Enhanced broad spectrum in vitro antiviral efficacy of 3-F-4-MeO-Bn, 3-CN, and 4-CN derivatives of lipid remdesivir nucleoside monophosphate prodrugs
McMillan RE , Lo MK , Zhang XQ , Beadle JR , Valiaeva N , Garretson AF , Clark AE , Freshman J , Murphy J , Montgomery JM , Spiropoulou CF , Schooley RT , Hostetler KY , Carlin AF . Antiviral Res 2023 219 105718 Broad spectrum oral antivirals are urgently needed for the early treatment of many RNA viruses of clinical concern. We previously described the synthesis of 1-O-octadecyl-2-O-benzyl-glycero-3-phospho-RVn (V2043), an orally bioavailable lipid prodrug of remdesivir nucleoside (RVn, GS-441524) with broad spectrum antiviral activity against viruses with pandemic potential. Here we compared the relative activity of V2043 with new RVn lipid prodrugs containing sn-1 alkyl ether or sn-2 glycerol modifications. We found that 3-F-4-MeO-Bn, 3-CN-Bn, and 4-CN-Bn sn-2 glycerol modifications improved antiviral activity compared to V2043 when tested in vitro against clinically important RNA viruses from 5 virus families. These results support the continued development of V2043 and sn-2 glycerol modified RVn lipid prodrugs for the treatment of a broad range of RNA viruses for which there are limited therapies. |
Safety of longer-term doxycycline use: A systematic review and meta-analysis with implications for bacterial STI chemoprophylaxis
Chan PA , Le Brazidec DL , Becasen JS , Martin H , Kapadia J , Reno H , Bachmann L , Barbee LA . Sex Transm Dis 2023 50 (11) 701-712 BACKGROUND: Sexually transmitted infections (STIs) such as syphilis, gonorrhea, and chlamydia have significantly increased over the past decade in the United States. Doxycycline as chemoprophylaxis (i.e., post-exposure prophylaxis [PEP]) offers promise for addressing bacterial STIs. The goal of the current study was to evaluate the safety of longer-term doxycycline use (defined as eight or more weeks) in the context of potential use as STI chemoprophylaxis through a systematic literature review and meta-analysis. METHODS: This review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to search MEDLINE/PubMed for clinical studies published from August 2003 through January 2023 that reported on adverse events with doxycycline use with a focus on side-effects and metabolic effects of long-term use. RESULTS: A total of 67 studies were included in the systematic review. Overall, studies on longer-term doxycycline use reported 0% to over 50% adverse events ranging from mild to severe. Most common adverse events included gastrointestinal symptoms (i.e., nausea, vomiting, and abdominal pain), dermatologic (i.e., rash), and neurological (i.e., headache and dizziness) symptoms. Discontinuation of doxycycline due to adverse events was relatively uncommon in most studies. A meta-analysis of placebo controlled clinical trials (N = 18) revealed gastrointestinal and dermatological adverse events were more likely to occur in the doxycycline group. CONCLUSION: Longer-term (8+ weeks) doxycycline use is generally safe and may be associated with minor side-effects. Further research is needed on the potential metabolic impact of longer-term doxycycline use. |
Environmental and psychosocial predictors of cervical cancer screening among women in Gwagwalada Area Council, Abuja, North Central, Nigeria
Abah AU , Omokhapue A , Adewole A , Usifoh N , Iyanuoluwa OA . Afr J Reprod Health 2023 27 (7) 32-42 Cervical cancer (CC) is the second leading cause of cancer morbidity and mortality among Nigerian women. Although screening is a cost-effective strategy for reducing its burden, uptake remains sub-optimal. A descriptive cross-sectional study was conducted among 514 sexually active women aged ≥25 years in Gwagwalada Area Council, Abuja, Nigeria using a semi-structured interviewer administered questionnaire. Mean age of respondents was 38.4±11.6years. 246(46.9%) had good knowledge of CC screening while 268(51.2%) had poor knowledge. Religion (aOR:1.8 [95% CI: 1.1 - 3.1]), location (aOR:1.2 [95% CI: 1.2 - 3.4) and number of children (aOR:2.3 [95% CI: 1.3 - 3.9]) were predictors for screening. Poor access routes to health facilities (aOR:0.5 [95% CI: 0.2 - 0.9]), high cost of screening (aOR:0.4 [95% CI: 0.2 - 0.9]), unaware of screening centers (aOR:0.4 [95% CI: 0.2 - 0.9]) and long waiting hours (aOR:0.5 [95% CI: 0.2 - 0.9) were identified environmental predictors. Fear of positive diagnosis/stigma (aOR:0.3 [95% CI: 0.1 - 0.9]), unacceptable touch (aOR:0.2 [95% CI: 0.1 - 0.8), deficiency in awareness programs (aOR:0.3 [95% CI: 0.2 - 0.7]), and not aware of appropriate screening age (aOR:0.1 [95% CI: 0.1 - 0.4]) were identified psychosocial predictors. This study highlights the need to intensify enlightenment programs, subsidize screening services, and encourage community screening. |
Annual report to the nation on the status of cancer, part 2: Early assessment of the COVID-19 pandemic's impact on cancer diagnosis
Negoita S , Chen HS , Sanchez PV , Sherman RL , Henley SJ , Siegel RL , Sung H , Scott S , Benard VB , Kohler BA , Jemal A , Cronin KA . Cancer 2023 130 (1) 117-127 BACKGROUND: With access to cancer care services limited because of coronavirus disease 2019 control measures, cancer diagnosis and treatment have been delayed. The authors explored changes in the counts of US incident cases by cancer type, age, sex, race, and disease stage in 2020. METHODS: Data were extracted from selected US population-based cancer registries for diagnosis years 2015-2020 using first-submission data from the North American Association of Central Cancer Registries. After a quality assessment, the monthly numbers of newly diagnosed cancer cases were extracted for six cancer types: colorectal, female breast, lung, pancreas, prostate, and thyroid. The observed numbers of incident cancer cases in 2020 were compared with the estimated numbers by calculating observed-to-expected (O/E) ratios. The expected numbers of incident cases were extrapolated using Joinpoint trend models. RESULTS: The authors report an O/E ratio <1.0 for major screening-eligible cancer sites, indicating fewer newly diagnosed cases than expected in 2020. The O/E ratios were lowest in April 2020. For every cancer site except pancreas, Asians/Pacific Islanders had the lowest O/E ratio of any race group. O/E ratios were lower for cases diagnosed at localized stages than for cases diagnosed at advanced stages. CONCLUSIONS: The current analysis provides strong evidence for declines in cancer diagnoses, relative to the expected numbers, between March and May of 2020. The declines correlate with reductions in pathology reports and are greater for cases diagnosed at in situ and localized stage, triggering concerns about potential poor cancer outcomes in the coming years, especially in Asians/Pacific Islanders. PLAIN LANGUAGE SUMMARY: To help control the spread of coronavirus disease 2019 (COVID-19), health care organizations suspended nonessential medical procedures, including preventive cancer screening, during early 2020. Many individuals canceled or postponed cancer screening, potentially delaying cancer diagnosis. This study examines the impact of the COVID-19 pandemic on the number of newly diagnosed cancer cases in 2020 using first-submission, population-based cancer registry database. The monthly numbers of newly diagnosed cancer cases in 2020 were compared with the expected numbers based on past trends for six cancer sites. April 2020 had the sharpest decrease in cases compared with previous years, most likely because of the COVID-19 pandemic. |
Prevalence of diagnosed depression, anxiety, and ADHD among youth with type 1 or type 2 diabetes mellitus
Park J , Tang S , Mendez I , Barrett C , Danielson ML , Bitsko RH , Holliday C , Bullard KM . Prim Care Diabetes 2023 17 (6) 658-660 We examined the prevalence of diagnosed depression, anxiety, and ADHD among youth by diabetes type, insurance type, and race/ethnicity. These mental disorders were more prevalent among youth with diabetes, particularly those with type 2 diabetes, with non-Hispanic White youth with Medicaid and diabetes having a higher prevalence than other races/ethnicities. |
Promoting healthy aging: Public health as a leader for reducing dementia risk
Jackson EMJ , O'Brien K , McGuire LC , Baumgart M , Gore J , Brandt K , Levey AI , Lamont H . Public Policy Aging Rep 2023 33 (2) 92-95 Alzheimer’s disease and related dementias (ADRD) remain a public health priority, with prevalence of Alzheimer’s disease—the most common cause of dementia—among people aged 65 years and older living in the United States expected to grow to nearly 13.8 million people by 2060 (Alzheimer’s Association, 2023). ADRD are not normal aging; they impair memory and cognitive functioning, disrupting daily life. Over time, people with ADRD need increased assistance with basic activities of daily living and must rely on others for support, affecting family, friends, professional caregiving infrastructures, health and long-term care systems, and financial institutions designed to pay for care. In 2023, the formal cost of caring for people with ADRD to the health and long-term care systems in the United States is projected to total $345 billion (Alzheimer’s Association, 2023). Additionally, unpaid caregiving by family and friends was valued at nearly $339.5 billion in 2022 (Alzheimer’s Association, 2023). | | The lifetime cost of care for a person with Alzheimer’s disease was more than double the cost of care for a person without Alzheimer’s disease (Alzheimer’s Association, 2023). The total formal cost of ADRD care is projected to reach around $1 trillion in 2050 (Alzheimer’s Association, 2023; Zissimopoulos et al., 2014). These estimates do not consider the loss of quality of life for people with ADRD and their caregivers. It is imperative for the health of our systems and our population that public health address modifiable risk factors of ADRD. |
Serum concentrations of per- and polyfluoroalkyl substances and risk of renal cell carcinoma in the Multiethnic Cohort Study
Rhee J , Chang VC , Cheng I , Calafat AM , Botelho JC , Shearer JJ , Sampson JN , Setiawan VW , Wilkens LR , Silverman DT , Purdue MP , Hofmann JN . Environ Int 2023 180 108197 Per- and polyfluoroalkyl substances (PFAS) are environmentally persistent organic pollutants detectable in the serum of most U.S. adults. We previously reported a positive association between serum perfluorooctanoate (PFOA) concentrations and risk of renal cell carcinoma (RCC) within the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial, comprising predominantly White individuals enrolled in 1993-2001. To extend our investigations to a larger and more racially and ethnically diverse population, we conducted a nested case-control study of serum PFAS concentrations and RCC within the Multiethnic Cohort Study. We measured pre-diagnostic serum concentrations of nine PFAS among 428 RCC cases and 428 individually matched controls. We estimated odds ratios (ORs) and 95 % confidence intervals (CIs) for risk of RCC in relation to each PFAS using conditional logistic regression, adjusting for RCC risk factors and other PFAS. PFOA was not associated with RCC risk overall [doubling in serum concentration, OR(continuous) = 0.89 (95 %CI = 0.67, 1.18)]. However, we observed suggestive positive associations among White participants [2.12 (0.87, 5.18)] and among participants who had blood drawn before 2002 [1.49 (0.77, 2.87)]. Furthermore, higher perfluorononanoate (PFNA) concentration was associated with increased risk of RCC overall [fourth vs. first quartile, OR = 1.84 (0.97, 3.50), P(trend) = 0.04; OR(continuous) = 1.29 (0.97, 1.71)], with the strongest association observed among African American participants [OR(continuous) = 3.69 (1.33, 10.25)], followed by Native Hawaiian [2.24 (0.70, 7.19)] and White [1.98 (0.92, 4.25)] participants. Most other PFAS were not associated with RCC. While PFOA was not associated with RCC risk overall in this racially and ethnically diverse population, the positive associations observed among White participants and those with sera collected before 2002 are consistent with previous PLCO findings. Our study also provided new evidence of a positive association between PFNA and RCC risk that was strongest in African American participants. These findings highlight the need for additional epidemiologic research investigating PFAS exposures and RCC in large racially and ethnically diverse populations. |
Preventing measles in children and adolescents with HIV
Kaur G , Perry RT . AIDS 2023 37 (13) 2087-2089 Measles – clinically recognized as fever, rash and one or more of cough, coryza, or conjunctivitis – has been a leading cause of vaccine-preventable disease and death. Despite the existence of a well tolerated and effective vaccine, an estimated 128 000 children worldwide died of measles in 2021 [1]. Measles complications typically include pneumonia and diarrhea, caused either directly by measles virus or indirectly by measles-induced loss of preexisting immunity to common childhood pathogens [2–5]. Among people with HIV (PWH), measles infection can lead to severe pneumonia, encephalitis, and death; among children with HIV (CHIV), the mortality risk doubles [3,6]. | | For infants exposed to HIV in utero or HIV-infected but asymptomatic, WHO recommends a supplementary measles vaccine dose at 6 months of age in addition to the doses routinely recommended by the country's immunization schedule [7]. A measles vaccine dose at 6 months aims to vaccinate these infants soon after they lose maternally derived antibodies and while HIV-infected infants are better able to develop an immune response [8,9]. Although immune reconstitution during antiretroviral therapy (ART) does not restore preexisting measles immunity [10], vaccination after reconstitution can induce protective immunity against measles [11,12]. WHO therefore recommends providing at least one measles vaccine dose after immune reconstitution following ART initiation, or 6–12 months after ART initiation when CD4+ testing is not available [7]. |
Quantifying missed opportunities for tuberculosis among people with HIV in the US President's Emergency Plan for AIDS Relief
Peterson M , Briceno-Robaugh R , O'Connor S , Date A , Moonan PK , Fukunaga R , Vovc E , Dessai M , Nichols C , Pierre P , Sahu S , Baddeley A , Mavhunga F , Ferris R , Ahmedov S . AIDS 2023 37 (13) 2103-2104 The US President's Emergency Plan for AIDS Relief (PEPFAR) is the largest HIV program globally, serving roughly 58% of the estimated 28.7 million people with HIV (PWH) on antiretroviral therapy (ART) in 2021 [1,2]. Tuberculosis (TB) remains the leading cause of death among PWH; an estimated 46% of TB cases are undiagnosed at the time of death, emphasizing the challenge of TB detection among this population [3]. The WHO four-symptom screen at every clinical encounter is the primary TB case finding strategy implemented in PEPFAR. Recent program data show 87% of PWH were screened for TB symptoms and, among those, only 2.7% screened positive and were referred for further TB evaluation [2]. Although the expected rate of TB symptom positivity among PWH is debated, PEPFAR's yield is not yet optimal compared with reports from the literature ranging from 30% to 67% [4]. Poor case detection leads to PWH with undiagnosed, untreated, and unreported TB, which contributes to subsequent TB-attributable mortality among PWH. The extent of gaps in case detection and mortality have been difficult to quantify. | | We estimated the number of missed TB/HIV diagnoses and TB-attributable deaths in the populations PEPFAR serves using data from PEPFAR, WHO, and the Joint United Nations Programme on HIV/AIDS (UNAIDS) [1,5]. Data was analyzed for 2018–2021, reflecting data from before the COVID-19 pandemic through the most recently available year. WHO and UNAIDS reporting periods were aligned with PEPFAR data wherever possible. Country-level data was analyzed by year for the 32 countries where PEPFAR operated and reported TB data. All datasets were downloaded in April 2023 and analyzed in Tableau, version 2022.1. |
Pharyngeal co-infections with monkeypox virus and group A streptococcus, United States, 2022
Kaiser RM , Cash-Goldwasser S , Lehnertz N , Griffith J , Ruprecht A , Stanton J , Feldpausch A , Pavlick J , Bruen CA , Perez-Molinar D , Peglow SR , Akinsete OO , Morris SB , Raizes E , Gregory C , Lynfield R . Emerg Infect Dis 2023 29 (9) 1855-1858 We report 2 cases of pharyngeal monkeypox virus and group A Streptococcus co-infection in the United States. No rash was observed when pharyngitis symptoms began. One patient required intubation before mpox was diagnosed. Healthcare providers should be aware of oropharyngeal mpox manifestations and possible co-infections; early treatment might prevent serious complications. |
Lessons learned from identifying clusters of severe acute respiratory infections with influenza sentinel surveillance, Bangladesh, 2009-2020
Islam MA , Hassan MZ , Aleem MA , Akhtar Z , Chowdhury S , Rahman M , Rahman MZ , Ahmmed MK , Mah EMuneer S , Alamgir ASM , Anwar SNR , Alam AN , Shirin T , Rahman M , Davis WW , Mott JA , Azziz-Baumgartner E , Chowdhury F . Influenza Other Respir Viruses 2023 17 (9) e13201 BACKGROUND: We explored whether hospital-based surveillance is useful in detecting severe acute respiratory infection (SARI) clusters and how often these events result in outbreak investigation and community mitigation. METHODS: During May 2009-December 2020, physicians at 14 sentinel hospitals prospectively identified SARI clusters (i.e., ≥2 SARI cases who developed symptoms ≤10 days of each other and lived <30 min walk or <3 km from each other). Oropharyngeal and nasopharyngeal swabs were tested for influenza and other respiratory viruses by real-time reverse transcriptase-polymerase chain reaction (rRT-PCR). We describe the demographic of persons within clusters, laboratory results, and outbreak investigations. RESULTS: Field staff identified 464 clusters comprising 1427 SARI cases (range 0-13 clusters per month). Sixty percent of clusters had three, 23% had two, and 17% had ≥4 cases. Their median age was 2 years (inter-quartile range [IQR] 0.4-25) and 63% were male. Laboratory results were available for the 464 clusters with a median of 9 days (IQR = 6-13 days) after cluster identification. Less than one in five clusters had cases that tested positive for the same virus: respiratory syncytial virus (RSV) in 58 (13%), influenza viruses in 24 (5%), human metapneumovirus (HMPV) in five (1%), human parainfluenza virus (HPIV) in three (0.6%), adenovirus in two (0.4%). While 102/464 (22%) had poultry exposure, none tested positive for influenza A (H5N1) or A (H7N9). None of the 464 clusters led to field deployments for outbreak response. CONCLUSIONS: For 11 years, none of the hundreds of identified clusters led to an emergency response. The value of this event-based surveillance might be improved by seeking larger clusters, with stronger epidemiologic ties or decedents. |
Opportunities for enhanced prevention and control of hepatitis C through improved screening and testing efforts
Cartwright EJ , Patel PR . J Infect Dis 2023 An estimated 2.4 million people in the United States are living with hepatitis C virus (HCV) infection. In 2020, the Centers for Disease Control and Prevention updated hepatitis C screening recommendations to test adults aged ≥ 18 years at least once in a lifetime and pregnant persons during each pregnancy. For those with ongoing exposure to HCV, periodic testing is recommended. The recommended testing sequence is to obtain an HCV antibody test and, when positive, perform an HCV RNA test. Examination of HCV care cascades has found incomplete HCV testing occurs when a separate visit is required to obtain the HCV RNA test. Hepatitis C core antigen (HCVcAg) testing has been shown to be a useful tool for diagnosing current HCV infection is some settings. Hepatitis C testing that is completed, accurate, and efficient is necessary to achieve hepatitis C elimination goals. |
Lessons learned from global hepatitis C elimination programs
Handanagic S , Shadaker S , Drobeniuc J , Tsereteli M , Alkhazashvili M , Adesigbin C , Adamu I , Adabe R , Agwuocha C , Adisa O , Azania A , Boeke CE , Ngwije A , Serumondo J , Armstrong PA . J Infect Dis 2023 In 2016, World Health Organization (WHO) introduced global targets for the care and management of hepatitis C virus (HCV) infection to eliminate hepatitis C as a public health threat by 2030. Despite significant improvements in testing and treatment, in 2020 only 23% of all persons infected with HCV globally were diagnosed. We explore examples from global hepatitis C programs in Georgia, Rwanda, and Nigeria that have used decentralized and integrated models to increase access to HCV testing. Georgia established the world's first national hepatitis C elimination program in 2015. In 2022, 2.6 million people (80% of the adults) have been screened for antibodies for HCV infection, and 80,000 persons with HCV virus detected were treated. To achieve these results, Georgia implemented HCV core antigen (HCVcAg) testing, utilization of point-of-care HCV RNA, and simplification of HCV viremia detection by qualitative HCV RNA. Rwanda was the first country in sub-Saharan Africa to commit to HCV elimination in 2018, and as of 2022 it has achieved its screening target of 7 million people and initiated approximately 60,000 patients on hepatitis C treatment by rapid decentralization and integration of HCV services. In Nigeria, the integrated near-point-of-care testing approach in Nasarawa state has been effective in expanding access to HCV viremia testing and enabling the possibility of same-day testing and treatment initiation. Examples of decentralization and integration of HCV testing and linkage to care in Georgia, Rwanda and Nigeria could help inform effective strategies to reach 2030 hepatitis C elimination goals in other countries. |
QuickStats: Sepsis-related* death rates(†) among persons aged ≥ 65 years, by age group and sex - National Vital Statistics System, United States, 2021
Gorina Y , Kramarow EA . MMWR Morb Mortal Wkly Rep 2023 72 (38) 1043 In 2021, the sepsis-related death rate among persons aged ≥65 years was 330.9 deaths per 100,000 population; the rate among men (371.7) was higher than that among women (297.4). Sepsis-related death rates among men were higher than those among women in each age group: 232.7 versus 173.0 (65–74 years), 477.3 versus 349.8 (75–84 years), and 1,037.8 versus 755.5 (≥85 years). Sepsis-related death rates increased with age from 201.1 among persons aged 65–74 years to 858.3 among those aged ≥85 years. Sepsis-related death rates increased with age among both men and women. |
Home-based testing and COVID-19 isolation recommendations, United States
Moonan PK , Smith JP , Borah BF , Vohra D , Matulewicz HH , DeLuca N , Caruso E , Loosier PS , Thorpe P , Taylor MM , Oeltmann JE . Emerg Infect Dis 2023 29 (9) 1921-1924 Using a nationally representative panel survey, we examined isolation behaviors among persons in the United States who had positive SARS-CoV-2 test results during January 2021-March 2022. Compared with persons who received provider-administered results, persons with home-based results had 29% (95% CI 5%-47%) lower odds of following isolation recommendations. |
Factors associated with COVID-19 vaccine confidence among primary care providers in Kazakhstan, March-April 2021
Nabirova D , Horth R , Kassabekova L , Henderson A , Yesmagambetova A , Alaverdyan S , Nuorti JP , Smagul M . Front Public Health 2023 11 1245750 INTRODUCTION: Vaccination is a critical public health intervention, and vaccine hesitancy is a major threat. Globally, confidence in COVID-19 vaccines has been low, and rates of routine immunizations decreased during the COVID-19 pandemic. Because healthcare providers are a trusted source of information on vaccination in Kazakhstan, it was vital to understand their knowledge, attitudes and practices (KAP) related to both routine and COVID-19 vaccines. METHODS: From March to April 2021, we conducted a cross-sectional study among the healthcare providers responsible for vaccination in 54 primary care facilities in three cities in Kazakhstan. All consenting providers anonymously completed structured online questionnaires at their place of work. A provider was classified as having COVID-19 vaccine confidence if they planned to get a COVID-19 vaccine, believed that COVID-19 vaccines are important to protect their community and either believed the vaccine was important to protect themselves or believed that getting a vaccine was safer than getting COVID-19. Statistical analysis included chi-square, Spearman's rank correlation coefficient, and Poisson regression. RESULTS: Of 1,461 providers, 30% had COVID-19 vaccine confidence, 40% did not, and 30% would refuse vaccination. Participants were mostly female (92%) and ≤ 35 years old (57%). Additionally, 65% were nurses, 25% were family physicians, and 10% were pediatricians. Adequate KAP for routine vaccines was low (22, 17, and 32%, respectively). Adequate knowledge was highest among pediatricians (42%) and family physicians (28%) and lowest among nurses (17%). Misconceptions about vaccines were high; 54% believed that influenza vaccines cause flu, and 57% believed that there is a scientifically proven association between vaccination and autism and multiple sclerosis. About half (45%) of the practitioners felt confident answering patient vaccine-related concerns. In adjusted models, COVID-19 vaccine confidence was positively associated with adequate knowledge of vaccines (prevalence ratio: 1.2, 95% confidence interval: 1.0-1.4) and adequate attitudes related to routine vaccines (3.1, 2.7-3.6). CONCLUSION: Our study uncovers critical areas for interventions to improve KAP related to routine immunizations and COVID-19 vaccine confidence among providers in Kazakhstan. The complex relationship between KAP of routine vaccines and COVID-19 vaccine confidence underscores the importance of addressing vaccine hesitancy more broadly and not focusing solely on COVID-19. |
Acceptability of minimally invasive autopsy by community members and healthcare workers in Siaya and Kisumu counties, western Kenya, 2017-2018
Otieno P , Akelo V , Khagayi S , Omore R , Akoth K , Nyanjom M , Ngere S , Ochola K , Maixenchs M , Kone A , Blevins J , Zielinski-Gutierrez E , Barr BAT . PLOS Glob Public Health 2023 3 (9) e0001319 Worldwide, nearly six million children under the age of five (<5s) die annually, a substantial proportion of which are due to preventable and treatable diseases. Efforts to reduce child mortality indicators in the most affected regions are often undermined by a lack of accurate cause of death data. To generate timely and more accurate causes of death data for <5s, the Child Health and Mortality Prevention Surveillance (CHAMPS) Network established mortality surveillance in multiple countries using Minimally Invasive Tissue Sampling (MITS) in <5 deaths. Here we present acceptability of MITS by community members and healthcare workers in Siaya and Kisumu counties, western Kenya. From April 2017 to February 2018, we conducted 40 in-depth interviews and five focus group discussions with healthcare workers and community members, before and during CHAMPS implementation. Participants were purposively selected. Field observations to understand traditional death-related practices were also performed. Interviews were transcribed into Nvivo 11.0 for data organization and management. Analysis was guided by the grounded theory approach. Facilitators of acceptability were desire to understand why death occurred, timely performance of MITS procedures, potential for MITS results in improving clinical practice and specific assistance provided to families by the CHAMPS program. However, cultural and religious beliefs highlighted important challenges to acceptability, including CHAMPS teams recruiting after a child's death, rumours and myths, unmet expectations from families, and fear by healthcare workers that some families could use MITS results to sue for negligence. Increasing MITS uptake requires sustained strategies to strengthen the identified facilitators of acceptability and simultaneously address the barriers. MITS acceptance will contribute to better characterization of causes of death and support the development of improved interventions aimed at reducing <5 mortality. |
Venous thromboembolism prophylaxis for hospitalized adult patients: a survey of US health care providers on attitudes and practices
Lam BD , Dodge LE , Datta S , Rosovsky RP , Robertson W , Lake L , Reyes N , Adamski A , Abe K , Panoff S , Pinson A , Elavalakanar P , Vlachos IS , Zwicker JI , Patell R . Res Pract Thromb Haemost 2023 7 (6) 102168 BACKGROUND: Venous thromboembolism (VTE) is a leading cause of preventable mortality among hospitalized patients, but appropriate risk assessment and thromboprophylaxis remain underutilized or misapplied. OBJECTIVES: We conducted an electronic survey of US health care providers to explore attitudes, practices, and barriers related to thromboprophylaxis in adult hospitalized patients and at discharge. RESULTS: A total of 607 US respondents completed the survey: 63.1% reported working in an academic hospital, 70.7% identified as physicians, and hospital medicine was the most frequent specialty (52.1%). The majority of respondents agreed that VTE prophylaxis is important (98.8%; 95% CI: 97.6%-99.5%) and that current measures are safe (92.6%; 95% CI: 90.2%-94.5%) and effective (93.8%; 95% CI: 91.6%-95.6%), but only half (52.0%; 95% CI: 47.9%-56.0%) believed that hospitalized patients at their institution are on appropriate VTE prophylaxis almost all the time. One-third (35.4%) reported using a risk assessment model (RAM) to determine VTE prophylaxis need; 44.9% reported unfamiliarity with RAMs. The most common recommendation for improving rates of appropriate thromboprophylaxis was to leverage technology. A majority of respondents (84.5%) do not reassess a patient's need for VTE prophylaxis at discharge, and a minority educates patients about the risk (16.2%) or symptoms (18.9%) of VTE at discharge. CONCLUSION: Despite guideline recommendations to use RAMs, the majority of providers in our survey do not use them. A majority of respondents believed that technology could help improve VTE prophylaxis rates. A majority of respondents do not reassess the risk of VTE at discharge or educate patients about this risk of VTE at discharge. |
Ambient air quality and fatal asthma exacerbations among children in North Carolina
Mirabelli MC , Flanders WD , Vaidyanathan A , Beavers DP , Gower WA . Epidemiology 2023 34 (6) 888-891 BACKGROUND: Little is known about the role of air quality in fatal asthma exacerbations among children. METHODS: We collected information about 80 deaths that occurred in North Carolina from 2001 through 2016, among children aged 5-17 years, with asthma identified as the primary cause of death. We linked information about each death with county-level estimates of particulate matter ≤2.5 µm (PM2.5) and ozone (O3). Using the linked data, we conducted a case-crossover analysis of associations between PM2.5 and O3 lagged by 3-5 days with the odds of fatal asthma exacerbations. RESULTS: In the highest tertile of PM2.5 lag(3-5), the odds of a fatal exacerbation of asthma were more than twice the odds in the lowest tertile (odds ratio = 2.2; 95% confidence interval = 1.1, 4.6). CONCLUSION: These findings from North Carolina provide evidence to support the hypothesis that ambient air pollution increases the risk of fatal exacerbations of asthma among children. |
Blastomycosis-associated hospitalizations, United States, 2010-2020
Benedict K , Hennessee I , Gold JAW , Smith DJ , Williams S , Toda M . J Fungi (Basel) 2023 9 (9) BACKGROUND: Blastomycosis is an environmentally acquired fungal disease that can cause severe illness, with approximately 65% of reported cases requiring hospitalization. Recent trends in blastomycosis-associated hospitalizations in the United States have not been described. METHODS: We analyzed hospital discharge data from the Healthcare Cost and Utilization Project (HCUP) National (Nationwide) Inpatient Sample. We calculated hospitalization rates per 100,000 population using U.S. census data and examined factors associated with in-hospital mortality. RESULTS: An estimated 11,776 blastomycosis-associated hospitalizations occurred during 2010-2020 (average yearly rate 0.3 per 100,000 persons), with no apparent temporal trend. Rates were consistently highest among persons ≥65 years old and males. In-hospital death occurred in 7.9% and approximately doubled from 3.9% in 2010 to 8.5% in 2020. Older age, chronic obstructive pulmonary disease, and malignancy were associated with mortality. CONCLUSIONS: Blastomycosis-associated hospitalizations can result in poor outcomes, underscoring the continued need for attention to early detection and treatment of blastomycosis and monitoring of disease trends. |
Thrombocytopenia associated with elemental mercury poisoning in two siblings - Connecticut, July 2022
Hogeland EW , Somers TS , Yip L , Doyon S , Redlich CA , Orsey AD , Woda CB , Swan ST , Feder HM Jr . MMWR Morb Mortal Wkly Rep 2023 72 (38) 1027-1031 Two siblings aged 5 and 15 years from Connecticut were hospitalized with petechial rash, oral mucositis, and severe thrombocytopenia approximately 10 days after they played with a jar of elemental mercury they found in their home. Before the mercury exposure was disclosed, the siblings were treated with platelet transfusions, intravenous immune globulin (IVIG) for possible immune thrombocytopenic purpura, and antibiotics for possible infectious causes. When their conditions did not improve after 6 days, poison control facilitated further questioning about toxic exposures including mercury, testing for mercury, and chelation with dimercaptosuccinic acid. The older sibling soon recovered, but the younger child required a prolonged hospitalization for severe thrombocytopenia, ultimately receiving repeated doses of IVIG, steroids, and romiplostim, a thrombopoietin receptor agonist. Close collaboration among multiple agencies was required to identify the extent of mercury contamination, evaluate and treat the other family members, and decontaminate the home. These cases demonstrate the importance of ongoing public health outreach to promote early detection of elemental mercury toxicity, and the need to evaluate for environmental exposures when multiple close contacts experience similar signs and symptoms. |
Worker studies suggest unique liver carcinogenicity potential of polyvinyl chloride microplastics
Zarus GM , Muianga C , Brenner S , Stallings K , Casillas G , Pohl HR , Mumtaz MM , Gehle K . Am J Ind Med 2023 66 (12) 1033-1047 BACKGROUND: Plastic debris pervades our environment. Some breaks down into microplastics (MPs) that can enter and distribute in living organisms causing effects in multiple target organs. MPs have been demonstrated to harm animals through environmental exposure. Laboratory animal studies are still insufficient to evaluate human impact. And while MPs have been found in human tissues, the health effects at environmental exposure levels are unclear. AIM: We reviewed and summarized existing evidence on health effects from occupational exposure to MPs. Additionally, the diverse effects documented for workers were organized by MP type and associated co-contaminants. Evidence of the unique effects of polyvinyl chloride (PVC) on liver was then highlighted. METHODS: We conducted two stepwise online literature reviews of publications focused on the health risks associated with occupational MP exposures. This information was supplemented with findings from animal studies. RESULTS: Our analysis focused on 34 published studies on occupational health effects from MP exposure with half involving exposure to PVC and the other half a variety of other MPs to compare. Liver effects following PVC exposure were reported for workers. While PVC exposure causes liver toxicity and increases the risk of liver cancers, including angiosarcomas and hepatocellular carcinomas, the carcinogenic effects of work-related exposure to other MPs, such as polystyrene and polyethylene, are not well understood. CONCLUSION: The data supporting liver toxicity are strongest for PVC exposure. Overall, the evidence of liver toxicity from occupational exposure to MPs other than PVC is lacking. The PVC worker data summarized here can be useful in assisting clinicians evaluating exposure histories from PVC exposure and designing future cell, animal, and population exposure-effect research studies. |
Outcomes of population surveillance data collection pilots and the behavioral risk factor surveillance system: What happens in Texas
Kirtland K , Garvin W , Yan T , Cavazos M , Berzofsky M , Freedner N , Muldavin B , Levine B , Gamble S , Town M . Surv Pract 2023 16 (1) 1-12 Declining response rates and rising costs have prompted the search for alternatives to traditional random-digit dialing (RDD) interviews. In 2021, three Behavioral Risk Factor Surveillance System (BRFSS) pilots were conducted in Texas: data collection using an RDD short message service (RDD SMS) text-messaging push-to-web pilot, an address-based push-to-web pilot, and an internet panel pilot. We used data from the three pilots and from the concurrent Texas BRFSS Computer Assisted Telephone Interview (CATI). We compared unweighted data from these four sources to demographic information from the American Community Survey (ACS) for Texas, comparing respondents' health information across the protocols as well as cost and response rates. Non-Hispanic White adults and college graduates disproportionately responded in all survey protocols. Comparing costs across protocols was difficult due to the differences in methods and overhead, but some cost comparisons could be made. The cost per complete for BRFSS/CATI ranged from $75 to $100, compared with costs per complete for address-based sampling ($31 to $39), RDD SMS ($12 to $20), and internet panel (approximately $25). There were notable differences among survey protocols and the ACS in age, race/ethnicity, education, and marital status. We found minimal differences in respondents' answers to heart disease-related questions; however, responses to flu vaccination questions differed by protocol. Comparable responses were encouraging. Properly weighted web-based data collection may help use data collected by new protocols as a supplement to future BRFSS efforts. |
An improved framework for detecting discrete epidemiologically meaningful partitions in hierarchically clustered genetic data
Jacobson DK , Low R , Plucinski MM , Barratt JLN . Bioinform Adv 2023 3 (1) vbad118 MOTIVATION: Hierarchical clustering of microbial genotypes has the limitation that hierarchical clusters are nested, where smaller groups of related isolates exist within larger groups that get progressively larger as relationships become increasingly distant. In an epidemiologic context, investigators must dissect hierarchical trees into discrete groupings that are epidemiologically meaningful. We recently described a statistical framework (Method A) for dissecting hierarchical trees that attempts to minimize investigator bias. Here, we apply a modified version of that framework (Method B) to a hierarchical tree constructed from 2111 genotypes of the foodborne parasite Cyclospora, including 639 genotypes linked to epidemiologically defined outbreaks. To evaluate Method B's performance, we examined the concordance between these epidemiologically defined groupings and the genetic partitions identified. We also used the same epidemiologic clusters to evaluate the performance of Method A, plus two tree-dissection methods (cutreeHybrid and cutreeDynamic) available within the Dynamic Tree Cut R package, in addition to the TreeCluster method and PARNAS. RESULTS: Compared to the other methods, Method B, TreeCluster, and PARNAS were the most accurate (99.4%) in identifying genetic groups that reflected the epidemiologic groupings, noting that TreeCluster and PARNAS performed identically on our dataset. CutreeHybrid identified groups reflecting patterns in the wider Cyclospora population structure but lacked finer, strain-level discrimination (Simpson's D: cutreeHybrid=0.785). CutreeDynamic displayed good strain discrimination (Simpson's D = 0.933), though lacked sensitivity (77%). At two different threshold/radius settings TreeCluster/PARNAS displayed similar utility to Method B. However, Method B computes a tree-dissection threshold automatically, and the threshold/radius settings used when executing TreeCluster/PARNAS here were computed using Method B. Using a TreeCluster threshold of 0.045 as recommended in the TreeCluster documentation, epidemiologic utility dropped markedly below that of Method B. AVAILABILITY AND IMPLEMENTATION: Relevant code and data are publicly available. Source code (Method B) and instructions for its use are available here: https://github.com/Joel-Barratt/Hierarchical-tree-dissection-framework. |
A phylogeographic description of histoplasma capsulatum in the United States
Bagal UR , Gade L , Benedict K , Howell V , Christophe N , Gibbons-Burgener S , Hallyburton S , Ireland M , McCracken S , Metobo AK , Signs K , Warren KA , Litvintseva AP , Chow NA . J Fungi (Basel) 2023 9 (9) Histoplasmosis is one of the most under-diagnosed and under-reported endemic mycoses in the United States. Histoplasma capsulatum is the causative agent of this disease. To date, molecular epidemiologic studies detailing the phylogeographic structure of H. capsulatum in the United States have been limited. We conducted genomic sequencing using isolates from histoplasmosis cases reported in the United States. We identified North American Clade 2 (NAm2) as the most prevalent clade in the country. Despite high intra-clade diversity, isolates from Minnesota and Michigan cases were predominately clustered by state. Future work incorporating environmental sampling and veterinary surveillance may further elucidate the molecular epidemiology of H. capsulatum in the United States and how genomic sequencing can be applied to the surveillance and outbreak investigation of histoplasmosis. |
Rotavirus genotypes in the post-vaccine era: A systematic review and meta-analysis of global, regional, and temporal trends in settings with and without rotavirus vaccine introduction
Amin AB , Cates JE , Liu Z , Wu J , Ali I , Rodriguez A , Panjwani J , Tate JE , Lopman BA , Parashar UD . J Infect Dis 2023 BACKGROUND: Even moderate differences in rotavirus vaccine effectiveness against non-vaccine genotypes may exert selective pressures on circulating rotaviruses. Whether this vaccine effect or natural temporal fluctuations underlie observed changes in genotype distributions is unclear. METHODS: We systematically reviewed studies reporting rotavirus genotypes from children <5 years of age globally between 2005 and 2023. We compared rotavirus genotypes between vaccine-introducing and non-introducing settings globally and by World Health Organization (WHO) region, calendar time, and time since vaccine introduction. RESULTS: Crude pooling of genotype data from 361 studies indicated higher G2P[4], a non-vaccine genotype, prevalence in vaccine-introducing settings, both globally and by WHO region. This difference did not emerge when examining genotypes over time in the Americas, the only region with robust longitudinal data. Relative to non-introducing settings, G2P[4] detections were more likely in settings with recent introduction (e.g. 1-2 years post-introduction aOR: 4.39 (95% CI: 2.87-6.72)) but were similarly likely in settings with more time elapsed since introduction, (e.g. 7 or more years aOR (1.62 95% CI: 0.49-5.37)). CONCLUSIONS: When accounting for both regional and temporal trends, there was no substantial evidence of long-term vaccine-related selective pressures on circulating genotypes. Increased prevalence of G2P[4] may be transient after rotavirus vaccine introduction. |
Broad-spectrum detection of HPV in male genital samples using target-enriched whole-genome sequencing
Li T , Unger ER , Rajeevan MS . Viruses 2023 15 (9) Most human papillomavirus (HPV) surveillance studies target 30-50 of the more than 200 known types. We applied our recently described enriched whole-genome sequencing (eWGS) assay to demonstrate the impact of detecting all known and novel HPV types in male genital samples (n = 50). HPV was detected in nearly all (82%) samples, (mean number of types/samples 13.6; range 1-85), and nearly all HPV-positive samples included types in multiple genera (88%). A total of 560 HPV detections (237 unique HPV types: 46 alpha, 55 beta, 135 gamma, and 1 mu types) were made. The most frequently detected HPV types were alpha (HPV90, 43, and 74), beta (HPV115, 195, and 120), and gamma (HPV134, mSD2, and HPV50). High-risk alpha types (HPV16, 18, 31, 39, 52, and 58) were not common. A novel gamma type was identified (now officially HPV229) along with 90 unclassified types. This pilot study demonstrates the utility of the eWGS assay for broad-spectrum type detection and suggests a significantly higher type diversity in males compared to females that warrants further study. |
Changes in oral and anal sex with opposite-sex partners among sexually active females and males ages 15-44 in the United States: National Survey of Family Growth, 2011-2019
Katz DA , Copen CE , Haderxhanaj LT , Hogben M , Goodreau SM , Spicknall IH , Hamilton DT . Sex Transm Dis 2023 50 (11) 713-719 BACKGROUND: Oral and anal sex with opposite-sex partners are common and associated with STI transmission. Trends in these behaviors over the last decade, during which bacterial STI diagnoses have reached historic highs while HIV diagnoses have decreased, are not well understood. We examined recent trends in oral and anal sex and associated condom use with opposite-sex partners among females and males. METHODS: We analyzed data from 16,926 female and 13,533 male respondents ages 15-44 who reported sex with an opposite-sex partner in the past 12 months from the National Survey of Family Growth, 2011-2019. We used survey-weighted linear or logistic regression to evaluate linear temporal trends in oral and anal sex behaviors. RESULTS: From 2011-13 to 2017-19, reports of oral sex and number of oral sex partners in the past 12 months increased among females (85.4% in 2011-13 to 89.4% in 2017-19, OR = 1.05, 95%CI = 1.02-1.09; and β = 0.014, 95%CI = 0.005-0.023; respectively) but not males (ranges = 87.9-89.1%; 1.27-1.31). Condom use at last oral sex decreased among both females and males (6.3% to 4.3%, OR = 0.93, 95%CI = 0.88-0.99; 5.9% to 4.4%, OR = 0.95, 95%CI = 0.91-1.00). Anal sex (female range = 21.0-23.3%, male = 23.3-24.6%), number of anal sex partners (females = 0.22-0.25; males = 0.26-0.30), and condom use at last anal sex (females = 15.3-18.2%; males = 27.0-28.7%) remained stable. CONCLUSIONS: The frequency of oral and anal sex with opposite-sex partners among U.S. 15-44-year-olds, paired with limited and - for oral sex - decreasing condom use, demonstrates the need to understand the role of these behaviors in increasing STI diagnosis rates and the potential role of extragenital screening and condoms in reducing STI transmission. |
Testing for hepatitis C during pregnancy among persons with Medicaid and commercial insurance: Cohort study
Khan MA , Thompson WW , Osinubi A , Meyer Rd WA , Kaufman HW , Armstrong PA , Foster MA , Nelson NP , Wester C . JMIR Public Health Surveill 2023 9 e40783 BACKGROUND: The reported incidence of acute hepatitis C virus (HCV) infection is increasing among persons of childbearing age in the United States. Infants born to pregnant persons with HCV infection are at risk for perinatal HCV acquisition. In 2020, the United States Preventive Services Task Force and Centers for Disease Control and Prevention recommended that all pregnant persons be screened during each pregnancy for hepatitis C. However, there are limited data on trends in hepatitis C testing during pregnancy. OBJECTIVE: We estimated hepatitis C testing rates in a large cohort of patients with Medicaid and commercial insurance who gave birth during 2015-2019 and described demographic and risk-based factors associated with testing. METHODS: Medicaid and commercial insurance claims for patients aged 15-44 years and who gave birth between 2015 and 2019 were included. Birth claims were identified using procedure and diagnosis codes for vaginal or cesarean delivery. Hepatitis C testing was defined as an insurance claim during the 42 weeks before delivery. Testing rates were calculated among patients who delivered and among the subset of patients who were continuously enrolled for 42 weeks before delivery. We also compared the timing of testing relative to delivery among patients with commercial or Medicaid insurance. Multivariable logistic regression was used to identify factors associated with testing. RESULTS: Among 1,142,770 Medicaid patients and 1,207,132 commercially insured patients, 175,223 (15.3%) and 221,436 (18.3%) were tested for hepatitis C during pregnancy, respectively. Testing rates were 89,730 (21.8%) and 187,819 (21.9%) among continuously enrolled Medicaid and commercially insured patients, respectively. Rates increased from 2015 through 2019 among Medicaid (from 20,758/108,332, 19.2% to 13,971/52,330, 26.8%) and commercially insured patients (from 38,308/211,555, 18.1% to 39,152/139,972, 28%), respectively. Among Medicaid patients, non-Hispanic Black (odds ratio 0.73, 95% CI 0.71-0.74) and Hispanic (odds ratio 0.53, 95% CI 0.51-0.56) race or ethnicity were associated with lower odds of testing. Opioid use disorder, HIV infection, and high-risk pregnancy were associated with higher odds of testing in both Medicaid and commercially insured patients. CONCLUSIONS: Hepatitis C testing during pregnancy increased from 2015 through 2019 among patients with Medicaid and commercial insurance, although tremendous opportunity for improvement remains. Interventions to increase testing among pregnant persons are needed. |
Barriers to COVID-19 prevention measures among people experiencing homelessness with substance use disorder or serious mental illness
Meehan AA , Jeffers A , Barker J , Ray CM , Laws RL , Fields VL , Miedema SS , Cha S , Cassell CH , DiPietro B , Cary M , Yang M , McLendon H , Marcus R , Mosites E . J Prev (2022) 2023 44 (6) 663-678 People experiencing homelessness (PEH) are at disproportionate risk of becoming infected and having severe illness from coronavirus disease 2019 (COVID-19), especially when residing in congregate settings like homeless shelters. Behavioral health problems related to substance use disorder (SUD) and severe mental illness (SMI) may have created additional challenges for PEH to practice prevention measures like mask wearing, physical distancing, handwashing, and quarantine and isolation. The study objective was to understand the perceived barriers PEH face regarding COVID-19 non-pharmaceutical prevention strategies and identify recommendations for overcoming barriers. From August-October 2020, qualitative phone interviews with 50 purposively selected behavioral health professionals across the United States serving PEH with SUD or SMI were conducted. Professionals described that PEH faced barriers to prevention that were structural (e.g., access to necessary resources), behavioral (related to SUD or SMI), or related to the priority of other needs. Recommendations to overcome these barriers included providing free prevention resources (e.g., masks and hand sanitizer), providing education about importance of prevention strategies, and prioritizing access to stable housing. Interviews took place before COVID-19 vaccines were available, so barriers to vaccination are not included in this paper. Findings can help support tailored approaches during COVID-19 and future public health threats. |
Race, age, and kidney transplant waitlisting among patients receiving incident dialysis in the United States
Buford J , Retzloff S , Wilk AS , McPherson L , Harding JL , Pastan SO , Patzer RE . Kidney Med 2023 5 (10) 100706 RATIONALE & OBJECTIVE: Patients with kidney failure from racial and ethnic minority groups and older patients have reduced access to the transplant waitlist relative to White and younger patients. Although racial disparities in the waitlisting group have declined after the 2014 kidney allocation system change, whether there is intersectionality of race and age in waitlisting access is unknown. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: 439,455 non-Hispanic White and non-Hispanic Black US adults initiating dialysis between 2015 and 2019 were identified from the United States Renal Data System, and followed through 2020. EXPOSURES: Patient race and ethnicity (non-Hispanic White and non-Hispanic Black) and age group (18-29, 30-49, 50-64, and 65-80 years). OUTCOMES: Placement on the United Network for Organ Sharing deceased donor waitlist. ANALYTICAL APPROACH: Age- and race-stratified waitlisting rates were compared. Multivariable Cox proportional hazards models, censored for death, examined the association between race and waitlisting, and included interaction term for race and age. RESULTS: Over a median follow-up period of 1 year, the proportion of non-Hispanic White and non-Hispanic Black patients waitlisted was 20.7% and 20.5%, respectively. In multivariable models, non-Hispanic Black patients were 14% less likely to be waitlisted (aHR, 0.86, 95% CI, 0.77-0.95). Relative differences between non-Hispanic Black and non-Hispanic White patients were different by age group. Non-Hispanic Black patients were 27%, 12%, and 20% less likely to be waitlisted than non-Hispanic White patients for ages 18-29 years (aHR, 0.73; 95% CI, 0.61-0.86), 50-64 (aHR, 0.88; 95% CI, 0.80-0.98), and 65-80 years (aHR, 0.80; 95% CI, 0.71-0.90), respectively, but differences were attenuated among patients aged 30-49 years (aHR, 0.89; 95% CI, 0.77-1.02). LIMITATIONS: Race and ethnicity data is physician reported, residual confounding, and analysis is limited to non-Hispanic White and non-Hispanic Black patients. CONCLUSIONS: Racial disparities in waitlisting exist between non-Hispanic Black and non-Hispanic White individuals and are most pronounced among younger patients with kidney failure. Results suggest that interventions to address inequalities in waitlisting may need to be targeted to younger patients with kidney failure. PLAIN-LANGUAGE SUMMARY: Research has shown that patients from racial and ethnic minority groups and older patients have reduced access to transplant waitlisting relative to White and younger patients; nevertheless, how age impacts racial disparities in waitlisting is unknown. We compared waitlisting between non-Hispanic Black and non-Hispanic White patients with incident kidney failure, within age strata, using registry data for 439,455 US adults starting dialysis (18-80 years) during 2015-2019. Overall, non-Hispanic Black patients were less likely to be waitlisted and relative differences between the two racial groups differed by age. After adjusting for patient-level factors, the largest disparity in waitlisting was observed among adults aged 18-29 years. These results suggest that interventions should target younger adults to reduce disparities in access to kidney transplant waitlisting. |
Update on outbreak of fungal meningitis among U.S. residents who received epidural anesthesia at two clinics in Matamoros, Mexico
Smith DJ , Gold JAW , Chiller T , Bustamante ND , Marinissen MJ , Rodriquez GG , Cortes VBG , Molina CD , Williams S , Vazquez Deida AA , Byrd K , Pappas PG , Patterson TF , Wiederhold NP , Thompson Iii GR , Ostrosky-Zeichner L . Clin Infect Dis 2023 BACKGROUND: Public health officials are responding to an outbreak of fungal meningitis among patients who received procedures under epidural anesthesia at two clinics (River Side Surgical Center and Clinica K-3) in Matamoros, Mexico, during January 1-May 13, 2023. This report describes outbreak epidemiology and outlines interim diagnostic and treatment recommendations. METHODS: Interim recommendations for diagnosis and management were developed by the Mycoses Study Group Research Education and Consortium (MSGERC) based on the clinical experience of clinicians caring for patients during the current outbreak or during previous outbreaks of healthcare-associated fungal meningitis in Durango, Mexico, and the United States. RESULTS: As of July 7, 2023, the situation has evolved into a multistate and multinational fungal meningitis outbreak. A total of 185 residents in 22 U.S. states and jurisdictions have been identified who might be at risk of fungal meningitis because they received epidural anesthesia at the clinics of interest in 2023. Among these patients, 11 suspected, 10 probable, and 10 confirmed U.S. cases have been diagnosed, with severe vascular complications and eight deaths occurring. Fusarium solani species complex has been identified as the causative agent, with antifungal susceptibility testing of a single isolate demonstrating poor in vitro activity for most available antifungals. Currently, triple therapy with intravenous voriconazole, liposomal amphotericin B, and fosmanogepix is recommended. CONCLUSIONS: Efforts to understand the source of this outbreak and optimal treatment approaches are ongoing, but infectious diseases physicians should be aware of available treatment recommendations. New information will be available on CDC's website. |
Healthcare-associated infections and conditions in the era of digital measurement
Classen DC , Rhee C , Dantes RB , Benin AL . Infect Control Hosp Epidemiol 2023 1-6 As the third edition of the Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals is released with the latest recommendations for the prevention and management of healthcare-associated infections (HAIs), a new approach to reporting HAIs is just beginning to unfold. This next generation of HAI reporting will be fully electronic and based largely on existing data in electronic health record (EHR) systems and other electronic data sources. It will be a significant change in how hospitals report HAIs and how the Centers for Disease Control and Prevention (CDC) and other agencies receive this information. This paper outlines what that future electronic reporting system will look like and how it will impact HAI reporting. |
Characterizing infection of B cells with wild-type and vaccine strains of measles virus
Melot L , Bankamp B , Rota PA , Coughlin MM . iScience 2023 26 (10) 107721 Acute infection with measles virus (MeV) causes transient immunosuppression often leading to secondary infections. MeV infection of B lymphocytes results in changes in the antibody repertoire and memory B cell populations for which the mechanism is unknown. In this study, we characterize the infection of primary B cells with wild-type and vaccine strains of MeV. Vaccine-infected B cells were characterized by a higher percentage of cells positive for viral protein, a higher level of viral transcription and reduced cell death compared to wild-type infected cells, regardless of B cell subtype. Vaccine-infected cells showed more production of TNF-α and IL-10 but less production of IL-8 compared to wild-type infected cells. IL-4 and IL-6 levels detected were increased during both vaccine and wild-type infection. Despite evidence of replication, measles-infected B cells did not produce detectable viral progeny. This study furthers our understanding of the outcomes of MeV infection of human B cells. |
Progress toward poliomyelitis eradication - Afghanistan, January 2022-June 2023
Bjork A , Akbar IE , Chaudhury S , Wadood MZ , Ather F , Jorba J , Martinez M . MMWR Morb Mortal Wkly Rep 2023 72 (38) 1020-1026 When the Global Polio Eradication Initiative began in 1988, wild poliovirus (WPV) transmission was reported in 125 countries. Since 2017, Afghanistan and Pakistan remain the only countries with uninterrupted endemic WPV type 1 (WPV1) transmission. This report describes activities and progress toward polio eradication in Afghanistan during January 2022-June 2023. Two WPV1 cases were reported during January-December 2022 and five during January-June 2023 (as of August 26), all from three provinces in the southeast and east regions bordering Pakistan. All five 2023 patients had reportedly received ≥16 oral poliovirus vaccine doses. WPV1 was detected in sewage samples from a site in the south region in May 2023 and one in the north region in June 2023, the first detections since February 2021 and March 2020, respectively. Restrictions on house-to-house vaccination limit the effectiveness of vaccination campaigns in parts of the south and northeast regions. Because of population movement, the risk for transmission in Afghanistan and Pakistan will remain if WPV1 circulation continues in either country. Despite operational improvements in vaccination activities, interruption of WPV1 transmission in Afghanistan will require committed, uninterrupted efforts, including ongoing coordination with Pakistan on polio eradication activities, to address vaccination coverage gaps that sustain WPV1 circulation. |
Notes from the field: Circulating vaccine-derived poliovirus type 2 emergences linked to novel oral poliovirus vaccine type 2 use - six African countries, 2021-2023
Davlantes E , Jorba J , Henderson E , Bullard K , Deka MA , Kfutwah A , Martin J , Bessaud M , Shulman LM , Hawes K , Diop OM , Bandyopadhyay AS , Zipursky S , Burns CC . MMWR Morb Mortal Wkly Rep 2023 72 (38) 1041-1042 Circulating vaccine-derived poliovirus (cVDPV) outbreaks can occur when oral poliovirus vaccine strains (most often, Sabin monovalent oral poliovirus vaccine type 2 [mOPV2]) undergo prolonged circulation in undervaccinated populations, resulting in genetic reversion to neurovirulence. A novel type 2 oral poliovirus vaccine (nOPV2) has been developed, which has been shown in clinical trials to be less likely than mOPV2 to revert to paralytic variants and to have limited genetic modifications in initial field use (1–4). Approximately 700 million doses of nOPV2 have been administered worldwide in response to outbreaks of cVDPV type 2 (cVDPV2). cVDPV2 detections originating from nOPV2 use from initial rollout during March 2021–September 7, 2023, are described in this report. |
Recommendations on data sharing in HIV drug resistance research
Inzaule SC , Siedner MJ , Little SJ , Avila-Rios S , Ayitewala A , Bosch RJ , Calvez V , Ceccherini-Silberstein F , Charpentier C , Descamps D , Eshleman SH , Fokam J , Frenkel LM , Gupta RK , Ioannidis JPA , Kaleebu P , Kantor R , Kassaye SG , Kosakovsky Pond SL , Kouamou V , Kouyos RD , Kuritzkes DR , Lessells R , Marcelin AG , Mbuagbaw L , Minalga B , Ndembi N , Neher RA , Paredes R , Pillay D , Raizes EG , Rhee SY , Richman DD , Ruxrungtham K , Sabeti PC , Schapiro JM , Sirivichayakul S , Steegen K , Sugiura W , van Zyl GU , Vandamme AM , Wensing AMJ , Wertheim JO , Gunthard HF , Jordan MR , Shafer RW . PLoS Med 2023 20 (9) e1004293 Author summary • Human immunodeficiency virus (HIV) drug resistance has implications for antiretroviral treatment strategies and for containing the HIV pandemic because the development of HIV drug resistance leads to the requirement for antiretroviral drugs that may be less effective, less well-tolerated, and more expensive than those used in first-line regimens. • HIV drug resistance studies are designed to determine which HIV mutations are selected by antiretroviral drugs and, in turn, how these mutations affect antiretroviral drug susceptibility and response to future antiretroviral treatment regimens. • Such studies collectively form a vital knowledge base essential for monitoring global HIV drug resistance trends, interpreting HIV genotypic tests, and updating HIV treatment guidelines. • Although HIV drug resistance data are collected in many studies, such data are often not publicly shared, prompting the need to recommend best practices to encourage and standardize HIV drug resistance data sharing. • In contrast to other viruses, sharing HIV sequences from phylogenetic studies of transmission dynamics requires additional precautions as HIV transmission is criminalized in many countries and regions. • Our recommendations are designed to ensure that the data that contribute to HIV drug resistance knowledge will be available without undue hardship to those publishing HIV drug resistance studies and without risk to people living with HIV. |
The Biosafety Research Road Map: The search for evidence to support practices in the laboratory-zoonotic avian influenza and mycobacterium tuberculosis
Blacksell SD , Dhawan S , Kusumoto M , Le KK , Summermatter K , O'Keefe J , Kozlovac J , Almuhairi SS , Sendow I , Scheel CM , Ahumibe A , Masuku ZM , Bennett AM , Kojima K , Harper DR , Hamilton K . Appl Biosaf 2023 28 (3) 135-151 INTRODUCTION: The Biosafety Research Road Map reviewed the scientific literature on a viral respiratory pathogen, avian influenza virus, and a bacterial respiratory pathogen, Mycobacterium tuberculosis. This project aims at identifying gaps in the data required to conduct evidence-based biorisk assessments, as described in Blacksell et al. One significant gap is the need for definitive data on M. tuberculosis sample aerosolization to guide the selection of engineering controls for diagnostic procedures. METHODS: The literature search focused on five areas: routes of inoculation/modes of transmission, infectious dose, laboratory-acquired infections, containment releases, and disinfection and decontamination methods. RESULTS: The available data regarding biosafety knowledge gaps and existing evidence have been collated and presented in Tables 1 and 2. The guidance sources on the appropriate use of biosafety cabinets for specific procedures with M. tuberculosis require clarification. Detecting vulnerabilities in the biorisk assessment for respiratory pathogens is essential to improve and develop laboratory biosafety in local and national systems. |
Ferrets as a mammalian model to study influenza virus-bacteria interactions
Basu Thakur P , Mrotz VJ , Maines TR , Belser JA . J Infect Dis 2023 Ferrets represent an invaluable model for the study of influenza virus pathogenicity and transmissibility due to the ability of this species to recapitulate clinical symptoms of influenza infection present in humans. Ferrets are also employed for the study of bacterial pathogens that naturally infect humans at different anatomical sites, including the respiratory and gastrointestinal tracts. While viral and bacterial infection studies in isolation using animal models are important for furthering our understanding of pathogen biology and for the development of improved therapeutics, it is also critical to extend our knowledge to pathogen coinfections in vivo, to more closely examine interkingdom dynamics that may contribute to overall disease outcomes. Despite the increasing use of ferrets for studies with influenza virus, few reports have investigated influenza and bacterial coinfection challenges in ferrets. In this review, we discuss how ferrets have been employed to study a diverse range of both influenza viruses and bacterial species and summarize key studies that have utilized the ferret model for primary influenza virus challenge followed by secondary bacterial infection. These co-pathogenesis studies have provided critical insight into the dynamic interplay between these pathogens, underscoring the utility of ferrets as a model system for investigating influenza virus-bacteria interactions. |
Molecular characterization of the 2022 Sudan virus disease outbreak in Uganda
Balinandi S , Whitmer S , Mulei S , Nassuna C , Pimundu G , Muyigi T , Kainulainen M , Shedroff E , Krapiunaya I , Scholte F , Nyakarahuka L , Tumusiime A , Kyondo J , Baluku J , Kiconco J , Harris JR , Ario AR , Kagirita A , Bosa HK , Ssewanyana I , Nabadda S , Mwebesa HG , Aceng JR , Atwine D , Lutwama JJ , Shoemaker TR , Montgomery JM , Kaleebu P , Klena JD . J Virol 2023 97 (10) e0059023 Uganda experienced five Ebola disease outbreaks caused by Bundibugyo virus (n = 1) and Sudan virus (SUDV) (n = 4) from 2000 to 2021. On 20 September 2022, Uganda declared a fifth Sudan virus disease outbreak in the Mubende district, resulting in 142 confirmed and 22 probable cases by the end of the outbreak declaration on 11 January 2023. The earliest identified cases, through retrospective case investigations, had onset in early August 2022. From the 142 confirmed cases, we performed unbiased (Illumina) and SUDV-amplicon-specific (Minion) high-throughput sequencing to obtain 120 SUDV genome-and coding-complete sequences, representing 95.4% (104/109) of SVD-confirmed individuals within a sequence-able range (Ct ≤30) and 10 genome sequences outside of this range and 6 duplicate genome sequences. A comparison of the nucleotide genetic relatedness for the newly emerged Mubende variant indicated that it was most closely related to the Nakisamata SUDV sequence from 2011, represented a likely new zoonotic spillover event, and exhibited an inter- and intra-outbreak substitution rate consistent with previous outbreaks. The most recent common ancestor for the Mubende variant was estimated to have occurred in October and November 2021. The Mubende variant glycoprotein amino acid sequences exhibited 99.7% similarity altogether and a maximum of 96.1% glycoprotein similarity compared to historical SUDV strains from 1976. Integrating the genetic sequence and epidemiological data into the response activities generated a broad overview of the outbreak, allowing for quick fact-checking of epidemiological connections between the identified patients. IMPORTANCE Ebola disease (EBOD) is a public health threat with a high case fatality rate. Most EBOD outbreaks have occurred in remote locations, but the 2013-2016 Western Africa outbreak demonstrated how devastating EBOD can be when it reaches an urban population. Here, the 2022 Sudan virus disease (SVD) outbreak in Mubende District, Uganda, is summarized, and the genetic relatedness of the new variant is evaluated. The Mubende variant exhibited 96% amino acid similarity with historic SUDV sequences from the 1970s and a high degree of conservation throughout the outbreak, which was important for ongoing diagnostics and highly promising for future therapy development. Genetic differences between viruses identified during the Mubende SVD outbreak were linked with epidemiological data to better interpret viral spread and contact tracing chains. This methodology should be used to better integrate discrete epidemiological and sequence data for future viral outbreaks. |
Neighborhood deprivation and neural tube defects
Pruitt Evans S , Ailes EC , Kramer MR , Shumate CJ , Reefhuis J , Insaf TZ , Yazdy MM , Carmichael SL , Romitti PA , Feldkamp ML , Neo DT , Nembhard WN , Shaw GM , Palmi E , Gilboa SM . Epidemiology 2023 34 (6) 774-785 BACKGROUND: Individual measures of socioeconomic status (SES) have been associated with an increased risk of neural tube defects (NTDs); however, the association between neighborhood SES and NTD risk is unknown. Using data from the National Birth Defects Prevention Study (NBDPS) from 1997 to 2011, we investigated the association between measures of census tract SES and NTD risk. METHODS: The study population included 10,028 controls and 1829 NTD cases. We linked maternal addresses to census tract SES measures and used these measures to calculate the neighborhood deprivation index. We used generalized estimating equations to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) estimating the impact of quartiles of census tract deprivation on NTDs adjusting for maternal race-ethnicity, maternal education, and maternal age at delivery. RESULTS: Quartiles of higher neighborhood deprivation were associated with NTDs when compared with the least deprived quartile (Q2: aOR = 1.2; 95% CI = 1.0, 1.4; Q3: aOR = 1.3, 95% CI = 1.1, 1.5; Q4 (highest): aOR = 1.2; 95% CI = 1.0, 1.4). Results for spina bifida were similar; however, estimates for anencephaly and encephalocele were attenuated. Associations differed by maternal race-ethnicity. CONCLUSIONS: Our findings suggest that residing in a census tract with more socioeconomic deprivation is associated with an increased risk for NTDs, specifically spina bifida. |
Association between SARS-CoV-2 infections during pregnancy and preterm live birth
Mohanty S , Tita AT , Varner M , Stockwell MS , Newes-Adeyi G , Battarbee AN , Reichle L , Morrill T , Daugherty M , Mourad M , Silverio Francisco RA , Woodworth K , Wielgosz K , Galang R , Maniatis P , Semenova V , Dawood FS . Influenza Other Respir Viruses 2023 17 (9) e13192 We examined associations between mild or asymptomatic prenatal SARS-CoV-2 infection and preterm live birth in a prospective cohort study. During August 2020-October 2021, pregnant persons were followed with systematic surveillance for RT-PCR or serologically confirmed SARS-CoV-2 infection until pregnancy end. The association between prenatal SARS-CoV-2 infection and preterm birth was assessed using Cox proportional-hazards regression. Among 954 pregnant persons with a live birth, 185 (19%) had prenatal SARS-CoV-2 infection and 123 (13%) had preterm birth. The adjusted hazard ratio for the association between SARS-CoV-2 infection and preterm birth was 1.28 (95% confidence interval 0.82-1.99, p = 0.28), although results did not reach statistical significance. |
Parental perspectives on communication from health care providers following a newborn diagnosis of congenital cytomegalovirus infection: A secondary analysis of a qualitative study
Lanzieri TM , Hall MAK , Rau A , McBride H , Watson D , Rheaume C , Demmler-Harrison G . Int J Neonatal Screen 2023 9 (3) The study objective was to identify communication messages that parents of children diagnosed with congenital cytomegalovirus (cCMV) infection reported as essential and helpful. We performed a secondary analysis of focus groups and interviews conducted with 41 parents of children with cCMV who had enrolled in a long-term follow-up cCMV study at an academic medical center. Three groups of parents who had children with cCMV participated in the study: parents with children symptomatic at birth, parents with children asymptomatic at birth who later developed sensorineural hearing loss, and parents with children asymptomatic at birth who remained asymptomatic into adulthood. Using a health marketing approach, we identified six general themes from the focus group sessions: initial diagnosis, likely health outcome(s), comfort and coping, symptom watch, resources, and prevention. Receiving the initial diagnosis was shocking for many parents, and they wanted to know how their child would or could be affected. They valued access to the information, follow-up visits for early detection of hearing loss and other developmental delays, and support from other parents. Parents wished to obtain this information from their pediatrician but felt that experts offered more up-to-date knowledge about prognosis, monitoring, and treatment. With more U.S. states implementing cCMV screening strategies which would lead to more infant diagnoses, it will be necessary for providers to meet parents' expectations and communication needs. |
Parents' understanding about children's bullying: Fall ConsumerStyles Survey, United States, 2017, 2018, and 2019
Mercado MC , Daniel L , Allen CT , Mercer Kollar LM , Wang J , Roby SJ . J Interpers Violence 2023 39 8862605231197153 The purpose of this study was to explore U.S. parents' and caregivers' understanding about children's bullying-what bullying is and how to address it. We analyzed 2017, 2018, and 2019 Fall ConsumerStyles online panel survey data from U.S. parents/caregivers of children ages 10 to 17 years (N = 1,516), including 20 items representing statements consistent or inconsistent with the bullying prevention evidence and best practices. Percentage of endorsement for each item and a summary measure of understanding about bullying were calculated. The association between low overall understanding about bullying and sociodemographic characteristics was explored. Most parents identified bullying as harmful (77%), repetitive (63%), and involving power imbalance (51%). At least half of parents answered 13 or more items (20 total) consistent with the bullying prevention evidence or best practices. Being male, non-Hispanic Black or Hispanic, having high school or less education, and small household size were associated with higher odds of low overall understanding about bullying. Awareness of parents' understanding about bullying and how to appropriately address it is vital for bullying prevention. Findings can inform the strategic development of bullying prevention health messages for parents. |
Seasonal trends in emergency department visits for mental and behavioral health conditions among children and adolescents aged 5-17 years - United States, January 2018-June 2023
Radhakrishnan L , Carey K , Pell D , Ising A , Brathwaite D , Waller A , Gay J , Watson-Smith H , Person M , Zamore K , Brumsted T , Price C , Clark PM , Haas GA , Gracy L , Johnston S , Chen Y , Muñoz K , Henry M , Willis B , Nevels D , Asaolu I , Lee S , Wilkins NJ , Bacon S , Sheppard M , Kite-Powell A , Blau G , King M , Whittaker M , Leeb RT . MMWR Morb Mortal Wkly Rep 2023 72 (38) 1032-1040 Mental and behavioral health conditions among school-aged children, including substance use disorders and overall emotional well-being, are a public health concern in the United States. Timely data on seasonal patterns in child and adolescent conditions can guide optimal timing of prevention and intervention strategies. CDC examined emergency department (ED) visit data from the National Syndromic Surveillance Program for 25 distinct conditions during January 2018-June 2023 among U.S. children and adolescents aged 5-17 years, stratified by age group. Each year, during 2018-2023, among persons aged 10-14 and 15-17 years, the number and proportion of weekly ED visits for eight conditions increased in the fall school semester and remained elevated throughout the spring semester; ED visits were up to twice as high during school semesters compared with the summer period. Among children aged 5-9 years, the number and proportion of visits increased for five mental and behavioral health conditions. Seasonal increases in ED visits for some conditions among school-aged children warrant enhanced awareness about mental distress symptoms and the challenges and stressors in the school environment. Systemic changes that prioritize protective factors (e.g., physical activity; nutrition; sleep; social, community, or faith-based support; and inclusive school and community environments) and incorporate preparedness for increases in conditions during back-to-school planning might improve child and adolescent mental health. |
HIV testing during pregnancy among women with a recent live birth-Seven US States, 2016-2019
Nwangwu-Ike N , Kapaya M , Oladapo K , DAngelo DV . Womens Health (Lond) 2023 19 17455057231199571 BACKGROUND: Although the United States has made progress in reducing the transmission of HIV from mother-to-child, it has not yet met the goal of reducing such transmissions to 70%. Self-reported HIV testing varied by state of residence. Approximately, two in three women reported that their health care provider asked them about HIV testing during prenatal care, and 82.3% of those asked reported receipt of a test. OBJECTIVES: The aim of this study was (1) to examine the prevalence of receipt of an HIV test during pregnancy and (2) to examine differences in HIV testing during pregnancy by race/ethnicity, state of residence, and other sociodemographic characteristics. DESIGN: Population-based surveillance of women with a recent live birth from seven US states. Individuals were sampled from birth certificate records 2-6 months postpartum and surveyed about their behaviors and experiences before, during, and shortly after pregnancy. METHODS: Data from the Pregnancy Risk Assessment Monitoring System, a large, population-based survey, were used to estimate the prevalence of HIV testing during pregnancy during 2016-2019. Weighted prevalence estimates and 95% confidence intervals were calculated overall and by demographic and other selected characteristics. RESULTS: Approximately two-thirds of women (66.1%) self-reported having a test for HIV during pregnancy. Prevalence varied by maternal characteristics and was highest among women who were non-Hispanic Black (80.7%) and among women who were aged ⩽ 24 years, had a high school education or less, were unmarried, or had Medicaid or no insurance for prenatal care (each > 70%). Self-reported HIV testing varied by state of residence. Approximately two in three women reported that their health care provider asked them about HIV testing during prenatal care, and 82.3% of those asked reported receipt of a test. CONCLUSION: About one in three Pregnancy Risk Assessment Monitoring System respondents did not report an HIV test during pregnancy. Health care providers can help educate pregnant patients about the importance of HIV testing and ensure universal testing to help identify individuals needing treatment and reduce the rates of mother-to-child HIV transmission. |
Elastomeric half-mask respirator disinfection practices among healthcare personnel
Hines SE , Thurman P , Zhuang E , Chen H , McDiarmid M , Chalikonda S , Angelilli S , Waltenbaugh H , Napoli M , Haas E , McClain C , Sietsema M , Fernando R . Am J Ind Med 2023 66 (12) 1056-1068 BACKGROUND: Disposable N95 respirator shortages during the COVID-19 and 2009 H1N1 influenza pandemics highlighted the need for reusable alternatives, such as elastomeric half-mask respirators (EHMRs). Two US medical organizations deployed reusable EHMRs during the COVID-19 response. In addition to wipe-based disinfection following patient care episodes expected per local policies at both organizations, postshift centralized cleaning and disinfection (C&D) was expected at one site (A), permitting shared-pool EHMR use, and optional at the other (Site B), where EHMRs were issued to individuals. Using a survey, we evaluated disinfection practices reported by EHMR users and predictors of disinfection behaviors and perceptions. METHODS: Surveys assessed EHMR disinfection practices, occupational characteristics, EHMR use frequency, training, and individual-issue versus shared-pool EHMR use. RESULTS: Of 1080 EHMR users completing the survey, 76% reported that they disinfect the EHMR after each patient encounter, which was the expected practice at both sites. Increasing EHMR use, recall of disinfection training, and work in intensive care or emergency settings significantly influenced higher reporting of this practice. 36% of respondents reported using centralized C&D, although reporting was higher at the site (A) where this was expected (53%). Confidence in cleanliness of the EHMR following centralized C&D was not influenced by individual versus shared-pool EHMR issue. CONCLUSIONS: Most EHMR users reported adherence with expected post-care individual-based disinfection of EHMRs but did not necessarily use standardized, centralized C&D. Future efforts to limit reliance on behavior related to respirator disinfection may improve EHMR implementation in healthcare to avert dependence on single-use, disposable N95 respirators. |
Occupational injuries and illnesses among law enforcement officers, 2001-2019: Findings from the Ohio Bureau of Workers'Compensation
Tiesman HM , Konda S , Wurzelbacher SJ , Naber SJ , Attwood WR . Am J Ind Med 2023 66 (12) 1079-1089 BACKGROUND: Occupational injuries are common among law enforcement officers (LEOs) and can impact an agency's ability to serve communities. Workers' compensation (WC) data are an underutilized source for occupational injury surveillance in the law enforcement field. METHODS: LEOs WC claims from the Ohio Bureau of Workers' Compensation (OHBWC) from 2001 to 2019 were identified based on manual review of the occupation title and injury description. Worker, employer, incident, and injury characteristics were described by claim type-medical-only (MO) and lost-time (8 or more days away from work). Data are presented using injury claim counts. RESULTS: From 2001 to 2019, 50,793 WC claims were identified among Ohio LEOs. Of these, 68% were MO claims (n = 34,622). WC claims significantly decreased over the 19-year period (p < 0.001). Seventy-five percent of WC claims were from a LEO with more than one claim and of these, 34% were from a LEO with five or more claims during the study period. Male officers and those aged 25-54 years incurred the highest proportion of total claims (87.8% & 91.8%, respectively). Violence (n = 17,247; 34%), falls/slips/trips (n = 9079; 17.9%), and transportation events (n = 7977; 15.7%) were the leading events. Among the 50,793 claims, there were 79,637 unique clinical diagnosis groups. The most common injury diagnoses were sprains (n = 32,796; 41.2%) followed by contusions (n = 13,529; 17%). CONCLUSIONS: Results can guide the development or improvement of workplace injury prevention strategies for LEOs. Efforts should be focused on better understanding and preventing violent injury events and sprains among LEOs, as well as preventing multiple injury events. |
Prevalence and incidence of tuberculosis infection among healthcare workers in chest diseases hospitals, Bangladesh: Putting infection control into context
Islam MS , Gurley ES , Banu S , Hossain K , Heffelfinger JD , Amin Chowdhury KI , Ahmed S , Afreen S , Islam MT , Rahman SMM , Rahman A , Pearson ML , Chai SJ . PLoS One 2023 18 (9) e0291484 BACKGROUND: Healthcare workers (HCWs) are at increased risk of tuberculosis infection (TBI). We estimated the prevalence and incidence of TBI and risk factors among HCWs in Bangladeshi hospitals to target TB infection prevention and control (IPC) interventions. METHODS: During 2013-2016, we conducted a longitudinal study among HCWs in four chest disease hospitals. At baseline, we administered a questionnaire on sociodemographic and occupational factors for TB, tuberculin skin tests (TST) in all hospitals, and QuantiFERON ®-TB Gold in-Tube (QFT-GIT) tests in one hospital. We assessed factors associated with baseline TST positivity (induration ≥10mm), TST conversion (induration increase ≥10mm from baseline), baseline QFT-GIT positivity (interferon-gamma ≥0.35 IU/mL), and QFT-GIT conversion (interferon-gamma <0.35 IU/mL to ≥0.35 IU/mL). We included factors with a biologically plausible relationship with TBI identified in prior studies or having an association (p = <0.20) in the bivariate analyses with TST positivity or QFT-GIT positivity in multivariable generalized linear models. The Kaplan-Meier was used to estimate the cumulative TBI incidence rate per 100 person-years. RESULTS: Of the 758 HCWs invited, 732 (97%) consented to participate and 731 completed the one-step TST, 40% had a positive TST result, and 48% had a positive QFT-GIT result. In multivariable models, HCWs years of service 11-20 years had 2.1 (95% CI: 1.5-3.0) times higher odds of being TST-positive and 1.6 (95% CI 1.1-2.5) times higher odds of QFT-GIT-positivity at baseline compared with those working ≤10 years. HCWs working 11-20 years in pulmonary TB ward had 2.0 (95% CI: 1.4-2.9) times higher odds of TST positivity, and those >20 years had 2.5 (95% CI: 1.3-4.9) times higher odds of QFT-GIT-positivity at baseline compared with those working <10 years. TBI incidence was 4.8/100 person-years by TST and 4.2/100 person-years by QFT-GIT. Females had 8.5 (95% CI: 1.5-49.5) times higher odds of TST conversion than males. CONCLUSIONS: Prevalent TST and QFT-GIT positivity was associated with an increased number of years working as a healthcare worker and in pulmonary TB wards. The incidence of TBI among HCWs suggests ongoing TB exposure in these facilities and an urgent need for improved TB IPC in chest disease hospitals in Bangladesh. |
Primaquine dose and the risk of haemolysis in patients with uncomplicated Plasmodium vivax malaria: a systematic review and individual patient data meta-analysis
Rajasekhar M , Simpson JA , Ley B , Edler P , Chu CS , Abreha T , Awab GR , Baird JK , Bancone G , Barber BE , Grigg MJ , Hwang J , Karunajeewa H , Lacerda MVG , Ladeia-Andrade S , Llanos-Cuentas A , Pukrittayakamee S , Rijal KR , Saravu K , Sutanto I , Taylor WRJ , Thriemer K , Watson JA , Guerin PJ , White NJ , Price RN , Commons RJ . Lancet Infect Dis 2023 BACKGROUND: Primaquine radical cure is used to treat dormant liver-stage parasites and prevent relapsing Plasmodium vivax malaria but is limited by concerns of haemolysis. We undertook a systematic review and individual patient data meta-analysis to investigate the haematological safety of different primaquine regimens for P vivax radical cure. METHODS: For this systematic review and individual patient data meta-analysis, we searched MEDLINE, Web of Science, Embase, and Cochrane Central for prospective clinical studies of uncomplicated P vivax from endemic countries published between Jan 1, 2000, and June 8, 2023. We included studies if they had active follow-up of at least 28 days, if they included a treatment group with daily primaquine given over multiple days where primaquine was commenced within 3 days of schizontocidal treatment and was given alone or coadministered with chloroquine or one of four artemisinin-based combination therapies (ie, artemether-lumefantrine, artesunate-mefloquine, artesunate-amodiaquine, or dihydroartemisinin-piperaquine), and if they recorded haemoglobin or haematocrit concentrations on day 0. We excluded studies if they were on prevention, prophylaxis, or patients with severe malaria, or if data were extracted retrospectively from medical records outside of a planned trial. For the meta-analysis, we contacted the investigators of eligible trials to request individual patient data and we then pooled data that were made available by Aug 23, 2021. The main outcome was haemoglobin reduction of more than 25% to a concentration of less than 7 g/dL by day 14. Haemoglobin concentration changes between day 0 and days 2-3 and between day 0 and days 5-7 were assessed by mixed-effects linear regression for patients with glucose-6-phosphate dehydrogenase (G6PD) activity of (1) 30% or higher and (2) between 30% and less than 70%. The study was registered with PROSPERO, CRD42019154470 and CRD42022303680. FINDINGS: Of 226 identified studies, 18 studies with patient-level data from 5462 patients from 15 countries were included in the analysis. A haemoglobin reduction of more than 25% to a concentration of less than 7 g/dL occurred in one (0·1%) of 1208 patients treated without primaquine, none of 893 patients treated with a low daily dose of primaquine (<0·375 mg/kg per day), five (0·3%) of 1464 patients treated with an intermediate daily dose (0·375 mg/kg per day to <0·75 mg/kg per day), and six (0·5%) of 1269 patients treated with a high daily dose (≥0·75 mg/kg per day). The covariate-adjusted mean estimated haemoglobin changes at days 2-3 were -0·6 g/dL (95% CI -0·7 to -0·5), -0·7 g/dL (-0·8 to -0·5), -0·6 g/dL (-0·7 to -0·4), and -0·5 g/dL (-0·7 to -0·4), respectively. In 51 patients with G6PD activity between 30% and less than 70%, the adjusted mean haemoglobin concentration on days 2-3 decreased as G6PD activity decreased; two patients in this group who were treated with a high daily dose of primaquine had a reduction of more than 25% to a concentration of less than 7 g/dL. 17 of 18 included studies had a low or unclear risk of bias. INTERPRETATION: Treatment of patients with G6PD activity of 30% or higher with 0·25-0·5 mg/kg per day primaquine regimens and patients with G6PD activity of 70% or higher with 0·25-1 mg/kg per day regimens were associated with similar risks of haemolysis to those in patients treated without primaquine, supporting the safe use of primaquine radical cure at these doses. FUNDING: Australian National Health and Medical Research Council, Bill & Melinda Gates Foundation, and Medicines for Malaria Venture. |
Interpersonal communication, cultural norms, and community perceptions associated with care-seeking for fever among children under age five in Mago district, Mozambique
Hutchinson P , Zulliger R , Butts JK , Candrinho B , Saifodine A , Eisele TP , Yukich J . Malar J 2023 22 (1) 279 BACKGROUND: Malaria is endemic throughout Mozambique, contributing significantly to the country's burden of disease. Prompt and effective treatment for fevers in children can limit the mortality and morbidity impacts of the disease but many children in the country are not taken for formal care when ill. Using an ideational model of behaviour, this study assesses the magnitude of the relationships for potential drivers of care-seeking, including interpersonal communication, malaria messaging, and knowledge and attitudes about malaria, with actual care-seeking behaviours for under-five children with fever in Magoé district, Mozambique. METHODS: Data on the care-seeking behaviours for fever come from a 2019 household malaria survey in Magoé district. Households were randomly selected for interview from among those with at least one child under age five and one net for every two household members. From 1621 mother-child dyads, the analytical sample consists of 300 children under age five with a fever in the 2 weeks prior to the survey. Multilevel random effects logistic regression models are estimated to test for associations between care-seeking behaviours and hypothesized behavioural determinants, including interpersonal communication (IPC), malaria messaging, ideational factors (e.g., norms, attitudes, beliefs, risk perceptions), and community characteristics. RESULTS: Overall, 18.5% of children under age five (N = 300) were reported to have fever in the previous 2 weeks and, of these, 68.5% were taken to a formal sector health care provider. Multivariate models highlight significant roles for interpersonal communication; care-seeking was highest among mothers who spoke only with friends/community members about malaria (94.0%, p < 0.001), followed by those who spoke only with their husband (78.6%, p = 0.015), relative to 63.3% who spoke with no one. Care-seeking decisions made by a child's grandmother were associated with a 25.0% point (p = 0.001) greater likelihood of seeking care relative to decisions made by the mother alone. Exposure to any malaria messaging was also positively associated with care-seeking (90.5% versus 62.7%, p < 0.001). In contrast, among all individual- and community-level ideational factors, only perceptions of self-efficacy to seek care were related to care-seeking behaviours. CONCLUSIONS: These results suggest that social and behaviour change interventions that focus on encouraging families and community members to talk about malaria and the need to promptly seek treatment for fevers in children may be particularly effective at increasing this behaviour in this and similar settings. Such messaging and IPC should consider grandmothers as a target audience, as they appear to be perceived as highly influential in care-seeking decision-making in this community. |
Strengthening public health capacity to address infectious diseases: Lessons from 3 Centers of Excellence in Public Health and Homelessness
Bien MB , Whitton A , Meehan A , Thornhill L , Ellis K , Leopold J , Borne D , Vickery KD , Imbert E , Twohey-Jacobs L , Perez KA , Mosites E . J Public Health Manag Pract 2023 29 (6) 775-779 People experiencing homelessness are disproportionately affected by infectious diseases and often face barriers to receiving appropriate medical treatment. Responding to the needs of people experiencing homelessness requires state and local health departments to integrate information sources and coordinate multisector efforts. From 2021 to 2023, the CDC Foundation, in cooperation with the Centers for Disease Control and Prevention, established pilot Centers of Excellence in Public Health and Homelessness in Seattle, Washington; San Francisco, California; and the state of Minnesota. These centers strengthened their capacity to address the needs of people experiencing homelessness by supporting cross-sector partnerships, assessing the interoperability of data systems, prioritizing infectious disease needs, and identifying health disparities. These programs demonstrated that health departments are heterogeneous entities with differing resources and priorities. They also showed the importance of employing dedicated public health staff focused on homelessness, establishing diverse partnerships and the need for support from local leaders to address homelessness. |
Centers for Disease Control and Prevention Harvard program evaluation practicum: 10 years of partnership in public health program evaluation
Ramsey LM , Thompson HL , Conrey E , Fuller TR , Brown MJ , Tiemeier H , Arellano D , Davis D , Okoroh E . J Womens Health (Larchmt) 2023 32 (11) 1150-1157 The Centers for Disease Control and Prevention (CDC)'s Division of Reproductive Health and Harvard T.H. Chan School of Public Health (HSPH) Program Evaluation Practicum (CDC/HSPH Practicum) is a mutually beneficial workforce development partnership formed to provide state, local, and tribal public health organizations with an evaluation plan for a maternal and child health (MCH) program. State, local, and tribal public health organizations submit an MCH program in need of evaluation for inclusion consideration. Student pairs are matched with the selected programs in a 3-week practical field-based experience. This Practicum provides didactic training for both program staff and students followed by field work at the public health organizations. Students provide organizations with comprehensive evaluation plans, complete with logic model, methodology, and indicators. Since the Practicum's inception in 2013, 104 HSPH graduate students have been trained and 30 states and 1 territory have participated and received evaluation plans for their MCH programs. The utility and importance of the CDC/HSPH Practicum is evidenced by program staff and student feedback. Multiple states have implemented the plans designed by the students, with some evaluations leading to program enhancements. The CDC/HSPH Practicum prepares students for the workforce and adds much needed capacity to public health organizations by providing them with evaluation knowledge and skills, and usable evaluation plans to improve MCH-a win-win for all. |
Incidence of TB disease among persons who use drugs in California
Frazier C , Nabity SA , Flood J . Int J Tuberc Lung Dis 2023 27 (10) 781-783 TB may disproportionately affect persons who use drugs (PWUD),1–3 but the TB incidence rate among PWUD has not been estimated in the United States (U.S). California has the highest TB case burden and the highest frequency of current drug use: in 2019, 23.5% of incident TB cases in the U.S. occurred in California (5.3/100,000), and the state has an estimated 4.7 million PWUD.4,5 A better understanding of the intersection between drug use and TB will promote equity-informed interventions that account for social aspects of TB risk.6 In the study presented here, we estimate the incidence of TB disease among PWUD in California, describe the characteristics of TB patients who use drugs, and evaluate drug use as a risk factor for adverse treatment outcomes. | | We analyzed surveillance data of incident TB disease reported to the California Department of Public Health (CDPH; Richmond, CA, USA) TB registry in persons ≥12 years of age from 2015–2019. The denominator population of PWUD (who reported drug use in the past year) was derived from the National Survey of Drug Use and Mental Health (NSDUH) of noninstitutionalized civilians who were aged ≥12 years and resided in fixed-address households. We accessed prevalence estimates derived from the NSDUH through the Restricted Online Data Access System.7 NSDUH prevalence estimates are based on 2 years of pooled sample data and, because each year had two estimates (e.g., for 2018 data for 2017–2018 and 2018–2019), we used the average for the annual denominator value. We considered persons with TB who use drugs (PWUD-TB) as patients who reported any injecting or noninjecting drug use in the year preceding TB diagnosis. We used the NSDUH past-year variable ‘Any illicit drug use’ as the PWUD population denominator. We determined whether cases were attributable to recent transmission using a plausible source-case algorithm that associates genetic isolates with likely TB source cases.8 We defined TB treatment noncompletion as premature treatment cessation due to loss to follow-up, refusal, or nonadherence. We defined treatment extension as the completion of an appropriate regimen in more than 12 months, excluding patients with multidrug-resistant TB. We calculated the annual incidence of TB disease among PWUD aged ≥12 years from 2015 to 2019 by dividing the annual frequency of PWUD-TB by the corresponding NSDUH prevalence estimate of past-year drug use for California, stratified by place of birth. We used the χ2 test for comparison of categorical variables and the Wilcoxon rank-sum test for continuous variables (α = 0.05). Finally, we constructed multivariable log-binomial models to determine the independent association of drug use with treatment extension and treatment noncompletion (α = 0.05). This activity was determined to meet the requirements of public health surveillance by the Centers for Disease Control and Prevention (CDC) as defined in 45 CFR 46.102(l)(2), and thus did not require institutional board review. CDPH also determined this work to be non-research. Informed consent was not required. |
One-year association of drug possession law change with fatal drug overdose in Oregon and Washington
Joshi S , Rivera BD , Cerdá M , Guy GP Jr , Strahan A , Wheelock H , Davis CS . JAMA Psychiatry 2023 IMPORTANCE: Two states modified laws to remove or substantially reduce criminal penalties for any drug possession. The hypothesis was that removing criminal penalties for drug possession may reduce fatal drug overdoses due to reduced incarceration and increased calls for help at the scene of an overdose. OBJECTIVE: To evaluate whether decriminalization of drug possession in Oregon and Washington was associated with changes in either direction in fatal drug overdose rates. DESIGN, SETTING, AND PARTICIPANTS: This cohort study used a synthetic control method approach to examine whether there were changes in drug possession laws and fatal drug overdose rates in Oregon and Washington in the postpolicy period (February 1, 2021, to March 31, 2022, in Oregon and March 1, 2021, to March 31, 2022, in Washington). A counterfactual comparison group (synthetic controls) was created for Oregon and Washington, using 48 states and the District of Columbia, that did not implement similar policies during the study period (January 1, 2018, to March 31, 2022). For 2018-2021, final multiple cause-of-death data from the National Vital Statistics System (NVSS) were used. For 2022, provisional NVSS data were used. Drug overdose deaths were identified using International Statistical Classification of Diseases and Related Health Problems, 10th Revision underlying cause-of-death codes X40-X44, X60-X64, X85, and Y10-Y14. EXPOSURES: In Oregon, Measure 110 went into effect on February 1, 2021. In Washington, the Washington Supreme Court decision in State v Blake occurred on February 25, 2021. MAIN OUTCOME: Monthly fatal drug overdose rates. RESULTS: Following the implementation of Measure 110, absolute monthly rate differences between Oregon and its synthetic control were not statistically significant (probability = 0.26). The average rate difference post Measure 110 was 0.268 fatal drug overdoses per 100 000 state population. Following the implementation of the policy change in Washington, the absolute monthly rate differences between Washington and synthetic Washington were not statistically significant (probability = 0.06). The average rate difference post Blake was 0.112 fatal drug overdoses per 100 000 state population. CONCLUSIONS AND RELEVANCE: This study found no evidence of an association between legal changes that removed or substantially reduced criminal penalties for drug possession in Oregon and Washington and fatal drug overdose rates. Additional research could examine potential other outcomes as well as longer-term associations with fatal drug overdose overall and across racial and ethnic groups. |
Rickettsia tillamookensis (Rickettsiales: Rickettsiaceae) in Ixodes scapularis (Acari: Ixodidae) in Oklahoma
Noden BH , Gilliland M , Propst J , Slater K , Karpathy SE , Paddock CD . J Med Entomol 2023 Some of the most prevalent arthropod-borne pathogens impacting humans in the United States are transmitted by Ixodes ticks. However, little is known regarding the Rickettsia species that inhabit Ixodes scapularis in the United States. The aim of this study was to screen adult I. scapularis collected in central Oklahoma over an 8-yr period for the presence of tick-borne rickettsial pathogens or potential pathogens. During 2014-2021, 112 adult specimens of I. scapularis were collected from central Oklahoma. Amplicons for Rickettsia spp. were amplified from 53 (47.3%) of the samples. Of the positive ticks, 42 (79.2%) amplicon-positive Rickettsia samples were 100% identical to Rickettsia buchneri, 10 (18.9%) were 100% identical to R. tillamookensis strain Tillamook 23, and 1 (1.9%) specimen showed high identity for Rickettsia amblyommatis. This study highlights the importance of considering Rickettsia-specific assays when assessing Ixodes species ticks for potential pathogens. |
Tackling a global epidemic threat: Nipah surveillance in Bangladesh, 2006-2021
Satter SM , Aquib WR , Sultana S , Sharif AR , Nazneen A , Alam MR , Siddika A , Akther Ema F , Chowdhury KIA , Alam AN , Rahman M , Klena JD , Rahman MZ , Banu S , Shirin T , Montgomery JM . PLoS Negl Trop Dis 2023 17 (9) e0011617 Human Nipah virus (NiV) infection is an epidemic-prone disease and since the first recognized outbreak in Bangladesh in 2001, human infections have been detected almost every year. Due to its high case fatality rate and public health importance, a hospital-based Nipah sentinel surveillance was established in Bangladesh to promptly detect Nipah cases and respond to outbreaks at the earliest. The surveillance has been ongoing till present. The hospital-based sentinel surveillance was conducted at ten strategically chosen tertiary care hospitals distributed throughout Bangladesh. The surveillance staff ensured that routine screening, enrollment, data, and specimen collection from suspected Nipah cases were conducted daily. The specimens were then processed and transported to the reference laboratory of Institute of Epidemiology, Disease Control and Research (IEDCR) and icddr,b for confirmation of diagnosis through serology and molecular detection. From 2006 to 2021, through this hospital-based surveillance platform, 7,150 individuals were enrolled and tested for Nipah virus. Since 2001, 322 Nipah infections were identified in Bangladesh, 75% of whom were laboratory confirmed cases. Half of the reported cases were primary cases (162/322) having an established history of consuming raw date palm sap (DPS) or tari (fermented date palm sap) and 29% were infected through person-to-person transmission. Since the initiation of surveillance, 68% (218/322) of Nipah cases from Bangladesh have been identified from various parts of the country. Fever, vomiting, headache, fatigue, and increased salivation were the most common symptoms among enrolled Nipah patients. Till 2021, the overall case fatality rate of NiV infection in Bangladesh was 71%. This article emphasizes that the overall epidemiology of Nipah virus infection in Bangladesh has remained consistent throughout the years. This is the only systematic surveillance to detect human NiV infection globally. The findings from this surveillance have contributed to early detection of NiV cases in hospital settings, understanding of Nipah disease epidemiology, and have enabled timely public health interventions for prevention and containment of NiV infection. Although we still have much to learn regarding the transmission dynamics and risk factors of human NiV infection, surveillance has played a significant role in advancing our knowledge in this regard. |
Content Index (Achived Edition)
- Antimicrobial Resistance and Antibiotic Stewardship
- Chronic Diseases and Conditions
- Communicable Diseases
- Community Health Services
- Environmental Health
- Epidemiology and Surveillance
- Genetics and Genomics
- Health Behavior and Risk
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- Immunity and Immunization
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- Laboratory Sciences
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- Substance Use and Abuse
- Zoonotic and Vectorborne Diseases
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