Recent changes in attitudes of US adults toward people with epilepsy - results from the 2005 SummerStyles and 2013 FallStyles surveys
Cui W , Kobau R , Zack MM , Buelow JM , Austin JK . Epilepsy Behav 2015 52 108-118 OBJECTIVES: This study aimed to evaluate the validity and the reliability of two components of the Attitudes and Beliefs about Living with Epilepsy (ABLE) scale and to measure the magnitude of the public's attitudes and behaviors toward persons with epilepsy using U.S. nationally representative samples in 2005 and 2013. METHODS: We used data from the cross-sectional 2005 SummerStyles and 2013 FallStyles surveys to test the underlying structure of 16 items of the work and role expectations and personal fear and social avoidance subscales of ABLE by performing exploratory factor analysis (EFA). We estimated the percentages and 95% confidence intervals of adults who agreed or disagreed with each item. We also calculated the mean score of each subscale and used linear regression to obtain means adjusted for selected sociodemographic characteristics. RESULTS: Exploratory factor analysis confirmed a two-factor structure, but with the exception of omitting one item regarding work activities persons with epilepsy cannot do work activities safely, from one subscale. Both subscales also showed a high level of reliability (Cronbach's alpha=0.8 and Cronbach's alpha=0.9, respectively). Among the items in the work and role expectations subscale, a significantly higher percentage of adults in 2013 than in 2005 reported strongly or moderately agreeing that persons with epilepsy can do anything as well as anyone else (56.4%, 95% CI=54.1-58.7 vs. 47.6%, 95% CI=45.8-49.3) and can cope with everyday life (69.8%, 95% CI=67.5-72.0 vs. 55.0%, 95% CI=53.2-56.7). Among the items in the personal fear and social avoidance subscale, a significantly higher percentage of adults reported in 2013 than in 2005 strongly or moderately agreeing that they would be nervous around persons with epilepsy (25.4%, 95% CI=23.4-27.5 vs. 16.8%, 95% CI=15.4-18.2) and would avoid those with frequent seizures (12.4%, 95% CI=11.0-13.9 vs. 7.6%, 95% CI=6.7-8.7). The adjusted mean score for work and role expectations differed by sex, age, race/ethnicity, education, and income in both years. The adjusted mean score for personal fear and social avoidance differed by sex, age, race/ethnicity, education, and marital status. Negative attitudes were slightly but significantly higher in 2013 than in 2005. CONCLUSIONS: Centers for Disease Control and Prevention's ABLE scale is a valid and reliable scale that can be used to study and to track the public's attitudes and behaviors toward persons with epilepsy. Compared with 2005, US adults' reported level of expectations for persons with epilepsy improved only in certain aspects by 2013. Adults' level of personal fear and intention for social avoidance worsened from 2005 to 2013. Because the levels of expectations and of fear and social avoidance differed by sociodemographic characteristics, continued efforts tailored to specific groups are needed. To supplement educational programs focused on improving knowledge, new communication approaches grounded in decision theory that quell risk perceptions and allay negative emotional responses are recommended. |
A Blueprint to Address Research Gaps in the Development of Biomarkers for Pediatric Tuberculosis.
Nicol MP , Gnanashanmugam D , Browning R , Click ES , Cuevas LE , Detjen A , Graham SM , Levin M , Makhene M , Nahid P , Perez-Velez CM , Reither K , Song R , Spiegel HM , Worrell C , Zar HJ , Walzl G . Clin Infect Dis 2015 61Suppl 3 S164-72 Childhood tuberculosis contributes significantly to the global tuberculosis disease burden but remains challenging to diagnose due to inadequate methods of pathogen detection in paucibacillary pediatric samples and lack of a child-specific host biomarker to identify disease. Accurately diagnosing tuberculosis in children is required to improve case detection, surveillance, healthcare delivery, and effective advocacy. In May 2014, the National Institutes of Health convened a workshop including researchers in the field to delineate priorities to address this research gap. This blueprint describes the consensus from the workshop, identifies critical research steps to advance this field, and aims to catalyze efforts toward harmonization and collaboration in this area. |
Trends in pertussis diagnostic testing in the United States, 1990-2012
Faulkner AE , Skoff TH , Tondella ML , Cohn A , Clark TA , Martin SW . Pediatr Infect Dis J 2015 35 (1) 39-44 BACKGROUND: Reports of pertussis have been increasing in the U.S. since the 1990s and pertussis diagnostics have evolved during that time. Here we describe temporal changes in pertussis diagnostic practices in the U.S. during 1990-2012 and discuss potential implications. METHODS: Pertussis cases reported through the National Notifiable Diseases Surveillance System (NNDSS) during 1990- 2012 were included in this analysis. Laboratory results were stratified by test type, case classification, age group, and case-patient state of residence. RESULTS: 291,290 cases were included with 64% (n=186,766) reporting at least one pertussis laboratory result. Culture and DFA were the primary results reported during the early 1990s; however, PCR surpassed all other test types during the late 1990s and 2000s. By 2012 more than 91% of cases with known results were tested using PCR, either alone or in combination with another test type. Before 2005, Massachusetts reported 71% of serology results, but an increasing number of states reported serologic results during 2005-2012. When stratified by age group, overall testing trends persist. As of 2012, culture confirmation is used infrequently across all ages, while use of serology increases with age and is most prevalent among adults aged ≥ 20 years. CONCLUSIONS: PCR has become the primary diagnostic method, and serologic assays now are used in a majority of states. Epidemiologic trends must be considered in the context of changing diagnostic tests, and modifications to surveillance case definitions should be considered to better reflect current testing practices. |
Viral loads among HIV-infected persons diagnosed with primary and secondary syphilis in 4 US cities: New York City, Philadelphia, PA, Washington, DC, and Phoenix, AZ
Taylor MM , Newman DR , Schillinger JA , Lewis FMT , Furness B , Braunstein S , Mickey T , Skinner J , Eberhart M , Opoku J , Blank S , Peterman TA . J Acquir Immune Defic Syndr 2015 70 (2) 179-185 BACKGROUND: Incident syphilis among HIV-infected persons indicates the ongoing behavioral risk for HIV transmission. Detectable viral loads (VLs) among coinfected cases may amplify this risk. METHODS: Primary and secondary cases reported during 2009-2010 from 4 US sites were crossmatched with local HIV surveillance registries to identify syphilis case-persons infected with HIV before or shortly after the syphilis diagnosis. We examined HIV VL and CD4 results collected within 6 months before or after syphilis diagnosis for the coinfected cases identified. Independent correlates of detectable VLs (≥200 copies/mL) were determined. RESULTS: We identified 1675 cases of incident primary or secondary syphilis among persons with HIV. Median age was 37 years; 99.5% were men, 41.1% were African American, 24.5% were Hispanics, and 79.9% of the HIV diagnoses were made at least 1 year before syphilis diagnosis. Among those coinfected, there were no VL results reported for 188 (11.2%); of the 1487 (88.8%) with reported VL results, 809 (54.4%) had a detectable VL (median, 25,101 copies/mL; range, 206-3,590,000 copies/mL). Detectable VLs independently correlated with syphilis diagnosed at younger age, at an sexually transmitted disease clinic, and closer in time to HIV diagnosis. CONCLUSIONS: More than half of syphilis case-persons identified with HIV had a detectable VL collected within 6 months of the syphilis diagnosis. This suggests virologic and active behavioral risk for transmitting HIV. |
Management of latent Mycobacterium tuberculosis infection: WHO guidelines for low tuberculosis burden countries
Getahun H , Matteelli A , Abubakar I , Aziz MA , Baddeley A , Barreira D , Den Boon S , Borroto Gutierrez SM , Bruchfeld J , Burhan E , Cavalcante S , Cedillos R , Chaisson R , Chee CB , Chesire L , Corbett E , Dara M , Denholm J , de Vries G , Falzon D , Ford N , Gale-Rowe M , Gilpin C , Girardi E , Go UY , Govindasamy D , Grant AD , Grzemska M , Harris R , Horsburgh CR Jr , Ismayilov A , Jaramillo E , Kik S , Kranzer K , Lienhardt C , LoBue P , Lonnroth K , Marks G , Menzies D , Migliori GB , Mosca D , Mukadi YD , Mwinga A , Nelson L , Nishikiori N , Oordt-Speets A , Rangaka MX , Reis A , Rotz L , Sandgren A , Sane Schepisi M , Schunemann HJ , Sharma SK , Sotgiu G , Stagg HR , Sterling TR , Tayeb T , Uplekar M , van der Werf MJ , Vandevelde W , van Kessel F , Van't Hoog A , Varma JK , Vezhnina N , Voniatis C , Vonk Noordegraaf-Schouten M , Weil D , Weyer K , Wilkinson RJ , Yoshiyama T , Zellweger JP , Raviglione M . Eur Respir J 2015 46 (6) 1563-76 Latent tuberculosis infection (LTBI) is characterised by the presence of immune responses to previously acquired Mycobacterium tuberculosis infection without clinical evidence of active tuberculosis (TB). Here we report evidence-based guidelines from the World Health Organization for a public health approach to the management of LTBI in high risk individuals in countries with high or middle upper income and TB incidence of <100 per 100 000 per year. The guidelines strongly recommend systematic testing and treatment of LTBI in people living with HIV, adult and child contacts of pulmonary TB cases, patients initiating anti-tumour necrosis factor treatment, patients receiving dialysis, patients preparing for organ or haematological transplantation, and patients with silicosis. In prisoners, healthcare workers, immigrants from high TB burden countries, homeless persons and illicit drug users, systematic testing and treatment of LTBI is conditionally recommended, according to TB epidemiology and resource availability. Either commercial interferon-gamma release assays or Mantoux tuberculin skin testing could be used to test for LTBI. Chest radiography should be performed before LTBI treatment to rule out active TB disease. Recommended treatment regimens for LTBI include: 6 or 9 month isoniazid; 12 week rifapentine plus isoniazid; 3-4 month isoniazid plus rifampicin; or 3-4 month rifampicin alone. |
Human infection with Ehrlichia muris-like pathogen, United States, 2007-2013
Johnson DK , Schiffman EK , Davis JP , Neitzel DF , Sloan LM , Nicholson WL , Fritsche TR , Steward CR , Ray JA , Miller TK , Feist MA , Uphoff TS , Franson JJ , Livermore AL , Deedon AK , Theel ES , Pritt BS . Emerg Infect Dis 2015 21 (10) 1794-9 An Ehrlichia muris-like (EML) pathogen was detected among 4 patients in Minnesota and Wisconsin during 2009. We characterized additional cases clinically and epidemiologically. During 2004-2013, blood samples from 75,077 patients from all 50 United States were tested by PCR from the groEL gene for Ehrlichia spp. and Anaplasma phagocytophilum. During 2007-2013, samples from 69 (0.1%) patients were positive for the EML pathogen; patients were from 5 states: Indiana (1), Michigan (1), Minnesota (33), North Dakota (3), and Wisconsin (31). Most (64%) patients were male; median age was 63 (range 15-94) years; and all 69 patients reported likely tick exposure in Minnesota or Wisconsin. Fever, malaise, thrombocytopenia, and lymphopenia were the most common symptoms. Sixteen (23%) patients were hospitalized (median 4 days); all recovered, and 96% received doxycycline. Infection with the EML pathogen should be considered for persons reporting tick exposure in Minnesota or Wisconsin. |
Identifying best practices for increasing linkage to, retention, and re-engagement in HIV medical care: findings from a systematic review, 1996-2014
Higa DH , Crepaz N , Mullins MM . AIDS Behav 2015 20 (5) 951-66 A systematic review was conducted to identify best practices for increasing linkage, retention and re-engagement in HIV care (LRC) for persons living with HIV (PLWH). Our search strategy consisted of automated searches of electronic databases and hand searches of journals, reference lists and listservs. We developed two sets of criteria: evidence-based to identify evidence-based interventions (EBIs) tested with a comparison group and evidence-informed to identify evidence-informed interventions (EIs) tested with a one-group design. Eligible interventions included being published between 1996 and 2014, U.S.-based studies with a comparison or one-group designs with pre-post data, international randomized controlled trials, and having objective measures of LRC-relevant outcomes. We identified 10 best practices: 5 EBIs and 5 EIs. None focused on re-engagement. Providers and prevention planners can use the review findings to identify best practices suitable for their clinics, agencies, or communities to increase engagement in care for PLWH, ultimately leading to viral suppression. |
All-cause mortality and progression risks to hepatic decompensation and hepatocellular carcinoma in patients infected with hepatitis C
Xu F , Moorman AC , Tong X , Gordon SC , Rupp LB , Lu M , Teshale EH , Spradling PR , Boscarino JA , Trinacty CM , Schmidt MA , Holmberg SD . Clin Infect Dis 2015 62 (3) 289-297 BACKGROUND: A key question in chronic hepatitis C (HCV) care is beginning treatment immediately versus delaying treatment. Risks of mortality and disease progression in "real-world" settings are important to assess the implications of delaying HCV treatment. METHODS: A cohort study in HCV patients identified from four integrated health systems in the United States who had liver biopsies during 2001-2012. The probabilities of death and progression to hepatocellular carcinoma, hepatic decompensation (hepatic encephalopathy, esophageal varices, ascites or portal hypertension) or liver transplant were estimated over 1, 2 or 5 years by fibrosis stage (Metavir F0-F4) determined by biopsy at beginning of observation. RESULTS: Among 2,799 HCV mono-infected patients who had a qualifying liver biopsy, the mean age at the time of biopsy was 50.7 years. The majority were male (58.9%) and non-Hispanic white (66.9%). Over a mean observation of 5.0 years, 261 (9.3%) patients died and 34 (1.2%) received liver transplants. At 5 years after biopsy, the estimated progression risks to hepatic decompensation or hepatocellular carcinoma was 37.2% in F4 patients, 19.6% in F3, 4.7% in F2, and 2.3% in F0/F1 patients. Baseline biopsy stage F3 or F4 and platelet count below normal were the strongest predictors of progression to hepatic decompensation or hepatocellular carcinoma. CONCLUSIONS: The risks of death and progression to liver failure varied greatly by fibrosis stage. Clinicians and policy makers could use these progression risk data in prioritization and in determining the timing of treatment for patients in early stages of liver disease. |
Burkholderia pseudomallei infection in US traveler returning from Mexico, 2014
Cheng JW , Hayden MK , Singh K , Heimler I , Gee JE , Proia L , Sha BE . Emerg Infect Dis 2015 21 (10) 1884-1885 Melioidosis is an infection with clinical manifestations ranging from skin abscess to overwhelming sepsis and death. It is caused by Burkholderia pseudomallei, a gram-negative, saprophytic bacillus found in soil and water. Melioidosis is highly endemic to Southeast Asia and northern Australia, and endemic to the Indian subcontinent, southern China, Hong Kong, and Taiwan (1). | The extent of melioidosis in the Western Hemisphere is unknown. However, new endemic foci have been identified in Puerto Rico and Brazil, and sporadic cases have been reported in other parts of the Caribbean, Central America, and South America (2–5). Melioidosis is rare in the United States; 0–5 cases are reported annually, and most cases occur in travelers returning from disease-endemic areas (2,3). Case clusters have been associated with extreme weather events, such as tropical storms or heavy rainfall (5,6). We report a case of melioidosis in a returned traveler from Los Cabos, Mexico, after Hurricane Odile. | In September 2014, a 59-year-old woman came to a hospital in Chicago, Illinois, USA, with a 4-day history of right-sided upper back and anterior chest pain, fevers, and shortness of breath. She had diabetes mellitus and well-controlled HIV infection; and had received a cadaveric renal transplant 13 months earlier. Her medications included tacrolimus, prednisone, and mycophenolate. She had traveled to Los Cabos, Mexico, 7 days before admission and was present when Hurricane Odile hit the area. |
Decreased Ebola transmission after rapid response to outbreaks in remote areas, Liberia, 2014
Lindblade KA , Kateh F , Nagbe TK , Neatherlin JC , Pillai SK , Attfield KR , Dweh E , Barradas DT , Williams SG , Blackley DJ , Kirking HL , Patel MR , Dea M , Massoudi MS , Wannemuehler K , Barskey AE , Zarecki SL , Fomba M , Grube S , Belcher L , Broyles LN , Maxwell TN , Hagan JE , Yeoman K , Westercamp M , Forrester J , Mott J , Mahoney F , Slutsker L , DeCock KM , Nyenswah T . Emerg Infect Dis 2015 21 (10) 1800-7 We measured the reproduction number before and after interventions were implemented to reduce Ebola transmission in 9 outbreaks in Liberia during 2014. We evaluated risk factors for secondary cases and the association between patient admission to an Ebola treatment unit (ETU) and survival. The reproduction number declined 94% from 1.7 (95% CI 1.1-2.6) to 0.1 (95% CI 0.02-0.6) after interventions began. The risk for secondary infections was 90% lower for patients admitted to an ETU (risk ratio 0.1, 95% CI 0.04-0.3) than for those who died in the community. The case-fatality rate was 68% (95% CI 60-74), and ETU admission was associated with a 50% reduction in death (hazard ratio 0.5, 95% CI 0.4-0.8). Isolation and treatment of Ebola patients had the dual benefit of interrupting community transmission and improving survival. |
Prenatal DDT and DDE exposure and child IQ in the CHAMACOS cohort
Gaspar FW , Harley KG , Kogut K , Chevrier J , Mora AM , Sjodin A , Eskenazi B . Environ Int 2015 85 206-212 Although banned in most countries, dichlorodiphenyl-trichloroethane (DDT) continues to be used for vector control in some malaria endemic areas. Previous findings from the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS) cohort study found increased prenatal levels of DDT and its breakdown product dichlorodiphenyl-dichloroethylene (DDE) to be associated with altered neurodevelopment in children at 1 and 2years of age. In this study, we combined the measured maternal DDT/E concentrations during pregnancy obtained for the prospective birth cohort with predicted prenatal DDT and DDE levels estimated for a retrospective birth cohort. Using generalized estimating equation (GEE) and linear regression models, we evaluated the relationship of prenatal maternal DDT and DDE serum concentrations with children's cognition at ages 7 and 10.5years as assessed using the Full Scale Intelligence Quotient (IQ) and 4 subtest scores (Working Memory, Perceptual Reasoning, Verbal Comprehension, and Processing Speed) of the Wechsler Intelligence Scale for Children (WISC). In GEE analyses incorporating both age 7 and 10.5 scores (n=619), we found prenatal DDT and DDE levels were not associated with Full Scale IQ or any of the WISC subscales (p-value>0.05). In linear regression analyses assessing each time point separately, prenatal DDT levels were inversely associated with Processing Speed at age 7years (n=316), but prenatal DDT and DDE levels were not associated with Full Scale IQ or any of the WISC subscales at age 10.5years (n=595). We found evidence for effect modification by sex. In girls, but not boys, prenatal DDE levels were inversely associated with Full Scale IQ and Processing Speed at age 7years. We conclude that prenatal DDT levels may be associated with delayed Processing Speed in children at age 7years and the relationship between prenatal DDE levels and children's cognitive development may be modified by sex, with girls being more adversely affected. |
Structural and Functional Characterization of an Ancient Bacterial Transglutaminase Sheds Light on the Minimal Requirements for Protein Cross-Linking.
Fernandes CG , Placido D , Lousa D , Brito JA , Isidro A , Soares CM , Pohl J , Carrondo MA , Archer M , Henriques AO . Biochemistry 2015 54 (37) 5723-5734 Transglutaminases are best known for their ability to catalyze protein cross-linking reactions that impart chemical and physical resilience to cellular structures. Here, we report the crystal structure and characterization of Tgl, a transglutaminase from the bacterium Bacillus subtilis. Tgl is produced during sporulation and cross-links the surface of the highly resilient spore. Tgl-like proteins are found only in spore-forming bacteria of the Bacillus and Clostridia classes, indicating an ancient origin. Tgl is a single-domain protein, produced in active form, and the smallest transglutaminase characterized to date. We show that Tgl is structurally similar to bacterial cell wall endopeptidases and has an NlpC/P60 catalytic core, thought to represent the ancestral unit of the cysteine protease fold. We show that Tgl functions through a unique partially redundant catalytic dyad formed by Cys116 and Glu187 or Glu115. Strikingly, the catalytic Cys is insulated within a hydrophobic tunnel that traverses the molecule from side to side. The lack of similarity of Tgl to other transglutaminases together with its small size suggests that an NlpC/P60 catalytic core and insulation of the active site during catalysis may be essential requirements for protein cross-linking. |
Medicaid provider reimbursement policy for adult immunizations
Stewart AM , Lindley MC , Cox MA . Vaccine 2015 33 (43) 5801-5808 BACKGROUND: State Medicaid programs establish provider reimbursement policy for adult immunizations based on: costs, private insurance payments, and percentage of Medicare payments for equivalent services. Each program determines provider eligibility, payment amount, and permissible settings for administration. Total reimbursement consists of different combinations of Current Procedural Terminology codes: vaccine, vaccine administration, and visit. OBJECTIVE: Determine how Medicaid programs in the 50 states and the District of Columbia approach provider reimbursement for adult immunizations. DESIGN: Observational analysis using document review and a survey. SETTING AND PARTICIPANTS: Medicaid administrators in 50 states and the District of Columbia. MEASUREMENTS: Whether fee-for-service programs reimburse providers for: vaccines; their administration; and/or office visits when provided to adult enrollees. We assessed whether adult vaccination services are reimbursed when administered by a wide range of providers in a wide range of settings. RESULTS: Medicaid programs use one of 4 payment methods for adults: (1) a vaccine and an administration code; (2) a vaccine and visit code; (3) a vaccine code; and (4) a vaccine, visit, and administration code. LIMITATIONS: Study results do not reflect any changes related to implementation of national health reform. Nine of fifty one programs did not respond to the survey or declined to participate, limiting the information available to researchers. CONCLUSIONS: Medicaid reimbursement policy for adult vaccines impacts provider participation and enrollee access and uptake. While programs have generally increased reimbursement levels since 2003, each program could assess whether current policies reflect the most effective approach to encourage providers to increase vaccination services. |
An economic analysis of poliovirus risk management policy options for 2013-2052
Duintjer Tebbens RJ , Pallansch MA , Cochi SL , Wassilak SGF , Thompson KM . BMC Infect Dis 2015 15 389 BACKGROUND: The Global Polio Eradication Initiative plans for coordinated cessation of oral poliovirus vaccine (OPV) after interrupting all wild poliovirus (WPV) transmission, but many questions remain related to long-term poliovirus risk management policies. METHODS: We used an integrated dynamic poliovirus transmission and stochastic risk model to simulate possible futures and estimate the health and economic outcomes of maintaining the 2013 status quo of continued OPV use in most developing countries compared with OPV cessation policies with various assumptions about global inactivated poliovirus vaccine (IPV) adoption. RESULTS: Continued OPV use after global WPV eradication leads to continued high costs and/or high cases. Global OPV cessation comes with a high probability of at least one outbreak, which aggressive outbreak response can successfully control in most instances. A low but non-zero probability exists of uncontrolled outbreaks following a poliovirus reintroduction long after OPV cessation in a population in which IPV-alone cannot prevent poliovirus transmission. We estimate global incremental net benefits during 2013-2052 of approximately $16 billion (US$2013) for OPV cessation with at least one IPV routine immunization dose in all countries until 2024 compared to continued OPV use, although significant uncertainty remains associated with the frequency of exportations between populations and the implementation of long term risk management policies. CONCLUSIONS: Global OPV cessation offers the possibility of large future health and economic benefits compared to continued OPV use. Long-term poliovirus risk management interventions matter (e.g., IPV use duration, outbreak response, containment, continued surveillance, stockpile size and contents, vaccine production site requirements, potential antiviral drugs, and potential safer vaccines) and require careful consideration. Risk management activities can help to ensure a low risk of uncontrolled outbreaks and preserve or further increase the positive net benefits of OPV cessation. Important uncertainties will require more research, including characterizing immunodeficient long-term poliovirus excretor risks, containment risks, and the kinetics of outbreaks and response in an unprecedented world without widespread live poliovirus exposure. |
Cost analysis of a novel HIV testing strategy in community pharmacies and retail clinics
Lecher SL , Shrestha RK , Botts LW , Alvarez J , Moore JH Jr , Thomas V , Weidle PJ . J Am Pharm Assoc (2003) 2015 55 (5) 488-92 OBJECTIVE: To document the cost of implementing point-of-care (POC) human immunodeficiency virus (HIV) rapid testing in busy community pharmacies and retail clinics. Providing HIV testing services in community pharmacies and retail clinics is an innovative way to expand HIV testing. The cost of implementing POC HIV rapid testing in a busy retail environment needs to be documented to provide program and policy leaders with adequate information for planning and budgeting. DESIGN: Cost analysis from a pilot project that provided confidential POC HIV rapid testing services in community pharmacies and retail clinics. SETTING: The pharmacy sites were operated under several different ownership structures (for-profit, nonprofit, sole proprietorship, corporation, public, and private) in urban and rural areas. We included data from the initial six sites that participated in the project. We collected the time spent by pharmacy and retail clinic staff for pretest and posttest counseling in an activity log for time-in-motion for each interaction. PARTICIPANTS: Pharmacists and retail clinic staff. INTERVENTION: HIV rapid testing. MAIN OUTCOME MEASURES: The total cost was calculated to include costs of test kits, control kits, shipping, test supplies, training, reporting, program administration, and advertising. RESULTS: The six sites trained 22 staff to implement HIV testing. A total of 939 HIV rapid tests were conducted over a median time of 12 months, of which 17 were reactive. Median pretest counseling time was 2 minutes. Median posttest counseling time was 2 minutes for clients with a nonreactive test and 10 minutes for clients with a reactive test. The average cost per person tested was an estimated $47.21. When we considered only recurrent costs, the average cost per person tested was $32.17. CONCLUSIONS: Providing POC HIV rapid testing services required a modest amount of staff time and costs that are comparable to other services offered in these settings. HIV testing in pharmacies and retail clinics can provide an additional alternative venue for increasing the availability and accessibility of HIV testing services in the United States. |
Did the 2009 American Recovery and Reinvestment Act affect dietary intake of low-income individuals?
Waehrer G , Deb P , Decker SL . Econ Hum Biol 2015 19 170-183 This paper examines the relationship between increased Supplemental Nutritional Assistance Program (SNAP) benefits following the 2009 American Recovery and Reinvestment Act (ARRA) and the diet quality of individuals from SNAP-eligible compared to ineligible (those with somewhat higher income) households using data from the 2007-2010 National Health and Nutrition Examination Survey. The ARRA increased SNAP monthly benefits by 13.6% of the maximum allotment for a given household size, equivalent to an increase of $24 to $144 for one-to-eight person households respectively. In the full sample, we find that these increases in SNAP benefits are not associated with changes in nutrient intake and diet quality. However, among those with no more than a high school education, higher SNAP benefits are associated with a 46% increase in the mean caloric share from sugar-sweetened beverages (SSBs) and a decrease in overall diet quality especially for those at the lower end of the diet quality distribution, amounting to a 9% decline at the 25th percentile. |
Cluster of Cryptococcus neoformans infections in intensive care unit, Arkansas, USA, 2013
Vallabhaneni S , Haselow D , Lloyd S , Lockhart S , Moulton-Meissner H , Lester L , Wheeler G , Gladden L , Garner K , Derado G , Park B , Harris JR . Emerg Infect Dis 2015 21 (10) 1719-24 We investigated an unusual cluster of 6 patients with Cryptococcus neoformans infection at a community hospital in Arkansas during April–December 2013, to determine source of infection. Four patients had bloodstream infection and 2 had respiratory infection; 3 infections occurred within a 10-day period. Five patients had been admitted to the intensive care unit (ICU) with diagnoses other than cryptococcosis; none had HIV infection, and 1 patient had a history of organ transplantation. We then conducted a retrospective cohort study of all patients admitted to the ICU during April–December 2013 to determine risk factors for cryptococcosis. Four patients with C. neoformans infection had received a short course of steroids; this short-term use was associated with increased risk for cryptococcosis (rate ratio 19.1; 95% CI 2.1–170.0; p<0.01). Although long-term use of steroids is a known risk factor for cryptococcosis, the relationship between short-term steroid use and disease warrants further study |
A toddler with rash, encephalopathy, and hemolytic anemia
Smith C , Dutmer C , Schmid DS , Dishop MK , Bellini WJ , Gelfand EW , Asturias EJ . J Pediatric Infect Dis Soc 2015 4 (4) 376-80 A 13-month-old female from New Mexico presented to a local emergency department with 5 days of fever, diarrhea, nasal congestion, and cough, 2 days of jaundice, and 1 day of an erythematous papular rash on her trunk, arms, and groin. Initial laboratory studies revealed severe macrocytic anemia, reticulocytosis, and a positive direct Coombs test. She was hospitalized at a local facility for management of severe hemolytic anemia. Hemolysis was persistent despite daily blood transfusions, intravenous immune globulin (IVIG), and high-dose methylprednisolone. A bone marrow aspirate revealed tri-lineage marrow with reactive erythroid hyperplasia and absence of blasts. Her rash subsequently progressed from papules to ulcerated, crusted lesions. A lesional skin biopsy revealed intranuclear inclusion bodies typical of herpesviridae; therefore, acyclovir was initiated 3 weeks into her illness. She later developed encephalopathy characterized by loss of truncal tone and speech, decreased alertness, and difficulty managing oral secretions. After 4 weeks of progressive illness, she was transferred to our facility for further management. |
Generation and Characterization of Live Attenuated Influenza A(H7N9) Candidate Vaccine Virus Based on Russian Donor of Attenuation.
Shcherbik S , Pearce N , Balish A , Jones J , Thor S , Davis CT , Pearce M , Tumpey T , Cureton D , Chen LM , Villanueva J , Bousse TL . PLoS One 2015 10 (9) e0138951 BACKGROUND: Avian influenza A (H7N9) virus has emerged recently and continues to cause severe disease with a high mortality rate in humans prompting the development of candidate vaccine viruses. Live attenuated influenza vaccines (LAIV) are 6:2 reassortant viruses containing the HA and NA gene segments from wild type influenza viruses to induce protective immune responses and the six internal genes from Master Donor Viruses (MDV) to provide temperature sensitive, cold-adapted and attenuated phenotypes. METHODOLOGY/PRINCIPAL FINDINGS: LAIV candidate A/Anhui/1/2013(H7N9)-CDC-LV7A (abbreviated as CDC-LV7A), based on the Russian MDV, A/Leningrad/134/17/57 (H2N2), was generated by classical reassortment in eggs and retained MDV temperature-sensitive and cold-adapted phenotypes. CDC-LV7A had two amino acid substitutions N123D and N149D (H7 numbering) in HA and one substitution T10I in NA. To evaluate the role of these mutations on the replication capacity of the reassortants in eggs, the recombinant viruses A(H7N9)RG-LV1 and A(H7N9)RG-LV2 were generated by reverse genetics. These changes did not alter virus antigenicity as ferret antiserum to CDC-LV7A vaccine candidate inhibited hemagglutination by homologous A(H7N9) virus efficiently. Safety studies in ferrets confirmed that CDC-LV7A was attenuated compared to wild-type A/Anhui/1/2013. In addition, the genetic stability of this vaccine candidate was examined in eggs and ferrets by monitoring sequence changes acquired during virus replication in the two host models. No changes in the viral genome were detected after five passages in eggs. However, after ten passages additional mutations were detected in the HA gene. The vaccine candidate was shown to be stable in the ferret model; post-vaccination sequence data analysis showed no changes in viruses collected in nasal washes present at day 5 or day 7. CONCLUSIONS/SIGNIFICANCE: Our data indicate that the A/Anhui/1/2013(H7N9)-CDC-LV7A reassortant virus is a safe and genetically stable candidate vaccine virus that is now available for distribution by WHO to vaccine manufacturers. |
Evaluating Ebola vaccine trials: insights from simulation.
Pulliam JRC , Bellan SE , Gambhir M , Meyers LA , Dushoff J . Lancet Infect Dis 2015 15 (10) 1134 Piszczek and Parlow1 outlined expected benefits of a stepped-wedge cluster trial (SWCT) design, with specific reference to the Sierra Leone Trial to Introduce a Vaccine against Ebola (STRIVE). STRIVE, however, is not an SWCT, but a phased-rollout trial in which randomization to immediate or delayed vaccination arms occurs at the individual level (RCT) within trial clusters.2 While the SWCT design is advantageous in certain circumstances, many of the benefits described by Piszczek and Parlow would not apply to evaluation of Ebola vaccine candidates in Sierra Leone. | In a recently published study, we used simulations to compare statistical validity and power for an SWCT and a STRIVE-like RCT in the same trial population.3 Piszczek and Parlow contend that an SWCT can achieve greater statistical power than an RCT via multiple before-and-after and between-group comparisons; however, we found that the declining and heterogeneous epidemic incidence across Sierra Leone undermine such cluster-level comparisons and, consequently, the power of an SWCT. Specifically, we estimated that the SWCT design would be 3–10 times less likely than an individually randomized, phased roll-out RCT to definitively identify an efficacious vaccine. For example, an SWCT starting in April 2015 was expected to have a less than 10% chance of detecting the effect of a 90% efficacious vaccine. |
Post-Licensure Surveillance of Trivalent Live-Attenuated Influenza Vaccine in Children Aged 2-18 Years, Vaccine Adverse Event Reporting System, United States, July 2005-June 2012.
Haber P , Moro PL , Cano M , Vellozzi C , Lewis P , Woo EJ , Broder K . J Pediatric Infect Dis Soc 2015 4 (3) 205-13 BACKGROUND: The first trivalent live-attenuated influenza vaccine (LAIV3) was licensed in 2003 for use in healthy persons 5-49 years of age. In 2007, the US Food and Drug Administration expanded its indication to healthy children 2-4 years of age. METHODS: We searched the Vaccine Adverse Event Reporting System (VAERS) for US reports after LAIV3 from July 1, 2005 to June 30, 2012 in children aged 2-18 years. Medical records were requested for nonmanufacturer reports coded as serious (ie, death, hospitalization, prolonged hospitalization, life-threatening illness, disability). We characterized electronic data and clinically reviewed all serious reports and reports of special interest. Empirical Bayesian data mining was used to identify new or unexpected adverse events (AEs). RESULTS: During the study period, VAERS received 2619 US LAIV3 reports for children aged 2-18 years; 197 (7.5%) reports were serious, including 5 deaths. The 2 most frequent nonfatal serious reports involved neurological and respiratory systems, with 56 (29.2%) and 43 (22.4%) reports, respectively. The most frequent neurological diagnoses were seizures and Guillain-Barre Syndrome, and the most frequent respiratory conditions were pneumonia and asthma or reactive airway disease. Data mining showed increased proportions for reports of medication errors, most commonly vaccine administration errors not associated with an AE. CONCLUSIONS: In this VAERS analysis of reports following LAIV3, we found no new or unexpected AEs patterns. Reports of LAIV3 administration to persons, for whom it is not recommended, including children with a history of asthma or reactive airway disease or wheezing, indicate that ongoing monitoring and education in vaccine indications are needed. |
Impact of the maturing varicella vaccination program on varicella and related outcomes in the United States: 1994-2012
Leung J , Harpaz R . J Pediatric Infect Dis Soc 2015 5 (4) 395-402 BACKGROUND: Although the 1-dose varicella vaccination program, introduced in 1996, has led to significant declines in varicella disease, outbreaks continued to occur, which led to the adoption of a 2-dose vaccination program in 2007. We previously reported an 88% decline in varicella-related hospitalizations and a 59% decline in outpatient visits during 1994-2002. We now update data on varicella healthcare utilization with 10 years of additional data, during a period of stabilizing first-dose coverage and rapidly increasing second-dose coverage. METHODS: We performed a retrospective cohort study using claims data from 1994-2012 Truven Health MarketScan databases. We examined trends in rates of varicella-related outpatient visits and hospitalizations for MarketScan enrollees aged 0-49 years, including outpatient laboratory testing, outpatient antiviral use, and pediatric strokes, with 1994-1995 as the prevaccination period and 2006-2012 as the 2-dose varicella vaccination period. RESULTS: Varicella outpatient visits declined 84% in 2012 versus the prevaccination period, with a 60% decline during the 2-dose period. Varicella hospitalizations declined 93% in 2012 versus the prevaccination period, with a 38% decline during the 2-dose period. The proportion of those with a varicella outpatient visit having varicella laboratory testing increased from 6% in 2003 to 17% in 2012. There were 21 445 (17%) with a claim for antivirals, which was relatively stable over time. There was no reduction in pediatric strokes during 1994-2012. CONCLUSIONS: We document from our large study population that the varicella vaccination program has led to significant declines in outpatient visits and hospitalizations from the prevaccination period through 2012, with additional declines during the 2-dose varicella vaccination period. |
Intussusception cases among children admitted to referral hospitals in Kenya, 2002-2013: implications for monitoring postlicensure safety of rotavirus vaccines in Africa
Omore R , Osawa F , Musia J , Rha B , Ismail A , Kiulia NM , Moke F , Vulule J , Wainaina AM , Tole J , Machoki SM , Nuorti JP , Breiman RF , Parashar UD , Montgomery JM , Tate JE . J Pediatric Infect Dis Soc 2015 5 (4) 465-469 To describe the epidemiology of intussusception before introduction of the rotavirus vaccine, we reviewed the records of 280 patients younger than 5 years who were hospitalized in Kenya between 2002 and 2013. The patients who died (18 [6.4%]) had sought care later after symptom onset than the patients who survived (median, 5 vs 3 days, respectively; P = .04). Seeking prompt care may improve therapeutic outcomes. |
Comparison of Whole-Genome Sequencing and Molecular-Epidemiological Techniques for Clostridium difficile Strain Typing.
Dominguez SR , Anderson LJ , Kotter CV , Littlehorn CA , Arms LE , Dowell E , Todd JK , Frank DN . J Pediatric Infect Dis Soc 2015 5 (3) 329-32 We analyzed in parallel 27 pediatric Clostridium difficile isolates by repetitive sequence-based polymerase chain reaction (RepPCR), pulsed-field gel electrophoresis (PFGE), and whole-genome next-generation sequencing. Next-generation sequencing distinguished 3 groups of isolates that were indistinguishable by RepPCR and 1 isolate that clustered in the same PFGE group as other isolates. |
Collaborative Effort for a Centralized Worldwide Tuberculosis Relational Sequencing Data Platform.
Starks AM , Aviles E , Cirillo DM , Denkinger CM , Dolinger DL , Emerson C , Gallarda J , Hanna D , Kim PS , Liwski R , Miotto P , Schito M , Zignol M . Clin Infect Dis 2015 61Suppl 3 S141-6 Continued progress in addressing challenges associated with detection and management of tuberculosis requires new diagnostic tools. These tools must be able to provide rapid and accurate information for detecting resistance to guide selection of the treatment regimen for each patient. To achieve this goal, globally representative genotypic, phenotypic, and clinical data are needed in a standardized and curated data platform. A global partnership of academic institutions, public health agencies, and nongovernmental organizations has been established to develop a tuberculosis relational sequencing data platform (ReSeqTB) that seeks to increase understanding of the genetic basis of resistance by correlating molecular data with results from drug susceptibility testing and, optimally, associated patient outcomes. These data will inform development of new diagnostics, facilitate clinical decision making, and improve surveillance for drug resistance. ReSeqTB offers an opportunity for collaboration to achieve improved patient outcomes and to advance efforts to prevent and control this devastating disease. |
Utility of oral swab sampling for Ebola virus detection in Guinea pig model
Spengler JR , Chakrabarti AK , Coleman-McCray JD , Martin BE , Nichol ST , Spiropoulou CF , Bird BH . Emerg Infect Dis 2015 21 (10) 1816-9 To determine the utility of oral swabs for diagnosing infection with Ebola virus, we used a guinea pig model and obtained daily antemortem and postmortem swab samples. According to quantitative reverse transcription PCR analysis, the diagnostic value was poor for antemortem swab samples but excellent for postmortem samples. |
GHSI emergency radionuclide bioassay laboratory network: summary of a recent exercise
Li C , Ansari A , Bartizel C , Battisti P , Franck D , Gerstmann U , Giardina I , Guichet C , Hammond D , Hartmann M , Jones RL , Kim E , Ko R , Morhard R , Quayle D , Sadi B , Saunders D , Paquet F . Radiat Prot Dosimetry 2015 171 (3) 351-357 The Global Health Security Initiative (GHSI) established a laboratory network within the GHSI community to develop their collective surge capacity for radionuclide bioassay in response to a radiological or nuclear emergency. A recent exercise was conducted to test the participating laboratories for their capabilities in screening and in vitro assay of biological samples, performing internal dose assessment and providing advice on medical intervention, if necessary, using a urine sample spiked with a single radionuclide, 241Am. The laboratories were required to submit their reports according to the exercise schedule and using pre-formatted templates. Generally, the participating laboratories were found to be capable with respect to rapidly screening samples for radionuclide contamination, measuring the radionuclide in the samples, assessing the intake and radiation dose, and providing advice on medical intervention. However, gaps in bioassay measurement and dose assessment have been identified. The network may take steps to ensure that procedures and practices within this network be harmonised and a follow-up exercise be organised on a larger scale, with potential participation of laboratories from the networks coordinated by the International Atomic Energy Agency and the World Health Organization. |
The challenges of introducing routine G6PD testing into radical cure: a workshop report
Ley B , Luter N , Espino FE , Devine A , Kalnoky M , Lubell Y , Thriemer K , Baird JK , Poirot E , Conan N , Kheong CC , Dysoley L , Khan WA , Dion-Berboso AG , Bancone G , Hwang J , Kumar R , Price RN , von Seidlein L , Domingo GJ . Malar J 2015 14 (1) 377 The only currently available drug that effectively removes malaria hypnozoites from the human host is primaquine. The use of 8-aminoquinolines is hampered by haemolytic side effects in glucose-6-phosphate dehydrogenase (G6PD) deficient individuals. Recently a number of qualitative and a quantitative rapid diagnostic test (RDT) format have been developed that provide an alternative to the current standard G6PD activity assays. The WHO has recently recommended routine testing of G6PD status prior to primaquine radical cure whenever possible. A workshop was held in the Philippines in early 2015 to discuss key challenges and knowledge gaps that hinder the introduction of routine G6PD testing. Two point-of-care (PoC) test formats for the measurement of G6PD activity are currently available: qualitative tests comparable to malaria RDT as well as biosensors that provide a quantitative reading. Qualitative G6PD PoC tests provide a binomial test result, are easy to use and some products are comparable in price to the widely used fluorescent spot test. Qualitative test results can accurately classify hemizygous males, heterozygous females, but may misclassify females with intermediate G6PD activity. Biosensors provide a more complex quantitative readout and are better suited to identify heterozygous females. While associated with higher costs per sample tested biosensors have the potential for broader use in other scenarios where knowledge of G6PD activity is relevant as well. The introduction of routine G6PD testing is associated with additional costs on top of routine treatment that will vary by setting and will need to be assessed prior to test introduction. Reliable G6PD PoC tests have the potential to play an essential role in future malaria elimination programmes, however require an improved understanding on how to best integrate routine G6PD testing into different health settings. |
Rickets and vitamin D deficiency in Alaska native children
Singleton R , Lescher R , Gessner BD , Benson M , Bulkow L , Rosenfeld J , Thomas T , Holman RC , Haberling D , Bruce M , Bartholomew M , Tiesinga J . J Pediatr Endocrinol Metab 2015 28 815-823 BACKGROUND: Rickets and vitamin D deficiency appeared to increase in Alaskan children starting in the 1990s. We evaluated the epidemiology of rickets and vitamin D deficiency in Alaska native (AN) children in 2001-2010. METHODS: We analyzed 2001-2010 visits with rickets or vitamin D deficiency diagnosis for AN and American Indian children and the general US population aged <10 years. We conducted a case-control study of AN rickets/vitamin D deficient cases and age- and region-matched controls. RESULTS: In AN children, annual rickets-associated hospitalization rate (2.23/100,000 children/year) was higher than the general US rate (1.23; 95% CI 1.08-1.39). Rickets incidence increased with latitude. Rickets/vitamin D deficiency cases were more likely to have malnutrition (OR 38.1; 95% CI 4.9-294), had similar breast-feeding prevalence, and were less likely to have received vitamin D supplementation (OR 0.23; 95% CI 0.1-0.87) than controls. CONCLUSIONS: Our findings highlight the importance of latitude, malnutrition, and lack of vitamin D supplementation as risk factors for rickets. |
Progestogen-only contraceptive use among breastfeeding women: a systematic review
Phillips SJ , Tepper NK , Kapp N , Nanda K , Temmerman M , Curtis KM . Contraception 2015 94 (3) 226-52 BACKGROUND: Postpartum women need effective contraception. Concerns have been raised that use of progestogen-only contraceptives may affect breastfeeding performance and infant health outcomes. OBJECTIVES: We investigated the clinical outcomes of breastfeeding duration, initiation of supplemental feeding, and weaning, as well as infant outcomes including infant growth, health and development among breastfeeding women using progestogen-only contraceptives compared with breastfeeding women not using progestogen-only contraceptives. SEARCH STRATEGY: We searched the PubMed database for all articles published from database inception through December 2014. SELECTION CRITERIA: We included primary research studies of breastfeeding women of any age or parity who received progestogen-only contraceptives (POCs), including progestogen-only pills, injectables, implants, or hormonal intrauterine devices (IUDs). The main outcomes were breastfeeding performance (as measured by initiation, continuation, frequency and exclusivity of breastfeeding) and infant health (as measured by growth, development or adverse health effects). RESULTS: Forty-nine articles reporting on 47 different studies were identified that investigated the use of POCs in breastfeeding women and reported clinically-relevant outcomes of infant growth, health or breastfeeding performance. Studies ranged from poor to fair methodological quality and generally failed to show negative effects of the use of POCs on breastfeeding outcomes or on infant growth or development. One randomized controlled trial (RCT) raises concerns that immediate insertion of the levonorgestrel IUD postpartum may be associated with poorer breast-feeding performance when compared with delayed insertion, although two other RCTs evaluating early etonogestrel implants compared with delayed initiation of implants or depot medroxyprogesterone acetate failed to find such an association. CONCLUSION: The preponderance of evidence fails to demonstrate adverse breastfeeding outcomes or negative health outcomes in infants such as restricted growth, health problems, or impaired development. Evidence newly added to this review was largely consistent with previous evidence. |
Examining parents' experiences and information needs regarding early identification of developmental delays: qualitative research to inform a public health campaign
Raspa M , Levis DM , Kish-Doto J , Wallace I , Rice C , Barger B , Green KK , Wolf RB . J Dev Behav Pediatr 2015 36 (8) 575-85 OBJECTIVE: The purpose of this study was to assess the approach and materials of Centers for Disease Control and Prevention's "Learn the Signs. Act Early." (LTSAE) health education campaign, which aims to improve awareness of developmental milestones and early warning signs of developmental delay among parents of young children. METHODS: We conducted 2 phases of qualitative research. Focus groups assessed the campaign's objectives by exploring the experiences of parents with children who have developmental delays or disabilities to determine facilitators of and barriers to identification. In-depth interviews were conducted with parents of typically developing children, who reviewed campaign materials and provided feedback on appropriateness, appeal, and clarity with regard to the campaign's objectives. RESULTS: Phase 1: Parents were typically the first to express concern about their child's development, and most talked with their child's health care provider. Two categories of health care providers emerged: those who proactively asked about a child's development, used tools to facilitate conversations, and made referrals, and those who did not ask about development, told parents to "wait and see," and did not provide information about services and supports. Few parents knew about special education services before identification. Phase 2: Participants found the campaign materials appealing, but were unclear about how to act early and why acting early was important. CONCLUSIONS: Results affirmed LTSAE's evidence-based approach to educating parents about child development. Additional campaign considerations include providing more information about how to act early and why acting early is important and enhancing outreach to providers to help them communicate with concerned parents. |
Co-occurring exposure to perchlorate, nitrate and thiocyanate alters thyroid function in healthy pregnant women
Horton MK , Blount BC , Valentin-Blasini L , Wapner R , Whyatt R , Gennings C , Factor-Litvak P . Environ Res 2015 143 1-9 BACKGROUND: Adequate maternal thyroid function during pregnancy is necessary for normal fetal brain development, making pregnancy a critical window of vulnerability to thyroid disrupting insults. Sodium/iodide symporter (NIS) inhibitors, namely perchlorate, nitrate, and thiocyanate, have been shown individually to competitively inhibit uptake of iodine by the thyroid. Several epidemiologic studies examined the association between these individual exposures and thyroid function. Few studies have examined the effect of this chemical mixture on thyroid function during pregnancy OBJECTIVES: We examined the cross sectional association between urinary perchlorate, thiocyanate and nitrate concentrations and thyroid function among healthy pregnant women living in New York City using weighted quantile sum (WQS) regression. METHODS: We measured thyroid stimulating hormone (TSH) and free thyroxine (FreeT4) in blood samples; perchlorate, thiocyanate, nitrate and iodide in urine samples collected from 284 pregnant women at 12 (+/-2.8) weeks gestation. We examined associations between urinary analyte concentrations and TSH or FreeT4 using linear regression or WQS adjusting for gestational age, urinary iodide and creatinine. RESULTS: Individual analyte concentrations in urine were significantly correlated (Spearman's r 0.4-0.5, p<0.001). Linear regression analyses did not suggest associations between individual concentrations and thyroid function. The WQS revealed a significant positive association between the weighted sum of urinary concentrations of the three analytes and increased TSH. Perchlorate had the largest weight in the index, indicating the largest contribution to the WQS. CONCLUSIONS: Co-exposure to perchlorate, nitrate and thiocyanate may alter maternal thyroid function, specifically TSH, during pregnancy. |
Perspectives on the design of safer nanomaterials and manufacturing processes
Geraci C , Heidel D , Sayes C , Hodson L , Schulte P , Eastlake A , Brenner S . J Nanopart Res 2015 17 (9) 366 A concerted effort is being made to insert Prevention through Design principles into discussions of sustainability, occupational safety and health, and green chemistry related to nanotechnology. Prevention through Design is a set of principles, which includes solutions to design out potential hazards in nanomanufacturing including the design of nanomaterials, and strategies to eliminate exposures and minimize risks that may be related to the manufacturing processes and equipment at various stages of the lifecycle of an engineered nanomaterial. |
Construction of a job exposure matrix to dust, fluoride, and polycyclic aromatic hydrocarbons in the Norwegian aluminum industry using prediction models
Soyseth V , Henneberger P , Virji MA , Bakke B , Kongerud J . Ann Occup Hyg 2015 59 (9) 1106-21 BACKGROUND: The Norwegian aluminum industry developed and implemented a protocol for prospective monitoring of employees' exposure using personal samplers. We analyzed these data to develop prediction lines to construct a job exposure matrix (JEM) for the period 1986-1995. METHODS: The protocol for personal monitoring of exposure was implemented in all seven Norwegian aluminum plants in 1986 and continued until 1995. Personal samplers were used to collect total dust, fluorides, and total polycyclic aromatic hydrocarbons (PAH). In addition, exposure could be categorized according to process, i.e. prebake, Soderberg, and 'other'. We constructed four-dimensional JEMs characterized by: Plant, Job descriptor, Process, and Year. Totally 8074, 6734, and 3524 measurements were available for dust, fluorides, and PAH, respectively. The data were analyzed using linear mixed models with two-way interactions. The models were assessed using the Akaike criterion (AIC) and unadjusted R 2. The significance level was set to 10% (two-sided) for retaining variables in the model. RESULTS: In 1986, the geometric mean (95% confidence interval in parentheses) for total dust, total fluorides, and PAH were 3.18 (0.46-22.2) mg m-3, 0.58 (0.085-4.00) mg m-3, and 33.9 (2.3-504) microg m-3, respectively. During 10 years of follow-up, the exposure to total dust, fluorides, and PAH decreased by 9.2, 11.7, and 14.9% per year, respectively. Each model encompassed from 49 to 72 significant components of the interaction terms. The interaction components were at least as important as the main effects, and 65 to 91% of the significant components of the interaction terms were time-dependent. CONCLUSION: Our prediction models indicated that exposures were highly time-dependent. We expect that the time-dependent changes in exposure are of major importance for longitudinal studies of health effects in the aluminum industry. |
Taeniasis among refugees living on Thailand-Myanmar border, 2012
McCleery EJ , Patchanee P , Pongsopawijit P , Chailangkarn S , Tiwananthagorn S , Jongchansittoe P , Dantrakool A , Morakote N , Phyu H , Wilkins PP , Noh JC , Phares C , O'Neal S . Emerg Infect Dis 2015 21 (10) 1824-6 We tested refugee camp residents on the Thailand-Myanmar border for Taenia solium infection. Taeniasis prevalence was consistent with that for other disease-endemic regions, but seropositivity indicating T. solium taeniasis was rare. Seropositivity indicating cysticercosis was 5.5% in humans, and 3.2% in pigs. Corralling pigs and providing latrines may control transmission of these tapeworms within this camp. |
Local and international implications of schistosomiasis acquired in Corsica, France
Gautret P , Mockenhaupt FP , Von Sonnenburg F , Rothe C , Libman M , De Winkel KV , Bottieau E , Grobusch MP , Hamer DH , Esposito DH , Parola P , Schlagenhauf P , Harms-Zwinge G , Cramer J , Ward B . Emerg Infect Dis 2015 21 (10) 1865-1868 We report 11 cases of schistosomiasis in international travelers who had bathed in rivers in Corsica, France, during 2012–2014. The infections were diagnosed in 2014 and reported to the GeoSentinel Surveillance Network and European Travel Medicine Network. Travelers can be sentinels for emerging infections; thus, this situation warrants a concerted human and veterinary epidemiologic response. |
Optimizing intradermal administration of cryopreserved Plasmodium falciparum sporozoites in controlled human malaria infection
Lyke KE , Laurens MB , Strauss K , Adams M , Billingsley PF , James E , Manoj A , Chakravarty S , Plowe CV , Li ML , Ruben A , Edelman R , Green M , Dube TJ , Sim BK , Hoffman SL . Am J Trop Med Hyg 2015 93 (6) 1274-1284 Controlled human malaria infection (CHMI) is a powerful tool to evaluate malaria vaccine and prophylactic drug efficacy. Until recently CHMI was only carried out by the bite of infected mosquitoes. A parenteral method of CHMI would standardize Plasmodium falciparum sporozoite (PfSPZ) administration, eliminate the need for expensive challenge facility infrastructure, and allow for use of many P. falciparum strains. Recently, intradermal (ID) injection of aseptic, purified, cryopreserved PfSPZ was shown to induce P. falciparum malaria; however, 100% infection rates were not achieved by ID injection. To optimize ID PfSPZ dosing so as to achieve 100% infection, 30 adults aged 18-45 years were randomized to one of six groups composed of five volunteers each. The parameters of dose (1 x 104 versus 5 x 104 PfSPZ total dose per volunteer), number of injections (two versus eight), and aliquot volume per ID injection (10 muL versus 50 muL) were studied. Three groups attained 100% infection: 1 x 104 PfSPZ in 50 muL/2 doses, 1 x 104 PfSPZ in 10 muL/2 doses, and 5 x 104 PfSPZ in 10 muL/8 doses. The group that received 5 x 104 PfSPZ total dose in eight 10-muL injections had a 100% infection rate and the shortest prepatent period (mean of 12.7 days), approaching the prepatent period for the current CHMI standard of five infected mosquitoes. |
Perinatal screening for Chagas disease in southern Texas
Edwards MS , Rench MA , Todd CW , Czaicki N , Steurer FJ , Bern C , Montgomery SP . J Pediatric Infect Dis Soc 2015 4 (1) 67-70 Perinatal screening for Trypanosoma cruzi in a cohort of 4000 predominantly Hispanic women in southern Texas revealed that Chagas disease occurs with sufficient frequency (0.25%) that targeted perinatal screening should be considered to identify infected mothers and infants at risk for congenital infection. |
Predictive value of school-aged children's schistosomiasis prevalence and egg intensity for other age groups in Western Kenya
Mwinzi PN , Muchiri G , Wiegand RE , Omedo M , Abudho B , Karanja DM , Montgomery SP , Secor WE . Am J Trop Med Hyg 2015 93 (6) 1311-7 World Health Organization recommendations for the timing and target population for mass drug administration (MDA) for schistosomiasis are based on the prevalence of infection in school children within a given community. In a large study comparing MDA approaches for Schistosoma mansoni control, we evaluated whether prevalence of infection and egg burdens in 9- to 12-year-old students reflected infection levels in young children and adults in the same community. Cross-sectional surveys of preadolescents (9-12 years old) were compared with those of first year students (5-8 years old) in 225 villages and adults (20-55 years old) in 150 villages along the Kenyan shores of Lake Victoria. Village schistosomiasis prevalence and intensity levels in preadolescents strongly correlated (P < 0.0001) with prevalence and infection intensity for other age groups in the community. Our findings suggest that S. mansoni prevalence and intensity among 9- to 12-year-olds are valid for community sampling purposes in mapping for MDAs. |
Electrocardiographic and echocardiographic abnormalities in Chagas disease: findings in residents of rural Bolivian communities hyperendemic for Chagas disease
Fernandez AB , Nunes MC , Clark EH , Samuels A , Menacho S , Gomez J , Bozo Gutierrez RW , Crawford TC , Gilman RH , Bern C . Glob Heart 2015 10 (3) 159-66 BACKGROUND: Chagas disease is a neglected and preventable tropical disease that causes significant cardiac morbidity and mortality in Latin America. OBJECTIVES: This study sought to describe cardiac findings among inhabitants of rural communities of the Bolivian Chaco. METHODS: The cardiac study drew participants from an epidemiologic study in 7 indigenous Guarani communities. All infected participants 10 years or older were asked to undergo a brief physical examination and 12-lead electrocardiogram (ECG). A subset had echocardiograms. ECG and echocardiograms were read by 1 or more cardiologists. RESULTS: Of 1,137 residents 10 years or older, 753 (66.2%) had Trypanosoma cruzi infection. Cardiac evaluations were performed for 398 infected participants 10 years or older. Fifty-five participants (13.8%) had 1 or more ECG abnormalities suggestive of Chagas cardiomyopathy. The most frequent abnormalities were bundle branch blocks in 42 (11.3%), followed by rhythm disturbances or ventricular ectopy in 13 (3.3%), and atrioventricular blocks (AVB) in 10 participants (2.6%). The prevalence of any abnormality rose from 1.1% among those 10 to 19 years old to 14.2%, 17.3%, and 26.4% among those 20 to 39, 40 to 59, and older than 60 years, respectively. First-degree AVB was seen most frequently in participants 60 years or older, but the 4 patients with third-degree AVB were all under 50 years old. Eighteen and 2 participants had a left ventricular ejection fraction of 40% to 54% and <40%, respectively. An increasing number of ECG abnormalities was associated with progressively larger left ventricular end-diastolic dimensions and lower left ventricular ejection fraction. CONCLUSIONS: We found a high prevalence of ECG abnormalities and substantial evidence of Chagas cardiomyopathy. Programs to improve access to basic cardiac care (annual ECG, antiarrhythmics, pacemakers) could have an immediate impact on morbidity and mortality in these highly endemic communities. |
Clinical determinants of early parasitological response to ACTs in African patients with uncomplicated falciparum malaria: a literature review and meta-analysis of individual patient data
Abdulla S , Adam I , Adjei GO , Adjuik MA , Alemayehu B , Allan R , Arinaitwe E , Ashley EA , Ba MS , Barennes H , Barnes KI , Bassat Q , Baudin E , Berens-Riha N , Bjorkman A , Bompart F , Bonnet M , Borrmann S , Bousema T , Brasseur P , Bukirwa H , Checchi F , Dahal P , D'Alessandro U , Desai M , Dicko A , Djimde AA , Dorsey G , Doumbo OK , Drakeley CJ , Duparc S , Eshetu T , Espie E , Etard JF , Faiz AM , Falade CO , Fanello CI , Faucher JF , Faye B , Faye O , Filler S , Flegg JA , Fofana B , Fogg C , Gadalla NB , Gaye O , Genton B , Gething PW , Gil JP , Gonzalez R , Grandesso F , Greenhouse B , Greenwood B , Grivoyannis A , Guerin PJ , Guthmann JP , Hamed K , Hamour S , Hay SI , Hode EM , Humphreys GS , Hwang J , Ibrahim ML , Jima D , Jones JJ , Jullien V , Juma E , Kachur PS , Kager PA , Kamugisha E , Kamya MR , Karema C , Kayentao K , Kieche JR , Kironde F , Kofoed PE , Kremsner PG , Krishna S , Lameyre V , Lell B , Lima A , Makanga M , Malik EM , Marsh K , Martensson A , Massougbodji A , Menan H , Menard D , Menendez C , Mens PF , Meremikwu M , Moreira C , Nabasumba C , Nambozi M , Ndiaye JL , Ngasala BE , Nikiema F , Nsanzabana C , Ntoumi F , Oguike M , Ogutu BR , Olliaro P , Omar SA , Ouedraogo JB , Owusu-Agyei S , Penali LK , Pene M , Peshu J , Piola P , Plowe CV , Premji Z , Price RN , Randrianarivelojosia M , Rombo L , Roper C , Rosenthal PJ , Sagara I , Same-Ekobo A , Sawa P , Schallig HDFH , Schramm B , Seck A , Shekalaghe SA , Sibley CH , Sinou V , Sirima SB , Some FA , Sow D , Staedke SG , Stepniewska K , Sutherland CJ , Swarthout TD , Sylla K , Talisuna AO , Taylor WRJ , Temu EA , Thwing JI , Tine RCK , Tinto H , Tommasini S , Toure OA , Ursing J , Vaillant MT , Valentini G , Van den Broek I , Vugt MV , Ward SA , Winstanley PA , Yavo W , Yeka A , Zolia YM , Zongo I , WWARN Artemisinin based Combination Therapy (ACT) Africa Baseline Study Group . BMC Med 2015 13 212 BACKGROUND: Artemisinin-resistant Plasmodium falciparum has emerged in the Greater Mekong sub-region and poses a major global public health threat. Slow parasite clearance is a key clinical manifestation of reduced susceptibility to artemisinin. This study was designed to establish the baseline values for clearance in patients from Sub-Saharan African countries with uncomplicated malaria treated with artemisinin-based combination therapies (ACTs). METHODS: A literature review in PubMed was conducted in March 2013 to identify all prospective clinical trials (uncontrolled trials, controlled trials and randomized controlled trials), including ACTs conducted in Sub-Saharan Africa, between 1960 and 2012. Individual patient data from these studies were shared with the WorldWide Antimalarial Resistance Network (WWARN) and pooled using an a priori statistical analytical plan. Factors affecting early parasitological response were investigated using logistic regression with study sites fitted as a random effect. The risk of bias in included studies was evaluated based on study design, methodology and missing data. RESULTS: In total, 29,493 patients from 84 clinical trials were included in the analysis, treated with artemether-lumefantrine (n = 13,664), artesunate-amodiaquine (n = 11,337) and dihydroartemisinin-piperaquine (n = 4,492). The overall parasite clearance rate was rapid. The parasite positivity rate (PPR) decreased from 59.7 % (95 % CI: 54.5-64.9) on day 1 to 6.7 % (95 % CI: 4.8-8.7) on day 2 and 0.9 % (95 % CI: 0.5-1.2) on day 3. The 95th percentile of observed day 3 PPR was 5.3 %. Independent risk factors predictive of day 3 positivity were: high baseline parasitaemia (adjusted odds ratio (AOR) = 1.16 (95 % CI: 1.08-1.25); per 2-fold increase in parasite density, P <0.001); fever (>37.5 degreeC) (AOR = 1.50 (95 % CI: 1.06-2.13), P = 0.022); severe anaemia (AOR = 2.04 (95 % CI: 1.21-3.44), P = 0.008); areas of low/moderate transmission setting (AOR = 2.71 (95 % CI: 1.38-5.36), P = 0.004); and treatment with the loose formulation of artesunate-amodiaquine (AOR = 2.27 (95 % CI: 1.14-4.51), P = 0.020, compared to dihydroartemisinin-piperaquine). CONCLUSIONS: The three ACTs assessed in this analysis continue to achieve rapid early parasitological clearance across the sites assessed in Sub-Saharan Africa. A threshold of 5 % day 3 parasite positivity from a minimum sample size of 50 patients provides a more sensitive benchmark in Sub-Saharan Africa compared to the current recommended threshold of 10 % to trigger further investigation of artemisinin susceptibility. |
Content Index (Achived Edition)
About
CDC Science Clips is an online, continuously updated, searchable database of scientific literature published by CDC authors. Each article features an Altmetric Attention Score to track social and mainstream media mentions. If you are aware of a CDC-authored publication that does not appear in this database, please let us know.
- Page last reviewed:Feb 1, 2024
- Page last updated:Apr 29, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure