highest rates per 1,000 person-years were heart disease (2.0), non-AIDS cancers other than lung cancer (1.4), and accidents (0.8). During 1990-2011, among persons with AIDS, the annual rate of death due to HIV-attributable causes decreased by 89% (from 122.0 to 13.2), and the rate due to non-HIV-attributable-causes decreased by 57% (from 20.0 to 8.6), while the percentage of deaths caused by non-HIV-attributable causes increased from 11% to 43%. During 2000-2011, among persons with HIV infection, the rate of death due to HIV-attributable causes decreased by 69% (from 26.4 to 8.3), and the rate due to non-HIV-attributable causes decreased by 28% (from 10.5 to 7.6), while the percentage of deaths caused by non-HIV-attributable causes increased from 25% to 48%. CONCLUSION: Among HIV-infected persons, as rates of death due to HIV-attributable causes decreased, rates due to non-HIV-attributable causes also decreased, but the percentages of deaths due to non-HIV-attributable causes, such as heart disease and non-AIDS cancers increased. |
Changing clinician practices and attitudes regarding the use of antiretroviral therapy for HIV treatment and prevention: results from the HPTN 065 study
Buchacz K , Farrior J , Beauchamp G , McKinstry L , Kurth AE , Zingman BS , Gordin FM , Donnell D , Mayer KH , El-Sadr WM , Branson B . J Int Assoc Provid AIDS Care 2016 16 (1) 81-90 As part of the HPTN065 study in the Bronx, New York and Washington, the authors, we surveyed clinicians to assess for shifts in their practices and attitudes around HIV treatment and prevention. Antiretroviral therapy (ART)-prescribing clinicians at 39 HIV care sites were offered an anonymous Web-based survey at baseline (2010-2011) and at follow-up (2013). The 165 respondents at baseline and 141 respondents at follow-up had similar characteristics-almost 60% were female, median age was 47 years, two-thirds were physicians, and nearly 80% were HIV specialists. The percentage who reported recommending ART irrespective of CD4 count was higher at follow-up (15% versus 68%), as was the percentage who would initiate ART earlier for patients having unprotected sex with partners of unknown HIV status (64% versus 82%), and for those in HIV-discordant partnerships (75% versus 87%). In line with changing HIV treatment guidelines during 2010 to 2013, clinicians increasingly supported early ART for treatment and prevention. |
Constitutively expressed IFITM3 protein in human pulmonary endothelial cells poses an early infection block to human influenza viruses
Sun X , Zeng H , Kumar A , Belser JA , Maines TR , Tumpey TM . J Virol 2016 90 (24) 11157-11167 A role for pulmonary endothelial cells in the orchestration of cytokine production and leukocyte recruitment during influenza virus infection, leading to severe lung damage, has been recently identified. As the mechanistic pathway for this ability is not fully known, we extended previous studies on influenza virus tropism in cultured human pulmonary endothelial cells. Here, we found that a subset of avian influenza viruses, including potentially pandemic H5N1, H7N9, and H9N2 viruses, could infect human pulmonary endothelial cells (HULEC) with high efficiency compared to human H1N1 or H3N2 viruses. In HULEC, human influenza viruses were capable of binding to host cellular receptors, becoming internalized and initiating hemifusion, but failed to uncoat viral nucleocapsid and replicate in host nuclei. Unlike numerous cell types, including epithelial cells, we found that pulmonary endothelial cells constitutively express a high level of the restriction protein IFITM3 in endosomal compartments. IFITM3 knockdown by siRNA could partially rescue H1N1 virus infection in HULEC, suggesting IFITM3 proteins were involved in blocking human influenza virus infection in endothelial cells. In contrast, selected avian influenza viruses were able to escape IFITM3 restriction in endothelial cells, possibly by fusing in early endosomes at higher pH or by other unknown mechanisms. Collectively, our study demonstrates that the human pulmonary endothelium possesses an intrinsic immunity to human influenza viruses, in part due to the constitutive expression of IFITM3 proteins. Notably, certain avian influenza viruses have evolved to escape this restriction, possibly contributing to virus-induced pneumonia and severe lung disease in humans. IMPORTANCE: Avian influenza viruses, including H5N1 and H7N9 have been associated with severe respiratory disease and fatal outcomes in humans. Although acute respiratory distress syndrome (ARDS) and progressive pulmonary endothelial damage are known to be present during severe human infections, the role of pulmonary endothelial cells in the pathogenesis of avian influenza virus infections is largely unknown. By comparing human seasonal influenza strains to avian influenza viruses we provide greater insight into the interaction of influenza virus with human pulmonary endothelial cells. We show that human influenza virus infection is blocked during the early stages of virus entry, which is likely due to the relatively high expression of the host antiviral factor IFITMs (interferon-induced transmembrane proteins) located in membrane-bound compartments inside cells. Overall, this study provides a mechanism by which human endothelial cells limit replication of human influenza strains whereas avian influenza viruses overcome these restriction factors in this cell type. |
Host-seeking phenology of Ixodes pacificus (Acari: Ixodidae) nymphs in northwestern California in relation to calendar week, woodland type, and weather conditions
Eisen RJ , Clark RJ , Monaghan AJ , Eisen L , Delorey MJ , Beard CB . J Med Entomol 2016 54 (1) 125-131 Local knowledge of when humans are at elevated risk for exposure to tick vectors of human disease agents is required both for the effective use of personal protection measures to avoid tick bites and for implementation of control measures to suppress host-seeking ticks. Here, we used previously published data on the seasonal density of host-seeking Ixodes pacificus Cooley and Kohls nymphs, the primary vectors of Lyme disease spirochetes in the far western USA, collected across a broad habitat and climate gradient in northwestern California to identify predictors of periods of time within the year when questing nymphal density is elevated. Models based on calendar week alone performed similarly to models based on calendar week and woodland type, or meteorological variables. The most suitable model for a given application will depend on user objectives, timescale of interest, and the geographic extent of predictions. Our models sought not only to identify when seasonal host-seeking activity commences, but also when it diminishes to low levels. Overall, we report a roughly 5-7 month period in Mendocino County during which host-seeking nymphal densities exceed a low threshold value. |
Comparison of vector efficiency of Ixodes scapularis (Acari: Ixodidae) from the Northeast and Upper Midwest of the United States for the Lyme disease spirochete Borrelia mayonii
Eisen L , Breuner NE , Hojgaard A , Hoxmeier JC , Pilgard MA , Replogle AJ , Biggerstaff BJ , Dolan MC . J Med Entomol 2016 54 (1) 239-242 Borrelia mayonii, a recently recognized species within the Borrelia burgdorferi sensu lato complex, has been detected in host-seeking Ixodes scapularis Say ticks and found to be associated with Lyme disease in the Upper Midwest. This spirochete has, to date, not been documented from the Northeast, but we previously demonstrated that I. scapularis ticks originating from Connecticut are capable of serving as a vector of B. mayonii In this follow-up study, we compared the vector efficiency for B. mayonii (strain MN14-1420) of I. scapularis ticks originating from Minnesota in the Upper Midwest and Connecticut in the Northeast. CD-1 outbred white mice previously infected with B. mayonii via tick bite were exposed to simultaneous feeding by Minnesota and Connecticut larvae contained within separate feeding capsules. We found no difference in the ability of Minnesota and Connecticut larvae to acquire B. mayonii from infected mice and pass spirochetes to the nymphal stage (overall nymphal infection rates of 11.6 and 13.3%, respectively). Moreover, the efficiency of transmission of B. mayonii by single infected nymphs was similar for the Minnesota and Connecticut ticks (33 and 44%, respectively). We conclude that the examined I. scapularis ticks from the Upper Midwest and Northeast did not differ in their efficiency as vectors for B. mayonii. |
State regulations and opioid use among disabled adults
Jones CM , Baldwin GT , Tefera L . N Engl J Med 2016 375 (14) 1396-1397 Meara et al. (July 7 issue)1 conclude that state laws such as those supporting prescription-drug monitoring programs (PDMPs) do not reduce hazardous opioid use or nonfatal overdose. These conclusions may cause clinicians and policymakers to discount the value of PDMPs. In addition, the findings of the study diverge from those of other recent studies assessing the effect of PDMPs.2-4 Patrick et al., using a more rigorous design to account for the specific features of PDMPs, found that these programs were associated with declines in deaths from opioid overdose.3 Bao et al., using a nationally representative sample — not only Medicare beneficiaries with disabilities — found a 30% decline in the prescribing of Schedule II opioids after the implementation of PDMPs.4 The decision by Meara et al. to include multiple laws regarding controlled substances in a single analysis presupposes that each law within a category is identical. Categorizing laws as enacted or not enacted ignores heterogeneity across laws of the same type. It is the components of a law and the implementation and enforcement of those components that matter. The null findings of the study may be a by-product of these methodologic choices. Additional investigation is needed to further evaluate the effects of PDMPs and other state-level interventions. |
Mandatory provider review and pain clinic laws reduce the amounts of opioids prescribed and overdose death rates
Dowell D , Zhang K , Noonan RK , Hockenberry JM . Health Aff (Millwood) 2016 35 (10) 1876-1883 To address the opioid overdose epidemic in the United States, states have implemented policies to reduce inappropriate opioid prescribing. These policies could affect the coincident heroin overdose epidemic by either driving the substitution of heroin for opioids or reducing simultaneous use of both substances. We used IMS Health's National Prescription Audit and government mortality data to examine the effect of these policies on opioid prescribing and on prescription opioid and heroin overdose death rates in the United States during 2006-13. The analysis revealed that combined implementation of mandated provider review of state-run prescription drug monitoring program data and pain clinic laws reduced opioid amounts prescribed by 8 percent and prescription opioid overdose death rates by 12 percent. We also observed relatively large but statistically insignificant reductions in heroin overdose death rates after implementation of these policies. This combination of policies was effective, but broader approaches to address these coincident epidemics are needed. |
Outpatient antibiotic prescribing among United States nurse practitioners and physician assistants
Sanchez GV , Hersh AL , Shapiro DJ , Cawley JF , Hicks LA . Open Forum Infect Dis 2016 3 (3) ofw168 We examined US nurse practitioner (NP) and physician assistant (PA) outpatient antibiotic prescribing. Antibiotics were more frequently prescribed during visits involving NP/PA visits compared with physician-only visits, including overall visits (17% vs 12%, P < .0001) and acute respiratory infection visits (61% vs 54%, P < .001). Antibiotic stewardship interventions should target NPs and PAs. |
Outpatient antibiotic prescribing practices for uncomplicated urinary tract infection in women in the United States, 2002-2011
Kobayashi M , Shapiro DJ , Hersh AL , Sanchez GV , Hicks LA . Open Forum Infect Dis 2016 3 (3) ofw159 Background. Urinary tract infection (UTI) is one of the most common diagnoses leading to an antibiotic prescription for women seeking ambulatory care. Understanding current national outpatient antibiotic prescribing practices will help ongoing stewardship efforts to optimize antibiotic use; however, information on recent national outpatient antibiotic prescribing trends for UTI is limited. Methods. We analyzed the National Ambulatory Medical Care and National Hospital Ambulatory Medical Care Survey datasets from 2002 to 2011. Outpatient visits of women aged ≥18 years with a diagnosis of uncomplicated UTI were included for analysis. We conducted weighted descriptive analyses, examined time trends in antibiotic prescribing, and used multivariable logistic regression to identify patient and provider factors associated with fluoroquinolone prescribing. Results. A total of 7111 visits were identified. Eighty percent of visits resulted in an antibiotic prescription; fluoroquinolones were the most frequently prescribed antibiotics throughout the study period (49% overall). Older patients (adjusted odds ratio [AOR] for adults aged ≥70 years = 2.5; 95% confidence interval [CI], 1.6-3.8) and patients treated by internists (AOR = 2.0; 95% CI, 1.1-3.3) were more likely than younger patients and those treated by family practitioners to receive fluoroquinolones. Outpatient visits in the West US Census region were less likely to be associated with fluoroquinolone prescribing (AOR = 0.6; 95% CI, .4-1.0) compared with visits in the Northeast. Conclusions. Fluoroquinolones were the most frequently selected antibiotic treatment for uncomplicated UTI in women during the study period. Outpatient antibiotic stewardship initiatives should include efforts to reduce overuse of fluoroquinolones for uncomplicated UTI. |
Public perception of quality and support for required access to drinking water in schools and parks
Long MW , Gortmaker SL , Patel AI , Onufrak SJ , Wilking CL , Cradock AL . Am J Health Promot 2016 32 (1) 72-74 PURPOSE: We assessed public support for required water access in schools and parks and perceived safety and taste of water in these settings to inform efforts to increase access to and consumption of tap water. DESIGN: Cross-sectional survey of the US public collected from August to November 2011. SETTING: Random digit-dialed telephone survey. PARTICIPANTS: Participants (n = 1218) aged 17 and older from 1055 US counties in 46 states. MEASURES: Perceived safety and taste of water in schools and parks as well as support for required access to water in these settings. ANALYSIS: Survey-adjusted perceived safety and taste as well as support for required access were estimated. RESULTS: There was broad support for required access to water throughout the day in schools (96%) and parks (89%). Few participants believed water was unsafe in schools (10%) or parks (18%). CONCLUSION: This study provides evidence of public support for efforts to increase access to drinking water in schools and parks and documents overall high levels of perceived taste and safety of water provided in these settings. |
Measuring urinary N-acetyl-S-(4-hydroxy-2-methyl-2-buten-1-yl)-L-cysteine (IPMA3) as a potential biomarker of isoprene exposure
Alwis KU , Bailey TL , Patel D , Wang L , Blount BC . Anal Chim Acta 2016 941 61-66 Isoprene, the 2-methyl analog of 1,3-butadiene, is identified as a possible human carcinogen by the International Agency for Research on Cancer (IARC). Isoprene is ubiquitous in the environment with numerous natural and anthropogenic sources. Tobacco smoke is the main exogenous source of isoprene exposure in indoor environments. Among smoke constituents, isoprene is thought to contribute significantly to cancer risk; however, no selective urinary biomarkers of isoprene exposure have been identified for humans. In this manuscript, we measured the minor isoprene metabolite IPMA1 (mixture of N-acetyl-S-(1-[hydroxymethyl]-2-methyl-2-propen-1-yl)-L-cysteine and N-acetyl-S-(2-hydroxy-3-methyl-3-buten-1-yl)-L-cysteine), and we identified IPMA3 (N-acetyl-S-(4-hydroxy-2-methyl-2-buten-1-yl)-L-cysteine) as a major isoprene metabolite and novel isoprene exposure biomarker for humans. Urinary isoprene metabolites were measured using ultra high performance liquid chromatography coupled with electrospray ionization triple quad tandem mass spectrometry (UPLC/ESI-MSMS). The detection rates of IPMA1 and IPMA3 are <20% and 82%, respectively. The selectivity and abundance of IPMA3 make it a useful urinary biomarker of isoprene exposure. The limit of detection of IPMA3 in urine was 0.5 ng mL-1. IPMA3 was stable under different storage temperatures and following ten freeze-thaw cycles. The average recovery of urine spiked with IPMA3 at three different levels was 99%. IPMA3 was measured in urine samples received from 75 anonymous subjects; the median (25th percentile, 75th percentile) IPMA3 level in smokers was 36.2 (18.2, 56.8) ng mL-1 and non-smokers 2.31 (2.31, 4.38) ng mL-1. Application of this method to large population studies will help to characterize isoprene exposure and assess potential health impact. |
Whole-Genome Characterization of Epidemic Neisseria meningitidis Serogroup C and Resurgence of Serogroup W, Niger, 2015.
Kretz CB , Retchless AC , Sidikou F , Issaka B , Ousmane S , Schwartz S , Tate AH , Pana A , Njanpop-Lafourcade BM , Nzeyimana I , Nse RO , Deghmane AE , Hong E , Brynildsrud OB , Novak RT , Meyer SA , Oukem-Boyer OO , Ronveaux O , Caugant DA , Taha MK , Wang X . Emerg Infect Dis 2016 22 (10) 1762-8 In 2015, Niger reported the largest epidemic of Neisseria meningitidis serogroup C (NmC) meningitis in sub-Saharan Africa. The NmC epidemic coincided with serogroup W (NmW) cases during the epidemic season, resulting in a total of 9,367 meningococcal cases through June 2015. To clarify the phylogenetic association, genetic evolution, and antibiotic determinants of the meningococcal strains in Niger, we sequenced the genomes of 102 isolates from this epidemic, comprising 81 NmC and 21 NmW isolates. The genomes of 82 isolates were completed, and all 102 were included in the analysis. All NmC isolates had sequence type 10217, which caused the outbreaks in Nigeria during 2013-2014 and for which a clonal complex has not yet been defined. The NmC isolates from Niger were substantially different from other NmC isolates collected globally. All NmW isolates belonged to clonal complex 11 and were closely related to the isolates causing recent outbreaks in Africa. |
Comparative genomic analysis of Haemophilus haemolyticus and non-typeable Haemophilus influenzae and a new testing scheme for their discrimination.
Hu F , Rishishwar L , Sivadas A , Mitchell GJ , Jordan IK , Murphy TF , Gilsdorf JR , Mayer LW , Wang X . J Clin Microbiol 2016 54 (12) 3010-3017 Haemophilus haemolyticus (H. haemolyticus) has been recently discovered to have the potential to cause invasive disease. It is closely related to non-typeable Haemophilus influenzae (NT H. influenzae). NT H. influenzae and H. haemolyticus are often misidentified because none of the existing tests targeting the known phenotypes of H. haemolyticus are able to specifically identify H. haemolyticus Through comparative genomic analysis of H. haemolyticus and NT H. influenzae, we identified genes unique to H. haemolyticus that can be used as targets for the identification of H. haemolyticus A real-time PCR targeting purT (encoding phosphoribosylglycinamide formyltransferase 2 in the purine synthesis pathway) was developed and evaluated. The lower limit of detection was 40 genomes/PCR reaction; the sensitivity and specificity in detecting H. haemolyticus were 98.9% and 97%, respectively. To improve the discrimination of H. haemolyticus and NT H. influenzae, a testing scheme combining two targets (H. haemolyticus purT and H. influenzae hpd encoding protein D lipoprotein) was also evaluated and showed 96.7% sensitivity and 98.2% specificity for the identification of H. haemolyticus, and 92.8% sensitivity and 100% specificity for the identification of H. influenzae The dual-target testing scheme can be used for the diagnosis and surveillance of infection disease caused by H. haemolyticus and NT H. influenzae. |
Naturally Occurring Genetic Variants of Human Acetylcholinesterase and Butyrylcholinesterase and Their Potential Impact on the Risk of Toxicity from Cholinesterase Inhibitors.
Lockridge O , Norgren RB Jr , Johnson RC , Blake TA . Chem Res Toxicol 2016 29 (9) 1381-92 Acetylcholinesterase (AChE) is the physiologically important target for organophosphorus toxicants (OP) including nerve agents and pesticides. Butyrylcholinesterase (BChE) in blood serves as a bioscavenger that protects AChE in nerve synapses from inhibition by OP. Mass spectrometry methods can detect exposure to OP by measuring adducts on the active site serine of plasma BChE. Genetic variants of human AChE and BChE do exist, but loss of function mutations have been identified only in the BCHE gene. The most common AChE variant, His353Asn (H322N), also known as the Yt blood group antigen, has normal AChE activity. The most common BChE variant, Ala567Thr (A539T) or the K-variant in honor of Werner Kalow, has 33% reduced plasma BChE activity. The genetic variant most frequently associated with prolonged response to muscle relaxants, Asp98Gly (D70G) or atypical BChE, has reduced activity and reduced enzyme concentration. Early studies in young, healthy males, performed at a time when it was legal to test nerve agents in humans, showed that individuals responded differently to the same low dose of sarin with toxic symptoms ranging in severity from minimal to moderate. Additionally, animal studies indicated that BChE protects from toxicants that have a higher reactivity with AChE than with BChE (e.g., nerve agents) but not from toxicants that have a higher reactivity with BChE than with AChE (e.g., OP pesticides). As a corollary, we hypothesize that individuals with genetic variants of BChE may be at increased risk of toxicity from nerve agents but not from OP pesticides. |
Absenteeism and employer costs associated with chronic diseases and health risk factors in the US workforce
Asay GR , Roy K , Lang JE , Payne RL , Howard DH . Prev Chronic Dis 2016 13 E141 INTRODUCTION: Employers may incur costs related to absenteeism among employees who have chronic diseases or unhealthy behaviors. We examined the association between employee absenteeism and 5 conditions: 3 risk factors (smoking, physical inactivity, and obesity) and 2 chronic diseases (hypertension and diabetes). METHODS: We identified 5 chronic diseases or risk factors from 2 data sources: MarketScan Health Risk Assessment and the Medical Expenditure Panel Survey (MEPS). Absenteeism was measured as the number of workdays missed because of sickness or injury. We used zero-inflated Poisson regression to estimate excess absenteeism as the difference in the number of days missed from work by those who reported having a risk factor or chronic disease and those who did not. Covariates included demographics (eg, age, education, sex) and employment variables (eg, industry, union membership). We quantified absenteeism costs in 2011 and adjusted them to reflect growth in employment costs to 2015 dollars. Finally, we estimated absenteeism costs for a hypothetical small employer (100 employees) and a hypothetical large employer (1,000 employees). RESULTS: Absenteeism estimates ranged from 1 to 2 days per individual per year depending on the risk factor or chronic disease. Except for the physical inactivity and obesity estimates, disease- and risk-factor-specific estimates were similar in MEPS and MarketScan. Absenteeism increased with the number of risk factors or diseases reported. Nationally, each risk factor or disease was associated with annual absenteeism costs greater than $2 billion. Absenteeism costs ranged from $16 to $81 (small employer) and $17 to $286 (large employer) per employee per year. CONCLUSION: Absenteeism costs associated with chronic diseases and health risk factors can be substantial. Employers may incur these costs through lower productivity, and employees could incur costs through lower wages. |
Increase in Middle East Respiratory Syndrome-Coronavirus Cases in Saudi Arabia Linked to Hospital Outbreak With Continued Circulation of Recombinant Virus, July 1-August 31, 2015.
Assiri AM , Biggs HM , Abedi GR , Lu X , Bin Saeed A , Abdalla O , Mohammed M , Al-Abdely HM , Algarni HS , Alhakeem RF , Almasri MM , Alsharef AA , Nooh R , Erdman DD , Gerber SI , Watson JT . Open Forum Infect Dis 2016 3 (3) ofw165 During July-August 2015, the number of cases of Middle East respiratory syndrome (MERS) reported from Saudi Arabia increased dramatically. We reviewed the 143 confirmed cases from this period and classified each based upon likely transmission source. We found that the surge in cases resulted predominantly (90%) from secondary transmission largely attributable to an outbreak at a single healthcare facility in Riyadh. Genome sequencing of MERS coronavirus from 6 cases demonstrated continued circulation of the recently described recombinant virus. A single unique frameshift deletion in open reading frame 5 was detected in the viral sequence from 1 case. |
Highlighting the need for more infection control practitioners in low- and middle-income countries
Lipke V , Emerson C , McCarthy C , Briggs-Hagen M , Farley J , Verani AR , Riley PL . Public Health Action 2016 6 (3) 160-163 Background: Many low- and middle-income countries struggle to implement, monitor and evaluate the efficacy of infection control (IC) measures within health care facilities. This hampers their ability to prevent nosocomial infections, identify emerging pathogens and rapidly alert officials to possible outbreaks. The lack of dedicated and trained IC practitioners (ICPs) is a serious deficit in the health care workforce, and is worsened by the lack of institutions that offer IC training. Discussion: While no single individual can entirely eliminate the risk of nosocomial transmission, there is literature to support the value of designated IC persons. Recommendations from the World Health Organization in 2008 and 2009 describe the need for this specialized cadre of workers, but many countries lack the national regulations to authorize, train and manage such professionals at the national or local level. This article provides an overview of how ICPs are trained and credentialed in several countries, and discusses approaches countries can use to train ICPs. Conclusion: Trained ICPs can help prevent future outbreaks and control nosocomial transmission of diseases in health care facilities. For this to occur, supportive national policies, availability of training institutions and local administrative support will be required. |
Comparison of data collection for healthcare-associated infection surveillance in nursing homes
Epstein L , Stone ND , LaPlace L , Harper J , Lynfield R , Warnke L , Whitten T , Maloney M , Melchreit R , Rodriguez R , Quinlan G , Concannon C , Dumyati G , Thompson DL , Thompson N . Infect Control Hosp Epidemiol 2016 37 (12) 1-6 OBJECTIVE To facilitate surveillance and describe the burden of healthcare-associated infection (HAI) in nursing homes (NHs), we compared the quality of resident-level data collected by NH personnel and external staff. DESIGN A 1-day point-prevalence survey SETTING AND PARTICIPANTS Overall, 9 nursing homes among 4 Centers for Disease Control and Prevention (CDC) Emerging Infection Program (EIP) sites were included in this study. METHODS NH personnel collected data on resident characteristics, clinical risk factors for HAIs, and the presence of 3 HAI screening criteria on the day of the survey. Trained EIP surveillance officers collected the same data elements via retrospective medical chart review for comparison; surveillance officers also collected available data to identify HAIs (using revised McGeer definitions). Overall agreement was calculated among residents identified by both teams with selected risk factors and HAI screening criteria. The impact of using NH personnel to collect screening criteria on HAI prevalence was assessed. RESULTS The overall prevalence of clinical risk factors among the 1,272 residents was similar between NH personnel and surveillance officers, but the level of positive agreement (residents with factors identified by both teams) varied between 39% and 87%. Surveillance officers identified 253 residents (20%) with ≥1 HAI screening criterion, resulting in 67 residents with an HAI (5.3 per 100 residents). The NH personnel identified 152 (12%) residents with ≥1 HAI screening criterion; 42 residents had an HAI (3.5 per 100 residents). CONCLUSION We identified discrepancies in resident-level data collection between surveillance officers and NH personnel, resulting in varied estimates of the HAI prevalence. These findings have important implications for the design and implementation of future HAI prevalence surveys. Infect Control Hosp Epidemiol 2016;1-6. |
Population-Level Effects of Human Papillomavirus Vaccination Programs on Infections with Nonvaccine Genotypes.
Mesher D , Soldan K , Lehtinen M , Beddows S , Brisson M , Brotherton JM , Chow EP , Cummings T , Drolet M , Fairley CK , Garland SM , Kahn JA , Kavanagh K , Markowitz L , Pollock KG , Soderlund-Strand A , Sonnenberg P , Tabrizi SN , Tanton C , Unger E , Thomas SL . Emerg Infect Dis 2016 22 (10) 1732-40 We analyzed human papillomavirus (HPV) prevalences during prevaccination and postvaccination periods to consider possible changes in nonvaccine HPV genotypes after introduction of vaccines that confer protection against 2 high-risk types, HPV16 and HPV18. Our meta-analysis included 9 studies with data for 13,886 girls and women ≤19 years of age and 23,340 women 20-24 years of age. We found evidence of cross-protection for HPV31 among the younger age group after vaccine introduction but little evidence for reductions of HPV33 and HPV45. For the group this same age group, we also found slight increases in 2 nonvaccine high-risk HPV types (HPV39 and HPV52) and in 2 possible high-risk types (HPV53 and HPV73). However, results between age groups and vaccines used were inconsistent, and the increases had possible alternative explanations; consequently, these data provided no clear evidence for type replacement. Continued monitoring of these HPV genotypes is important. |
Real-time monitoring of vaccination campaign performance using mobile phones - Nepal, 2016
Oh DH , Dabbagh A , Goodson JL , Strebel PM , Thapa S , Giri JN , Shakya SR , Khanal S . MMWR Morb Mortal Wkly Rep 2016 65 (39) 1072-1076 In 2012, the Global Vaccine Action Plan established a goal to achieve measles and rubella elimination in five of the six World Health Organization (WHO) regions (194 countries) by 2020. Measles elimination strategies aim to achieve ≥95% coverage with 2 routine doses of measles-containing vaccine, and implement supplementary immunization activities (SIAs) in settings where routine coverage is low or where there are subpopulations at high risk. To ensure SIA quality and to achieve ≥95% SIA coverage nationally, rapid convenience monitoring (RCM) is used during or immediately after SIAs. The objective of RCM is to find unvaccinated children and to identify reasons for nonvaccination in areas with persons at high risk, to enable immediate implementation of corrective actions (e.g., reassigning teams to poorly vaccinated areas, modifying the timing of vaccination, or conducting mop-up vaccination activities). This report describes pilot testing of RCM using mobile phones (RCM-MP) during the second phase of an SIA in Nepal in 2016. Use of RCM-MP resulted in 87% timeliness and 94% completeness of data reporting and found that, although 95% of children were vaccinated, 42% of areas required corrective vaccination activities. RCM-MP challenges included connecting to mobile networks, small phone screen size, and capturing Global Positioning System (GPS) coordinates. Nonetheless, use of RCM-MP led to faster data transmission, analysis, and decision-making and to increased accountability among levels of the health system. |
Review of naturally occurring intussusception in young children in the WHO African Region prior to the era of rotavirus vaccine utilization in the expanded programme of immunization
Mpabalwani EM , Mwenda JM , Tate JE , Parashar UD . J Trop Pediatr 2016 63 (3) 221-228 Rotavirus vaccines, Rotarix and RotaTeq, are increasingly being introduced in national immunization programmes in Africa to prevent severe dehydrating acute gastroenteritis. A low-level risk of intussusception has been associated with rotavirus vaccines. We reviewed published data on intussusception in children <2 years of age in Africa. PubMed electronic database search was used to retrieve papers published on intussusception. The search was further refined to identify surveillance reports and case series conducted from 1980 to 2014, with at least 25 cases. The initial search identified 34 studies, and the refined search yielded 16. Intussusception occurred naturally in infants 2-4 months and peaked around 5-8 months of age. Delayed presentation was common and required surgical intervention in 87% (1008 of 1158) of cases with a high CFR, 10-33.7%. In African children, intussusception has been reported infrequently at a young age when the first dose of rotavirus vaccine is administered. |
Update on incidence of herpes zoster among children and adolescents after implementation of varicella vaccination, Antelope Valley, CA, 2000 to 2010
Civen R , Marin M , Zhang J , Abraham A , Harpaz R , Mascola L , Bialek SR . Pediatr Infect Dis J 2016 35 (10) 1132-6 BACKGROUND: Changes in herpes zoster (HZ) epidemiology are expected with childhood varicella vaccination. We reported previously that during 2000 to 2006 HZ incidence decreased 55% in children <10 years of age, while among 10- to 19-year olds it increased by 63%. We update the analysis with 4 additional years of data. METHODS: Population-based active surveillance was conducted for HZ in Antelope Valley, California. Structured telephone interviews and medical chart reviews collected data on demographics, varicella vaccinations, disease histories and clinical information. We calculated HZ incidence for 2007 to 2010 and assessed trends since 2000. RESULTS: Among children <10 years of age, HZ incidence continued the decreasing trend previously reported. During 2007 to 2010, the average incidence was 12.8 cases/100,000 children compared with 41.6 cases/100,000 children during 2000 to 2006, a 69% decline (P < 0.0001). For the 10- to 19-year olds, during 2007 to 2010 HZ incidence did not continue the increasing trend reported from 2000 to 2006; lower rates than in 2006 were observed in 3 of the 4 additional years evaluated. During 2007 to 2010 the average incidence was 78.2 cases/100,000 children compared with 68.0 cases/100,000 children during 2000 to 2006, a 13% increase (P = 0.123), with substantial fluctuation in annual rates throughout the 11 years of surveillance. CONCLUSIONS: During the mature varicella vaccination program, declines in HZ incidence among children <10 years of age continued through 2010. Among the 10- to 19-year olds, the increase reported through 2006 did not continue further and lower rates than in 2006 were observed through 2010. Widespread use of varicella vaccine could reduce HZ incidence among vaccinated populations. Ongoing monitoring of HZ incidence is needed to detect and understand changes in HZ epidemiology in the varicella vaccine era. |
Vaccination coverage among children aged 19-35 months - United States, 2015
Hill HA , Elam-Evans LD , Yankey D , Singleton JA , Dietz V . MMWR Morb Mortal Wkly Rep 2016 65 (39) 1065-1071 Sustained high coverage with recommended vaccinations among children has kept many vaccine-preventable diseases at low levels in the United States. To assess coverage with vaccinations recommended for children by age 2 years in the United States. CDC analyzed data collected by the 2015 National Immunization Survey (NIS) for children aged 19-35 months (born January 2012-May 2014). Overall, coverage did not change during 2014-2015. Coverage in 2015 was highest for ≥3 doses of poliovirus vaccine (93.7%), ≥3 doses of hepatitis B vaccine (HepB) (92.6%), ≥1 dose of measles, mumps, and rubella vaccine (MMR) (91.9%), and ≥1 dose of varicella vaccine (91.8%). The data were also examined for potential vaccination coverage differences by race/ethnicity, poverty status, and urbanicity. Although disparities were noted for each of these factors, the most striking differences were seen for poverty status. Children living below the federal poverty level* had lower coverage with most of the vaccinations assessed compared with children living at or above the poverty level; the largest disparities were for rotavirus vaccine (66.8% versus 76.8%), ≥4 doses of pneumococcal conjugate vaccine (PCV) (78.9% versus 87.2%), the full series of Haemophilus influenzae type b vaccine (Hib) (78.1% versus 85.5%), and ≥4 doses of diphtheria, tetanus, and acellular pertussis vaccine (DTaP) (80.2% versus 87.1%). Although coverage was high in some groups, opportunities exist to continue to address disparities. Implementation of evidence-based interventions, including strategies to enhance access to vaccination services and systems strategies that can reduce missed opportunities, has the potential to increase vaccination coverage for children living below the poverty level and in rural areas. |
Vaccination coverage among children in kindergarten - United States, 2015-16 school year
Seither R , Calhoun K , Mellerson J , Knighton CL , Street E , Dietz V , Underwood JM . MMWR Morb Mortal Wkly Rep 2016 65 (39) 1057-1064 State-mandated vaccination requirements for school entry protect children and communities against vaccine-preventable diseases. Each school year, federally funded immunization programs (e.g., states, territories, jurisdictions) collect and report kindergarten vaccination data to CDC. This report describes vaccination coverage estimates in all 50 states and the District of Columbia (DC), and the estimated number of kindergartners with at least one vaccine exemption in 47 states and DC, during the 2015-16 school year. Median vaccination coverage was 94.6% for 2 doses of measles, mumps and rubella vaccine (MMR); 94.2% for diphtheria, tetanus, and acellular pertussis vaccine (DTaP); and 94.3% for 2 doses of varicella vaccine. MMR coverage increased in 32 states during the last year, and 22 states reported coverage ≥95%. A total of 45 states and DC had either a grace period allowing students to attend school before providing documentation of vaccination or provisional enrollment that allows undervaccinated students to attend school while completing a catch-up schedule. Among the 23 states that were able to voluntarily report state-level data on grace period or provisional enrollment to CDC, a median of 2.0% of kindergartners were not documented as completely vaccinated and were attending school within a grace period or were provisionally enrolled. The median percentage of kindergartners with an exemption from one or more vaccinations was 1.9%. State and local immunization programs, in cooperation with schools, can improve vaccination coverage by ensuring that all kindergartners are vaccinated during the grace period or provisional enrollment. |
Promoting influenza vaccination to restaurant employees
Graves MC , Harris JR , Hannon PA , Hammerback K , Parrish AT , Ahmed F , Zhou C , Allen CL . Am J Health Promot 2016 30 (7) 498-500 PURPOSE: To evaluate an evidence-based workplace approach to increasing adult influenza vaccination levels applied in the restaurant setting DESIGN: We implemented an intervention and conducted a pre/post analysis to determine effect on vaccination. SETTING: Eleven Seattle-area restaurants. SUBJECTS: Restaurants with 25+ employees speaking English or Spanish and over 18 years. INTERVENTION: Restaurants received influenza vaccination promotion materials, assistance arranging on-site vaccination events, and free influenza vaccinations for employees. MEASURES: Pre/post employee surveys of vaccination status with direct observation and employer interviews to evaluate implementation. ANALYSIS: We conducted descriptive analysis of employee survey data and performed qualitative analysis of implementation data. To assess intervention effect, we used a mixed-effects logistic regression model with a restaurant-specific random effect. RESULTS: Vaccination levels increased from 26% to 46% (adjusted odds ratio 2.33, 95% confidence interval 1.69, 3.22), with 428 employees surveyed preintervention, 305 surveyed postintervention, and response rates of 73% and 55%, respectively. The intervention was effective across subgroups, but there were restaurant-level differences. CONCLUSION: An access-based workplace intervention can increase influenza vaccination levels in restaurant employees, but restaurant-level factors may influence success. |
Effect of 10-valent pneumococcal conjugate vaccine on nasopharyngeal carriage of Streptococcus pneumoniae and Haemophilus influenzae among children in Sao Paulo, Brazil
Brandileone MC , Zanella RC , Almeida SC , Brandao AP , Ribeiro AF , Carvalhanas TM , Sato H , Andrade AL , Verani JR . Vaccine 2016 34 (46) 5604-5611 In March 2010, Brazil introduced the 10-valent pneumococcal conjugate vaccine (PCV10) in the routine infant immunization program using a 4-dose schedule and catch-up for children <23months. We investigated PCV10 effect on nasopharyngeal carriage with vaccine-type Streptococcus pneumoniae (Spn) and non-typeable Haemophilus influenzae (NTHi) among children in Sao Paulo city. Cross-sectional surveys were conducted in 2010 (baseline) and 2013 (post-PCV10). Healthy PCV-naive children aged 12-23months were recruited from primary health centers during immunization campaigns. Nasopharyngeal swabs were collected and tested for Hi; for Spn, all baseline and a stratified random sample of 400 post-PCV10 swabs were tested. We compared vaccine-type Spn and NTHi carriage prevalence pre-/post-PCV10, and used logistic regression to estimate PCV10 effectiveness (1-adjusted odds ratiox100%). Overall 501 children were included in the baseline and 1167 in the post-PCV10 survey (including 400 tested for Spn). Spn was detected in 40.3% of children at baseline and 48.8% post-PCV10; PCV10 serotypes were found in 19.8% and 1.8% respectively, representing a decline of 90.9% (p<0.0001). Carriage of vaccine-related serotypes increased (10.8-21.0%, p<0.0001), driven primarily by a rise in serotype 6C (1.8-11.2%, p<0.0001); carriage of serotypes 6A and 19A did not significantly change. PCV10 effectiveness (4 doses) against vaccine-type carriage was 97.3% (95% confidence interval 88.7-99.3). NTHi prevalence increased from 26.0% (130/501) to 43.6% (509/1167, p<0.0001); PCV10 vaccination seemed significantly associated with NTHi carriage, even after adjusting for other known risk factors. Carriage with PCV10 serotypes among toddlers declined dramatically following PCV10 introduction in Sao Paulo, Brazil. No protection of PCV10 against NTHi was observed. Our findings contribute to a growing body of evidence of PCV10 impact on vaccine-type carriage and highlight the importance of PCV10 as a tool to reduce the burden of pneumococcal disease in Brazil and globally. |
Integrating pharmacies into public health program planning for pandemic influenza vaccine response
Fitzgerald TJ , Kang Y , Bridges CB , Talbert T , Vagi SJ , Lamont B , Graitcer SB . Vaccine 2016 34 (46) 5643-5648 BACKGROUND: During an influenza pandemic, to achieve early and rapid vaccination coverage and maximize the benefit of an immunization campaign, partnerships between public health agencies and vaccine providers are essential. Immunizing pharmacists represent an important group for expanding access to pandemic vaccination. However, little is known about nationwide coordination between public health programs and pharmacies for pandemic vaccine response planning. METHODS: To assess relationships and planning activities between public health programs and pharmacies, we analyzed data from Centers for Disease Control and Prevention assessments of jurisdictions that received immunization and emergency preparedness funding from 2012 to 2015. RESULTS: Forty-seven (88.7%) of 53 jurisdictions reported including pharmacies in pandemic vaccine distribution plans, 24 (45.3%) had processes to recruit pharmacists to vaccinate, and 16 (30.8%) of 52 established formal relationships with pharmacies. Most jurisdictions plan to allocate less than 10% of pandemic vaccine supply to pharmacies. DISCUSSION: While most jurisdictions plan to include pharmacies as pandemic vaccine providers, work is needed to establish formalized agreements between public health departments and pharmacies to improve pandemic preparedness coordination and ensure that vaccinating pharmacists are fully utilized during a pandemic. |
2014-2015 influenza vaccine effectiveness in the United States by vaccine type
Zimmerman RK , Nowalk MP , Chung J , Jackson ML , Jackson LA , Petrie JG , Monto AS , McLean HQ , Belongia EA , Gaglani M , Murthy K , Fry AM , Flannery B . Clin Infect Dis 2016 63 (12) 1564-1573 BACKGROUND: The circulating A/H3N2 influenza viruses drifted significantly after the selection of strains for the 2014-2015 influenza vaccines. Also in 2014-2015, the Advisory Committee on Immunization Practices recommended preferential use of live attenuated influenza vaccine (LAIV) over inactivated influenza vaccine (IIV) among children 2-8 years old. METHODS: Vaccine effectiveness (VE) across age groups and vaccine types was examined among individuals seeking outpatient treatment for acute respiratory illness from 5 U.S. sites using a test-negative design that compared the odds of vaccination among reverse transcription polymerase chain reaction-confirmed influenza positives and negatives. RESULTS: Of the 9,311 enrollees with complete data, 7,078 (76%) were negative for influenza, 1,840 (19.8%) were positive for influenza A (A/H3N2, n=1817) and 395 (4.2%) for influenza B (B/Yamagata, n=340). The overall adjusted VE for influenza A and B was 19% (95%CI= 10% to 27%) and was statistically significant in all age strata except 18-64 year-olds. The adjusted VE of 6% (95%CI= -5% to 17%) against A/H3N2-associated illness was not statistically significant, unlike VE for influenza B/Yamagata which was 55% (95%CI= 43% to 65%). Among those aged 2-8 years, VE against A/H3N2 was 15% (95%CI= -16% to 38%) for IIV and -3% (CI= -50% to 29%) for LAIV; whereas, VE against B/Yamagata was 40% (95%CI= -20% to 70%) for IIV and 74% (95%CI= 25% to 91%) for LAIV. CONCLUSION: The 2014-2015 influenza vaccines offered little protection against the predominant influenza A/H3N2 virus, but were effective against influenza B. Preferential use of LAIV among young children was not supported. |
Assessing strategies for increasing urban routine immunization coverage of childhood vaccines in low and middle-income countries: A systematic review of peer-reviewed literature
Nelson KN , Wallace AS , Sodha SV , Daniels D , Dietz V . Vaccine 2016 34 (46) 5495-5503 INTRODUCTION: Immunization programs in developing countries increasingly face challenges to ensure equitable delivery of services within cities where rapid urban growth can result in informal settlements, poor living conditions, and heterogeneous populations. A number of strategies have been utilized in developing countries to ensure high community demand and equitable availability of urban immunization services; however, a synthesis of the literature on these strategies has not previously been undertaken. METHODS: We reviewed articles published in English in peer-reviewed journals between 1990 and 2013 that assessed interventions for improving routine immunization coverage in urban areas in low- and middle-income countries. We categorized the intervention in each study into one of three groups: (1) interventions aiming to increase utilization of immunization services; (2) interventions aiming to improve availability of immunization services by healthcare providers, or (3) combined availability and utilization interventions. We summarized the main quantitative outcomes from each study and effective practices from each intervention category. RESULTS: Fifteen studies were identified; 87% from the African, Eastern Mediterranean and Southeast Asian regions of the World Health Organization (WHO). Six studies were randomized controlled trials, eight were pre- and post-intervention evaluations, and one was a cross-sectional study. Four described interventions designed to improve availability of routine immunization services, six studies described interventions that aimed to increase utilization, and five studies aiming to improve both availability and utilization of services. All studies reported positive change in their primary outcome indicator, although seven different primary outcomes indicators were used across studies. Studies varied considerably with respect to the type of intervention assessed, study design, and length of intervention assessment. CONCLUSION: Few studies have assessed interventions designed explicitly for the unique challenges facing immunization programs in urban areas. Further research on sustainability, scalability, and cost-effectiveness of interventions is needed to fill this gap. |
Assessing the potential cost-effectiveness of microneedle patches in childhood measles vaccination programs: the case for further research and development
Adhikari BB , Goodson JL , Chu SY , Rota PA , Meltzer MI . Drugs R D 2016 16 (4) 327-338 OBJECTIVE: Currently available measles vaccines are administered by subcutaneous injections and require reconstitution with a diluent and a cold chain, which is resource intensive and challenging to maintain. To overcome these challenges and potentially increase vaccination coverage, microneedle patches are being developed to deliver the measles vaccine. This study compares the cost-effectiveness of using microneedle patches with traditional vaccine delivery by syringe-and-needle (subcutaneous vaccination) in children's measles vaccination programs. METHODS: We built a simple spreadsheet model to compute the vaccination costs for using microneedle patch and syringe-and-needle technologies. We assumed that microneedle vaccines will be, compared with current vaccines, more heat stable and require less expensive cool chains when used in the field. We used historical data on the incidence of measles among communities with low measles vaccination rates. RESULTS: The cost of microneedle vaccination was estimated at US$0.95 (range US$0.71-US$1.18) for the first dose, compared with US$1.65 (range US$1.24-US$2.06) for the first dose delivered by subcutaneous vaccination. At 95 % vaccination coverage, microneedle patch vaccination was estimated to cost US$1.66 per measles case averted (range US$1.24-US$2.07) compared with an estimated cost of US$2.64 per case averted (range US$1.98-US$3.30) using subcutaneous vaccination. CONCLUSIONS: Use of microneedle patches may reduce costs; however, the cost-effectiveness of patches would depend on the vaccine recipients' acceptability and vaccine effectiveness of the patches relative to the existing conventional vaccine-delivery method. This study emphasizes the need to continue research and development of this vaccine-delivery method that could boost measles elimination efforts through improved access to vaccines and increased vaccination coverage. |
CVD 103-HgR vaccine for travelers
Wong KK , Mahon BE , Reingold A . Travel Med Infect Dis 2016 14 (6) 632-633 The CVD 103-HgR vaccine (Vaxchora), described in “Re-born in the USA: Another cholera vaccine for travellers” by Dr. Freedman, will soon be available to adult travelers to cholera-affected areas [1]. In the United States, most cholera cases reported to the national Cholera and Other Vibrio Illness Surveillance (COVIS) system are associated with travel to cholera-affected areas. In 2011, after the cholera epidemic began in Haiti, 42 cases of laboratory-confirmed cholera were reported [2]. Few cases were reported in 2012 (18), 2013 (14), and 2014 (7). Although cholera is rare in the United States, cases reported to COVIS underestimate the risk to travelers for several reasons. First, cholera is under-reported in the United States, as testing stool specimens for Vibrio cholerae is not routine. Second, although cholera can be life-threatening, illness is usually fairly mild and self-limited, so ill persons may not seek medical care. Third, the incubation period is short, thus many infections likely occur during travel rather than after return to the United States. Such illnesses are not captured by COVIS. Among 90 cases of travel-associated cholera in the United States reported from 2001 to 2011, reasons for travel included visiting friends and relatives (62%), medical missions or other relief work (9%), tourism (7%), and business (7%) [3]. | In June 2016, the Advisory Committee on Immunization Practices (ACIP) approved a recommendation for CVD 103- HgR vaccine for adult (18–64 years old) travelers to areas of active cholera transmission [4]. The ACIP considered additional risk factors for travelers to these areas, including increased risk of toxigenic V. cholerae O1 exposure and increased risk of severe outcomes. However, only travel to an area of active cholera transmission was included in the approved recommendation; other risk factors are not mentioned in the recommendation. The proposed definition of an area of active cholera transmission is a province, state, or other administrative subdivision within a country with endemic or epidemic cholera caused by toxigenic V. cholerae O1. It includes areas with cholera activity within the last 1 year that are prone to recurrence of cholera epidemics; it does not include areas where rare sporadic cases have been reported. The vaccine is not routinely recommended for most travelers from the United States, as most travelers from the United States do not visit areas with active cholera transmission. CDC is developing resources for clinicians and travelers to learn which travel destinations may have active cholera transmission. |
Investigation of epizootic papillomatosis in bluegill Lepomis macrochirus (Rafinesque 1810) using next-generation sequencing.
Dill JA , Williams SM , Leary JH , Ng TF , Camus AC . J Fish Dis 2016 40 (7) 947-952 Orocutaneous neplasms in fish have been recognized for over a century. Most are benign epidermal hyperplasias and papillomas, with rare squamous cell carcinomas. In the brown bullhead Ameiurus nebulous, evidence suggests a possible chemical aetiology, while virus or virus-like particles have been demonstrated in other species. Some sources relate tumour development to potential interactions between environmental contaminants and viruses. Several tumour-associtaed cirus particles have been tentatively identified based on morphology only, including herpesviruses, retroviruses, adenoviruses and others. |
High-throughput and sensitive analysis of urinary heterocyclic aromatic amines using isotope-dilution liquid chromatography-tandem mass spectrometry and robotic sample preparation system
Zhang L , Xia Y , Xia B , Nicodemus KJ , McGuffey J , McGahee E , Blount B , Wang L . Anal Bioanal Chem 2016 408 (28) 8149-8161 Heterocyclic aromatic amines (HCAA) are listed by the US Food and Drug Administration (FDA) as harmful or potentially harmful constituents of tobacco smoke. However, quantifying HCAA exposure is challenging. In this study, we developed a sensitive, precise, and accurate isotope dilution, liquid chromatography-tandem mass spectrometry (LC-MS/MS) method to quantify urinary HCAAs in smokers and nonsmokers. The high-throughput robotic sample preparation system could handle a throughput of over 300 samples per day, while maintaining intra-day and inter-day imprecision and bias ≤10 %. The limits of detection of carcinogenic HCAAs ranged from 0.31 to 0.83 pg/mL. The validated method was applied to measure HCAAs in urine collected from smokers and non-smokers. This sensitive and efficient analytical method is ideal to support large-scale biomonitoring studies of HCAA exposure. Graphical Abstract LC/MS/MS and robotic sample preparation system for urinary HCAA analysis. |
Detection of human norovirus in intestinal biopsies from immunocompromised transplant patients
Karandikar UC , Crawford SE , Ajami NJ , Murakami K , Kou B , Ettayebi K , Papanicolaou GA , Jongwutiwes U , Perales MA , Shia J , Mercer D , Finegold MJ , Vinje J , Atmar RL , Estes MK . J Gen Virol 2016 97 (9) 2291-300 Human noroviruses (HuNoVs) can often cause chronic infections in solid organ and haematopoietic stem cell transplant (HSCT) patients. Based on histopathological changes observed during HuNoV infections, the intestine is the presumed site of virus replication in patients; however, the cell types infected by HuNoVs remain unknown. The objective of this study was to characterize histopathological changes during HuNoV infection and to determine the cell types that may be permissive for HuNoV replication in transplant patients. We analysed biopsies from HuNoV-infected and non-infected (control) transplant patients to assess histopathological changes in conjunction with detection of HuNoV antigens to identify the infected cell types. HuNoV infection in immunocompromised patients was associated with histopathological changes such as disorganization and flattening of the intestinal epithelium. The HuNoV major capsid protein, VP1, was detected in all segments of the small intestine, in areas of biopsies that showed histopathological changes. Specifically, VP1 was detected in enterocytes, macrophages, T cells and dendritic cells. HuNoV replication was investigated by detecting the non-structural proteins, RdRp and VPg. We detected RdRp and VPg along with VP1 in duodenal and jejunal enterocytes. These results provide critical insights into histological changes due to HuNoV infection in immunocompromised patients and propose human enterocytes as a physiologically relevant cell type for HuNoV cultivation. |
Population-level effectiveness of PMTCT Option A on early mother-to-child (MTCT) transmission of HIV in South Africa: Implications for eliminating MTCT
Goga AE , Dinh TH , Jackson DJ , Lombard CJ , Puren A , Sherman G , Ramokolo V , Woldesenbet S , Doherty T , Noveve N , Magasana V , Singh Y , Ramraj T , Bhardwaj S , Pillay Y . J Glob Health 2016 6 (2) 020405 BACKGROUND: Eliminating mother-to-child transmission of HIV (EMTCT), defined as ≤50 infant HIV infections per 100 000 live births, is a global priority. Since 2011 policies to prevent mother-to-child transmission of HIV (PMTCT) shifted from maternal antiretroviral (ARV) treatment or prophylaxis contingent on CD4 cell count to lifelong maternal ARV treatment (cART). We sought to measure progress with early (4-8 weeks postpartum) MTCT prevention and elimination, 2011-2013, at national and sub-national levels in South Africa, a high antenatal HIV prevalence setting ( approximately 29%), where early MTCT was 3.5% in 2010. METHODS: Two surveys were conducted (August 2011-March 2012 and October 2012-May 2013), in 580 health facilities, randomly selected after two-stage probability proportional to size sampling of facilities (the primary sampling unit), to provide valid national and sub-national-(provincial)-level estimates. Data collectors interviewed caregivers of eligible infants, reviewed patient-held charts, and collected infant dried blood spots (iDBS). Confirmed positive HIV enzyme immunoassay (EIA) and positive total HIV nucleic acid polymerase chain reaction (PCR) indicated infant HIV exposure or infection, respectively. Weighted survey analysis was conducted for each survey and for the pooled data. FINDINGS: National data from 10 106 and 9120 participants were analyzed (2011-12 and 2012-13 surveys respectively). Infant HIV exposure was 32.2% (95% confidence interval (CI) 30.7-33.6%), in 2011-12 and 33.1% (95% CI 31.8-34.4%), provincial range of 22.1-43.6% in 2012-13. MTCT was 2.7% (95% CI 2.1%-3.2%) in 2011-12 and 2.6% (95% CI 2.0-3.2%), provincial range of 1.9-5.4% in 2012-13. HIV-infected ARV-exposed mothers had significantly lower unadjusted early MTCT (2.0% [2011-12: 1.6-2.5%; 2012-13:1.5-2.6%]) compared to HIV-infected ARV-naive mothers [10.2% in 2011-12 (6.5-13.8%); 9.2% in 2012-13 (5.6-12.7%)]. Pooled analyses demonstrated significantly lower early MTCT among exclusive breastfeeding (EBF) mothers receiving >10 weeks ARV prophylaxis or cART compared with EBF and no ARVs: (2.2% [95% CI 1.25-3.09%] vs 12.2% [95% CI 4.7-19.6%], respectively); among HIV-infected ARV-exposed mothers, 24.9% (95% CI 23.5-26.3%) initiated cART during or before the first trimester, and their early MTCT was 1.2% (95% CI 0.6-1.7%). Extrapolating these data, assuming 32% EIA positivity and 2.6% or 1.2% MTCT, 832 and 384 infants per 100 000 live births were HIV infected, respectively. CONCLUSIONS: Although we demonstrate sustained national-level PMTCT impact in a high HIV prevalence setting, results are far-removed from EMTCT targets. Reducing maternal HIV prevalence and treating all maternal HIV infection early are critical for further progress. |
Predicting severe pneumonia outcomes in children
Williams DJ , Zhu Y , Grijalva CG , Self WH , Harrell FE Jr , Reed C , Stockmann C , Arnold SR , Ampofo KK , Anderson EJ , Bramley AM , Wunderink RG , McCullers JA , Pavia AT , Jain S , Edwards KM . Pediatrics 2016 138 (4) BACKGROUND: Substantial morbidity and excessive care variation are seen with pediatric pneumonia. Accurate risk-stratification tools to guide clinical decision-making are needed. METHODS: We developed risk models to predict severe pneumonia outcomes in children (<18 years) by using data from the Etiology of Pneumonia in the Community Study, a prospective study of community-acquired pneumonia hospitalizations conducted in 3 US cities from January 2010 to June 2012. In-hospital outcomes were organized into an ordinal severity scale encompassing severe (mechanical ventilation, shock, or death), moderate (intensive care admission only), and mild (non-intensive care hospitalization) outcomes. Twenty predictors, including patient, laboratory, and radiographic characteristics at presentation, were evaluated in 3 models: a full model included all 20 predictors, a reduced model included 10 predictors based on expert consensus, and an electronic health record (EHR) model included 9 predictors typically available as structured data within comprehensive EHRs. Ordinal regression was used for model development. Predictive accuracy was estimated by using discrimination (concordance index). RESULTS: Among the 2319 included children, 21% had a moderate or severe outcome (14% moderate, 7% severe). Each of the models accurately identified risk for moderate or severe pneumonia (concordance index across models 0.78-0.81). Age, vital signs, chest indrawing, and radiologic infiltrate pattern were the strongest predictors of severity. The reduced and EHR models retained most of the strongest predictors and performed as well as the full model. CONCLUSIONS: We created 3 risk models that accurately estimate risk for severe pneumonia in children. Their use holds the potential to improve care and outcomes. |
Explaining the recent decrease in US infant mortality rate, 2007-2013
Callaghan WM , Macdorman MF , Shapiro-Mendoza CK , Barfield WD . Am J Obstet Gynecol 2016 216 (1) 73 e1-73 e8 BACKGROUND: The U.S. infant mortality rate has been steadily decreasing in recent years as has the preterm birth rate; preterm birth is a major factor associated with death during the first year of life. The degree to which changes in gestational age-specific mortality and changes in the distribution of births by gestational age have contributed to the decrease in the infant mortality rate requires clarification. OBJECTIVES: To better understand the major contributors to the 2007-2013 infant mortality decline for the total population, and for infants born to non-Hispanic black, non-Hispanic white, and Hispanic women. STUDY DESIGN: We identified births and infant deaths from 2007 and 2013 Centers for Disease Control and Prevention National Vital Statistics System's period linked birth and infant death files. We included all deaths and births for which there was a reported gestational age at birth on the birth certificate of 22 weeks or greater. The decrease in the infant mortality rate was disaggregated such that all of the change could be attributed to improvements in gestational age-specific infant mortality rates and changes in the distribution of gestational age, by week of gestation, using the Kitagawa method. Sensitivity analyses were performed to account for records where obstetric estimate of gestational age was missing and for deaths and births less than 22 weeks gestation. Maternal race and ethnicity information was obtained from the birth certificate. RESULTS: The infant mortality rates after exclusions were 5.72 and 4.92 per 1000 live births for 2007 and 2013 respectively with an absolute difference of -0.80 (14% decrease). Infant mortality rates declined by 11% for non-Hispanic whites, by 19% for non-Hispanic blacks, and by 14% for Hispanics during the period. Compared to 2007, the proportion of births in each gestational age category was lower in 2013 with the exception of 39 weeks where there was an increase in the proportion of births from 30.1 percent in 2007 to 37.5 percent in 2013. Gestational age-specific mortality decreased for each gestational age category between 2007 and 2013 except 33 weeks and >42 weeks. About 31 percent of the decrease in the US infant mortality rate from 2007-2013 was due to changes in the gestational age distribution, and 69 percent was due to improvements in gestational age-specific survival. Improvements in the gestational age distribution from 2007-2013 benefitted infants of non-Hispanic white women (48%) the most, followed by infants of non-Hispanic black (31%) and Hispanic (17%) women. CONCLUSIONS: Infant mortality improved between 2007 and 2013 as a result of both improvements in the distribution of gestational age at birth and improvements in survival after birth. The differential contribution of improvements in the gestational age distribution at birth by race and ethnicity suggests that preconception and antenatal health and health care aimed at preventing or delaying preterm birth may not be reaching all populations. |
A pilot study of healthy living options at 16 truck stops across the United States
Lincoln JE , Birdsey J , Sieber WK , Chen GX , Hitchcock EM , Nakata A , Robinson CF . Am J Health Promot 2016 32 (3) 546-553 PURPOSE: There is a growing body of evidence that the built environment influences diet and exercise and, as a consequence, community health status. Since long-haul truck drivers spend long periods of time at truck stops, it is important to know if this built environment includes resources that contribute to the emotional and physical well-being of drivers. SETTING: The truck stop environment was defined as the truck stop itself, grocery stores, and medical clinics near the truck stop that could be accessed by a large truck or safely on foot. DESIGN: Researchers at the National Institute for Occupational Safety and Health (NIOSH) developed and utilized a checklist to record the availability of resources for personal hygiene and comfort, communication and mental stimulation, health care, safety, physical activity, and nutrition at truck stops. SUBJECTS: The NIOSH checklist was used to collect data at a convenience sample of 16 truck stops throughout the United States along both high-flow and low-flow truck traffic routes. MEASURES: The checklist was completed by observation within and around the truck stops. RESULTS: No truck stops offered exercise facilities, 94% lacked access to health care, 81% lacked a walking path, 50% lacked fresh fruit, and 37% lacked fresh vegetables in their restaurant or convenience store. CONCLUSION: The NIOSH found that most truck stops did not provide an overall healthy living environment. |
Healthful nutrition of foods in Navajo nation stores: Availability and pricing
Kumar G , Jim-Martin S , Piltch E , Onufrak S , McNeil C , Adams L , Williams N , Blanck HM , Curley L . Am J Health Promot 2016 30 (7) 501-10 PURPOSE: Low availability and affordability of healthier foods in food stores on the Navajo Nation (NN) may be a community-level risk factor for the high prevalence of obesity among the Navajo people. This study assessed the availability and pricing of foods and beverages in supermarkets and convenience stores throughout the NN. DESIGN: Descriptive study design using the Nutrition Environment Measurement Survey in Stores audit tool. SETTING: Supermarkets (n = 13) and convenience stores (n = 50) on NN and border-town supermarkets (n = 9). SUBJECTS: Not applicable. MEASURES: Availability and pricing of healthy and less-healthy foods. ANALYSIS: Descriptive and chi(2) analyses. RESULTS: Navajo convenience stores offered fewer healthier food options compared to Navajo supermarkets. In Navajo convenience stores, 100% whole grain products, reduced-fat cheese, lean meats, reduced-fat chips, and fat-free or light hot dogs were available in fewer stores than their corresponding less-healthy versions (all with p < .05). In both Navajo supermarkets and convenience stores, 100% whole wheat bread, lean cold cuts, and reduced-fat cheese were all more expensive per unit than their corresponding less-healthy versions (all with p < .05). CONCLUSIONS: According to this study, healthier foods are not as readily available in Navajo convenience stores as they are in Navajo supermarkets. Improving access to and affordability of healthier foods in reservation stores of all sizes may support healthy eating among Navajo residents. |
Development and validation of an assessment tool for a national young worker curriculum
Guerin RJ , Okun AH , Kelley P . Am J Ind Med 2016 59 (11) 969-978 BACKGROUND: An online, multiple-choice assessment was developed and validated for Youth@Work-Talking Safety, a NIOSH curriculum that equips middle and high school students with foundational workplace safety and health knowledge and skills. METHODS: Classical Test Theory was used for the test development and validation; the Jaeger method was used for cut score determination. A total of 118 multiple-choice items were developed to measure the acquisition of knowledge and skills taught through the NIOSH curriculum. Pilot testing was conducted with 192 8-12th grade students and a cut score was determined. RESULTS: The mean score for all test-takers on the Talking Safety assessment was 80.9%; total test reliability measured using an Alpha/KR20 statistic was 0.93. A minimum passing (cut) score of 74% was established. CONCLUSIONS: The assessment provides an objective measure of students' acquisition of the foundational workplace safety and health competencies taught through the Talking Safety curriculum. Am. J. Ind. Med. |
Plasmodium vivax VIR proteins are targets of naturally-acquired antibody and T cell immune responses to malaria in pregnant women
Requena P , Rui E , Padilla N , Martinez-Espinosa FE , Castellanos ME , Botto-Menezes C , Malheiro A , Arevalo-Herrera M , Kochar S , Kochar SK , Kochar DK , Umbers AJ , Ome-Kaius M , Wangnapi R , Hans D , Menegon M , Mateo F , Sanz S , Desai M , Mayor A , Chitnis CC , Bardaji A , Mueller I , Rogerson S , Severini C , Fernandez-Becerra C , Menendez C , Del Portillo H , Dobano C . PLoS Negl Trop Dis 2016 10 (10) e0005009 P. vivax infection during pregnancy has been associated with poor outcomes such as anemia, low birth weight and congenital malaria, thus representing an important global health problem. However, no vaccine is currently available for its prevention. Vir genes were the first putative virulent factors associated with P. vivax infections, yet very few studies have examined their potential role as targets of immunity. We investigated the immunogenic properties of five VIR proteins and two long synthetic peptides containing conserved VIR sequences (PvLP1 and PvLP2) in the context of the PregVax cohort study including women from five malaria endemic countries: Brazil, Colombia, Guatemala, India and Papua New Guinea (PNG) at different timepoints during and after pregnancy. Antibody responses against all antigens were detected in all populations, with PNG women presenting the highest levels overall. P. vivax infection at sample collection time was positively associated with antibody levels against PvLP1 (fold-increase: 1.60 at recruitment -first antenatal visit-) and PvLP2 (fold-increase: 1.63 at delivery), and P. falciparum co-infection was found to increase those responses (for PvLP1 at recruitment, fold-increase: 2.25). Levels of IgG against two VIR proteins at delivery were associated with higher birth weight (27 g increase per duplicating antibody levels, p<0.05). Peripheral blood mononuclear cells from PNG uninfected pregnant women had significantly higher antigen-specific IFN-gamma TH1 responses (p=0.006) and secreted less pro-inflammatory cytokines TNF and IL-6 after PvLP2 stimulation than P. vivax-infected women (p<0.05). These data demonstrate that VIR antigens induce the natural acquisition of antibody and T cell memory responses that might be important in immunity to P. vivax during pregnancy in very diverse geographical settings. |
Controlling neglected tropical diseases (NTDS) in Haiti: Implementation strategies and evidence of their success
Lemoine JF , Desormeaux AM , Monestime F , Fayette CR , Desir L , Direny AN , Carciunoiu S , Miller L , Knipes A , Lammie P , Smith P , Stockton M , Trofimovich L , Bhandari K , Reithinger R , Crowley K , Ottesen E , Baker M . PLoS Negl Trop Dis 2016 10 (10) e0004954 Lymphatic filariasis (LF) and soil-transmitted helminths (STH) have been targeted since 2000 in Haiti, with a strong mass drug administration (MDA) program led by the Ministry of Public Health and Population and its collaborating international partners. By 2012, Haiti's neglected tropical disease (NTD) program had reached full national scale, and with such consistently good epidemiological coverage that it is now able to stop treatment for LF throughout almost all of the country. Essential to this success have been in the detail of how MDAs were implemented. These key programmatic elements included ensuring strong community awareness through an evidence-based, multi-channel communication and education campaign facilitated by voluntary drug distributors; strengthening community trust of the drug distributors by ensuring that respected community members were recruited and received appropriate training, supervision, identification, and motivation; enforcing a "directly observed treatment" strategy; providing easy access to treatment though numerous distribution posts and a strong drug supply chain; and ensuring quality data collection that was used to guide and inform MDA strategies. The evidence that these strategies were effective lies in both the high treatment coverage obtained- 100% geographical coverage reached in 2012, with almost all districts consistently achieving well above the epidemiological coverage targets of 65% for LF and 75% for STH-and the significant reduction in burden of infection- 45 communes having reached the target threshold for stopping treatment for LF. By taking advantage of sustained international financial and technical support, especially during the past eight years, Haiti's very successful MDA campaign resulted in steady progress toward LF elimination and development of a strong foundation for ongoing STH control. These efforts, as described, have not only helped establish the global portfolio of "best practices" for NTD control but also are poised to help solve two of the most important future NTD challenges-how to maintain control of STH infections after the community-based LF "treatment platform" ceases and how to ensure appropriate morbidity management for patients currently suffering from lymphatic filarial disease. |
Palaeoclimate, environmental factors, and bird body size: A multivariable analysis of avian fossil preservation
Gardner EE , Walker SE , Gardner LI . Earth Sci Rev 2016 162 177-197 For this study, we abstracted data on 693 avian fossil specimens from 398 publications to determine preservation biases in the avian fossil record. Our results show that dissociated wing and leg bones are the most commonly preserved avian skeletal elements and they are preferentially preserved in environments of high erosion and reworking potential—notably continental shelf marine environments. Using bivariate descriptive displays and multivariable regression analyses, we investigated the trends and associations between well-preserved avian specimens (i.e., fully- or partially-articulated) and a variety of taphonomic factors, including depositional environment, body size, and palaeoclimate. The regression model shows that well-preserved specimens are independently associated with depositional environments of low reworking potential commensurate with low energy systems, warm and humid climates, and smaller bird body size. Our results also indicate that fossils of smaller birds are less common than those of larger birds, but they are more often well-preserved. Bivariate analyses revealed that five times as many articulated specimens are found in warm and humid climates as in cool or dry climates, and this association persists in the multivariable regression model. Warm climates, the strongest predictor of better skeletal preservation, may be underestimated as a source of taphonomic bias in the avian fossil record, possibly because of the indirect nature of climate effects. Rapid burial events, such as volcanic ash accumulations and mudflows, are recognised for their influence on preservation, but climate-related storm events may be more important to avian taphonomy than previously understood. Our analyses indicate that geologic processes leading to high quality preservation of avian fossils are closely associated with climate. Additional studies, based both on fossils and modern taphonomic experiments, with improved collection of climate-related data, are needed to advance our understanding of avian taphonomy. |
State-specific prevalence of current cigarette smoking and smokeless tobacco use among adults - United States, 2014
Nguyen KH , Marshall L , Brown S , Neff L . MMWR Morb Mortal Wkly Rep 2016 65 (39) 1045-1051 Tobacco use is the leading cause of preventable disease and death in the United States, resulting in approximately 480,000 premature deaths and more than $300 billion in direct health care expenditures and productivity losses each year. In recent years, cigarette smoking prevalence has declined in many states; however, there has been relatively little change in the prevalence of current smokeless tobacco use or concurrent use of cigarettes and smokeless tobacco in most states, and in some states prevalence has increased. CDC analyzed data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) to assess state-specific prevalence estimates of current use of cigarettes, smokeless tobacco, and cigarette and/or smokeless tobacco (any cigarette/smokeless tobacco use) among U.S. adults. Current cigarette smoking ranged from 9.7% (Utah) to 26.7% (West Virginia); current smokeless tobacco use ranged from 1.4% (Hawaii) to 8.8% (Wyoming); current use of any cigarette and/or smokeless tobacco product ranged from 11.3% (Utah) to 32.2% (West Virginia). Disparities in tobacco use by sex and race/ethnicity were observed; any cigarette and/or smokeless tobacco use was higher among males than females in all 50 states. By race/ethnicity, non-Hispanic whites had the highest prevalence of any cigarette and/or smokeless tobacco use in eight states, followed by non-Hispanic other races in six states, non-Hispanic blacks in five states, and Hispanics in two states (p<0.05); the remaining states did not differ significantly by race/ethnicity. Evidence-based interventions, such as increasing tobacco prices, implementing comprehensive smoke-free policies, conducting mass media anti-tobacco use campaigns, and promoting accessible smoking cessation assistance, are important to reduce tobacco use and tobacco-related disease and death among U.S. adults, particularly among subpopulations with the highest use prevalence. |
Multilevel small-area estimation of multiple cigarette smoking status categories using the 2012 Behavioral Risk Factor Surveillance System
Berkowitz Z , Zhang X , Richards TB , Peipins L , Henley SJ , Holt J . Cancer Epidemiol Biomarkers Prev 2016 25 (10) 1402-1410 BACKGROUND: Smoking is the leading preventable cause of death; however, small-area estimates for detailed smoking status are limited. We developed multilevel small-area estimate mixed models to generate county-level estimates for six smoking status categories: current, some days, every day, former, ever, and never. METHOD: Using 2012 Behavioral Risk Factor Surveillance System (BRFSS) data (our sample size = 405,233 persons), we constructed and fitted a series of multilevel logistic regression models and applied them to the U.S. Census population to generate county-level prevalence estimates. We mapped the estimates by sex and aggregated them into state and national estimates. We conducted comparisons for internal consistency with BRFSS states' estimates using Pearson correlation coefficients, and external validation with the 2012 National Health Interview Survey current smoking prevalence. RESULTS: Correlation coefficients ranged from 0.908 to 0.982, indicating high internal consistency. External validation indicated complete agreement (prevalence = 18.06%). We found large variations in current and former smoking status between and within states and by sex. County prevalence of former smokers was highest among men in the Northeast, North, and West. Utah consistently had the lowest smoking prevalence. CONCLUSIONS: Our models, which include demographic and geographic characteristics, provide reliable estimates that can be applied to multiple category outcomes and any demographic group. County and state estimates may help understand the variation in smoking prevalence in the United States and provide information for control and prevention. IMPACT: Detailed county and state smoking category estimates can help identify areas in need of tobacco control and prevention and potentially allow planning for health care. Cancer Epidemiol Biomarkers Prev; 25(10); 1402-10. |
Update: Interim guidance for preconception counseling and prevention of sexual transmission of Zika virus for persons with possible Zika virus exposure - United States, September 2016
Petersen EE , Meaney-Delman D , Neblett-Fanfair R , Havers F , Oduyebo T , Hills SL , Rabe IB , Lambert A , Abercrombie J , Martin SW , Gould CV , Oussayef N , Polen KN , Kuehnert MJ , Pillai SK , Petersen LR , Honein MA , Jamieson DJ , Brooks JT . MMWR Morb Mortal Wkly Rep 2016 65 (39) 1077-1081 CDC has updated its interim guidance for persons with possible Zika virus exposure who are planning to conceive and interim guidance to prevent transmission of Zika virus through sexual contact, now combined into a single document. Guidance for care for pregnant women with possible Zika virus exposure was previously published. Possible Zika virus exposure is defined as travel to or residence in an area of active Zika virus transmission (http://www.cdc.gov/zika/geo/index.html), or sex without a condom with a partner who traveled to or lived in an area of active transmission. Based on new though limited data, CDC now recommends that all men with possible Zika virus exposure who are considering attempting conception with their partner, regardless of symptom status, section sign wait to conceive until at least 6 months after symptom onset (if symptomatic) or last possible Zika virus exposure (if asymptomatic). Recommendations for women planning to conceive remain unchanged: women with possible Zika virus exposure are recommended to wait to conceive until at least 8 weeks after symptom onset (if symptomatic) or last possible Zika virus exposure (if asymptomatic). Couples with possible Zika virus exposure, who are not pregnant and do not plan to become pregnant, who want to minimize their risk for sexual transmission of Zika virus should use a condom or abstain from sex for the same periods for men and women described above. Women of reproductive age who have had or anticipate future Zika virus exposure who do not want to become pregnant should use the most effective contraceptive method that can be used correctly and consistently. These recommendations will be further updated when additional data become available. |
Zoonotic tuberculosis in human beings caused by Mycobacterium bovis-a call for action
Olea-Popelka F , Muwonge A , Perera A , Dean AS , Mumford E , Erlacher-Vindel E , Forcella S , Silk BJ , Ditiu L , El Idrissi A , Raviglione M , Cosivi O , LoBue P , Fujiwara PI . Lancet Infect Dis 2016 17 (1) e21-e25 Mycobacterium tuberculosis is recognised as the primary cause of human tuberculosis worldwide. However, substantial evidence suggests that the burden of Mycobacterium bovis, the cause of bovine tuberculosis, might be underestimated in human beings as the cause of zoonotic tuberculosis. In 2013, results from a systematic review and meta-analysis of global zoonotic tuberculosis showed that the same challenges and concerns expressed 15 years ago remain valid. These challenges faced by people with zoonotic tuberculosis might not be proportional to the scientific attention and resources allocated in recent years to other diseases. The burden of zoonotic tuberculosis in people needs important reassessment, especially in areas where bovine tuberculosis is endemic and where people live in conditions that favour direct contact with infected animals or animal products. As countries move towards detecting the 3 million tuberculosis cases estimated to be missed annually, and in view of WHO's end TB strategy endorsed by the health authorities of WHO Member States in 2014 to achieve a world free of tuberculosis by 2035, we call on all tuberculosis stakeholders to act to accurately diagnose and treat tuberculosis caused by M bovis in human beings. |
Multistate outbreak of human Salmonella Typhimurium infections linked to live poultry from agricultural feed stores and mail-order hatcheries, United States 2013
Anderson TC , Nguyen TA , Adams JK , Garrett NM , Bopp CA , Baker JB , McNeil C , Torres P , Ettestad PJ , Erdman MM , Brinson DL , Gomez TM , Barton Behravesh C . One Health 2016 2 144-149 Live poultry-associated salmonellosis is an emerging public health issue in the United States. Public and animal health officials collaborated to investigate one of the largest (356 cases, 39 states) of these outbreaks reported to date. A case was defined as illness in a person infected with the outbreak strain of Salmonella Typhimurium with illness onset between 1 March and 22 October 2013. The median patient age was seven years (range: < 1–87 years); 58% of ill persons were children ≤ 10 years, 51% were female, 25% were hospitalized; 189 (76%) of 250 patients reported live poultry exposure in the week before illness; and 149 (95%) of 157 reported purchasing live poultry from agricultural feed stores. Traceback investigations identified 18 live poultry sources, including 16 mail-order hatcheries. Environmental sampling was conducted at two mail-order hatcheries. One (2.5%) of 40 duplicate samples collected at one hatchery yielded the outbreak strain. Live poultry are an important source of human salmonellosis, particularly among children, highlighting the need for educational campaigns and comprehensive interventions at the mail-order hatchery and agricultural feed store levels. Prevention and control efforts depend on a One Health approach, involving cooperation between public and animal health officials, industry, health professionals, and consumers. |
Mutation in West Nile virus structural protein prM during human infection
Lustig Y , Lanciotti RS , Hindiyeh M , Keller N , Milo R , Mayan S , Mendelson E . Emerg Infect Dis 2016 22 (9) 1647-9 A mutation leading to substitution of a key amino acid in the prM protein of West Nile virus (WNV) occurred during persistent infection of an immunocompetent patient. WNV RNA persisted in the patient's urine and serum in the presence of low-level neutralizing antibodies. This case demonstrates active replication of WNV during persistent infection. |
Outbreaks of human salmonella infections associated with live poultry, United States, 1990-2014
Basler C , Nguyen TA , Anderson TC , Hancock T , Behravesh CB . Emerg Infect Dis 2016 22 (10) 1705-11 Backyard poultry flocks have increased in popularity concurrent with an increase in live poultry-associated salmonellosis (LPAS) outbreaks. Better understanding of practices that contribute to this emerging public health issue is needed. We reviewed outbreak reports to describe the epidemiology of LPAS outbreaks in the United States, examine changes in trends, and inform prevention campaigns. LPAS outbreaks were defined as ≥2 culture-confirmed human Salmonella infections linked to live poultry contact. Outbreak data were obtained through multiple databases and a literature review. During 1990-2014, a total of 53 LPAS outbreaks were documented, involving 2,630 illnesses, 387 hospitalizations, and 5 deaths. Median patient age was 9 years (range <1 to 92 years). Chick and duckling exposure were reported by 85% and 38% of case-patients, respectively. High-risk practices included keeping poultry inside households (46% of case-patients) and kissing birds (13%). Comprehensive One Health strategies are needed to prevent illnesses associated with live poultry. |
The eco-epidemiology of Pacific Coast tick fever in California
Padgett KA , Bonilla D , Eremeeva ME , Glaser C , Lane RS , Porse CC , Castro MB , Messenger S , Espinosa A , Hacker J , Kjemtrup A , Ryan B , Scott JJ , Hu R , Yoshimizu MH , Dasch GA , Kramer V . PLoS Negl Trop Dis 2016 10 (10) e0005020 Rickettsia philipii (type strain "Rickettsia 364D"), the etiologic agent of Pacific Coast tick fever (PCTF), is transmitted to people by the Pacific Coast tick, Dermacentor occidentalis. Following the first confirmed human case of PCTF in 2008, 13 additional human cases have been reported in California, more than half of which were pediatric cases. The most common features of PCTF are the presence of at least one necrotic lesion known as an eschar (100%), fever (85%), and headache (79%); four case-patients required hospitalization and four had multiple eschars. Findings presented here implicate the nymphal or larval stages of D. occidentalis as the primary vectors of R. philipii to people. Peak transmission risk from ticks to people occurs in late summer. Rickettsia philipii DNA was detected in D. occidentalis ticks from 15 of 37 California counties. Similarly, non-pathogenic Rickettsia rhipicephali DNA was detected in D. occidentalis in 29 of 38 counties with an average prevalence of 12.0% in adult ticks. In total, 5,601 ticks tested from 2009 through 2015 yielded an overall R. philipii infection prevalence of 2.1% in adults, 0.9% in nymphs and a minimum infection prevalence of 0.4% in larval pools. Although most human cases of PCTF have been reported from northern California, acarological surveillance suggests that R. philipii may occur throughout the distribution range of D. occidentalis. |
Cat-scratch disease in the United States, 2005-2013
Nelson CA , Saha S , Mead PS . Emerg Infect Dis 2016 22 (10) 1741-6 Cat-scratch disease (CSD) is mostly preventable. More information about the epidemiology and extent of CSD would help direct prevention efforts to those at highest risk. To gain such information, we reviewed the 2005-2013 MarketScan national health insurance claims databases and identified patients <65 years of age with an inpatient admission or outpatient visit that included a CSD code from the International Classification of Diseases, Ninth Revision, Clinical Modification. Incidence of CSD was highest among those who lived in the southern United States (6.4 cases/100,000 population) and among children 5-9 years of age (9.4 cases/100,000 population). Inpatients were significantly more likely than outpatients to be male and 50-64 years of age. We estimate that each year, 12,000 outpatients are given a CSD diagnosis and 500 inpatients are hospitalized for CSD. Prevention measures (e.g., flea control for cats) are particularly helpful in southern states and in households with children. |
Characteristics of children aged <18 years with Zika virus disease acquired postnatally - U.S. States, January 2015-July 2016
Goodman AB , Dziuban EJ , Powell K , Bitsko RH , Langley G , Lindsey N , Franks JL , Russell K , Dasgupta S , Barfield WD , Odom E , Kahn E , Martin S , Fischer M , Staples JE . MMWR Morb Mortal Wkly Rep 2016 65 (39) 1082-1085 Zika virus is an emerging mosquito-borne flavivirus that typically causes an asymptomatic infection or mild illness, although infection during pregnancy is a cause of microcephaly and other serious brain abnormalities. Guillain-Barre syndrome and other neurologic complications can occur in adults after Zika virus infection. However, there are few published reports describing postnatally acquired Zika virus disease among children. During January 2015-July 2016, a total of 158 cases of confirmed or probable postnatally acquired Zika virus disease among children aged <18 years were reported to CDC from U.S. states. The median age was 14 years (range = 1 month-17 years), and 88 (56%) were female. Two (1%) patients were hospitalized; none developed Guillain-Barre syndrome, and none died. All reported cases were travel-associated. Overall, 129 (82%) children had rash, 87 (55%) had fever, 45 (29%) had conjunctivitis, and 44 (28%) had arthralgia. Health care providers should consider a diagnosis of Zika virus disease in children who have an epidemiologic risk factor and clinically compatible illness, and should report cases to their state or local health department. |
Distribution and diversity of Bartonella washoensis strains in ground squirrels from California and their potential link to human cases
Osikowicz LM , Billeter SA , Rizzo MF , Rood MP , Freeman AN , Burns JE , Hu R , Juieng P , Loparev V , Kosoy M . Vector Borne Zoonotic Dis 2016 16 (11) 683-690 We investigated the prevalence of Bartonella washoensis in California ground squirrels (Otospermophilus beecheyi) and their fleas from parks and campgrounds located in seven counties of California. Ninety-seven of 140 (69.3%) ground squirrels were culture positive and the infection prevalence by location ranged from 25% to 100%. In fleas, 60 of 194 (30.9%) Oropsylla montana were found to harbor Bartonella spp. when screened using citrate synthase (gltA) specific primers, whereas Bartonella DNA was not found in two other flea species, Hoplopsyllus anomalus (n = 86) and Echidnophaga gallinacea (n = 6). The prevalence of B. washoensis in O. montana by location ranged from 0% to 58.8%. A majority of the gltA sequences (92.0%) recovered from ground squirrels and fleas were closely related (similarity 99.4-100%) to one of two previously described strains isolated from human patients, B. washoensis NVH1 (myocarditis case in Nevada) and B. washoensis 08S-0475 (meningitis case in California). The results from this study support the supposition that O. beecheyi and the flea, O. montana, serve as a vertebrate reservoir and a vector, respectively, of zoonotic B. washoensis in California. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Disease Reservoirs and Vectors
- Drug Safety
- Environmental Health
- Genetics and Genomics
- Health Economics
- Healthcare Associated Infections
- Immunity and Immunization
- Laboratory Sciences
- Maternal and Child Health
- Nutritional Sciences
- Occupational Safety and Health
- Parasitic Diseases
- Sciences, General
- Substance Use and Abuse
- Zoonotic and Vectorborne Diseases
About
CDC Science Clips is an online, continuously updated, searchable database of scientific literature published by CDC authors. Each article features an Altmetric Attention Score to track social and mainstream media mentions. If you are aware of a CDC-authored publication that does not appear in this database, please let us know.
- Page last reviewed:Feb 1, 2024
- Page last updated:Sep 03, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure