Population variation in glial fibrillary acidic protein levels in brain ageing: relationship to alzheimer-type pathology and dementia
Wharton SB , O'Callaghan JP , Savva GM , Nicoll JA , Matthews F , Simpson JE , Forster G , Shaw PJ , Brayne C , Ince PG , MRC Cognitive Function and Ageing Neuropathology Study Group . Dement Geriatr Cogn Disord 2009 27 (5) 465-73 BACKGROUND: The cellular pathology of astrocytes in brain ageing and their role in modulating the brain's response to neurodegenerative pathology remain incompletely understood. METHODS: Using quantitative ELISA, we have investigated glial fibrillary acidic protein (GFAP) expression in the population-based neuropathology cohort of the Medical Research Council Cognitive Function and Ageing Study to determine: (1) the population variation in the astroglial hypertrophic response, (2) its relationship to the presence of Alzheimer-type pathology, and (3) its association with cognition. RESULTS: Increasing GFAP was found with increasing Braak stage, levels increasing even at early stages. Within Braak stages, GFAP did not differ between demented and non-demented individuals, but there was greater variance in GFAP in the demented. Possession of ApoE epsilon4 was associated with slightly increased GFAP levels (not significant) for given amyloid beta protein loads. CONCLUSION: In a population-based sample, increasing gliosis precedes development of Alzheimer lesions. Population variation in GFAP with varying Alzheimer lesion burdens suggests that they are not the only driver for astrogliosis. GFAP was not independently predictive of dementia, but the variation in astrocytic responses may be a factor modulating brain responses to neurodegenerative pathology. |
Trends in high levels of low-density lipoprotein cholesterol in the United States, 1999-2006
Kuklina EV , Yoon PW , Keenan NL . JAMA 2009 302 (19) 2104-10 CONTEXT: Studies show that a large proportion of adults with high levels of low-density lipoprotein cholesterol (LDL-C) remain untreated or undertreated despite growing use of lipid-lowering medications. OBJECTIVE: To investigate trends in screening prevalence, use of cholesterol-lowering medications, and LDL-C levels across 4 study cycles (1999-2000, 2001-2002, 2003-2004, and 2005-2006). DESIGN, SETTING, AND PARTICIPANTS: The National Health and Nutrition Examination Survey (NHANES) is a cross-sectional, stratified, multistage probability sample survey of the US civilian, noninstitutionalized population. After we restricted the study sample to fasting participants aged 20 years or older (n = 8018) and excluded pregnant women (n = 464) and participants with missing data (n = 510), our study sample consisted of 7044 participants. MAIN OUTCOME MEASURE: High LDL-C levels, defined as levels above the specific goal for each risk category outlined in guidelines from the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III). All presented results are weighted and age-standardized to 2000 standard population estimates. RESULTS: Prevalence of high LDL-C levels among persons aged 20 years or older decreased from 31.5% in 1999-2000 to 21.2% in 2005-2006 (P < .001 for linear trend) but varied by risk category. By the 2005-2006 study cycle, prevalence of high LDL-C was 58.9%, 30.2%, and 11.0% for high-, intermediate-, and low-risk categories, respectively. Self-reported use of lipid-lowering medications increased from 8.0% to 13.4% (P < .001 for linear trend), but screening rates did not change significantly, remaining less than 70% (P = .16 for linear trend) during the study periods. CONCLUSIONS: Among the NHANES population aged 20 years or older, the prevalence of high LDL-C levels decreased from 1999-2000 to 2005-2006. In the most recent period, the prevalence was 21.2%. |
Multiple risk factors associated with a large statewide increase in cryptosporidiosis
Valderrama AL , Hlavsa MC , Cronquist A , Cosgrove S , Johnston SP , Roberts JM , Stock ML , Xiao L , Xavier K , Beach MJ . Epidemiol Infect 2009 137 (12) 1781-8 Cryptosporidium species have emerged as a major cause of outbreaks of diarrhoea and have been associated with consumption of contaminated recreational and drinking water and food as well as contact with infected attendees of child-care programmes. In August 2007, the Colorado Department of Public Health and Environment detected an increase in cryptosporidiosis cases over baseline values. We conducted a case-control study to assess risk factors for infection and collected stool specimens from ill persons for microscopy and molecular analysis. Laboratory-confirmed cases (n=47) were more likely to have swallowed untreated water from a lake, river, or stream [adjusted matched odds ratio (aOR) 8.0, 95% confidence interval (CI) 1.3-48.1], have had exposure to recreational water (aOR 4.6, 95% CI 1.4-14.6), or have had contact with a child in a child-care programme or in diapers (aOR 3.8, 95% CI 1.5-9.6). Although exposure to recreational water is commonly implicated in summertime cryptosporidiosis outbreaks, this study demonstrates that investigations of increased incidence of cases in summer should also examine other potential risk factors. This study emphasizes the need for public health education efforts that address the multiple transmission routes for Cryptosporidium and appropriate prevention measures to avoid future transmission. |
The OASIS project: novel approaches to using STD surveillance data
Gaffga NH , Samuel MC , Stenger MR , Stover JA , Newman LM . Public Health Rep 2009 124 1-4 This supplemental issue of Public Health Reports presents a selection of innovative strategies designed and implemented between 1998 and 2005 to enhance the ability of public health officials to use surveillance data to monitor and respond to the epidemic of sexually transmitted diseases (STDs) in the United States. These strategies reflect the collaborative efforts of the Outcome Assessment through Systems of Integrated Surveillance (OASIS) Project workgroup, a group of public health STD epidemiologists from local and state health departments and the Centers for Disease Control and Prevention (CDC). Many of the challenges encountered in the surveillance of STDs are similar to those encountered in the surveillance and investigation of other diseases, and many of the solutions presented in this supplemental issue are generalizable to the public health practice of epidemiologists working with other diseases. |
Pharyngeal gonorrhea: an important reservoir of infection?
Weinstock H , Workowski KA . Clin Infect Dis 2009 49 (12) 1798-800 In 2008, >330,000 cases of gonorrhea were reported to the Centers for Disease Control and Prevention (CDC). The actual number of infections per year is thought to be much higher because of underdetection and underreporting [1]. Neisseria gonorrhoeae can cause cervicitis, urethritis, proctitis, pelvic inflammatory disease with long-term sequelae (eg, infertility, ectopic pregnancy, and chronic pelvic pain), adverse outcomes of pregnancy, and increased susceptibility to and facilitated transmission of human immunodeficiency virus (HIV) infection. An essential element in gonorrhea control is the availability and provision of effective antimicrobial therapy. Effective treatment not only eradicates infection in the affected individual and prevents the development of complications, it also has an important public health benefit by shortening the duration of infection, thus decreasing transmission and eliminating reservoirs of infection. However, gonorrhea treatment has been complicated by the development of resistance to multiple classes of antimicrobials over the past 60 years [2]. | Because of the recent emergence of quinolone-resistant N. gonorrhoeae (QRNG) in the United States, there is only a single class of antimicrobials among the recommended gonorrhea treatment options: the cephalosporins. Ceftriaxone, available only as an injection, is the recommended regimen for uncomplicated urogenital, anorectal, and pharyngeal infection. Cefixime (400 mg) is the only oral regimen recommended for urogenital and anorectal gonorrhea treatment. Several other alternative oral cephalosporins are active against N. gonorrhoeae for urogenital and anorectal infection, but none have substantial advantages over the recommended regimens. Oral cephalosporins have insufficient efficacy for treating gonococcal infections of the pharynx and should not be used in persons in whom pharyngeal infection is suspected [3]. N. gonorrhoeae infections of the pharynx are more difficult to eradicate than infections at urogenital and anorectal sites, and ceftriaxone is the only recommended regimen for treating pharyngeal infections. |
Resurrected pandemic influenza viruses
Tumpey TM , Belser JA . Annu Rev Microbiol 2009 63 79-98 Influenza viruses continue to pose a major global public health problem. There is a need to better understand the pathogenicity and transmission of pandemic influenza viruses so that we may develop improved methods for their prevention and control. Reconstruction of the 1918 virus and studies elucidating the exceptional virulence and transmissibility of the virus are providing exciting new insights into this devastating pandemic strain. The primary approach has been to reconstruct and analyze recombinant viruses, in which genes of the 1918 virus are replaced with genes of contemporary influenza viruses of lesser virulence. This review highlights the current status of the field and discusses the molecular determinants of the 1918 pandemic virus that may have contributed to its virulence and spread. Identifying the exact genes responsible for the high virulence of the 1918 virus will be an important step toward understanding virulent influenza strains and will allow the world to better prepare for and respond to future influenza pandemics. |
Special supplement on Hispanics/Latinos and HIV/AIDS. Introduction.
Stallworth JM , Herbst JH , Romaguera RA , Alvarez ME , Amaro H , Dean HD . AIDS Educ Prev 2009 21 3-6 This special supplement serves as a comprehensive resource to better understand the HIV/AIDS epidemic among Hispanics/Latinos in USA. The articles included in this supplement describe the epidemiology of the HIV epidemic among subgroups of Hispanics/Latinos, illustrate structural or socioecologic antecedents of HIV risk, report findings from the implementation and evaluation of HIV prevention interventions for Hispanics/Latinos conducted in USA or Puerto Rico, and describe national efforts to build HIV prevention capacity within Hispanic/Latino communities. |
Summary of comments and recommendations from the CDC consultation on the HIV/AIDS epidemic and prevention in the Hispanic/Latino community
Alvarez ME , Jakhmola P , Painter TM , Taillepierre JD , Romaguera RA , Herbst JH , Wolitski RJ . AIDS Educ Prev 2009 21 7-18 In April 2008, the U.S. Centers for Disease Control and Prevention (CDC) hosted a national consultation meeting of academic researchers, public health officials, service providers, and community leaders to examine the HIV/AIDS epidemic and prevention needs of Hispanics/Latinos in the United States and its territories. The consultation engaged key stakeholders to review available information on HIV-related behavioral research and prevention efforts, describe gaps in current HIV prevention programs and research on Hispanics/Latinos, and identify community and societal-level factors that can increase vulnerability of Hispanics/Latinos for acquiring or transmitting HIV infection. Recommendations were also made to CDC for future collaboration with the Hispanic/Latino community in areas of HIV prevention research and prevention programs. This article summarizes participants' recommendations for HIV prevention research, program and capacity building, policy and planning, and partnerships and communication. These recommendations will be used by CDC to inform the development of a National Plan of Action for HIV/AIDS prevention among Hispanics/Latinos, and can provide a framework for use by other federal and non-federal agencies, academic researchers, community-based organizations, and policymakers as they seek to curtail the HIV epidemic among Hispanics/Latinos. |
Trends in antimicrobial prescribing rates for Alaska Native and American Indian persons <18 years of age residing in the Anchorage region
Bott AM , Bruce MG , Bulkow L , Coleman J , Hennessy TW . Int J Circumpolar Health 2009 68 (4) 337-46 OBJECTIVES: In the U.S., the total number of antimicrobials prescribed in ambulatory care declined between 1989 and 2000; however, antimicrobial resistance increased among many pathogens. We evaluated antimicrobial prescribing patterns from 1992 to 2004 in Alaska Native/American Indian (AI/AN) persons. STUDY DESIGN: Retrospective study based on medical records. METHODS: Medical records were used to obtain data on oral antibiotics prescribed for ambulatory and emergency-room visits. Antimicrobial prescribing rates were calculated per population and per ambulatory-clinic visit. RESULTS: The total number of antimicrobial courses prescribed increased 94% from 4,929 (1992) to 9,561 (2004). However, the total number of ambulatory-clinic visits also increased (79%) from 49,008 (1992) to 87,486 (2004), while the population of AI/AN persons. |
Adverse outcomes in Alaska Natives who recovered from or have chronic hepatitis C infection
McMahon BJ , Bruden D , Bruce MG , Livingston S , Christensen C , Homan C , Hennessy TW , Williams J , Sullivan D , Rosen HR , Gretch D . Gastroenterology 2009 138 (3) 922-31.e1 BACKGROUND & AIMS: The factors associated with adverse outcome from hepatitis C virus (HCV) infection are incompletely understood. To determine the incidence and risk factors associated with the development of end-stage liver disease (ESLD) and liver-related death (LRD), we conducted a retrospective-prospective population-based study in a cohort of Alaska Native Persons chronically infected with HCV from 1994 to 2005. METHODS: We followed 960 persons prospectively for an average of 7.2 years and retrospectively for 12.1 years using data from medical records and serum samples. We compared data from subjects that were chronically infected with those who recovered from HCV infection, stratified by alcohol use. Survival models were used to examine factors associated with ESLD and LRD in chronically infected patients. RESULTS: During prospective follow-up, 80 (8.8%) and 47 (5.2%) patients developed ESLD and LRD, respectively. In examining incidence per 100 person years, no difference was found among heavy alcohol users in the incidence of LRD (2.28 vs 3.50; P=.34) or ESLD (3.21 vs. 5.69; P=0.13) in persons with chronic HCV compared to those recovered from HCV infection. In subjects that consumed more than 50 gm/day of alcohol, the incidences of LRD were 0.77 and 0.09 (P=0.01) and of ESLD were 1.58 vs 0.36 (P=0.002), respectively, in subjects with chronic infection vs those that recovered. Multivariate analysis revealed that older age, heavy alcohol use, and HCV genotype 3 were associated with ESLD. CONCLUSIONS: A history of heavy alcohol use is associated with the highest incidence of LRD and ESLD, regardless of whether patients are chronically infected or recover from HCV infection. |
Establishment of public health security in Saudi Arabia for the 2009 Hajj in response to pandemic influenza A H1N1
Memish Z , McNabb S , Mahoney F , Alrabiah F , Marano N , Ahmed Q , Mahjour J , Hajjeh R , Formenty P , Harmanci F , El Bushra H , Uyeki T , Nunn M , Isla N , Barbeschi M , The Jeddah Hajj Consultancy Group . Lancet 2009 384 (9703) 1786-91 Mass gatherings of people challenge public health capacities at host locations and the visitors' places of origin. Hajj-the yearly pilgrimage by Muslims to Saudi Arabia-is one of the largest, most culturally and geographically diverse mass gatherings in the world. With the 2009 pandemic influenza A H1N1 and upcoming Hajj, the Saudi Arabian Ministry of Health (MoH) convened a preparedness consultation in June, 2009. Consultants from global public health agencies met in their official capacities with their Saudi Arabian counterparts. The MoH aimed to pool and share public health knowledge about mass gatherings, and review the country's preparedness plans, focusing on the prevention and control of pandemic influenza. This process resulted in several practical recommendations, many to be put into practice before the start of Hajj and the rest during Hajj. These preparedness plans should ensure the optimum provision of health services for pilgrims to Saudi Arabia, and minimum disease transmission on their return home. Review of the implementation of these recommendations and their effect will not only inform future mass gatherings in Saudi Arabia, but will also strengthen preparedness efforts in other settings. |
Hospitalized patients with 2009 H1N1 influenza in the United States, April-June 2009
Jain S , Kamimoto L , Bramley AM , Schmitz AM , Benoit SR , Louie J , Sugerman DE , Druckenmiller JK , Ritger KA , Chugh R , Jasuja S , Deutscher M , Chen S , Walker JD , Duchin JS , Lett S , Soliva S , Wells EV , Swerdlow D , Uyeki TM , Fiore AE , Olsen SJ , Fry AM , Bridges CB , Finelli L , Pandemic Influenza A (H1N1) Virus Hospitalizations Investigation Team . N Engl J Med 2009 361 (20) 1935-44 BACKGROUND: During the spring of 2009, a pandemic influenza A (H1N1) virus emerged and spread globally. We describe the clinical characteristics of patients who were hospitalized with 2009 H1N1 influenza in the United States from April 2009 to mid-June 2009. METHODS: Using medical charts, we collected data on 272 patients who were hospitalized for at least 24 hours for influenza-like illness and who tested positive for the 2009 H1N1 virus with the use of a real-time reverse-transcriptase-polymerase-chain-reaction assay. RESULTS: Of the 272 patients we studied, 25% were admitted to an intensive care unit and 7% died. Forty-five percent of the patients were children under the age of 18 years, and 5% were 65 years of age or older. Seventy-three percent of the patients had at least one underlying medical condition; these conditions included asthma; diabetes; heart, lung, and neurologic diseases; and pregnancy. Of the 249 patients who underwent chest radiography on admission, 100 (40%) had findings consistent with pneumonia. Of the 268 patients for whom data were available regarding the use of antiviral drugs, such therapy was initiated in 200 patients (75%) at a median of 3 days after the onset of illness. Data suggest that the use of antiviral drugs was beneficial in hospitalized patients, especially when such therapy was initiated early. CONCLUSIONS: During the evaluation period, 2009 H1N1 influenza caused severe illness requiring hospitalization, including pneumonia and death. Nearly three quarters of the patients had one or more underlying medical conditions. Few severe illnesses were reported among persons 65 years of age or older. Patients seemed to benefit from antiviral therapy. |
Increases in HIV diagnoses at the U.S.-Mexico border, 2003-2006
Espinoza L , Hall HI , Hu X . AIDS Educ Prev 2009 21 19-33 The population at the U.S.-Mexico border has experienced growth, more than double the U.S. national average. Movements of populations in this region have contributed to increased incidence of certain infectious diseases. We used information on persons diagnosed with HIV during 2003 to 2006 and aged 13 years or older (n = 4,279) reported to the Centers for Disease Control and Prevention for 45 U.S. border counties. We estimated the annual percent change and rates with Poisson regression. Overall, 47% of persons diagnosed with HIV in the border region were Hispanic; 39% nonHispanic white; and 10% nonHispanic black. During 2003 to 2006, HIV diagnoses increased 7.8% per year. Increases were observed among males, particularly among men who have sex with men. Among females, HIV diagnoses remained stable but decreased among females in nonborder regions. The number of HIV diagnoses at the border has increased. To decrease incidence of HIV disease it is necessary to develop prevention and education programs specific to this region. |
Nanoparticle inhalation impairs endothelium-dependent vasodilation in subepicardial arterioles
LeBlanc AJ , Cumpston JL , Chen BT , Frazer D , Castranova V , Nurkiewicz TR . J Toxicol Environ Health A 2009 72 (24) 1576-1584 Exposure to fine particulate matter (PM, mean aerodynamic diameter <= 2.5 mu m) has been shown to be a risk factor for cardiovascular disease mortality and may contribute to acute coronary events such as myocardial infarction (MI). There is sufficient reason to believe that smaller particles, such as nanoparticles, might be even more detrimental than larger sized particles due to their increased surface area and higher pulmonary deposition. Our laboratory showed that nanoparticle inhalation impairs endothelium-dependent arteriolar vasodilation in skeletal muscle. However, it is not known whether coronary microvascular endothelial function is affected in a similar manner. Rats were exposed to filtered air (control) or TiO2 nanoparticles (primary particle diameter, similar to 21 nm) via inhalation at concentrations that produced measured depositions (10 mu g) relevant to ambient air pollution. Subepicardial arterioles(similar to 150 mm in diameter) were isolated and responses to transmural pressure, flow-induced dilation (FID), acetylcholine (ACh), the Ca2+ ionophore A23187, and sodium nitroprusside (SNP) were assessed. Myogenic responsiveness was preserved between groups. In addition, there was no difference in the vasodilation to SNP, signifying that smooth muscle sensitivity to nitric oxide (NO) is unaffected by nano-TiO2 exposure. However, inhalation of nano-TiO2 produced an increase in spontaneous tone in coronary arterioles and also impaired endothelium-dependent FID. In addition, ACh-induced and A23187-induced vasodilation was also blunted in arterioles after inhalation of nano-TiO2. Data showed that nanoparticle exposure significantly impairs endothelium-dependent vasodilation in subepicardial arterioles. Such disturbances in coronary microvascular function are consistent with the cardiac events associated with particle pollution exposure. |
Water safety plans: CDC's role
Gelting R . J Environ Health 2009 72 (4) 44-5 Working with numerous public health | partners, the Centers for Disease | Control and Prevention (CDC) recently began a new initiative to support implementation of Water Safety Plans (WSPs) | in Latin American and Caribbean countries. | WSPs are a relatively new methodology being | promoted by the World Health Organization | (WHO) to assess and manage risk factors in | drinking water systems from source to consumer (Figure 1). Each year, poor water quality and inadequate sanitation and hygiene | account for 1.8 million deaths worldwide | among children. These poor water conditions have significant economic effects, not | only due to lost wages from illness but also | from time spent gathering water (mostly by | women and girls) for household use. In Latin | America and the Caribbean, an estimated 50 | million persons lack access to an improved | water supply. |
Notes from the field: Outbreak of 2009 pandemic influenza A (H1N1) virus at a large public university in Delaware, April-May 2009
Iuliano AD , Reed C , Guh A , Desai M , Dee DL , Kutty P , Gould LH , Sotir M , Grant G , Lynch M , Mitchell T , Getchell J , Shu B , Villanueva J , Lindstrom S , Massoudi MS , Siebold J , Silverman PR , Armstrong G , Swerdlow DL . Clin Infect Dis 2009 49 (12) 1811-20 BACKGROUND: In late April 2009, the first documented 2009 pandemic influenza A (pH1N1) virus infection outbreak in a university setting occurred in Delaware, with large numbers of students presenting with respiratory illness. At the time of this investigation, little was known about the severity of illness, effectiveness of the vaccine, or transmission factors of pH1N1 virus infection. We characterized illness, determined the impact of this outbreak, and examined factors associated with transmission. METHODS: Health clinic records were reviewed. An online survey was administered to all students, staff, and faculty to assess influenza-like illness (ILI), defined as documented or subjective fever with cough or sore throat. RESULTS: From 26 April-2 May 2009, the health clinic experienced a sharp increase in visits for respiratory illness, with 1080 such visits among a total of 1430 student visits, and then a return to baseline visit levels within 2 weeks. More than 500 courses of oseltamivir were distributed, and 24 cases of influenza A (pH1N1) virus infection were confirmed. Of 29,000 university students and faculty/staff, 7450 (30%) responded to the survey. ILI was reported by 604 (10%) of the students and 73 (5%) of the faculty/staff. Travel to Mexico (relative risk [RR], 2.9; 95% confidence interval [CI], 1.8-4.7) and participation in "Greek Week" activities (RR, 2.2; 95% CI, 1.8-2.8) were associated with ILI. Recipients of the 2008-2009 seasonal influenza vaccine had the same risk of ILI as nonrecipients (RR, 1.0). Four (3%) of the students with ILI were hospitalized; there were no deaths. CONCLUSIONS: pH1N1 spread rapidly through the University of Delaware community with a surge in illness over a 2-week period. Although initial cases appear to be associated with travel to Mexico, a rapid increase in cases was likely facilitated by increased student interactions during Greek Week. No protective effect from receiving seasonal influenza vaccine was identified. Although severe illness was rare, the outbreak caused a substantial burden and challenge to the university health care system. Preparedness efforts in universities and similar settings should include enhancing health care surge capacity. |
Practical considerations for matching STD and HIV surveillance data with data from other sources
Newman LM , Samuel MC , Stenger MR , Gerber TM , Macomber K , Stover JA , Wise W . Public Health Rep 2009 124 7-17 Data to guide programmatic decisions in public health are needed, but frequently epidemiologists are limited to routine case report data for notifiable conditions such as sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV). However, case report data are frequently incomplete or provide limited information on comorbidity or risk factors. Supplemental data often exist but are not easily accessible, due to a variety of real and perceived obstacles. Data matching, defined as the linkage of records across two or more data sources, can be a useful method to obtain better or additional data, using existing resources. This article reviews the practical considerations for matching STD and HIV surveillance data with other data sources, including examples of how STD and HIV programs have used data matching. |
Surveillance for severe community-associated methicillin-resistant Staphylococcus aureus infection
Wiersma P , Tobin D'Angelo M , Daley WR , Tuttle J , Arnold KE , Ray SM , Ladson JL , Bulens SN , Drenzek CL . Epidemiol Infect 2009 137 (12) 1674-8 Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has rapidly emerged in the USA as a cause of severe infections in previously healthy persons without traditional risk factors. We describe the epidemiology of severe CA-MRSA disease in the state of Georgia, USA and analyse the risk of death associated with three different clinical syndromes of CA-MRSA disease - pneumonia, invasive disease, and skin and soft-tissue infections (SSTIs). A total of 1670 cases of severe CA-MRSA disease were reported during 2005-2007. The case-fatality rate was 3.4%; sex and race of fatal and non-fatal cases did not differ significantly. While CA-MRSA pneumonia and invasive disease were less common than SSTIs, they were about 15 times more likely to result in death [risk ratio 16.69, 95% confidence interval (CI) 10.28-27.07 and 13.98, 95% CI 7.74-25.27, respectively]. When controlling for age and the presence of other clinical syndromes the odds of death in patients manifesting specific severe CA-MRSA syndromes was highest in those with pneumonia (odds ratio 11.34). Possible risk factors for severe CA-MRSA SSTI and pneumonia included the draining of lesions without medical assistance and an antecedent influenza-like illness. |
Toward integration of STD, HIV, TB, and viral hepatitis surveillance
Weinstock H , Douglas JM , Fenton KA . Public Health Rep 2009 124 5-6 Public health surveillance is “the ongoing systematic collection, analysis, and interpretation of outcome-specific data for use in the planning, implementation, and evaluation of public health practice.”1 While the fundamental activities of surveillance include data collection, analysis, and dissemination, the value of surveillance is measured through its impact on public health practice. The integration of surveillance data on sexually transmitted diseases (STDs), human immunodeficiency virus (HIV), tuberculosis (TB), and viral hepatitis is important insofar as an understanding of the intersection of these diseases geographically, in different populations, and by risk behaviors impacts the ability of public health programs to operate more efficiently and effectively. As Jennings et al.2 recommend in this special supplement of Public Health Reports, surveillance systems should be patient-based rather than case-based because program services themselves are most effective when they are patient-based. As many of the articles in this supplement illustrate, it is at the local and state levels where duplication and inefficiencies are felt most. These inefficiencies are felt by the patients who do not get the care they need in a timely fashion or who get fragmented care, by the programs that are being asked to accomplish more with diminished resources, and by the public, who are often provided fragmented rather than comprehensive summaries of problems of importance to their communities. | This special supplement highlights approaches to the integrated use of data by STD epidemiologists in the Outcome Assessment through Systems of Integrated Surveillance (OASIS) workgroup. OASIS was originally funded in 1998 by the Centers for Disease Control and Prevention's (CDC's) National Center for HIV, STD, and TB Prevention (the name was changed to the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention [NCHHSTP] in 2007) to promote the integrated interpretation and use of surveillance data across disease programs. The work of OASIS, only partially reflected in this supplement, demonstrates that state and local health departments, which have the most to gain from program integration, truly are the laboratories for creatively engineering more integrated surveillance and information systems. A system such as the Patient Reporting Investigation Surveillance Manager (PRISM), developed by the Florida Bureau of STD Prevention and Control and supported by OASIS, is one such example, as Shiver et al. describe in this issue.3 Groups like OASIS, consisting of local and state STD epidemiologists, can provide the energy and ideas to develop these efforts locally, but CDC must facilitate this work through leadership, coordination, funding, and dissemination of best practices. |
Integration of surveillance for STDs, HIV, hepatitis, and TB: a survey of US STD control programs
Dowell D , Gaffga NH , Weinstock H , Peterman TA . Public Health Rep 2009 124 31-38 OBJECTIVES: Integration of surveillance for sexually transmitted diseases (STDs), human immunodeficiency virus (HIV), hepatitis, and tuberculosis (TB) may improve disease prevention and control. We determined the extent of surveillance integration in these programs, the benefits of integration, and barriers to increased integration. METHODS: We e-mailed a survey to the 58 federally funded local and state STD control programs and followed up with phone interviews of nine program representatives. RESULTS: The response rate was 81%. Many had compared infections by population subgroup for STDs and HIV (89%), STDs and hepatitis (53%), or STDs and TB (28%). Most (74%) had examined co-infections with HIV and STDs at the individual level and entered STD and HIV surveillance data into the same database (54%). All respondents thought some integration would be useful. Many (72%) used integrated data to disseminate information or change program strategies. The most commonly reported barriers to integration were policies preventing work with HIV data (85%) and incompatible databases (59%). CONCLUSIONS: Most STD control programs in the United States have some experience integrating surveillance data, but the degree of integration varies widely. Specific barriers to further integration were identified. The Centers for Disease Control and Prevention can help address these barriers by facilitating access to information and sharing technical solutions. Local and state programs can continue advancing surveillance integration by improving understanding of where integrated data are needed, increasing the use of available data, and pressing for appropriate and secure data sharing. |
Adoption of rotavirus vaccination by pediatricians and family medicine physicians in the United States
Kempe A , Patel MM , Daley MF , Crane LA , Beaty B , Stokley S , Barrow J , Babbel C , Dickinson LM , Tempte JL , Parashar UD . Pediatrics 2009 124 (5) e809-16 OBJECTIVES: The goals were to assess, among pediatricians and family medicine physicians, (1) rates of offering the vaccine in their office; (2) knowledge of Advisory Committee on Immunization Practices recommendations; (3) barriers to use; and (4) factors associated with offering the vaccine. METHODS: Surveys of pediatricians and family medicine physicians were conducted in August to October 2007. RESULTS: Response rates were 84% for pediatricians and 79% for family medicine physicians (N = 623). Proportions routinely offering the vaccine were 85% of pediatricians and 45% of family medicine physicians (P < .0001); 70% of pediatricians and 22% of family medicine strongly recommended the vaccine (P < .0001). Sixty-two percent of pediatricians and 32% of family medicine physicians (P < .0001) knew the age by which all 3 doses should be completed. Definite barriers to vaccine use included reported lack of coverage by insurance companies (family medicine physicians: 22%; pediatricians: 19%; not significant), costs of purchasing vaccine (family medicine physicians: 22%; pediatricians: 17%; not significant), lack of adequate reimbursement (family medicine physicians: 18%; pediatricians: 15%; not significant), concerns about safety (family medicine physicians: 25%; pediatricians: 9%; P < .0001), and concerns about adding another vaccine to the schedule (family medicine physicians: 22%; pediatricians: 5%; P < .0001). CONCLUSIONS: Rates of offering the new rotavirus vaccine are high among pediatricians but <50% among family medicine physicians. Both specialties identified financial barriers to use of the vaccine, but family medicine physicians had significantly more concerns about safety and about adding another vaccine to the vaccination schedule. |
Food allergy among children in the United States
Branum AM , Lukacs SL . Pediatrics 2009 124 (6) 1549-55 OBJECTIVES: The goals were to estimate the prevalence of food allergy and to describe trends in food allergy prevalence and health care use among US children. METHODS: A cross-sectional survey of data on food allergy among children <18 years of age, as reported in the 1997-2007 National Health Interview Survey, 2005-2006 National Health and Nutrition Examination Survey, 1993-2006 National Hospital Ambulatory Medical Care Survey and National Ambulatory Medical Care Survey, and 1998-2006 National Hospital Discharge Survey, was performed. Reported food allergies, serum immunoglobulin E antibody levels for specific foods, ambulatory care visits, and hospitalizations were assessed. RESULTS: In 2007, 3.9% of US children <18 years of age had reported food allergy. The prevalence of reported food allergy increased 18% (z = 3.4; P < .01) from 1997 through 2007. In 2005-2006, serum immunoglobulin E antibodies to peanut were detectable for an estimated 9% of US children. Ambulatory care visits tripled between 1993 and 2006 (P < .01). From 2003 through 2006, an estimated average of 317000 food allergy-related, ambulatory care visits per year (95% confidence interval: 195000-438000 visits per year) to emergency and outpatient departments and physician's offices were reported. Hospitalizations with any recorded diagnoses related to food allergy also increased between 1998-2000 and 2004-2006, from an average of 2600 discharges per year to 9500 discharges per year (z = 3.4; P < .01), possibly because of increased use of food allergy V codes. CONCLUSION: Several national health surveys indicate that food allergy prevalence and/or awareness has increased among US children in recent years. |
The incidence and clinical characteristics of herpes zoster among children and adolescents after implementation of varicella vaccination
Civen R , Chaves SS , Jumaan A , Wu H , Mascola L , Gargiullo P , Seward JF . Pediatr Infect Dis J 2009 28 (11) 954-9 BACKGROUND: The varicella-zoster virus (VZV) vaccine strain may reactivate to cause herpes zoster. Limited data suggest that the risk of herpes zoster in vaccinated children could be lower than in children with naturally acquired varicella. We examine incidence trends, risk and epidemiologic and clinical features of herpes zoster disease among children and adolescents by vaccination status. METHODS: Population-based active surveillance was conducted among <20 years old residents in Antelope Valley, California, from 2000 through 2006. Structured telephone interviews collected demographic, varicella vaccination and disease histories, and clinical information. RESULTS: From 2000 to 2006, the incidence of herpes zoster among children <10 years of age declined by 55%, from 42 cases reported in 2000 (74.8/100,000 persons; 95% confidence interval [95% CI]: 55.3-101.2) to 18 reported in 2006 (33.3/100,000; 95% CI: 20.9-52.8; P < 0.001). During the same period, the incidence of herpes zoster among 10- to 19-year-olds increased by 63%, from 35 cases reported in 2000 (59.5/100,000 persons; 95% CI: 42.7-82.9) to 64 reported in 2006 (96.7/100,000; 95% CI: 75.7-123.6; P < 0.02). Among children aged <10 years, those with a history of varicella vaccination had a 4 to 12 times lower risk for developing herpes zoster compared with children with history of varicella disease. CONCLUSIONS: Varicella vaccine substantially decreases the risk of herpes zoster among vaccinated children and its widespread use will likely reduce overall herpes zoster burden in the United States. The increase in herpes zoster incidence among 10- to 19-year-olds could not be confidently explained and needs to be confirmed from other data sources. |
Influence of cytokine gene variations on immunization to childhood vaccines
Yucesoy B , Johnson VJ , Fluharty K , Kashon ML , Slaven JE , Wilson NW , Weissman DN , Biagini RE , Germolec DR , Luster MI . Vaccine 2009 27 (50) 6991-7 The magnitude of the immune response to vaccinations can be influenced by genetic variability. In the present study, we aimed to investigate whether cytokine or cytokine receptor gene polymorphisms were associated with variations in the immune response to childhood vaccination. The study group consisted of 141 healthy infants who had been immunized with hepatitis B vaccine (HBV), 7-valent pneumococcal conjugate (PCV7), and diphtheria, tetanus, acellular pertussis (DTaP) vaccines according to standard childhood immunization schedules. Genotype analysis was performed on genomic DNA using a 5' nuclease PCR assay. Post vaccination total, isotypic, and antigen-specific serum antibody levels were measured using multiplex immunoassays. Significant associations were observed between SNPs in the TNFalpha, IL-12B, IL-4Ralpha, and IL-10 genes and vaccine-specific immune responses (p<0.05). In addition, SNPs in the IL-1beta, TNFalpha, IL-2, IL-4, IL-10, IL-4Ralpha, and IL-12B genes were associated with variations in serum levels of immunoglobulins (IgG, IgA, IgM) and IgG isotypes (IgG1-IgG3) (p<0.05). These data suggest that genetic variations in cytokine genes can influence vaccine-induced immune responses in infants, which in turn may influence vaccine efficacy. |
The public health approach to youth violence and child maltreatment prevention at the Centers for Disease Control and Prevention
Hammond WR , Haegerich TM , Saul J . Psychol Serv 2009 6 (4) 253-263 Millions of people in the United States suffer the consequences of violence, including physical injuries, psychological trauma, and death. Solutions to violence have traditionally been reactive. Through the lens of the public health perspective, the Centers for Disease Control and Prevention (CDC) views violence as predictable based on various contributing factors, and thus as preventable. Within CDC, the Division of Violence Prevention (DVP) leads efforts to prevent injury, death, and disability, and to reduce the suffering and medical costs caused by violence. DVP employs a multidisciplinary, public health approach to identify factors associated with violence, and to develop, evaluate, and disseminate preventive interventions. Psychology is one discipline that has contributed to our approach. The authors present a series of violence prevention initiatives funded by the CDC that are framed within a public health perspective, with attention to the contributions of psychology to youth violence and child maltreatment prevention. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract). |
A live attenuated H1N1 M1 mutant provides broad cross-protection against influenza A viruses, including highly pathogenic A/Vietnam/1203/2004, in mice
Xie H , Liu TM , Lu X , Wu Z , Belser JA , Katz JM , Tumpey TM , Ye Z . J Infect Dis 2009 200 (12) 1874-1883 The emergence of novel influenza A H1N1 and highly pathogenic avian influenza (HPAI) H5N1 viruses underscores the urgency of developing efficient vaccines against an imminent pandemic. M(NLS-88R) (H1N1), an A/WSN/33 mutant with modifications in the multibasic motif 101RKLKR105 of the matrix (M1) protein and its adjacent region, was generated by reverse genetics. The M(NLS-88R) mutant had in vitro growth characteristics similar to those of wild-type A/WSN/33 (wt-WSN), but it was attenuated in mice. Vaccination with M(NLS-88R) not only fully protected mice from lethal homologous challenges but also prevented mortality caused by antigenically distinct H3N2 and H5N1 viruses. M(NLS-88R)-induced homologous protection was mainly antibody dependent, but cellular immunity was also beneficial in protecting against sublethal wt-WSN infection. Adoptive transfer studies indicated that both humoral and cellular immune responses were crucial for M(NLS-88R)-induced heterologous protection. Our study suggests an alternative approach to attenuate wt influenza viruses for the development of a pandemic vaccine with broad cross-protection. |
Nocardia mikamii sp. nov., isolated from human pulmonary infections in the United States
Jannat-Khah DP , Kroppenstedt RM , Klenk HP , Sproer C , Schumann P , Lasker BA , Steigerwalt AG , Hinrikson HP , Brown JM . Int J Syst Evol Microbiol 2009 60 (10) 2272-2276 Four nocardioform bacteria were isolated from clinical respiratory sources (W7467, W7811, W8061T and W9013) in the United States. Macroscopic examination showed scant aerial hyphae and beige-red substrate hyphae. They showed chemotaxonomic markers that were consistent with the classification of Nocardia: i.e., meso-diaminopimelic acid; arabinose and galactose as diagnostic sugars; the phospholipids diphosphatidylglycerol, phosphatidylethanolamine, phosphatidylinositol and phosphatidylinositol mannosides; a menaquinone with a omega-cyclic isoprene side chain MK-8(H4cycl.); a fatty acid pattern composed of unbranched saturated and monounsaturated fatty acids with considerable amount of tuberculostearic acid; and mycolic acids comprising 52 to 62 carbon atoms with three principal mycolic acids which were mono- and polyunsaturated showing a chain length of C54, C56 and C58. 16S rRNA gene sequence data and phenotypic characters showed they were most closely related to Nocardia aobensis (DSM 44805T ). The G+C content was 68.3 mol %. Analysis of a 1,245-bp fragment of gyrB gene showed a clade separate from N. aobensis and was supported by the DNA relatedness of 67 % of W8061T to N. aobensis. These data indicated that the novel isolates represent a new species within the genus Nocardia, for which the name Nocardia mikamii sp. nov. is proposed, with W8061T (DSM 45174T = JCM 15508T) designated as the type strain. |
Pyrethroid and organophosphates resistance in Anopheles (N.) nuneztovari Gabaldon populations from malaria endemic areas in Colombia
Fonseca-Gonzalez I , Cardenas R , Quinones ML , McAllister J , Brogdon WG . Parasitol Res 2009 105 (5) 1399-409 Field populations of Colombian malaria vector Anopheles (N.) nuneztovari were studied using World Health Organization (WHO) and Center for Disease Control and Prevention (CDC) bioassay techniques and through the use of biochemical microplate-based assays for resistance enzymes. Insecticides evaluated included the pyrethroids lambda-cyhalothrin and deltamethrin, organophosphates malathion and fenitrothion, and the organochlorine dichlorodiphenyltrichloroethane (DDT). Study sites selected were based upon malaria incidence, vector presence, and control activities in Colombia. Early stage selection for reduced susceptibility was observed in the bioassays for some locations. Data from the WHO and CDC bioassay methods were broadly consistent, with some differences noted. Evidence is presented for low-level initial selection of some resistance mechanisms such as mixed-function oxidases and modified acetylcholinesterase. Data from the site Encharcazon implies that selection for DDT-pyrethroid cross-resistance has occurred, though not likely at a level that currently threatens vector control by either class of insecticides, and further implies that knockdown resistance (kdr) may be present in those populations. Further studies using synergists and development of a kdr-specific assay for A. nuneztovari thus become priorities. The resistance levels to lambda-cyhalothrin and deltamethrin found in the Encharcazon population are of concern since these two insecticides are currently used for both indoor spraying and treated nets. In addition, the resistance to fenitrothion, the indoor spray insecticide mostly used for this species due to their exophilic behavior, found in the El Zulia population, makes urgent to find alternatives for chemical control in these areas. These data provide the initial baselines for insecticide susceptibility profiles for A. nuneztovari in Colombia and the first report of insecticide resistance in this vector. |
Re-evaluation, optimization, and multilaboratory validation of the PulseNet-standardized pulsed-field gel electrophoresis protocol for listeria monocytogenes
Halpin JL , Garrett NM , Ribot EM , Graves LM , Cooper KL . Foodborne Pathog Dis 2009 7 (3) 293-8 The PulseNet Methods Development and Validation Laboratory began a re-evaluation of the standardized pulsed-field gel electrophoresis (PFGE) protocols with the goal of optimizing their overall performance and robustness. Herein, we describe a stepwise evaluation of the PulseNet-standardized PFGE protocol for Listeria monocytogenes that led to the modification of several steps which significantly improved the overall appearance and reproducibility of the resulting PFGE data. These improvements included the following: (1) reducing the cell suspension concentration, (2) increasing lysozyme incubation temperature from 37 degrees C to 56 degrees C, and (3) decreasing the number of units of restriction enzymes AscI and ApaI. These changes were incorporated into a proposed protocol that was evaluated by 16 PulseNet participating laboratories, including 2 international participants. Results from the validation study indicated that the updated L. monocytogenes protocol is more robust than the original PulseNet-standardized protocol established in 1998 and this resulted in the official adoption of the new protocol into the PulseNet system in the spring of 2008. The modifications not only represent an improvement to the protocol but also describe procedural improvements that could be potentially applied to the PFGE analysis of other Gram-positive organisms. |
Removal of species constraints in antibody detection
Basile AJ , Biggerstaff BJ , Kosoy OL , Junna SR , Panella NA , Powers AM , Stark LM , Nemeth NM . Clin Vaccine Immunol 2009 17 (1) 56-61 Serum antibodies from myriad species, particularly birds, can provide key information regarding transmission and territory expansion of emerging pathogens. Expedient antibody analysis is constrained by a lack of species-specific reagents, a deficiency potentially highlighted by the recent swine-origin influenza A (H1N1) outbreak. Available methodologies present difficulties that discourage thorough serologic monitoring of potential disease vectors or hosts. Rapid high throughput procedures were developed that combined serum amine labeling via biotinylation, contaminant removal, and microsphere-based immunoassays for antibodies to three arboviruses. Agent-specific adaptations of this simple format should facilitate expanded surveillance and diagnostic capabilities regarding pathogens of human and veterinary importance. |
Revival and emended description of 'Mycobacterium paraffinicum' (Davis, Chase and Raymond 1956) as Mycobacterium paraffinicum (ex Davis, Chase and Raymond 1956) sp. nov., nom. rev
Toney NC , Adekambi T , Toney S , Yakrus M , Butler WR . Int J Syst Evol Microbiol 2009 60 (10) 2307-2313 The omission of the name 'Mycobacterium paraffinicum' from the 1980 Approved List of Bacterial Names was due to phenotypic confusion surrounding a close relationship with Mycobacterium scrofulaceum. Correspondingly 'M. paraffinicum' strains grew slowly in >7 days, stained acid-alcohol fast, produced yellow-pigmented smooth waxy colonies in the dark at an optimal temperature of 35 degrees C. However 'M. paraffinicum' strains demonstrated no activity for urease, nicotinamidase or pyrazinamidase, and lacked growth at 42 degrees C as compared to M. scrofulaceum. The mycolic acid pattern as determined by high performance liquid chromatography (HPLC) clustered 'M. paraffinicum' with M. scrofulaceum, Mycobacterium avium, and Mycobacterium parascrofulaceum. Strains were fully susceptible to linezolid, rifabutin, clarithromycin and amikacin. Examination of the historical reference strain of 'M. paraffinicum' ATCC 12670 and five additional isolates using comparative gene studies with 16S rRNA, hsp65, rpoB and concatenated sequences demonstrated separate, monophyletic tree branching that was distinct from similar nontuberculous mycobacteria and formed a tight taxonomical group with the classical reference strain of 'M. paraffinicum'. Multilocus enzyme electrophoresis (MEE) analysis confirmed a close association of the five additional isolates with the reference strain of 'M. paraffinicum' with a genetic distance of 0.12 and was distinct from other closely related species. These genetic results provided unambiguous evidence of the uniqueness of the slow-growing, scotochromogenic species and supported the revival of the name as Mycobacterium paraffinicum (ex Davis, Chase and Raymond 1956) sp. nov., nom. rev. We propose the previously deposited reference strain located in the worldwide collections as the type strain ATCC 12670T =DSM 44181T =NCIMB10420T. |
Subtype analysis of Cryptosporidium specimens from sporadic cases in Colorado, Idaho, New Mexico, and Iowa in 2007: widespread occurrence of one Cryptosporidium hominis subtype and case history of an infection with the Cryptosporidium horse genotype
Xiao L , Hlavsa MC , Yoder J , Ewers C , Dearen T , Yang W , Nett R , Harris S , Brend SM , Harris M , Onischuk L , Valderrama AL , Cosgrove S , Xavier K , Hall N , Romero S , Young S , Johnston SP , Arrowood M , Roy S , Beach MJ . J Clin Microbiol 2009 47 (9) 3017-20 Subtyping was conducted in late 2007 on 57 Cryptosporidium specimens from sporadic cases in Colorado, Idaho, New Mexico, and Iowa. One previously rare Cryptosporidium hominis subtype was identified in 40 cases (70%) from all four states, and the Cryptosporidium horse genotype was identified in a pet shop employee with severe clinical symptoms. |
Surveillance for neuraminidase-inhibitor-resistant influenza viruses in Japan, 1996-2007
Tashiro M , McKimm-Breschkin JL , Saito T , Klimov A , Macken C , Zambon M , Hayden FG , Neuraminidase Inhibitor Susceptibility Network . Antivir Ther 2009 14 (6) 751-61 BACKGROUND: High usage of the neuraminidase inhibitor (NAI) oseltamivir in Japan since 2003 led the Neuraminidase Inhibitor Susceptibility Network to assess the susceptibility of community isolates of influenza viruses to oseltamivir and zanamivir. METHODS: Isolates were tested by the enzyme inhibition assay and by neuraminidase (NA) sequence analysis. RESULTS: Among 1,141 A(H3N2) viruses and 171 type B viruses collected in Japan during the 2003-2004 season, 3 (0.3%) A(H3N2) isolates showed high 50% inhibitory concentrations (IC(50)) to oseltamivir. Each possessed a known resistance NA mutation at R292K or E119V. During the 2004-2005 season, no resistance was found among 567 influenza A(H3N2) or 60 A(H1N1) isolates, but 1 of 58 influenza B isolates had an NAI resistance mutation (D197N). Sequence analysis found that 4 (3%) of 132 A(H1N1) viruses from 2005-2006 had known NA resistance mutations (all H274Y), but no additional resistant isolates were detected from that or the subsequent 2006-2007 season. Concurrent testing of a selection of 500 influenza B viruses from 2000 to 2006 showed significant variations between seasons in both oseltamivir and zanamivir IC(50) values, but no persistent increases over this period. CONCLUSIONS: Our findings suggested possible low-level transmission of resistant variants from oseltamivir-treated patients in several seasons in Japan but no sustained reductions in NAI susceptibility or consistently increased frequency of detecting resistant variants for any strain or subtype, despite high levels of drug use. In particular, although oseltamivir-resistant A(H1N1) viruses with the H274Y mutation spread globally in 2007-2008, we found little evidence for increasing levels of resistant A(H1N1) variants in Japan in preceding years. |
WHO Global Salm-Surv external quality assurance system for serotyping of Salmonella isolates from 2000 to 2007
Hendriksen RS , Mikoleit M , Carlson VP , Karlsmose S , Vieira AR , Jensen AB , Seyfarth AM , DeLong SM , Weill FX , Wong DM , Angulo FJ , Wegener HC , Aarestrup FM . J Clin Microbiol 2009 47 (9) 2729-36 An international external quality assurance system (EQAS) for the serotyping of Salmonella species was initiated in 2000 by WHO Global Salm-Surv to enhance the capacity of national reference laboratories to obtain reliable data for surveillance purposes worldwide. Seven EQAS iterations were conducted between 2000 and 2007. In each iteration, participating laboratories submitted serotyping results for eight Salmonella isolates. A total of 249 laboratories in 96 countries participated in at least one EQAS iteration. A total of 756 reports were received from the participating laboratories during the seven EQAS iterations. Cumulatively, 76% of participating laboratories submitted data for all eight strains, and 82% of strains were correctly serotyped. In each iteration, 84% to 96% of the laboratories correctly serotyped the Salmonella enterica serovar Enteritidis isolate that was included as an internal quality control strain. Regional differences in performance were observed, with laboratories in Central Asia and the Middle East performing less well overall than those in other regions. Errors that resulted in incorrect serovar identification were typically caused by difficulties in the detection of the phase two flagellar antigen or in differentiation within antigen complexes; some of these errors are likely related to the quality of the antisera available. The results from the WHO Global Salm-Surv EQAS, the largest of its kind in the world, show that most laboratories worldwide are capable of correctly serotyping Salmonella species. However, this study also indicates a continuing need for improvement. Future training efforts should be aimed at enhancing the ability to detect the phase two flagellar antigen and at disseminating information on where to purchase high-quality antisera. |
Biofilm formation and effect of caspofungin on biofilm structure of Candida species bloodstream isolates
Ferreira JA , Carr JH , Starling CE , de Resende MA , Donlan RM . Antimicrob Agents Chemother 2009 53 (10) 4377-84 Candida biofilms are microbial communities, embedded in a polymeric matrix, growing attached to a surface, and are highly recalcitrant to antimicrobial therapy. These biofilms exhibit enhanced resistance against most antifungal agents except echinocandins and lipid formulations of amphotericin B. In this study, biofilm formation by different Candida species, particularly Candida albicans, C. tropicalis, and C. parapsilosis, was evaluated, and the effect of caspofungin (CAS) was assessed using a clinically relevant in vitro model system. CAS displayed in vitro activity against C. albicans and C. tropicalis cells within biofilms. Biofilm formation was evaluated after 48 h of antifungal drug exposure, and the effects of CAS on preformed Candida species biofilms were visualized using scanning electron microscopy (SEM). Several species-specific differences in the cellular morphologies associated with biofilms were observed. Our results confirmed the presence of paradoxical growth (PG) in C. albicans and C. tropicalis biofilms in the presence of high CAS concentrations. These findings were also confirmed by SEM analysis and were associated with the metabolic activity obtained by biofilm susceptibility testing. Importantly, these results suggest that the presence of atypical, enlarged, conical cells could be associated with PG and with tolerant cells in Candida species biofilm populations. The clinical implications of these findings are still unknown. |
Clostridium difficile strains from community-associated infections
Limbago BM , Long CM , Thompson AD , Killgore GE , Hannett GE , Havill NL , Mickelson S , Lathrop S , Jones TF , Park MM , Harriman KH , Gould LH , McDonald LC , Angulo FJ . J Clin Microbiol 2009 47 (9) 3004-7 Clostridium difficile isolates from presumed community-associated infections (n = 92) were characterized by toxinotyping, pulsed-field gel electrophoresis, tcdC and cdtB PCR, and antimicrobial susceptibility. Nine toxinotypes (TOX) and 31 PFGE patterns were identified. TOX 0 (48, 52%), TOX III (18, 20%), and TOX V (9, 10%) were the most common; three isolates were nontoxigenic. |
The dengue virus type 2 envelope protein fusion peptide is essential for membrane fusion
Huang CY , Butrapet S , Moss KJ , Childers T , Erb SM , Calvert AE , Silengo SJ , Kinney RM , Blair CD , Roehrig JT . Virology 2009 396 (2) 305-15 The flaviviral envelope (E) protein directs virus-mediated membrane fusion. To investigate membrane fusion as a requirement for virus growth, we introduced 27 unique mutations into the fusion peptide of an infectious cDNA clone of dengue 2 virus and recovered seven stable mutant viruses. The fusion efficiency of the mutants was impaired, demonstrating for the first time the requirement for specific FP AAs in optimal fusion. Mutant viruses exhibited different growth kinetics and/or genetic stabilities in different cell types and adult mosquitoes. Virus particles could be recovered following RNA transfection of cells with four lethal mutants; however, recovered viruses could not re-infect cells. These viruses could enter cells, but internalized virus appeared to be retained in endosomal compartments of infected cells, thus suggesting a fusion blockade. Mutations of the FP also resulted in reduced virus reactivity with flavivirus group-reactive antibodies, confirming earlier reports using virus-like particles. |
Detection of low levels of human immunodeficiency virus (HIV) may be critical for early diagnosis of pediatric HIV infection by use of dried blood spots
Walter J , Kuhn L , Semrau K , Decker DW , Sinkala M , Kankasa C , Thea DM , Bulterys M , Ou CY , Aldrovandi GM . J Clin Microbiol 2009 47 (9) 2989-91 We compared a DNA-based assay with a total nucleic acid-based assay for early detection of infant human immunodeficiency virus (HIV) infection. The codetection of DNA and RNA did not result in an overall higher sensitivity compared to that of DNA alone. Discordant results were associated with low levels of HIV DNA, indicating that the sample amount may be critical. |
Host cell selection of influenza neuraminidase variants: implications for drug resistance monitoring in A(H1N1) viruses
Okomo-Adhiambo M , Nguyen HT , Sleeman K , Sheu TG , Deyde VM , Garten RJ , Xu X , Shaw MW , Klimov AI , Gubareva LV . Antiviral Res 2009 85 (2) 381-8 The neuraminidase inhibitors (NAIs), oseltamivir and zanamivir, are essential for treatment and prevention of influenza A and B infections. Oseltamivir resistance among influenza A (H1N1) viruses rapidly emerged and spread globally during the 2007-2008 and 2008-2009 influenza seasons. Approximately 20% and 90% of viruses tested for NAI susceptibility at CDC during these seasons, respectively, were resistant to oseltamivir (IC(50) approximately 100-3000 time>those of sensitive viruses), based on the chemiluminescent NA inhibition assay. Pyrosequencing analysis confirmed H274Y mutation (H275Y in N1 numbering) in the neuraminidase (NA) gene of oseltamivir-resistant viruses. Full NA sequence analysis of a subset of oseltamivir-resistant and sensitive virus isolates from both seasons (n=725) showed that 53 (7.3%) had mutations at residue D151 (D-->E/G/N), while 9 (1.2%) had mutations at Q136 (Q-->K) and 2 (0.3%) had mutations at both residues. Viruses with very high IC(50) for oseltamivir and peramivir, and elevated IC(50) for zanamivir, had H274Y in addition to mutations at D151 and/or Q136, residues which can potentially confer NAI-resistance based on recent N1 NA crystal structure data. Mutations at D151 without H274Y, did not elevate IC(50) for any tested NAI, however, Q136K alone significantly reduced susceptibility to zanamivir (36-fold), peramivir (80-fold) and A-315675 (114-fold) but not oseltamivir. Mutations at D151 and Q136 were present only in MDCK-grown viruses but not in matching original clinical specimens (n=33) which were available for testing, suggesting that these variants were the result of cell culture selection or they were present in very low proportions. Our findings provide evidence that propagation of influenza virus outside its natural host may lead to selection of virus variants with mutations in the NA that affect sensitivity to NAIs and thus poses implications for drug resistance monitoring and diagnostics. |
Prevalence of developmental disabilities and receipt of special education services among children with an inborn error of metabolism
Powell K , Van Naarden Braun K , Singh R , Shapira SK , Olney RS , Yeargin-Allsopp M . J Pediatr 2009 156 (3) 420-6 OBJECTIVE: To examine the presence of developmental disabilities and receipt of special education services in children with an inborn error of metabolism. STUDY DESIGN: The study population was children born from 1988 through 2001 in whom a metabolic disorder was diagnosed after identification by newborn screening (n = 97) or after clinical identification (n = 34). These children were linked to the Metropolitan Atlanta Development Disability Surveillance Program (MADDSP) and Special Education Database of Metropolitan Atlanta (SEDMA) to determine developmental outcomes at 8 years of age and 3 through 10 years of age, respectively. Medical and educational records were examined to consider factors contributing to developmental outcomes. RESULTS: Of 97 children with a metabolic disorder identified with newborn screening, 12 (12.4%) were identified by SEDMA as receiving special education services and 2 (2.7%) were identified by MADDSP as having a developmental disability. Of the 34 children with a clinically identified metabolic disorder, 8 (23.5%) were identified with SEDMA, and 5 (17.2%) were identified with a MADDSP developmental disability. CONCLUSION: Early identification and treatment have been successful in limiting the impact of severe developmental disabilities. Continued surveillance and research are needed to monitor less severe developmental outcomes. |
Born a bit too early: recent trends in late preterm births
Martin JA , Kirmeyer S , Osterman M , Shepherd RA . NCHS Data Brief 2009 (24) 1-8 KEY FINDINGS: The U.S. late preterm birth rate rose 20% from 1990 to 2006. If the late preterm rate had not risen from the 1990 level, more than 50,000 fewer infants would have been delivered late preterm in 2006. On average, more than 900 late preterm babies are born every day in the United States, or a total of one-third of 1 million infants (333,461). Increases in late preterm births are seen for mothers of all ages, and for non-Hispanic white and Hispanic mothers. The rate for black mothers declined during the 1990s, but has been on the rise since 2000. Late preterm birth rates rose for all U.S. states, but declined in the District of Columbia. The percentage of late preterm births for which labor was induced more than doubled from 1990 to 2006; the percentage of late preterm births delivered by cesarean also rose markedly. |
Control selection and participation in an ongoing, population-based, case-control study of birth defects: the National Birth Defects Prevention Study
Cogswell ME , Bitsko RH , Anderka M , Caton AR , Feldkamp ML , Hockett Sherlock SM , Meyer RE , Ramadhani T , Robbins JM , Shaw GM , Mathews TJ , Royle M , Reefhuis J , National Birth Defects Prevention Study . Am J Epidemiol 2009 170 (8) 975-85 To evaluate the representativeness of controls in an ongoing, population-based, case-control study of birth defects in 10 centers across the United States, researchers compared 1997-2003 birth certificate data linked to selected controls (n = 6,681) and control participants (n = 4,395) with those from their base populations (n = 2,468,697). Researchers analyzed differences in population characteristics (e.g., percentage of births at > or =2,500 g) for each group. Compared with their base populations, control participants did not differ in distributions of maternal or paternal age, previous livebirths, maternal smoking, or diabetes, but they did differ in other maternal (i.e., race/ethnicity, education, entry into prenatal care) and infant (i.e., birth weight, gestational age, and plurality) characteristics. Differences in distributions of maternal, but not infant, characteristics were associated with participation by selected controls. Absolute differences in infant characteristics for the base population versus control participants were < or =1.3 percentage points. Differences in infant characteristics were greater at centers that selected controls from hospitals compared with centers that selected controls from electronic birth certificates. These findings suggest that control participants in the National Birth Defects Prevention Study generally are representative of their base populations. Hospital-based control selection may slightly underascertain infants affected by certain adverse birth outcomes. |
From the American Academy of Pediatrics: Policy statement--Tobacco use: a pediatric disease
Committee On Environmental Health , Committee On Substance Abuse , Committee On Adolescence , Committee On Native American Child Health , Anderson M . Pediatrics 2009 124 (5) 1474-87 Tobacco use and secondhand tobacco-smoke (SHS) exposure are major national and international health concerns. Pediatricians and other clinicians who care for children are uniquely positioned to assist patients and families with tobacco-use prevention and treatment. Understanding the nature and extent of tobacco use and SHS exposure is an essential first step toward the goal of eliminating tobacco use and its consequences in the pediatric population. The next steps include counseling patients and family members to avoid SHS exposures or cease tobacco use; advocacy for policies that protect children from SHS exposure; and elimination of tobacco use in the media, public places, and homes. Three overarching principles of this policy can be identified: (1) there is no safe way to use tobacco; (2) there is no safe level or duration of exposure to SHS; and (3) the financial and political power of individuals, organizations, and government should be used to support tobacco control. Pediatricians are advised not to smoke or use tobacco; to make their homes, cars, and workplaces tobacco free; to consider tobacco control when making personal and professional decisions; to support and advocate for comprehensive tobacco control; and to advise parents and patients not to start using tobacco or to quit if they are already using tobacco. Prohibiting both tobacco advertising and the use of tobacco products in the media is recommended. Recommendations for eliminating SHS exposure and reducing tobacco use include attaining universal (1) smoke-free home, car, school, work, and play environments, both inside and outside, (2) treatment of tobacco use and dependence through employer, insurance, state, and federal supports, (3) implementation and enforcement of evidence-based tobacco-control measures in local, state, national, and international jurisdictions, and (4) financial and systems support for training in and research of effective ways to prevent and treat tobacco use and SHS exposure. Pediatricians, their staff and colleagues, and the American Academy of Pediatrics have key responsibilities in tobacco control to promote the health of children, adolescents, and young adults. |
A miniature disk electrostatic aerosol classifier (mini-disk EAC) for personal nanoparticle sizers
Li L , Chen DR , Qi C , Kulkarni PS . J Aerosol Sci 2009 40 (11) 982-992 We have developed a miniature disk electrostatic aerosol classifier (mini-disk EAC) for use in electrical mobility-based personal nanoparticle instrumentation for measurement of personal exposures to nanoaerosols. The prototype consists of two parallel disk electrodes separated by an electrically insulating spacer, to create the particle classification zone. The aerosol enters and exits the classification zone along the bottom disk electrode. An additional, particle-free sheath flow is used to improve the measurement resolution. The transmission measurement of the mini-disk EAC for DMA-classified particles shows that particle losses due to diffusion and electrical image forces were low. The particle penetration at 10 nm diameter (the designed lower size limit for the classifier) was 67% when the prototype was operated at the aerosol and sheath flow rates of 0.5 and 1.0 l min-1, respectively. The performance of the mini-disk EAC was experimentally characterized using the particle cutoff curves that describe their penetration through the classifier as a function of applied voltage across the two disk electrodes. Based on the measurement of particle penetration at different aerosol and sheath flows, it was found that the aerosol and sheath flow rates of 0.5 and 1.5 l min-1 were optimal for classifier operation. Finally, a semi-empirical model was also developed to describe the transfer function of the mini-disk EAC for non-diffusive particles. |
Occupational safety and health in nanotechnology and Organisation for Economic Cooperation and Development
Murashov V , Engel S , Savolainen K , Fullam B , Lee M , Kearns P . J Nanopart Res 2009 11 (7) 1587-1591 The Organization for Economic Cooperation and Development (OECD), an intergovernmental organization, is playing a critical global role in ensuring that emerging technologies, such as nanotechnology, are developed responsibly. This article describes OECD activities around occupational safety and health of nanotechnology and provides state-of-the-science overview resulting from an OECD workshop on exposure assessment and mitigation for nanotechnology workplace. |
The role of p53 in silica-induced cellular and molecular responses associated with carcinogenesis
Gwinn MR , Leonard SS , Sargent LM , Lowry DT , McKinstry K , Meighan T , Reynolds SH , Kashon M , Castranova V , Vallyathan V . J Toxicol Environ Health A 2009 72 (23) 1509-1519 Crystalline silica (silica), a suspected human carcinogen, produces an increase in reactive oxygen species (ROS) when fractured using mechanical tools used in several occupations. Although ROS has been linked to apoptosis, DNA damage, and carcinogenesis, the role of enhanced ROS production by silica in silica-induced carcinogenesis is not completely understood. The goal of this study was to compare freshly fractured and aged silica-induced molecular alterations in human immortalized/transformed bronchial epithelial cells (BEAS-IIB) and lung cancer cells with altered (H460) or deficient (H1299) p53 expression. Exposure to freshly fractured or aged silica produced divergent cellular responses in certain downstream cellular events, including ROS production, apoptosis, cell cycle and chromosomal changes, and gene expression. ROS production increased significantly following exposure to freshly fractured silica compared to aged silica in BEAS-IIB and H460 cells. Apoptosis showed a comparable enhanced level of induction with freshly fractured or aged silica in both cancer lines with p53 functional changes. p53 protein was present in the BEAS-IIB and was absent in cancer cell lines after silica exposure. Exposure to freshly fractured silica also resulted in a rise in aneuploidy in cancer cells with a significantly greater increase in p53-deficient cells. Cytogenetic analysis demonstrated increased metaphase spreads, chromosome breakage, rearrangements, and endoreduplication in both cancer cells. These results suggest that altered and deficient p53 affects the cellular response to freshly fractured silica exposure, and thereby enhances susceptibility and augments cell proliferation and lung cancer development. |
Workplace violence intervention effectiveness: a systematic literature review
Wassell JT . Saf Sci 2009 47 (8) 1049-1055 This is a systematic review of literature published since 1992, to determine the effectiveness of interventions in preventing workplace violence and to suggest interventions that need further evaluation research. The health care industry is the topic of 54% of the papers, the retail industry is the topic of 11% of the papers, and the remaining papers address the workplace in general or other situations. This finding drives the organization of this review: the first group of papers discussed in this review evaluates interventions to prevent workplace violence in the retail industry - mostly to prevent robbery and violence to retail workers. Singly or in combination, environmental designs in the retail industry, such as increased lighting to improve visibility and a limited cash-handling policy, can make workers safer, but more research is needed to overcome the barriers to implementation of environmental designs, especially in small businesses. The second group of papers in this review is about interventions to prevent violence to health care workers - mostly training and techniques of dealing with combative patients, Training health care workers to better cope with violent patients and to avoid injury is becoming standard practice, but research is needed to identify specific aspects of training and patient management programs that are most effective. Published by Elsevier Ltd. |
Commercial drivers' health: a naturalistic study of body mass index, fatigue, and involvement in safety-critical events
Wiegand DM , Hanowski RJ , McDonald SE . Traffic Inj Prev 2009 10 (6) 573-9 OBJECTIVE: To explore the relation of commercial truck drivers' body mass indexex (BMI) to fatigued driving episodes and involvement in safety-critical events. METHODS: One hundred and three professional truck drivers participated in a long-term naturalistic (on-road) driving study whereby vehicle motion data as well as video of the driver and driving environment were gathered continuously. This data set was analyzed to identify safety-critical events as well as fatigued driving episodes using two independent measures of fatigue. Odds ratio analyses were then performed to explore the relative risk of driving while fatigued and involvement in safety-critical events based on driver's BMI classification (obese versus non-obese). RESULTS: Results indicated that of the 103 participating truck drivers, 53.4 percent were obese based on BMI. Odds ratio calculations revealed that obese individuals were between 1.22 (CI = 1.03-1.45) and 1.69 times (CI = 1.32-2.18) more likely than non-obese individuals to be rated as fatigued based on the two measures of fatigue. Other analyses showed that obese individuals were at 1.37 times (CI = 1.19-1.59) greater risk for involvement in a safety-critical event than non-obese individuals. Finally, one of the fatigue measures showed that obese individuals were 1.99 times (CI = 1.02-3.88) more likely than non-obese individuals to be fatigued while involved in an at-fault safety-critical incident. CONCLUSION: The results of this study support other research in the field of health and well-being that indicate a link between obesity and fatigue, which is a major safety issue surrounding commercial motor vehicle operations given the long hours these drivers spend on the road. |
Using ergonomics to enhance safe production at a surface coal mine--a case study with powder crews
Torma-Krajewski J , Wiehagen W , Etcheverry A , Turin F , Unger R . J Occup Environ Hyg 2009 6 (10) D55-62 Job tasks that involve exposure to work-related musculoskeletal disorder (WMSD) risk factors may impact both the risk of injury and production downtime. Common WMSD risks factors associated with mining tasks include forceful exertions, awkward postures, repetitive motion, jolting and jarring, forceful gripping, contact stress, and whole body and segmental vibration. Mining environments that expose workers to temperature/humidity extremes, windy conditions, and slippery and uneven walking surfaces also contribute to injury risk. National Institute for Occupational Safety and Health (NIOSH) researchers worked with powder crew members from the Bridger Coal Company to identify and rank routine work tasks based on perceived exposure to WMSD risk factors. This article presents the process followed to identify tasks that workers believed involved the greatest exposure to risk factors and discusses risk reduction strategies. Specifically, the proposed prill truck design changes addressed cab ingress/egress, loading blast holes, and access to the upper deck of the prill truck. |
Putting physical activity into public health: a historical perspective from the CDC
Pratt M , Epping JN , Dietz WH . Prev Med 2009 49 (4) 301-2 This commentary reviews the role that the U.S. Centers for Disease Control and Prevention (CDC) has played since 1964 in moving science, policy, and practice from exercise and fitness to physical activity and health. |
The rise and fall of supervision in a project designed to strengthen supervision of Integrated Management of Childhood Illness in Benin
Rowe AK , Onikpo F , Lama M , Deming MS . Health Policy Plan 2009 25 (2) 125-34 OBJECTIVE: In developing countries, supervision is a widely recognized strategy for improving health worker performance; and anecdotally, maintaining regular, high-quality supervision is difficult. However, remarkably little research has explored in depth why supervision is so challenging. METHODS: In the context of a trial to improve health worker adherence to Integrated Management of Childhood Illness (IMCI) guidelines and strengthen supervision in southeastern Benin, we used record reviews, focus group discussions, key informant interviews, and cross-sectional surveys to examine the supervision process. FINDINGS: Initially, little IMCI supervision occurred. The frequency increased substantially after implementing a series of workshops, but then deteriorated. Quantitative and qualitative data revealed obstacles to supervision at multiple levels of the health system. Based on supervisors' opinions, the main problems were: poor coordination; inadequate management skills and ineffective management teams; a lack of motivation; problems related to decentralization; health workers sometimes resisting IMCI implementation; and less priority given to IMCI supervision because of incentives for non-supervision activities, a lack of leadership, and an expectation of integrated supervision. To this list, based on our observations, we add: the increasing supervision workload, time required for non-supervision activities, project interventions not always being implemented as planned, and the loss of particularly effective supervisors. In terms of correctly completing steps of the supervision process, the quality of supervision was generally good. CONCLUSIONS: Managers should monitor supervision, understand the evolving influences on supervision, and use their resources and authority to both promote supervision and remove impediments to supervision. Support from leaders can be crucial, thus donors and politicians should help make supervision a true priority. As with front-line clinicians, supervisors are health workers who need support. We emphasize the importance of research to identify effective and affordable strategies for improving supervision frequency and quality. (ClinicalTrials.gov number NCT00510679.). |
Intrinsic job satisfaction, overall satisfaction, and intention to leave the job among nursing assistants in nursing homes
Decker FH , Harris-Kojetin LD , Bercovitz A . Gerontologist 2009 49 (5) 596-610 PURPOSE: We examined predictors of intrinsic job satisfaction, overall satisfaction, and intention to leave the job among nursing assistants (NAs). DESIGN AND METHODS: The study focused on NAs who worked 30 or more hours per week in a nursing home. Data on 2,146 NAs meeting this criterion came from the 2004 National Nursing Assistant Survey, the first telephone interview survey of NAs nationwide. Regression equations were calculated in which intrinsic satisfaction, overall satisfaction, and intention to leave were dependent variables. NA attributes (e.g., job tenure and education) and extrinsic job factors (e.g., assessment of supervisor behavior, pay satisfaction, and benefits) were exogenous variables. RESULTS: A positive assessment of the supervisor's behavior had the strongest association with intrinsic satisfaction. Pay satisfaction had the second strongest association with intrinsic satisfaction. Predictors with the strongest associations with intention to leave were overall and intrinsic satisfaction. Assessment of the supervisor was not associated directly with intention to leave. Assessments of the supervisor and pay may affect overall satisfaction and intention to leave in part through their direct effects on intrinsic satisfaction. Some facility and NA attributes were related to intrinsic satisfaction but not to overall satisfaction, suggesting that intrinsic satisfaction may be an intervening variable in the impact of these attributes on overall satisfaction. IMPLICATIONS: Intrinsic satisfaction and extrinsic job factors amenable to change appear central to NAs' overall satisfaction and intention to leave. A facility may be able to improve extrinsic job factors that improve NAs' job-related affects, including intrinsic satisfaction. |
Diffusion of effective behavioral interventions and Hispanic/Latino populations
Stallworth JM , Andia JF , Burgess R , Alvarez ME , Collins C . AIDS Educ Prev 2009 21 152-63 The national HIV/AIDS prevention program, the Diffusion of Effective Behavioral Interventions (DEBI), is described in the context of addressing Hispanics/Latinos at risk for HIV/AIDS in the United States and Puerto Rico. The eight-step DEBI model is referenced in terms of the interventions and Division of HIV/AIDS Prevention/Capacity Building Branch (DHAP/CBB) Latino Diffusion Team activities. A summary of activities and examples addressing diffusion needs for the diverse Hispanic/Latino populations is discussed. Challenges and successes in diffusion and partner collaborations are also presented, with comment on future directions such as translations and trainings to serve the needs of the Hispanic/Latino-serving community-based organizations and their communities. |
The implementation of a culturally based HIV sexual risk reduction program for Latino youth in a Denver area high school
Mueller TE , Castaneda CA , Sainer S , Martinez D , Herbst JH , Wilkes AL , Villarruel AM . AIDS Educ Prev 2009 21 164-70 In the United States, Latino youth experience disproportionately higher rates of teen pregnancy and sexually transmitted infections (STIs) than non-Latino Whites. As a result, organizations serving Latino youth seek culturally appropriate evidence-based prevention programs that promote sexual abstinence and condom use. Cuidate! is an efficacious HIV sexual risk reduction program for Latino youth aged 13-18. The program incorporates cultural beliefs that are common among Latino youth and associated with sexual risk behavior, and uses these beliefs to frame abstinence and condom use as culturally accepted and effective ways to prevent unintended pregnancy and STIs, including HIV/AIDS. Cuidate! has been successfully delivered in community agencies and after-school programs but has not been integrated into an existing school curriculum. This brief case study describes efforts to implement Cuidate! in a predominantly Latino urban high school in Denver. Ninety-three youth participated in the program from October 2007 to May 2008. Cuidate! was adapted to accommodate the typical class period by delivering program content over a larger number of sessions and extending the total amount of time of the program to allow for additional activities. Major challenges of program implementation included student recruitment and the "opt in" policy for participation. Despite these challenges, Cuidate! was implemented with minor adaptations in a school setting. |
Broadly reactive pan-paramyxovirus reverse transcription polymerase chain reaction and sequence analysis for the detection of canine distemper virus in a case of canine meningoencephalitis of unknown etiology
Schatzberg SJ , Li Q , Porter BF , Barber RM , Claiborne MK , Levine JM , Levine GJ , Israel SK , Young BD , Kiupel M , Greene C , Ruone S , Anderson L , Tong S . J Vet Diagn Invest 2009 21 (6) 844-9 Despite the immunologic protection associated with routine vaccination protocols, Canine distemper virus (CDV) remains an important pathogen of dogs. Antemortem diagnosis of systemic CDV infection may be made by reverse transcription polymerase chain reaction (RT-PCR) and/or immunohistochemical testing for CDV antigen; central nervous system infection often requires postmortem confirmation via histopathology and immunohistochemistry. An 8-month-old intact male French Bulldog previously vaccinated for CDV presented with multifocal neurologic signs. Based on clinical and postmortem findings, the dog's disease was categorized as a meningoencephalitis of unknown etiology. Broadly reactive, pan-paramyxovirus RT-PCR using consensus-degenerate hybrid oligonucleotide primers, combined with sequence analysis, identified CDV amplicons in the dog's brain. Immunohistochemistry confirmed the presence of CDV antigens, and a specific CDV RT-PCR based on the phosphoprotein gene identified a wild-type versus vaccinal virus strain. This case illustrates the utility of broadly reactive PCR and sequence analysis for the identification of pathogens in diseases with unknown etiology. |
Comparison of two immunochromatographic assays and the indirect immunofluorescence antibody test for diagnosis of Trypanosoma cruzi infection in dogs in south central Louisiana
Nieto PD , Boughton R , Dorn PL , Steurer F , Raychaudhuri S , Esfandiari J , Goncalves E , Diaz J , Malone JB . Vet Parasitol 2009 165 241-7 Two rapid tests evaluated in dogs considered to be of high risk of infection with the Chagas parasite Trypanosoma cruzi using two immunochromatographic assays: Trypanosoma Detect for canine, InBios, Seattle, WA and CHAGAS STAT-PAK assay, Chembio Diagnostic Systems, Medford, NY, in south central Louisiana. For this purpose a serological survey was carried out in a total of 122 dogs and a serum bank was created. These 122 animals were first tested by IFAT that was used as the standard test. From the serum bank 50 samples were tested using the two rapid Chagas assays and results compared to the standard test IFAT. The serological survey using IFAT showed a prevalence of T. cruzi infection in 22.1% of the tested dogs. In the immunochromatographic assays, 13 and 11 animals were positive on rapid assay: Trypanosoma Detect for canine, InBios and CHAGAS STAT-PAK, Chembio Diagnostic Systems, respectively compared to 11 positive by IFAT. These two immunochromatographic tests have shown high susceptibility and specificity compared to our standard method IFAT. The rapid, easy and accurate screening assays used in conjunction with confirmatory tests, would be an excellent tool for veterinarians to diagnose T. cruzi infection. Early detection of T. cruzi infection may prevent complications through an effective treatment. Greater awareness by veterinarians of the risk, clinical findings, history along with diagnostic methods will contribute greatly to an understanding of the true prevalence of Chagas disease in dogs in Louisiana. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Environmental Health
- Epidemiology and Surveillance
- Immunity and Immunization
- Injury and Violence
- Laboratory Sciences
- Maternal and Child Health
- Occupational Safety and Health
- Occupational Safety and Health - Mining
- Physical Activity
- Public Health Leadership and Management
- Social and Behavioral Sciences
- Veterinary Medicine
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