Surveillance for cancer incidence and mortality - United States, 2012
Singh SD , Henley SJ , Ryerson AB . MMWR Morb Mortal Wkly Rep 2016 63 (55) 17-58 This report provides, in tabular and graphic form, official federal statistics on the occurrence of cancer for 2012 and trends for 1999-2012 as reported by CDC and the National Cancer Institute (NCI) (1). Cancer incidence data are from population-based cancer registries that participate in CDC's National Program of Cancer Registries (NPCR) and NCI's Surveillance, Epidemiology, and End Results (SEER) program reported as of November 2014. Cancer mortality data are from death certificate information reported to state vital statistics offices through 2012 and compiled into a national file for the entire United States by CDC's National Center for Health Statistics' (NCHS) National Vital Statistics System (NVSS). This report is a part of the Summary of Notifiable Noninfectious Conditions and Disease Outbreaks - United States, which encompasses various surveillance years but is being published in 2016 (2). The Summary of Notifiable Noninfectious Conditions and Disease Outbreaks appears in the same volume of MMWR as the annual Summary of Notifiable Infectious Diseases (3). |
Patterns and trends in age-specific black-white differences in breast cancer incidence and mortality - United States, 1999-2014
Richardson LC , Henley SJ , Miller JW , Massetti G , Thomas CC . MMWR Morb Mortal Wkly Rep 2016 65 (40) 1093-1098 Breast cancer continues to be the most commonly diagnosed cancer and the second leading cause of cancer deaths among U.S. women (1). Compared with white women, black women historically have had lower rates of breast cancer incidence and, beginning in the 1980s, higher death rates (1). This report examines age-specific black-white disparities in breast cancer incidence during 1999-2013 and mortality during 2000-2014 in the United States using data from United States Cancer Statistics (USCS) (2). Overall rates of breast cancer incidence were similar, but death rates remained higher for black women compared with white women. During 1999-2013, breast cancer incidence decreased among white women but increased slightly among black women resulting in a similar average incidence at the end of the period. Breast cancer incidence trends differed by race and age, particularly from 1999 to 2004-2005, when rates decreased only among white women aged ≥50 years. Breast cancer death rates decreased significantly during 2000-2014, regardless of age with patterns varying by race. For women aged ≥50 years, death rates declined significantly faster among white women compared with black women; among women aged <50 years, breast cancer death rates decreased at the same rate among black and white women. Although some of molecular factors that lead to more aggressive breast cancer are known, a fuller understanding of the exact mechanisms might lead to more tailored interventions that could decrease mortality disparities. When combined with population-based approaches to increase knowledge of family history of cancer, increase physical activity, promote a healthy diet to maintain a healthy bodyweight, and increase screening for breast cancer, targeted treatment interventions could reduce racial disparities in breast cancer. |
Introduction to the Summary of Notifiable Noninfectious Conditions and Disease Outbreaks - United States
Coates RJ , Stanbury M , Jajosky R , Thomas K , Monti M , Schleiff P , Singh SD . MMWR Morb Mortal Wkly Rep 2016 63 (55) 1-4 With this 2016 Summary of Notifiable Noninfectious Conditions and Disease Outbreaks - United States, CDC is publishing official statistics for the occurrence of nationally notifiable noninfectious conditions and disease outbreaks for the second time in the same volume of MMWR as the annual Summary of Notifiable Infectious Diseases and Conditions. As was the case for the 2015 Summary of Notifiable Noninfectious Conditions and Disease Outbreaks, this joint publication is the result of a request by the Council of State and Territorial Epidemiologists (CSTE) to provide readers with information on all nationally notifiable conditions and disease outbreaks in a single publication. |
Xpert MTB/RIF Assay shows faster clearance of M. tuberculosis DNA with higher rifapentine exposure.
Jayakumar A , Savic RM , Everett CK , Benator D , Alland D , Heilig CM , Weiner M , Friedrich SO , Martinson NA , Kerrigan A , Zamudio C , Goldberg SV , Whitworth WC , Davis JL , Nahid P . J Clin Microbiol 2016 The Xpert(R) MTB/RIF assay is both sensitive and specific as a diagnostic test. Xpert also reports quantitative output in cycle thresholds (Ct), which may provide a dynamic measure of sputum bacillary burden when used longitudinally. We evaluated the relationship between Xpert Ct trajectory and drug exposure during TB treatment to evaluate the potential utility of Xpert Ct for treatment monitoring. We obtained serial sputum samples from patients with smear-positive pulmonary TB consecutively enrolled at ten international clinical trial sites participating in Study 29X, a CDC-sponsored TB Trials Consortium study evaluating the tolerability, safety, and antimicrobial activity of rifapentine at daily doses up to 20 mg/kg. Xpert was performed at weeks 0, 2, 4, 6, 8, and 12. Longitudinal Ct data were modeled using a nonlinear mixed effects model, in relation to rifapentine exposure (area under the concentration-time curve [AUC]). The rate of change of Ct was higher in subjects receiving rifapentine compared to that in subjects receiving standard dose rifampin. Moreover, rifapentine exposure, but not assigned dose, was significantly associated with rate of change in Ct (p = 0.02). The estimated increase in Ct slope for every additional 100 mcg*h/mL of rifapentine drug exposure (as measured by AUC) was 0.11 Ct/week (95% CI 0.05 - 0.17). Increasing rifapentine exposure is associated with faster rate of change of Xpert Ct, indicating faster clearance of MTB DNA. These data suggest that the quantitative outputs of the Xpert MTB/RIF assay may be useful as a dynamic measure of TB treatment response. |
Research agenda on persistent and unpredictable threat of influenza and emerging respiratory infections: a public health necessity in the Eastern Mediterranean Region
Mandil A , Bresee J , Tageldin MA , Azad TM , Khan W . East Mediterr Health J 2016 22 (7) 430-431 Infectious diseases continue to represent a significant threat to global health | security, particularly in the context of | increasing globalization, interconnectedness and interdependence. Chief | among such threats are influenza viruses | and other respiratory pathogens, such | as Middle East Respiratory Syndrome | coronavirus (MERS-CoV), because | of their risk of high transmissibility and | acuity of illness. Annual epidemics of | seasonal influenza cause an estimated | 3–5 million cases of severe illness and | more than 500 000 deaths (1), with | the prospect of pandemic influenza | viruses causing far greater impact. In | addition, the appearance of severe acute | respiratory syndrome (SARS) in 2003, | widespread and continued outbreaks of | avian influenza A (H5N1) since 2004, | the H1N1 pandemic in 2009 and emergence of MERS CoV in 2012 reflect the | seriousness of public health challenges | posed by influenza and emerging respiratory infections. |
Risk factors associated with hospitalisation for influenza-associated severe acute respiratory illness in South Africa: A case-population study
Abadom TR , Smith AD , Tempia S , Madhi SA , Cohen C , Cohen AL . Vaccine 2016 34 (46) 5649-5655 BACKGROUND: Influenza is a common cause of severe respiratory illness, but risk factors for hospitalisation in low income settings with a high HIV prevalence are not well described. We aimed to assess risk factors associated with influenza-associated severe acute respiratory illness (SARI) hospitalisation in South Africa. METHODS: We conducted a case-population study using data on risk conditions in patients hospitalised with SARI and the national prevalence of these conditions. Data on hospitalised cases were from the national SARI surveillance program while data on the referent population were from the latest national census or health and demographic surveillance surveys. FINDINGS: From 2009 to 2012, we identified 3646 (7.9%) of 46,031 enrolled cases of SARI that were associated with influenza infection. Risk factors associated with hospitalisation included previous history of smoking [case-population ratio (CPR) 3.82, 95% confidence interval (CI) 3.5-4.16], HIV infection (CPR 3.61, 95% CI 3.5-3.71), asthma (CPR 2.45, 95% CI 2.19-2.73), previous history of hospital admission in the past 12months (CPR 2.07, 95% CI 1.92-2.23), and tuberculosis (CPR 1.85, 95% CI 1.68-2.02). When stratified by age, there is increased risk of hospitalisation in those 5yearsof age (CPR 3.07, 95% CI 2.93-3.21) and among those 35yearsof age and above (CPR 1.23, 95% CI 1.28-1.18). Male sex (CPR 0.85, 95% CI 0.82-0.88) and completion of pneumococcal conjugate vaccination schedule in children <5yearsof age (CPR 0.74, 95% CI 0.71-0.77) were associated with decreased risk of hospitalisation. CONCLUSION: These results identify groups at high-risk for severe influenza who should be considered potential targets for influenza vaccination in South Africa and similar settings. |
State-of-the-art series on tuberculosis and migration
Lonnroth K , Shah NS , Lange C . Int J Tuberc Lung Dis 2016 20 (10) 1280-1281 The world health organization’s (WHO’s) global tuberculosis (TB) strategy targets a 90% reduction in global incidence by 2035.1 Low-incidence countries—presently a group of predominantly wealthy nations—are already preparing to move towards TB elimination, defined by less than 1 case per 1 million population.2 Rapid decline of TB, as well as eventual elimination, will not be possible unless TB care and prevention is seen as a shared responsibility across countries. In the age of increasing globalization and migration, no single country or region can successfully move towards TB elimination unless there is a substantial and sustainable global reduction in TB burden. We have been reminded of this by the recent increase in TB incidence in the two low-incidence countries that have received the largest number of asylum seekers during the ongoing wave of migration to Western Europe: in 2015, Germany and Sweden experienced an increase of 30%3 and 22%,4 respectively. | Migration is a fundamental phenomenon of human existence. Throughout history it has been a driver of societal change, economic growth, knowledge-sharing, innovation, and development of language and culture. It has also caused tension and conflicts. With the increasing ease of travel, improved connectivity, and interlinked world economy, the world is experiencing an acceleration of migration that is likely to continue. Although most of it is voluntary and planned, economic hardship, military conflicts, and other disasters force people to migrate. Bearing these conditions in mind, TB control must include variables of globalization and migration in the equation. |
Summary of Notifiable Infectious Diseases and Conditions - United States, 2014
Adams DA , Thomas KR , Jajosky RA , Foster L , Sharp P , Onweh DH , Schley AW , Anderson WJ . MMWR Morb Mortal Wkly Rep 2016 63 (54) 1-152 The Summary of Notifiable Infectious Diseases and Conditions-United States, 2014 (hereafter referred to as the summary) contains the official statistics, in tabular and graphic form, for the reported occurrence of nationally notifiable infectious diseases and conditions in the United States for 2014. Unless otherwise noted, data are final totals for 2014 reported as of June 30, 2015. These statistics are collected and compiled from reports sent by U.S. state and territory, New York City, and District of Columbia health departments to the National Notifiable Diseases Surveillance System (NNDSS), which is operated by CDC in collaboration with the Council of State and Territorial Epidemiologists (CSTE). This summary is available at http://www.cdc.gov/mmwr/mmwr_nd/index.html. This site also includes summary publications from previous years. |
Treatment of active tuberculosis in Chicago, 2008-2011: The role of public health departments
Fletcher R , Jones JD , Shah NS . PLoS One 2016 11 (10) e0164162 OBJECTIVE: Evaluate differences in TB outcomes among different provider types in Chicago, IL. METHODS: We retrospectively reviewed all TB cases reported to the Chicago Department of Public Health (CDPH) from 2008 through 2011. Provider type was stratified into three groups: public, public-private, and private providers. Multivariate regression was used to evaluate treatment duration and time to sputum culture conversion. A Cox proportional hazard model was used to assess treatment completion. RESULTS: Of 703 cases, 203 (28.9%), 314 (44.7%), and 186 (26.5%) were treated by public, public-private and private providers, respectively. Adjusted regression showed private provider patients had a 48-day (95% CI 22.0-74.3) increase in treatment duration and a 30-day (95% C.I. 9.5-51.1) increase in time to sputum culture conversion. Cox model showed increased risk of remaining on treatment was associated with extra-pulmonary TB (aHR 0.78, 95% C.I. 0.62-0.98), being foreign-born (aHR 0.74, 95% C.I. 0.58-0.95), and any drug resistance (aHR 0.59, 95% C.I. 0.46-0.76). There were no differences in outcomes between public and public-private providers. CONCLUSION: Patients treated solely in the private sector had prolonged time to sputum culture conversion and treatment duration which lead to increased cost for treatment, prolonged infectiousness, potential for transmission, and the possibility for increased medication side effects. |
Unmet needs for ancillary services among Hispanics/Latinos receiving HIV medical care - United States, 2013-2014
Korhonen LC , DeGroote NP , Shouse RL , Valleroy LA , Prejean J , Bradley H . MMWR Morb Mortal Wkly Rep 2016 65 (40) 1104-1107 The prevalence of diagnosed human immunodeficiency virus (HIV) infection in Hispanics/Latinos in the United States is more than twice as high as the prevalence among non-Hispanic whites (1). Services that support retention in HIV medical care and assist with day-to-day living, referred to here as ancillary services, help persons living with HIV access HIV medical care, adhere to HIV treatment, and attain HIV viral suppression. The needs for these ancillary services among Hispanics/Latinos are not well described (2). To obtain nationally representative estimates of and reasons for unmet needs for such services among Hispanic/Latino adults receiving outpatient HIV medical care during 2013-2014, CDC analyzed data from the Medical Monitoring Project (MMP). The analysis found that Hispanics/Latinos in all age and sexual orientation/behavior subgroups reported substantial unmet needs, including 24% needing dental care, 21% needing eye or vision care, 15% needing food and nutrition services, and 9% needing transportation assistance. Addressing unmet needs for ancillary services among Hispanics/Latinos living with HIV might help increase access to HIV care, improve health outcomes, and reduce health disparities. |
HIV testing and outcomes among Hispanics/Latinos - United States, Puerto Rico, and U.S. Virgin Islands, 2014
Rao S , Seth P , Walker T , Wang G , Mulatu MS , Gilford J , German EJ . MMWR Morb Mortal Wkly Rep 2016 65 (40) 1099-1103 The 2015 National HIV/AIDS Strategy provides an updated plan to address health disparities in communities at high risk for human immunodeficiency virus (HIV) infection (1,2). Hispanics/Latinos* are disproportionately affected by HIV in the United States. In 2014, 23% of HIV diagnoses were among Hispanics/Latinos, who represented 16% of the U.S. population (3). To examine HIV testing services, CDC analyzed 2014 data from the National HIV Prevention Program Monitoring and Evaluation (NHM&E) system submitted by 60 CDC-funded health departmentsdagger and 151 community-based organizations. Among Hispanics/Latinos tested, gay, bisexual, and other men who have sex with men (MSM) had the highest percentage of HIV diagnoses (2%). MSM accounted for 19.8% of HIV test events conducted among Hispanics/Latinos and 63.8% of Hispanics/Latinos who received an HIV diagnosis in non-health care settings. section sign Approximately 60% of Hispanics/Latinos who received an HIV diagnosis were linked to HIV medical care within 90 days; this percentage was lower in the South than in other U.S. Census regions. HIV prevention programs that are focused on expanding routine HIV screening and targeting and improving linkage to medical care and other services (e.g., partner services) for Hispanics/Latinos can help identify undiagnosed HIV cases and reduce HIV transmission. |
Infectious disease physicians' perceptions about Ebola preparedness early in the US response: a qualitative analysis and lessons for the future
Santibanez S , Polgreen PM , Beekmann SE , Rupp ME , Del Rio C . Health Secur 2016 14 (5) 345-50 On September 30, 2014, the first US patient with Ebola virus disease was diagnosed. Hospitals and healthcare systems identified many complex issues that needed to be addressed to prepare for possible future outbreaks. Here we summarize themes identified in free text responses from a query of infectious disease physicians from the Infectious Disease Society of America's (IDSA) Emerging Infections Network (EIN) early in the domestic Ebola response and place them into the context of biopreparedness for possible future events. We queried infectious disease physician members of the EIN from October 21-November 11, 2014, about their institutions' experience with Ebola preparedness at that time. Of 1,566 EIN physicians, 869 replied to this query, and 318 provided 448 write-in comments in response to the question, "What gaps have been identified in order for facilities to safely care for suspected Ebola patients?" or in a section for general comments. Six themes emerged from the responses: the unique challenges faced by small community hospitals (87 comments), the burden placed on infectious disease and infection control staff (61), ethical questions and planning for vulnerable populations (40), misinformation and stigma (29), financial issues faced by response staff (27), and long-term sustainability (16). This qualitative analysis provides insights into early thinking about challenges in preparing for Ebola and other emerging infections in the United States. The themes identified here should be considered during local, state, and national planning. |
An influenza A virus (H7N9) anti-neuraminidase monoclonal antibody with prophylactic and therapeutic activity in vivo
Wilson JR , Guo Z , Reber A , Kamal RP , Music N , Gansebom S , Bai Y , Levine M , Carney P , Tzeng WP , Stevens J , York IA . Antiviral Res 2016 135 48-55 Zoonotic A(H7N9) avian influenza viruses emerged in China in 2013 and continue to be a threat to human public health, having infected over 800 individuals with a mortality rate approaching 40%. Treatment options for people infected with A(H7N9) include the use of neuraminidase (NA) inhibitors. However, like other influenza viruses, A(H7N9) can become resistant to these drugs. The use of monoclonal antibodies is a rapidly developing strategy for controlling influenza virus infection. Here we generated a murine monoclonal antibody (3c10-3) directed against the NA of A(H7N9) and show that prophylactic systemic administration of 3c10-3 fully protected mice from lethal challenge with wild-type A/Anhui/1/2013 (H7N9). Further, post-infection treatment with a single systemic dose of 3c10-3 at either 24, 48 or 72 h post A(H7N9) challenge resulted in both dose- and time-dependent protection of up to 100% of mice, demonstrating therapeutic potential for 3c10-3. Epitope mapping revealed that 3c10-3 binds near the enzyme active site of NA, and functional characterization showed that 3c10-3 inhibits the enzyme activity of NA and restricts the cell-to-cell spread of the virus in cultured cells. Affinity analysis also revealed that 3c10-3 binds equally well to recombinant NA of wild-type A/Anhui/1/2013 and to a variant NA carrying a R289K mutation known to infer NAI resistance. These results suggest that 3c10-3 has the potential to be used as a therapeutic to treat A(H7N9) infections either as an alternative to, or in combination with, current NA antiviral inhibitors. |
Elevated blood lead levels among employed adults - United States, 1994-2013
Alarcon WA . MMWR Morb Mortal Wkly Rep 2016 63 (55) 59-65 CDC's National Institute for Occupational Safety and Health (NIOSH) and state health departments collect data on laboratory-reported adult blood lead levels (BLLs). This report presents data on elevated BLLs among employed adults (defined as persons aged ≥16 years) in the United States for 1994-2013. This report is a part of the Summary of Notifiable Noninfectious Conditions and Disease Outbreaks - United States, which encompasses various surveillance years but is being published in 2016. The Summary of Notifiable Noninfectious Conditions and Disease Outbreaks appears in the same volume of the Morbidity Mortality Weekly Report (MMWR) as the annual Summary of Notifiable Infectious Diseases. |
Acute nonoccupational pesticide-related illness and injury - United States, 2007-2011
Namulanda G , Monti MM , Mulay P , Higgins S , Lackovic M , Schwartz A , Prado JB , Waltz J , Mitchell Y , Calvert GM . MMWR Morb Mortal Wkly Rep 2016 63 (55) 5-10 CDC's National Institute for Occupational Safety and Health (NIOSH) collects data on acute pesticide-related illness and injury reported by 12 states (California, Florida, Iowa, Louisiana, Michigan, North Carolina, Nebraska, New Mexico, New York, Oregon, Texas, and Washington). This report summarizes the data on illnesses and injuries arising from nonoccupational exposure to conventional pesticides that were reported during 2007-2011. Conventional pesticides include insecticides, herbicides, fungicides, and fumigants. They exclude disinfectants (e.g., chlorine and hypochlorites) and biological pesticides. This report is a part of the Summary of Notifiable Noninfectious Conditions and Disease Outbreaks - United States, which encompasses various surveillance years but is being published in 2016. The Summary of Notifiable Noninfectious Conditions and Disease Outbreaks appears in the same volume of MMWR as the annual Summary of Notifiable Infectious Diseases. In a separate report, data on illnesses and injuries from occupational exposure to conventional pesticides during 2007-2011 are summarized. |
Blood lead levels in children aged <5 Years - United States, 2007-2013
Raymond J , Brown MJ . MMWR Morb Mortal Wkly Rep 2016 63 (55) 66-72 This report provides data concerning childhood blood lead levels (BLLs) in the United States during 2007-2013. These data were collected and compiled from raw data extracts sent by state and local health departments to CDC's Childhood Blood Lead Surveillance (CBLS) system. These raw data extracts have been de-identified and coded into a format specifically for childhood lead reporting. The numbers of children aged <5 years reported to CDC for 2013 with newly confirmed BLLs ≥10 microg/dL are provided in tabular form by month (Table 1) and geographic location (Table 2). The incidence of BLLs ≥10 microg/dL is reported by age group for 2007-2013 (Table 3). The numbers of children aged <5 years with BLLs 5-9microg/dL for 2013 are reported (Table 4). For the period 2007-2013, the numbers of children newly confirmed with BLLs ≥70 microg/dL are summarized (Figure 1) as well as the percentage of children with BLLs ≥5 microg/dL (Figure 2). This report is a part of the Summary of Notifiable Noninfectious Conditions and Disease Outbreaks - United States, which encompasses various surveillance years but is being published in 2016 (1). The Summary of Notifiable Noninfectious Conditions and Disease Outbreaks appears in the same volume of MMWR as the annual Summary of Notifiable Infectious Diseases (2). |
Foodborne (1973-2013) and waterborne (1971-2013) disease outbreaks - United States
Dewey-Mattia D , Roberts VA , Vieira A , Fullerton KE . MMWR Morb Mortal Wkly Rep 2016 63 (55) 79-84 CDC collects data on foodborne and waterborne disease outbreaks reported by all U.S. states and territories through the Foodborne Disease Outbreak Surveillance System (FDOSS) (http://www.cdc.gov/foodsafety/fdoss/surveillance/index.html) and the Waterborne Disease and Outbreak Surveillance System (WBDOSS) http://www.cdc.gov/healthywater/surveillance), respectively. These two systems are the primary source of national data describing the number of reported outbreaks; outbreak-associated illnesses, hospitalizations, and deaths; etiologic agents; water source or implicated foods; settings of exposure; and other factors associated with recognized foodborne and waterborne disease outbreaks in the United States. |
Whole genome-based population biology and epidemiological surveillance of Listeria monocytogenes.
Moura A , Criscuolo A , Pouseele H , Maury MM , Leclercq A , Tarr C , Bjorkman JT , Dallman T , Reimer A , Enouf V , Larsonneur E , Carleton H , Bracq-Dieye H , Katz LS , Jones L , Touchon M , Tourdjman M , Walker M , Stroika S , Cantinelli T , Chenal-Francisque V , Kucerova Z , Rocha EP , Nadon C , Grant K , Nielsen EM , Pot B , Gerner-Smidt P , Lecuit M , Brisse S . Nat Microbiol 2016 2 16185 Listeria monocytogenes (Lm) is a major human foodborne pathogen. Numerous Lm outbreaks have been reported worldwide and associated with a high case fatality rate, reinforcing the need for strongly coordinated surveillance and outbreak control. We developed a universally applicable genome-wide strain genotyping approach and investigated the population diversity of Lm using 1,696 isolates from diverse sources and geographical locations. We define, with unprecedented precision, the population structure of Lm, demonstrate the occurrence of international circulation of strains and reveal the extent of heterogeneity in virulence and stress resistance genomic features among clinical and food isolates. Using historical isolates, we show that the evolutionary rate of Lm from lineage I and lineage II is low ( approximately 2.5 x 10-7 substitutions per site per year, as inferred from the core genome) and that major sublineages (corresponding to so-called 'epidemic clones') are estimated to be at least 50-150 years old. This work demonstrates the urgent need to monitor Lm strains at the global level and provides the unified approach needed for global harmonization of Lm genome-based typing and population biology. |
State-level medical and absenteeism cost of asthma in the United States
Nurmagambetov T , Khavjou O , Murphy L , Orenstein D . J Asthma 2016 54 (4) 357-370 OBJECTIVE: For medically treated asthma, we estimated prevalence, medical and absenteeism costs, and projected medical costs from 2015 to 2020 for the entire population and separately for children in the 50 US states and District of Columbia (DC) using the most recently available data. METHODS: We used multiple data sources, including the Medical Expenditure Panel Survey, U.S. Census Bureau, Kaiser Family Foundation, Medical Statistical Information System, and Current Population Survey. We used a two-part regression model to estimate annual medical costs of asthma and a negative binomial model to estimate annual school and work days missed due to asthma. RESULTS: Per capita medical costs of asthma ranged from $1,860 (Mississippi) to $2,514 (Michigan). Total medical costs of asthma ranged from $60.7 million (Wyoming) to $3.4 billion (California). Medicaid costs ranged from $4.1 million (Wyoming) to $566.8 million (California), Medicare from $5.9 million (DC) to $446.6 million (California), and costs paid by private insurers ranged from $27.2 million (DC) to $1.4 billion (California). Total annual school and work days lost due to asthma ranged from 22.4 thousand (Wyoming) to 1.5 million days (California) and absenteeism costs ranged from $4.4 million (Wyoming) to $345 million (California). Projected increase in medical costs from 2015 to 2020 ranged from 9% (DC) to 34% (Arizona). CONCLUSION: Medical and absenteeism costs of asthma represent a significant economic burden for states and these costs are expected to rise. Our study results emphasize the urgency for strategies to strengthen state level efforts to prevent and control asthma attacks. |
Economic evaluation of Mumbai and its satellite cancer registries: Implications for expansion of data collection
Koyande S , Subramanian S , Edwards P , Hoover S , Deshmane V , Tankga F , Dikshit R , Saraiya M . Cancer Epidemiol 2016 45 Suppl 1 S43-S49 BACKGROUND: The Mumbai Cancer Registry is a population-based cancer registry that has been in operation for more than five decades and has successfully initiated and integrated three satellite registries in Pune, Nagpur, and Aurangabad, each covering specific urban populations of the Indian state Maharashtra. Data collectors at the satellites perform data abstraction, but Mumbai carries out all other core registration activities such as data analysis and quality assurance. Each of the three satellite registries follows the same data collection methodology as the main Mumbai Cancer Registry. This study examines the cost of operating the Mumbai and its satellite cancer registries. METHODS: We modified and used the Centers for Disease Control and Prevention's (CDC's) International Registry Costing Tool (IntRegCosting Tool) to collect cost and resource use data for the Mumbai Cancer Registry and three satellites. RESULTS: Almost 60% of the registration expenditure was borne by the Indian Cancer Society, which hosts the Mumbai Cancer Registry, and more than half of the registry expenditure was related to data collection activities. Across the combined registries, 93% of the expenditure was spent on labor. Overall, registration activities had a low cost per case of 226.10 Indian rupees (or a little less than 4.00 US dollars in 2014 [used average exchange rate in 2014: 1 US $=60 Indian rupees]). CONCLUSION: The centralization of fixed-cost activities in Mumbai likely resulted in economies of scale in operating the Mumbai and satellite registries, which, together, report on almost 20,000 cancer cases annually. In middle-income countries like India, where financial resources are limited, the operational framework provided by the Mumbai and satellite registries can serve as a model for other registries looking to expand data collection. |
Developing and testing a cost data collection instrument for noncommunicable disease registry planning
Subramanian S , Tangka F , Edwards P , Hoover S , Cole-Beebe M . Cancer Epidemiol 2016 45 Suppl 1 S4-S12 BACKGROUND: This article reports on the methods and framework we have developed to guide economic evaluation of noncommunicable disease registries. METHODS: We developed a cost data collection instrument, the Centers for Disease Control and Prevention's (CDC's) International Registry Costing Tool (IntRegCosting Tool), based on established economics methods We performed in-depth case studies, site visit interviews, and pilot testing in 11 registries from multiple countries including India, Kenya, Uganda, Colombia, and Barbados to assess the overall quality of the data collected from cancer and cardiovascular registries. RESULTS: Overall, the registries were able to use the IntRegCosting Tool to assign operating expenditures to specific activities. We verified that registries were able to provide accurate estimation of labor costs, which is the largest expenditure incurred by registries. We also identified several factors that can influence the cost of registry operations, including size of the geographic area served, data collection approach, local cost of living, presence of rural areas, volume of cases, extent of consolidation of records to cases, and continuity of funding. CONCLUSION: Internal and external registry factors reveal that a single estimate for the cost of registry operations is not feasible; costs will vary on the basis of factors that may be beyond the control of the registries. Some factors, such as data collection approach, can be modified to improve the efficiency of registry operations. These findings will inform both future economic data collection using a web-based tool and cost and cost-effectiveness analyses of registry operations in low- and middle-income countries (LMICs) and other locations with similar characteristics. |
Rotavirus vaccines: Current global impact and future perspectives
Burnett E , Yen C , Tate JE , Parashar UD . Future Virol 2016 11 (10) 699-708 As of May 2016, 81 countries have introduced Rotarix or RotaTeq rotavirus vaccines into their national immunization program. Despite initially slow uptake in some countries and differences in vaccine effectiveness (VE) between high-, low- and middle-income countries, impact of the vaccines has been swift and striking in all settings, with good VE against vaccine-type and nonvaccine-type strains. Newly published research indicates poor nutrition is associated with decreased VE and breastfeeding at the time of vaccination does not affect vaccine response. Vaccines in development and proposed alternate schedules also promise to address limitations of the current vaccines and optimize rotavirus disease prevention. |
National and state-specific shingles vaccination among adults aged ≥60 years
Lu PJ , O'Halloran A , Williams WW , Harpaz R . Am J Prev Med 2016 52 (3) 362-372 INTRODUCTION: Shingles (herpes zoster) causes substantial morbidity, especially among older adults. The shingles vaccine has been recommended for people aged ≥60 years since 2006. This study assessed recent shingles vaccination at national and state levels among adults aged ≥60 years. METHODS: The 2014 Behavioral Risk Factor Surveillance System data were analyzed in 2015 to assess shingles vaccination coverage among adults aged ≥60 years at national and state levels. Multivariable logistic regression and predictive marginal models identified factors independently associated with vaccination. RESULTS: Shingles vaccination coverage among adults aged ≥60 years was 31.8% (95% CI=31.4%, 32.2%). Among states, shingles vaccination coverage ranged from 17.8% (95% CI=15.8%, 20.0%) in Mississippi to 46.6% (95% CI=44.3%, 48.8%) in Vermont, with a median of 33.3%. Coverage was <25% in four states and >40% in nine states. For all states, coverage was significantly higher among non-Hispanic whites compared with non-white races except for Oregon, with coverage differences ranging from -33.2% in the District of Columbia to 0.9% in Oregon and a median of -16.0%. Characteristics independently associated with vaccination were age, race/ethnicity, sex, education, employment status, household income, region, perceived health status, health insurance status, personal healthcare provider, routine checkup status, and whether reporting that cost was a barrier to seeing a doctor. CONCLUSIONS: Coverage varied dramatically by state. State-level comparisons may aid in designing tailored intervention programs through sharing of best practices. Strategies are needed to mitigate financial barriers for both provider and patients, improve awareness, and increase provider recommendation of the vaccine. |
Ecological association of human papillomavirus vaccination with cervical dysplasia prevalence in the United States, 2007-2014
Flagg EW , Torrone EA , Weinstock H . Am J Public Health 2016 106 (12) e1-e8 OBJECTIVES: To examine prevalence of low- and high-grade cervical lesions over time in a large cohort of US female adolescents and women. METHODS: We used health care claims data from 9 million privately insured female patients aged 15 to 39 years to estimate annual prevalence of cytologically detected cervical low-grade (LSIL) and high-grade squamous intraepithelial lesions (HSIL) and high-grade histologically detected cervical intraepithelial neoplasia grades 2 and 3 (CIN2+) during 2007 through 2014. We restricted analyses to those who received cervical cancer screening in a given calendar year. RESULTS: Prevalence of HSIL and CIN2+ decreased significantly for those aged 15 to 19 years. Average annual percent change in prevalence in this group during 2007 through 2014 for HSIL and CIN2+ was -8.3% and -14.4%, respectively (P < .001 for both estimates). Prevalence of HSIL and CIN2+ also decreased significantly for women aged 20 to 24 years. No decreases were seen in women aged 30 to 39 years. CONCLUSIONS: Decreases in high-grade lesions reflected their greater association with human papillomavirus types 16 and 18, compared with low-grade lesions, providing ecological evidence of population effectiveness of human papillomavirus vaccination among young, privately insured women. |
Changes in childhood immunization decisions in the United States: Results from 2012 & 2014 National Parental Surveys
Frew PM , Fisher AK , Basket MM , Chung Y , Schamel J , Weiner JL , Mullen J , Omer SB , Orenstein WA . Vaccine 2016 34 (46) 5689-5696 OBJECTIVE: Understanding the current status of parents' vaccine decision making is crucial to inform public policy. We sought to assess changes in vaccine decisions among parents of young children. METHODS: We conducted a web-based national poll of parents of children <7years in 2012 and 2014. Participants reported vaccine decisions for their youngest child. We calculated survey-weighted population estimates of overall immunizations decisions, and delay/refusal rates for specific vaccines. RESULTS: In 2012, 89.2% (95% CI, 87.3-90.8%) reported accepting or planning to accept all recommended non-influenza childhood vaccines, 5.5% (4.5-6.6%) reported intentionally delaying one or more, and 5.4% (4.1-6.9%) reported refusing one or more vaccines. In 2014, the acceptance, delay, and refusal rates were 90.8% (89.3-92.1%), 5.6% (4.6-6.9%), and 3.6% (2.8-4.5%), respectively. Between 2012 and 2014, intentional vaccine refusal decreased slightly among parents of older children (2-6years) but not younger children (0-1years). The proportion of parents working to catch up on all vaccines increased while those refusing some but not all vaccines decreased. The South experienced a significant increase in estimated acceptance (90.1-94.1%) and a significant decrease in intentional ongoing refusal (5.0-2.1%). Vaccine delay increased in the Northeast (3.2-8.8%). CONCLUSIONS: Nationally, acceptance and ongoing intentional delay of recommended non-influenza childhood vaccines were stable. These findings suggest that more effort is warranted to counter persistent vaccine hesitancy, particularly at the local level. Longitudinal monitoring of immunization attitudes is also warranted to evaluate temporal shifts over time and geographically. |
Geriatric assault victims treated at U.S. trauma centers: Five-year analysis of the National Trauma Data Bank
Rosen T , Clark S , Bloemen EM , Mulcare MR , Stern ME , Hall JE , Flomenbaum NE , Lachs MS , Eachempati SR . Injury 2016 47 (12) 2671-2678 INTRODUCTION: While geriatric trauma patients have begun to receive increased attention, little research has investigated assault-related injuries among older adults. Our goal was to describe characteristics, treatment, and outcomes of geriatric assault victims and compare them both to geriatric victims of accidental injury and younger assault victims. PATIENTS AND METHODS: We conducted a retrospective analysis of the 2008-2012 National Trauma Data Bank. We identified cases of assault-related injury admitted to trauma centers in patients aged ≥60 using the variable "intent of injury." RESULTS: 3564 victims of assault-related injury in patients aged ≥60 were identified and compared to 200,194 geriatric accident victims and 94,511 assault victims aged 18-59. Geriatric assault victims were more likely than geriatric accidental injury victims to be male (81% vs. 47%) and were younger than accidental injury victims (67+/-7 vs. 74+/-9 years). More geriatric assault victims tested positive for alcohol or drugs than geriatric accident victims (30% vs. 9%). Injuries for geriatric assault victims were more commonly on the face (30%) and head (27%) than for either comparison group. Traumatic brain injury (34%) and penetrating injury (32%) occurred commonly. The median injury severity score (ISS) for geriatric assault victims was 9, with 34% having severe trauma (ISS≥16). Median length of stay was 3 days, 39% required ICU care, and in-hospital mortality was 8%. Injury severity was greater in geriatric than younger adult assault victims, and, even when controlling for injury severity, in-hospital mortality, length of hospitalization, and need for ICU-level care were significantly higher in older adults. CONCLUSIONS: Geriatric assault victims have characteristics and injury patterns that differ significantly from geriatric accidental injury victims. These victims also have more severe injuries, higher mortality, and poorer outcomes than younger victims. Additional research is necessary to improve identification of these victims and inform treatment strategies for this unique population. |
Identification of bacterial pathogens from formalin-fixed, paraffin-embedded tissues by using 16S sequencing: retrospective correlation of results to clinicians' responses.
Racsa LD , DeLeon-Carnes M , Hiskey M , Guarner J . Hum Pathol 2016 59 132-138 16S sequencing on formalin-fixed paraffin-embedded (FFPE) material has been used to identify bacteria when culture-based phenotyping techniques have not worked. The objective of this study was to determine how frequently 16S sequencing used in FFPE material was helpful to clinicians in the diagnosis and treatment of infectious diseases. Requests for testing occurred upon consultation between an infectious disease pathologist and a surgical pathologist or an infectious disease physician. A selected paraffin block from each case was referred for 16S sequencing. Retrospectively, we correlated clinical history and management decisions on 27 cases that were tested by paneubacterial 16S sequencing. Samples included 24 surgical specimens, 1 autopsy, and 2 cytology blocks. Seventeen of the 27 cases (63%) had a positive 16S sequencing. Acute inflammation was present in ten of these cases and organisms were observed using special stains in three. In 11 of the 17 cases (65%) clinicians considered the organism identified by 16S sequencing to be the cause or possible cause of the infectious process. Organisms included common (Citrobacter) and fastidious bacteria (Haemophilus, Fusobacterium). In 3 cases clinicians changed antibiotic treatment based on the bacteria identified, while in 8 (including 2 where no organism was found) clinicians continued the antibiotic treatment. The use of 16S sequencing on FFPE identified specific bacteria even when organisms were not observed histopathologically. 16S results had an impact in infectious disease management decisions. |
A biological safety cabinet certification program: experiences in Southeast Asia
Whistler T , Kaewpan A , Blacksell SD . Appl Biosaf 2016 21 (3) 121-127 Biological safety cabinets (BSCs) are the primary means of containment used in laboratories worldwide for the safe handling of infectious microorganisms. They provide protection to the laboratory worker and the surrounding environment from pathogens. To ensure the correct functioning of BSCs, they need to be properly maintained beyond the daily care routines of the laboratory. This involves annual maintenance and certification by a qualified technician in accordance to the NSF/American National Standards Institute 49-2014 Biosafety Cabinetry: Design, Construction, Performance, and Field Certification. Service programs can be direct from the manufacturer or through third-party service companies, but in many instances, technicians are not accredited by international bodies, and these services are expensive. This means that a large number of BSCs may not be operating in a safe manner. In this article, we discuss our approach to addressing the lack of trained and qualified personnel in Thailand who can install, maintain, and certify BSCs in a cost-effective and practical manner. We initiated a program to create both local and regional capacity for repair, maintenance, and certification of BSCs and share our experiences with the reader. |
Comprehensive laboratory evaluation of a highly specific lateral flow assay for the presumptive identification of Bacillus anthracis spores in suspicious white powders and environmental samples
Ramage JG , Prentice KW , DePalma L , Venkateswaran KS , Chivukula S , Chapman C , Bell M , Datta S , Singh A , Hoffmaster A , Sarwar J , Parameswaran N , Joshi M , Thirunavkkarasu N , Krishnan V , Morse S , Avila JR , Sharma S , Estacio PL , Stanker L , Hodge DR , Pillai SP . Health Secur 2016 14 (5) 351-65 We conducted a comprehensive, multiphase laboratory evaluation of the Anthrax BioThreat Alert((R)) test strip, a lateral flow immunoassay (LFA) for the rapid detection of Bacillus anthracis spores. The study, conducted at 2 sites, evaluated this assay for the detection of spores from the Ames and Sterne strains of B. anthracis, as well as those from an additional 22 strains. Phylogenetic near neighbors, environmental background organisms, white powders, and environmental samples were also tested. The Anthrax LFA demonstrated a limit of detection of about 10(6) spores/mL (ca. 1.5 x 10(5) spores/assay). In this study, overall sensitivity of the LFA was 99.3%, and the specificity was 98.6%. The results indicated that the specificity, sensitivity, limit of detection, dynamic range, and repeatability of the assay support its use in the field for the purpose of qualitatively evaluating suspicious white powders and environmental samples for the presumptive presence of B. anthracis spores. |
Surveillance for silicosis - Michigan and New Jersey, 2003-2011
Schleiff PL , Mazurek JM , Reilly MJ , Rosenman KD , Yoder MB , Lumia ME , Worthington K . MMWR Morb Mortal Wkly Rep 2016 63 (55) 73-78 CDC's National Institute for Occupational Safety and Health (NIOSH), state health departments, and other state entities maintain a state-based surveillance program of confirmed silicosis cases. Data on confirmed cases are collected and compiled by state entities and submitted to CDC. This report summarizes information for cases of silicosis that were reported to CDC for 2003-2011 by Michigan and New Jersey, the only states that continue to provide data voluntarily to NIOSH. The data for this report were final as of January 8, 2015. Data are presented in tabular form on the number and distribution of cases of silicosis by year (Table 1), duration of employment in occupations with potential exposure to dust containing respirable crystalline silica (Table 2), industry (Table 3), and occupation (Table 4). The number of cases by year is presented graphically (Figure). This report is a part of the Summary of Notifiable Noninfectious Conditions and Disease Outbreaks - United States, which encompasses various surveillance years but is being published in 2016 (1). The Summary of Notifiable Noninfectious Conditions and Disease Outbreaks appears in the same volume of MMWR as the annual Summary of Notifiable Infectious Diseases (2). |
Acute occupational pesticide-related illness and injury -United States, 2007-2011
Calvert GM , Beckman J , Prado JB , Bojes H , Schwartz A , Mulay P , Leinenkugel K , Higgins S , Lackovic M , Waltz J , Stover D , Moraga-McHaley S . MMWR Morb Mortal Wkly Rep 2016 63 (55) 11-16 CDC's National Institute for Occupational Safety and Health (NIOSH) collects data on acute pesticide-related illness and injury reported by 12 states (California, Florida, Iowa, Louisiana, Michigan, Nebraska, North Carolina, New Mexico, New York, Oregon, Texas, and Washington). This report summarizes the data on illnesses and injuries arising from occupational exposure to conventional pesticides from 2007 through 2011. This report is a part of the Summary of Notifiable Noninfectious Conditions and Disease Outbreaks - United States, which encompasses various surveillance years but is being published in 2016. The Summary of Notifiable Noninfectious Conditions and Disease Outbreaks appears in the same volume of MMWR as the annual Summary of Notifiable Infectious Diseases. In a separate report, data on illnesses and injuries from nonoccupational exposure to pesticides during 2007-2011 are summarized. |
Serum osteopontin is a biomarker of severe fibrosis and portal hypertension in human and murine schistosomiasis mansoni
Pereira TA , Syn WK , Pereira FE , Lambertucci JR , Secor WE , Diehl AM . Int J Parasitol 2016 46 829-832 Schistosomiasis is a major cause of fibrosis and portal hypertension. The reason 4-10% of infected subjects develop hepatosplenic schistosomiasis remains unclear. Chronically infected male CBA/J mice reproduce the dichotomic forms of human schistosomiasis. Most mice (80%) develop moderate splenomegaly syndrome (MSS, similar to hepatointestinal disease in humans) and 20% present severe hypersplenomegaly syndrome (HSS, analogous to human hepatosplenic disease). We demonstrated that the profibrogenic molecule osteopontin discriminates between mice with severe and mild disease and could be a novel morbidity biomarker in murine and human schistosomiasis. Failure to downregulate osteopontin during the chronic phase may explain why hepatosplenic subjects develop severe fibrosis. |
Progress toward global eradication of dracunculiasis - January 2015-June 2016
Hopkins DR , Ruiz-Tiben E , Eberhard ML , Roy SL , Weiss AJ . MMWR Morb Mortal Wkly Rep 2016 65 (40) 1112-1116 Dracunculiasis (Guinea worm disease) is caused by Dracunculus medinensis, a parasitic worm. Approximately 1 year after a person acquires infection from drinking contaminated water, the worm emerges through the skin, usually on the leg. Pain and secondary bacterial infection can cause temporary or permanent disability that disrupts work and schooling. The campaign to eradicate dracunculiasis worldwide began in 1980 at CDC. In 1986, the World Health Assembly called for dracunculiasis elimination (1), and the global Guinea Worm Eradication Program, led by the Carter Center and supported by the World Health Organization (WHO), United Nations Children's Fund (UNICEF), CDC, and other partners, began assisting ministries of health in countries where dracunculiasis was endemic. In 1986, an estimated 3.5 million cases were occurring each year in 20 countries in Africa and Asia (1,2). Since then, although the goal of eradicating dracunculiasis has not been achieved, substantial progress has been made. Compared with the 1986 estimate, the annual number of reported cases in 2015 has been reduced by >99%, and cases are confined to four countries with endemic disease. This report updates published (3-5) and unpublished surveillance data reported by ministries of health and describes progress toward dracunculiasis eradication during January 2015-June 2016. In 2015, a total of 22 cases were reported from four countries (Chad [nine cases], Mali [five], South Sudan [five], and Ethiopia [three]), compared with 126 cases reported in 2014 from the same four countries (Table 1). The overall 83% reduction in cases from 2014 to 2015 is the largest such annual overall reduction ever achieved during this global campaign. During the first 6 months of 2016, however, cases increased 25% compared with the same period in 2015. Continued active surveillance and aggressive detection and appropriate management of cases are essential eradication program components; however, epidemiologic challenges and civil unrest and insecurity pose potential barriers to eradication. |
Increase in adverse reactions associated with use of synthetic cannabinoids - Anchorage, Alaska, 2015-2016
Springer YP , Gerona R , Scheunemann E , Shafer SL , Lin T , Banister SD , Cooper MP , Castrodale LJ , Levy M , Butler JC , McLaughlin JB . MMWR Morb Mortal Wkly Rep 2016 65 (40) 1108-1111 In July 2015, personnel in the Alaska Division of Public Health's Section of Epidemiology became aware of an increase in the number of patients being treated in Anchorage hospital emergency departments for adverse reactions associated with use of synthetic cannabinoids (SCs). SCs are a chemically diverse class of designer drugs that bind to the same cannabinoid receptors as tetrahydrocannabinol, the main psychoactive component of cannabis. A public health investigation was initiated to describe clinical outcomes, characterize the outbreak, and identify SC chemicals circulating in Anchorage. During July 15, 2015-March 15, 2016, a total of 1,351 ambulance transports to Anchorage emergency departments for adverse SC reactions were identified. A review of charts obtained from two Anchorage hospitals determined that among 167 emergency department visits for adverse SC reactions during July 15-September 30, 2015, 11 (6.6%) involved a patient who required endotracheal intubation, 17 (10.2%) involved a patient who was admitted to the intensive care unit, and 66 (39.5%) involved a patient classified as being homeless. Testing of 25 product and paraphernalia samples collected from patients at one hospital identified 11 different SC chemicals. Educational outreach campaigns focused on the considerable health risks of using SCs need to complement judicial and law enforcement actions to reduce SC use. |
Multistate outbreak of human Salmonella typhimurium infections linked to pet hedgehogs - United States, 2011-2013
Anderson TC , Marsden-Haug N , Morris JF , Culpepper W , Bessette N , Adams JK , Bidol S , Meyer S , Schmitz J , Erdman MM , Gomez TM , Barton Behravesh C . Zoonoses Public Health 2016 64 (4) 290-298 Zoonotic Salmonella infections cause approximately 130 000 illnesses annually in the United States. Of 72.9 million US households owning at least one pet, five million own small mammals; 3000 hedgehogs were documented by USDA in USDA-licensed breeding facilities and pet stores in 2012. State health department collaborators and PulseNet, the national bacterial subtyping network, identified human infections of a Salmonella Typhimurium outbreak strain, which were investigated by CDC, USDA-APHIS and state public and animal health officials. A case was defined as an illness in a person infected with the outbreak strain identified between 1 December 2011 and 3 June 2013. Investigators collected information on patient exposures, cultured animal and environmental specimens for Salmonella, and conducted traceback investigations of USDA-licensed hedgehog facilities. There were 26 cases in 12 states. Illness onset dates ranged from 26 December 2011 to 8 April 2013. The median patient age was 15 years (range = <1-91 years); 58% were female. Among 23 persons with available information, 8 (35%) were hospitalized and one outbreak strain-associated death was reported. Of 25 patients with available information, 20 (80%) reported pet hedgehog contact in the week before illness onset. The outbreak strain was isolated from animal and environmental samples collected from three ill persons' homes in three states. Hedgehogs were purchased in geographically distant states from USDA-licensed breeders (10/17, 59%); a USDA-licensed pet store (1/17, 6%); unlicensed or unknown status breeders (3/17, 18%); and private individuals (3/17, 18%). Traceback investigations of USDA-licensed facilities did not reveal a single source of infection. Public and animal health collaboration linked pet hedgehog contact to human infections of Salmonella Typhimurium, highlighting the importance of a One Health investigative approach to zoonotic salmonellosis outbreaks. More efforts are needed to increase awareness among multiple stakeholders on the risk of illness associated with pet hedgehogs. |
Enhanced protective immunogenicity of homodimeric Borrelia burgdorferi outer surface protein C
Edmondson DG , Prabhakaran S , Norris SJ , Ullmann AJ , Piesman J , Dolan M , Probst C , Radzimski C , Stocker W , Komorowski L . Clin Vaccine Immunol 2016 24 (1) Lyme borreliosis is caused by tick-transmitted spirochetes of the Borrelia burgdorferi sensu lato group and is the most common vector-borne disease in the United States and Europe. Outer surface protein C (OspC) is a 23 kDa outer surface lipoprotein expressed during spirochete transmission from the tick to the vertebrate host. In a previous study, we found that immunization with a recombinant disulfide-bridged dimeric form of OspC (D-OspC) stimulates increased antibody responses relative to immunization with commonly employed monomeric OspC. Here we report that mice immunized with dimeric OspC proteins also exhibited enhanced protection against infection with the cognate B. burgdorferi strain. Mice were protected by four immunizations containing as little as 100 nanograms of dimeric OspC, suggesting that this form of the protein can induce protective immunity within a dose range reasonable for a human or veterinary vaccine. In contrast, monomeric OspC was only partially protective at much higher doses. IgG subclass analysis revealed that D-OspC immunized animals mainly possessed anti-OspC-IgG1. In contrast, infected animals develop anti-OspC restricted to the IgG3 isotype. A subset of antibodies generated by dimeric OspC immunization did not recognize the monomeric variant, indicating that unique epitopes exist on the dimeric form. Moreover, monoclonal antibodies that recognized only dimeric OspC protected mice from B. burgdorferi challenge, whereas another monoclonal that recognized both immunogens was not protective. These studies suggest that this dimeric OspC presents distinctive epitopes that generate antibodies protective against B. burgdorferi infection and could be a useful vaccine component. |
Enhanced surveillance for fatal dengue-like acute febrile illness in Puerto Rico, 2010-2012
Tomashek KM , Rivera A , Torres-Velasquez B , Hunsperger EA , Munoz-Jordan JL , Sharp TM , Rivera I , Sanabria D , Blau DM , Galloway R , Torres J , Rodriguez R , Serrano J , Chavez C , Davila F , Perez-Padilla J , Ellis EM , Caballero G , Wright L , Zaki SR , Deseda C , Rodriguez E , Margolis HS . PLoS Negl Trop Dis 2016 10 (10) e0005025 BACKGROUND: Dengue is a leading cause of morbidity throughout the tropics; however, accurate population-based estimates of mortality rates are not available. METHODS/PRINCIPAL FINDINGS: We established the Enhanced Fatal Acute Febrile Illness Surveillance System (EFASS) to estimate dengue mortality rates in Puerto Rico. Healthcare professionals submitted serum and tissue specimens from patients who died from a dengue-like acute febrile illness, and death certificates were reviewed to identify additional cases. Specimens were tested for markers of dengue virus (DENV) infection by molecular, immunologic, and immunohistochemical methods, and were also tested for West Nile virus, Leptospira spp., and other pathogens based on histopathologic findings. Medical records were reviewed and clinical data abstracted. A total of 311 deaths were identified, of which 58 (19%) were DENV laboratory-positive. Dengue mortality rates were 1.05 per 100,000 population in 2010, 0.16 in 2011 and 0.36 in 2012. Dengue mortality was highest among adults 19-64 years and seniors ≥65 years (1.17 and 1.66 deaths per 100,000, respectively). Other pathogens identified included 34 Leptospira spp. cases and one case of Burkholderia pseudomallei and Neisseria meningitidis. CONCLUSIONS/SIGNIFICANCE: EFASS showed that dengue mortality rates among adults were higher than reported for influenza, and identified a leptospirosis outbreak and index cases of melioidosis and meningitis. |
A chronological review of experimental infection studies of the role of wild animals and livestock in the maintenance and transmission of Crimean-Congo hemorrhagic fever virus
Spengler JR , Estrada-Pena A , Garrison AR , Schmaljohn C , Spiropoulou CF , Bergeron E , Bente DA . Antiviral Res 2016 135 31-47 This article provides a definitive review of experimental studies of the role of wild animals and livestock in the maintenance and transmission of Crimean-Congo hemorrhagic fever virus (CCHFV), the etiologic agent of Crimean-Congo hemorrhagic fever (CCHF), beginning with the first recognized outbreak of the human disease in Crimea in 1944. Published reports by researchers in the former Soviet Union, Bulgaria, South Africa, and other countries where CCHF has been observed show that CCHFV is maintained in nature in a tick-vertebrate-tick enzootic cycle. Human disease most commonly results from the bite of an infected tick, but may also follow crushing of infected ticks or exposure to the blood and tissues of infected animals during slaughter. Wild and domestic animals are susceptible to infection with CCHFV, but do not develop clinical illness. Vertebrates are important in CCHF epidemiology, as they provide blood meals to support tick populations, transport ticks across wide geographic areas, and transmit CCHFV to ticks and humans during the period of viremia. Many aspects of vertebrate involvement in the maintenance and spread of CCHFV are still poorly understood. Experimental investigations in wild animals and livestock provide important data to aid our understanding of CCHFV ecology. This article is the second in a series of reviews of more than 70 years of research on CCHF, summarizing important findings, identifying gaps in knowledge, and suggesting directions for future research. |
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