Multilevel Regression for Small-Area Estimation of Mammography Use in the United States, 2014.
Berkowitz Z , Zhang X , Richards TB , Sabatino SA , Peipins LA , Holt J , White MC . Cancer Epidemiol Biomarkers Prev 2018 28 (1) 32-40 BACKGROUND: The US Preventive Services Task Force recommends biennial screening mammography for average-risk women aged 50 to 74 years. County-level information on population measures of mammography use can inform targeted intervention to reduce geographic disparities in mammography use. County-level estimates for mammography use nationwide are rarely presented. METHODS: We used data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) (n=130,289 women), linked it to the American Community Survey poverty data, and fitted multilevel logistic regression models with two outcomes: mammography within the past 2 years (up-to-date); and most recent mammography 5 or more years ago or never (rarely/never). We post-stratified the data with US Census population counts to run Monte Carlo simulations. We generated county-level estimates nationally and by urban-rural county classifications. County-level prevalence estimates were aggregated into state and national estimates. We validated internal consistency between our model-based state-specific estimates and urban-rural estimates with BRFSS direct estimates using Spearman correlation coefficients and mean absolute differences. RESULTS: Correlation coefficients were 0.94 or larger. Mean absolute differences for the 2 outcomes ranged from 0.79 to 1.03. Although 78.45% (95% CI: 77.95% horizontal line 78.92%) of women nationally were up-to-date with mammography, more than half of the states had counties with >15% of women rarely/never using a mammogram, many in rural areas. CONCLUSIONS: We provided estimates for all U.S. counties and identified marked variations in mammography use. Many states and counties were far from the 2020 target (81.1%). IMPACT: Our results suggest a need for planning and resource allocation on a local level to increase mammography uptake. |
A qualitative study of realtor knowledge, attitudes, and practices related to radon health effects: implications for comprehensive cancer control
Momin B , McNaughton C , Galanek JD , Neri A , Gallaway MS , Puckett M . Cancer Causes Control 2018 29 (12) 1249-1255 BACKGROUND: Lung cancer is the leading cause of cancer-related deaths in the United States, and radon exposure is the second leading risk factor. Fewer than 25% of existing U.S. homes have been tested for radon, and only 5-10% of new homes use some form of radon prevention. OBJECTIVE: This qualitative study sought to determine radon-related knowledge, attitudes, and practices among Realtors to inform cancer control activities at local and state levels. METHODS: We conducted focus groups with Realtors in four states to collect information about knowledge, attitudes, and practices regarding radon. RESULTS: Realtors reported obtaining information on radon in similar ways, being aware of radon and its characteristics, and dealing with radon issues as a normal part of home sales. Differences in attitudes toward testing varied across states. Realtors in states with radon policies generally expressed more positive attitudes toward testing than those in states without policies. Radon mitigation was identified as an added expense to buyers and sellers. Realtors cited concerns about the reliability and credibility of mitigation systems and installers. CONCLUSIONS: These findings suggest that attitudes and practices vary among Realtors and that additional educational resources about radon as a cancer risk factor may be beneficial. When comprehensive cancer control programs update their plans, they may want to add objectives, strategies, or activities to reduce radon exposure and prevent lung cancer. These activities could include partnering with Realtors to improve their knowledge, attitudes, and practices about radon, as well as developing and distributing radon educational resources. |
Symptoms of anxiety and depression among adults with arthritis - United States, 2015-2017
Guglielmo D , Hootman JM , Boring MA , Murphy LB , Theis KA , Croft JB , Barbour KE , Katz PP , Helmick CG . MMWR Morb Mortal Wkly Rep 2018 67 (39) 1081-1087 An estimated 54.4 million (22.7%) U.S. adults have doctor-diagnosed arthritis (1). A report in 2012 found that, among adults aged >/=45 years with arthritis, approximately one third reported having anxiety or depression, with anxiety more common than depression (2). Studies examining mental health conditions in adults with arthritis have focused largely on depression, arthritis subtypes, and middle-aged and older adults, or have not been nationally representative (3). To address these knowledge gaps, CDC analyzed 2015-2017 National Health Interview Survey (NHIS) data* to estimate the national prevalence of clinically relevant symptoms of anxiety and depression among adults aged >/=18 years with arthritis. Among adults with arthritis, age-standardized prevalences of symptoms of anxiety and depression were 22.5% and 12.1%, respectively, compared with 10.7% and 4.7% among adults without arthritis. Successful treatment approaches to address anxiety and depression among adults with arthritis are multifaceted and include screenings, referrals to mental health professionals, and evidence-based strategies such as regular physical activity and participation in self-management education to improve mental health. |
Association between receipt of school-based HIV education and contraceptive use among sexually active high school students United States, 20112013
Demissie Z , Clayton HB , Dunville RL . Sex Educ 2018 19 (2) 237-246 Sexual health education, including HIV prevention information, can help prevent unintended pregnancy and sexually transmitted infections. National Youth Risk Behavior Survey data from 2011 and 2013 were used to determine HIV education prevalence among 9,825 currently sexually active students in grades 912. Associations between HIV education and contraceptive methods used at last sexual intercourse were examined for: (1) condom use; (2) any contraceptive method; (3) dual use of a condom and either birth control pills; IUD or implant; or shot, patch, or birth control ring; and (4) primary contraceptive method. Primary contraceptive method options were (1) no method; (2) birth control pills; (3) condoms; (4) IUD or implant; (5) shot, patch, or birth control ring; (6) withdrawal or some other method; and (7) not sure. Logistic regression (prevalence ratios [PRs] and 95% confidence intervals [CIs]) and Chi-squares were used for testing. Students who received HIV education were more likely than students who did not to use a condom (PR:1.09;CI:1.01,1.18) and any contraceptive method (PR:1.08;CI:1.04,1.12); there was no significant association with dual use. Primary contraceptive method varied significantly by receipt of HIV education (p<.001). School-based HIV education may be important for promotion of adolescent condom and contraceptive use. |
Chlamydia, gonorrhea, and HIV infection among transgender women and transgender men attending clinics that provide STD services in six US cities: Results from the STD Surveillance Network
Pitasi MA , Kerani RP , Kohn R , Murphy RD , Pathela P , Schumacher CM , Tabidze I , Llata E . Sex Transm Dis 2018 46 (2) 112-117 BACKGROUND: Transgender women and transgender men are disproportionately affected by HIV infection and may be vulnerable to other STDs, but the lack of surveillance data inclusive of gender identity hinders prevention and intervention strategies. METHODS: We analyzed data from 506 transgender women (1,045 total visits) and 120 transgender men (209 total visits) who attended 26 publicly funded clinics that provide STD services in six US cities during a 3.5-year observation period. We used clinical and laboratory data to examine the proportion of transgender women and transgender men who tested positive for urogenital and extragenital chlamydial or gonococcal infections and who self-reported or tested positive for HIV infection during the observation period. RESULTS: Of the transgender women tested, 13.1% tested positive for chlamydia and 12.6% tested positive for gonorrhea at one or more anatomic sites, and 14.2% were HIV-infected. Of transgender men tested, 7.7% and 10.5% tested positive for chlamydia and gonorrhea at one or more anatomic sites, and 8.3% were HIV-infected., Most transgender women (86.0% and 80.9%, respectively) and more than a quarter of transgender men (28.6% and 28.6%, respectively) with an extragenital chlamydial or gonococcal infection had a negative urogenital test at the same visit. CONCLUSIONS: Publicly funded clinics providing STD services are likely an important source of STD care for transgender persons. More data are needed to understand the most effective screening approaches for urogenital, rectal, and pharyngeal CT and GC infections in transgender populations. |
Developing a model to predict unfavourable treatment outcomes in patients with tuberculosis and human immunodeficiency virus co-infection in Delhi, India
Madan C , Chopra KK , Satyanarayana S , Surie D , Chadha V , Sachdeva KS , Khanna A , Deshmukh R , Dutta L , Namdeo A , Shukla A , Sagili K , Chauhan LS . PLoS One 2018 13 (10) e0204982 BACKGROUND: Tuberculosis (TB) patients with human immunodeficiency virus (HIV) co-infection have worse TB treatment outcomes compared to patients with TB alone. The distribution of unfavourable treatment outcomes differs by socio-demographic and clinical characteristics, allowing for early identification of patients at risk. OBJECTIVE: To develop a statistical model that can provide individual probabilities of unfavourable outcomes based on demographic and clinical characteristics of TB-HIV co-infected patients. METHODOLOGY: We used data from all TB patients with known HIV-positive test results (aged >/=15 years) registered for first-line anti-TB treatment (ATT) in 2015 under the Revised National TB Control Programme (RNTCP) in Delhi, India. We included variables on demographics and pre-treatment clinical characteristics routinely recorded and reported to RNTCP and the National AIDS Control Organization. Binomial logistic regression was used to develop a statistical model to estimate probabilities of unfavourable TB treatment outcomes (i.e., death, loss to follow-up, treatment failure, transfer out of program, and a switch to drug-resistant regimen). RESULTS: Of 55,260 TB patients registered for ATT in 2015 in Delhi, 928 (2%) had known HIV-positive test results. Of these, 816 (88%) had drug-sensitive TB and were >/=15 years. Among 816 TB-HIV patients included, 157 (19%) had unfavourable TB treatment outcomes. We developed a model for predicting unfavourable outcomes using age, sex, disease classification (pulmonary versus extra-pulmonary), TB treatment category (new or previously treated case), sputum smear grade, known HIV status at TB diagnosis, antiretroviral treatment at TB diagnosis, and CD4 cell count at ATT initiation. The chi-square p-value for model calibration assessed using the Hosmer-Lemeshow test was 0.15. The model discrimination, measured as the area under the receiver operator characteristic (ROC) curve, was 0.78. CONCLUSION: The model had good internal validity, but should be validated with an independent cohort of TB-HIV co-infected patients to assess its performance before clinical or programmatic use. |
Distribution of hepatitis A antibodies in US blood donors
Tejada-Strop A , Zafrullah M , Kamili S , Stramer SL , Purdy MA . Transfusion 2018 58 (12) 2761-2765 BACKGROUND: Recently, there has been an increase in the number of hepatitis A outbreaks in the United States. Although the presence of hepatitis A virus (HAV) RNA in blood donors is known to be low, HAV antibody prevalence in this population is unknown. STUDY DESIGN AND METHODS: Samples from 5001 US blood donors collected primarily in the midwestern United States in 2015 were tested for the presence of HAV IgG antibodies using chemiluminescent microparticle immunoassays on the ARCHITECT platform (Abbott Laboratories). RESULTS: The overall prevalence of IgG anti-HAV was 60%. Only one specimen was IgM anti-HAV positive, for an incidence of 0.02%. IgG anti-HAV prevalence among donors aged 16 to 19 years was 67%, decreased to 54% among donors aged 40 to 49 years and increased to 70% among donors aged 80 to 93 years. No differences were seen by sex with overall IgG anti-HAV prevalence of 61% and 60% for males and females, respectively. Among the five states (Illinois, Indiana, Kansas, Kentucky, and Missouri) with the highest number of donors tested, IgG anti-HAV prevalence in Missouri (65%) was significantly higher (p <0.01) than that in Illinois (52%) or Kentucky (59%). No other significant differences between states were noted. CONCLUSION: This study demonstrates the overall high rates of IgG anti-HAV in US blood donors, with the low associated risk of HAV transfusion transmission likely the result of low incidence and effective vaccination. |
Distribution of HIV self-tests by HIV-positive men who have sex with men to social and sexual contacts
Wesolowski L , Chavez P , Sullivan P , Freeman A , Sharma A , Mustanski B , McNaghten AD , MacGowan R . AIDS Behav 2018 23 (4) 893-899 HIV-positive men who have sex with men (MSM) were recruited on www.Facebook.com and www.Poz.com to give HIV self-tests to their contacts. Study participants completed a baseline survey, were given two self-tests, and completed a survey 2 months later. Of 133 eligible men, 40 (30%) completed both surveys. Most participants were 30-54 years old and non-Hispanic white. Some had a detectable viral load (n = 4), had condomless anal sex with male partners of negative or unknown status (n = 17), and had met anal sex partners at gay dating websites (n = 23). Of 80 self-tests given to participants, 59 (74%) were distributed, primarily to non-Hispanic white MSM, 30-54 years old who were friends. Participants reported results from 31 distributed tests; 2 sex partners of participants had positive results. Participants indicated these two persons were unaware of their infections. Expanding recruitment websites might reach non-white MSM. Unrecognized infections were identified through online recruitment and self-test distribution via HIV-positive persons. |
Factors contributing to congenital syphilis cases - New York City, 2010-2016
Slutsker JS , Hennessy RR , Schillinger JA . MMWR Morb Mortal Wkly Rep 2018 67 (39) 1088-1093 Congenital syphilis occurs when syphilis is transmitted from a pregnant woman to her fetus; congenital syphilis can be prevented through screening and treatment during pregnancy. Transmission to the fetus can occur at any stage of maternal infection, but is more likely during primary and secondary syphilis, with rates of transmission up to 100% at these stages (1). Untreated syphilis during pregnancy can cause spontaneous abortion, stillbirth, and early infant death. During 2013-2017, national rates of congenital syphilis increased from 9.2 to 23.3 cases per 100,000 live births (2), coinciding with increasing rates of primary and secondary syphilis among women of reproductive age (3). In New York City (NYC), cases of primary and secondary syphilis among women aged 15-44 years increased 147% during 2015-2016. To evaluate measures to prevent congenital syphilis, the NYC Department of Health and Mental Hygiene (DOHMH) reviewed data for congenital syphilis cases reported during 2010-2016 and identified patient-, provider-, and systems-level factors that contributed to these cases. During this period, 578 syphilis cases among pregnant women aged 15-44 years were reported to DOHMH; a congenital syphilis case was averted or otherwise failed to occur in 510 (88.2%) of these pregnancies, and in 68, a case of congenital syphilis occurred (eight cases per 100,000 live births).* Among the 68 pregnant women associated with these congenital syphilis cases, 21 (30.9%) did not receive timely (>/=45 days before delivery) prenatal care. Among the 47 pregnant women who did access timely prenatal care, four (8.5%) did not receive an initial syphilis test until <45 days before delivery, and 22 (46.8%) acquired syphilis after an initial nonreactive syphilis test. These findings support recommendations that health care providers screen all pregnant women for syphilis at the first prenatal care visit and then rescreen women at risk in the early third trimester. |
HIV care and viral load suppression after sexual health clinic visits by out-of-care HIV-positive persons
Tymejczyk O , Jamison K , Pathela P , Braunstein S , Schillinger JA , Nash D . AIDS Patient Care STDS 2018 32 (10) 390-398 Outcomes among people living with HIV (PLWH) in New York City (NYC) remain suboptimal. To assess the potential role of the city's sexual health clinics (SHCs) in improving HIV outcomes and reducing HIV transmission, we examined HIV care status and its correlates among HIV-positive SHC patients in NYC. Clinic electronic medical records were merged with longitudinal NYC HIV surveillance data to identify HIV-positive patients and derive their retrospective and prospective HIV care status. Evidence of HIV care and viral load suppression (VLS) after clinic visit were considered outcomes. Logistic regression models were used to assess their correlates. A third of the 1045 PLWH who visited NYC SHCs in 2012 were out of HIV care (OOC) in the 12 months preceding the clinic visit, and were less likely than those previously in HIV care (IC) to have subsequent evidence of HIV care (42% vs. 72%) or VLS in the 12 months after the visit (39% vs. 76%). VLS was particularly low among patients diagnosed with >/=2 sexually transmitted infections (46%). The odds of VLS were lowest among those OOC before the clinic visit [versus those IC, adjusted odds ratio (aOR): 0.21, 95% confidence interval (CI): 0.16-0.29], non-Hispanic blacks (versus non-Hispanic whites, aOR: 0.58, 95% CI: 0.37-0.90), and residents of high-poverty neighborhoods (>30% vs. <10%, aOR: 0.51, 95% CI: 0.29-0.89). Our findings suggest that SHCs could serve as an intervention point to (re-)link PLWH to HIV care. Real-time provider alerts about patients' OOC status could help achieve that goal. |
HIV-related stigma by healthcare providers in the United States: A systematic review
Geter A , Herron AR , Sutton MY . AIDS Patient Care STDS 2018 32 (10) 418-424 Reducing HIV-related stigma may enhance the quality of HIV prevention and care services and is a national prevention goal. The objective of this systematic review was to identify studies of HIV-related stigma among healthcare providers. For studies published between 2010 and 2017, we: (1) searched databases using our keywords, (2) excluded nonpeer reviewed studies, (3) limited the findings to the provider perspective and studies conducted in the United States, (4) extracted and summarized the data, and (5) conducted a contextual review to identify common themes. Of 619 studies retrieved, 6 were included, with 3 themes identified: (1) attitudes, beliefs, and behaviors (n = 6), (2) quality of patient care (n = 3), and (3) education and training (n = 2). Factors associated with HIV-related stigma varied by gender, race, provider category, and clinical setting. Providers with limited recent HIV-stigma training were more likely to exhibit stigmatizing behaviors toward patients. Developing provider-centered stigma-reduction interventions may help advance national HIV prevention and care goals. |
Lymphogranuloma venereum: an increasingly common anorectal infection among men who have sex with men attending New York City Sexual Health Clinics
Pathela P , Jamison K , Kornblum J , Quinlan T , Halse TA , Schillinger JA . Sex Transm Dis 2018 46 (2) e14-e17 Using Chlamydia trachomatis anorectal specimens routinely tested for LGV (2008-2011) and samples of archived specimens tested for LGV (2012-2015), we observed increased LGV positivity among men-who-have-sex-with-men attending NYC Sexual Health Clinics. Using clinical data, we determined predictors of anorectal LGV that may guide clinical management. |
Psychrobacter sanguinis wound infection associated with marine environment exposure, Washington, USA
Bonwitt J , Tran M , Droz A , Gonzalez A , Glover WA . Emerg Infect Dis 2018 24 (10) 1942-1944 We report a 26-year-old man with Psychrobacter sanguinis cellulitis of a wound sustained during ocean fishing in Washington, USA, in 2017. Psychrobacter spp. are opportunistic pathogens found in a wide range of environments. Clinicians should be aware of Psychrobacter spp. and perform 16S rRNA sequencing if this pathogen is suspected. |
Quantitative assessment of brief messages about HIV pre-exposure prophylaxis among HIV-infected and HIV-uninfected black/African American and Hispanic/Latino MSM
Mansergh G , Baack BN , Holman J , Mimiaga MJ , Landers S , Herbst JH . J Acquir Immune Defic Syndr 2018 80 (1) 31-35 BACKGROUND: HIV pre-exposure prophylaxis (PrEP) is efficacious, however many MSM (especially racial/ethnic minorities) are still unaware of and under-utilize it. METHODS: The 2014 Messages4Men Study focuses on black and Hispanic/Latino MSM in Chicago, Fort Lauderdale, and Kansas City (n=937). Brief (2-3 sentence) messages were tested: a PrEP message tailored for HIV-uninfected MSM (n=607) and a PrEP message tailored for HIV-infected MSM (n=330). After reading the message, participants reported believability and awareness, and intent to use PrEP and condoms. Analyses consisted of bivariate and multivariable approaches. RESULTS: Among HIV-uninfected MSM, black (vs. Hispanic/Latino) MSM indicated greater intentions to use PrEP (81% vs. 70% respectively, p<.05); 72% overall had similar intentions to use condoms after hearing a PrEP message. PrEP information was new (63%) and believable (80%), with no racial/ethnic differences (p>.05). In multivariable analysis, men who reported recent condomless anal sex were less likely to report the PrEP message enhanced their intent to use condoms in the future. DISCUSSION: Several years into the availability of PrEP, black and Hispanic/Latino MSM continue to be unaware of PrEP and its benefits, although information is largely believable once provided. The HIV prevention field should be prepared to incorporate new information about HIV prevention options into brief messages delivered through technology and social media. |
Reactor grids for prioritizing syphilis investigations: Are primary syphilis cases being missed
Cha S , Matthias JM , Rahman M , Schillinger JA , Furness BW , Pugsley RA , Kidd S , Bernstein KT , Peterman TA . Sex Transm Dis 2018 45 (10) 648-654 BACKGROUND: Health departments prioritize investigations of reported reactive serologic tests based on age, gender, and titer using reactor grids. We wondered how reactor grids are used in different programs, and if administratively closing investigations of low-titer tests could lead to missed primary syphilis cases. METHODS: We obtained a convenience sample of reactor grids from 13 health departments. Interviews with staff from several jurisdictions described the role of grids in surveillance and intervention. From 5 jurisdictions, trends in reactive nontreponemal tests and syphilis cases over time (2006-2015) were assessed by gender, age, and titer. In addition, nationally-reported primary syphilis cases (2013-2015) were analyzed to determine what proportion had low titers (</=1:4) that might be administratively closed by grids without further investigation. RESULTS: Grids and follow-up approaches varied widely. Health departments in the study received a total of 48,573 to 496,503 reactive serologies over a 10-year period (3044-57,242 per year). In 2006 to 2015, the number of reactive serologies increased 37% to 169%. Increases were largely driven by tests for men although the ratios of tests per reported case remained stable over time. Almost one quarter of reported primary syphilis had low titers that would be excluded by most grids. The number of potentially missed primary syphilis cases varied by gender and age with 41- to 54-year-old men accounting for most. CONCLUSIONS: Reactor grids that close tests with low titers or from older individuals may miss some primary syphilis cases. Automatic, computerized record searches of all reactive serologic tests could help improve prioritization. |
Reconsidering the number of women with HIV infection who give birth annually in the United States
Nesheim SR , FitzHarris LF , Lampe MA , Gray KM . Public Health Rep 2018 133 (6) 33354918800466 OBJECTIVES: The annual number of women with HIV infection who delivered infants in the United States was estimated to be 8700 in 2006. An accurate, current estimate is important for guiding perinatal HIV prevention efforts. Our objective was to analyze whether the 2006 estimate was consistent with the number of infants with HIV infection observed in the United States and with other data on perinatal HIV transmission. METHODS: We compared the number of infants born with HIV in 2015 (n = 53) with data on interventions to prevent perinatal HIV transmission (eg, maternal HIV diagnosis before and during pregnancy and prenatal antiretroviral use). We also estimated the annual number of deliveries to women living with HIV by using the number of women of childbearing age living with HIV during 2008-2014 and the estimated birth rate among these women. Finally, we determined any changes in the annual number of infants born to women with HIV from 2007-2015, among 19 states that reported these data. RESULTS: The low number of infants born in the United States with HIV infection and the uptake of interventions to prevent perinatal HIV transmission were not consistent with the 2006 estimate (n = 8700), even with the best uptake of interventions to prevent perinatal HIV transmission. Given the birth rate among women with HIV (estimated at 7%) and the number of women aged 13-44 living with HIV during 2008-2014 (n = 111 273 in 2008, n = 96 363 in 2014), no more than about 5000 women with HIV would be giving birth. Among states consistently reporting the annual number of births to women with HIV, the number declined about 14% from 2008 to 2014. CONCLUSION: The current annual number of women with HIV infection delivering infants in the United States is about 5000, which is substantially lower than the 2006 estimate. More accurate estimates would require comprehensive reporting of perinatal HIV exposure. |
Repeated Chlamydia trachomatis infections are associated with lower bacterial loads
Gupta K , Bakshi RK , Van Der Pol B , Daniel G , Brown L , Press CG , Gorwitz R , Papp J , Lee JY , Geisler WM . Epidemiol Infect 2018 147 1-3 Chlamydia trachomatis (CT) infections remain highly prevalent. CT reinfection occurs frequently within months after treatment, likely contributing to sustaining the high CT infection prevalence. Sparse studies have suggested CT reinfection is associated with a lower organism load, but it is unclear whether CT load at the time of treatment influences CT reinfection risk. In this study, women presenting for treatment of a positive CT screening test were enrolled, treated and returned for 3- and 6-month follow-up visits. CT organism loads were quantified at each visit. We evaluated for an association of CT bacterial load at initial infection with reinfection risk and investigated factors influencing the CT load at baseline and follow-up in those with CT reinfection. We found no association of initial CT load with reinfection risk. We found a significant decrease in the median log10 CT load from baseline to follow-up in those with reinfection (5.6 CT/ml vs. 4.5 CT/ml; P = 0.015). Upon stratification of reinfected subjects based upon presence or absence of a history of CT infections prior to their infection at the baseline visit, we found a significant decline in the CT load from baseline to follow-up (5.7 CT/ml vs. 4.3 CT/ml; P = 0.021) exclusively in patients with a history of CT infections prior to our study. Our findings suggest repeated CT infections may lead to possible development of partial immunity against CT. |
Repeated false-positive HIV test results in a patient taking HIV pre-exposure prophylaxis
Stekler JD , Violette LR , Niemann L , McMahan VM , Katz DA , Baeten JM , Grant RM , Delaney KP . Open Forum Infect Dis 2018 5 (9) ofy197 Regular HIV testing is required to ensure the safety of HIV pre-exposure prophylaxis (PrEP). We describe and discuss a series of false-positive HIV test results from an individual receiving PrEP. The expansion of PrEP will likely result in greater numbers of false-positive test results that may pose challenges for interpretation. |
Severe respiratory illness outbreak associated with human coronavirus NL63 in a long-term care facility
Hand J , Rose EB , Salinas A , Lu X , Sakthivel SK , Schneider E , Watson JT . Emerg Infect Dis 2018 24 (10) 1964-1966 We describe an outbreak of severe respiratory illness associated with human coronavirus NL63 in a long-term care facility in Louisiana in November 2017. Six of 20 case-patients were hospitalized with pneumonia, and 3 of 20 died. Clinicians should consider human coronavirus NL63 for patients in similar settings with respiratory disease. |
Simple estimates for local prevalence of latent tuberculosis infection, United States, 2011-2015
Haddad MB , Raz KM , Lash TL , Hill AN , Kammerer JS , Winston CA , Castro KG , Gandhi NR , Navin TR . Emerg Infect Dis 2018 24 (10) 1930-1933 We used tuberculosis genotyping results to derive estimates of prevalence of latent tuberculosis infection in the United States. We estimated <1% prevalence in 1,981 US counties, 1%-<3% in 785 counties, and >3% in 377 counties. This method for estimating prevalence could be applied in any jurisdiction with an established tuberculosis surveillance system. |
Tenofovir exposure during pregnancy and postpartum in women receiving tenofovir disoproxil fumarate for the prevention of mother-to-child transmission of hepatitis B virus
Cressey TR , Harrison L , Achalapong J , Kanjanavikai P , Patamasingh Na Ayudhaya O , Liampongsabuddhi P , Siriwachirachai T , Putiyanun C , Suriyachai P , Tierney C , Salvadori N , Chinwong D , Decker L , Tawon Y , Murphy TV , Ngo-Giang-Huong N , Siberry GK , Jourdain G . Antimicrob Agents Chemother 2018 62 (12) We assessed tenofovir exposure during pregnancy and postpartum in hepatitis B virus (HBV)-infected, HIV-uninfected, women receiving tenofovir disoproxil fumarate (TDF) to prevent mother-to-child transmission of HBV. Data from 154 women who received TDF within a randomized-controlled trial were included. Individual plasma tenofovir exposures (AUC0-24) were estimated using a population pharmacokinetic approach. Estimated geometric mean tenofovir AUC0-24 was 20% (95% CI: 19-21%) lower during pregnancy compared to postpartum; this modest reduction in the absence of HBV transmission suggests no dose adjustment is needed. |
Age-specific associations of ozone and PM2.5 with respiratory emergency department visits in the US
Strosnider HM , Chang HH , Darrow LA , Liu Y , Vaidyanathan A , Strickland MJ . Am J Respir Crit Care Med 2018 199 (7) 882-890 RATIONALE: While associations between air pollution and respiratory morbidity for adults 65 and older are well-documented in the United States, the evidence for people under 65 is less extensive. To address this gap, the Centers for Disease Control and Prevention's National Environmental Public Health Tracking Program collected respiratory emergency department (ED) data from 17 states. OBJECTIVES: Estimate age-specific acute effects of ozone and fine particulate matter (PM2.5) on respiratory ED visits. METHODS: We conducted time-series analyses in 894 counties by linking daily respiratory ED visits with estimated ozone and PM2.5 concentrations during the week before the date of the visit. Overall effect estimates were obtained using a Bayesian hierarchical model to combine county estimates for each pollutant by age group (children 0-18, adults 19-64, adults >/=65, and all ages) and by outcome group (acute respiratory infection, asthma, chronic obstructive pulmonary disease, pneumonia, and all respiratory ED visits). MEASUREMENTS AND MAIN RESULTS: Rate ratios (95% credible interval) per 10 microg/m3 increase in PM2.5 and all respiratory ED visits were 1.024 (1.018, 1.029) among children, 1.008 (1.004, 1.012) among adults <65, and 1.002 (0.996, 1.007) among adults 65 and older. Per 20 ppb increase in ozone, rate ratios were 1.017 (1.011, 1.023) among children, 1.051 (1.046, 1.056) among adults <65, and 1.033 (1.026, 1.040) among adults 65 and older. Associations varied in magnitude by age group for each outcome group. CONCLUSIONS: These results address a gap in the evidence used to ensure adequate public health protection under national air pollution policies. |
Prenatal exposure to perfluoroalkyl substances: Infant birth weight and early life growth
Shoaff J , Papandonatos GD , Calafat AM , Chen A , Lanphear BP , Ehrlich S , Kelsey KT , Braun JM . Environ Epidemiol 2018 2 (2) Background: Prenatal perfluoroalkyl substance (PFAS) exposure has been associated with reduced birth weight and excess child adiposity, but the relationship between PFAS and early life growth is unknown. Objective: To determine if prenatal PFAS exposure was associated with birth weight, body composition and growth until 2 years of age. Methods: In a prospective cohort of women and their children from Cincinnati, OH, we quantified perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorononanoic acid (PFNA), and perfluorohexane sulfonic acid (PFHxS) in pregnant women's serum. We used linear regression to estimate associations of PFAS with birth weight z-scores (n=345) and linear mixed models to estimate associations with repeated weight and length/height measurements (n=334) at ages 4 weeks and 1 and 2 years, after adjusting for sociodemographic, perinatal, nutritional, and environmental factors. Results: We found non-significant inverse associations between PFAS and infant birth weight. For example, each log2 increase in PFOA was associated with a 0.03 standard deviation reduction in birth weight z-score (95% CI:-0.17, 0.10). Compared to associations with birth weight, we observed stronger associations between PFAS and child anthropometry from 4 weeks to 2 years. For instance, each log2 increase in PFOA was associated with a 0.12 standard deviation decrease in BMI z-score (95% CI: -0.25, 0.01). We did not observe any differences in growth rate associated with PFAS. Conclusion: We observed inverse associations between prenatal serum PFAS concentrations and anthropometry until age 2 years. Prenatal serum PFAS concentrations were not associated with growth rate in the first 2 years of life. |
Outbreak of Salmonella Chailey Infections Linked To Precut Coconut Pieces - United States and Canada, 2017.
Luna S , Taylor M , Galanis E , Asplin R , Huffman J , Wagner D , Hoang L , Paccagnella A , Shelton S , Ladd-Wilson S , Seelman S , Whitney B , Elliot E , Atkinson R , Marshall K , Basler C . MMWR Morb Mortal Wkly Rep 2018 67 (39) 1098-1100 Foodborne salmonellosis causes an estimated 1 million illnesses and 400 deaths annually in the United States (1). In recent years, salmonellosis outbreaks have been caused by foods not typically associated with Salmonella. On May 2, 2017, PulseNet, CDC's national molecular subtyping network for foodborne disease surveillance, identified a cluster of 14 Salmonella Chailey isolates with a rare pulsed-field gel electrophoresis (PFGE) pattern. On May 29, Canadian health officials informed CDC that they were also investigating a cluster of five Salmonella Chailey infections in British Columbia with the same PFGE pattern. Nineteen cases were identified and investigated by CDC, U.S. state health departments, the Public Health Agency of Canada, and the British Columbia Centre for Disease Control. Isolates from all cases were highly related by whole genome sequencing (WGS). Illness onset dates ranged from March 10 to May 7, 2017. Initial interviews revealed that infected persons consumed various fresh foods and shopped at grocery chain A; focused questionnaires identified precut coconut pieces from grocery chain A as a common vehicle. The Canadian Food Inspection Agency (CFIA) and the U.S. Food and Drug Administration (FDA) conducted a traceback investigation that implicated a single lot of frozen, precut coconut as the outbreak source. Grocery chain A voluntarily removed precut coconut pieces from their stores. This action likely limited the size and scope of this outbreak. |
Notes from the Field: Multiple Cyclosporiasis Outbreaks - United States, 2018
Casillas SM , Bennett C , Straily A . MMWR Morb Mortal Wkly Rep 2018 67 (39) 1101-1102 Cyclosporiasis is an intestinal illness caused by the parasite Cyclospora cayetanensis through ingestion of fecally contaminated food or water. Symptoms of cyclosporiasis might include watery diarrhea (most common), loss of appetite, weight loss, cramping, bloating, increased gas, nausea, and fatigue. Typically, increased numbers of cases are reported in the United States during spring and summer; since the mid-1990s, outbreaks have been identified and investigated almost every year. Past outbreaks have been associated with various types of imported fresh produce (e.g., basil, cilantro, and raspberries) (1). There are currently no validated molecular typing tools* to facilitate linking cases to each other, to food vehicles, or their sources. Therefore, cyclosporiasis outbreak investigations rely primarily on epidemiologic data. |
Nonconforming gender expression and associated mental distress and substance use among high school students
Lowry R , Johns MM , Gordon AR , Austin SB , Robin LE , Kann LK . JAMA Pediatr 2018 172 (11) 1020-1028 Importance: The cultural roles and expectations attributed to individuals based on their sex often shape health behaviors and outcomes. Gender nonconformity (GNC) (ie, gender expression that differs from societal expectations for feminine or masculine appearance and behavior) is an underresearched area of adolescent health that is often linked to negative health outcomes. Objective: To examine the associations of GNC with mental distress and substance use among high school students. Design, Setting, and Participants: Cross-sectional study based on data from the Youth Risk Behavior Survey (YRBS) conducted in 2015. The setting was 3 large urban US school districts (2 in California and 1 in Florida). Participants were a racially/ethnically diverse population-based sample of 6082 high school students representative of all public school students in grades 9 through 12 attending these 3 school districts. Main Outcomes and Measures: Sex-stratified adjusted prevalence ratios (APRs) (adjusted for race/ethnicity, grade, and sexual identity) for high gender-nonconforming students (very/mostly/somewhat feminine male students or very/mostly/somewhat masculine female students) and moderate gender-nonconforming students (equally feminine and masculine students) relative to a referent group of low gender-nonconforming students (very/mostly/somewhat masculine male students or very/mostly/somewhat feminine female students). Results: Among 6082 high school students, 881 (15.9%) were white, 891 (19.1%) black, 3163 (55.1%) Hispanic, and 1008 (9.9%) other race/ethnicity. Among female students (2919 [50.0% of the study population]), moderate GNC was significantly associated with feeling sad and hopeless (APR, 1.22; 95% CI, 1.05-1.41), seriously considering attempting suicide (APR, 1.41; 95% CI, 1.14-1.74), and making a suicide plan (APR, 1.52; 95% CI, 1.22-1.89); however, substance use was not associated with GNC. Among male students (3139 [50.0% of the study population]), moderate GNC was associated with feeling sad and hopeless (APR, 1.55; 95% CI, 1.25-1.92); high GNC was associated with seriously considering attempting suicide (APR, 1.72; 95% CI, 1.16-2.56), making a suicide plan (APR, 1.79; 95% CI, 1.17-2.73), and attempting suicide (APR, 2.78; 95% CI, 1.75-4.40), as well as nonmedical use of prescription drugs (APR, 1.81; 95% CI, 1.23-2.67), cocaine use (APR, 2.84; 95% CI, 1.80-4.47), methamphetamine use (APR, 4.52; 95% CI, 2.68-7.61), heroin use (APR, 4.59; 95% CI, 2.48-8.47), and injection drug use (APR, 8.05; 95% CI, 4.41-14.70). Conclusions and Relevance: This study suggests mental distress is associated with GNC among female and male students. Substance use also appeared to be strongly associated with GNC among male students. These findings underscore and suggest the importance of implementing school-based programs to prevent substance use and promote student mental health that are inclusive of gender diversity in students. |
Medical expenditures associated with diabetes among adult Medicaid enrollees in eight states
Ng BP , Shrestha SS , Lanza A , Smith B , Zhang P . Prev Chronic Dis 2018 15 E116 INTRODUCTION: Little information is available on state-specific financial burdens of diabetes in the Medicaid population, yet such information is essential for state Medicaid programs to plan diabetes care and evaluate the benefits of diabetes prevention. We estimated medical expenditures associated with diabetes among adult Medicaid enrollees in 8 states. METHODS: We analyzed the latest available 2012 CMS Medicaid claims data for 1,193,811 adult enrollees aged 19-64 years in 8 states: Alabama, California, Connecticut, Florida, Illinois, Iowa, New York, and Oklahoma. For each state, we stratified the study population by Medicaid eligibility criteria: disability and nondisability. For each group, we estimated per capita annual medical expenditures on outpatient care, inpatient care, and prescription drugs by using a 2-part model, adjusted for age, sex, race/ethnicity, and comorbidities. We calculated the expenditures associated with diabetes as the difference in predicted expenditures for enrollees with and without diabetes. Analyses were done in 2017. RESULTS: For disability-based enrollees, the estimated total per capita annual diabetes expenditures ranged from $6,183 in Alabama to $15,319 in New York (all P < .001). For nondisability-based enrollees, the corresponding estimates ranged from $4,985 in Alabama to $15,366 in New York (all P < .001). The proportion of individual components varied by state and eligibility criteria. CONCLUSION: Medical expenditures associated with diabetes among adults on Medicaid were substantial and varied across studied states. Our estimates can be used by the 8 state Medicaid programs to prepare health care resources needed for diabetes care and assess the financial benefits of diabetes prevention programs. |
Prevalence of out-of-pocket payments for mammography screening among recently screened women
Sabatino SA , Thompson TD , Miller JW , Breen N , White MC , Breslau E , Shoemaker ML . J Womens Health (Larchmt) 2018 28 (7) 910-918 BACKGROUND: Because cost may be a barrier to receiving mammography screening, cost sharing for "in-network" screening mammograms was eliminated in many insurance plans with implementation of the Affordable Care Act. We examined prevalence of out-of-pocket payments for screening mammography after elimination in many plans. MATERIALS AND METHODS: Using 2015 National Health Interview Survey data, we examined whether women aged 50-74 years who had screening mammography within the previous year (n = 3,278) reported paying any cost for mammograms. Logistic regression models stratified by age (50-64 and 65-74 years) examined out-of-pocket payment by demographics and insurance (ages 50-64 years: private, Medicaid, other, and uninsured; ages 65-74 years: private +/- Medicare, Medicare+Medicaid, Medicare Advantage, Medicare only, and other). RESULTS: Of women aged 50-64 years, 23.5% reported payment, including 39.1% of uninsured women. Compared with that of privately insured women, payment was less likely for women with Medicaid (adjusted OR 0.17 [95% CI 0.07-0.41]) or other insurance (0.49 [0.25-0.96]) and more likely for uninsured women (1.99 [0.99-4.02]) (p < 0.001 across groups). For women aged 65-74 years, 11.9% reported payment, including 22.5% of Medicare-only beneficiaries. Compared with private +/- Medicare beneficiaries, payment was less likely for Medicare+Medicaid beneficiaries (adjusted OR 0.21 [95% CI 0.06-0.73]) and more likely for Medicare-only beneficiaries (1.83 [1.01-3.32]) (p = 0.005 across groups). CONCLUSIONS: Although most women reported no payment for their most recent screening mammogram in 2015, some payment was reported by >20% of women aged 50-64 years or aged 65-74 years with Medicare only, and by almost 40% of uninsured women aged 50-64 years. Efforts are needed to understand why many women in some groups report paying out of pocket for mammograms and whether this impacts screening use. |
Provider payments and the receipt of human papillomavirus vaccine among privately insured adolescents
Tsai Y , Lindley MC , Zhou F , Stokley S . Health Aff (Millwood) 2018 37 (10) 1587-1595 Financial concerns such as high vaccine purchase costs and inadequate insurance reimbursement are cited as a key barrier to human papillomavirus (HPV) vaccination of adolescents who are covered by private health insurance. Statistical evidence on the relationship between payments to providers for HPV vaccination and HPV vaccine uptake is limited. This study used data for 2008-14 from the MarketScan Commercial Claims and Encounters database and included adolescents ages 11-17 who had been continuously enrolled in the same noncapitated private insurance plan. Our estimates showed that a $1 increase in median provider payments in a state was associated with a 0.48-percentage-point increase in the probability of initiating the HPV vaccine series and a 0.25-percentage-point increase in the probability of receiving two or more doses. These numbers translated to an average increase of 49,435 adolescents initiating the series and 25,314 adolescents receiving two or more doses. The association between provider payments and HPV vaccine uptake was stronger among adolescents ages 11-12 than among older adolescents, and among adolescents who lived in a Metropolitan Statistical Area than those who did not. |
Candida auris in healthcare facilities, New York, USA, 2013-2017
Adams E , Quinn M , Tsay S , Poirot E , Chaturvedi S , Southwick K , Greenko J , Fernandez R , Kallen A , Vallabhaneni S , Haley V , Hutton B , Blog D , Lutterloh E , Zucker H . Emerg Infect Dis 2018 24 (10) 1816-1824 Candida auris is an emerging yeast that causes healthcare-associated infections. It can be misidentified by laboratories and often is resistant to antifungal medications. We describe an outbreak of C. auris infections in healthcare facilities in New York City, New York, USA. The investigation included laboratory surveillance, record reviews, site visits, contact tracing with cultures, and environmental sampling. We identified 51 clinical case-patients and 61 screening case-patients. Epidemiologic links indicated a large, interconnected web of affected healthcare facilities throughout New York City. Of the 51 clinical case-patients, 23 (45%) died within 90 days and isolates were resistant to fluconazole for 50 (98%). Of screening cultures performed for 572 persons (1,136 total cultures), results were C. auris positive for 61 (11%) persons. Environmental cultures were positive for samples from 15 of 20 facilities. Colonization was frequently identified during contact investigations; environmental contamination was also common. |
Clostridioides difficile Infection
Guh AY , Kutty PK . Ann Intern Med 2018 169 (7) Itc49-itc64 Clostridioides difficile (formerly Clostridium difficile) infection is the most frequently identified health care-associated infection in the United States. C difficile has also emerged as a cause of community-associated diarrhea, resulting in increased incidence of community-associated infection. Clinical illness ranges in severity from mild diarrhea to fulminant colitis and death. Appropriate management of infection requires understanding of the various diagnostic assays and therapeutic options as well as relevant measures to infection prevention. This article provides updated recommendations regarding the prevention, diagnosis, and treatment of incident and recurrent C difficile infection. |
A DS-1 like G9P[6] human strain CDC-6 as a new rotavirus vaccine candidate
Wang Y , Resch T , Esona MD , Moon SS , Jiang B . Vaccine 2018 36 (45) 6844-6849 Human rotavirus vaccine Rotarix(R) (G1P[8]) has shown broad cross protection against homotypic and heterotypic Wa-like human rotavirus strains among children worldwide. This vaccine, however, appears to induce slightly less or non-consistent protection against DS-1 like rotavirus P[4] strains in some settings. In addition, children who are secretor or Lewis-negative and are vaccinated with Rotarix(R) often experience breakthrough infection with P[6] strains. By contrast, P[6] strains infect all children, irrespective of their secretor or Lewis status. In the present study, we report successful adaptation of a DS-1 like human rotavirus G9P[6] strain (CDC-6) to high growth in Vero cells and identify sequence changes that may be critical for enhanced growth in vitro and attenuation in vivo. This human G9P[6] strain could serve as a promising new and potential low-cost vaccine candidate for global use, particularly in targeted population with secretor or Lewis-negative status and high prevalent DS-1 like P[6] strains. |
Influenza vaccination coverage among English-speaking Asian Americans
Srivastav A , O'Halloran A , Lu PJ , Williams WW . Am J Prev Med 2018 55 (5) e123-e137 INTRODUCTION: English-speaking non-Hispanic Asians (Asians) in the U.S. include populations with multiple geographic origins and ethnicities (e.g., Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese). Health behaviors and outcomes can differ widely among Asian ethnicities, and highlight the importance of subgroup analysis. Aggregating Asians may mask differences in influenza vaccination across various ethnicities. METHODS: Combined data from 2013 to 2015 Behavioral Risk Factor Surveillance System, a population-based, telephone survey of the non-institutionalized, U.S. population aged >/=18years, were analyzed in 2017 to assess influenza vaccination among Asians. Weighted proportions were calculated. Multivariable logistic regression was used to determine independent associations between sociodemographic factors and receipt of influenza vaccination. RESULTS: Influenza vaccination varied widely among Asian ethnicities, both nationally and by state. Overall, 42.1% of Asians reported having received an influenza vaccine, similar to vaccination among whites (42.4%). Coverage ranged from 36.1% among Koreans to 50.9% among Japanese. Factors independently associated with influenza vaccination among some or all Asian ethnicities included age (>/=50 years), female, never married, high school or higher education, annual household income >/=$75,000, possession of medical insurance and personal healthcare provider, routine checkup in the previous year, and presence of certain chronic conditions. CONCLUSIONS: Though Asians and whites had similar overall influenza vaccination coverage, differences existed between Asian ethnicities, both nationally and by state. This information may help community-based, state-level, and national-level public health agencies to support targeted approaches for outreach to these populations, such as improving cultural and linguistic access to care, to improve influenza vaccination. |
Preliminary validity of the Eyberg Child Behavior Inventory with Taiwanese clinic-referred children
Chen YC , Fortson BL , Tiano JD . J Child Fam Stud 2018 27 (12) 3816-3830 The Eyberg Child Behavior Inventory (ECBI) has previously been shown to be a psychometrically sound instrument used to assess disruptive behaviors in children in the United States and in other cultures/countries but not in Taiwan. The purpose of this study was to examine the factor structure and to establish the discriminative validity of the ECBI with two groups of Taiwanese children: 70 clinic-referred children with clinically elevated externalizing behavior problems and 70 community-based matched comparison children. Exploratory factor analyses resulted in a six-factor model for the clinic-referred sample and a five-factStrengths and Difficultieor model for the matched comparison sample, indicating that the ECBI is not unidimensional. Adequate convergent and divergent validity also were established between the ECBI Intensity and Problem Scales and another measure of child externalizing (for assessing convergent validity) and internalizing (for determining divergent validity) behavior. The results of the present study suggest that the ECBI is a valid measure of assessing externalizing behavior problems in Taiwanese children. Future research may seek to refine the factor structure of the ECBI in a Taiwanese sample. Future studies are also needed to examine other psychometrics of the ECBI, replicate this study with a larger sample, and establish its normative data in Taiwan. |
Prevalence of parent-reported traumatic brain injury in children and associated health conditions
Haarbauer-Krupa J , Lee AH , Bitsko RH , Zhang X , Kresnow-Sedacca MJ . JAMA Pediatr 2018 172 (11) 1078-1086 Importance: Traumatic brain injury (TBI) in children results in a high number of emergency department visits and risk for long-term adverse effects. Objectives: To estimate lifetime prevalence of TBI in a nationally representative sample of US children and describe the association between TBI and other childhood health conditions. Design, Setting, and Participants: Data were analyzed from the 2011-2012 National Survey of Children's Health, a cross-sectional telephone survey of US households with a response rate of 23%. Traumatic brain injury prevalence estimates were stratified by sociodemographic characteristics. The likelihood of reporting specific health conditions was compared between children with and without TBI. Age-adjusted prevalence estimates were computed for each state. Associations between TBI prevalence, insurance type, and parent rating of insurance adequacy were examined. Data analysis was conducted from February 1, 2016, through November 1, 2017. Main Outcomes and Measures: Lifetime estimate of TBI in children, associated childhood health conditions, and parent report of health insurance type and adequacy. Results: The lifetime estimate of parent-reported TBI among children was 2.5% (95% CI, 2.3%-2.7%), representing over 1.8 million children nationally. Children with a lifetime history of TBI were more likely to have a variety of health conditions compared with those without a TBI history. Those with the highest prevalence included learning disorders (21.4%; 95% CI, 18.1%-25.2%); attention-deficit/hyperactivity disorder (20.5%; 95% CI, 17.4%-24.0%); speech/language problems (18.6%; 95% CI, 15.8%-21.7%); developmental delay (15.3%; 95% CI, 12.9%-18.1%); bone, joint, or muscle problems (14.2%; 95% CI, 11.6%-17.2%); and anxiety problems (13.2%; 95% CI, 11.0%-16.0%). States with a higher prevalence of childhood TBI were more likely to have a higher proportion of children with private health insurance and higher parent report of adequate insurance. Examples of states with higher prevalence of TBI and higher proportion of private insurance included Maine, Vermont, Pennsylvania, Washington, Montana, Wyoming North Dakota, South Dakota, and Colorado. Conclusions and Relevance: A large number of US children have experienced a TBI during childhood. Higher TBI prevalence in states with greater levels of private insurance and insurance adequacy may suggest an underrecognition of TBI among children with less access to care. For more comprehensive monitoring, health care professionals should be aware of the increased risk of associated health conditions among children with TBI. |
Field Epidemiology and Laboratory Training Program, where is the L-track
Gatei W , Galgalo T , Abade A , Henderson A , Rayfield M , McAlister D , Montgomery JM , Peruski LF , Albetkova AA . Front Public Health 2018 6 264 Background: Modifications of the Field Epidemiology Training Program (FETP) curricula to include a laboratory track (L-Track), to become Field Epidemiology and Laboratory Training Program (FELTP), began in 2004 in Kenya. The L-Track offered candidates training on laboratory competencies in management, policy, quality systems, and diagnostic methods as well as epidemiology, disease surveillance and outbreak response. Since then several FELTPs have discontinued the L-Track and instead offer all candidates, epidemiologists and laboratorians, a single FETP curriculum. Reasons for these changes are reported here. Methods: A questionnaire was sent to directors of 13 FELTP programs collecting information on the status of the programs, reasons for any changes, basic entry qualifications, source institutions and where residents were post enrollment or after graduation. Data from previous CDC internal assessments on FELTP L-Track was also reviewed. Results: Out of the 13 FELTPs included, directors from 10 FELTPs sent back information on their specific programs. The FELTPs in Kenya, Mozambique, Cameroon and Kazakhstan and Mali have discontinued a separate L-Track while those in Ghana, Georgia, Nigeria, Rwanda, and Tanzania continue to offer the separate L-Track. Reasons for discontinuation included lack of standardized curriculum, unclear strategies of the separate L-Track, and funding constraints. Two countries Kenya and Tanzania reported on the career progression of their graduates. Results show 84% (Kenya) and 51% (Tanzania) of candidates in the FELTP, L-Track were recruited from national/regional medical health laboratories. However post-graduation, 56% (Kenya) and 43% (Tanzania) were working as epidemiologists, program managers, program coordinators, or regulatory/inspection boards. Professional upward mobility was high; 87% (Kenya) and 73% (Tanzania) residents, reported promotions either in the same or in new institutions. Conclusions: The FELTP L-Track residents continue to offer critical contributions to public health workforce development with high upward mobility. While this may be a reflection of professional versatility and demand of the FELTP graduates, the move from core laboratory services underscores the challenges in filling and retaining qualified staff within the laboratory systems. Results suggest different strategies are needed to strengthen laboratory management and leadership programs with a clear focus on laboratory systems and laboratory networks to meet current and future clinical and public health laboratory workforce demands. |
Identity and validity of conserved B cell epitopes of filovirus glycoprotein: towards rapid diagnostic testing for Ebola and possibly Marburg virus disease
Babirye P , Musubika C , Kirimunda S , Downing R , Lutwama JJ , Mbidde EK , Weyer J , Paweska JT , Joloba ML , Wayengera M . BMC Infect Dis 2018 18 (1) 498 BACKGROUND: Ebolavirus and Marburgvirus are genera of the virus family Filoviridae. Filoviruses cause rare but fatal viral hemorrhagic fevers (VHFs) in remote villages of equatorial Africa with potential for regional and international spread. Point-of-care (POC) rapid diagnostic tests (RDTs) are critical for early epidemic detection, reponse and control. There are 2 RDTs for Zaire ebolavirus (EBOV), but not other Ebolavirus spp. or Marburg marburgvirus (MARV). We validate 3 conserved B cell epitopes of filovirus glycoprotein (GP) using ebola virus diseases (EVD) survivor samples, towards devising pan-filovirus RDTs. METHODS: In-silico Immuno-informatics:- (a) multiple and basic local alignments of amino-acid sequences of filovirus (4 Ebolavirus spp. & MARV) Gp1, 2 and epitope prediction and conservation analyses within context of ClusterW, BLAST-P and the immune epitope database analysis resource (IEDB-AR); alongside (b) in-vitro enzyme immuno-assays (EIAs) for SUDV Gp1, 2 antigen and host-specific antibodies (IgM and IgG) among 94 gamma irradiated EVD survivor serum and 9 negative controls. RESULTS: Linear B cell epitopes were present across the entire length of all Gp1, 2, most lying in the region between amino acids positioned 350 and 500. Three seperate epitopes 97/80_GAFFLYDRLAST, 39_YEAGEWAENCY and 500_CGLRQLANETTQALQLFLRATTELR (designated UG-Filo-Peptide- 1, 2 and 3 respectively) were conserved within all studied filovirus species Gp1, 2. Gp1, 2 host specific IgM levels were comparably low (av. ODs < 0.04 [95% CI: 0.02837 to 0.04033]) among the 9 negative controls and 57 survivor samples analyzed. Host specific IgG levels, on the other hand, were elevated (av. ODs > 1.7525 [95% CI: 0.3010 to 3.1352]) among the 92 survivor samples relative to the 9 negative controls (av. ODs < 0.2.321 [95% CI: -0.7596 to 0.5372]). Filovirus Gp1, 2 antigen was not detected [av. ODs < 0.20] within EVD survivor serum relative to recombinant protein positive controls [av. ODs = 0.50]. CONCLUSIONS: These conserved B cell epitopes of filovirus Gp1, 2 and their derivative antibodies are promising for research and development of RDTs for EVD, with potential for extension to detect MVD. |
Iron catalysis of lipid peroxidation in ferroptosis: Regulated enzymatic or random free radical reaction
Stoyanovsky DA , Tyurina YY , Shrivastava I , Bahar I , Tyurin VA , Protchenko O , Jadhav S , Bolevich SB , Kozlov AV , Vladimirov YA , Shvedova AA , Philpott CC , Bayir H , Kagan VE . Free Radic Biol Med 2018 133 153-161 Duality of iron as an essential cofactor of many enzymatic metabolic processes and as a catalyst of poorly controlled redox-cycling reactions defines its possible biological beneficial and hazardous role in the body. In this review, we discuss these two "faces" of iron in a newly conceptualized program of regulated cell death, ferroptosis. Ferroptosis is a genetically programmed iron-dependent form of regulated cell death driven by enhanced lipid peroxidation and insufficient capacity of thiol-dependent mechanisms (glutathione peroxidase 4, GPX4) to eliminate hydroperoxy-lipids. We present arguments favoring the enzymatic mechanisms of ferroptotically engaged non-heme iron of 15-lipoxygenases (15-LOX) in complexes with phosphatidylethanolamine binding protein 1 (PEBP1) as a catalyst of highly selective and specific oxidation reactions of arachidonoyl- (AA) and adrenoyl-phosphatidylethanolamines (PE). We discuss possible role of iron chaperons as control mechanisms for guided iron delivery directly to their "protein clients" thus limiting non-enzymatic redox-cycling reactions. We also consider opportunities of loosely-bound iron to contribute to the production of pro-ferroptotic lipid oxidation products. Finally, we propose a two-stage iron-dependent mechanism for iron in ferroptosis by combining its catalytic role in the 15-LOX-driven production of 15-hydroperoxy-AA-PE (HOO-AA-PE) as well as possible involvement of loosely-bound iron in oxidative cleavage of HOO-AA-PE to oxidatively truncated electrophiles capable of attacking nucleophilic targets in yet to be identified proteins leading to cell demise. |
Longevity of adenovirus vector immunity in mice and its implications for vaccine efficacy
Sayedahmed EE , Kumari R , Shukla S , Hassan AO , Mohammed SI , York IA , Gangappa S , Sambhara S , Mittal SK . Vaccine 2018 36 (45) 6744-6751 There is a high incidence of adenovirus (AdV) infection in humans due to the presence of more than 60 types of human adenoviruses (HAdVs). The majority of individuals are exposed to one or more HAdV types early in their lives, leading to the development of AdV type-specific neutralizing antibodies. Similarly, immunization or gene therapy with AdV vectors leads to immune responses to the AdV vector. This 'vector immunity' is a concern for AdV vector-based applications for vaccines or gene therapy, especially when the repeated administration of a vector is required. The objective of this investigation was to establish whether AdV neutralizing antibody titers decline sufficiently in a year to permit annual vaccination with the same AdV vector. Naive or human adenoviral vector group C, type 5 (HAdV-C5)-primed mice were mock-inoculated (with PBS) or inoculated i.m. with 10(8)PFU of either HAd-GFP [HAdV-C5 vector expressing the green fluorescent protein (GFP)] to mimic the conditions for the first inoculation with an AdV vector-based vaccine. At 1, 3, 6, and 10months post-HAd-GFP inoculation, naive- or HAdV-primed animals were vaccinated i.m. with 10(8)PFU of HAd-H5HA [HAdV-C5 vector expressing hemagglutinin (HA) of H5N1 influenza virus]. There was a significant continual decrease in vector immunity titers with time, thereby leading to significant continual increases in the levels of HA-specific humoral and cell-mediated immune responses. In addition, significant improvement in protection efficacy against challenge with an antigenically heterologous H5N1 virus was observed in HAdV-primed animals at 6months and onwards. These results indicate that the annual immunization with the same AdV vector may be effective due to a significant decline in vector immunity. |
Nuts and bolts of protein quantification by online trypsin digestion coupled LC-MS/MS analysis
Toth CA , Kuklenyik Z , Barr JR . Methods Mol Biol 2019 1871 295-311 Protein digestion coupled to liquid chromatography and tandem mass spectrometry (LC-MS/MS) detection enables multiplexed quantification of proteins in complex biological matrices. However, the reproducibility of enzymatic digestion of proteins to produce proteotypic target peptides is a major limiting factor of assay precision. Online digestion using immobilized trypsin addresses this problem through precise control of digestion conditions and time. Because online digestion is typically for a short time, the potential for peptide degradation, a major source of measurement bias, is significantly reduced. Online proteolysis requires minimal sample preparation and is easily coupled to LC-MS/MS systems, further reducing potential method variability. We describe herein a method optimized for the multiplexed quantification of several apolipoproteins in human serum using on-column digestion. We highlight key features of the method that enhance assay accuracy and precision. These include the use of value-assigned serum as calibrators and stable isotope-labeled (SIL) peptide analogs as internal standards. We also comment on practical aspects of column switching valve design, instrument maintenance, tandem mass spectrometry data acquisition, and data processing. |
Pneumococcal and legionella urinary antigen tests in community-acquired pneumonia: Prospective evaluation of indications for testing
Bellew S , Grijalva CG , Williams DJ , Anderson EJ , Wunderink RG , Zhu Y , Waterer GW , Bramley AM , Jain S , Edwards KM , Self WH . Clin Infect Dis 2018 68 (12) 2026-2033 Background: Adult community-acquired pneumonia (CAP) guidelines from the Infectious Diseases Society of America (IDSA) and American Thoracic Society (ATS) include indications for urinary antigen tests (UATs) for Streptococcus pneumoniae (SP) and Legionella pneumophila (LP). These recommendations were based on expert opinion and have not been rigorously evaluated. Methods: We used data from a multicenter prospective surveillance study of adults hospitalized with CAP to evaluate the sensitivity and specificity of the IDSA/ATS UAT indications for identifying patients who test positive. SP and LP UATs were completed on all included patients. Separate analyses were completed for SP and LP using two-by-two contingency tables comparing the IDSA/ATS indications (UAT recommended vs not recommended) and UAT results (positive vs negative). Additionally, logistic regression was used to evaluate the association of each individual criterion in the IDSA/ATS indications with positive UAT results. Results: Among 1,941 patients, UATs were positive for SP in 81 (4.2%) and LP in 32 (1.6%). IDSA/ATS indications had 61% (95% CI: 49%-71%) sensitivity and 39% (95% CI: 37%-41%) specificity for SP, and 63% (95% CI: 44%-79%) sensitivity and 35% (95% CI: 33%-37%) specificity for LP. No clinical characteristics were strongly associated with positive SP UATs, while features associated with positive LP UATs were hyponatremia, fever, diarrhea, and recent travel. Conclusions: Recommended indications for SP and LP urinary antigen testing in the IDSA/ATS CAP guidelines have poor sensitivity and specificity for identifying patients with positive tests; future CAP guidelines should consider other strategies for determining which patients should undergo urinary antigen testing. |
Predicting nanotube fibrogenicity through stem cell-mediated fibroblast focus and spheroid formation
He X , Kiratipaiboon C , Porter DW , Rojanasakul LW , Dinu CZ , Wang K , Yang Y , Rojanasakul Y . Nano Lett 2018 18 (10) 6500-6508 Fibroblast stem cells or stemlike cells (FSCs) are proposed to play a pivotal role in extracellular matrix (ECM) regeneration by serving as a key source of ECM-producing fibroblasts. We developed a mechanism-based in vitro model for fibrogenicity testing of nanomaterials based on their ability to induce FSCs. Using a FSC-enriched fibroblast focus model to mimic in vivo fibrogenic response, we demonstrated a dose-dependent increase in fibroblast focus formation and collagen production by primary lung fibroblasts treated with multiwalled carbon nanotubes (MWCNTs). The focus-forming cells exhibited stem properties as indicated by stem cell markers expression, sphere formation, and ALDH activity assays. Inhibition of ALDH activity diminished the focus and sphere formation as well as collagen production. In vivo animal studies supported the in vitro findings and indicated the potential utility of FSC-based assays as a rapid screening tool for fibrogenicity testing of nanomaterials. This study also unveils a novel mechanism of nanotube-induced fibrogenesis through ALDH-dependent FSC activation. |
Quantification of microcystin-LR in human urine by immunocapture liquid chromatography tandem mass spectrometry
Wharton RE , Ojeda-Torres G , Cunningham B , Feyereisen MC , Hill KL , Abbott NL , Seymour C , Hill D , Lang J , Hamelin EI , Johnson RC . Chem Res Toxicol 2018 31 (9) 898-903 Microcystins are toxins produced by many cyanobacteria species, which are often released into waterways during blue-green algal blooms in freshwater and marine habitats. The consumption of microcystin-contaminated water is a public health concern as these toxins are recognized tumor promoters and are hepatotoxic to humans and animals. A method to confirm human exposures to microcystins is needed; therefore, our laboratory has developed an immunocapture liquid chromatography tandem mass spectrometry (LC-MS/MS) method targeting the conserved adda portion of microcystins for the quantitation of a prevalent and highly toxic congener of microcystin, microcystin-LR (MC-LR). An acute exposure method was initially evaluated for accuracy and precision by analyzing calibrators and quality control (QC) samples ranging from 0.500 to 75.0 ng/mL in urine. All calibrators and QC samples characterized were within 15% of theoretical concentrations. An analysis of acutely exposed mouse urine samples using this method identified MC-LR levels from 10.7 to 33.9 ng/mL. Since human exposures are anticipated to result from low-dose or chronic exposures, a high-sensitivity method was validated with 20 calibration curves and QC samples ranging from 0.0100 to 7.50 ng/mL. Relative standard deviations (RSDs) and inaccuracies of these samples were within 15%, meeting United States Food and Drug Administration (FDA) guidelines for analytical methods, and the limit of detection was 0.00455 ng/mL. In conclusion, we have developed a method which can be used to address public health concerns by precisely and accurately measuring MC-LR in urine samples. |
Emergency preparedness is equally important as response in optimizing the health and well-being of the nation's children
Peacock G , So M , Franks J . Pediatrics 2018 142 (4) We commend the policy statement by Kuo et al1 in which they highlight the critical need for collaboration between pediatric and public health sectors in safeguarding the health of our nation’s children,1 and in particular, we commend the authors’ emphasis on emergency management and response efforts surrounding the 2016 Flint water contamination crisis, 2015 Zika virus emergency, and 2015 Disneyland measles outbreak. In addition, we agree that synergy between public health and pediatricians on emergency preparedness is a key opportunity for primary prevention and health promotion. In this letter, we highlight the crucial partnership between the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) and discuss ongoing preparedness activities used to address the call to action put forth by Kuo et al.1 |
Evaluating implementation of the Updated Care Considerations for Duchenne Muscular Dystrophy
Ong KS , Kinnett K , Soelaeman R , Webb L , Bain JS , Martin AS , Westfield C , Bolen J , Street N . Pediatrics 2018 142 S118-s128 Care Considerations for Duchenne Muscular Dystrophy were published in 2010. However, little is known about the extent to which these considerations were implemented after publication. With this article, we provide direction on evaluating the uptake of the 2018 Duchenne Muscular Dystrophy Care Considerations. We identify key elements of care and present suggestions for their use in evaluation and research. |
Pilot randomized controlled trial of a Mediterranean diet or diet supplemented with fish oil, walnuts, and grape juice in overweight or obese US adults
Jaacks LM , Sher S , Staercke C , Porkert M , Alexander WR , Jones DP , Vaccarino V , Ziegler TR , Quyyumi AA . BMC Nutr 2018 4 26 Background: The 2015-2020 Dietary Guidelines for Americans recommend a Mediterranean-type diet as one of three healthful eating patterns. However, only one previous trial has evaluated the effects of a Mediterranean diet intervention in a US sample population. Methods: To address this gap, we conducted a pilot, non-blinded, 8-week randomized controlled trial on the comparative efficacy of consumption of a Mediterranean diet or a diet supplemented with fish oil, walnuts, and grape juice versus controls. Participants (overweight or obese US adults; 73% female and mean age 51 years) were randomly assigned to one of three groups: (1) Mediterranean diet; (2) habitual high-fat American-type diet supplemented with fish oil, walnuts, and grape juice; or (3) habitual high-fat American-type diet (controls). Intent-to-treat analysis of within-subject differences (Student's paired t-test or Wilcoxon sign ranks test) and between-subject differences (mixed-effects models with a group-by-time interaction term, adjusted for baseline health outcome) was conducted. Results: Participants in the Mediterranean diet arm (n = 11) had significantly greater weight loss despite no significant change in total caloric intake, and lower plasma cystine, indicative of decreased oxidative stress, compared to controls (n = 9) at both 4 and 8 weeks. Compared to controls, they also had significantly lower total cholesterol and low-density lipoprotein cholesterol levels at 4 weeks. Participants in the supplement arm (n = 10) had significantly lower adiponectin levels compared to controls at 4 weeks. No significant improvements in endothelial function or inflammatory biomarkers were observed in either intervention group compared to controls. Conclusion: These results suggest that adopting a dietary pattern reflecting a Mediterranean diet improves weight and cardio-metabolic health among overweight or obese US adults, and may be more beneficial than supplementing habitual American diets with fish oil, walnuts, and grape juice. |
Consideration of occupational and environmental lung carcinogen exposures for lung cancer screening using low-dose chest CT
de la Hoz RE , Weissman DN . Chest 2018 154 (4) 996-997 We read with great interest the American College of Chest Physicians’ guidelines for lung cancer screening1 and the excellent Point and Counterpoint editorials by Drs Wood and Mazzone2, 3, 4, 5 in CHEST (June 2018) addressing the important issue of how to approach persons at high risk for lung cancer who don’t meet the guidelines’ core criteria for lung cancer screening. In his final rebuttal, Dr Mazzone5 states that the guidelines “…recommend that the cohort that does not meet our core eligibility criteria, but is at elevated risk for lung cancer based on risk calculators, should not be ‘routinely’ screened. We remark under this recommendation that although we do not recommend ‘routinely’ screening this cohort, we recognize that some individuals within this high-risk cohort will be healthy enough to consider screening.” |
Notes from the field: Lead exposures among employees at a bullet manufacturing company - Missouri, 2017
Jackson DA , Burr GA , Braun CR , de Perio MA . MMWR Morb Mortal Wkly Rep 2018 67 (39) 1103 Lead is toxic to all human organ systems, resulting in adverse health effects that include impaired kidney function, elevated blood pressure, and neurologic health effects (1). Lead primarily enters the body through inhalation and ingestion, but direct absorption through the skin can occur (2). According to 2014 national lead surveillance data, >94% of the 3,616 U.S. adults with elevated blood lead levels (BLLs) whose exposure source was known were exposed at work (3). | | Because of concerns about employees’ occupational lead exposures, a Missouri bullet manufacturing company that melts lead ingots and casts them into bullets asked CDC’s National Institute for Occupational Safety and Health (NIOSH) to conduct a health hazard evaluation. In October 2017, NIOSH visited the worksite to determine the routes and extent of lead exposure among employees and the prevalence of elevated BLLs and to assess controls in place to protect employees from lead exposure. |
Novel test method for the evaluation of fluid leakage at the glove-gown interface and investigation of test parameters
Kilinc-Balci FS , Kahveci Z , Yorio P . J Am Coll Surg 2018 227 (6) 573-586 BACKGROUND: Exposure to patients' blood/body fluids could be life-affecting, when providing care to patients with infectious diseases. Although the glove-gown interface is considered one of the weakest points of the protective ensemble system, there is a lack of research and existing standards do not provide much guidance on the strategies to minimize gaps between the gowns and gloves. Currently, there is no known standard test method to evaluate fluid leakage or assess performance improvements with new gowns/gloves. STUDY DESIGN: A novel test method with a robotic arm, which has the capability to simulate healthcare personnel's arm movements during fluid exposures, was developed to determine the leakage at the glove-gown interface. This paper explains the test method and investigates the effect of movement, exposure type, exposure duration, procedure duration, and existence of pressure on the amount of leaked fluid at the glove-gown interface. RESULTS: Test results suggest that, with the exception of procedure duration, all parameters significantly affected the amount of fluid leaked at the glove-gown interface. Leakage was higher for soaking when compared to spraying, increased as the exposure duration increased, and was greater with the application of pressure. CONCLUSIONS: The novel method developed in this study could be used by manufacturers of personal protective equipment to evaluate their products. Standard development organizations could adapt this test method in their specifications, testing standards, and guidelines. |
Rates of carpal tunnel syndrome in a state workers' compensation information system, by industry and occupation - California, 2007-2014
Jackson R , Beckman J , Frederick M , Musolin K , Harrison R . MMWR Morb Mortal Wkly Rep 2018 67 (39) 1094-1097 Carpal tunnel syndrome (CTS) occurs when the median nerve becomes compressed as it passes through the wrist within the carpal tunnel, resulting in pain, tingling, weakness, or numbness in the hand or the wrist. Occupational risk factors for CTS include engaging in work activities that require forceful, repetitive tasks, prolonged use of the hands or wrists in an awkward posture, or vibration (1). To assess trends and identify high-risk industries and occupations for CTS, the California Department of Public Health (CDPH) analyzed California workers' compensation claims for CTS by industry (2007-2014) and occupation (2014) and calculated rates per full-time equivalent (FTE) worker. During 2007-2014, a total of 139,336 CTS cases were reported (incidence = 6.3 cases per 10,000 FTE) in California workers; the rate among women (8.2) was 3.3 times higher than that among men (2.5). Industries with the highest rates of CTS were textile, fabric finishing, and coating mills (44.9), apparel accessories and other apparel manufacturing (43.1), and animal slaughtering and processing (39.8). Industries with high rates of CTS should consider implementing intervention measures, including ergonomic evaluations and development of tools and instruments that require less repetition and force and that correct awkward postures. |
Skin cancer and welding
Falcone LM , Zeidler-Erdely PC . Clin Exp Dermatol 2018 44 (2) 130-134 Many workers in several different occupations can be exposed to ultraviolet radiation (UVR), which may increase their risk of developing skin cancer. Welding, an occupation employing an estimated 11 million people worldwide, is one such occupation. Welders are known to be exposed to the full spectrum of UVR from the welding arc and often experience burns and localized cutaneous erythema. In 2017, UVR from welding was classified as carcinogenic to humans based on sufficient evidence of ocular melanoma in humans. It has been hypothesized that exposure to UVR from the welding arc also may increase the risk of skin cancer among workers in this occupation. This review summarizes the current literature on skin cancer risk in welders. |
Population genetic analysis of Chadian Guinea worms reveals that human and non-human hosts share common parasite populations.
Thiele EA , Eberhard ML , Cotton JA , Durrant C , Berg J , Hamm K , Ruiz-Tiben E . PLoS Negl Trop Dis 2018 12 (10) e0006747 Following almost 10 years of no reported cases, Guinea worm disease (GWD or dracunculiasis) reemerged in Chad in 2010 with peculiar epidemiological patterns and unprecedented prevalence of infection among non-human hosts, particularly domestic dogs. Since 2014, animal infections with Guinea worms have also been observed in the other three countries with endemic transmission (Ethiopia, Mali, and South Sudan), causing concern and generating interest in the parasites' true taxonomic identity and population genetics. We present the first extensive population genetic data for Guinea worm, investigating mitochondrial and microsatellite variation in adult female worms from both human and non-human hosts in the four endemic countries to elucidate the origins of Chad's current outbreak and possible host-specific differences between parasites. Genetic diversity of Chadian Guinea worms was considerably higher than that of the other three countries, even after controlling for sample size through rarefaction, and demographic analyses are consistent with a large, stable parasite population. Genealogical analyses eliminate the other three countries as possible sources of parasite reintroduction into Chad, and sequence divergence and distribution of genetic variation provide no evidence that parasites in human and non-human hosts are separate species or maintain isolated transmission cycles. Both among and within countries, geographic origin appears to have more influence on parasite population structure than host species. Guinea worm infection in non-human hosts has been occasionally reported throughout the history of the disease, particularly when elimination programs appear to be reaching their end goals. However, no previous reports have evaluated molecular support of the parasite species identity. Our data confirm that Guinea worms collected from non-human hosts in the remaining endemic countries of Africa are Dracunculus medinensis and that the same population of worms infects both humans and dogs in Chad. Our genetic data and the epidemiological evidence suggest that transmission in the Chadian context is currently being maintained by canine hosts. |
Association of water quality with soil-transmitted helminthiasis and diarrhea in Nueva Santa Rosa, Guatemala, 2010
Matanock A , Lu X , Derado G , Cuellar VM , Juliao P , Alvarez M , Lopez B , Munoz F , Thornton A , Patel JC , Lopez G , Reyes L , Arvelo W , Blackstock AJ , Lindblade KA , Roy SL . J Water Health 2018 16 (5) 724-736 Improved water quality reduces diarrhea, but the impact of improved water quality on Ascaris and Trichuris, soil-transmitted helminths (STH) conveyed by the fecal-oral route, is less well described. To assess water quality associations with diarrhea and STH, we conducted a cross-sectional survey in households of south-eastern Guatemala. Diarrhea was self-reported in the past week and month. STH was diagnosed by stool testing using a fecal parasite concentrator method. We explored associations between Escherichia coli-positive source water (water quality) and disease outcomes using survey logistic regression models. Overall, 732 persons lived in 167 households where water was tested. Of these, 79.4% (581/732) had E. coli-positive water, 7.9% (58/732) had diarrhea within the week, 14.1% (103/732) had diarrhea within the month, and 6.6% (36/545) tested positive for Ascaris or Trichuris, including 1% (6/536) who also reported diarrhea. Univariable analysis found a statistically significant association between water quality and STH (odds ratio [OR] = 5.1, 95% confidence interval [CI] = 1.1-24.5) but no association between water quality and diarrhea. Waterborne transmission and effects of water treatment on STH prevalence should be investigated further. If a causal relationship is found, practices such as household water treatment including filtration might be useful adjuncts to sanitation, hygiene, and deworming in STH control programs. |
Evidence of likely autochthonous transmission of Chagas disease in Arizona
Beatty NL , Perez-Velez CM , Yaglom HD , Carson S , Liu E , Khalpey ZI , Klotz SA , Elliott SP . Am J Trop Med Hyg 2018 99 (6) 1534-1536 A healthy 16-year-old girl born and raised in Tucson, AZ, had screening and confirmatory testing revealing Chagas disease; clinical evaluation established that she had the indeterminate form of chronic Chagas disease with evidence of likely autochthonous transmission. Trypanosoma cruzi DNA was detected by conventional PCR in Triatoma rubida captured at her home. |
When should the emphasis on schistosomiasis control move to elimination
Secor WE , Colley DG . Trop Med Infect Dis 2018 3 (3) The stated goal of the World Health Organization's program on schistosomiasis is paraphrased as follows: to control morbidity and eliminate transmission where feasible. Switching from a goal of controlling morbidity to interrupting transmission may well be currently feasible in some countries in the Caribbean, some areas in South America, northern Africa, and selected endemic areas in sub-Saharan Africa where there have been improvements in sanitation and access to clean water. However, in most of sub-Saharan Africa, where programmatic interventions still consist solely of annual mass drug administration, such a switch in strategies remains premature. There is a continued need for operational research on how best to reduce transmission to a point where interruption of transmission may be achievable. The level of infection at which it is feasible to transition from control to elimination must also be defined. In parallel, there is also a need to develop and evaluate approaches for achieving and validating elimination. There are currently neither evidence-based methods nor tools for breaking transmission or verifying that it has been accomplished. The basis for these statements stems from numerous studies that will be reviewed and summarized in this article; many, but not all of which were undertaken as part of SCORE, the Schistosomiasis Consortium for Operational Research and Evaluation. |
Young adults in endemic areas: An untreated group in need of school-based preventive chemotherapy for schistosomiasis control and elimination
Korir HK , Riner DK , Kavere E , Omondi A , Landry J , Kittur N , Ndombi EM , Ondigo BN , Secor WE , Karanja DMS , Colley DG . Trop Med Infect Dis 2018 3 (3) Parasitologic surveys of young adults in college and university settings are not commonly done, even in areas known to be endemic for schistosomiasis and soil-transmitted helminths. We have done a survey of 291 students and staff at the Kisumu National Polytechnic in Kisumu, Kenya, using the stool microscopy Kato-Katz (KK) method and the urine point-of-care circulating cathodic antigen (POC-CCA) test. Based on three stools/two KK slides each, in the 208 participants for whom three consecutive stools were obtained, Schistosoma mansoni prevalence was 17.8%. When all 291 individuals were analyzed based on the first stool, as done by the national neglected tropical disease (NTD) program, and one urine POC-CCA assay (n = 276), the prevalence was 13.7% by KK and 23.2% by POC-CCA. Based on three stools, 2.5% of 208 participants had heavy S. mansoni infections (>/=400 eggs/gram feces), with heavy S. mansoni infections making up 13.5% of the S. mansoni cases. The prevalence of the soil-transmitted helminths (STH: Ascaris lumbricoides, Trichuris trichiura and hookworm) by three stools was 1.4%, 3.1%, and 4.1%, respectively, and by the first stool was 1.4%, 2.4% and 1.4%, respectively. This prevalence and intensity of infection with S. mansoni in a college setting warrants mass drug administration with praziquantel. This population of young adults is 'in school' and is both approachable and worthy of inclusion in national schistosomiasis control and elimination programs. |
Electronic cigarette sales in the United States, 2013-2017
King BA , Gammon DG , Marynak KL , Rogers T . JAMA 2018 320 (13) 1379-1380 This study uses e-cigarette retail sales data to estimate estimate e-cigarette sales and market share of e-cigarette sales by manufacturer in the United States during 2013-2017. |
Inter- and intra-host sequence diversity reveal the emergence of viral variants during an overwintering epidemic caused by dengue virus serotype 2 in southern Taiwan
Ko HY , Li YT , Chao DY , Chang YC , Li ZT , Wang M , Kao CL , Wen TH , Shu PY , Chang GJ , King CC . PLoS Negl Trop Dis 2018 12 (10) e0006827 Purifying selection during dengue viral infection has been suggested as the driving force of viral evolution and the higher complexity of the intra-host quasi-species is thought to offer an adaptive advantage for arboviruses as they cycle between arthropod and vertebrate hosts. However, very few studies have been performed to investigate the viral genetic changes within (intra-host) and between (inter-host) humans in a spatio-temporal scale. Viruses of different serotypes from various countries imported to Taiwan cause annual outbreaks. During 2001-2003, two consecutive outbreaks were caused by dengue virus serotype 2 (DENV-2) and resulted in a larger-scale epidemic with more severe dengue cases in the following year. Phylogenetic analyses showed that the viruses from both events were similar and related to the 2001 DENV-2 isolate from the Philippines. We comprehensively analyzed viral sequences from representative dengue patients and identified three consensus genetic variants, group Ia, Ib and II, with different spatio-temporal population dynamics. The phylodynamic analysis suggested group Ib variants, characterized by lower genetic diversity, transmission rate, and intra-host variant numbers, might play the role of maintenance variants. The residential locations among the patients infected by group Ib variants were in the outer rim of case clusters throughout the 2001-2003 period whereas group Ia and II variants were located in the centers of case clusters, suggesting that group Ib viruses might serve as "sheltered overwintering" variants in an undefined ecological niche. Further deep sequencing of the viral envelope (E) gene directly from individual patient serum samples confirmed the emergence of variants belonging to three quasi-species (group Ia, Ib, and II) and the ancestral role of the viral variants in the latter phase of the 2001 outbreak contributed to the later, larger-scale epidemic beginning in 2002. These findings enhanced our understanding of increasing epidemic severity over time in the same epidemic area. It also highlights the importance of combining phylodynamic and deep sequencing analysis as surveillance tools for detecting dynamic changes in viral variants, particularly searching for and monitoring any specific viral subpopulation. Such subpopulations might have selection advantages in both fitness and transmissibility leading to increased epidemic severity. |
Knowledge and practices regarding Middle East Respiratory Syndrome Coronavirus among camel handlers in a Slaughterhouse, Kenya, 2015
Kamau E , Ongus J , Gitau G , Galgalo T , Lowther SA , Bitek A , Munyua P . Zoonoses Public Health 2018 66 (1) 169-173 Dromedary camels are implicated as reservoirs for the zoonotic transmission of Middle East Respiratory Syndrome coronavirus (MERS-CoV) with the respiratory route thought to be the main mode of transmission. Knowledge and practices regarding MERS among herders, traders and slaughterhouse workers were assessed at Athi-River slaughterhouse, Kenya. Questionnaires were administered, and a check list was used to collect information on hygiene practices among slaughterhouse workers. Of 22 persons, all washed hands after handling camels, 82% wore gumboots, and 65% wore overalls/dustcoats. None of the workers wore gloves or facemasks during slaughter processes. Fourteen percent reported drinking raw camel milk; 90% were aware of zoonotic diseases with most reporting common ways of transmission as: eating improperly cooked meat (90%), drinking raw milk (68%) and slaughter processes (50%). Sixteen (73%) were unaware of MERS-CoV. Use of personal protective clothing to prevent direct contact with discharges and aerosols was lacking. Although few people working with camels were interviewed, those met at this centralized slaughterhouse lacked knowledge about MERS-CoV but were aware of zoonotic diseases and their transmission. These findings highlight need to disseminate information about MERS-CoV and enhance hygiene and biosafety practices among camel slaughterhouse workers to reduce opportunities for potential virus transmission. |
New tools in the Ebola arsenal
Damon IK , Rollin PE , Choi MJ , Arthur RR , Redfield RR . N Engl J Med 2018 379 (21) 1981-1983 Human Ebola virus disease can be caused by four viruses: Sudan virus, Tai Forest virus, Bundibugyo virus, and Ebola virus (EBOV, species Zaire ebolavirus). The 2014 outbreak of EBOV in West Africa was the worst ever, with more than 28,000 cases and more than 11,000 deaths in Liberia, Guinea, Sierra Leone, Nigeria, and Mali. Investigational studies undertaken during the latter stages of the response, however, have led to progress in the development and use of biologic and chemical compounds to treat EBOV and Ebola virus disease (EVD). Recommendations to study vaccines and therapeutics and evaluate their benefit in the context of Ebola responses have been issued by a panel of the National Academies of Sciences, Engineering, and Medicine and by the World Health Organization (WHO) in the form of an EVD Blueprint.1,2 |
Notes from the field: Spatially associated coincident and noncoincident cases of La Crosse encephalitis - North Carolina, 2002-2017
Byrd BD , Williams CJ , Staples JE , Burkhalter KL , Savage HM , Doyle MS . MMWR Morb Mortal Wkly Rep 2018 67 (39) 1104-1105 La Crosse virus (LACV) is the most common cause of pediatric arthropod-borne viral (arboviral) encephalitis in the United States (1). It is a California serogroup bunyavirus primarily transmitted by the eastern tree-hole mosquito (Aedes triseriatus) (2). LACV encephalitis is a reportable condition in North Carolina and is a nationally notifiable disease. In North Carolina, LACV encephalitis is the most common endemic arboviral disease reported in humans, with seven western counties accounting for approximately 80% of confirmed cases since 2003 (3). The fatality rate for LACV encephalitis is <1%, with most patients recovering without overt clinical sequelae; however, long-term neurologic sequelae reported in some patients include recurrent seizures, hemiparesis, and cognitive and neurobehavioral abnormalities (4). |
Travel and tick-borne diseases: Lyme disease and beyond
Parola P , Paddock CD . Travel Med Infect Dis 2018 26 1-2 On a global scale, ticks are second only to mosquitoes as the most important of vectors of infectious disease agents of humans [1]. Ticks transmit a greater diversity of viral, bacterial and protozoan infections than any other arthropod on earth, and in many temperate regions of the world, including Europe and the United States, tick-borne diseases (TBD) are the most widespread and medically important of all vector-borne infections. Lyme borreliosis, caused by Borrelia burgdorferi sensu lato species and transmitted by various Ixodes spp., afflicts tens and possibly hundreds of thousands of persons in the Northern Hemisphere each year and has brought the subject of TBD to general attention more than any other associated infection. Nonetheless, the scope and magnitude of other TBD have expanded worldwide: both in the United States and Europe, 14 newly recognized TBD have been identified in only the last 25 years [2]. |
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