Prevalence of asthma and its association with glycemic control among youth with diabetes
Black MH , Anderson A , Bell RA , Dabelea D , Pihoker C , Saydah S , Seid M , Standiford DA , Waitzfelder B , Marcovina SM , Lawrence JM . Pediatrics 2011 128 (4) e839-47 OBJECTIVE: To estimate the prevalence of asthma among youth with types 1 and 2 diabetes and examine associations between asthma and glycemic control. METHODS: This was a cross-sectional analysis of data from the SEARCH for Diabetes in Youth study, which included youth diagnosed with type 1 (n = 1683) and type 2 (n = 311) diabetes from 2002 through 2005. Asthma status and medications were ascertained from medical records and self-administered questionnaires, and glycemic control was assessed from hemoglobin A1c measured at the study visit. RESULTS: Prevalence of asthma among all youth with diabetes was 10.9% (95% confidence interval [CI]: 9.6%-12.3%). The prevalence was 10.0% (95% CI: 8.6%-11.4%) among youth with type 1 and 16.1% (95% CI: 12.0%-20.2%) among youth with type 2 diabetes and differed according to race/ethnicity. Among youth with type 1 diabetes, those with asthma had higher mean A1c levels than those without asthma, after adjustment for age, gender, race/ethnicity, and BMI (7.77% vs 7.49%; P = .034). Youth with asthma were more likely to have poor glycemic control, particularly those with type 1 diabetes whose asthma was not treated with pharmacotherapy, although this association was attenuated by adjustment for race/ethnicity. CONCLUSIONS: Prevalence of asthma may be elevated among youth with diabetes relative to the general US population. Among youth with type 1 diabetes, asthma is associated with poor glycemic control, especially if asthma is untreated. Specific asthma medications may decrease systemic inflammation, which underlies the complex relationship between pulmonary function, BMI, and glycemic control among youth with diabetes. |
The impact of knee and hip chondrocalcinosis on disability in older people: the ProVA Study from northeastern Italy
Musacchio E , Ramonda R , Perissinotto E , Sartori L , Hirsch R , Punzi L , Zambon S , Corti MC , Baggio G , Manzato E , Doria A , Crepaldi G . Ann Rheum Dis 2011 70 (11) 1937-43 OBJECTIVES: Chondrocalcinosis is frequently associated with osteoarthritis. The role of osteoarthritis in the onset and progression of disability is well known. The impact of chondrocalcinosis on disability has never been investigated in epidemiological studies. METHODS: Progetto Veneto Anziani is a survey of 3099 older Italians, focusing on chronic diseases and disability. Assessment was by questionnaires, physical performance tests and clinical evaluations. Chondrocalcinosis was determined by x-ray readings of 1629 consecutive subjects. Knee and hip osteoarthritis severity was evaluated by summing the radiographic features score (RFS) assigned during x-ray reading. RESULTS: Subjects with chondrocalcinosis were older and more frequently women (age-adjusted p<0.0001). The gender association disappeared following adjustment for osteoarthritis severity. However, at the knee, the prevalence of osteoarthritis was higher in chondrocalcinosis patients independently of age and sex (age-adjusted p<0.0001). No difference was found between chondrocalcinosis and controls in sociodemographic variables and comorbidity. Knee chondrocalcinosis was strongly associated with clinical features of knee osteoarthritis and with disability assessment parameters in the bivariate analysis. Most associations remained after adjusting for age. After further adjustment for RFS, a significant association remained for knee deformity and pain, the need for a cane, difficulty walking 500 m, using a toilet, shopping and repeatedly rising from a chair. CONCLUSIONS: Pain and physical function are the outcome measures of choice for assessing disability in osteoarthritis patients. The presence of chondrocalcinosis contributes to both, independently of age and osteoarthritis severity, thus compromising the quality of life and worsening comorbidity. |
Rift Valley fever virus inhibits a pro-inflammatory response in experimentally infected human monocyte derived macrophages and a pro-inflammatory cytokine response may be associated with patient survival during natural infection.
McElroy AK , Nichol ST . Virology 2011 422 (1) 6-12 Rift Valley fever virus (RVFV) causes significant morbidity and mortality in humans and livestock throughout Africa and the Middle East. The clinical disease ranges from mild febrile illness, to hepatitis, retinitis, encephalitis and fatal hemorrhagic fever. RVFV NSs protein has previously been shown to interfere in vitro with the interferon response, and RVFV lacking the NSs protein is attenuated in several animal models. Monocytes and macrophages are key players in the innate immune response via expression of various cytokines and chemokines. Here we demonstrate that wild-type RVFV infection of human monocyte-derived macrophages leads to a productive infection and inhibition of the innate immune response via decreased expression of IFN-alpha2, IFN-beta and TNF-alpha. Using a recombinant virus lacking the NSs protein, we show that this effect is mediated by the viral NSs protein. Finally, analysis of RVF patient samples demonstrated an association between a pro-inflammatory cytokine response and patient survival. |
Time to first annual HIV care visit and associated factors for patients in care for HIV infection in 10 US cities
Sullivan PS , Juhasz M , McNaghten AD , Frankel M , Bozzette S , Shapiro M . AIDS Care 2011 23 (10) 1314-20 BACKGROUND: Visiting a medical provider less frequently than clinical circumstances would suggest is appropriate has been reported to be associated with worse clinical outcomes for patients living with HIV infection. Patients with less frequent attendance to HIV care also may be systematically underrepresented in research or surveillance studies that enroll patients sequentially over a specified enrollment period - for example several months. For both reasons, understanding factors associated with time to care visit is important. METHODS: We used data from the Adult and Adolescent Spectrum of HIV Disease (ASD) project, a multi-site clinical outcomes surveillance system that enrolled and followed patients in care for HIV prospectively from 1990 to 2004. For this analysis, we used data from all patients observed in ASD at least one time before 1 January 2003, and who had at least one HIV care visit in 2003. We documented time to first annual HIV care visit for each patient, and used Kaplan-Meier plots and proportional hazards regression to describe factors associated with longer time to care visit. RESULTS: A total of 12,135 patients had ≥1 care visit during 2003 and were included in the analysis. Of these, 81%, 88%, and 95% had their first visit within three, four, and six months, respectively. In multivariate analysis, having a delayed (later) care visit was associated with not ever having had an AIDS diagnosis, having an HIV RNA concentration ≥10,000 copies/mL, having a current CD4 count <100 cells/microL, having no health insurance, and not being currently prescribed antiretroviral therapy. Having a delayed care visit was not associated with race/ethnicity or age. CONCLUSIONS: Having a delayed first annual HIV care visit was associated with higher viremia, lower CD4 cell count, and lack of health insurance. Interventions to address these factors are likely to ameliorate some of the consequences of HIV. For studies enrolling patients in care for HIV over a finite time period, an enrollment period of four-six months should sufficiently reflect the patient population seen in a one-year period, including those attending care infrequently. |
Mumps antibody levels among students before a mumps outbreak: in search of a correlate of immunity
Cortese MM , Barskey AE , Tegtmeier GE , Zhang C , Ngo L , Kyaw MH , Baughman AL , Menitove JE , Hickman CJ , Bellini WJ , Dayan GH , Hansen GR , Rubin S . J Infect Dis 2011 204 (9) 1413-22 BACKGROUND: In 2006, a mumps outbreak occurred on a university campus despite ≥ 95% coverage of students with 2 doses of measles-mumps-rubella (MMR) vaccine. Using plasma samples from a blood drive held on campus before identification of mumps cases, we compared vaccine-induced preoutbreak mumps antibody levels between individuals who developed mumps (case patients) and those who did not develop mumps (nonpatients). METHODS: Preoutbreak samples were available from 11 case patients, 22 nonpatients who reported mumps exposure but no mumps symptoms, and 103 nonpatients who reported no known exposure and no symptoms. Antibody titers were measured by plaque reduction neutralization assay using Jeryl Lynn vaccine virus and the outbreak virus Iowa-G/USA-06 and by enzyme immunoassay (EIA). RESULTS: Preoutbreak Jeryl Lynn virus neutralization titers were significantly lower among case patients than unexposed nonpatients (P = .023), and EIA results were significantly lower among case patients than exposed nonpatients (P = .007) and unexposed nonpatients (P = .009). Proportionately more case patients than exposed nonpatients had a preoutbreak anti-Jeryl Lynn titer < 31 (64% vs 27%, respectively; P = .065), an anti-Iowa-G/USA-06 titer < 8 (55% vs 14%; P = .033), and EIA index standard ratio < 1.40 (64% vs 9%; P = .002) and < 1.71 (73% vs 14%, P = .001). DISCUSSION: Case patients generally had lower preoutbreak mumps antibody levels than nonpatients. However, titers overlapped and no cutoff points separated all mumps case patients from all nonpatients. |
Premastication as a route of pediatric HIV transmission: case-control and cross-sectional investigations: pediatric HIV risk via premastication
Ivy W 3rd , Dominguez KL , Rakhmanina NY , Iuliano AD , Danner SP , Borkowf CB , Denson AP , Gaur AH , Mitchell CD , Henderson SL , Paul ME , Barton T , Herbert-Grant M , Hader SL , Garcia EP , Malachowski JL , Nesheim SR . J Acquir Immune Defic Syndr 2011 59 (2) 207-12 BACKGROUND: Three cases of pediatric HIV transmission attributed to the feeding practice of premasticating food for children have been reported. The degree of risk that premastication poses for pediatric HIV transmission and the prevalence of this behavior among HIV-infected caregivers is unknown. METHODS: During December 2009-February 2010, we conducted a case-control investigation of late-diagnosed HIV infection in children at six HIV clinics, using in-person and telephone interviews. A cross-sectional investigation of premastication was conducted in concert with this case-control investigation. RESULTS: We compared 11 case-patients to 35 HIV-exposed controls of similar age. Sixteen (35%) of 46 children were fed premasticated food, 10 (22%) by an HIV-infected caregiver. Twenty-seven percent of case-patients received premasticated food from an HIV-infected caregiver compared to 20% of controls (odds ratio = 1.5; 95% confidence interval = 0.3 - 7.1). In the cross-sectional investigation, 48 (31%) of 154 primary caregivers of children aged ≥6 months reported the children received premasticated food from themselves or someone else. The prevalence of premastication decreased with increasing caregiver age, and had been used to feed children aged 1-36 months. CONCLUSIONS: Premastication, a potential route of HIV transmission to children, was a common practice of caregivers. Public health officials and healthcare providers should educate the public about the potential risk of disease transmission via premastication. |
Enteroviral meningitis and concurrent peripheral motor axonal polyneuropathy
Dulek DE , Donofrio PD , Sejvar JJ , Edwards KM . Pediatr Infect Dis J 2011 31 (2) 206-8 Enteroviral infections can cause acute flaccid paralysis resulting from anterior myelitis, but the occurrence of axonal polyneuropathy is not well described. We report an 8-year-old boy who presented with symmetric, ascending flaccid paralysis and was diagnosed with concurrent echovirus type 9 viral meningitis. |
Initial recovery and rebound of type F intestinal colonization botulism after administration of investigational heptavalent botulinum antitoxin
Fagan RP , Neil KP , Sasich R , Luquez C , Asaad H , Maslanka S , Khalil W . Clin Infect Dis 2011 53 (9) e125-8 Investigational heptavalent botulinum antitoxin (HBAT) is now the primary antitoxin for US noninfant botulism patients. HBAT consists of equine Fab/F(ab')2 IgG fragments, which are cleared from circulation faster than whole immunoglobulins. Rebound botulism after antitoxin administration is not previously documented but occurred in our patient 10 days after HBAT administration. |
Cryptococcus gattii in the United States: clinical aspects of infection with an emerging pathogen
Harris JR , Lockhart SR , Debess E , Marsden-Haug N , Goldoft M , Wohrle R , Lee S , Smelser C , Park B , Chiller T . Clin Infect Dis 2011 53 (12) 1188-95 BACKGROUND: Cryptococcus gattii (Cg) has caused increasing infections in the US Pacific Northwest (PNW) since 2004. We describe this outbreak and compare clinical aspects of infection in the United States among patients infected with different Cg genotypes. METHODS: Beginning in 2005, PNW state health departments conducted retrospective and prospective passive surveillance for Cg infections, including patient interviews and chart reviews; clinical isolates were genotyped at the US Centers for Disease Control and Prevention (CDC). We examined symptom frequency and underlying conditions in US patients with Cg infection and modeled factors associated with death. RESULTS: From 1 December 2004 to July 2011, 96 Cg infections were reported to the CDC. Eighty-three were in patients in or travelers to the PNW, 78 of which were genotypes VGIIa, VGIIb, or VGIIc (outbreak strains). Eighteen patients in and outside the PNW had other molecular type Cg infections (nonoutbreak strains). Patients with outbreak strain infections were more likely than those with nonoutbreak-strain infections to have preexisting conditions (86% vs 31%, respectively; P < .0001) and respiratory symptoms (75% vs 36%, respectively; P = .03) and less likely to have central nervous system (CNS) symptoms (37% vs 90%, respectively; P = .008). Preexisting conditions were associated with increased pneumonia risk and decreased risk of meningitis and CNS symptoms. Nineteen (33%) of 57 patients died. Past-year oral steroid use increased odds of death in multivariate analysis (P = .05). CONCLUSIONS: Clinical differences may exist between outbreak-strain (VGIIa, VGIIb, and VGIIc) and nonoutbreak-strain Cg infections in the United States. Clinicians should have a low threshold for testing for Cg, particularly among patients with recent travel to the PNW. |
Assessing the effectiveness of a community intervention for monkeypox prevention in the Congo Basin
Roess AA , Monroe BP , Kinzoni EA , Gallagher S , Ibata SR , Badinga N , Molouania TM , Mabola FS , Mombouli JV , Carroll DS , Macneil A , Benzekri NA , Moses C , Damon IK , Reynolds MG . PLoS Negl Trop Dis 2011 5 (10) e1356 BACKGROUND: In areas where health resources are limited, community participation in the recognition and reporting of disease hazards is critical for the identification of outbreaks. This is particularly true for zoonotic diseases such as monkeypox that principally affect people living in remote areas with few health services. Here we report the findings of an evaluation measuring the effectiveness of a film-based community outreach program designed to improve the understanding of monkeypox symptoms, transmission and prevention, by residents of the Republic of the Congo (ROC) who are at risk for disease acquisition. METHODOLOGY/PRINCIPAL FINDINGS: During 90 days, monkeypox outreach was conducted for approximately 23,860 people in northern ROC. Two hundred seventy-one attendees (selected via a structured sample) were interviewed before and after participating in a small-group outreach session. The proportion of interviewees demonstrating monkeypox-specific knowledge before and after was compared. Significant gains were measured in areas of disease recognition, transmission, and mitigation of risk. The ability to recognize at least one disease symptom and a willingness to take a family member with monkeypox to the hospital increased from 49 and 45% to 95 and 87%, respectively (p<0.001, both). Willingness to deter behaviors associated with zoonotic risk, such as eating the carcass of a primate found dead in the forest, remained fundamentally unchanged however, suggesting additional messaging may be needed. CONCLUSIONS/SIGNIFICANCE: These results suggest that our current program of film-based educational activities is effective in improving disease-specific knowledge and may encourage individuals to seek out the advice of health workers when monkeypox is suspected. |
Phylogeography and molecular epidemiology of Yersinia pestis in Madagascar.
Vogler AJ , Chan F , Wagner DM , Roumagnac P , Lee J , Nera R , Eppinger M , Ravel J , Rahalison L , Rasoamanana BW , Beckstrom-Sternberg SM , Achtman M , Chanteau S , Keim P . PLoS Negl Trop Dis 2011 5 (9) e1319 BACKGROUND: Plague was introduced to Madagascar in 1898 and continues to be a significant human health problem. It exists mainly in the central highlands, but in the 1990s was reintroduced to the port city of Mahajanga, where it caused extensive human outbreaks. Despite its prevalence, the phylogeography and molecular epidemiology of Y. pestis in Madagascar has been difficult to study due to the great genetic similarity among isolates. We examine island-wide geographic-genetic patterns based upon whole-genome discovery of SNPs, SNP genotyping and hypervariable variable-number tandem repeat (VNTR) loci to gain insight into the maintenance and spread of Y. pestis in Madagascar. METHODOLOGY/PRINCIPAL FINDINGS: We analyzed a set of 262 Malagasy isolates using a set of 56 SNPs and a 43-locus multi-locus VNTR analysis (MLVA) system. We then analyzed the geographic distribution of the subclades and identified patterns related to the maintenance and spread of plague in Madagascar. We find relatively high levels of VNTR diversity in addition to several SNP differences. We identify two major groups, Groups I and II, which are subsequently divided into 11 and 4 subclades, respectively. Y. pestis appears to be maintained in several geographically separate subpopulations. There is also evidence for multiple long distance transfers of Y. pestis, likely human mediated. Such transfers have resulted in the reintroduction and establishment of plague in the port city of Mahajanga, where there is evidence for multiple transfers both from and to the central highlands. CONCLUSIONS/SIGNIFICANCE: The maintenance and spread of Y. pestis in Madagascar is a dynamic and highly active process that relies on the natural cycle between the primary host, the black rat, and its flea vectors as well as human activity. |
Evidence of efficient transovarial transmission of Culex flavivirus by Culex pipiens (Diptera: Culicidae)
Saiyasombat R , Bolling BG , Brault AC , Bartholomay LC , Blitvich BJ . J Med Entomol 2011 48 (5) 1031-8 This study determined the transovarial transmission (TOT) potential and tissue tropisms of Culex flavivirus (CxFV), an insect-specific flavivirus, in Culex pipiens (L.). Several hundred mosquito egg rafts were collected in the field, transferred to the insectaries, reared to the fourth larval instar, and identified using morphological characteristics. Cx. pipiens were reared to adults, allowed to oviposit in individual containers, and tested for CxFV RNA by reverse transcription-polymerase chain reaction (RT-PCR) and nucleotide sequencing. Eighteen CxFV RNA-positive females were identified from 26 females that oviposited viable egg rafts. Thirty F1 adults from each positive female were individually tested by RT-PCR for CxFV RNA. Viral RNA was detected in 526 of 540 progeny, and thus, the filial infection rate was 97.4%. Because all 18 positive females produced infected offspring, the TOT prevalence was 100%. These data indicated that efficient TOT of CxFV occurs in nature. To define the tissue tropisms of CxFV, different tissues (salivary glands, ovaries, testes, head, fat bodies, and midguts) were removed from the remainder of the F1 and tested by RT-PCR for CxFV RNA. Viral RNA was detected in all tissues. Additionally, uninfected laboratory-colonized Cx. pipiens were infected with CxFV by needle inoculation, and ovaries were collected at 4, 6, 8, and 12 d postinoculation and tested for CxFV RNA by RT-PCR. Viral RNA was detected at all time points, demonstrating that CxFV infects the ovaries as early as 4 d postinoculation. Surprisingly, however, we were unable to demonstrate transovarial transmission despite the presence of viral RNA in the ovaries. Nevertheless, the experiments performed with field-infected Cx. pipiens demonstrate that TOT is an efficient mechanism by which CxFV is maintained in mosquitoes in nature. |
American Mosquito Control Association presidential address: association activities in 2010-11
McAllister JC . J Am Mosq Control Assoc 2011 27 (3) 187-90 Welcome to Anaheim and the 77th annual meeting of the American Mosquito Control Association (AMCA). I would like to sincerely thank you for showing your confidence in me by making me your president this past year. I think of AMCA as the flagship association in the world when it comes to mosquitoes and associated vectors. I truly believe that status comes from what I consider to be the greatest strength of the association: the diverse group of people that make up the AMCA. As you are aware, the AMCA is made up of individuals and institutions. Membership spans a wide variety of groups: practitioners, academicians, industry, and regulators. Within each group there are still more specialized interests. For example, among academicians there are taxonomists, toxicologists, ecologists, malariaologists, statisticians, and many other disciplines. Among practitioners there are managers, biologists, inspectors, pilots, mechanics, and trustees among others. Among industry there are sales representatives, managers, product developers, and more. Each group brings a different perspective to the association and each group has different expectations as to what they need and expect from AMCA. Indeed, it is with this diversity in mind that AMCA has been trying to provide better reasons for becoming and staying a member. | Several recent initiatives have begun to provide more opportunity for members to get more value for their dues. The first of these is print on demand. The AMCA has partnered with Fairfax County, VA, to offer access to their art work for calendars, books, and more. Jorge Arias has offered their material to anyone to put their own logo on. This service will be coordinated through the printer Fairfax County uses. If you want to find out more information and see examples please stop by the AMCA booth in the exhibit hall. |
The Centers for Disease Control and Prevention resting trap: a novel device for collecting resting mosquitoes
Panella NA , Crockett RJ , Biggerstaff BJ , Komar N . J Am Mosq Control Assoc 2011 27 (3) 323-5 Commercially available wood-fiber pots used to collect resting mosquitoes were modified to improve sampling efficiency. The modified traps, called the Centers for Disease Control and Prevention resting traps, collected 16.0 and 5.2 times more adult Culex pipiens and Cx. tarsalis than the conventional wood-fiber pots. The resting trap increases the mean number of resting mosquitoes collected per trap-night and is useful for collecting blood-engorged mosquitoes. |
Dioxin and polychlorinated biphenyl concentrations in mother's serum and the timing of pubertal onset in sons
Humblet O , Williams PL , Korrick SA , Sergeyev O , Emond C , Birnbaum LS , Burns JS , Altshul L , Patterson DG Jr , Turner WE , Lee MM , Revich B , Hauser R . Epidemiology 2011 22 (6) 827-835 BACKGROUND: Animal studies have demonstrated that timing of pubertal onset can be altered by prenatal exposure to dioxins or polychlorinated biphenyls (PCBs), but studies of human populations have been quite limited. METHODS: We assessed the association between maternal serum concentrations of dioxins and PCBs and the sons' age of pubertal onset in a prospective cohort of 489 mother-son pairs from Chapaevsk, Russia, a town contaminated with these chemicals during past industrial activity. The boys were recruited at ages 8 to 9 years, and 4 years of annual follow-up data were included in the analysis. Serum samples were collected at enrollment from both mothers and sons for measurement of dioxin and PCB concentrations using high-resolution mass spectrometry. The sons' pubertal onset-defined as pubertal stage 2 or higher for genitalia (G) or pubic hair (P), or testicular volume >3 mL-was assessed annually by the same physician. RESULTS: In multivariate Cox models, elevated maternal serum PCBs were associated with earlier pubertal onset defined by stage G2 or higher (4th quartile hazard ratio = 1.7 [95% confidence interval = 1.1- 2.5]), but not for stage P2 or higher or for testicular volume >3 mL. Maternal serum concentrations of dioxin toxic equivalents were not consistently associated with the sons' pubertal onset, although a dose-related delay in pubertal onset (only for G2 or higher) was seen among boys who breast-fed for 6 months or more. CONCLUSIONS: Maternal PCB serum concentrations measured 8 or 9 years after sons' births-which may reflect sons' prenatal and early-life exposures-were associated with acceleration in some, but not all, measures of pubertal onset. |
Using social media for research and public health surveillance
Eke PI . J Dent Res 2011 90 (9) 1045-6 The article in this issue of JDR by Heaivilin and colleagues with the title ‘Public Health Surveillance of Dental Pain via Twitter” (Heaivilin et al., 2011) introduces a potential new data source for dental surveillance and research, namely, publicly available information from the social network medium “Twitter”. The authors present a novel idea and approach in using publicly available Twitter data to assess dental pain experiences. Undoubtedly, monitoring episodes of dental pain, including the impact of the pain and actions taken to relieve pain, is a worthwhile objective for dental public health and has indeed been assessed in previous population-based surveys such as in the National Health and Nutrition Survey (NHANES) and National Health Interview Surveys (NHIS) (Beltrán-Aguilar et al., 2005; NIDCR/CDC DRC, 2011). This perspective provides a brief critical assessment of the use of Twitter for public health surveillance and research. | Public health surveillance is the ongoing systematic collection, analysis, and interpretation of health data from defined populations for use in planning, implementing, and evaluating public health programs (Thacker and Berkelman, 1988). The most important attributes of public health surveillance systems include simplicity, flexibility, and acceptability of the data collection instruments, as well as sensitivity, positive predictive value, representativeness, and timeliness of the data collected (Romaguera et al., 2000). It can be argued that tools such as Twitter do possess some of these attributes. Notably, Twitter data are available publically, and the data are relatively simple to access, extract, and analyze, as exemplified by the study by Heaivilin’s group (Heaivilin et al., 2011). Furthermore, tweets are reported in real time by millions of real persons from across several continents and are communicated via a variety of simple and easy-to-use formats, which are increasingly accessible in most populations. |
Challenges and opportunities in a tuberculosis outbreak investigation in southern Mississippi, 2005-2007
Bloss E , Newbill K , Peto H , Rice MJ , Ainsworth G , Travnicek R , Holcombe M , Haddad MB , Oeltmann JE . South Med J 2011 104 (11) 731-5 OBJECTIVE: Between December 2005 and November 2007, a cluster of 11 tuberculosis (TB) cases emerged in Jackson County, Mississippi. We investigated the potential sources of disease transmission and epidemiologic links in this cluster to prevent future transmission in the community. MATERIALS AND METHODS: Cases of TB reported in Jackson County from December 2005 to November 2007 having matching genotypes or social links to patients with matching genotypes were included in the investigation. We interviewed patients, reviewed medical records, and performed contact investigations. RESULTS: The combined genotyping and epidemiologic data pointed to ongoing TB transmission in this rural community. A combination of patient-specific and programmatic factors, including substance use, delays in TB diagnosis, nonadherence, and TB program staffing cuts, contributed to this outbreak in the context of the 2004 and 2005 Atlantic hurricane seasons. CONCLUSIONS: To eliminate Mycobacterium tuberculosis transmission in this setting, recommendations for the TB program include enhanced coordination with substance abuse programs, community and provider education, and increased outreach capacity. |
Gnathostomiasis in a patient who frequently consumes sushi
Jarell AD , Dans MJ , Elston DM , Mathison BA , Ruben BS . Am J Dermatopathol 2011 33 (8) e91-3 A 45-year-old woman presented for evaluation of a solitary pruritic nodule on the abdomen that suddenly appeared 3 weeks before. She was healthy without a significant medical history, travel history, exposures, medications, or pets. She reported that she consumed sushi at least weekly in the city of San Francisco. A punch biopsy revealed a superficial and deep perivascular and interstitial infiltrates consisting of lymphocytes, plasma cells, and many eosinophils. Most notably, there was a parasite centered in the reticular dermis with prominent lateral chords, a well-developed muscular esophagus, and an intestine that contained a brush border and multinucleate cells. Evaluation of these histological sections by the Centers for Disease Control and Prevention determined the parasite to be a nematode of the genus Gnathostoma. The patient underwent a systemic work-up for gnathostomiasis, including imaging, and no other abnormalities were found. She completed a 3-week course of albendazole and has remained asymptomatic since the biopsy of her abdominal lesion. Although gnathostomiasis is often a systemic illness, this patient did well with apparently only localized cutaneous disease. Gnathostomiasis should be considered in patients who present with nonspecific papules and nodules, especially when there is a history of frequent consumption of raw fish. |
Implementing screening for Lynch syndrome among patients with newly diagnosed colorectal cancer: summary of a public health/clinical collaborative meeting.
Bellcross CA , Bedrosian SR , Daniels E , Duquette D , Hampel H , Jasperson K , Joseph DA , Kaye C , Lubin I , Meyer LJ , Reyes M , Scheuner MT , Schully SD , Senter L , Stewart SL , St Pierre J , Westman J , Wise P , Yang VW , Khoury MJ . Genet Med 2011 14 (1) 152-62 Lynch syndrome is the most common cause of inherited colorectal cancer, accounting for approximately 3% of all colorectal cancer cases in the United States. In 2009, an evidence-based review process conducted by the independent Evaluation of Genomic Applications in Practice and Prevention Working Group resulted in a recommendation to offer genetic testing for Lynch syndrome to all individuals with newly diagnosed colorectal cancer, with the intent of reducing morbidity and mortality in family members. To explore issues surrounding implementation of this recommendation, the Centers for Disease Control and Prevention convened a multidisciplinary working group meeting in September 2010. This article reviews background information regarding screening for Lynch syndrome and summarizes existing clinical paradigms, potential implementation strategies, and conclusions, which emerged from the meeting. It was recognized that wide-spread implementation will present substantial challenges, and additional data from pilot studies will be needed. However, evidence of feasibility and population health benefits and the advantages of considering a public health approach were acknowledged. Lynch syndrome can potentially serve as a model to facilitate the development and implementation of population-level programs for evidencebased genomic medicine applications involving follow-up testing of at-risk relatives. Such endeavors will require multilevel and multidisciplinary approaches building on collaborative public health and clinical partnerships. |
Mammography adherence: results of a focus group study
Watson-Johnson LC , Degroff A , Steele CB , Revels M , Smith JL , Justen E , Barron-Simpson R , Sanders L , Richardson LC . J Womens Health (Larchmt) 2011 20 (12) 1887-94 BACKGROUND: Regular mammography accounts for half of the recent declines in breast cancer mortality. Mammography use declined significantly in 2008. Given the success of regular breast cancer screening, understanding why mammography use decreased is important. We undertook a focus group study to explore reasons women who were previously adherent with regular mammography no longer were screened. METHODS: We conducted 20 focus groups with white non-Hispanic, black non-Hispanic, Hispanic, Japanese American, and American Indian/Alaska Native women, and segmented the groups by age, race/ethnicity, and health insurance status. A conceptual framework, based on existing research, informed the development of the focus group guide. Discussion topics included previous mammography experiences, perceptions of personal breast cancer risk, barriers to mammography, and risks and benefits associated with undergoing mammography. Atlas.ti was used to facilitate data analysis. RESULTS: All focus groups (n=128 women) were completed in 2009 in five cities across the United States. Half of the groups were held with white non-Hispanic women and the remainder with other racial/ethnic groups. Major barriers to routine mammography included (1) concerns about test efficacy, (2) personal concerns about the procedure, (3) access to screening services, (4) psychosocial issues, and (5) cultural factors. For uninsured women, lack of health insurance was the primary barrier to mammography. CONCLUSIONS: Multilevel interventions at the health-care provider and system levels are needed to address barriers women experience to undergoing regular mammography screening. Ultimately, breast cancer screening with mammography is an individual behavior; therefore, individual behavioral change strategies will continue to be needed. |
Hepatitis B outbreak associated with a hematology-oncology office practice in New Jersey, 2009.
Greeley RD , Semple S , Thompson ND , High P , Rudowski E , Handschur E , Xia GL , Ganova-Raeva L , Crawford J , Robertson C , Tan C , Montana B . Am J Infect Control 2011 39 (8) 663-70 BACKGROUND: Transmission of bloodborne pathogens due to breaches in infection control is becoming increasingly recognized as greater emphasis is placed on reducing health care-associated infections. Two women, aged 60 and 77 years, were diagnosed with acute hepatitis B virus (HBV) infection; both received chemotherapy at the same physician's office. Due to suspicion of health care-associated HBV transmission, a multidisciplinary team initiated an investigation of the hematology-oncology office practice. METHODS: We performed an onsite inspection and environmental assessment, staff interviews, records review, and observation of staff practices. Patients who visited the office practice between January 1, 2006 and March 3, 2009 were advised to seek testing for bloodborne pathogens. Patients and medical providers were interviewed. Specimens from HBV-infected patients were sent to the Centers for Disease Control and Prevention for HBV DNA testing and phylogenic analysis. RESULTS: Multiple breaches in infection control were identified, including deficient policies and procedures, improper hand hygiene, medication preparation in a blood processing area, common-use saline bags, and reuse of single-dose vials. The office practice was closed, and the physician's license was suspended. Out of 2,700 patients notified, test results were available for 1,394 (51.6%). Twenty-nine outbreak-associated HBV cases were identified. Specimens from 11 case-patients demonstrated 99.9%-100% nucleotide identity on phylogenetic analysis. CONCLUSION: Systematic breaches in infection control led to ongoing transmission of HBV infection among patients undergoing invasive procedures at the office practice. This investigation underscores the need for improved regulatory oversight of outpatient health care settings, improved infection control and injection safety education for health care providers, and the development of mechanisms for ongoing communication and cooperation among public health agencies. |
Infection control: accomplishments and priorities from an individual, state, national, and international perspective
Rasslan O , Ellingson K , Stricof RL , Grant PS . Am J Infect Control 2011 39 (8) 624-7 In celebration of International Infection Control Week (October 16-22), we have asked 4 of AJIC's colleagues to address the following: | • | Major accomplishments in infection prevention over the past decade or so; | • | major priorities for infection prevention for the next 5 years; and | • | 1 “action message” for infection preventionists (ie, something they should attend to/focus on). | | Dr. Rasslan provides an international perspective, Dr. Ellingson a national perspective, Ms. Stricof a state perspective, and Ms. Grant responds from the perspective of the individual infection preventionist. |
Report of the 7th meeting on Evaluation of Pandemic Influenza Vaccines in Clinical Trials, World Health Organization, Geneva, 17-18 February 2011
Girard MP , Katz JM , Pervikov Y , Hombach J , Tam JS . Vaccine 2011 29 (44) 7579-86 On February 17-18, 2011, the World Health Organization convened the 7th meeting on "The Evaluation of Pandemic Influenza Vaccines in Clinical Trials" to review the progress made on pandemic A (H1N1) 2009 vaccines and the evaluation of their effectiveness in the field, especially in children less than 3 years of age and in pregnant women. Other topics to be addressed included a comparison of egg- and cell culture-based influenza vaccines, technical issues related to vaccine strain development and vaccine potency, and the status of development of prototype influenza vaccines using new technologies. Pandemic A (H1N1) vaccines were safe in young children, pregnant women and immunocompromized individuals. Overall effectiveness of inactivated A (H1N1) vaccines for all ages was found to vary between 72% and 100% in different countries and with different vaccine preparations. Effectiveness of pandemic A (H1N1) 2009 live attenuated vaccine was estimated to be approximately 80% in pediatric populations in the USA. A single dose of inactivated vaccine adjuvanted with AS03, MF59 or AF03 induced protective immunity in young children and pregnant women. However, unadjuvanted vaccines as well as low dose adjuvanted vaccines (1.9 mcg HA) required two doses to elicit protective antibody levels in these populations. Clinical trials of influenza vaccines developed using new technologies showed they were well tolerated and induced antibody and/or T cell immune responses to viral proteins. Further studies are warranted to validate novel immunological criteria for evaluation and licensing of such new influenza vaccine concepts. On the regulatory side, work should be undertaken to harmonize the results of serological tests used to evaluate the immunogenicity of traditional influenza vaccines. |
Safety and immunogenicity of LC16m8, an attenuated smallpox vaccine in vaccinia-naive adults
Kennedy JS , Gurwith M , Dekker CL , Frey SE , Edwards KM , Kenner J , Lock M , Empig C , Morikawa S , Saijo M , Yokote H , Karem K , Damon I , Perlroth M , Greenberg RN . J Infect Dis 2011 204 (9) 1395-402 INTRODUCTION: LC16m8 is an attenuated cell culture-adapted Lister vaccinia smallpox vaccine missing the B5R protein and licensed for use in Japan. METHODS: We conducted a phase I/II clinical trial that compared the safety and immunogenicity of LC16m8 with Dryvax in vaccinia-naive participants. Adverse events were assessed, as were electrocardiography and laboratory testing for cardiotoxicity and viral culturing of the vaccination sites. Neutralization titers to vaccinia, monkeypox, and variola major were assessed and cell-mediated immune responses were measured by interferon (IFN)-gamma enzyme-linked immunosorbent spot and lymphoproliferation assays. RESULTS: Local and systemic reactions after vaccination with LC16m8 were similar to those reported after Dryvax. No clinically significant abnormalities consistent with cardiac toxicity were seen for either vaccine. Both vaccines achieved antivaccinia, antivariola, and antimonkeypox neutralizing antibody titers >1:40, although the mean plaque reduction neutralization titer of LC16m8 at day 30 after vaccination was significantly lower than Dryvax for anti-NYCBH vaccinia (P < .01), antimonkeypox (P < .001), and antivariola (P < .001). LC16m8 produced robust cellular immune responses that trended higher than Dryvax for lymphoproliferation (P = .06), but lower for IFN-gamma ELISPOT (P = .02). CONCLUSIONS: LC16m8 generates neutralizing antibody titers to multiple poxviruses, including vaccinia, monkeypox, and variola major, and broad T-cell responses, indicating that LC16m8 may have efficacy in protecting individuals from smallpox. CLINICAL TRIALS REGISTRATION: NCT00103584. |
Safety of zoster vaccine in adults from a large managed care cohort: a Vaccine Safety Datalink Study
Tseng HF , Liu A , Sy L , Marcy SM , Fireman B , Weintraub E , Baggs J , Weinmann S , Baxter R , Nordin J , Daley MF , Jackson L , Jacobsen SJ . J Intern Med 2011 271 (5) 510-20 OBJECTIVES: The aim of this study is to examine a large cohort of adults who received the zoster vaccine for evidence of an increased risk of pre-specified adverse events requiring medical attention. DESIGN: Two self-comparison approaches, including a case-centered approach and a self-controlled case series (SCCS) analysis were used. SETTING: Eight managed care organizations participating in the Vaccine Safety Datalink project in the United States. SUBJECTS: A total of 193,083 adults aged 50 and older receiving a zoster vaccine from January 1(st) 2007 to December 31(st) 2008 were included. MAIN OUTCOME MEASURES: Pre-specified adverse events were identified by aggregated International Classification of Diseases, Ninth Revision (ICD-9) codes in automated health plan datasets. RESULTS: The risk of allergic reaction was significantly increased within 1-7 days of vaccination (relative risk =2.13, 95% Confidence Interval (CI): 1.87-2.40 by case-centered method and relative rate=2.32, 95% CI: 1.85-2.91 by SCCS). No increased risk was found for the following adverse event groupings: cerebrovascular events; cardiovascular events; meningitis, encephalitis, and encephalopathy; and Ramsay-Hunt syndrome and Bell's palsy. CONCLUSIONS: The results of this study support the findings from the pre-licensure clinical trials, providing reassurance that the zoster vaccine is generally safe and well tolerated with a small increased risk of allergic reactions in 1-7 days after vaccination. |
Vaccines and neurologic disease
Sejvar JJ . Semin Neurol 2011 31 (3) 338-55 Vaccines have undoubtedly been a medical milestone, preventing immeasurable morbidity and mortality from infectious diseases worldwide. Modern vaccines have tremendously reduced the global impact of numerous infections; they have succeeded in eliminating smallpox completely. However, the nature by which vaccines confer their protection-by stimulation of the immune system-means that in rare cases, adverse often immunologically mediated events may occur following vaccination. Some of the most severe of these involve the nervous system. The author provides an overview of the mechanisms of vaccinology, and describes the various vaccines available for particular neurologic illnesses. Possible neurologic adverse events following vaccinations, and the possible mechanisms of these events, are also discussed. Finally, procedures in place to ensure vaccine safety are reviewed. |
Virus-like particle vaccine containing hemagglutinin confers protection against 2009 H1N1 pandemic influenza
Hossain MJ , Bourgeois M , Quan FS , Lipatov AS , Song JM , Chen LM , Compans RW , York I , Kang SM , Donis RO . Clin Vaccine Immunol 2011 18 (12) 2010-7 Immunization of the world population before an influenza pandemic such as the 2009 H1N1 spreads globally is not possible with current vaccine production platforms. New influenza vaccine technologies, such as virus-like-particles (VLP), offer a promising alternative. Here, we tested the immunogenicity and protective efficacy of a VLP vaccine containing HA and M1 from the 2009 pandemic H1N1 influenza virus (H1N1pdm) in ferrets and compared IM and IN routes of immunization. Vaccination of ferrets with VLPs containing the M1 and HA proteins from A/California/04/2009 (H1N1pdm) induced high antibody titers and conferred significant protection against virus challenge. VLP-vaccinated animals lost less weight, shed less virus in nasal washes, and had markedly lower virus titers in all organs tested than naive controls. A single dose of VLPs, either IM or IN, induced higher levels of antibody than did two doses of commercial split vaccine. Ferrets vaccinated with split vaccine were incompletely protected against challenge; these animals had lower virus titers in olfactory bulbs, tonsils, and intestines, but lost weight and shed virus in nasal washes to a similar extent as naive controls. Challenge with heterologous A/Brisbane/59/07 (H1N1) virus revealed that the VLPs conferred minimal cross-protection to heterologous infection as revealed by the lack of reduction in nasal wash and lung virus titers and slightly higher weight loss relative to controls. In summary, these experiments demonstrate the strong immunogenicity and protective efficacy of VLPs compared to the split vaccine, and show that IN vaccination with VLPs has the potential for highly efficacious vaccination against influenza. |
Wheezing lower respiratory disease and vaccination of premature infants
Mullooly JP , Schuler R , Mesa J , Drew L , Destefano F . Vaccine 2011 29 (44) 7611-7617 PURPOSE: Premature infants are at increased risk of wheezing in association with respiratory syncytial virus (RSV) and rhinovirus infections. We assess possible associations between wheezing and routine vaccinations of premature infants. METHODS: We conducted a self-controlled case series (SCCS) study of premature infants born at five health maintenance organizations (HMO's) from 1997 to 2002 (N=18,628). Episodes of medically attended wheezing lower respiratory diseases (WLRD) were ascertained from ICD-9 coded database records. Relative risks of WLRD during post-vaccination exposure windows were estimated by Cox proportional hazard regression with time-dependent vaccine exposure variables, adjusted for age, season, and frequency of well-baby visits. RESULTS: WLRD hazard ratios (HR) were not significantly elevated for any vaccine type among non-fragile or fragile premature infants. Among non-fragile infants the 8-14 days HR was significantly reduced for live attenuated MMR (0.68, 0.52-0.88) and Varicella (0.71, 0.53-0.94) vaccines, and similarly but insignificantly reduced for infrequently used live attenuated OPV vaccine (0.70, 0.46-1.06). There was a smaller significant reduction (0.83, 0.69-0.998) in the 15-30 days HR for MMR and a similar but not significant reduction (0.86, 0.71-1.05) in the 31-44 days HR for MMR. Hepatitis B vaccine (HBV), which is not a live vaccine, had significantly reduced 8-14 days (0.84, 0.72-0.98) and 31-44 days (0.88, 0.78-0.98) HRs among non-fragile infants. The apparent protective effect of HBV may be confounded by live vaccines administered simultaneously with the third dose of HBV. Among fragile infants there was a large significant reduction in the 8-14 days HR for live attenuated OPV vaccine (0.40, 0.23-0.70) and smaller significant reductions in the 8-14 days HR for inactivated DTaP (0.82, 0.71-0.95), Hib (0.83, 0.73-0.96), and PCV7 (0.84, 0.70-0.997) vaccines. Delays in vaccinating fragile infants may have made simultaneous administration of live vaccines and third doses of these inactivated vaccines more likely. CONCLUSIONS: We found no evidence of increased WLRD risk following routine vaccinations of premature infants. WLRD risk among non-fragile premature infants appears to be reduced for a few weeks after live attenuated vaccinations. |
A multi-center, qualitative assessment of pediatrician and maternal perspectives on rotavirus vaccines and the detection of Porcine circovirus
Payne DC , Humiston S , Opel D , Kennedy A , Wikswo M , Downing K , Klein EJ , Kobayashi A , Locke D , Albertin C , Chesley C , Staat MA . BMC Pediatr 2011 11 83 BACKGROUND: In 2010, researchers using novel laboratory techniques found that US-licensed rotavirus vaccines contain DNA or DNA fragments from Porcine circovirus (PCV), a virus common among pigs but not believed to cause illness in humans. We sought to understand pediatricians' and mothers' perspectives on this finding. METHODS: We conducted three iterations of focus groups for pediatricians and non-vaccine hesitant mothers in Seattle, WA, Cincinnati, OH, and Rochester, NY. Focus groups explored perceptions of rotavirus disease, rotavirus vaccination, and attitudes about the detection of PCV material in rotavirus vaccines. RESULTS: Pediatricians understood firsthand the success of rotavirus vaccines in preventing severe acute gastroenteritis among infants and young children. They measured this benefit against the theoretical risk of DNA material from PCV in rotavirus vaccines, determining overall that the PCV finding was of no clinical significance. Particularly influential was the realization that the large, randomized clinical trials that found both vaccines to be highly effective and safe were conducted with DNA material from PCV already in the vaccines. Most mothers supported the ideal of full disclosure regarding vaccination risks and benefits. However, with a scientific topic of this complexity, simplified information regarding PCV material in rotavirus vaccines seemed frightening and suspicious, and detailed information was frequently overwhelming. Mothers often remarked that if they did not understand a medical or technical topic regarding their child's health, they relied on their pediatrician's guidance. Many mothers and pediatricians were also concerned that persons who abstain from pork consumption for religious or personal reasons may have unsubstantiated fears of the PCV finding. CONCLUSIONS: Pediatricians considered the detection of DNA material from PCV in rotavirus vaccines a "non-issue" and reported little hesitation in continuing to recommend the vaccines. Mothers desired transparency, but ultimately trusted their pediatrician's recommendation. Both vaccines are currently approved for their intended use, and no risk of human PCV illness has been reported. Communicating this topic to pediatricians and mothers requires sensitivity to a broad range of technical understanding and personal concerns. |
Novel formulations enhance the thermal stability of live-attenuated flavivirus vaccines
Wiggan O , Livengood JA , Silengo SJ , Kinney RM , Osorio JE , Huang CY , Stinchcomb DT . Vaccine 2011 29 (43) 7456-62 Thermal stability is important for the manufacture, distribution and administration of vaccines, especially in tropical developing countries, where particularly adverse field conditions exist. Current live-attenuated flavivirus vaccines exhibit relatively poor liquid stability in clinical settings, and clinicians are instructed to discard the yellow fever vaccine 1h after reconstitution. We have identified novel combinations of excipients that greatly enhance the thermal stability of live-attenuated DEN-2 PDK-53-based flavivirus vaccine candidates. Liquid formulations comprising a sugar, albumin and a pluronic polymer minimized the loss of flavivirus infectious titer to less than 0.5log(10)pfu after storage for at least 8h at 37 degrees C, 7 days at room temperature or at least 11 weeks at 4 degrees C. Additionally, these formulations prevented reduction of viral infectivity after two freeze-thaw cycles of virus. Formulated candidate vaccines were readily lyophilized and reconstituted with minimal loss of viral titers. In mice, the formulations were safe and did not hinder the ability of the vaccine virus to generate a potent, protective immune response. These formulations provided significantly greater liquid-phase stability than has been reported previously for other flavivirus vaccine formulations. The enhanced thermal stability provided by the formulations described here will facilitate the effective distribution of flavivirus vaccines worldwide. |
Parent and adolescent perspectives about adolescent vaccine delivery: practical considerations for vaccine communication
Rand CM , Humiston SG , Schaffer SJ , Albertin CS , Shone LP , Blumkin AK , Stokley S , Szilagyi PG . Vaccine 2011 29 (44) 7651-8 We surveyed parents of adolescents (n=430) and their adolescents ages 15-17 years (n=208) in 9 primary-care settings in Monroe County, NY to assess perceptions about adolescent vaccine delivery. Parents and adolescents most wanted to discuss vaccine side effects and the diseases prevented with the adolescents' provider. Those who perceived vaccines as very safe were more accepting of adolescent vaccines. Most participants agreed with vaccinating the teen during a mild illness and with providing multiple vaccines concomitantly. Participants most preferred medical, as opposed to other settings, for receipt of adolescent vaccines. For parents and adolescents who are wary of vaccination, strategies are needed to enhance communication about risks and benefits of vaccinations. |
Evaluation of hepatitis B vaccine immunogenicity among older adults during an outbreak response in assisted living facilities
Tohme RA , Awosika-Olumo D , Nielsen C , Khuwaja S , Scott J , Xing J , Drobeniuc J , Hu DJ , Turner C , Wafeeg T , Sharapov U , Spradling PR . Vaccine 2011 29 (50) 9316-20 BACKGROUND: During the past decade, in the United States, an increasing number of hepatitis B outbreaks have been reported in assisted living facilities (ALFs) as a result of breaches in infection control practices. We evaluated the seroprotection rates conferred by hepatitis B vaccine among older adults during a response to an outbreak that occurred in multiple ALFs and assessed the influence of demographic and clinical factors on vaccine response. METHODS: Residents were screened for hepatitis B and C infection prior to vaccination and susceptible residents were vaccinated against hepatitis B with one dose of 20mcg Engerix-B (GSK) given at 0, 1, and 4 months. Blood samples were collected 80-90 days after the third vaccine dose to test for anti-HBs levels. RESULTS: Of the 48 residents who had post-vaccination blood specimens collected after the third vaccine dose, 16 (33.3%) achieved anti-HBs concentration ≥10mIU/mL. Age was a significant determinant of seroprotection with rates decreasing from 88% among persons aged ≤60 years to 12% among persons aged ≥90 years (p=0.001). Geometric mean concentrations were higher among non-diabetic than diabetic residents, however, the difference was not statistically significant (5.1 vs. 3.8mIU/mL, p=0.7). CONCLUSIONS: These findings highlight that hepatitis B vaccination is of limited effectiveness when administered to older adults. Improvements in infection control and vaccination at earlier ages might be necessary to prevent spread of infection in ALFs. |
From the CDC: new country-specific recommendations for pre-travel typhoid vaccination
Johnson KJ , Gallagher NM , Mintz ED , Newton AE , Brunette GW , Kozarsky PE . J Travel Med 2011 18 (6) 430-433 Typhoid fever continues to be an important concern for travelers visiting many parts of the world. This communication provides updated guidance for pre-travel typhoid vaccination from the US Centers for Disease Control and Prevention (CDC) and describes the methodology for assigning country-specific recommendations. |
2008 estimate of worldwide rotavirus-associated mortality in children younger than 5 years before the introduction of universal rotavirus vaccination programmes: a systematic review and meta-analysis
Tate JE , Burton AH , Boschi-Pinto C , Steele AD , Duque J , Parashar UD . Lancet Infect Dis 2011 12 (2) 136-41 BACKGROUND: WHO recommends routine use of rotavirus vaccines in all countries, particularly in those with high mortality attributable to diarrhoeal diseases. To establish the burden of life-threatening rotavirus disease before the introduction of a rotavirus vaccine, we aimed to update the estimated number of deaths worldwide in children younger than 5 years due to diarrhoea attributable to rotavirus infection. METHODS: We used PubMed to identify studies of at least 100 children younger than 5 years who had been admitted to hospital with diarrhoea. Additionally, we required the studies to have a data collection midpoint of the year 2000 or later, to be done in full-year increments, and to assesses diarrhoea attributable to rotavirus with EIAs or polyacrylamide gel electrophoresis. We also included data from countries that participated in the WHO-coordinated Global Rotavirus Surveillance Network (consisting of participating member states during 2009) and that met study criteria. For countries that have introduced a rotavirus vaccine into their national immunisation programmes, we excluded data subsequent to the introduction. We classified studies into one of five groups on the basis of region and the level of child mortality in the country in which the study was done. For each group, to obtain estimates of rotavirus-associated mortality, we multiplied the random-effect mean rotavirus detection rate by the 2008 diarrhoea-related mortality figures for countries in that group. We derived the worldwide mortality estimate by summing our regional estimates. FINDINGS: Worldwide in 2008, diarrhoea attributable to rotavirus infection resulted in 453 000 deaths (95% CI 420 000-494 000) in children younger than 5 years-37% of deaths attributable to diarrhoea and 5% of all deaths in children younger than 5 years. Five countries accounted for more than half of all deaths attributable to rotavirus infection: Democratic Republic of the Congo, Ethiopia, India, Nigeria, and Pakistan; India alone accounted for 22% of deaths (98 621 deaths). INTERPRETATION: Introduction of effective and available rotavirus vaccines could substantially affect worldwide deaths attributable to diarrhoea. Our new estimates can be used to advocate for rotavirus vaccine introduction and to monitor the effect of vaccination on mortality once introduced. FUNDING: None. |
Acceptability of school requirements for human papillomavirus vaccine
Smith JS , Brewer NT , Chang Y , Liddon N , Guerry S , Pettigrew E , Markowitz LE , Gottlieb SL . Hum Vaccin 2011 7 (9) 952-7 We characterized parental attitudes regarding school HPV vaccination requirements for adolescent girls. Study participants were 889 parents of 10-18 year-old girls in areas of North Carolina with elevated cervical cancer incidence. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) by logistic regression. Approximately half (47%) of parents agreed that laws requiring HPV immunization for school attendance "are a good idea" when opt-out provisions were not mentioned. Far more agreed that "these laws are okay only if parents can opt out if they want to" (84%). Predictors of supporting requirements included believing HPV vaccine is highly effective against cervical cancer (OR=2.5, 95%CI:1.7-5.0) or is more beneficial if provided at an earlier age (OR=16.1, 95%CI:8.4-30.9). Parents were less likely to agree with vaccine requirements being a good idea if they expressed concerns related to HPV vaccine safety (OR=0.3, 95%CI:0.1-0.5), its recent introduction (OR=0.3,95%CI:0.2-0.6), or its potential to increase their daughters' sexual activity (OR=0.4,95%CI:0.2-0.6). Parental acceptance of school requirements appears to depend on perceived HPV vaccine safety and efficacy, understanding of the optimal age for vaccine administration, and inclusion of opt-out provisions. |
Antiviral activity and increased host defense against influenza infection elicited by the human cathelicidin LL-37
Barlow PG , Svoboda P , Mackellar A , Nash AA , York IA , Pohl J , Davidson DJ , Donis RO . PLoS One 2011 6 (10) e25333 The extensive world-wide morbidity and mortality caused by influenza A viruses highlights the need for new insights into the host immune response and novel treatment approaches. Cationic Host Defense Peptides (CHDP, also known as antimicrobial peptides), which include cathelicidins and defensins, are key components of the innate immune system that are upregulated during infection and inflammation. Cathelicidins have immunomodulatory and anti-viral effects, but their impact on influenza virus infection has not been previously assessed. We therefore evaluated the effect of cathelicidin peptides on disease caused by influenza A virus in mice. The human cathelicidin, LL-37, and the murine cathelicidin, mCRAMP, demonstrated significant anti-viral activity in vivo, reducing disease severity and viral replication in infected mice to a similar extent as the well-characterized influenza virus-specific antiviral drug zanamivir. In vitro and in vivo experiments suggested that the peptides may act directly on the influenza virion rather than via receptor-based mechanisms. Influenza virus-infected mice treated with LL-37 had lower concentrations of pro-inflammatory cytokines in the lung than did infected animals that had not been treated with cathelicidin peptides. These data suggest that treatment of influenza-infected individuals with cathelicidin-derived therapeutics, or modulation of endogenous cathelicidin production may provide significant protection against disease. |
Attitudes and practices of obstetrician-gynecologists regarding influenza vaccination in pregnancy
Kissin DM , Power ML , Kahn EB , Williams JL , Jamieson DJ , Macfarlane K , Schulkin J , Zhang Y , Callaghan WM . Obstet Gynecol 2011 118 (5) 1074-80 OBJECTIVE: To assess knowledge, attitudes, and practices of obstetrician-gynecologists (ob-gyns) regarding vaccination of pregnant women during the 2009 H1N1 pandemic. METHODS: From February to July 2010, a self-administered mail survey was conducted among a random sample of American College of Obstetricians and Gynecologists (the College) members involved in obstetric care. To assess predictors of routinely offering influenza vaccination, adjusted prevalence ratios and 95% confidence intervals (CIs) were calculated from survey data. RESULTS: Among 3,096 survey recipients, 1,310 (42.3%) responded to the survey, of whom 873 were eligible for participation. The majority of ob-gyns reported routinely offering both seasonal and 2009 H1N1 influenza vaccination to their pregnant patients (77.6% and 85.6%, respectively) during the 2009-2010 season; 21.1% and 13.3% referred patients to other specialists. Reported reasons for not offering vaccination included inadequate reimbursement, storage limitations, or belief that vaccine should be administered by another provider. Seasonal and 2009 H1N1 influenza vaccination during the first trimester was not recommended by 10.6% and 9.6% of ob-gyns, respectively. Predictors of routinely offering 2009 H1N1 influenza vaccine included: considering primary care and preventive medicine a very important part of practice (adjusted prevalence ratio 1.2, CI 1.01-1.4); observing serious conditions attributed to influenza-like illness (adjusted prevalence ratio 1.1, CI 1.02-1.1); personally receiving 2009 H1N1 influenza vaccination (adjusted prevalence ratio 1.2, CI 1.1-1.4); and practicing in multispecialty group (adjusted prevalence ratio 1.1, CI 1.1-1.2). Physicians in solo practice were less likely to routinely offer influenza vaccine (adjusted prevalence ratio 0.8, CI 0.7-0.9). CONCLUSION: Although most ob-gyns routinely offered influenza vaccination to pregnant patients, vaccination coverage rates may be improved by addressing logistic and financial challenges of vaccine providers. LEVEL OF EVIDENCE: III. |
Characteristics of fatal abusive head trauma among children in the USA: 2003-2007: an application of the CDC operational case definition to national vital statistics data
Parks SE , Kegler SR , Annest JL , Mercy JA . Inj Prev 2011 18 (3) 193-9 OBJECTIVE: In March of 2008, an expert panel was convened at the Centers for Disease Control and Prevention to develop code-based case definitions for abusive head trauma (AHT) in children under 5 years of age based on the International Classification of Diseases, 10th Revision (ICD-10) nature and cause of injury codes. This study presents the operational case definition and applies it to US death data. METHODS: National Center for Health Statistics National Vital Statistics System data on multiple cause-of-death from 2003 to 2007 were examined. RESULTS: Inspection of records with at least one ICD-10 injury/disease code and at least one ICD-10 cause code from the AHT case definition resulted in the identification of 780 fatal AHT cases, with 699 classified as definite/presumptive AHT and 81 classified as probable AHT. The fatal AHT rate was highest among children age <1 year with a peak in incidence that occurred at 1-2 months of age. Fatal AHT incidence rates were higher for men than women and were higher for non-Hispanic African-Americans compared to other racial/ethnic groups. Fatal AHT incidence was relatively constant across seasons. CONCLUSIONS: This report demonstrates that the definition can help to identify population subgroups at higher risk for AHT defined by year and month of death, age, sex and race/ethnicity. This type of definition may be useful for various epidemiological applications including research and surveillance. These activities can in turn inform further development of prevention activities, including educating parents about the dangers of shaking and strategies for managing infant crying. |
Dating Matters: Strategies to Promote Healthy Teen Relationships
Tharp AT , Burton T , Freire K , Hall DM , Harrier S , Latzman NE , Luo F , Niolon PH , Ramirez M , Vagi KJ . J Womens Health (Larchmt) 2011 20 (12) 1761-5 Teen dating violence (TDV) is a preventable public health problem that has negative consequences for youth. Despite evidence that youth in urban communities with high crime and economic disadvantage may be at particularly high risk for TDV, little work has specifically addressed TDV in these communities. The Centers for Disease Control and Prevention (CDC) has developed a comprehensive approach to prevent TDV-Dating Matters: Strategies to Promote Healthy Teen Relationships-that addresses gaps in research and practice. This Report from CDC describes the programmatic activities, implementation support, evaluation, and surveillance of the Dating Matters initiative, which will be implemented in four urban communities. |
The iron-responsive regulator irr is required for wild-type expression of the gene encoding the heme transporter BhuA in Brucella abortus 2308.
Anderson ES , Paulley JT , Martinson DA , Gaines JM , Steele KH , Roop RM 2nd . J Bacteriol 2011 193 (19) 5359-64 Irr and RirA, rather than Fur, serve as the major iron-responsive regulators in the alphaproteobacteria. With only a few exceptions, however, the relative contributions of these transcriptional regulators to the differential expression of specific iron metabolism genes in Brucella strains are unclear. The gene encoding the outer membrane heme transporter BhuA exhibits maximum expression in Brucella abortus 2308 during growth under iron-deprived conditions, and mutational studies indicate that this pattern of bhuA expression is mediated by the iron-responsive regulator Irr. Specifically, a bhuA-lacZ transcriptional fusion does not produce elevated levels of beta-galactosidase in response to iron deprivation in the isogenic irr mutant BEA5, and, unlike the parental strain, B. abortus BEA5 cannot utilize heme as an iron source in vitro and is attenuated in mice. A derivative of the bhuA-lacZ transcriptional fusion lacking the predicted Irr binding site upstream of the bhuA promoter does not produce elevated levels of beta-galactosidase in response to iron deprivation in the parental B. abortus 2308 strain, and a direct and specific interaction between a recombinant version of the Brucella Irr and the bhuA promoter region was observed in an electrophoretic mobility shift assay. Despite the fact that it lacks the heme regulatory element linked to the iron-responsive degradation of its counterpart in Bradyrhizobium japonicum, readily detectable levels of Irr were found only in B. abortus 2308 cells by Western blot analysis following growth under iron-deprived conditions. |
Comparison of real-time PCR and a microimmunofluorescence serological assay for detection of chlamydophila pneumoniae infection in an outbreak investigation.
Benitez AJ , Thurman KA , Diaz MH , Conklin L , Kendig NE , Winchell JM . J Clin Microbiol 2011 50 (1) 151-3 We assessed the performance of a recently validated real-time PCR assay and a commercially available microimmunofluorescence serologic test for the detection of Chlamydophila pneumoniae infection during an outbreak. Evaluation of specimens from 137 individuals suggests that real-time PCR holds greater utility as a diagnostic tool for early C. pneumoniae detection. |
Gene expression analysis in the thalamus and cerebrum of horses experimentally infected with West Nile virus.
Bourgeois MA , Denslow ND , Seino KS , Barber DS , Long MT . PLoS One 2011 6 (10) e24371 Gene expression associated with West Nile virus (WNV) infection was profiled in the central nervous system of horses. Pyrosequencing and library annotation was performed on pooled RNA from the CNS and lymphoid tissues on horses experimentally infected with WNV (vaccinated and naive) and non-exposed controls. These sequences were used to create a custom microarray enriched for neurological and immunological sequences to quantitate gene expression in the thalamus and cerebrum of three experimentally infected groups of horses (naive/WNV exposed, vaccinated/WNV exposed, and normal). From the sequenced transcriptome, 41,040 sequences were identified by alignment against five databases. 31,357 good sequence hits (e<10(-4)) were obtained with 3.1% of the sequences novel to the equine genome project. Sequences were compared to human expressed sequence tag database, with 31,473 equine sequences aligning to human sequences (69.27% contigs, 78.13% seed contigs, 80.17% singlets). This indicated a high degree of sequence homology between human and equine transcriptome (average identity 90.17%). Significant differences (p<0.05) in gene expression were seen due to virus exposure (9,020), survival (7,395), and location (7,649). Pathways analysis revealed many genes that mapped to neurological and immunological categories. Involvement of both innate and adaptive components of immunity was seen, with higher levels of expression correlating with survival. This was highlighted by increased expression of suppressor of cytokine signaling 3 in horses exposed to WNV which functions to suppress innate immunity. Pentraxin 3 was most increased in expression for all horses exposed to WNV. Neurological pathways that demonstrated the greatest changes in gene expression included neurotransmitter and signaling pathways. Decreased expression of transcripts in both the glutamate and dopamine signaling pathways was seen in horses exposed to WNV, providing evidence of possible glutamate excitotoxicity and clinical signs associated with decreased dopamine. Many transcripts mapped to non-infectious neurological disease functions, including mental disorders and degenerative neuropathies. |
Virus infection stages and distinct Th1 or Th17/Th22 T-cell responses in malaria/SHIV coinfection correlate with different outcomes of disease
Ryan-Payseur B , Ali Z , Huang D , Chen CY , Yan L , Wang RC , Collins WE , Wang Y , Chen ZW . J Infect Dis 2011 204 (9) 1450-62 BACKGROUND: Malaria and AIDS represent 2 leading causes of death from infectious diseases worldwide, and their high geographic overlap means coinfection is prevalent. It remains unknown whether distinct immune responses during coinfection with malaria and human immunodeficiency virus (HIV) affect clinical outcomes. METHODS: We tested this hypothesis by employing macaque models of coinfection with malaria and simian-human immunodeficiency virus (SHIV). RESULTS: Plasmodium fragile malaria coinfection of acutely SHIV-infected macaques induced hyperimmune activation and remarkable expansion of CD4+ and CD8+ T effector cells de novo producing interferon gamma or tumor necrosis factor alpha. Malaria-driven cellular hyperactivation/expansion and high-level Th1-cytokines enhanced SHIV disease characterized by increasing CD4+ T-cell depletion, profound lymphoid depletion or destruction, and even necrosis in lymph nodes and spleens. Importantly, malaria/SHIV-mediated depletion, destruction, and necrosis in lymphoid tissues led to bursting parasite replication and fatal virus-associated malaria. Surprisingly, chronically SHIV-infected macaques without AIDS employed different defense mechanisms during malaria coinfection, and mounted unique approximately 200-fold expansion of interleukin 17+/interleukin 22+ T effectors with profound Th1 suppression. Such remarkable expansion of Th17/Th22 cells and inhibition of Th1 response coincided with development of immunity against fatal virus-associated malaria without accelerating SHIV disease. CONCLUSIONS: These novel findings suggest that virus infection status and selected Th1 or Th17/Th22 responses after malaria/AIDS-virus coinfection correlate with distinct outcomes of virus infection and malaria. |
Performance of an alternative laboratory-based algorithm for HIV diagnosis in a high-risk population
Delaney KP , Heffelfinger JD , Wesolowski LG , Owen SM , Meyer WA 3rd , Kennedy S , Uniyal A , Kerndt PR , Branson BM . J Clin Virol 2011 52 Suppl 1 S5-10 BACKGROUND: An immunoassay (IA) followed by Western blot (WB) or immunofluorescence assay has been the primary algorithm used to provide laboratory confirmation of the diagnosis of HIV infection in the US for more than 20 years. Recently, an alternative diagnostic algorithm was proposed to more accurately identify early HIV-1 infection and differentiate between HIV-1 and HIV-2 infection. OBJECTIVES: Evaluate a sequential alternative algorithm in which reactive IAs are followed by a rapid HIV test and, if negative, a nucleic acid amplification test (NAAT). STUDY DESIGN: Specimens from high-risk persons were tested with 4 HIV IAs, 6 rapid HIV tests and NAAT (APTIMA((R))), which are approved by the United States Food and Drug Administration. IAs were repeated in duplicate if specimen volumes were sufficient. The performance of the alternative algorithm was compared to HIV WB and NAAT. RESULTS: The original study classified 377 specimens as HIV-positive and 3070 as HIV-negative. All 4 IAs correctly identified >99.5% of HIV-positive specimens and, on initial screening, >95.8% of HIV-negative specimens. When repeated, specificity of IAs improved to >99%. Between 6.7% and 12.4% of IA-repeatedly reactive specimens required APTIMA for resolution. The alternative algorithm led to the correct classification of all IA-reactive specimens. CONCLUSIONS: Regardless of screening IA and rapid test used, the alternative algorithm correctly classified the infection status of all persons with reactive screening IA results. Few specimens required NAAT for resolution, and the proportion requiring NAAT was lower when repeat IA test results were considered. |
Establishment of a new human pneumococcal standard reference serum, 007sp
Goldblatt D , Plikaytis BD , Akkoyunlu M , Antonello J , Ashton L , Blake M , Burton R , Care R , Durant N , Feavers I , Fernsten P , Fievet F , Giardina P , Jansen K , Katz L , Kierstead L , Lee L , Lin J , Maisonneuve J , Nahm MH , Raab J , Romero-Steiner S , Rose C , Schmidt D , Stapleton J , Carlone GM . Clin Vaccine Immunol 2011 18 (10) 1728-36 Lot 89SF has been the reference standard serum pool used in pneumococcal enzyme-linked immunosorbent assays (ELISAs) since 1990. In 2005, it was estimated that there remained between 2 and 5 years' supply of lot 89SF. Since lot 89SF was the reference standard used in the evaluation of the seven-valent pneumococcal conjugate vaccine Prevnar (PCV7), the link to clinical efficacy would be severed if stocks became completely depleted. Furthermore, demonstration of immune responses comparable to those elicited by PCV7 is a licensure approach used for new pneumococcal conjugate vaccines, so a replacement reference standard was required. A total of 278 volunteers were immunized with the 23-valent unconjugated polysaccharide vaccine Pneumovax II, and a unit of blood was obtained twice within 120 days following immunization. Plasma was prepared, pooled, and confirmed to be free from hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV. The pooled serum was poured at 6 ml per vial into 15,333 vials and lyophilized. Immunological bridging of 007sp to 89SF was used to establish equivalent reference values for 13 pneumococcal capsular serotypes (1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F and 23F) by five independent laboratories. Antibody concentrations in 007sp were established relative to the lot 89SF reference preparation using the WHO reference ELISA. Subsequently, 12 existing WHO calibration sera had concentrations reassigned for 13 pneumococcal serotypes using new serum 007sp as the reference, and these were compared to concentrations relative to the original reference serum. Agreement was excellent for the 12 WHO calibration sera. The 007sp preparation has replaced 89SF as the pneumococcal reference standard. Sufficient quantity of this new preparation is available such that, with judicious use, it should be available for at least 25 years. |
Determination of levamisole in urine by gas chromatography-mass spectrometry
Trehy ML , Brown DJ , Woodruff JT , Westenberger BJ , Nychis WG , Reuter N , Schier JG , Vagi SJ , Hwang RJ . J Anal Toxicol 2011 35 (8) 545-50 The United States Public Health Service Substance Abuse and Mental Health Services Administration is alerting medical professionals that a substantial percentage of cocaine imported into the United States is adulterated with levamisole, a veterinary pharmaceutical that can cause blood cell disorders such as severe neutropenia and agranulocytosis. Levamisole HCl is the active ingredient in a number of veterinary drugs approved to treat worm infestations in animals. Levamisole HCl was also the active ingredient in a human drug for oral administration approved on June 18, 1990, as adjuvant treatment in combination with fluorouracil after surgical resection in patients with Duke's stage C colon cancer. This drug was withdrawn from the U.S. market around 2000, and it has not been marketed in the U.S. since then. The objective of this study was to develop a method to determine the amount of levamisole in urine samples. The procedure will be provided to state health laboratories as needed to be used in the evaluation of patients that have developed neutropenia or agranulocytosis in the setting of recent cocaine use. A gas chromatography-mass spectrometry method was validated and tested at two different laboratories, and the method limit of detection for levamisole is 1 ng/mL in urine when using a 5-mL sample. Confirmation of the stereoisomer of levamisole was done by high-performance liquid chromatography using a chiral column. |
Development of a method to estimate mouth-level benzo[a]pyrene intake by filter analysis
Ding Y , Chou T , Abdul-Salaam S , Hearn B , Watson CH . Cancer Epidemiol Biomarkers Prev 2011 21 (1) 39-44 BACKGROUND: Benzo[a]pyrene is one of the most potent carcinogens generated in cigarette smoke. During smoking, cigarette filters trap a significant portion of mainstream smoke benzo[a]pyrene. This trapped portion is proportional to what exits the end of the filter and is drawn into the smoker's mouth. METHODS: We developed a new method to estimate mouth-level benzo[a]pyrene intake using filter analysis. In this analysis, cigarettes are smoked by a smoking machine using a variety of conditions to yield a range of mainstream smoke deliveries, which approximate a range of human puffing characteristics. Mainstream smoke benzo[a]pyrene collected on Cambridge filter pads and the corresponding 1-cm mouth-end cigarette filter butts is extracted, purified by solid phase extraction, and quantified by high performance liquid chromatography coupled with a fluorescence detector. Based on the amount of benzo[a]pyrene retained in cigarette butts and the amount collected on pads, we can relate them using a linear regression model. RESULTS: Using this model and subsequently analyzing cigarette filters collected from smokers, we are able to estimate their mouth-level intakes, which smokers received when they consumed cigarettes. We made a series of measurements using research cigarettes and select commercial cigarettes having a wide range of machine smoke "tar" and nicotine deliveries. CONCLUSIONS: In all cases, results indicate a linear relation of benzo[a]pyrene between cigarette filter butts and Cambridge filter pads, with R2 ranging from 0.93 to 0.98. IMPACT: This technique provides a non-invasive means to examine intake on a per cigarette basis to examine both exposure and behavioral aspects of smoking. |
Setting research priorities to reduce global mortality from childhood pneumonia by 2015
Rudan I , El Arifeen S , Bhutta ZA , Black RE , Brooks A , Chan KY , Chopra M , Duke T , Marsh D , Pio A , Simoes EA , Tamburlini G , Theodoratou E , Weber MW , Whitney CG , Campbell H , Qazi SA . PLoS Med 2011 8 (9) e1001099 Igor Rudan and colleagues report the results of their consensus building exercise that identified health research priorities to help reduce child mortality from pneumonia. |
Use of antiepileptic medications in pregnancy in relation to risks of birth defects
Werler MM , Ahrens KA , Bosco JL , Mitchell AA , Anderka MT , Gilboa SM , Holmes LB . Ann Epidemiol 2011 21 (11) 842-850 PURPOSE: To evaluate use of specific antiepileptic drugs (AEDs) in pregnancy in relation to specific birth defects. METHODS: Using data from the National Birth Defects Prevention Study, we assessed use of AEDs and the risk of neural tube defects (NTDs), oral clefts (OCs), heart defects (HDs), hypospadias, and other major birth defects, taking specific agent, timing, and indication into consideration. RESULTS: Drug-specific increased risks were observed for valproic acid in relation to NTDs [adjusted odds ratio (aOR), 9.7;, 95% confidence interval (CI), 3.4-27.5], OCs (aOR, 4.4; 95% CI, 1.6-12.2), HDs (aOR, 2.0; 95% CI, 0.78-5.3), and hypospadias (aOR. 2.4; 95% CI, 0.62-9.0), and for carbamazapine in relation to NTDs (aOR, 5.0; 95% CI, 1.9-12.7). Epilepsy history without AED use did not seem to increase risk. CONCLUSIONS: Valproic acid, which current guidelines suggest should be avoided in pregnancy, was most notable in terms of strength and breadth of its associations. Carbamazapine was associated with NTDs, even after controlling for folic acid use. Sample sizes were still too small to adequately assess risks of less commonly used AEDs, but our findings support further study to identify lower risk options for pregnant women. |
Prevention of mother-to-child transmission of infections during pregnancy: implementation of recommended interventions, United States, 2003-2004
Koumans EH , Rosen J , van Dyke MK , Zell E , Phares CR , Taylor A , Loft J , Schrag S . Am J Obstet Gynecol 2011 206 (2) 158 e1-158 e11 OBJECTIVE: The objective of the study was to describe prenatal screening, positive test rates, and the administration of indicated interventions for hepatitis B, rubella, syphilis, group B streptococcus (GBS), chlamydia, and gonorrhea in the United States using 2 population-based surveys. STUDY DESIGN: Both surveys abstracted demographic, prenatal, and delivery data from a representative sample of delivering women in 10 states. Analyses accounted for the complex sampling design. RESULTS: Among the 7691 and 19,791 women in the 2 studies, screened proportions before delivery were more than 90% for hepatitis B and rubella, 80% for syphilis, 72-85% for GBS, and less than 80% for chlamydia and gonorrhea. Inadequate prenatal care was the strongest factor associated with no screening. Administration of interventions indicated by positive test results was variable but generally low. CONCLUSION: Improved prenatal screening and administration of indicated treatments or interventions, particularly for syphilis, GBS, chlamydia, and gonorrhea, will further protect newborns from infection. |
A replicated field intervention study evaluating the impact of a highly adjustable chair and office ergonomics training on visual symptoms
Menendez CC , Amick BC 3rd , Robertson M , Bazzani L , Derango K , Rooney T , Moore A . Appl Ergon 2011 43 (4) 639-44 OBJECTIVE: Examine the effects of two office ergonomics interventions in reducing visual symptoms at a private sector worksite. METHODS: A quasi-experimental study design evaluated the effects of a highly adjustable chair with office ergonomics training intervention (CWT group) and the training only (TO group) compared with no intervention (CO group). Data collection occurred 2 and 1 month(s) pre-intervention and 2, 6 and 12 months post-intervention. During each data collection period, a work environment and health questionnaire (covariates) and daily health diary (outcomes) were completed. Multilevel statistical models tested hypotheses. RESULTS: Both the training only intervention (p<0.001) and the chair with training intervention (p=0.01) reduced visual symptoms after 12 months. CONCLUSION: The office ergonomics training alone and coupled with a highly adjustable chair reduced visual symptoms. In replicating results from a public sector worksite at a private sector worksite the external validity of the interventions is strengthened, thus broadening its generalizability. |
A strategy for assessing workplace exposures to nanomaterials
Ramachandran G , Ostraat M , Evans DE , Methner MM , O'Shaughnessy P , D'Arcy J , Geraci CL , Stevenson E , Maynard A , Rickabaugh K . J Occup Environ Hyg 2011 8 (11) 673-85 This article describes a highly tailorable exposure assessment strategy for nanomaterials that enables effective and efficient exposure management (i.e., a strategy that can identify jobs or tasks that have clearly unacceptable exposures), while simultaneously requiring only a modest level of resources to conduct. The strategy is based on strategy general framework from AIHA(R) that is adapted for nanomaterials and seeks to ensure that the risks to workers handling nanomaterials are being managed properly. The strategy relies on a general framework as the basic foundation while building and elaborating on elements essential to an effective and efficient strategy to arrive at decisions based on collecting and interpreting available information. This article provides useful guidance on conducting workplace characterization; understanding exposure potential to nanomaterials; accounting methods for background aerosols; constructing SEGs; and selecting appropriate instrumentation for monitoring, providing appropriate choice of exposure limits, and describing criteria by which exposure management decisions should be made. The article is intended to be a practical guide for industrial hygienists for managing engineered nanomaterial risks in their workplaces. |
Nanotoxicology: "The end of the beginning" - signs on the roadmap to a strategy for assuring the safe application and use of nanomaterials - t4 workshop report
Silbergeld EK , Contreras EQ , Hartung T , Hirsch C , Hogberg H , Jachak AC , Jordan W , Landsiedel R , Morris J , Patri A , Pounds JG , de Vizcaya Ruiz A , Shvedova A , Tanguay R , Tatarazako N , van Vliet E , Walker NJ , Wiesner M , Wilcox N , Zurlo J . ALTEX 2011 28 (3) 236-41 In October 2010, a group of experts met as part of the transatlantic think tank for toxicology (t4) to exchange ideas about the current status and future of safety testing of nanomaterials. At present, there is no widely accepted path forward to assure appropriate and effective hazard identification for engineered nanomaterials. The group discussed needs for characterization of nanomaterials and identified testing protocols that incorporate the use of innovative alternative whole models such as zebrafish or C. elegans, as well as in vitro or alternative methods to examine specific functional pathways and modes of action. The group proposed elements of a potential testing scheme for nanomaterials that works towards an integrated testing strategy, incorporating the goals of the NRC report Toxicity Testing in the 21st Century: A Vision and a Strategy by focusing on pathways of toxic response, and utilizing an evidence-based strategy for developing the knowledge base for safety assessment. Finally, the group recommended that a reliable, open, curated database be developed that interfaces with existing databases to enable sharing of information. |
Estimating reusability of organic air-purifying respirator cartridges
Wood GO , Snyder JL . J Occup Environ Hyg 2011 8 (10) 609-17 Reuse of organic vapor air-purifying respirator cartridges after a job or shift can provide economy and energy savings. However, standards and manufacturers' guidance discourage reuse, presumably due to a lack of quantitative objective exposure and use information. Storage and simulated reuse laboratory studies and modeling have been done to provide such information. Two important parameters of breakthrough curves, midpoint time (related to adsorption capacity) and midpoint slope (related to adsorption rate), have been shown to be unchanged during storage for reuse. Extrapolations to smaller breakthrough concentrations and times can be made from this reference breakthrough and time. Significant step increases in breakthrough concentration upon cartridge reuse have been observed in some cases. Values of immediate breakthrough concentrations upon reuse (IBURs) have been measured and correlated. The Dubinin/Radushkevich adsorption isotherm equation has been used to estimate maximum IBURs, which depend on many factors, including conditions and duration of first use. An empirical equation describing rate of approach to maximum IBUR as a function of storage time has been developed to provide intermediate IBUR estimates, which are also very dependent on the vapor identity and extent of first-use loading. Using these equations, IBUR estimates with appropriate safety factors can be compared with the allowable breakthrough concentration to help the Industrial Hygienist make reusability decisions. |
Interaction of occupational and personal risk factors in workforce health and safety
Schulte PA , Pandalai S , Wulsin V , Chun H . Am J Public Health 2011 102 (3) 434-48 Most diseases, injuries, and other health conditions experienced by working people are multifactorial, especially as the workforce ages. Evidence supporting the role of work and personal risk factors in the health of working people is frequently underused in developing interventions. Achieving a longer, healthy working life requires a comprehensive preventive approach. To help develop such an approach, we evaluated the influence of both occupational and personal risk factors on workforce health. We present 32 examples illustrating 4 combinatorial models of occupational hazards and personal risk factors (genetics, age, gender, chronic disease, obesity, smoking, alcohol use, prescription drug use). Models that address occupational and personal risk factors and their interactions can improve our understanding of health hazards and guide research and interventions. (Am J Public Health. Published online ahead of print October 20, 2011:e1-e15. doi:10.2105/AJPH.2011.300249). |
Inverse dynamic analysis of the biomechanics of the thumb while pipetting: a case study
Wu JZ , Sinsel EW , Gloekler DS , Wimer BM , Zhao KD , An KN , Buczek FL . Med Eng Phys 2011 34 (6) 693-701 Thumb-push manual pipettes are commonly used tools in many medical, biological, and chemical laboratories. Epidemiological studies indicate that the use of thumb-push mechanical pipettes is associated with musculoskeletal disorders in the hand. The goal of the current study was to evaluate the kinematics and joint loading of the thumb during pipetting. The time-histories of joint angles and the interface contact force between the thumb and plunger during the pipetting action were determined experimentally, and the joint loadings and joint power in the thumb were calculated via an inverse dynamic approach. The moment, power, and energy absorption in each joint of the thumb during the extraction and dispensing actions were analyzed. The results indicate that the majority of the power is generated in the interphalangeal (IP) and carpometacarpal (CMC) joints for the pipetting action. The analysis method and results in the current study will be helpful in exploring the mechanism for musculoskeletal injuries of the hand associated with pipetting, providing a preliminary foundation for ergonomic design of the pipette. |
Study of nonoutbreak giardiasis: novel findings and implications for research
Cantey PT , Roy S , Lee B , Cronquist A , Smith K , Liang J , Beach MJ . Am J Med 2011 124 (12) 1175 e1-8 BACKGROUND: The burden of nonoutbreak-related Giardia infections in the US is poorly understood, with little information on its impact on people's lives and on unusual manifestations of infection. This study was designed with the objectives of better defining the impact of infection, examining the occurrence of extraintestinal manifestations, and determining risk factors for delayed treatment of infection. METHODS: Foodborne Diseases Active Surveillance Network surveillance was used to identify persons with non-outbreak-related, laboratory-confirmed Giardia infection. People were enrolled into the Risk Factor arm and the Delayed Enrollment arm. Detailed questionnaires collected information on clinical manifestations, impact on activities of daily living, health care utilization, and treatment. RESULTS: The study enrolled 290 people. Multivariate predictors of delayed study enrollment, a surrogate for delayed diagnosis of Giardia, included intermittent diarrheal symptoms, delayed time to first health care visit, and income. Decreased ability to participate in one's activities of daily living was reported by 210 (72.4%) participants. Appropriate therapeutic agent for Giardia was received by 237 (81.7%) by the time of study enrollment. Extraintestinal manifestations of Giardia were reported by 72 (33.8%) persons who enrolled in the Risk Factor arm. CONCLUSIONS: The presence of intermittent diarrhea contributes to delayed health-seeking behavior and to delayed diagnosis of Giardia. More study is needed to determine if this symptom can help distinguish Giardia from other causes of infectious diarrhea. The occurrence of extraintestinal manifestations of Giardia infection does not appear to be rare, and merits further study. |
Field epidemiology and laboratory training programs in sub-Saharan Africa from 2004 to 2010: need, the process and prospects
Nsubuga P , Johnson K , Tetteh C , Oundo J , Weathers A , Vaughan J , Elbon S , Tshimanga M , Ndugulile F , Ohuabunwo C , Evering-Watley M , Mosha F , Oleribe O , Nguku P , Davis L , Preacely N , Luce R , Antara S , Imara H , Ndjakani Y , Doyle T , Espinosa Y , Kazambu D , Delissaint D , Ngulefac J , Njenga K . Pan Afr Med J 2011 10 (24) 24 As of 2010 sub-Saharan Africa had approximately 865 million inhabitants living with numerous public health challenges. Several public health initiatives [e.g., the United States (US) President’s Emergency Plan for AIDS Relief and the US President’s Malaria Initiative] have been very successful at reducing mortality from priority diseases. A competently trained public health workforce that can operate multi-disease surveillance and response systems is necessary to build upon and sustain these successes and to address other public health problems. Sub-Saharan Africa appears to have weathered the recent global economic downturn remarkably well and its increasing middle class may soon demand stronger public health systems to protect communities. The Epidemic Intelligence Service (EIS) program of the US Centers for Disease Control and Prevention (CDC) has been the backbone of public health surveillance and response in the US during its 60 years of existence. EIS has been adapted internationally to create the Field Epidemiology Training Program (FETP) in several countries. In the 1990s CDC and the Rockefeller Foundation collaborated with the Uganda and Zimbabwe ministries of health and local universities to create 2-year Public Health Schools Without Walls (PHSWOWs) which were based on the FETP model. In 2004 the FETP model was further adapted to create the Field Epidemiology and Laboratory Training Program (FELTP) in Kenya to conduct joint competencybased training for field epidemiologists and public health laboratory scientists providing a master’s degree to participants upon completion. The FELTP model has been implemented in several additional countries in sub-Saharan Africa. By the end of 2010 these 10 FELTPs and two PHSWOWs covered 613 million of the 865 million people in sub-Saharan Africa and had enrolled 743 public health professionals. We describe the process that we used to develop 10 FELTPs covering 15 countries in sub-Saharan Africa from 2004 to 2010 as a strategy to develop a locally trained public health workforce that can operate multi-disease surveillance and response systems. |
Intrauterine contraceptive insertion postabortion: a systematic review
Steenland MW , Tepper NK , Curtis KM , Kapp N . Contraception 2011 84 (5) 447-64 BACKGROUND: This review was conducted to evaluate the evidence regarding the safety and effectiveness of intrauterine device (IUD) insertion immediately following spontaneous or induced abortion. STUDY DESIGN: We searched MEDLINE databases for all articles (in all languages) published in peer-reviewed journals from January 1966 through March 2010 for evidence comparing immediate postabortion IUD insertion with either no IUD insertion, insertion at a different time, insertion following first-trimester compared with second-trimester abortion or copper IUD insertion compared with hormone-releasing IUD insertion postabortion. We used standard abstraction forms to summarize and assess the quality of the evidence. RESULTS: The search strategy identified a total of 990 articles, of which 19 met our inclusion criteria for this review. Studies comparing immediate postabortion IUD insertion with no IUD insertion found that both groups experienced similar rates of pain and infection and a similar number of bleeding days, but one study reported that women with copper IUD insertion experienced a greater amount of bleeding than women without IUD insertion after abortion. Results from studies comparing immediate postabortion IUD insertion and insertion at a time not associated with pregnancy did not report differences between the two groups in the duration of bleeding, pain, expulsions or pelvic inflammatory disease (PID). One study however reported a greater amount of bleeding and another reported more removals for medical reasons among women with postabortion IUD insertion. Evidence from studies that examined immediate vs. delayed postabortion insertion reported minimal differences in bleeding, pain, expulsion and PID between groups. Studies comparing immediate IUD insertion after first- vs. second-trimester abortion reported no difference in removals for pain and bleeding, and an increased risk of expulsion among those women who had insertions after second-trimester abortion. In addition, women with insertions immediately after abortions occurring later in the first trimester had higher expulsion rates than those with insertions after early first-trimester abortions. Studies examining women using a copper IUD compared with a hormone-releasing IUD reported inconsistent results, with one paper reporting more bleeding days in the copper IUD group and another finding higher rates of removal for bleeding in the progesterone-releasing IUD group. CONCLUSION: Intrauterine device insertion immediately after abortion is not associated with an increased risk of adverse outcomes compared with use of other contraceptive methods or with no IUD insertion after abortion and compared with IUD insertion at times other than immediately after abortion. Intrauterine device expulsion rates, while generally low, were higher with insertions that occurred after later first-trimester abortion compared with after early first-trimester abortion and higher with IUD insertion after second-trimester abortion compared with after first-trimester abortion. |
Age-group differences in human papillomavirus types and cofactors for cervical intraepithelial neoplasia 3 among women referred to colposcopy
Gargano JW , Nisenbaum RA , Lee DR , Ruffin MT , Steinau M , Horowitz IR , Flowers LC , Tadros TS , Birdsong G , Unger ER . Cancer Epidemiol Biomarkers Prev 2011 21 (1) 111-21 BACKGROUND: Recommendations for high risk human papillomavirus (HR-HPV) testing as an adjunct to cytology for cervical cancer screening differ by age group, because HR-HPV tests lack adequate specificity in women aged <30. Here, we assess age-group differences in HPV types and other risk factors for cervical intraepithelial neoplasia (CIN) grade 3 or worse (CIN3+) versus CIN0-2 in women from four colposcopy clinics. METHODS: Women ages 18-69 (n=1658) were enrolled and completed structured interviews to elicit data on behavioral risk factors prior to their examinations. HPV genotyping was performed on exfoliated cervical cell samples. We estimated relative risks (RR) for HPV types and cofactors for CIN3+, overall and stratified by age group. RESULTS: After 2 years of follow-up, we identified 178 CIN3+, 1305 CIN0-2, and 175 indeterminate outcomes. Non-vaccine HR-HPV types were only associated with CIN3+ among women ≥30 (RR=2.3, 95% CI 1.5-3.4; <30: RR=0.9). Among all HR-HPV positive women, adjusting for age, significant cofactors for CIN3+ included current smoking (RR=1.5), former smoking (RR=1.8), regular Pap screening (RR=0.7), current regular condom use (RR=0.5), and parity ≥5 (RR=1.6, p-trend for increasing parity=.07). However, the parity association differed by age group (≥30: RR=1.8, p-trend=.008; <30: RR=0.9, p-trend=.55). CONCLUSIONS: Subgroup variation by age in the risk of CIN3+ points to the importance of the timing of exposures in relation to CIN3+ detection. IMPACT: Future screening strategies need to consider natural history and secular trends in cofactor prevalence in the pursuit of appropriately sensitive and specific screening tools applied to appropriate age groups. |
The influence of spirituality on service utilization and satisfaction for women residing in a domestic violence shelter
Fowler DN , Faulkner M , Learman J , Runnels R . Violence Against Women 2011 17 (10) 1244-59 Little is known about the influence of spirituality on service utilization and satisfaction among women survivors of intimate partner abuse (IPA). The purpose of this study was to examine differences between shelter and faith-based service utilization and satisfaction in a shelter sample (N = 73). Multiple regression techniques were used. The findings suggest that survivors with higher spirituality were more likely to utilize faith-based resources than shelters. Those who experienced greater IPA reported dissatisfaction with faith-based resources. These results suggest that spirituality should be incorporated into shelter services to meet survivors' spiritual needs, and faith-based services should adequately address IPA. |
A history of being prescribed controlled substances and risk of drug overdose death
Paulozzi LJ , Kilbourne EM , Shah NG , Nolte KB , Desai HA , Landen MG , Harvey W , Loring LD . Pain Med 2011 13 (1) 87-95 OBJECTIVE: The abuse of prescription drugs has increased dramatically since 1990. Persons who overdose on such drugs frequently consume large doses and visit multiple providers. The risk of fatal overdose for different patterns of use of opioid analgesics and sedative/hypnotics has not been fully quantified. DESIGN: Matched case-control study. Cases were 300 persons who died of unintentional drug overdoses in New Mexico during 2006-2008, and controls were 5,993 patients identified through the state prescription monitoring program with matching 6-month exposure periods. OUTCOME MEASURES: Death from drug overdose or death from opioid overdose. Exposures were demographic variables and characteristics of prescription history. Crude and adjusted odds ratios (AOR) were calculated. RESULTS: Increased risk was associated with male sex (AOR 2.4, 95% confidence interval [CI] 1.8-3.1), one or more sedative/hypnotic prescriptions (AOR 3.0, CI 2.2-4.2), greater age (AOR 1.3, CI 1.2-1.4 for each 10-year increment), number of prescriptions (AOR 1.1, CI 1.1-1.1 for each additional prescription), and a prescription for buprenorphine (AOR 9.5, CI 3.0-30.0), fentanyl (AOR 3.5, CI 1.7-7.0), hydromorphone (AOR 3.3, CI 1.4-7.5), methadone (AOR 4.9, CI 2.5-9.6), or oxycodone (AOR 1.9, CI 1.4-2.6). Patients receiving a daily average of >40 morphine milligram equivalents had an OR of 12.2 (CI 9.2-16.0). CONCLUSIONS: Patients being prescribed opioid analgesics frequently or at high dosage face a substantial overdose risk. Prescription monitoring programs might be the best way for prescribers to know their patients' prescription histories and accurately assess overdose risk. |
Health of adults in Los Angeles County: findings from the National Health and Nutrition Examination Survey, 1999-2004
Porter KS , Curtin LR , Carroll MD , Li X , Mohadjer L , Shih M , Simon PA , Fielding JE . Natl Health Stat Report 2011 (42) 1-14 OBJECTIVE: Los Angeles County has the largest population of any county in the nation. Population-based estimates of health conditions for Los Angeles County are based primarily on telephone surveys, which are known to underestimate conditions of public health importance. This report presents the prevalence of selected health conditions for civilian noninstitutionalized adults aged 20 and over living in Los Angeles County households and group quarters, based on survey data using direct physical measurements. METHODS: Combined data from the 1999-2000, 2001-2002, and 2003-2004 National Health and Nutrition Examination Surveys (NHANES), conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics, were used for this report. Sample weights were recalculated for participants examined in Los Angeles County using population totals provided by the Los Angeles County Department of Public Health, excluding the institutionalized population. RESULTS: Compared with the nation as a whole, adults in Los Angeles County had similar rates of health conditions even after age and age-race adjustment, with a few exceptions. A significantly smaller proportion of Los Angeles County adults were obese (age-adjusted rate, 23.8%) compared with the United States (31.0%); this difference held after age-race adjustment. The age-adjusted rate of diagnosed diabetes for men was higher in Los Angeles County (9.1%) than in the nation (7.3%); however, this difference did not hold after age-race adjustment. The rates of total diabetes adjusted for age and age-race were similar for men in Los Angeles County and the United States. CONCLUSIONS: The rates of selected health conditions in this report were similar for adults in Los Angeles County compared with adults in the United States, with the exception of obesity. The rates of obesity adjusted for age and age-race were lower among Los Angeles County adults compared with national rates. Health estimates based on direct physical measurements can be useful for local public health programs and prevention efforts. |
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