Antibiotic stewardship in outpatient telemedicine: Adapting Centers for Disease Control and Prevention core elements to optimize antibiotic use
Sanchez GV , Kabbani S , Tsay SV , Bizune D , Hersh AL , Luciano A , Hicks LA . Telemed J E Health 2023 The rapid expansion of telemedicine has highlighted challenges and opportunities to improve antibiotic use and effectively adapt antibiotic stewardship best practices to outpatient telemedicine settings. Antibiotic stewardship integration into telemedicine is essential to optimize antibiotic prescribing for patients and ensure health care quality. We performed a narrative review of published literature on antibiotic prescribing and stewardship in outpatient telemedicine to inform the adaptation of the Core Elements of Outpatient Antibiotic Stewardship framework to outpatient telemedicine settings. Our narrative review suggests that in-person antibiotic stewardship interventions can be adapted to outpatient telemedicine settings. We present considerations for applying the Core Elements of Outpatient Antibiotic Stewardship to outpatient telemedicine which builds upon growing evidence describing care delivery and quality improvement in this setting. Additional applied implementation research is necessary to inform the application of effective, sustainable, and equitable antibiotic stewardship interventions across the spectrum of outpatient telemedicine. |
Comparative antimicrobial use in coronavirus disease 2019 (COVID-19) and non-COVID-19 inpatients from 2019 to 2020: A multicenter ecological study
Santos CAQ , Tseng M , Martinez AI , Shankaran S , Hodgson HA , Ahmad FS , Zhang H , Sievert DM , Trick WE . Infect Control Hosp Epidemiol 2023 1-8 OBJECTIVE: We sought to determine whether increased antimicrobial use (AU) at the onset of the coronavirus disease 2019 (COVID-19) pandemic was driven by greater AU in COVID-19 patients only, or whether AU also increased in non-COVID-19 patients. DESIGN: In this retrospective observational ecological study from 2019 to 2020, we stratified inpatients by COVID-19 status and determined relative percentage differences in median monthly AU in COVID-19 patients versus non-COVID-19 patients during the COVID-19 period (March-December 2020) and the pre-COVID-19 period (March-December 2019). We also determined relative percentage differences in median monthly AU in non-COVID-19 patients during the COVID-19 period versus the pre-COVID-19 period. Statistical significance was assessed using Wilcoxon signed-rank tests. SETTING: The study was conducted in 3 acute-care hospitals in Chicago, Illinois. PATIENTS: Hospitalized patients. RESULTS: Facility-wide AU for broad-spectrum antibacterial agents predominantly used for hospital-onset infections was significantly greater in COVID-19 patients versus non-COVID-19 patients during the COVID-19 period (with relative increases of 73%, 66%, and 91% for hospitals A, B, and C, respectively), and during the pre-COVID-19 period (with relative increases of 52%, 64%, and 66% for hospitals A, B, and C, respectively). In contrast, facility-wide AU for all antibacterial agents was significantly lower in non-COVID-19 patients during the COVID-19 period versus the pre-COVID-19 period (with relative decreases of 8%, 7%, and 8% in hospitals A, B, and C, respectively). CONCLUSIONS: AU for broad-spectrum antimicrobials was greater in COVID-19 patients compared to non-COVID-19 patients at the onset of the pandemic. AU for all antibacterial agents in non-COVID-19 patients decreased in the COVID-19 period compared to the pre-COVID-19 period. |
State-level hypertension prevalence and control among adults in the U.S
He S , Park S , Fujii Y , Pierce SL , Kraus EM , Wall HK , Therrien NL , Jackson SL . Am J Prev Med 2023 66 (1) 46-54 INTRODUCTION: Improving hypertension control is a national priority. Electronic health record data have the potential to augment traditional surveillance systems. This study aimed to assess hypertension prevalence and control at the state level using a previously established electronic health record-based phenotype for hypertension. METHODS: Adult patients (N=11,031,368) were included from the IQVIA ambulatory electronic medical record-U.S. 2019 data set. IQVIA ambulatory electronic medical record comprises electronic health records from >100,000 providers and includes patients from every U.S. state and Washington DC. Authors compared hypertension prevalence and control estimates against those from the Behavioral Risk Factor Surveillance System 2019. Results were age-standardized and stratified by state and sociodemographic characteristics. Statistical analyses were conducted in 2022-2023. RESULTS: IQVIA ambulatory electronic medical record-U.S. patients had a median age of 55 years, and 56.7% were women. Overall age-standardized hypertension prevalence was higher in IQVIA ambulatory electronic medical record-U.S. (35.0%) than in the Behavioral Risk Factor Surveillance System (29.7%), however, state-level geographic patterns were similar, with the highest burden in the South and Appalachia. Similar patterns were also observed by sociodemographic characteristics in both data sets: hypertension prevalence was higher in older age groups (than younger), men (than women), and Black patients (than other races). Hypertension control varied widely across states: among states with >1% data coverage, control rates were lowest in Nevada (51.1%), Washington DC (52.0%), and Mississippi (55.2%); highest in Kansas (73.4%), New Jersey (72.3%), and Iowa (71.9%). CONCLUSIONS: This study provided the first-ever estimates of hypertension control for all states and Washington DC. Electronic health record-based surveillance could support hypertension prevention and control efforts at the state level. |
P16 expression and recurrent cervical intraepithelial neoplasia after cryotherapy among women living with HIV
Maina D , Chung MH , Temmerman M , Moloo Z , Wawire J , Greene SA , Unger ER , Mugo N , Sakr S , Sayed S , McGrath CJ . Front Med (Lausanne) 2023 10 1277480 BACKGROUND: The expression of p16 protein, a surrogate marker for high-risk human papillomavirus (hrHPV), is associated with cervical dysplasia. We evaluated correlates of p16 expression at treatment for high-grade cervical lesions and its utility in predicting the recurrence of cervical intraepithelial lesions grade 2 or higher (CIN2+) following cryotherapy among women with HIV. METHODS: This is a subgroup analysis of women with HIV in Kenya with baseline cervical biopsy-confirmed CIN2+ who were randomized to receive cryotherapy and followed every six-months for two-years for biopsy-confirmed recurrence of CIN2+. P16 immunohistochemistry was performed on the baseline cervical biopsy with a positive result defined as strong abnormal nuclear expression in a continuous block segment of cells (at least 10-20 cells). RESULTS: Among the 200 women with CIN2+ randomized to cryotherapy, 160 (80%) had a baseline cervical biopsy specimen available, of whom 94 (59%) were p16-positive. p16 expression at baseline was associated with presence of any one of 14 hrHPV genotypes [Odds Ratio (OR) = 3.2; 95% Confidence Interval (CI), 1.03-9.78], multiple lifetime sexual partners (OR = 1.6; 95% CI, 1.03-2.54) and detectable plasma HIV viral load (>1,000 copies/mL; OR = 1.43; 95% CI, 1.01-2.03). Longer antiretroviral therapy duration (≥2 years) at baseline had lower odds of p16 expression (OR = 0.46; 95% CI, 0.24-0.87) than <2 years of antiretroviral therapy. Fifty-one women had CIN2+ recurrence over 2-years, of whom 33 (65%) were p16-positive at baseline. p16 was not associated with CIN2+ recurrence (Hazard Ratio = 1.35; 95% CI, 0.76-2.40). CONCLUSION: In this population of women with HIV and CIN2+, 41% of lesions were p16 negative and baseline p16 expression did not predict recurrence of cervical neoplasia during two-year follow up. |
Prevalence and control of hypertension in a high HIV-prevalence setting, insights from a population based study in Botswana
Mosepele M , Bennett K , Gaolathe T , Makhema JM , Mmalane M , Holme MP , Lebelonyane R , Ometoruwa O , Mills LA , Powis KM , Leidner J , Jarvis JN , Tapela NM , Masupe T , Mokgatlhe L , Triant VA , Wirth KE , Moshomo T , Lockman S . Sci Rep 2023 13 (1) 17814 In a population-based representative sample of adults residing in 22 communities in Botswana, a southern African country with high HIV prevalence, 1 in 4 individuals had high blood pressure. High blood pressure was less prevalent in adults with HIV than without HIV. Sixty percent of persons with high blood pressure had not previously been diagnosed. Among individuals with a prior diagnosis of high blood pressure who reported being prescribed anti-hypertension medications, almost half had elevated blood pressure, irrespective of HIV-status. One-third of adults in this setting (mainly men) declined free non-invasive blood pressure assessments in their households. In conclusion, our study highlights alarmingly high hypertension rates in the community, with low levels of awareness and control, emphasizing the urgent need for community level BP screening and active management to reach recommended targets. |
Clinical features, etiologies, and outcomes of central nervous system infections in intensive care: A multicentric retrospective study in a large Brazilian metropolitan area
Andrade HB , da Silva IRF , Espinoza R , Ferreira MT , da Silva MST , Theodoro PHN , Detepo PJT , Varela MC , Ramos GV , da Silva AR , Soares J , Belay ED , Sejvar JJ , Bozza FA , Cerbino-Neto J , Japiassú AM . J Crit Care 2023 79 154451 PURPOSE: The goal of this study was to investigate severe central nervous system infections (CNSI) in adults admitted to the intensive care unit (ICU). We analyzed the clinical presentation, causes, and outcomes of these infections, while also identifying factors linked to higher in-hospital mortality rates. MATERIALS AND METHODS: We conducted a retrospective multicenter study in Rio de Janeiro, Brazil, from 2012 to 2019. Using a prediction tool, we selected ICU patients suspected of having CNSI and reviewed their medical records. Multivariate analyses identified variables associated with in-hospital mortality. RESULTS: In a cohort of 451 CNSI patients, 69 (15.3%) died after a median 11-day hospitalization (5-25 IQR). The distribution of cases was as follows: 29 (6.4%) had brain abscess, 161 (35.7%) had encephalitis, and 261 (57.8%) had meningitis. Characteristics: median age 41 years (27-53 IQR), 260 (58%) male, and 77 (17%) HIV positive. The independent mortality predictors for encephalitis were AIDS (OR = 4.3, p = 0.01), ECOG functional capacity limitation (OR = 4.0, p < 0.01), ICU admission from ward (OR = 4.0, p < 0.01), mechanical ventilation ≥10 days (OR = 6.1, p = 0.04), SAPS 3 ≥ 55 points (OR = 3.2, p = 0.02). Meningitis: Age > 60 years (OR = 234.2, p = 0.04), delay >3 days for treatment (OR = 2.9, p = 0.04), mechanical ventilation ≥10 days (OR = 254.3, p = 0.04), SOFA >3 points (OR = 2.7, p = 0.03). Brain abscess: No associated factors found in multivariate regression. CONCLUSIONS: Patients' overall health, prompt treatment, infection severity, and prolonged respiratory support in the ICU all significantly affect in-hospital mortality rates. Additionally, the implementation of CNSI surveillance with the used prediction tool could enhance public health policies. |
How the orthodox features of orthopoxviruses led to an unorthodox Mpox outbreak: What we've learned, and what we still need to understand
Brooks JT , Reynolds MG , Torrone E , McCollum A , Spicknall IH , Gigante CM , Li Y , Satheshkumar PS , Quilter LAS , Rao AK , O'Shea J , Guagliardo SAJ , Townsend M , Hutson CL . J Infect Dis 2023 Orthopoxviruses are complex, large-genome DNA viruses that have repeatedly confounded expectations in terms of the clinical illness they cause and their patterns of spread. Monkeypox virus (MPXV) was originally characterized during outbreaks among captive primates in the late 1950's. Human disease (mpox) has been observed since the 1970's and inter-human spread has largely been associated with non-sexual, close physical contact in endemic areas of west and central Africa. In May 2022, a focus of Clade IIb MPXV transmission was detected, spreading largely by sexual contact through international networks of gay, bisexual, and other men who have sex with men. Despite decades of preparedness for the potential biothreat risk posed by smallpox, the outbreak grew in both size and geographic scope, testing the strength of smallpox preparedness tools and public health science alike. In this article we consider what was known about mpox prior to the 2022 outbreak, what we have learned about mpox and Clade IIb virus during the outbreak, and what outbreak response actions and continued research are needed to ensure the global public health community is equipped to detect and halt the further spread of this disease threat. We focus on how epidemiologic characterization and investigation together with laboratory studies have advanced our understanding of the transmission and pathogenesis of mpox, and describe what work remains to be done to optimize diagnostics, therapeutics, and vaccines. Persistent health inequities challenge our capacity to fully eliminate circulation of the 2022 outbreak strain of MPXV currently in the United States. |
Preventable deaths during widespread community hepatitis A outbreaks - United States, 2016-2022
Hofmeister MG , Gupta N . MMWR Morb Mortal Wkly Rep 2023 72 (42) 1128-1133 Hepatitis A is acquired through the fecal-oral route and is preventable by a safe and effective vaccine. Although hepatitis A is generally mild and self-limited, serious complications, including death, can occur. Since 2016, widespread hepatitis A outbreaks have been reported in 37 U.S. states, primarily among persons who use drugs and those experiencing homelessness. Nearly twice as many hepatitis A-related deaths were reported during 2016-2022 compared with 2009-2015. CDC analyzed data from 27 hepatitis A outbreak-affected states* that contributed data during August 1, 2016-October 31, 2022, to characterize demographic, risk factor, clinical, and cause-of-death data among 315 outbreak-related hepatitis A deaths from those states. Hepatitis A was documented as an underlying or contributing cause of death on 60% of available death certificates. Outbreak-related deaths peaked in 2019, and then decreased annually through 2022. The median age at death was 55 years; most deaths occurred among males (73%) and non-Hispanic White persons (84%). Nearly two thirds (63%) of decedents had at least one documented indication for hepatitis A vaccination, including drug use (41%), homelessness (16%), or coinfection with hepatitis B (12%) or hepatitis C (31%); only 12 (4%) had evidence of previous hepatitis A vaccination. Increasing vaccination coverage among adults at increased risk for infection with hepatitis A virus or for severe disease from infection is critical to preventing future hepatitis A-related deaths. |
Vaginal microbiome, antiretroviral concentrations, and HIV genital shedding in the setting of hormonal contraception initiation in Malawi
Lantz AM , Cottrell ML , Corbett AH , Chinula L , Kourtis AP , Nelson JAE , Tegha G , Hurst S , Gajer P , Ravel J , Haddad LB , Tang JH , Nicol MR . AIDS 2023 37 (14) 2185-2190 OBJECTIVE: The aim of this study was to understand how vaginal microbiota composition affects antiretroviral concentrations in the setting of hormonal contraception initiation. METHODS: Cervicovaginal fluid (CVF) concentrations of tenofovir, lamivudine, and efavirenz from 73 Malawian women with HIV were compared before and after initiation of depot-medroxyprogesterone acetate (DMPA) or levonorgestrel implant. We evaluated antiretroviral concentrations and vaginal microbiota composition/structure in the context of contraception initiation and predicted genital shedding using multivariable repeated measurements models fit by generalized estimating equations. RESULTS: Mean lamivudine CVF concentrations decreased 37% 1 month after contraception initiation. Subgroup analyses revealed a 41% decrease in women 1 month after initiating levonorgestrel implant, but no significant difference was observed in DMPA group alone. Tenofovir, lamivudine, and efavirenz CVF concentrations were positively correlated with anaerobic bacteria associated with nonoptimal vaginal microbiota. Risk of genital HIV shedding was not significantly associated with tenofovir or lamivudine CVF concentrations [tenofovir relative risk (RR): 0.098, P = 0.75; lamivudine RR: 0.142, P = 0.54]. Lack of association between genital HIV shedding and efavirenz CVF concentrations did not change when adjusting for vaginal microbiota composition and lamivudine/tenofovir CVF concentrations (RR: 1.33, P = 0.531). CONCLUSION: No effect of hormone initiation on genital shedding provides confidence that women with HIV on either DMPA or levonorgestrel implant contraception will not have compromised ART efficacy. The unexpected positive correlation between antiretroviral CVF concentrations and certain bacterial taxa relative abundance requires further work to understand the mechanism and clinical relevance. |
HIV and mpox: a rapid review
O'Shea JG , Bonacci RA , Cholli P , Kimball A , Brooks JT . AIDS 2023 37 (14) 2105-2114 In this review, we discuss the history and epidemiology of mpox, prevention strategies, clinical characteristics and management, severity of mpox among persons with advanced HIV, and areas for future research relevant to persons with HIV. |
Notes from the field: Severe bartonella quintana infections among persons experiencing unsheltered homelessness - New York City, January 2020-December 2022
Rich SN , Beeson A , Seifu L , Mitchell K , Wroblewski D , Juretschko S , Keller M , Gnanaprakasam R , Agladze M , Kodama R , Kupferman T , Bhatnagar J , Martines RB , Reagan-Steiner S , Slavinski S , Kuehnert MJ , Bergeron-Parent C , Corvese G , Marx GE , Ackelsberg J . MMWR Morb Mortal Wkly Rep 2023 72 (42) 1147-1148 Bartonella quintana infection is a vectorborne disease transmitted by the human body louse (1). In the United States, homelessness is the principal risk factor for B. quintana infection (2), likely attributable to limited access to hygiene facilities (1). This infection is not nationally notifiable in the United States, and its incidence is unknown. Acute B. quintana infection can cause fever, headache, and bone pain; severe manifestations include chronic bacteremia, bacillary angiomatosis, and infective endocarditis (3). Because the bacterium requires special conditions to grow in culture, standard blood cultures are usually negative (4). Diagnosis by serology is most common; however, cross-reactivity with other Bartonella species (e.g., B. henselae) can hamper interpretation. Molecular assays specific for B. quintana have been developed (5), but availability is limited to a few laboratories. Once diagnosed, infection can be cured by several weeks to months of antibiotic therapy. |
Predictors of willingness to participate in COVID-19 screening testing from a pilot school survey in the United States
Mark-Carew M , Swanson M , Eller B , Cullen T , Valenzuela MO , LaBelle M , Persad N , Barrios LC , Szucs LE . J Sch Health 2023 93 (12) 1061-1069 BACKGROUND: COVID-19 screening testing (ST) can detect asymptomatic or pre-symptomatic cases, allowing for prompt identification of cases and close contacts. This study examined parents' and school staffs' knowledge and attitudes toward to a pilot school-based ST program in a school district in southern Arizona. METHODS: In May 2021, online surveys to parents and school staff were administered to examine attitudes toward ST and impacts of the COVID-19 pandemic. Unweighted percent estimates were calculated, and bivariate differences were examined by demographics. Associations were assessed using chi-square tests and logistic regression. RESULTS: The survey had response rates of 10% (606/6085) and 22% (187/849) among parents and staff, respectively. Approximately one-third of responding parents (35%) would or already allow their child to participate in school-based ST, 37% would not participate; 28% were unsure. Among responding staff, 46% would or already participate in ST, 33% would not; 21% were unsure. The top concern (38%) among responding staff was taking job-related leave if testing positive. CONCLUSION: Schools work to balance the needs of students, families, and staff by implementing supportive and flexible policies and practices founded on buy-in and acceptance from their communities. |
Impact of HIV treat-all and complementary policies on ART linkage in 13 PEPFAR-supported African countries
Russell A , Verani AR , Pals S , Reagon VM , Alexander LN , Galloway ET , Mange MM , Kalimugogo P , Nyika P , Fadil YM , Aoko A , Asiimwe FM , Ikpeazu A , Kayira D , Letebele M , Maida A , Magesa D , Mutandi G , Mwila AC , Onotu D , Nkwoh KT , Wangari E . BMC Health Serv Res 2023 23 (1) 1151 BACKGROUND: In 2015, the World Health Organization recommended that all people living with HIV begin antiretroviral treatment (ART) regardless of immune status, a policy known as 'Treat-All to end AIDS', commonly referred to as Treat-All. Almost all low- and middle-income countries adopted this policy by 2019. This study describes how linkage to treatment of newly diagnosed persons changed between 2015 and 2018 and how complementary policies may have similarly increased linkage for 13 African countries. These countries adopted and implemented Treat-All policies between 2015 and 2018 and were supported by the U.S. Government's President's Emergency Plan for AIDS Relief (PEPFAR). The focuses of this research were to understand 1) linkage rates to ART initiation before and after the adoption of Treat-All in each country; 2) how Treat-All implementation differed across these countries; and 3) whether complementary policies (including same-day treatment initiation, task-shifting, reduced ART visits, and reduced ART pickups) implemented around the same time may have increased ART linkage. METHODS: HIV testing and treatment data were collected by PEPFAR country programs in 13 African countries from 2015 to 2018. These countries were chosen based on the completeness of policy data and availability of program data during the study period. Program data were used to calculate proxy linkage rates. These rates were compared relative to the Treat All adoption period and the adoption of complementary policies. RESULTS: The 13 countries experienced an average increase in ART linkage of 29.3% over the entire study period. In examining individual countries, all but two showed increases in linkage to treatment immediately after Treat All adoption. Across all countries, those that had adopted four or more complementary policies showed an average increased linkage of 39.8% compared to 13.9% in countries with fewer than four complementary policies. CONCLUSIONS: Eleven of 13 country programs examined in this study demonstrated an increase in ART linkage after Treat-All policy adoption. Increases in linkage were associated with complementary policies. When exploring new public health policies, policymakers may consider which complementary policies might also help achieve the desired outcome of the public health policy. |
Influenza antiviral shortages reported by state and territorial public health officials, 2022-2023
Kojima N , Peterson L , Hawkins R , Allen M , Flannery B , Uyeki TM . JAMA 2023 330 (18) 1793-1795 This study provides survey results from state and territorial public health preparedness directors regarding antiviral shortages during the 2022-2023 respiratory viral season. | eng |
Smoke exposure associated with higher urinary benzene biomarker muconic acid (MUCA) in golestan cohort study participants
Bhandari D , Zhu Y , Zhang C , Zhu W , Alexandridis A , Etemadi A , Freedman ND , Chang C , Abnet CC , Dawsey SM , Inoue-Choi M , Poustchi H , Pourshams A , Boffetta P , Malekzadeh R , Blount B . Biomarkers 2023 28 (7) 1-9 Background. Benzene is a known human carcinogen. Human exposure to benzene can be assessed by measuring trans, trans-muconic acid (MUCA) in urine. Golestan Province in northeastern Iran has been reported to have high incidence of esophageal cancer linked to the use of tobacco products. This manuscript evaluates the urinary MUCA concentrations among the participants of the Golestan Cohort Study (GCS).Methods. We analyzed MUCA concentration in 177 GCS participants' urine samples and performed nonparametric pairwise multiple comparisons to determine statistically significant difference among six different product use groups. Mixed effects model was fitted on 22 participants who exclusively smoked cigarette and 51 participants who were classified as nonusers. The urinary MUCA data were collected at the baseline and approximately five years later, and intraclass correlation coefficient (ICC) was calculated from the model.Results. Compared with nonusers, tobacco smoking was associated with higher urinary MUCA concentrations. Based on the nonparametric test of pairwise multiple comparisons, MUCA concentrations among participants who smoked combusted tobacco products were statistically significantly higher compared to nonusers. Urinary MUCA collected five years apart from the same individuals showed moderate reliability (ICC = 0.41), which was expected given the relatively short half-life (∼6 hrs) of MUCA.Conclusion. Our study revealed that tobacco smoke was positively associated with increased levels of urinary MUCA concentration, indicating that it is a significant source of benzene exposure among GCS participants. |
How can global guidelines support sustainable hygiene systems?
Esteves Mills J , Thomas A , Abdalla N , El-Alam R , Al-Shabi K , Ashinyo ME , Bangoura FO , Charles K , Chipungu J , Cole AO , Engebretson B , Goyol K , Grasham CF , Grossi V , Hickling S , Kalandarov S , Ababu AK , Kholmuhammad K , Klaesener-Metzner N , Kugedera Z , Kwakye A , Lee-Llacer A , Maani PP , Makhafola B , Mohamed A , Monirul Alam M , Monse B , Northover H , Palomares A , Patabendi N , Paynter N , Prasad-Gautam O , Panthi SR , Rudge L , Saha S , Salaru I , Saltiel G , Sax L , Shahid MA , Gafur MS , Shrestha S , Szeberényi K , Tidwell JB , Trinies V , Yiha O , Ziganshin R , Gordon B , Cumming O . BMJ Glob Health 2023 8 (10) Hand hygiene is a cost-effective preventive measure to reduce transmission of infectious diseases. Yet, a quarter of the global population lack access to even a basic handwashing facility. | Forthcoming WHO and UNICEF guidelines on hand hygiene in community settings will provide evidence-based recommendations to guide action. | According to consulted future guideline end-users, sustainable implementation of such recommendations to improve hand hygiene requires government-led system-strengthening approaches that build sustainable and resilient national systems. | System-strengthening plans should be underpinned by a comprehensive situational analysis and needs assessment, and monitored on an ongoing basis for course correction where necessary. | Execution of system-strengthening plans should be integrated with existing programmes. | Health sector leadership is required to drive this agenda. |
Exposure to polycyclic aromatic hydrocarbons, volatile organic compounds, and tobacco-specific nitrosamines and incidence of esophageal cancer
Etemadi A , Poustchi H , Chang CM , Calafat AM , Blount BC , Bhandari D , Wang L , Roshandel G , Alexandridis A , Botelho JC , Xia B , Wang Y , Sosnoff CS , Feng J , Nalini M , Khoshnia M , Pourshams A , Sotoudeh M , Gail MH , Dawsey SM , Kamangar F , Boffetta P , Brennan P , Abnet CC , Malekzadeh R , Freedman ND . J Natl Cancer Inst 2023 BACKGROUND: Studying carcinogens in tobacco and non-tobacco sources may be key to understanding the pathogenesis and geographic distribution of esophageal cancer. METHODS: Golestan Cohort Study (GCS) has been conducted since 2004 in a region with high rates of esophageal squamous cell carcinoma (ESCC). For this nested study, the cases comprised of all incident cases by Jan 1, 2018; controls were matched to the case by age, sex, residence, time in cohort, and tobacco use. We measured urinary concentrations of 33 exposure biomarkers of nicotine, polycyclic aromatic hydrocarbons (PAHs), volatile organic compounds (VOCs), and tobacco-specific nitrosamines (TSNAs). We used conditional logistic regression to calculate odds ratios (OR) and 95% confidence intervals (95%CI) for associations between the 90th versus the 10th percentiles of the biomarker concentrations and incident ESCC. RESULTS: Among individuals who did not currently use tobacco (148 cases/163 controls), two acrolein metabolites, two acrylonitrile metabolites, one propylene oxide metabolite and one 1,3-butadiene metabolite were significantly associated with incident ESCC (adjusted ORs between 1.8 and 4.3). Among tobacco users (57 cases/63 controls), metabolites of two other VOCs (styrene and xylene) were associated with ESCC (ORs= 6.2 and 9.0). In tobacco users, two TSNAs (NNN and N'-Nitrosoanatabine) were also associated with ESCC. Suggestive associations were seen with some PAHs (especially 2-hydroxynaphthalene) in non-users of tobacco products and other TSNAs in tobacco users. CONCLUSION: These novel associations based on individual-level data and samples collected many years before cancer diagnosis, from a population without occupational exposure, have important public health implications. |
Time-specific impact of mono-benzyl phthalate (MBzP) and perfluorooctanoic acid (PFOA) on breast density of a Chilean adolescent cohort
Kim CE , Binder AM , Corvalan C , Pereira A , Shepherd J , Calafat AM , Botelho JC , Hampton JM , Trentham-Dietz A , Michels KB . Environ Int 2023 181 108241 INTRODUCTION: High mammographic density is among the strongest and most established predictors for breast cancer risk. Puberty, the period during which breasts undergo exponential mammary growth, is considered one of the critical stages of breast development for environmental exposures. Benzylbutyl phthalate (BBP) and perfluorooctanoic acid (PFOA) are pervasive endocrine disrupting chemicals that may increase hormone-sensitive cancers. Evaluating the potential impact of BBP and PFOA exposure on pubertal breast density is important to our understanding of early-life environmental influences on breast cancer etiology. OBJECTIVE: To prospectively assess the effect of biomarker concentrations of monobenzyl phthalate (MBzP) and PFOA at specific pubertal window of susceptibility (WOS) on adolescent breast density. METHOD: This study included 376 Chilean girls from the Growth and Obesity Cohort Study with data collection at four timepoints: Tanner breast stages 1 (B1) and 4 (B4), 1- year post- menarche (1YPM) and 2-years post-menarche (2YPM). Dual-energy X-ray absorptiometry was used to assess the absolute fibroglandular volume (FGV) and percent breast density (%FGV) at 2YPM. We used concentrations of PFOA in serum and MBzP in urine as an index of exposure to PFOA and BBP, respectively. Parametric G-formula was used to estimate the time-specific effects of MBzP and PFOA on breast density. The models included body fat percentage as a time-varying confounder and age, birthweight, age at menarche, and maternal education as fixed covariates. RESULTS: A doubling of serum PFOA concentration at B4 resulted in a non-significant increase in absolute FGV (β:11.25, 95% confidence interval (CI): -0.28, 23.49)), while a doubling of PFOA concentration at 1YPM resulted in a decrease in % FGV (β:-4.61, 95% CI: -7.45, -1.78). We observed no associations between urine MBzP and breast density measures. CONCLUSION: In this cohort of Latina girls, PFOA serum concentrations corresponded to a decrease in % FGV. No effect was observed between MBzP and breast density measures across pubertal WOS. |
Assessing the relationship between cyanobacterial blooms and respiratory-related hospital visits: Green bay, Wisconsin 2017-2019
Murray JF , Lavery AM , Schaeffer BA , Seegers BN , Pennington AF , Hilborn ED , Boerger S , Runkle JD , Loftin K , Graham J , Stumpf R , Koch A , Backer L . Int J Hyg Environ Health 2023 255 114272 Potential acute and chronic human health effects associated with exposure to cyanobacteria and cyanotoxins, including respiratory symptoms, are an understudied public health concern. We examined the relationship between estimated cyanobacteria biomass and the frequency of respiratory-related hospital visits for residents living near Green Bay, Lake Michigan, Wisconsin during 2017-2019. Remote sensing data from the Cyanobacteria Assessment Network was used to approximate cyanobacteria exposure through creation of a metric for cyanobacteria chlorophyll-a (Chl(BS)). We obtained counts of hospital visits for asthma, wheezing, and allergic rhinitis from the Wisconsin Hospital Association for ZIP codes within a 3-mile radius of Green Bay. We analyzed weekly counts of hospital visits versus cyanobacteria, which was modelled as a continuous measure (Chl(BS)) or categorized according to World Health Organization's (WHO) alert levels using Poisson generalized linear models. Our data included 2743 individual hospital visits and 114 weeks of satellite derived cyanobacteria biomass indicator data. Peak values of Chl(BS) were observed between the months of June and October. Using the WHO alert levels, 60% of weeks were categorized as no risk, 19% as Vigilance Level, 15% as Alert Level 1, and 6% as Alert Level 2. In Poisson regression models adjusted for temperature, dewpoint, season, and year, there was no association between Chl(BS) and hospital visits (rate ratio [RR] [95% Confidence Interval (CI)] = 0.98 [0.77, 1.24]). There was also no consistent association between WHO alert level and hospital visits when adjusting for covariates (Vigilance Level: RR [95% CI] 0.88 [0.74, 1.05], Alert Level 1: 0.82 [0.67, 0.99], Alert Level 2: 0.98 [0.77, 1.24], compared to the reference no risk category). Our methodology and model provide a template for future studies that assess the association between cyanobacterial blooms and respiratory health. |
Expansion of invasive group A streptococcus M1(uk) lineage in active bacterial core surveillance, United States, 2019‒2021
Li Y , Rivers J , Mathis S , Li Z , Chochua S , Metcalf BJ , Beall B , Onukwube J , Gregory CJ , McGee L . Emerg Infect Dis 2023 29 (10) 2116-2120 From 2015-2018 to 2019‒2021, hypertoxigenic M1(UK) lineage among invasive group A Streptococcus increased in the United States (1.7%, 21/1,230 to 11%, 65/603; p<0.001). M1(UK) was observed in 9 of 10 states, concentrated in Georgia (n = 41), Tennessee (n = 13), and New York (n = 13). Genomic cluster analysis indicated recent expansions. |
Restaurant and staff characteristics related to practices that could contribute to cross-contamination
Rickamer Hoover E , Masters M , Johnson J , McKelvey W , Hedeen N , Ripley D , Brown L . J Food Prot 2023 86 (12) 100182 Foodborne illness is a persistent public health concern in the U.S.; over 800 foodborne illness outbreaks are reported to the Centers for Disease Control and Prevention (CDC) annually. Most of these outbreaks (60%) are linked with restaurants. Contamination of food with foodborne pathogens during preparation and storage is a significant contributing factor to many of these outbreaks. The CDC's Environmental Health Specialists Network (EHS-Net) collected data to identify restaurant characteristics, policies, and practices associated with contamination prevention practices. Data collectors interviewed managers and conducted kitchen observations in 312 restaurants across six EHS-Net sites in five states. Data collectors observed at least one food worker action that could lead to contamination in 63.1% of restaurants. The most frequently observed action that could lead to contamination was bare hand or dirty glove contact with ready-to-eat food (35.9%). The estimated mean number of observed potential contamination actions was greater in restaurants that were independently owned (does not share a name and operations with other restaurants), did not require managers to be certified in food safety, did not have workers trained in food safety, did not have a handwashing policy, did not have a policy minimizing bare-hand contact with ready-to-eat foods, and had a manager with more than two years of experience at their current restaurant. These results suggest that to improve contamination prevention, the foodservice industry and food safety officials can consider supporting and encouraging strong food safety training and policies, particularly concerning hand hygiene, and targeting interventions to independent restaurants. |
Moving from assessment of Global Health Security to implementation
Brown SM , Garfield R . Health Secur 2023 21 (6) 530-532 In the last 5 years, the international community has developed an extensive set of tools to assess, plan, and monitor global health security capacity. More than 100 countries have carried out a Joint External Evaluation (JEE)1 to assess capacity in 19 key areas, and more than 70 countries developed a 5-year National Action Plan for Health Security (NAPHS)2 as part of the International Health Regulations Monitoring and Evaluation Framework (IHR MEF).3,4 Annual updates have been reported by most countries using the State Party Self-Assessment Annual Reporting (SPAR) tool,5,6 and several dozen countries have summarized their resource situation using the REMAP (Resource Mapping) tool.7 In retrospect, some of these efforts seem to have done more to burden than empower countries to prevent, detect, and respond to health emergencies more effectively.1 In practice we have found that: | | A NAPHS often takes months or years to develop, wasting valuable momentum and personnel time without improving implementation | | Many NAPHS list hundreds of activities but do not effectively set priorities or identify roles, responsibilities, or next-step actions | | The listed activities often are more aspirational than actionable, going far beyond resource or absorption capacity, and do not take sustaining those capacities into account |
Awareness of and willingness to use oral pre-exposure prophylaxis (PrEP) for HIV prevention among sexually active adults in Malawi: results from the 2020 Malawi population-based HIV impact assessment
Kabaghe AN , Singano V , Payne D , Maida A , Nyirenda R , Mirkovic K , Jahn A , Patel P , Brown K , Farahani M , Kayigamba F , Tenthani L , Ogollah F , Auld A , Zulu F , Msungama W , Wadonda-Kabondo N . BMC Infect Dis 2023 23 (1) 712 BACKGROUND: The World Health Organization recommends Pre-Exposure Prophylaxis (PrEP) for all populations at substantial risk of HIV infection. Understanding PrEP awareness and interest is crucial for designing PrEP programs; however, data are lacking in sub-Saharan Africa. In Malawi, oral PrEP was introduced in 2018. We analyzed data from the 2020 Malawi Population-based HIV Impact Assessment (MPHIA) to assess PrEP awareness and factors associated with PrEP interest in Malawi. METHODS: MPHIA 2020 was a national cross-sectional household-based survey targeting adults aged 15 + years. Oral PrEP was first described to the survey participants as taking a daily pill to reduce the chance of getting HIV. To assess awareness, participants were asked if they had ever heard of PrEP and to assess interest, were asked if they would take PrEP to prevent HIV, regardless of previous PrEP knowledge. Only sexually active HIV-negative participants are included in this analysis. We used multivariable logistic regression to assess sociodemographic factors and behaviors associated with PrEP interest. All results were weighted. RESULTS: We included 13,995 HIV-negative sexually active participants; median age was 29 years old. Overall, 15.0%, 95% confidence interval (CI): 14.2-15.9% of participants were aware of PrEP. More males (adjusted odds ratio (aOR): 1.3, 95% CI: 1.2-1.5), those with secondary (aOR: 1.5, 95% CI: 1.2-2.0) or post-secondary (aOR: 3.4, 95% CI: 2.4-4.9) education and the wealthiest (aOR: 1.6, 95% CI: 1.2-2.0) were aware of PrEP than female, those without education and least wealthy participants, respectively. Overall, 73.0% (95% CI: 71.8-74.1%) of participants were willing to use PrEP. Being male (aOR: 1.2; 95% CI: 1.1-1.3) and having more than one sexual partner (aOR: 1.7 95% CI: 1.4-1.9), were associated higher willingness to use PrEP. CONCLUSIONS: In this survey, prior PrEP knowledge and use were low while PrEP interest was high. High risk sexual behavior was associated with willingness to use PrEP. Strategies to increase PrEP awareness and universal access, may reduce HIV transmission. |
Trends in drug spending of oral anticoagulants for atrial fibrillation, 2014-2021
Lee JS , Han S , Therrien NL , Park C , Luo F , Essien UR . Am J Prev Med 2023 INTRODUCTION: This study documents cost trends in oral anticoagulants (OAC) in patients with newly diagnosed atrial fibrillation (AF). METHODS: Using MarketScan databases, the mean annual patients' out-of-pocket costs, insurance payments, and the proportion of patients initiating OAC within 90 days from AF diagnosis were calculated from July 2014 to June 2021. Costs of OACs (apixaban, dabigatran, edoxaban, rivaroxaban, and warfarin) and the payments by three insurance types (commercial payers, Medicare, and Medicaid) were calculated. Patients' out-of-pocket costs and insurance payments were adjusted to 2021 prices. Joinpoint regression models were used to test trends of outcomes and average annual percent changes (AAPC) were reported. Data analyses were performed in 2022-2023. RESULTS: From July 2014 to June 2021, the mean annual out-of-pocket costs of any OAC increased for commercial insurance (AAPC 3.0%) and Medicare (AAPC 5.1%) but decreased for Medicaid (AAPC -3.3%). The mean annual insurance payments for any OAC significantly increased for all insurance groups (AAPC 13.1% [95% CI 11.3 to 15.0] for Medicare; AAPC 11.8% [95% CI 8.0 to 15.6] for commercial insurance; and AAPC 16.3% [95% CI 11.3 to 21.4] for Medicaid). The initiation of any OAC increased (AAPC 7.3% for commercial insurance; AAPC 10.2% for Medicare; AAPC 5.3% for Medicaid). CONCLUSIONS: There was a substantial increase in the overall cost burden of OACs and OAC initiation rates in patients with newly diagnosed AF in 2014-2021; these findings provide insights into the current and anticipated impact of rising drug prices on patients' and payers' financial burden. |
Factors associated with in-hospital exclusive breastfeeding among a racially and ethnically diverse patient population
Bookhart LH , Anstey EH , Jamieson DJ , Kramer MR , Perrine CG , Ramakrishnan U , Worrell N , Young MF . Breastfeed Med 2023 18 (10) 751-758 Objective: The aim of this study is to examine in-hospital exclusive breastfeeding (EBF) and its association with sociodemographic factors, medical factors, breastfeeding intentions, and health care system breastfeeding support. Materials and Methods: We conducted a retrospective cross-sectional study using medical records from 2015 to 2019 of healthy term infants without breastfeeding contraindications at a public teaching hospital serving a racially and ethnically diverse patient population. Using multivariable regression analysis, we examined the associations between in-hospital EBF and sociodemographic factors, medical factors, breastfeeding intentions, and health care system breastfeeding support (in-hospital breastfeeding education and lactation support). Results: The prevalence of in-hospital EBF was 29.0%. The statistically significant findings from our fully adjusted regression analysis include that there was a higher prevalence of in-hospital EBF among adult mothers (prevalence ratio [PR]: range 1.78-1.96), married mothers (PR: 1.35, 95% confidence interval [CI]: 1.23-1.44), and mothers who were White (PR: 1.41, 95% CI: 1.20-1.66, compared with Black). Factors associated with a lower prevalence of in-hospital EBF were maternal diabetes (PR: 0.82, 95% CI: 0.70-0.95), pre-eclampsia/eclampsia (PR: 0.82, 95% CI: 0.71-0.95), cesarean delivery (PR: 0.84, 95% CI: 0.77-0.92), neonatal hypoglycemia (PR: 0.46, 95% CI: 0.36-0.59), and intention in the prenatal period to formula feed only (PR: 0.15, 95% CI: 0.10-0.22). In-hospital lactation support was associated with higher prevalence of in-hospital EBF (PR: 1.24, 95% CI: 1.16-1.33). Conclusions: Prioritizing lactation support for Black mothers, adolescent mothers, those intending in the prenatal period to formula feed only, and mother-infant dyads with certain medical factors could improve in-hospital EBF. |
A comprehensive analysis of neuroblastoma incidence, survival, and racial and ethnic disparities from 2001 to 2019
Campbell K , Siegel DA , Umaretiya PJ , Dai S , Heczey A , Lupo PJ , Schraw JM , Thompson TD , Scheurer ME , Foster JH . Pediatr Blood Cancer 2023 71 (1) e30732 BACKGROUND: We characterize the incidence and 5-year survival of children and adolescents with neuroblastoma stratified by demographic and clinical factors based on the comprehensive data from United States Cancer Statistics (USCS) and the National Program of Cancer Registries (NPCR). METHODS: We analyzed the incidence of neuroblastoma from USCS (2003-2019) and survival data from NPCR (2001-2018) for patients less than 20 years old. Incidence trends were calculated by average annual percent change (AAPC) using joinpoint regression. Differences in relative survival were estimated comparing non-overlapping confidence intervals (CI). RESULTS: We identified 11,543 primary neuroblastoma cases in USCS. Age-adjusted incidence was 8.3 per million persons [95% CI: 8.2, 8.5], with an AAPC of 0.4% [95% CI: -0.1, 0.9]. Five-year relative survival from the NPCR dataset (n = 10,676) was 79.7% [95% CI: 78.9, 80.5]. Patients aged less than 1 year had the highest 5-year relative survival (92.5%). Five-year relative survival was higher for non-Hispanic White patients (80.7%) or Hispanic patients (80.8%) compared to non-Hispanic Black patients (72.6%). CONCLUSION: Neuroblastoma incidence was stable during 2003-2019. Differences in relative survival exist by sex, age, race/ethnicity, and stage; patients who were male, older, non-Hispanic Black, or with distant disease had worse survival. Future studies could seek to assess the upstream factors driving disparities in survival, and evaluate interventions to address inequities and improve survival across all groups. |
Differences in meningococcal disease incidence by health insurance type and among persons experiencing homelessness-United States, 2016-2019
Isenhour CJ , Crowe SJ , McNamara LA . PLoS One 2023 18 (10) e0293070 Meningococcal disease is a serious but rare disease in the United States. Prior publications suggest incidence differs among privately vs publicly-insured persons, and that incidence is higher among persons experiencing homelessness (PEH) than persons not known to be experiencing homelessness (non-PEH). Using insurance claims data for persons aged <1 to 64 years, we calculated meningococcal disease incidence among a population with employer-sponsored commercial insurance and persons enrolled in state Medicaid programs nationwide. We also examined meningococcal disease incidence by PEH status in Medicaid data. From 2016 through 2019, persons who met our study inclusion criteria contributed a total of 84,460,548 person-years (PYs) to our analysis of commercial insurance data and 253,496,622 PYs to our analysis of Medicaid data. Incidence was higher among persons enrolled in Medicaid (0.12 cases per 100,000 PYs) than persons with commercial insurance (0.06 cases per 100,000 PYs). Incidence was 3.17 cases per 100,000 PYs among PEH in Medicaid, 27 times higher than among non-PEH in Medicaid. Understanding the underlying drivers of the higher meningococcal disease incidence among PEH and persons enrolled in Medicaid may inform prevention strategies for populations experiencing a higher burden of disease. |
Household hardships and responses to COVID-19 pandemic-related shocks in Eastern Ethiopia
Muir JA , Dheresa M , Madewell ZJ , Getachew T , Daraje G , Mengesha G , Whitney CG , Assefa N , Cunningham SA . BMC Public Health 2023 23 (1) 2086 BACKGROUND: COVID-19 resulted in enormous disruption to life around the world. To quell disease spread, governments implemented lockdowns that likely created hardships for households. To improve knowledge of consequences, we examine how the pandemic period was associated with household hardships and assess factors associated with these hardships. METHODS: We conducted a cross-sectional study using quasi-Poisson regression to examine factors associated with household hardships. Data were collected between August and September of 2021 from a random sample of 880 households living within a Health and Demographic Surveillance System (HDSS) located in the Harari Region and the District of Kersa, both in Eastern Ethiopia. RESULTS: Having a head of household with no education, residing in a rural area, larger household size, lower income and/or wealth, and community responses to COVID-19, including lockdowns and travel restrictions, were independently associated with experiencing household hardships. CONCLUSIONS: Our results identify characteristics of groups at-risk for household hardships during the pandemic; these findings may inform efforts to mitigate the consequences of COVID-19 and future disease outbreaks. |
Centering data sovereignty, tribal values, and practices for equity in American Indian and Alaska Native public health systems
Rhodes KL , Echo-Hawk A , Lewis JP , Cresci VL , Satter DE , Dillard DA . Public Health Rep 2023 333549231199477 As the first scientists on the American continents, American Indian and Alaska Native people followed various methodologies in the pursuit of knowledge to understand and respond to complex environmental situations.1 Examples include data necessary to guide access to safe food and medicine as well as community roles, kinship, travel, housing, and healing for the well-being of the community. These Tribal data have been transmitted through specific practices with strict protocols such as storytelling, songs, and ceremony. Colonialism and attempts to eradicate Tribal cultures have stolen or at the very least hidden most of the original Tribal data practices in all current public health systems.2 Current methodologies fail to accurately capture data on American Indian and Alaska Native populations, resulting in inaccurate and even harmful data outcomes. Efforts to improve public health data systems should begin with the reclamation of Tribal knowledge systems and the reconstruction of these systems to fit our modern context and Tribal data sovereignty, with intentionality toward future generations. |
Quickstats: Rate* of emergency department visits,(†) by homeless status(§) - National Hospital Ambulatory Medical Care Survey, United States, 2010-2021
Schappert SM , Santo L . MMWR Morb Mortal Wkly Rep 2023 72 (42) 1153 The rate of visits to hospital emergency departments by persons experiencing homelessness increased from an estimated 141 visits per 100 persons per year during 2010–2011 to 310 during 2020–2021. Rates increased during 2016–2017 compared with 2014–2015, and again during 2020–2021 compared with 2018–2019. Visit rates for persons not experiencing homelessness did not vary significantly across years, ranging from 42 visits per 100 persons per year during 2010–2011 to 40 during 2020–2021. Visit rates for persons experiencing homelessness were higher than rates for persons not experiencing homelessness in all years. |
Notes from the field: Mycobacterium abscessus outbreak related to contaminated water among ventilator-dependent residents of a pediatric facility - Pennsylvania, 2022
Sinkevitch JN , Paoline J , Smee A , Jones S , Spicer K , Gable P , Houston H , Stevens V , Bicking Kinsey C . MMWR Morb Mortal Wkly Rep 2023 72 (42) 1151-1152 Mycobacterium abscessus, a nontuberculous mycobacterium found in water and soil, is an opportunistic pathogen responsible for waterborne illness outbreaks in health care settings (1). On September 29, 2022, the Pennsylvania Department of Health (PADOH) received notification of M. abscessus–positive respiratory isolates from ventilator-dependent residents of a 34-bed pediatric facility. The facility is licensed for residential services, but not as a health care facility. A case was defined as the first M. abscessus–positive culture identified from a resident of this facility during March–August 2022. Three cases were identified: two colonizations and one clinical infection. PADOH investigated this outbreak to identify risk factors and recommend infection prevention and control (IPC) measures. |
Progress toward measles and rubella elimination - Indonesia, 2013-2022
Chacko S , Kamal M , Hastuti EB , Mildya F , Kelyombar C , Voronika V , Yosephine P , Tandy G , Anisiska D , Karolina S , Dewi LA , Khanal S , Bahl S , Wijayanti F , Merrill RD , Hsu CH , Morales M . MMWR Morb Mortal Wkly Rep 2023 72 (42) 1134-1139 In 2019, Indonesia and the other countries in the World Health Organization South-East Asia Region adopted the goal of measles and rubella elimination by 2023. This report describes Indonesia's progress toward measles and rubella elimination during 2013-2022. During this period, coverage with a first dose of measles-containing vaccine (MCV) decreased from 87% to 84%, and coverage with a second MCV dose decreased from 76% to 67%. After rubella vaccine was introduced in 2017, coverage with the first dose of rubella-containing vaccine increased approximately fivefold, from 15% in 2017 to 84% in 2022. During 2013-2021, annual reported measles incidence decreased by 95%, from 33.2 to 1.4 cases per million population; reported rubella incidence decreased 89%, from 9.3 to 1.0 cases per million population. However, a large surge in measles and rubella cases occurred in 2022, with a reported measles incidence of 29 cases per million and a reported rubella incidence of 3 per million, primarily related to disruption in immunization services caused by the COVID-19 pandemic. In 2022, approximately 26 million children (an estimated 73% of the target population) received a combined measles- and rubella-containing vaccine during supplementary immunization activities completed in 32 provinces. Progress toward measles and rubella elimination in Indonesia has been made; however, continued and urgent efforts are needed to restore routine immunization services that were adversely affected by the COVID-19 pandemic and close immunity gaps to accelerate progress toward measles and rubella elimination. |
Prevention and control of seasonal influenza with vaccines: Recommendations of the Advisory Committee On Immunization Practices — United States, 2023–24 influenza season
Grohskopf LA , Blanton LH , Ferdinands JM , Chung JR , Broder KR , Talbot HK . MMWR Recommendations and Reports 2023 72 (2) This report updates the 2022–23 recommendations of the Advisory Committee on Immunization Practices (ACIP) concerning the use of seasonal influenza vaccines in the United States (MMWR Recomm Rep 2022;71[No. RR-1]:1–28). Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications. All seasonal influenza vaccines expected to be available in the United States for the 2023–24 season are quadrivalent, containing hemagglutinin (HA) derived from one influenza A(H1N1)pdm09 virus, one influenza A(H3N2) virus, one influenza B/Victoria lineage virus, and one influenza B/Yamagata lineage virus. Inactivated influenza vaccines (IIV4s), recombinant influenza vaccine (RIV4), and live attenuated influenza vaccine (LAIV4) are expected to be available. For most persons who need only 1 dose of influenza vaccine for the season, vaccination should ideally be offered during September or October. However, vaccination should continue after October and throughout the season as long as influenza viruses are circulating and unexpired vaccine is available. Influenza vaccines might be available as early as July or August, but for most adults (particularly adults aged ≥65 years) and for pregnant persons in the first or second trimester, vaccination during July and August should be avoided unless there is concern that vaccination later in the season might not be possible. Certain children aged 6 months through 8 years need 2 doses; these children should receive the first dose as soon as possible after vaccine is available, including during July and August. Vaccination during July and August can be considered for children of any age who need only 1 dose for the season and for pregnant persons who are in the third trimester during these months if vaccine is available. ACIP recommends that all persons aged ≥6 months who do not have contraindications receive a licensed and age-appropriate seasonal influenza vaccine. With the exception of vaccination for adults aged ≥65 years, ACIP makes no preferential recommendation for a specific vaccine when more than one licensed, recommended, and age-appropriate vaccine is available. ACIP recommends that adults aged ≥65 years preferentially receive any one of the following higher dose or adjuvanted influenza vaccines: quadrivalent high-dose inactivated influenza vaccine (HD-IIV4), quadrivalent recombinant influenza vaccine (RIV4), or quadrivalent adjuvanted inactivated influenza vaccine (aIIV4). If none of these three vaccines is available at an opportunity for vaccine administration, then any other age-appropriate influenza vaccine should be used. Primary updates to this report include the following two topics: 1) the composition of 2023–24 U.S. seasonal influenza vaccines and 2) updated recommendations regarding influenza vaccination of persons with egg allergy. First, the composition of 2023–24 U.S. influenza vaccines includes an update to the influenza A(H1N1)pdm09 component. U.S.-licensed influenza vaccines will contain HA derived from 1) an influenza A/Victoria/4897/2022 (H1N1)pdm09-like virus (for egg-based vaccines) or an influenza A/Wisconsin/67/2022 (H1N1)pdm09-like virus (for cell culture-based and recombinant vaccines); 2) an influenza A/Darwin/9/2021 (H3N2)-like virus (for egg-based vaccines) or an influenza A/Darwin/6/2021 (H3N2)-like virus (for cell culture-based and recombinant vaccines); 3) an influenza B/Austria/1359417/2021 (Victoria lineage)-like virus; and 4) an influenza B/Phuket/3073/2013 (Yamagata lineage)-like virus. Second, ACIP recommends that all persons aged ≥6 months with egg allergy should receive influenza vaccine. Any influenza vaccine (egg based or nonegg based) that is otherwise appropriate for the recipient’s age and health status can be used. It is no longer recommended that persons who have had an allergic reaction to egg involving symptoms other than urticaria should be vaccinated in an inpatient or outpatient medical setting supervised by a health care provider who is able to recognize and man ge severe allergic reactions if an egg-based vaccine is used. Egg allergy alone necessitates no additional safety measures for influenza vaccination beyond those recommended for any recipient of any vaccine, regardless of severity of previous reaction to egg. All vaccines should be administered in settings in which personnel and equipment needed for rapid recognition and treatment of acute hypersensitivity reactions are available. © (2023). All Rights Reserved. |
Influenza vaccination coverage among persons ages six months and older in the Vaccine Safety Datalink in the 2017-18 through 2022-23 influenza seasons
Irving SA , Groom HC , Belongia EA , Crane B , Daley MF , Goddard K , Jackson LA , Kauffman TL , Kenigsberg TA , Kuckler L , Naleway AL , Patel SA , Tseng HF , Williams JTB , Weintraub ES . Vaccine 2023 41 (48) 7138-7146 BACKGROUND: In the United States, annual vaccination against seasonal influenza is recommended for all people ages ≥ 6 months. Vaccination coverage assessments can identify populations less protected from influenza morbidity and mortality and help to tailor vaccination efforts. Within the Vaccine Safety Datalink population ages ≥ 6 months, we report influenza vaccination coverage for the 2017-18 through 2022-23 seasons. METHODS: Across eight health systems, we identified influenza vaccines administered from August 1 through March 31 for each season using electronic health records linked to immunization registries. Crude vaccination coverage was described for each season, overall and by self-reported sex; age group; self-reported race and ethnicity; and number of separate categories of diagnoses associated with increased risk of severe illness and complications from influenza (hereafter referred to as high-risk conditions). High-risk conditions were assessed using ICD-10-CM diagnosis codes assigned in the year preceding each influenza season. RESULTS: Among individual cohorts of more than 12 million individuals each season, overall influenza vaccination coverage increased from 41.9 % in the 2017-18 season to a peak of 46.2 % in 2019-20, prior to declaration of the COVID-19 pandemic. Coverage declined over the next three seasons, coincident with widespread SARS-CoV-2 circulation, to a low of 40.3 % in the 2022-23 season. In each of the six seasons, coverage was lowest among males, 18-49-year-olds, non-Hispanic Black people, and those with no high-risk conditions. While decreases in coverage were present in all age groups, the declines were most substantial among children: 2022-23 season coverage for children ages six months through 8 years and 9-17 years was 24.5 % and 22.4 % (14 and 10 absolute percentage points), respectively, less than peak coverage achieved in the 2019-20 season. CONCLUSIONS: Crude influenza vaccination coverage increased from 2017 to 18 through 2019-20, then decreased to the lowest level in the 2022-23 season. In this insured population, we identified persistent disparities in influenza vaccination coverage by sex, age, and race and ethnicity. The overall low coverage, disparities in coverage, and recent decreases in coverage are significant public health concerns. |
Postmenopausal bleeding after COVID-19 vaccination
Kauffman TL , Irving SA , Brooks N , Vesco KK , Slaughter M , Smith N , Tepper NK , Olson CK , Weintraub ES , Naleway AL . Am J Obstet Gynecol 2023 230 (1) 71 e1-71 e14 BACKGROUND: There is a growing literature base regarding menstrual changes following COVID-19 vaccination among premenopausal people. However, relatively little is known about uterine bleeding in postmenopausal people following COVID-19 vaccination. OBJECTIVE: This study aimed to examine trends in incident postmenopausal bleeding diagnoses over time before and after COVID-19 vaccine introduction, and to describe cases of new-onset postmenopausal bleeding after COVID-19 vaccination. STUDY DESIGN: For postmenopausal bleeding incidence calculations, monthly population-level cohorts consisted of female Kaiser Permanente Northwest members aged ≥45 years. Those diagnosed with incident postmenopausal bleeding in the electronic medical record were included in monthly numerators. Members with preexisting postmenopausal bleeding or abnormal uterine bleeding, or who were at increased risk of bleeding due to other health conditions, were excluded from monthly calculations. We used segmented regression analysis to estimate changes in the incidence of postmenopausal bleeding diagnoses from 2018 through 2021 in Kaiser Permanente Northwest members meeting the inclusion criteria, stratified by COVID-19 vaccination status in 2021. In addition, we identified all members with ≥1 COVID-19 vaccination between December 14, 2020 and August 14, 2021, who had an incident postmenopausal bleeding diagnosis within 60 days of vaccination. COVID-19 vaccination, diagnostic procedures, and presumed bleeding etiology were assessed through chart review and described. A temporal scan statistic was run on all cases without clear bleeding etiology. RESULTS: In a population of 75,530 to 82,693 individuals per month, there was no statistically significant difference in the rate of incident postmenopausal bleeding diagnoses before and after COVID-19 vaccine introduction (P=.59). A total of 104 individuals had incident postmenopausal bleeding diagnosed within 60 days following COVID-19 vaccination; 76% of cases (79/104) were confirmed as postvaccination postmenopausal bleeding after chart review. Median time from vaccination to bleeding onset was 21 days (range: 2-54 days). Among the 56 postmenopausal bleeding cases with a provider-attributed etiology, the common causes of bleeding were uterine or cervical lesions (50% [28/56]), hormone replacement therapy (13% [7/56]), and proliferative endometrium (13% [7/56]). Among the 23 cases without a clear etiology, there was no statistically significant clustering of postmenopausal bleeding onset following vaccination. CONCLUSION: Within this integrated health system, introduction of COVID-19 vaccines was not associated with an increase in incident postmenopausal bleeding diagnoses. Diagnosis of postmenopausal bleeding in the 60 days following receipt of a COVID-19 vaccination was rare. |
Moving cholera vaccines ahead of the epidemic curve
Memish ZA , Blumberg L , Al-Maani AS , Baru R , Dube E , Gao GF , Jernigan DB , Leo YS , Peiris JSM , Masud JHB , McVernon J , Nonvignon J , Ogunsola FT , Reese H , Safdar RM , Ungchusak K , Wieler LH , Heymann D . Lancet 2023 The ongoing multi-country cholera outbreaks deserve greater attention and higher prioritisation globally.1 Since the early 1800s, there have been seven characterised global outbreaks of cholera. The seventh and current pandemic has been causing considerable illness effects since the early 1960s.2 Most recently, floods, droughts, natural disasters, and conflicts have displaced millions of people who have restricted access to clean water and live in settings with poor sewage management and increasing disease risk, further increasing the devasting effect of cholera around the globe.3 Currently, 1 billion people are at risk of contracting cholera and, concerningly, 28 countries with outbreaks in 2023, and 24 countries with active outbreaks were recorded by WHO by Sept 10, 2023 alone.4 In addition, recent outbreaks have had a high case fatality rate.5 The average cholera case fatality rate reported globally in 2021 was 1·9% (2·9% in Africa), a significant increase above the accepted target rate (<1%) and the highest recorded in over a decade.1, 5 Preliminary data suggest a similar trend for 2022 and 2023.1 Cholera is an old adversary that is both preventable and treatable.5 Despite widespread calls for strengthened pandemic preparedness and response, the global public health community are failing to apply lessons learned from COVID-19 to old challenges such as cholera. A key lesson learned from the COVID-19 pandemic is that early, rapid, and aggressive action is crucial in implementing public health interventions and countermeasure development.6 |
Use of updated COVID-19 vaccines 2023-2024 formula for persons aged ≥6 months: Recommendations of the Advisory Committee on Immunization Practices - United States, September 2023
Regan JJ , Moulia DL , Link-Gelles R , Godfrey M , Mak J , Najdowski M , Rosenblum HG , Shah MM , Twentyman E , Meyer S , Peacock G , Thornburg N , Havers FP , Saydah S , Brooks O , Talbot HK , Lee GM , Bell BP , Mahon BE , Daley MF , Fleming-Dutra KE , Wallace M . MMWR Morb Mortal Wkly Rep 2023 72 (42) 1140-1146 COVID-19 vaccines protect against severe COVID-19-associated outcomes, including hospitalization and death. As SARS-CoV-2 has evolved, and waning vaccine effectiveness has been noted, vaccine formulations and policies have been updated to provide continued protection against severe illness and death from COVID-19. Since September 2022, bivalent mRNA COVID-19 vaccines have been recommended in the United States, but the variants these vaccines protect against are no longer circulating widely. On September 11, 2023, the Food and Drug Administration (FDA) approved the updated (2023-2024 Formula) COVID-19 mRNA vaccines by Moderna and Pfizer-BioNTech for persons aged ≥12 years and authorized these vaccines for persons aged 6 months-11 years under Emergency Use Authorization (EUA). On October 3, 2023, FDA authorized the updated COVID-19 vaccine by Novavax for use in persons aged ≥12 years under EUA. The updated COVID-19 vaccines include a monovalent XBB.1.5 component, which is meant to broaden vaccine-induced immunity and provide protection against currently circulating SARS-CoV-2 XBB-sublineage variants including against severe COVID-19-associated illness and death. On September 12, 2023, the Advisory Committee on Immunization Practices recommended vaccination with updated COVID-19 vaccines for all persons aged ≥6 months. These recommendations will be reviewed as new evidence becomes available or new vaccines are approved and might be updated. |
Effectiveness of maternal mRNA COVID-19 vaccination during pregnancy against COVID-19-associated hospitalizations in infants aged <6 months during SARS-cov-2 Omicron predominance - 20 states, March 9, 2022-May 31, 2023
Simeone RM , Zambrano LD , Halasa NB , Fleming-Dutra KE , Newhams MM , Wu MJ , Orzel-Lockwood AO , Kamidani S , Pannaraj PS , Irby K , Maddux AB , Hobbs CV , Cameron MA , Boom JA , Sahni LC , Kong M , Nofziger RA , Schuster JE , Crandall H , Hume JR , Staat MA , Mack EH , Bradford TT , Heidemann SM , Levy ER , Gertz SJ , Bhumbra SS , Walker TC , Bline KE , Michelson KN , Zinter MS , Flori HR , Campbell AP , Randolph AG . MMWR Morb Mortal Wkly Rep 2023 72 (39) 1057-1064 Infants aged <6 months are not eligible for COVID-19 vaccination. Vaccination during pregnancy has been associated with protection against infant COVID-19-related hospitalization. The Overcoming COVID-19 Network conducted a case-control study during March 9, 2022-May 31, 2023, to evaluate the effectiveness of maternal receipt of a COVID-19 vaccine dose (vaccine effectiveness [VE]) during pregnancy against COVID-19-related hospitalization in infants aged <6 months and a subset of infants aged <3 months. VE was calculated as (1 - adjusted odds ratio) x 100% among all infants aged <6 months and <3 months. Case-patients (infants hospitalized for COVID-19 outside of birth hospitalization and who had a positive SARS-CoV-2 test result) and control patients (infants hospitalized for COVID-19-like illness with a negative SARS-CoV-2 test result) were compared. Odds ratios were determined using multivariable logistic regression, comparing the odds of receipt of a maternal COVID-19 vaccine dose (completion of a 2-dose vaccination series or a third or higher dose) during pregnancy with maternal nonvaccination between case- and control patients. VE of maternal vaccination during pregnancy against COVID-19-related hospitalization was 35% (95% CI = 15%-51%) among infants aged <6 months and 54% (95% CI = 32%-68%) among infants aged <3 months. Intensive care unit admissions occurred in 23% of all case-patients, and invasive mechanical ventilation was more common among infants of unvaccinated (9%) compared with vaccinated mothers (1%) (p = 0.02). Maternal vaccination during pregnancy provides some protection against COVID-19-related hospitalizations among infants, particularly those aged <3 months. Expectant mothers should remain current with COVID-19 vaccination to protect themselves and their infants from hospitalization and severe outcomes associated with COVID-19. |
Introducing seasonal influenza vaccine in Bhutan: Country experience and achievements
Wangchuk S , Prabhakaran AO , Dhakal GP , Zangmo C , Gharpure R , Dawa T , Phuntsho S , Burkhardsmeier B , Saha S , Wangmo D , Lafond KE . Vaccine 2023 41 (48) 7259-7264 Bhutan successfully introduced multiple vaccines since the establishment of the Vaccine Preventable Disease Program in 1979. Surveillance and subsequent introduction of influenza vaccination became a public health priority for the Ministry of Health following the influenza A(H1N1)pdm09 pandemic. Sentinel surveillance for influenza in Bhutan began in 2008, and a study of severe acute respiratory infection was conducted in 2017, which found the highest influenza burden in children aged <5 years and adults ≥50 years. Following review of surveillance and burden of disease data, the National Technical Advisory Group presented recommendations to Bhutan's Ministry of Health which approved influenza vaccine introduction for all five high-risk groups in the country. Upon the official launch of the program in June 2018, the Vaccine Preventable Disease Program began planning, budgeting, and procurement processes with technical and financial support from the Partnership for Influenza Vaccine Introduction, the United States Centers for Disease Control and Prevention, the Bhutan Health Trust Fund, and the World Health Organization. Influenza vaccination for high-risk groups was integrated into Bhutan's routine immunization services in all health care facilities beginning in November 2019 and vaccinated all populations in 2020 in response to the COVID-19 pandemic. Coverage levels between 2019 and 2022 were highest in children aged 6-24 months (62.5%-96.9%) and lowest in pregnant women (47.7%-62.5%). Bhutan maintained high coverage levels despite the COVID-19 pandemic by continued provision of influenza vaccine services at health centers during lockdowns, conducting communication and sensitization efforts, and using catch-up campaigns. Bhutan's experience with introducing and scaling up the influenza vaccine program contributed to the country's capacity to rapidly deploy its COVID-19 vaccination program in 2021. |
Further evidence of misclassification of the injury deaths in South Africa: When will the barriers to accurate injury death statistics be removed?
Groenewald P , Kallis N , Holmgren C , Glass T , Anthony A , Maud P , Akhalwaya Y , Afonso E , Niewoudt I , Martin LJ , De Vaal C , Cheyip M , Morof D , Prinsloo M , Matzopoulos R , Bradshaw D . S Afr Med J 2023 113 (9) 30-35 BACKGROUND: Contrary to the World Health Organization's internationally recommended medical certificate of cause of death, the South African (SA) death notification form (DNF) does not allow for the reporting of the manner of death to permit accurate coding of external causes of injury deaths. OBJECTIVES: To describe the injury cause-of-death profile from forensic pathology records collected for the National Cause-of-Death Validation (NCoDV) Project and compare it with profiles from other sources of injury mortality data. In particular, the recording of firearm use in homicides is compared between sources. METHODS: The NCoDV Project was a cross-sectional study of deaths that occurred during a fixed period in 2017 and 2018, from a nationally representative sample of 27 health subdistricts in SA. Trained fieldworkers scanned forensic records for all deaths investigated at the forensic mortuaries serving the sampled subdistricts during the study period. Forensic practitioners reviewed the records and completed a medical certificate of cause of death for each decedent. Causes of death were coded to the International Statistical Classification of Diseases, 10th revision (ICD-10), using Iris automated coding software. Cause-specific mortality fractions for injury deaths were compared with Injury Mortality Survey 2017 (IMS 2017) and Statistics South Africa 2017 (Stats SA 2017) datasets. The cause profile for all firearm-related deaths was compared between the three datasets. RESULTS: A total of 5 315 records were available for analysis. Males accounted for 77.6% of cases, and most decedents were aged between 25 and 44 years. Homicide was the leading cause of death (34.7%), followed by transport injuries (32.6%) and suicide (14.7%). This injury cause profile was similar to IMS 2017 but differed markedly from the official statistics, which showed markedly lower proportions of these three causes (15.0%, 11.6% and 0.7%, respectively), and a much higher proportion of other unintentional causes. Investigation of firearm-related deaths revealed that most were homicides in NCoDV 2017/18 (88.5%) and IMS 2017 (93.1%), while in the Stats SA 2017 data, 98.7% of firearm deaths were classified as accidental. Approximately 7% of firearm-related deaths were suicides in NCoDV 2017/18 and IMS 2017, with only 0.3% in Stats SA 2017. CONCLUSION: The official cause-of-death data for injuries in SA in 2017 differed substantially from findings from the NCoDV 2017/18 study and IMS 2017. Accurate data sources would ensure that public health interventions are designed to reduce the high injury burden. Inclusion of the manner of death on the DNF, as is recommended internationally, is critically important to enable more accurate, reliable and valid reporting of the injury profile. |
Importance of public and private partnership supporting data disaggregation to measure racial, sexual orientation, and gender identity disparities in COVID-19
Powell R , Parker B , Moore M , Xiong T , Evans D , Sidibe T . Health Secur 2023 21 S35-s41 The COVID-19 pandemic has exposed shortcomings in the US public health data system infrastructure, including incomplete or disparate processes related to data collection, management, sharing, and analysis. Public health data modernization is critical to ensure health equity is at the core of preparedness and response efforts and policies that prioritize equitable responses to health emergencies. To address the inequitable uptake and distribution of COVID-19 vaccinations in communities most disproportionately impacted by the pandemic, the CDC Foundation's Response Crisis and Preparedness Unit began partnering with community-based organizations in March 2021 to provide education and outreach and facilitate access to vaccines. These organizations engaged with partners and communities to address vaccine-related concerns, develop innovative and culturally appropriate communication strategies, and promote timely vaccination. Two grantees, Out Boulder County in Colorado and the Coalition of Asian American Leaders in Minnesota, experienced issues related to public health data collection standards and practices for COVID-19. Data collection tools often lack the appropriate or necessary demographic variables or level of disaggregation needed to be able to assess prioritization and disparities within racial and ethnic groups and across sexual orientation and gender identity categories. In this case study, both grantee organizations document their experiences, challenges, and strategies to overcome barriers to implementing their projects resulting from a lack of meaningful data. These examples identify inequities and systems-level changes related to data collection and surveillance, and they provide recommendations and lessons learned to improve data surveillance for more equitable public health responses. |
Notes from the field: Firearm homicide rates, by race and ethnicity - United States, 2019-2022
Kegler SR , Simon TR , Sumner SA . MMWR Morb Mortal Wkly Rep 2023 72 (42) 1149-1150 The rate of firearm homicide in the United States rose sharply from 2019 through 2020, reaching a level not seen in more than 2 decades, with ongoing and widening racial and ethnic disparities (1). During 2020–2021, the rate increased again (2). This report provides provisional firearm homicide data for 2022, stratified by race and ethnicity, presented both annually and by month (or quarter) to document subannual changes. |
Parental incarceration in childhood and adult intimate partner violence perpetration: Race/ethnicity and sex differences
Lee RD , Luo F . Crim Justice Behav 2023 Few studies have examined associations between parental incarceration (PI) and violence perpetration in adulthood. We used Wave I and Wave IV of the National Longitudinal Study of Adolescent to Adult Health to investigate such associations with intimate partner violence (IPV) perpetration. Exposure to PI was found significantly associated with increased risk of all IPV perpetration behaviors in adulthood, except forced sex. The association of PI exposure with issuing threats, pushing, and throwing objects did not differ by race/ethnicity or sex. Associations of PI exposure with slapping, hitting, or kicking and injuring a partner were stronger for non-Hispanic White persons than for non-Hispanic Black persons. Differing patterns of elevated violence risk in adults with PI history suggest tailored preventive strategies may be of value. © 2023 International Association for Correctional and Forensic Psychology. |
Meeting ferret enrichment needs in infectious disease laboratory settings
Anderson-Mondella CJ , Maines TR , Tansey CM , Belser JA . J Am Assoc Lab Anim Sci 2023 62 (6) 518-24 Environmental enrichment is a necessary component of all research vivarium settings. However, appropriate enrichmentdecisions vary greatly depending on the species involved and the research use of the animals. The increasing use of ferrets inresearch settings-notably for modeling the pathogenicity and transmissibility of viral pathogens that require containmentin ABSL-2 to -4 environments-presents a particular challenge for veterinary and research staff to ensure that enrichmentneeds for these animals are met consistently. Here, we discuss the species-specific enrichment needs of ferrets, enrichmentconsiderations for ferrets housed in research settings, and the challenges and importance of providing appropriate enrichmentduring experimentation, including when ferrets are housed in high-containment facilities. This article is organizedto support the easy availability of information that will facilitate the design and implementation of optimal environmentalenrichment for ferrets used in diverse research efforts in vivarium settings. |
OA4-AM23-ST-23 | performance of antibody boosting thresholds for serological detection of SARS-CoV-2 reinfections
Grebe E , Stone M , Wright D , Spencer B , Akinseye A , Bruhn R , Biggerstaff B , Custer B , Jones J , Busch M . Transfusion 2023 63 34A-35A |
P-BB-58 | nucleocapsid antibody boosting to identify SARS-CoV-2 reinfections among US blood donors
Haynes J , Spencer B , Grebe E , Stone M , Di Germanio C , Akinseye A , Jones J , Busch M , Stramer S . Transfusion 2023 63 130A-131A |
P-BB-3 | a case of brucella abortus RB51-positive platelet unit culture
Parsons M , Hermelin D , Tiller R , Hennenfent A , Negrón Sureda M , Annambhotla P , Basavaraju S , Katz L . Transfusion 2023 63 91A-92A |
Impact of SARS-CoV-2 infection on the association between laboratory tests and severe outcomes among hospitalized children
Xie J , Kuppermann N , Florin TA , Tancredi DJ , Funk AL , Kim K , Salvadori MI , Yock-Corrales A , Shah NP , Breslin KA , Chaudhari PP , Bergmann KR , Ahmad FA , Nebhrajani JR , Mintegi S , Gangoiti I , Plint AC , Avva UR , Gardiner MA , Malley R , Finkelstein Y , Dalziel SR , Bhatt M , Kannikeswaran N , Caperell K , Campos C , Sabhaney VJ , Chong SL , Lunoe MM , Rogers AJ , Becker SM , Borland ML , Sartori LF , Pavlicich V , Rino PB , Morrison AK , Neuman MI , Poonai N , Simon NE , Kam AJ , Kwok MY , Morris CR , Palumbo L , Ambroggio L , Navanandan N , Eckerle M , Klassen TP , Payne DC , Cherry JC , Waseem M , Dixon AC , Ferre IB , Freedman SB . Open Forum Infect Dis 2023 10 (10) ofad485 BACKGROUND: To assist clinicians with identifying children at risk of severe outcomes, we assessed the association between laboratory findings and severe outcomes among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected children and determined if SARS-CoV-2 test result status modified the associations. METHODS: We conducted a cross-sectional analysis of participants tested for SARS-CoV-2 infection in 41 pediatric emergency departments in 10 countries. Participants were hospitalized, had laboratory testing performed, and completed 14-day follow-up. The primary objective was to assess the associations between laboratory findings and severe outcomes. The secondary objective was to determine if the SARS-CoV-2 test result modified the associations. RESULTS: We included 1817 participants; 522 (28.7%) SARS-CoV-2 test-positive and 1295 (71.3%) test-negative. Seventy-five (14.4%) test-positive and 174 (13.4%) test-negative children experienced severe outcomes. In regression analysis, we found that among SARS-CoV-2-positive children, procalcitonin ≥0.5 ng/mL (adjusted odds ratio [aOR], 9.14; 95% CI, 2.90-28.80), ferritin >500 ng/mL (aOR, 7.95; 95% CI, 1.89-33.44), D-dimer ≥1500 ng/mL (aOR, 4.57; 95% CI, 1.12-18.68), serum glucose ≥120 mg/dL (aOR, 2.01; 95% CI, 1.06-3.81), lymphocyte count <1.0 × 10(9)/L (aOR, 3.21; 95% CI, 1.34-7.69), and platelet count <150 × 10(9)/L (aOR, 2.82; 95% CI, 1.31-6.07) were associated with severe outcomes. Evaluation of the interaction term revealed that a positive SARS-CoV-2 result increased the associations with severe outcomes for elevated procalcitonin, C-reactive protein (CRP), D-dimer, and for reduced lymphocyte and platelet counts. CONCLUSIONS: Specific laboratory parameters are associated with severe outcomes in SARS-CoV-2-infected children, and elevated serum procalcitonin, CRP, and D-dimer and low absolute lymphocyte and platelet counts were more strongly associated with severe outcomes in children testing positive compared with those testing negative. |
Estimating the global impact of rotavirus vaccines on child mortality
Clark A , Mahmud S , Debellut F , Pecenka C , Jit M , Perin J , Tate J , Soeters HM , Black RE , Santosham M , Sanderson C . Int J Infect Dis 2023 137 90-97 OBJECTIVES: To estimate the global impact of rotavirus vaccines on under-five deaths by year. METHODS: We used a proportionate outcomes model with a finely disaggregated age structure to estimate rotavirus deaths prevented by vaccination over the period 2006-2019 in 186 countries. We ran deterministic and probabilistic uncertainty analyses and compared our estimates to surveillance-based estimates in 20 countries. RESULTS: We estimate that rotavirus vaccines prevented 139,000 under-five rotavirus deaths (95% uncertainty interval 98,000 - 201,000) in the period 2006-2019. In 2019 alone, rotavirus vaccines prevented 15% (95% UI 11-21%) of under-five rotavirus deaths (0.5% of child mortality). Assuming global use of rotavirus vaccines and coverage equivalent to other co-administered vaccines could prevent 37% of under-five rotavirus deaths (1.2% of child mortality). Our estimates were sensitive to the choice of rotavirus mortality burden data and several vaccine impact modelling assumptions. WHO's recommendation to remove age restrictions in 2012 could have prevented up to 17,000 rotavirus deaths in the period 2013-2019. Our modelled estimates of rotavirus vaccine impact were broadly consistent with estimates from post-vaccination surveillance sites. CONCLUSIONS: Rotavirus vaccines have made a valuable contribution to global public health. Enhanced rotavirus mortality prevention strategies are needed in countries with high mortality in under-5-year-old children. |
Children's mental health during the COVID-19 pandemic: a population-based cohort study in the United States
Pampati S , Verlenden JV , Cree RA , Hertz M , Bitsko RH , Spencer P , Moore S , Michael SL , Dittus PJ . Ann Epidemiol 2023 88 7-14 PURPOSE: Examine children's mental health symptoms, including changes during the COVID-19 pandemic. METHODS: The COVID Experiences Surveys, designed to be representative of the U.S. household population, were administered online to parents of children aged 5-12 years (Wave 1, Oct-Nov 2020, n=1561; Wave 2, March-May 2021, n=1287). We modeled changes in children's symptoms of anxiety, depression, and psychological stress and examined associations between demographic characteristics, COVID-19 related experiences, and protective factors with symptoms across both waves using generalized estimating equations. RESULTS: Based on parent-report, children's symptoms of anxiety and depression decreased from W1 to W2 (Δ t-score anxiety = -1.8 [95% CI: -2.5, -1.0]; Δ t-score depression = -1.0 [CI: -1.7, -0.3]). Psychological stress remained consistent. Across waves, older children and children with an emotional, mental, developmental, behavioral, physical, or medical condition were more likely to have specific poor mental health symptoms. Poor mental health symptoms were more likely among children with several contextual stressors (e.g., economic stress, parental emotional strain) and less likely among children with protective factors (e.g., daily routines, neighborhood cohesion). CONCLUSIONS: Establishing programs that support mental health, improving access to mental health services, and fostering collaborations to advance children's mental health is important. |
Treatments and severe outcomes for patients diagnosed with MIS-C at four children's hospitals in the United States, March 16, 2020-March 10, 2021
Shah AB , Abrams JY , Godfred-Cato S , Kunkel A , Hammett TA , Perez MA , Hsiao HM , Baida N , Rostad CA , Ballan W , Ede K , Laham FR , Kao CM , Oster ME , Belay ED . Pediatr Infect Dis J 2023 42 (11) 990-998 BACKGROUND: Clinical management of multisystem inflammatory syndrome in children (MIS-C) has varied over time and by medical institution. METHODS: Data on patients with MIS-C were collected from 4 children's hospitals between March 16, 2020 and March 10, 2021. Relationships between MIS-C treatments and patient demographics, clinical characteristics, and outcomes were described. Propensity score matching was utilized to assess the relative risk of outcomes dependent on early treatment with intravenous immunoglobulin (IVIG) or low-dose steroids, controlling for potential confounding variables. RESULTS: Of 233 patients diagnosed with MIS-C, the most commonly administered treatments were steroids (88.4%), aspirin (81.1%), IVIG (77.7%) and anticoagulants (71.2%). Compared with those patients without respiratory features, patients with respiratory features were less likely to receive IVIG and steroids on the same day (combination treatment) (44.1%). Controlling for confounding variables, patients receiving IVIG within 1 day of hospitalization were less likely to have hospital length of stay ≥8 days (RR = 0.53, 95% CI: 0.31-0.88). Patients receiving low-dose steroids within 1 day of hospitalization were less likely to develop ventricular dysfunction (RR = 0.45, 95% CI: 0.26-0.77), have increasingly elevated troponin levels (RR = 0.55, 95% CI: 0.40-0.75) or have hospital length of stay ≥8 days (RR = 0.46, 95% CI: 0.29-0.74). CONCLUSION: Treatments for MIS-C differed by hospital, patient characteristics and illness severity. When IVIG and low-dose steroids were administered in combination or low-dose steroids were administered alone within 1 day of hospitalization, the risk of subsequent severe outcomes was decreased. |
A network model analysis of an unconventional gas well breach above an underground coal mine
Dougherty H , Watkins E , Kimutis R . Min Metall Explor 2023 Gas wells have often intersected mining resources, but unconventional shale well drilling has more recently challenged mines to balance the risk of interaction due to higher pressures and larger quantities of gas. Full extraction mining, such as the longwall method, induces ground movement that may influence the casings if wells are drilled within the mining area. The possibility of a casing shear would lead to the risk of unplanned gas migration into the mine. This has the potential to quickly overcome the ventilation system and reach the explosive range which, if ignited, can have catastrophic consequences on the health and safety of underground workers. The utilization of network software to model mine ventilation is a common practice in the mining industry as a predictive tool for planning and monitoring and can assist with a well breach scenario over a large mining area. This work focuses on a well breach in between two longwall panels after second panel mining with gas entering primarily through the gobs of the adjacent longwall panels. Applying the network software Ventsim, a gob zone and ventilation network were created to better understand the distribution of gas within the mine and the limitations and effectiveness of a ventilation system. The model shows both a transient flow simulation and steady state concentrations throughout the mine ventilation system. Using a standard Pittsburgh coal seam longwall ventilation scheme, we find that the system can dilute a significant inflow of up to 700 cfm of methane. © 2023, This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply. |
Visualizing the NIOSH Pocket Guide: open-source web application for accessing and exploring the NIOSH Pocket Guide to Chemical Hazards
Lucas L , Whittaker C , Bailer AJ . J Occup Environ Hyg 2023 1-11 The NIOSH Pocket Guide to Chemical Hazards is a trusted resource that displays key information for a collection of chemicals commonly encountered in the workplace. Entries contain chemical structures, occupational exposure limit information ranging from limits based on full-shift time-weighted averages to acute limits such as short-term exposure limits and immediately dangerous to life or health values, as well as a variety of other data such as chemical-physical properties and symptoms of exposure. The NIOSH Pocket Guide (NPG) is available as a printed, hardcopy book, a PDF version, an electronic database, and a downloadable application for mobile phones. All formats of the NIOSH Pocket Guide allow users to access the data for each chemical separately, however, the guide does not support data analytics or visualization across chemicals. This project reformatted existing data in the NPG to make it searchable and compatible with exploration and analysis using a web application. The resulting application allows users to investigate the relationships between occupational exposure limits, the range and distribution of occupational exposure limits, and specialized sorting of chemicals by health endpoint or to summarize information of particular interest. These tasks would have previously required manual extraction of the data and analysis. The usability of this application was evaluated among industrial hygienists and researchers and while the existing application seems most relevant to researchers, the open-source code and data are amenable to modification by users to increase customization. |
Risking one's life to save one's livelihood: Precarious work, presenteeism, and worry about disease exposure during the COVID-19 pandemic
Shoss MK , Min H , Horan K , Schlotzhauer AE , Nigam JAS , Swanson NG . J Occup Health Psychol 2023 28 (6) 363-379 The present study advances research on the negative consequences of precarious work experiences (PWE), which include perceptions of threats to one's job and financial security as well as a sense of powerlessness and inability to exercise rights in the workplace. Using the COVID-19 pandemic as a backdrop, we examine how PWE relate to sickness presenteeism and worry about work-related COVID-19 exposure. In a 12-week, four-wave study of workers working fully in-person, perceptions of powerlessness and job insecurity were associated with presenteeism (e.g., general presenteeism as well as attending work with known or possible COVID-19 infection) and concerns about disease exposure at work. Whereas powerlessness primarily operated at the between-person level of analysis, job insecurity's effects emerged at both levels of analysis. A sense of powerlessness at work also predicted sending children to school/daycare sick. In sum, the findings suggest that precarity related to being able to keep one's job and a sense of powerlessness at work contribute to concerns about the risk of COVID-19 exposure at work and, simultaneously, behaviors that may contribute to the health risks faced by others. This research provides added support to the argument that precarious work should be addressed in order to improve both worker well-being and public health. (PsycInfo Database Record (c) 2023 APA, all rights reserved). |
Impact of pyrethroid plus piperonyl butoxide synergist-treated nets on malaria incidence 24 months after a national distribution campaign in Rwanda
Kabera M , Mangala JN , Soebiyanto R , Mukarugwiro B , Munguti K , Mbituyumuremyi A , Lucchi NW , Hakizimana E . Am J Trop Med Hyg 2023 109 (6) 1356-1362 Malaria remains a public health priority in Rwanda. The use of insecticide-treated nets (ITNs) is a key malaria prevention tool. However, expanding pyrethroid resistance threatens the gains made in malaria control. In 2018, the Rwandan malaria program strategic approach included the use of newer types of ITNs such as pyrethroid plus piperonyl butoxide (PBO) synergist-treated nets to counter pyrethroid resistance. In February 2020, 5,892,280 ITNs were distributed countrywide; 1,085,517 of these were PBO nets distributed in five districts. This study was a pragmatic observational study that leveraged the 2020 net distribution and routinely collected confirmed malaria cases to determine the impact of PBO nets 1 and 2 years after ITN distribution. No differences were observed in the average net coverage between the PBO and standard net districts. A significant reduction in malaria incidence was reported in both the PBO (P = 0.019) and two control districts that received standard nets (P = 0.008) 1 year after ITN distribution. However, 2 years after, this reduction was sustained only in the PBO (P = 0.013) and not in the standard net districts (P = 0.685). One year after net distribution, all districts had a significant reduction in malaria incidence rate (incidence rate ratio < 1). In the second year, incidence in districts with PBO nets continued to decrease, whereas in districts with standard nets, incidences were similar to predistribution levels. The results indicate that PBO nets are a promising tool to combat pyrethroid resistance in Rwanda, with protective effects of up to 2 years post distribution. |
A population-based study of the utility of screening for tics and the relative contribution of tics and psychiatric comorbidity to academic and social impairment in adolescents
Smith JN , Owens JS , Evans SW , Bitsko RH , Holbrook JR . Evid Based Pract Child Adolesc Ment Health 2023 This study examined the performance of a brief screening tool for tics in adolescents. Academic and social impairment in students by tic screen status and emotional/behavioral problem status were examined. Data were collected as part of an epidemiologic study, the Project to Learn about Youth–Mental Health. Participants were 2,312 secondary school students at the Ohio site (47.4% female; 94.4% non-Hispanic white) and their teachers. Students completed 6 items from the Motor tic, Obsessions and compulsions, Vocal tic Evaluation Survey (MOVES-6) and the Strengths and Difficulties Questionnaire (SDQ). Teachers completed the Proxy Report Questionnaire for tics and SDQ. Based on responses to the MOVES-6, 11.1% of students screened positive for tics. Internal consistency was adequate (α = 0.76); inter-rater consistency between teachers and students was low (0.03). Based on student self-report, those who screened positive for tics self-reported more academic and social impairment than students who screened negative for tics; teacher-report of impairment was similar between those with a positive or negative tic screen. Students who screened positive for tics and reported internalizing difficulties reported more academic and social impairment than students with only a positive tic screen. Teachers perceived those screening positive for tics and externalizing difficulties as the most socially impaired. In conclusion, a positive self-reported tic screen was associated with self-reported academic and social impairment. Findings reveal the independent contribution of tics to impairment, even when internalizing and externalizing problems are present, and the potential utility of a school-based screening for tics in adolescents. © 2023 Society of Clinical Child & Adolescent Psychology. |
Adverse events among persons with TB using in-person vs. electronic directly observed therapy
Salerno MM , Burzynski J , Mangan JM , Hill A , deCastro BR , Goswami ND , Lam CK , Macaraig M , Schluger NW , Vernon AA . Int J Tuberc Lung Dis 2023 27 (11) 833-840 BACKGROUND: We evaluated patient safety within a randomized crossover trial comparing electronic directly observed therapy (eDOT) to in-person DOT (ipDOT) in persons undergoing TB treatment in New York City, NY, USA.METHODS: Participant symptoms, symptom severity, and clinical management were documented. We assessed adverse event reports (AERs) by DOT method during the two-period crossover. Using Cox proportional-hazards mixed-effects models, we estimated the adjusted hazard ratio (aHR) of participants reporting an adverse event (AE) vs. not reporting an AE.RESULTS: Of 211 participants, 57 (27.0%) reported AEs during the two-period crossover; of these, 54.4% (31/57) were reported while using eDOT vs. 45.6% (26/57) while using ipDOT. Controlling for study group and period, the aHR for eDOT vs. ipDOT was 0.98 (95% CI 0.49-1.93). Although statistically not significant, the wide confidence intervals suggest that a significant association cannot be entirely ruled out. Gastrointestinal symptoms were most frequently reported (42.1%, 24/57). AER types and severity did not differ significantly by DOT method. Days from symptom onset to medical attention was similar across DOT methods (median: 1.0 day, IQR 0.0-2.0). No participants switched DOT methods due to AERs or monitoring concerns.CONCLUSION: Further evaluation to ascertain whether AERs differ when patients use eDOT vs. ipDOT is warranted. |
Cache Valley virus: an emerging arbovirus of public and veterinary health importance
Hughes HR , Kenney JL , Calvert AE . J Med Entomol 2023 60 (6) 1230-1241 Cache Valley virus (CVV) is a mosquito-borne virus in the genus Orthobunyavirus (Bunyavirales: Peribunyaviridae) that has been identified as a teratogen in ruminants causing fetal death and severe malformations during epizootics in the U.S. CVV has recently emerged as a viral pathogen causing severe disease in humans. Despite its emergence as a public health and agricultural concern, CVV has yet to be significantly studied by the scientific community. Limited information exists on CVV's geographic distribution, ecological cycle, seroprevalence in humans and animals, and spectrum of disease, including its potential as a human teratogen. Here, we present what is known of CVV's virology, ecology, and clinical disease in ruminants and humans. We discuss the current diagnostic techniques available and highlight gaps in our current knowledge and considerations for future research. |
A systematic review of the data, methods and environmental covariates used to map Aedes-borne arbovirus transmission risk
Lim AY , Jafari Y , Caldwell JM , Clapham HE , Gaythorpe KAM , Hussain-Alkhateeb L , Johansson MA , Kraemer MUG , Maude RJ , McCormack CP , Messina JP , Mordecai EA , Rabe IB , Reiner RC Jr , Ryan SJ , Salje H , Semenza JC , Rojas DP , Brady OJ . BMC Infect Dis 2023 23 (1) 708 BACKGROUND: Aedes (Stegomyia)-borne diseases are an expanding global threat, but gaps in surveillance make comprehensive and comparable risk assessments challenging. Geostatistical models combine data from multiple locations and use links with environmental and socioeconomic factors to make predictive risk maps. Here we systematically review past approaches to map risk for different Aedes-borne arboviruses from local to global scales, identifying differences and similarities in the data types, covariates, and modelling approaches used. METHODS: We searched on-line databases for predictive risk mapping studies for dengue, Zika, chikungunya, and yellow fever with no geographical or date restrictions. We included studies that needed to parameterise or fit their model to real-world epidemiological data and make predictions to new spatial locations of some measure of population-level risk of viral transmission (e.g. incidence, occurrence, suitability, etc.). RESULTS: We found a growing number of arbovirus risk mapping studies across all endemic regions and arboviral diseases, with a total of 176 papers published 2002-2022 with the largest increases shortly following major epidemics. Three dominant use cases emerged: (i) global maps to identify limits of transmission, estimate burden and assess impacts of future global change, (ii) regional models used to predict the spread of major epidemics between countries and (iii) national and sub-national models that use local datasets to better understand transmission dynamics to improve outbreak detection and response. Temperature and rainfall were the most popular choice of covariates (included in 50% and 40% of studies respectively) but variables such as human mobility are increasingly being included. Surprisingly, few studies (22%, 31/144) robustly tested combinations of covariates from different domains (e.g. climatic, sociodemographic, ecological, etc.) and only 49% of studies assessed predictive performance via out-of-sample validation procedures. CONCLUSIONS: Here we show that approaches to map risk for different arboviruses have diversified in response to changing use cases, epidemiology and data availability. We identify key differences in mapping approaches between different arboviral diseases, discuss future research needs and outline specific recommendations for future arbovirus mapping. |
Rabies importation in dogs and reduction of waiting period - The fear for scientifically justified changes
Müller T , Wallace RM , Freuling CM . Vaccine 2023 The re-introduction of rabies into susceptible animal populations can have dire human and animal health impacts, in addition to substantial financial implications for re-elimination [1], [2]. In the late 1970s and early 1980s the canine rabies virus variant was reintroduced into the southern United States, resulting in 2 human and over 500 animal deaths and over $40m USD to re-eliminate the disease over the following 20 years [3], [4]. In 2015, canine rabies was introduced into Sarawak, Malaysia [5], where it has resulted in over 30 human deaths and control efforts are still ongoing to control the outbreak. Clearly, the introduction of canine rabies is no trivial matter, and global standards, such as those from the World Organization for Animal Health’s (WOAH) Terrestrial Animal Health Code [6], have been developed to support countries to prevent such occurrences. Current-day importation of rabies-infected dogs into North America and Europe are driven entirely be the illegal movement of dogs; that is, dogs that did not comply with national and international requirements for movement [7], [8], [9]. | | WOAH’s current standards for dog movement from countries endemic with rabies virus include criteria that the dog is healthy at the time of travel, is up-to-date on rabies vaccination, is permanently identified (e.g. microchip), has an adequate rabies virus neutralizing antibody (RVNA) titer (defined as >0.5 IU/ml), and has served a waiting period of at least 90 days (and not more than 365 days) after the date of which the adequate serum sample was collected – referred to as the “waiting period” [6]. Given the fact that nearly all modern-day rabies importation events have been associated with intentional or unintentional non-compliance with the WOAH waiting period, several peer-reviewed scientific publications have re-examined the rationale for the 90-day waiting period (Table 1), with particular interest in compromising between the scientific evidence and alleviating long-waiting periods that may be encouraging dog owners and importers to undermine the waiting period requirement [9], [10], [11]. This against the background that people are increasingly unsatisfied with the 90 day waiting period based on our experience and furthermore, that fraudulent documents can run rampant in the current system [12], [13]. |
2023 Updated ACVIM consensus statement on leptospirosis in dogs
Sykes JE , Francey T , Schuller S , Stoddard RA , Cowgill LD , Moore GE . J Vet Intern Med 2023 37 (6) 1966-1982 Since publication of the last consensus statement on leptospirosis in dogs, there has been revision of leptospiral taxonomy and advancements in typing methods, widespread use of new diagnostic tests and vaccines, and improved understanding of the epidemiology and pathophysiology of the disease. Leptospirosis continues to be prevalent in dogs, including in small breed dogs from urban areas, puppies as young as 11 weeks of age, geriatric dogs, dogs in rural areas, and dogs that have been inadequately vaccinated for leptospirosis (including dogs vaccinated with 2-serovar Leptospira vaccines in some regions). In 2021, the American College of Veterinary Internal Medicine (ACVIM) Board of Regents voted to approve the topic for a revised Consensus Statement. After identification of core panelists, a multidisciplinary group of 6 experts from the fields of veterinary medicine, human medicine, and public health was assembled to vote on the recommendations using the Delphi method. A draft was presented at the 2023 ACVIM Forum, and a written draft posted on the ACVIM website for comment by the membership before submission to the editors of the Journal of Veterinary Internal Medicine. This revised document provides guidance for veterinary practitioners on disease in dogs as well as cats. The level of agreement among the 12 voting members (including core panelists) is provided in association with each recommendation. A denominator lower than 12 reflects abstention of ≥1 panelists either because they considered the recommendation to be outside their scope of expertise or because there was a perceived conflict of interest. |
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CDC Science Clips is an online, continuously updated, searchable database of scientific literature published by CDC authors. Each article features an Altmetric Attention Score to track social and mainstream media mentions. If you are aware of a CDC-authored publication that does not appear in this database, please let us know.
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