Understanding barriers to cervical cancer screening in women with access to care, Behavioral Risk Factor Surveillance System, 2014
Crawford A , Benard V , King J , Thomas CC . Prev Chronic Dis 2016 13 E154 Cervical cancer screening can save lives when abnormal cervical lesions and early cancers are detected and treated; however, many women are not screened as recommended. We used the Behavioral Risk Factor Surveillance System survey to examine nonfinancial barriers to cervical cancer screening among women who reported having insurance and a personal doctor or health care provider. Among these women, a higher proportion who were never or rarely screened reported having multiple chronic conditions. The results of this study underscore the importance of incorporating preventive clinical services into the management of one or more chronic conditions. |
Epidemiological differences between localised and non-localised low back pain
Coggon D , Ntani G , Walker-Bone K , Palmer KT , Felli VE , Harari R , Barrero LH , Felknor SA , Gimeno D , Cattrell A , Vargas-Prada S , Bonzini M , Solidaki E , Merisalu E , Habib RR , Sadeghian F , Kadir MM , Warnakulasuriya SS , Matsudaira K , Nyantumbu B , Sim MR , Harcombe H , Cox K , Sarquis LMM , Marziale MH , Harari F , Freire R , Harari N , Monroy MV , Quintana LA , Rojas M , Harris EC , Serra C , Martinez JM , Delclos G , Benavides FG , Carugno M , Ferrario MM , Pesatori AC , Chatzi L , Bitsios P , Kogevinas M , Oha K , Freimann T , Sadeghian A , Peiris-John RJ , Sathiakumar N , Wickremasinghe AR , Yoshimura N , Kelsall HL , Hoe VCW , Urquhart DM , Derrett S , McBride D , Herbison P , Gray A , Salazar Vega EJ . Spine (Phila Pa 1976) 2016 42 (10) 740-747 STUDY DESIGN: Cross-sectional survey with longitudinal follow-up OBJECTIVES.: To test the hypothesis that pain which is localised to the low back differs epidemiologically from that which occurs simultaneously or close in time to pain at other anatomical sites SUMMARY OF BACKGROUND DATA.: Low back pain (LBP) often occurs in combination with other regional pain, with which it shares similar psychological and psychosocial risk factors. However, few previous epidemiological studies of LBP have distinguished pain that is confined to the low back from that which occurs as part of a wider distribution of pain. METHODS: We analysed data from CUPID, a cohort study that used baseline and follow-up questionnaires to collect information about musculoskeletal pain, associated disability and potential risk factors, in 47 occupational groups (office workers, nurses and others) from 18 countries. RESULTS: Among 12,197 subjects at baseline, 609 (4.9%) reported localised LBP in the past month, and 3,820 (31.3%) non-localised LBP. Non-localised LBP was more frequently associated with sciatica in the past month (48.1% vs. 30.0% of cases), occurred on more days in the past month and past year, was more often disabling for everyday activities (64.1% vs. 47.3% of cases), and had more frequently led to medical consultation and sickness absence from work. It was also more often persistent when participants were followed up after a mean of 14 months (65.6% vs. 54.1% of cases). In adjusted Poisson regression analyses, non-localised LBP was differentially associated with risk factors, particularly female sex, older age and somatising tendency. There were also marked differences in the relative prevalence of localised and non-localised LBP by occupational group. CONCLUSIONS: Future epidemiological studies should distinguish where possible between pain that is limited to the low back and LBP which occurs in association with pain at other anatomical locations. LEVEL OF EVIDENCE: 2. |
Epilepsy among Iraq and Afghanistan war veterans - United States, 2002-2015
Pugh MJ , Van Cott AC , Amuan M , Baca C , Rutecki P , Zack MM , Kobau R . MMWR Morb Mortal Wkly Rep 2016 65 (44) 1224-1227 The age-adjusted prevalence of seizure disorder in United States veterans deployed in Iraq and Afghanistan conflicts (IAV) is 6.1 per 1,000 persons, compared with 7.1 to 10 per 1,000 persons in the general population. Persons with epilepsy are at risk of excess mortality in part because of comorbidity. Although patterns of comorbidity have been associated with mortality in IAV, the unique contribution of epilepsy to excess mortality in IAV is unknown. A cohort study was developed using inpatient, outpatient, and pharmacy data from the U.S. Department of Veterans Affairs, Veterans Health Administration (VA) to identify epilepsy, demographic characteristics, and baseline comorbidity for IAV who received VA care in 2010 and 2011. The VA's vital status records were used to identify 5-year mortality (2011-2015). The unadjusted Kaplan-Meier estimator and adjusted proportional hazards regression models tested the hypothesis that excess mortality is associated with epilepsy. IAV with epilepsy were more likely than those without epilepsy to have mental and physical comorbidity, and significantly higher mortality, even after controlling for demographic characteristics and other comorbid conditions (adjusted hazard ratio = 2.6; 95% confidence interval [CI] 2.1-3.2). IAV with epilepsy could benefit from evidence-based chronic disease self-management programs to reduce physical and psychiatric comorbidity, and linkages to VA clinical and other community health and social service providers. |
Characterization of Resistance Genes and Plasmids from Outbreaks and Illness Clusters Caused by Salmonella Resistant to Ceftriaxone in the United States, 2011-2012.
Folster JP , Grass JE , Bicknese A , Taylor J , Friedman CR , Whichard JM . Microb Drug Resist 2016 23 (2) 188-193 Salmonella is an important cause of foodborne illness; however, quickly identifying the source of these infections can be difficult, and source identification is a crucial step in preventing additional illnesses. Although most infections are self-limited, invasive salmonellosis may require antimicrobial treatment. Ceftriaxone, an extended-spectrum cephalosporin, is commonly used for treatment of salmonellosis. Previous studies have identified a correlation between the food animal/retail meat source of ceftriaxone-resistant Salmonella and the type of resistance gene and plasmid it carries. In this study, we examined seven outbreaks of ceftriaxone-resistant Salmonella infections, caused by serotypes Typhimurium, Newport, Heidelberg, and Infantis. All isolates were positive for a plasmid-encoded blaCMY gene. Plasmid incompatibility typing identified five IncI1 and two IncA/C plasmids. Both outbreaks containing blaCMY-IncA/C plasmids were linked to consumption of cattle products. Three of five outbreaks with blaCMY-IncI1 (ST12) plasmids were linked to a poultry source. The remaining IncI1 outbreaks were associated with ground beef (ST20) and tomatoes (ST12). In addition, we examined isolates from five unsolved clusters of ceftriaxone-resistant Salmonella infections and used our plasmid-encoded gene findings to predict the source. Overall, we identified a likely association between the source of ceftriaxone-resistant Salmonella outbreaks and the type of resistance gene/plasmid it carries. |
Ocular syphilis - eight jurisdictions, United States, 2014-2015
Oliver SE , Aubin M , Atwell L , Matthias J , Cope A , Mobley V , Goode A , Minnerly S , Stoltey J , Bauer HM , Hennessy RR , DiOrio D , Fanfair RN , Peterman TA , Markowitz L . MMWR Morb Mortal Wkly Rep 2016 65 (43) 1185-1188 Ocular syphilis, a manifestation of Treponema pallidum infection, can cause a variety of ocular signs and symptoms, including eye redness, blurry vision, and vision loss. Although syphilis is nationally notifiable, ocular manifestations are not reportable to CDC. Syphilis rates have increased in the United States since 2000. After ocular syphilis clusters were reported in early 2015, CDC issued a clinical advisory in April 2015 and published a description of the cases in October 2015. Because of concerns about an increase in ocular syphilis, eight jurisdictions (California, excluding Los Angeles and San Francisco, Florida, Indiana, Maryland, New York City, North Carolina, Texas, and Washington) reviewed syphilis surveillance and case investigation data from 2014, 2015, or both to ascertain syphilis cases with ocular manifestations. A total of 388 suspected ocular syphilis cases were identified, 157 in 2014 and 231 in 2015. Overall, among total syphilis surveillance cases in the jurisdictions evaluated, 0.53% in 2014 and 0.65% in 2015 indicated ocular symptoms. Five jurisdictions described an increase in suspected ocular syphilis cases in 2014 and 2015. The predominance of cases in men (93%), proportion of those who are men who have sex with men (MSM), and percentage who are HIV-positive (51%) are consistent with the epidemiology of syphilis in the United States. It is important for clinicians to be aware of potential visual complications related to syphilis infections. Prompt identification of potential ocular syphilis, ophthalmologic evaluation, and appropriate treatment are critical to prevent or manage visual symptoms and sequelae of ocular syphilis. |
Outcomes of Nigeria's HIV/AIDS treatment program for patients initiated on antiretroviral treatment between 2004-2012
Dalhatu I , Onotu D , Odafe S , Abiri O , Debem H , Agolory S , Shiraishi RW , Auld AF , Swaminathan M , Dokubo K , Ngige E , Asadu C , Abatta E , Ellerbrock TV . PLoS One 2016 11 (11) e0165528 BACKGROUND: The Nigerian Antiretroviral therapy (ART) program started in 2004 and now ranks among the largest in Africa. However, nationally representative data on outcomes have not been reported. METHODS: We evaluated retrospective cohort data from a nationally representative sample of adults aged ≥15 years who initiated ART during 2004 to 2012. Data were abstracted from 3,496 patient records at 35 sites selected using probability-proportional-to-size (PPS) sampling. Analyses were weighted and controlled for the complex survey design. The main outcome measures were mortality, loss to follow-up (LTFU), and retention (the proportion alive and on ART). Potential predictors of attrition were assessed using competing risk regression models. RESULTS: At ART initiation, 66.4 percent (%) were females, median age was 33 years, median weight 56 kg, median CD4 count 161 cells/mm3, and 47.1% had stage III/IV disease. The percentage of patients retained at 12, 24, 36 and 48 months was 81.2%, 74.4%, 67.2%, and 61.7%, respectively. Over 10,088 person-years of ART, mortality, LTFU, and overall attrition (mortality, LTFU, and treatment stop) rates were 1.1 (95% confidence interval (CI): 0.7-1.8), 12.3 (95%CI: 8.9-17.0), and 13.9 (95% CI: 10.4-18.5) per 100 person-years (py) respectively. Highest attrition rates of 55.4/100py were witnessed in the first 3 months on ART. Predictors of LTFU included: lower-than-secondary level education (reference: Tertiary), care in North-East and South-South regions (reference: North-Central), presence of moderate/severe anemia, symptomatic functional status, and baseline weight <45kg. Predictor of mortality was WHO stage higher than stage I. Male sex, severe anemia, and care in a small clinic were associated with both mortality and LTFU. CONCLUSION: Moderate/Advanced HIV disease was predictive of attrition; earlier ART initiation could improve program outcomes. Retention interventions targeting men and those with lower levels of education are needed. Further research to understand geographic and clinic size variations with outcome is warranted. |
Pneumococcal serotype 5 colonization prevalence among newly arrived unaccompanied children one year after an outbreak-Texas, 2015
Kobayashi M , Misegades L , Fleming-Dutra KE , Ahmed S , Gierke R , Nanduri S , Healy JM , Nguyen D , Carvalho MD , Pimenta F , Waterman SH , Moore MR , Kim C , Whitney CG . Pediatr Infect Dis J 2016 36 (2) 236-238 In 2014, an acute respiratory illness outbreak affected unaccompanied children from Central America entering the US; 9% of 774 surveyed children were colonized with Streptococcus pneumoniae serotype 5. In our 2015 follow-up survey of 475 children, serotype 5 was not detected, and an interim recommendation to administer 13-valent pneumococcal conjugate vaccine to all unaccompanied children was discontinued. |
Progress toward poliomyelitis eradication - Afghanistan, January 2015-August 2016
Mbaeyi C , Shukla H , Smith P , Tangermann RH , Martinez M , Jorba JC , Hadler S , Ehrhardt D . MMWR Morb Mortal Wkly Rep 2016 65 (43) 1195-1199 Only 74 cases of wild poliovirus (WPV) were reported globally in 2015, the lowest number of cases ever reported worldwide (1,2). All of the reported cases were WPV type 1 (WPV1), the only known WPV type still circulating; WPV type 2 has been eradicated, and WPV type 3 has not been detected since November 2012 (1). In 2015 in Afghanistan, WPV detection also declined from 2014, and trends observed in 2016 suggest that circulation of the virus is limited to a few localized areas. Despite the progress, there are concerns about the ability of the country's Polio Eradication Initiative (PEI) to meet the goal of interrupting endemic WPV transmission by the end of 2016 (3). The deteriorating security situation in the Eastern and Northeastern regions of the country considerably limits the ability to reach and vaccinate children in these regions. Furthermore, because of frequent population movements to and from Pakistan, cross-border transmission of WPV1 continues (4). Although the national PEI has taken steps to improve the quality of supplementary immunization activities (SIAs),* significant numbers of children living in accessible areas are still being missed during SIAs, and routine immunization services remain suboptimal in many parts of the country. This report describes polio eradication activities and progress in Afghanistan during January 2015August 2016 and updates previous reports (5,6). During 2015, a total of 20 WPV1 cases were reported in Afghanistan, compared with 28 cases in 2014; eight cases were reported during JanuaryAugust 2016, compared with nine cases reported during the same period in 2015. To achieve interruption of poliovirus transmission in Afghanistan, it is important that the 2016-2017 National Emergency Action Plandagger for polio eradication be systematically implemented, including 1) improving the quality of SIAs and routine immunization services, 2) ensuring ongoing dialogue between PEI leaders and local authorities, 3) adopting innovative strategies for reaching children in security-compromised and inaccessible areas, and 4) strengthening cross-border coordination of polio vaccination and surveillance activities with Pakistan. |
Ebola: anatomy of an epidemic
Lo TQ , Marston BJ , Dahl BA , De Cock KM . Annu Rev Med 2016 68 359-370 As of the end of March 2016, the West Africa epidemic of Ebola virus disease (Ebola) had resulted in a total of 28,646 cases, 11,323 of them fatal, reported to the World Health Organization. Guinea, Liberia, and Sierra Leone were most heavily affected, but Ebola cases were exported to several other African and European countries as well as the United States, with limited further transmission, including to healthcare workers. We review the descriptive epidemiology of the outbreak, novel aspects and insights concerning the unprecedented response, scientific observations, and public health implications. The large number of Ebola survivors has highlighted the frequency of persistent symptoms and the possibility of virus persistence in sanctuary sites, sometimes leading to delayed transmission. Although transmission appears to have ceased in 2016, the West Africa Ebola epidemic has profoundly influenced discussions and practice concerning global health security. Expected final online publication date for the Annual Review of Medicine Volume 68 is January 14, 2017. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates. |
Estimating HIV incidence using a cross-sectional survey: comparison of three approaches in a hyperendemic setting, Ndhiwa sub-county, Kenya, 2012
Blaizot S , Kim AA , Zeh C , Riche B , Maman D , DeCock K , Etard JF , Ecochard R . AIDS Res Hum Retroviruses 2016 33 (5) 472-481 OBJECTIVES: Estimating HIV incidence is critical for identifying groups at risk for HIV infection, planning and targeting interventions, and evaluating these interventions over time. The use of reliable estimation methods for HIV incidence is thus of high importance. The aim of this study was to compare methods for estimating HIV incidence in a population-based cross-sectional survey. DESIGN/METHODS: The incidence estimation methods evaluated included assay-derived methods, a testing history-derived method, and a probability-based method applied to data from the Ndhiwa HIV Impact in Population Survey (NHIPS). Incidence rates by sex and age and cumulative incidence as a function of age were presented. RESULTS: HIV incidence ranged from 1.38 [95% confidence interval (CI) 0.67-2.09] to 3.30 [95% CI 2.78-3.82] per 100 persons-years overall; 0.59 [95% CI 0.00-1.34] to 2.89 [95% CI 0.11-5.68] in men; and 1.62 [95% CI 0.16-6.04] to 4.03 [95% CI 3.30-4.77] per 100 persons-years in women. Women had higher incidence rates than men for all methods. Incidence rates were highest among women aged 15-24 and 25-34 years and highest among men aged 25-34 years. CONCLUSION: Comparison of different methods showed variations in incidence estimates, but they were in agreement to identify most-at-risk groups. The use and comparison of several distinct approaches for estimating incidence are important to provide the best-supported estimate of HIV incidence in the population. |
The impact of prescriptions on sex partner treatment using expedited partner therapy for Chlamydia trachomatis infection, New York City, 2014-2015
Oliver A , Rogers M , Schillinger JA . Sex Transm Dis 2016 43 (11) 673-678 Background Chlamydia trachomatis reinfections, often resulting from resuming sex with untreated partners, can increase the risk of pelvic inflammatory disease, infertility, and ectopic pregnancy. Expedited partner therapy (EPT) has been shown to prevent reinfection when provided as medication (Medication-EPT) that patients give to sex partners; however, EPT is often provided as a prescription (Prescription-EPT). We compared partner treatment outcomes for Medication-EPT versus Prescription-EPT. Methods We conducted telephone interviews from October 2014 to October 2015 with a population-based random sample of women aged 15 to 25 years diagnosed with Chlamydia trachomatis. Interview questions included: demographics, patient-treatment, EPT type, and patient report of partner treatment. The main outcomes explored were: proportion of women receiving EPT, proportion of Prescription-EPT and Medication-EPT, and proportion of partners reported as treated. We used chi 2 and Fisher exact tests for analysis. Results A total of 421 women completed the interview; 357 (84.8%) of 421 women reported having been treated, and 109/357 (30.5%) received EPT for any partner. Women given a prescription (vs medication) for their own treatment were more likely to receive EPT (odds ratio, 1.57; P = 0.05) and to receive Prescription-EPT specifically (odds ratio, 6.85; P < 0.0001). Forty-eight (52.2%) of 92 patients who received EPT for their most recent partner received Prescription-EPT. There was no difference by EPT type in proportion of index patients reporting partner treatment: 77.1% (37/48) for Prescription-EPT versus 79.5% (35/44) for Medication-EPT (P > 0.05). Conclusions Prescription-EPT and Medication-EPT appear to result in comparable rates of partner treatment. Further research is needed to assess the effects of Prescription-EPT on partner treatment among adolescents and in other contexts. |
Investigation of the first seven reported cases of Candida auris, a globally emerging invasive, multidrug-resistant fungus - United States, May 2013-August 2016
Vallabhaneni S , Kallen A , Tsay S , Chow N , Welsh R , Kerins J , Kemble SK , Pacilli M , Black SR , Landon E , Ridgway J , Palmore TN , Zelzany A , Adams EH , Quinn M , Chaturvedi S , Greenko J , Fernandez R , Southwick K , Furuya EY , Calfee DP , Hamula C , Patel G , Barrett P , Lafaro P , Berkow EL , Moulton-Meissner H , Noble-Wang J , Fagan RP , Jackson BR , Lockhart SR , Litvintseva AP , Chiller TM . MMWR Morb Mortal Wkly Rep 2016 65 (44) 1234-1237 Candida auris, an emerging fungus that can cause invasive infections, is associated with high mortality and is often resistant to multiple antifungal drugs. C. auris was first described in 2009 after being isolated from external ear canal discharge of a patient in Japan. Since then, reports of C. auris infections, including bloodstream infections, have been published from several countries, including Colombia, India, Israel, Kenya, Kuwait, Pakistan, South Africa, South Korea, Venezuela, and the United Kingdom. To determine whether C. auris is present in the United States and to prepare for the possibility of transmission, CDC issued a clinical alert in June 2016 informing clinicians, laboratorians, infection control practitioners, and public health authorities about C. auris and requesting that C. auris cases be reported to state and local health departments and CDC. This report describes the first seven U.S. cases of C. auris infection reported to CDC as of August 31, 2016. Data from these cases suggest that transmission of C. auris might have occurred in U.S. health care facilities and demonstrate the need for attention to infection control measures to control the spread of this pathogen. |
Association between enacted stigma and HIV-related risk behavior among MSM, National HIV Behavioral Surveillance System, 2011
Balaji AB , Bowles KE , Hess KL , Smith JC , Paz-Bailey G . AIDS Behav 2016 21 (1) 227-237 MSM bear a disproportionate burden of the HIV epidemic. Enacted stigma (overt negative actions) against sexual minorities may play an important role in increasing HIV risk among this population. Using data from the 2011 National HIV Behavioral Surveillance system, MSM cycle, we examined the independent associations between three measures of enacted stigma (verbal harassment, discrimination, physical assault) and engagement in each of four HIV-related risk behaviors as outcomes: condomless anal intercourse (CAI) at last sex with a male partner of HIV discordant or unknown status and, in the past 12 months, CAI with a male partner, ≥4 male sex partners, and exchange sex. Of 9819 MSM, 32% experienced verbal harassment in the past 12 months, 23% experienced discrimination, and 8% experienced physical assault. Discordant CAI at last sex with a male partner was associated with previous discrimination and physical assault. Past 12 month CAI with a male partner, ≥4 male sex partners, and exchange sex were each associated with verbal harassment, discrimination, and physical assault. These findings indicate that a sizable proportion of MSM report occurrences of past 12 month enacted stigma and suggest that these experiences may be associated with HIV-related risk behavior. Addressing stigma towards sexual minorities must involve an integrated, multi-faceted approach, including interventions at the individual, community, and societal level. |
Core elements of outpatient antibiotic stewardship
Sanchez GV , Fleming-Dutra KE , Roberts RM , Hicks LA . MMWR Recomm Rep 2016 65 (6) 1-12 The Core Elements of Outpatient Antibiotic Stewardship provides a framework for antibiotic stewardship for outpatient clinicians and facilities that routinely provide antibiotic treatment. This report augments existing guidance for other clinical settings. In 2014 and 2015, respectively, CDC released the Core Elements of Hospital Antibiotic Stewardship Programs and the Core Elements of Antibiotic Stewardship for Nursing Homes. Antibiotic stewardship is the effort to measure and improve how antibiotics are prescribed by clinicians and used by patients. Improving antibiotic prescribing involves implementing effective strategies to modify prescribing practices to align them with evidence-based recommendations for diagnosis and management. The four core elements of outpatient antibiotic stewardship are commitment, action for policy and practice, tracking and reporting, and education and expertise. Outpatient clinicians and facility leaders can commit to improving antibiotic prescribing and take action by implementing at least one policy or practice aimed at improving antibiotic prescribing practices. Clinicians and leaders of outpatient clinics and health care systems can track antibiotic prescribing practices and regularly report these data back to clinicians. Clinicians can provide educational resources to patients and families on appropriate antibiotic use. Finally, leaders of outpatient clinics and health systems can provide clinicians with education aimed at improving antibiotic prescribing and with access to persons with expertise in antibiotic stewardship. Establishing effective antibiotic stewardship interventions can protect patients and improve clinical outcomes in outpatient health care settings. |
Foodborne disease outbreaks associated with organic foods in the United States
Harvey RR , Zakhour CM , Gould LH . J Food Prot 2016 79 (11) 1953-1958 Consumer demand for organically produced foods is increasing in the United States as well as globally. Consumer perception often credits organic foods as being safer than conventionally produced foods, although organic standards do not directly address safety issues such as microbial or chemical hazards. We reviewed outbreaks reported to the Centers for Disease Control and Prevention's Foodborne Disease Outbreak Surveillance System where the implicated food was reported to be organic. Information collected for each outbreak included the year, state, number of illnesses, pathogen, and implicated food. We identified 18 outbreaks caused by organic foods from 1992 to 2014, resulting in 779 illnesses, 258 hospitalizations, and 3 deaths; 56% of outbreaks occurred from 2010 to 2014. Nine outbreaks occurred in a single state, and nine outbreaks were multistate. Salmonella sp. (44% of outbreaks) and Escherichia coli O157:H7 (33%) were the most commonly occurring pathogens. Eight of the outbreaks were attributed to produce items, four to unpasteurized dairy products, two to eggs, two to nut and seed products, and two to multi-ingredient foods. Fifteen (83%) outbreaks were associated with foods that were definitely or likely U.S. Department of Agriculture certified. More foodborne outbreaks associated with organic foods in the United States have been reported in recent years, in parallel with increases in organic food production and consumption. We are unable to assess risk of outbreaks due to organic foods compared with conventional foods because foodborne outbreak surveillance does not systematically collect food production method. Food safety requires focused attention by consumers, regardless of whether foods are produced organically or conventionally. Consumers should be aware of the risk of milk and produce consumed raw, including organic. |
The effect of phylogenetic signal reduction on genotyping of hepatitis E viruses of the species Orthohepevirus A.
Purdy MA , Sue A . Arch Virol 2016 162 (3) 645-656 Commonly, hepatitis E virus (HEV) sequences are genotyped phylogenetically using subgenomic sequences. This paper examines this practice with sequences from members of the species Orthohepevirus A. As the length of sequences becomes progressively shorter, the number of identical sequences in an alignment tends to increase; however, these sequences retain their genotypic identity down to 100 nucleotides in length. The best substitution models tend to become less parameterized, bootstrap support decreases, and trees created from short subgenomic fragments are less likely to be isomorphic with trees from longer subgenomic fragments or complete genome sequences. However, it is still possible to correctly genotype sequences using fragments as small as 200 nucleotides. While it is possible to correctly genotype sequences with short subgenomic sequences, the estimates of evolutionary relationships between genotypes degrade to such an extent that sequences below 1600 nucleotides long cannot be used reliably to study these relationships, and comparisons of trees from different subgenomic regions with little or no sequence overlap can be problematic. Subtyping may be done, but it requires a careful examination of the region to be used to ensure that it correctly resolves the subtypes. |
Use of DNA barcoding to distinguish the malaria vector Anopheles neivai in Colombia.
Lopez-Rubio A , Suaza-Vasco J , Marcet PL , Ruiz-Molina N , Caceres L , Porter C , Uribe S . Zootaxa 2016 4175 (4) 377-389 A reference 535 bp barcode sequence from a fragment of the mitochondrial gene cytochrome oxidase I (COI), acquired from specimens of An. neivai Howard, Dyar & Knab, 1913 from its type locality in Panama, was used as a tool for distinguishing this species from others in the subgenus Kerteszia. Comparisons with corresponding regions of COI between An. neivai and other species in the subgenus (An. bellator Dyar & Knab 1906, An. homunculus Komp 1937, An cruzii Dyar & Knab, 1908 and An. laneanus Correa & Cerqueira, 1944) produced K2P genetic distances of 8.3-12.6%, values well above those associated with intraspecific variation. In contrast, genetic distances among 55 specimens from five municipalities in the Colombian Pacific coastal state of Choco were all within the range of 0-2.5%, with an optimized barcode threshold of 1.3%, the limit for unambiguous differentiation of An. neivai. Among specimens from the Choco region, 18 haplotypes were detected, two of which were widely distributed over the municipalities sampled. The barcode sequence permits discrimination of An. neivai from sympatric species and indicates genetic variability within the species; aspects key to malaria surveillance and control as well as defining geographic distribution and dispersion patterns. |
Complete, Closed Genome Sequences of 10 Salmonella enterica subsp. enterica Serovar Typhimurium Strains Isolated from Human and Bovine Sources.
Nguyen SV , Harhay DM , Bono JL , Smith TP , Fields PI , Dinsmore BA , Santovenia M , Kelley CM , Wang R , Bosilevac JM , Harhay GP . Genome Announc 2016 4 (6) Salmonella enterica is a leading cause of enterocolitis for humans and animals. S. enterica subsp. enterica serovar Typhimurium infects a broad range of hosts. To facilitate genomic comparisons among isolates from different sources, we present the complete genome sequences of 10 S Typhimurium strains, 5 each isolated from human and bovine sources. |
Novel Viruses Isolated from Mosquitoes in Pantanal, Brazil.
Pauvolid-Correa A , Solberg O , Couto-Lima D , Nogueira RM , Langevin S , Komar N . Genome Announc 2016 4 (6) Genomic sequences are described from five novel viruses and divergent strains of Brejeira and Guaico Culex viruses from mosquitoes collected in Pantanal, Brazil, in 2010. |
Understanding pneumococcal serotype 1 biology through population genomic analysis.
Chaguza C , Cornick JE , Harris SR , Andam CP , Bricio-Moreno L , Yang M , Yalcin F , Ousmane S , Govindpersad S , Senghore M , Ebruke C , Du Plessis M , Kiran AM , Pluschke G , Sigauque B , McGee L , Klugman KP , Turner P , Corander J , Parkhill J , Collard JM , Antonio M , von Gottberg A , Heyderman RS , French N , Kadioglu A , Hanage WP , Everett DB , Bentley SD . BMC Infect Dis 2016 16 (1) 649 BACKGROUND: Pneumococcus kills over one million children annually and over 90 % of these deaths occur in low-income countries especially in Sub-Saharan Africa (SSA) where HIV exacerbates the disease burden. In SSA, serotype 1 pneumococci particularly the endemic ST217 clone, causes majority of the pneumococcal disease burden. To understand the evolution of the virulent ST217 clone, we analysed ST217 whole genomes from isolates sampled from African and Asian countries. METHODS: We analysed 226 whole genome sequences from the ST217 lineage sampled from 9 African and 4 Asian countries. We constructed a whole genome alignment and used it for phylogenetic and coalescent analyses. We also screened the genomes to determine presence of antibiotic resistance conferring genes. RESULTS: Population structure analysis grouped the ST217 isolates into five sequence clusters (SCs), which were highly associated with different geographical regions and showed limited intracontinental and intercontinental spread. The SCs showed lower than expected genomic sequence, which suggested strong purifying selection and small population sizes caused by bottlenecks. Recombination rates varied between the SCs but were lower than in other successful clones such as PMEN1. African isolates showed higher prevalence of antibiotic resistance genes than Asian isolates. Interestingly, certain West African isolates harbored a defective chloramphenicol and tetracycline resistance-conferring element (Tn5253) with a deletion in the loci encoding the chloramphenicol resistance gene (cat pC194), which caused lower chloramphenicol than tetracycline resistance. Furthermore, certain genes that promote colonisation were absent in the isolates, which may contribute to serotype 1's rarity in carriage and consequently its lower recombination rates. CONCLUSIONS: The high phylogeographic diversity of the ST217 clone shows that this clone has been in circulation globally for a long time, which allowed its diversification and adaptation in different geographical regions. Such geographic adaptation reflects local variations in selection pressures in different locales. Further studies will be required to fully understand the biological mechanisms which makes the ST217 clone highly invasive but unable to successfully colonise the human nasopharynx for long durations which results in lower recombination rates. |
Comparison of DNA testing strategies in monitoring human papillomavirus infection prevalence through simulation.
Lin CY , Li L . BMC Infect Dis 2016 16 (1) 642 BACKGROUND: HPV DNA diagnostic tests for epidemiology monitoring (research purpose) or cervical cancer screening (clinical purpose) have often been considered separately. Women with positive Linear Array (LA) polymerase chain reaction (PCR) research test results typically are neither informed nor referred for colposcopy. Recently, a sequential testing by using Hybrid Capture 2 (HC2) HPV clinical test as a triage before genotype by LA has been adopted for monitoring HPV infections. Also, HC2 has been reported as a more feasible screening approach for cervical cancer in low-resource countries. Thus, knowing the performance of testing strategies incorporating HPV clinical test (i.e., HC2-only or using HC2 as a triage before genotype by LA) compared with LA-only testing in measuring HPV prevalence will be informative for public health practice. METHOD: We conducted a Monte Carlo simulation study. Data were generated using mathematical algorithms. We designated the reported HPV infection prevalence in the U.S. and Latin America as the "true" underlying type-specific HPV prevalence. Analytical sensitivity of HC2 for detecting 14 high-risk (oncogenic) types was considered to be less than LA. Estimated-to-true prevalence ratios and percentage reductions were calculated. RESULTS: When the "true" HPV prevalence was designated as the reported prevalence in the U.S., with LA genotyping sensitivity and specificity of (0.95, 0.95), estimated-to-true prevalence ratios of 14 high-risk types were 2.132, 1.056, 0.958 for LA-only, HC2-only, and sequential testing, respectively. Estimated-to-true prevalence ratios of two vaccine-associated high-risk types were 2.359 and 1.063 for LA-only and sequential testing, respectively. When designated type-specific prevalence of HPV16 and 18 were reduced by 50 %, using either LA-only or sequential testing, prevalence estimates were reduced by 18 %. CONCLUSION: Estimated-to-true HPV infection prevalence ratios using LA-only testing strategy are generally higher than using HC2-only or using HC2 as a triage before genotype by LA. HPV clinical testing can be incorporated to monitor HPV prevalence or vaccine effectiveness. Caution is needed when comparing apparent prevalence from different testing strategies. |
Next generation sequencing in clinical and public health microbiology
MacCannell D . Clin Microbiol Newsl 2016 38 (21) 169-176 The introduction of next generation sequencing (NGS) and other high-throughput laboratory technologies are beginning to have a broad impact on clinical medicine and public health practice. These new technologies hold tremendous promise in terms of improving the speed, accuracy, and resolution of infectious disease diagnostics; public health surveillance; and outbreak detection, investigation, and response. Sustainable implementation of these technologies will require ongoing research and commitment to laboratory and informatics capacity, workforce development, and development of standardized methods and protocols. |
Hepatitis C virus transmission in a skilled nursing facility, North Dakota, 2013
Calles DL , Collier MG , Khudyakov Y , Mixson-Hayden T , VanderBusch L , Weninger S , Miller TK . Am J Infect Control 2016 45 (2) 126-132 BACKGROUND: From March-May 2013, 3 cases of acute hepatitis C virus (HCV) infection were diagnosed among elderly patients residing at the same skilled nursing facility (facility A) and who received health care at hospital X during their likely exposure period. METHODS: We performed HCV testing of at-risk populations; quasispecies analysis was performed to determine relatedness of HCV in persons with current infection. Infection control practice assessments were conducted at facility A and hospital X. Persons residing in facility A on September 9, 2013, were enrolled in a case-control study to identify risk factors for HCV infection. RESULTS: Forty-five outbreak-associated infections were identified. Thirty cases and 62 controls were enrolled in the case-control study. Only podiatry (odds ratio, 11.6; 95% confidence interval, 2.4-57.2) and international normalized ratio monitoring by phlebotomy (odds ratio, 6.7; 95% confidence interval, 1.7-26.6) at facility A were significantly associated with case status. Infection control lapses during podiatry and point-of-care testing procedures at facility A were identified. CONCLUSIONS: HCV transmission was confirmed among residents of facility A. The exact mode of transmission was not able to be identified, but infection control lapses were likely responsible. This outbreak highlights the importance of prompt reporting and investigation of incident HCV infection and the need for adherence to basic infection control procedures by health care personnel. |
Comparative studies of infectivity, immunogenicity and cross-protective efficacy of live attenuated influenza vaccines containing nucleoprotein from cold-adapted or wild-type influenza virus in a mouse model.
Isakova-Sivak I , Korenkov D , Smolonogina T , Tretiak T , Donina S , Rekstin A , Naykhin A , Shcherbik S , Pearce N , Chen LM , Bousse T , Rudenko L . Virology 2016 500 209-217 This study sought to improve an existing live attenuated influenza vaccine (LAIV) by including nucleoprotein (NP) from wild-type virus rather than master donor virus (MDV). H7N9 LAIV reassortants with 6:2 (NP from MDV) and 5:3 (NP from wild-type virus) genome compositions were compared with regard to their growth characteristics, induction of humoral and cellular immune responses in mice, and ability to protect mice against homologous and heterologous challenge viruses. Although, in general, the 6:2 reassortant induced greater cell-mediated immunity in C57BL6 mice than the 5:3 vaccine, mice immunized with the 5:3 LAIV were better protected against heterologous challenge. The 5:3 LAIV-induced CTLs also had better in vivo killing activity against target cells loaded with the NP366 epitope of recent influenza viruses. Modification of the genome of reassortant vaccine viruses by incorporating the NP gene from wild-type viruses represents a simple strategy to improve the immunogenicity and cross-protection of influenza vaccines. |
Recommendations for use of meningococcal conjugate vaccines in HIV-infected persons - Advisory Committee on Immunization Practices, 2016
MacNeil JR , Rubin LG , Patton M , Ortega-Sanchez IR , Martin SW . MMWR Morb Mortal Wkly Rep 2016 65 (43) 1189-1194 At its June 2016 meeting, the Advisory Committee on Immunization Practices (ACIP) recommended routine use of meningococcal conjugate vaccine (serogroups A, C, W, and Y; including MenACWY-D [Menactra, Sanofi Pasteur] or MenACWY-CRM [Menveo, GlaxoSmithKline]) for persons aged ≥2 months with human immunodeficiency virus (HIV) infection. ACIP has previously recommended routine vaccination of persons aged ≥2 months who have certain medical conditions that increase risk for meningococcal disease (1), including persons who have persistent (e.g., genetic) deficiencies in the complement pathway (e.g., C3, properdin, Factor D, Factor H, or C5-C9); persons receiving eculizumab (Soliris, Alexion Pharmaceuticals) for treatment of atypical hemolytic uremic syndrome or paroxysmal nocturnal hemoglobinuria (because the drug binds C5 and inhibits the terminal complement pathway); and persons with functional or anatomic asplenia (including persons with sickle cell disease). Routine vaccination with meningococcal conjugate vaccine is also recommended for all healthy adolescents in the United States (1). This report summarizes the evidence considered by ACIP in recommending vaccination for HIV-infected persons, and provides recommendations and guidance for use of meningococcal conjugate vaccines (serogroups A, C, W, and Y) among HIV-infected persons aged ≥2 months; the majority of meningococcal disease among HIV-infected persons is caused by these four serogroups. |
Targeting pediatric versus elderly populations for norovirus vaccines: A model-based analysis of mass vaccination options
Steele MK , Remais JV , Gambhir M , Glasser JW , Handel A , Parashar UD , Lopman BA . Epidemics 2016 17 42-49 BACKGROUND: Noroviruses are the leading cause of acute gastroenteritis and foodborne diarrheal disease in the United States. Norovirus vaccine development has progressed in recent years, but critical questions remain regarding which age groups should be vaccinated to maximize population impact. METHODS: We developed a deterministic, age-structured compartmental model of norovirus transmission and immunity in the U.S. POPULATION: The model was fit to age-specific monthly U.S. hospitalizations between 1996 and 2007. We simulated mass immunization of both pediatric and elderly populations assuming realistic coverages of 90% and 65%, respectively. We considered two mechanism of vaccine action, resulting in lower vaccine efficacy (lVE) between 22% and 43% and higher VE (hVE) of 50%. RESULTS: Pediatric vaccination was predicted to avert 33% (95% CI: 27%, 40%) and 60% (95% CI: 49%, 71%) of norovirus episodes among children under five years for lVE and hVE, respectively. Vaccinating the elderly averted 17% (95% CI: 12%, 20%) and 38% (95% CI: 34%, 42%) of cases in 65+ year olds for lVE and hVE, respectively. At a population level, pediatric vaccination was predicted to avert 18-21 times more cases and twice as many deaths per vaccinee compared to elderly vaccination. CONCLUSIONS: The potential benefits are likely greater for a pediatric program, both via direct protection of vaccinated children and indirect protection of unvaccinated individuals, including adults and the elderly. These findings argue for a clinical development plan that will deliver a vaccine with a safety and efficacy profile suitable for use in children. |
Uptake of rotavirus vaccine among US infants at Immunization Information System Sentinel Sites
Pringle K , Cardemil CV , Pabst LJ , Parashar UD , Cortese MM . Vaccine 2016 34 (50) 6396-6401 OBJECTIVE: Coverage with rotavirus vaccine among US children has been lower compared to that with other routine childhood vaccines. Our objectives were to examine rotavirus vaccine (RV) uptake over time compared to other routine vaccinations, ages at administration, and quantitate potential missed opportunities for RV receipt. METHODS: We analyzed data from 6 Immunization Information System (IIS) Sentinel Sites, which represent approximately 10% of the United States (US) pediatric population. Among infants aged 5 months, we compared uptake of 1 dose of RV, to that of Diphtheria, Tetanus, and acellular Pertussis (DTaP) and pneumococcal conjugate vaccine (PCV), for each quarter during 2006-2013. We used data from infants in the 2012 birth cohort to examine RV receipt in more detail. RESULTS: Among infants aged 5months, the average site coverage with 1 dose of RV reached 78% in 2010 and subsequently stayed steady at 79-81% through 2013. The average difference between 1 dose DTaP coverage and RV coverage remained between about 6 and 8 percentage points during mid-2012 through 2013. Infants born in 2012 received RV doses closely in line with the timing recommended by the ACIP. Approximately one-third of the difference in coverage between 1 dose of DTaP and 1 dose of RV among infants could be due to the maximum age restriction of the first RV dose. The other two-thirds of the difference appears to have been a result of potential missed opportunities for starting the RV series--these infants received another routine immunization when age eligible to receive RV dose 1, but did not receive RV. CONCLUSION: Uptake with RV during infancy remains below that of other routine vaccines. Understanding the barriers to administration of RV among age-eligible infants could help improve vaccine coverage. |
Using the 4 pillars practice transformation program to increase adult influenza vaccination and reduce missed opportunities in a randomized cluster trial
Lin CJ , Nowalk MP , Pavlik VN , Brown AE , Zhang S , Raviotta JM , Moehling KK , Hawk M , Ricci EM , Middleton DB , Patel S , South-Paul JE , Zimmerman RK . BMC Infect Dis 2016 16 (1) 623 BACKGROUND: An evidence-based, step-by-step guide, the 4 Pillars Practice Transformation Program, was the foundation of an intervention to increase adult immunizations in primary care and was tested in a randomized controlled cluster trial. The purpose of this study is to report changes in influenza immunization rates and on factors related to receipt of influenza vaccine. METHODS: Twenty five primary care practices were recruited in 2013, stratified by city (Houston, Pittsburgh), location (rural, urban, suburban) and type (family medicine, internal medicine), and randomized to the intervention (n = 13) or control (n = 12) in Year 1 (2013-14). A follow-up intervention occurred in Year 2 (2014-15). Demographic and vaccination data were derived from de-identified electronic medical record extractions. RESULTS: A cohort of 70,549 adults seen in their respective practices (n = 24 with 1 drop out) at least once each year was followed. Baseline mean age was 55.1 years, 35 % were men, 21 % were non-white and 35 % were Hispanic. After one year, both intervention and control arms significantly (P < 0.001) increased influenza vaccination, with average increases of 2.7 to 6.5 percentage points. In regression analyses, likelihood of influenza vaccination was significantly higher in sites with lower percentages of patients with missed opportunities (P < 0.001) and, after adjusting for missed opportunities, the intervention further improved vaccination rates in Houston (lower baseline rates) but not Pittsburgh (higher baseline rates). In the follow-up intervention, the likelihood of vaccination increased for both intervention sites and those that reduced missed opportunities (P < 0.005). CONCLUSIONS: Reducing missed opportunities across the practice increases likelihood of influenza vaccination of adults. The 4 Pillars Practice Transformation Program provides strategies for reducing missed opportunities to vaccinate adults. TRIAL REGISTRATION: This study was registered as a clinical trial on 03/20/2013 at ClinicalTrials.gov, Clinical Trial Registry Number: NCT01868334 , with a date of enrollment of the first participant to the trial of April 1, 2013. |
Monovalent rotavirus vaccine effectiveness and impact on rotavirus hospitalizations in Zanzibar, Tanzania: data from the first 3 years post-introduction
Abeid KA , Jani B , Cortese MM , Kamugisha C , Mwenda JM , Pandu AS , Msaada KA , Mohamed AS , Khamis AU , Parashar UD , Saleh AA . J Infect Dis 2016 215 (2) 183-191 BACKGROUND: Low-income settings challenge the level of protection provided by live attenuated oral rotavirus vaccines. Rotarix (RV1) was introduced in the United Republic of Tanzania in early 2013, with two doses given at the WHO-recommended schedule of ages 6 and 10 weeks, along with oral polio vaccine. METHODS: We performed active surveillance for rotavirus hospitalizations at the largest hospital in Zanzibar, Tanzania from 2010-2015. Using case-test-negative control methodology, we estimated the vaccine effectiveness of 2 RV1 doses in preventing rotavirus hospitalizations. RESULTS: Based on 204 rotavirus cases and 601 test-negative controls aged 5-23 months, the effectiveness of 2 RV1 doses against hospitalization for rotavirus diarrhea was 57% (95% CI 14-78). Effectiveness tended to increase against hospitalizations with higher severity, reaching 69% (95% CI 15-88) against the top quarter of cases. Compared to pre-vaccine period, there was an estimated 40%, 46% and 69% reduction in the number of rotavirus hospitalizations among infants in 2013, 2014 and 2015, respectively, and a 36%, 26% and 64% reduction among children aged <5 years. CONCLUSIONS: With data encompassing three pre- and three post-introduction years, our results indicate that successful delivery of RV1 on the current WHO schedule can provide substantial health benefits in a resource-limited setting. |
Nationwide trends in bacterial meningitis before the introduction of 13-valent pneumococcal conjugate vaccine-Burkina Faso, 2011-2013
Kambire D , Soeters HM , Ouedraogo-Traore R , Medah I , Sangare L , Yameogo I , Sawadogo G , Ouedraogo AS , Hema-Ouangraoua S , McGee L , Srinivasan V , Ake F , Congo-Ouedraogo M , Sanou S , Ba AK , Novak RT , Van Beneden C . PLoS One 2016 11 (11) e0166384 BACKGROUND: Following introduction of Haemophilus influenzae type b vaccine in 2006 and serogroup A meningococcal conjugate vaccine in 2010, Streptococcus pneumoniae (Sp) became the leading cause of bacterial meningitis in Burkina Faso. We describe bacterial meningitis epidemiology, focusing on pneumococcal meningitis, before 13-valent pneumococcal conjugate vaccine (PCV13) introduction in the pediatric routine immunization program in October 2013. METHODS: Nationwide population-based meningitis surveillance collects case-level demographic and clinical information and cerebrospinal fluid (CSF) laboratory results. Sp infections are confirmed by culture, real-time polymerase chain reaction (rt-PCR), or latex agglutination, and CSF serotyped using real-time and conventional PCR. We calculated incidence rates in cases per 100,000 persons, adjusting for age and proportion of cases with CSF tested at national reference laboratories, and case fatality ratios (CFR). RESULTS: During 2011-2013, 1,528 pneumococcal meningitis cases were reported. Average annual adjusted incidence rates were 26.9 (<1 year), 5.4 (1-4 years), 7.2 (5-14 years), and 3.0 (≥15 years). Overall CFR was 23% and highest among children aged <1 year (32%) and adults ≥30 years (30%). Of 1,528 cases, 1,036 (68%) were serotyped: 71% were PCV13-associated serotypes, 14% were non-PCV13-associated serotypes, and 15% were non-typeable by PCR. Serotypes 1 (45%) and 12F/12A/12B/44/46 (8%) were most common. Among children aged <1 year, serotypes 5 (15%), 6A/6B (13%) and 1 (12%) predominated. CONCLUSIONS: In Burkina Faso, the highest morbidity and mortality due to pneumococcal meningitis occurred among children aged <1 year. The majority of cases were due to PCV13-associated serotypes; introduction of PCV13 should substantially decrease this burden. |
Progress toward regional measles elimination - worldwide, 2000-2015
Patel MK , Gacic-Dobo M , Strebel PM , Dabbagh A , Mulders MN , Okwo-Bele JM , Dumolard L , Rota PA , Kretsinger K , Goodson JL . MMWR Morb Mortal Wkly Rep 2016 65 (44) 1228-1233 Adopted in 2000, United Nations Millennium Development Goal 4 set a target to reduce child mortality by two thirds by 2015, with measles vaccination coverage as one of the progress indicators. In 2010, the World Health Assembly (WHA) set three milestones for measles control by 2015: 1) increase routine coverage with the first dose of measles-containing vaccine (MCV1) for children aged 1 year to ≥90% nationally and ≥80% in every district; 2) reduce global annual measles incidence to <5 cases per 1 million population; and 3) reduce global measles mortality by 95% from the 2000 estimate (1,2).* In 2012, WHA endorsed the Global Vaccine Action Plandagger with the objective to eliminate measles in four World Health Organization (WHO) regions by 2015. Countries in all six WHO regions have adopted measles elimination goals. Measles elimination is the absence of endemic measles transmission in a region or other defined geographical area for ≥12 months in the presence of a well performing surveillance system. This report updates a previous report (3) and describes progress toward global measles control milestones and regional measles elimination goals during 2000-2015. During this period, annual reported measles incidence decreased 75%, from 146 to 36 cases per 1 million persons, and annual estimated measles deaths decreased 79%, from 651,600 to 134,200. However, none of the 2015 milestones or elimination goals were met. Countries and their partners need to act urgently to secure political commitment, raise the visibility of measles, increase vaccination coverage, strengthen surveillance, and mitigate the threat of decreasing resources for immunization once polio eradication is achieved. |
eSIP-Saude: Mozambique's novel approach for a sustainable human resources for health information system
Waters KP , Mazivila ME , Dgedge M , Necochea E , Manharlal D , Zuber A , de Faria Leao B , Bossemeyer D , Vergara AE . Hum Resour Health 2016 14 (1) 66 INTRODUCTION: Over the past decade, governments and international partners have responded to calls for health workforce data with ambitious investments in human resources information systems (HRIS). However, documentation of country experiences in the use of HRIS to improve strategic planning and management has been lacking. The purpose of this case presentation is to document for the first time Mozambique's novel approach to HRIS, sharing key success factors and contributing to the scant global knowledge base on HRIS. CASE PRESENTATION: Core components of the system are a Government of Mozambique (GOM) registry covering all workers in the GOM payroll and a "health extension" which adds health-sector-specific data to the GOM registry. Separate databases for pre-service and in-service training are integrated through a business intelligence tool. The first aim of the HRIS was to identify the following: who and where are Mozambique's health workers? As of July 2015, 95 % of countrywide health workforce deployment information was populated in the HRIS, allowing the identification of health professionals' physical working location and their pay point. HRIS data are also used to quantify chronic issues affecting the Ministry of Health (MOH) health workforce. Examples include the following: HRIS information was used to examine the deployment of nurses trained in antiretroviral therapy (ART) vis-a-vis the health facilities where ART is being provided. Such results help the MOH align specialized skill sets with service provision. Twenty-five percent of the MOH health workforce had passed the 2-year probation period but had not been updated in the MOH information systems. For future monitoring of employee status, the MOH established a system of alerts in semi-monthly reports. As of August 2014, 1046 health workers were receiving their full salary but no longer working at the facilities. The MOH is now analyzing this situation to improve the retirement process and coordination with Social Security. CONCLUSION: The Mozambican system is an important example of an HRIS built on a local platform with local staff. Notable models of strategic data use demonstrate that the system is empowering the MOH to improve health services delivery, health workforce allocation, and management. Combined with committed country leadership and ownership of the program, this suggests strong chances of sustainability and real impact on public health equity and quality. |
Seeing students squirm: Student nurses' bullying experiences in clinical settings
Smith CR , Gillespie GL , Brown KC , Grubb PL . West J Nurs Res 2016 38 (10) 1397-8 Bullying against nurses has become such a pervasive problem that bullying is now a norm in nursing settings and becoming common in nursing schools. To develop interventions geared toward pre-licensure students, it is imperative to first understand student nurses’ experiences of bullying. The purpose of this qualitative arm of a larger quasi-experimental mixed-methods study is to describe bullying experienced by student nurses in a clinical setting. Oppression theory guided the study. A descriptive qualitative approach guided the study. Senior-level student nurses from four baccalaureate nursing programs in Southwest Ohio were recruited in person to participate in a one of eight focus group sessions. Focus group questions asked respondents to describe experiences of bullying, how the bullying affected meeting their clinical learning objectives, and to provide suggestions to address bullying of student nurses in the clinical setting. Focus group sessions were audio-recorded and transcribed verbatim. Data were analyzed using Colaizzi’s procedural steps in phenomenological data analysis to yield themes. Four global themes identified were bullying behavior, rationale for bullying, response to/impact of bullying, and recommendations. The five bullying behaviors described were being ignored, avoided, or isolated; non-verbal behavior; condescending or negative interaction; denying opportunities to learn; and hazing. The five rationales for bullying expressed were rite of passage, unpreventable, caused by other stressors, students not welcome, and not a nice person. Students reported eight types of responses to, and impacts of, bullying: physical response, emotional response, psychological response, avoidance, productivity/performance, learning, and view of nursing and health care. Finally, eight recommendations offered by students were educate and prepare students, student response to bullying, support, faculty member response, facility/organization response, qualifications of preceptor, making student assignments, and clarification of student role. Student nurses report experiencing and accepting a wide range of bullying behaviors in the clinical setting reflective of behaviors for an oppressed group. In addition, students’ responses to bullying mimic those reported by registered nurses. Finally, respondents’ recommendations can guide interventions to prevent bullying against student nurses and empower them to mitigate future bullying. |
In search of modifiable risk and protective factors for teen dating violence
Smith-Darden JP , Kernsmith PD , Reidy DE , Cortina KS . J Res Adolesc 2016 27 (2) 423-435 The present research explores the additive and interactive effects of anger or hostility (A/H), acceptance of violence (AoV), and constructive conflict resolution strategies (CRS) on the perpetration of physical and sexual teen dating violence (TDV). Adolescents completed surveys assessing physical and sexual TDV perpetration, A/H, AoV, and positive CRS. While the findings require replication with longitudinal data, the results suggest that developing interventions to modify AoV and A/H may have the potential to prevent instances of TDV perpetration among both boys and girls. The results for CRS were mixed and necessitate further exploration. These cross-sectional data provide insight into potentially fruitful areas of exploration for the development and tailoring of prevention strategies for teens at risk for physical and sexual TDV perpetration. |
Intimate partner violence and adherence to HIV pre-exposure prophylaxis (PrEP) in African women in HIV serodiscordant relationships: A prospective cohort study
Roberts ST , Haberer J , Celum C , Mugo N , Ware NC , Cohen CR , Tappero JW , Kiarie J , Ronald A , Mujugira A , Tumwesigye E , Were E , Irungu E , Baeten JM . J Acquir Immune Defic Syndr 2016 73 (3) 313-322 BACKGROUND: Intimate partner violence (IPV) is associated with higher HIV incidence, reduced condom use, and poor adherence to antiretroviral therapy and other medications. IPV may also affect adherence to pre-exposure prophylaxis (PrEP). METHODS: We analyzed data from 1785 HIV-uninfected women enrolled in a clinical trial of PrEP among African HIV serodiscordant couples. Experience of verbal, physical, or economic IPV was assessed at monthly visits by face-to-face interviews. Low PrEP adherence was defined as clinic-based pill count coverage <80% or plasma tenofovir levels <40 ng/mL. The association between IPV and low adherence was analyzed using generalized estimating equations, adjusting for potential confounders. In-depth interview transcripts were examined to explain how IPV could impact adherence. RESULTS: Sixteen percent of women reported IPV during a median of 34.8 months of follow-up (interquartile range 27.0-35.0). Overall, 7% of visits had pill count coverage <80%, and 32% had plasma tenofovir <40 ng/mL. Women reporting IPV in the past 3 months had increased risk of low adherence by pill count (adjusted risk ratio 1.49, 95% confidence interval: 1.17 to 1.89) and by plasma tenofovir (adjusted risk ratio 1.51, 95% confidence interval: 1.06 to 2.15). Verbal, economic, and physical IPV were all associated with low adherence. However, the impact of IPV diminished and was not statistically significant 3 months after the reported exposure. In qualitative interviews, women identified several ways in which IPV affected adherence, including stress and forgetting, leaving home without pills, and partners throwing pills away. CONCLUSIONS: Women who reported recent IPV in the Partners PrEP Study were at increased risk of low PrEP adherence. Strategies to mitigate PrEP nonadherence in the context of IPV should be evaluated. |
Adverse weather conditions and fatal motor vehicle crashes in the United States, 1994-2012
Saha S , Schramm P , Nolan A , Hess J . Environ Health 2016 15 (1) 104 BACKGROUND: Motor vehicle crashes are a leading cause of injury mortality. Adverse weather and road conditions have the potential to affect the likelihood of motor vehicle fatalities through several pathways. However, there remains a dearth of assessments associating adverse weather conditions to fatal crashes in the United States. We assessed trends in motor vehicle fatalities associated with adverse weather and present spatial variation in fatality rates by state. METHODS: We analyzed the Fatality Analysis Reporting System (FARS) datasets from 1994 to 2012 produced by the National Highway Traffic Safety Administration (NHTSA) that contains reported weather information for each fatal crash. For each year, we estimated the fatal crashes that were associated with adverse weather conditions. We stratified these fatalities by months to examine seasonal patterns. We calculated state-specific rates using annual vehicle miles traveled data for all fatalities and for those related to adverse weather to examine spatial variations in fatality rates. To investigate the role of adverse weather as an independent risk factor for fatal crashes, we calculated odds ratios for known risk factors (e.g., alcohol and drug use, no restraint use, poor driving records, poor light conditions, highway driving) to be reported along with adverse weather. RESULTS: Total and adverse weather-related fatalities decreased over 1994-2012. Adverse weather-related fatalities constituted about 16 % of total fatalities on average over the study period. On average, 65 % of adverse weather-related fatalities happened between November and April, with rain/wet conditions more frequently reported than snow/icy conditions. The spatial distribution of fatalities associated with adverse weather by state was different than the distribution of total fatalities. Involvement of alcohol or drugs, no restraint use, and speeding were less likely to co-occur with fatalities during adverse weather conditions. CONCLUSIONS: While adverse weather is reported for a large number of motor vehicle fatalities for the US, the type of adverse weather and the rate of associated fatality vary geographically. These fatalities may be addressed and potentially prevented by modifying speed limits during inclement weather, improving road surfacing, ice and snow removal, and providing transit alternatives, but the impact of potential interventions requires further research. |
Evaluation of the Illumigene Malaria LAMP: A Robust Molecular Diagnostic Tool for Malaria Parasites.
Lucchi NW , Gaye M , Diallo MA , Goldman IF , Ljolje D , Deme AB , Badiane A , Ndiaye YD , Barnwell JW , Udhayakumar V , Ndiaye D . Sci Rep 2016 6 36808 Isothermal nucleic acid amplification assays such as the loop mediated isothermal amplification (LAMP), are well suited for field use as they do not require thermal cyclers to amplify the DNA. To further facilitate the use of LAMP assays in remote settings, simpler sample preparation methods and lyophilized reagents are required. The performance of a commercial malaria LAMP assay (Illumigene Malaria LAMP) was evaluated using two sample preparation workflows (simple filtration prep (SFP)) and gravity-driven filtration prep (GFP)) and pre-dispensed lyophilized reagents. Laboratory and clinical samples were tested in a field laboratory in Senegal and the results independently confirmed in a reference laboratory in the U.S.A. The Illumigene Malaria LAMP assay was easily implemented in the clinical laboratory and gave similar results to a real-time PCR reference test with limits of detection of ≤2.0 parasites/mul depending on the sample preparation method used. This assay reliably detected Plasmodium sp. parasites in a simple low-tech format, providing a much needed alternative to the more complex molecular tests for malaria diagnosis. |
Skin vaccination against rotavirus using microneedles: Proof of concept in gnotobiotic piglets
Wang Y , Vlasova A , Velasquez DE , Saif LJ , Kandasamy S , Kochba E , Levin Y , Jiang B . PLoS One 2016 11 (11) e0166038 Live-attenuated oral rotavirus (RV) vaccines have lower efficacy in low income countries, and additionally are associated with a rare but severe adverse event, intussusception. We have been pursuing the development of an inactivated rotavirus vaccine (IRV) using the human rotavirus strain CDC-9 (G1P[8]) through parenteral immunization and previously demonstrated dose sparing and enhanced immunogenicity of intradermal (ID) unadjuvanted IRV using a coated microneedle patch in comparison with intramuscular (IM) administration in mice. The aim of this study was to evaluate the immune response and protection against RV infection and diarrhea conferred by the administration of the ID unadjuvanted IRV using the microneedle device MicronJet600(R) in neonatal gnotobiotic (Gn) piglets challenged with virulent Wa G1P[8] human RV. Three doses of 5 mug IRV when administered intradermally and 5 mug IRV formulated with aluminum hydroxide [Al(OH)3] when administered intramuscularly induced comparable rotavirus-specific antibody titers of IgA, IgG, IgG avidity index and neutralizing activity in sera of neonatal piglets. Both IRV vaccination regimens protected against RV antigen shedding in stools, and reduced the cumulative diarrhea scores in the piglets. This study demonstrated that the ID and IM administrations of IRV are immunogenic and protective against RV-induced diarrhea in neonatal piglets. Our findings highlight the potential value of an adjuvant sparing effect of the IRV ID delivery route. |
Validation of high throughput screening of human sera for detection of anti-PA IgG by Enzyme-Linked Immunosorbent Assay (ELISA) as an emergency response to an anthrax incident
Semenova VA , Steward-Clark E , Maniatis P , Epperson M , Sabnis A , Schiffer J . Biologicals 2016 45 61-68 To improve surge testing capability for a response to a release of Bacillus anthracis, the CDC anti-Protective Antigen (PA) IgG Enzyme-Linked Immunosorbent Assay (ELISA) was re-designed into a high throughput screening format. The following assay performance parameters were evaluated: goodness of fit (measured as the mean reference standard r2), accuracy (measured as percent error), precision (measured as coefficient of variance (CV)), lower limit of detection (LLOD), lower limit of quantification (LLOQ), dilutional linearity, diagnostic sensitivity (DSN) and diagnostic specificity (DSP). The paired sets of data for each sample were evaluated by Concordance Correlation Coefficient (CCC) analysis. The goodness of fit was 0.999; percent error between the expected and observed concentration for each sample ranged from -4.6% to 14.4%. The coefficient of variance ranged from 9.0% to 21.2%. The assay LLOQ was 2.6 mug/mL. The regression analysis results for dilutional linearity data were r2 = 0.952, slope = 1.02 and intercept = -0.03. CCC between assays was 0.974 for the median concentration of serum samples. The accuracy and precision components of CCC were 0.997 and 0.977, respectively. This high throughput screening assay is precise, accurate, sensitive and specific. Anti-PA IgG concentrations determined using two different assays proved high levels of agreement. The method will improve surge testing capability 18-fold from 4 to 72 sera per assay plate. |
Myofibroblasts and lung fibrosis induced by carbon nanotube exposure
Dong J , Ma Q . Part Fibre Toxicol 2016 13 (1) 60 Carbon nanotubes (CNTs) are newly developed materials with unique properties and a range of industrial and commercial applications. A rapid expansion in the production of CNT materials may increase the risk of human exposure to CNTs. Studies in rodents have shown that certain forms of CNTs are potent fibrogenic inducers in the lungs to cause interstitial, bronchial, and pleural fibrosis characterized by the excessive deposition of collagen fibers and the scarring of involved tissues. The cellular and molecular basis underlying the fibrotic response to CNT exposure remains poorly understood. Myofibroblasts are a major type of effector cells in organ fibrosis that secrete copious amounts of extracellular matrix proteins and signaling molecules to drive fibrosis. Myofibroblasts also mediate the mechano-regulation of fibrotic matrix remodeling via contraction of their stress fibers. Recent studies reveal that exposure to CNTs induces the differentiation of myofibroblasts from fibroblasts in vitro and stimulates pulmonary accumulation and activation of myofibroblasts in vivo. Moreover, mechanistic analyses provide insights into the molecular underpinnings of myofibroblast differentiation and function induced by CNTs in the lungs.In view of the apparent fibrogenic activity of CNTs and the emerging role of myofibroblasts in the development of organ fibrosis, we discuss recent findings on CNT-induced lung fibrosis with emphasis on the role of myofibroblasts in the pathologic development of lung fibrosis. Particular attention is given to the formation and activation of myofibroblasts upon CNT exposure and the possible mechanisms by which CNTs regulate the function and dynamics of myofibroblasts in the lungs. It is evident that a fundamental understanding of the myofibroblast and its function and regulation in lung fibrosis will have a major influence on the future research on the pulmonary response to nano exposure, particle and fiber-induced pneumoconiosis, and other human lung fibrosing diseases. |
Preparation of respirable crystalline silica samples for subsequent analysis
Harper M , Key-Schwartz RJ . Regul Toxicol Pharmacol 2016 83 100-102 We respectfully disagree with the conclusion in the paper by Lee, R.J. et al. (2016) that: “… muffle furnace preparation of [respirable crystalline] silica samples be discontinued” because the authors data and the results of previously published studies do not support this assertion. Muffle furnace treatment and low-temperature plasma ashing are regarded as equivalent sample preparation steps for respirable crystalline silica analysis in NIOSH Manual of Analytical Methods 7500 (NIOSH, 2003a) and 7602 (NIOSH, 2003b). Muffle furnace ashing is also used for sample preparation in several international standard methods (ASTM International, 2014; HSE, 1984; INSHT, 2005; INS, 2013; ISO, 2015). A previously published study by Cox et al. (2015) obtained results that indicated “under-reporting” of silica mass on test filters. Lee, R.J. et al. (2016) examines two possible reasons, “shipping” and “level of effort”, as to why results were low in the Cox et al. study. Although Lee, R.J. et al. (2016) correctly state that “OSHA (2016) reviewed the Cox et al. study and identified several deficiencies associated with filter generation and quality control testing that OSHA believes invalidates the Cox et al. findings”, they follow this with the statement that their study “addresses OSHA’s comments and finds the deficiencies cited did not contribute to the results of the Cox study”. This latter statement is surprising in that the major deficiency noted by OSHA in their criticism of the Cox et al, (2015) study involved “filter generation and quality control testing”, not “shipping” or “level of effort”. |
Elimination of mother-to-child transmission of HIV and syphilis in Cuba and Thailand
Ishikawa N , Newman L , Taylor M , Essajee S , Pendse R , Ghidinelli M . Bull World Health Organ 2016 94 (11) 787-787a Vertical transmission of human immunodeficiency virus (HIV) and syphilis can be effectively controlled through antenatal screening and treatment. However, each year there are still an estimated 150 000 cases of new paediatric HIV infections and 350 000 cases of congenital syphilis globally.1,2 The World Health Organization (WHO) has developed global health sector strategies for 2016–2021 on HIV and sexually transmitted infections that set the targets of achieving zero new HIV infections among infants by 2020 and less than or equal to 50 cases of congenital syphilis per 100 000 live births by 2030.2–4 | WHO has issued a Global guidance on criteria and processes for validation: elimination of mother-to-child transmission of HIV and syphilis.4 To be validated by WHO as achieving elimination of the vertical transmission of HIV and syphilis, countries must meet three impact and five process targets, have a high-quality monitoring and surveillance system and respect basic human rights considerations, such as voluntary testing and treatment, equality and non-discrimination.4 Validation indicators specify that new paediatric HIV infections and congenital syphilis cases have to be less than or equal to 50 per 100 000 live births, and mother-to-child transmission rates of HIV have to be less than 5% in breastfeeding populations or less than 2% in non-breastfeeding populations for at least one year. When a country successfully meets the targets, it can submit a validation request and a national validation report to WHO. The report is reviewed by independent experts and an in-country assessment is conducted. This assessment involves a programmatic and health system review, in which high-level political commitment to elimination targets, strong maternal and child health and disease control programmes, reliable laboratory services, a robust health information system, compliance with human rights principles, gender equality and civil society engagement must all be demonstrated. |
Factors associated with self-injurious behaviors in children with autism spectrum disorder: Findings from two large national samples
Soke GN , Rosenberg SA , Hamman RF , Fingerlin T , Rosenberg CR , Carpenter L , Lee LC , Giarelli E , Wiggins LD , Durkin MS , Reynolds A , DiGuiseppi C . J Autism Dev Disord 2016 47 (2) 285-296 In this study, we explored potential associations among self-injurious behaviors (SIB) and a diverse group of protective and risk factors in children with autism spectrum disorder from two databases: Autism and Developmental Disabilities Monitoring (ADDM) Network and the Autism Speaks-Autism Treatment Network (AS-ATN). The presence of SIB was determined from children's records in ADDM and a parent questionnaire in AS-ATN. We used multiple imputation to account for missing data and a non-linear mixed model with site as a random effect to test for associations. Despite differences between the two databases, similar associations were found; SIB were associated with developmental, behavioral, and somatic factors. Implications of these findings are discussed in relation to possible etiology, future longitudinal studies, and clinical practice. |
Complications of haemophilia in babies (first two years of life): a report from the Centers for Disease Control and Prevention Universal Data Collection System
Kulkarni R , Presley RJ , Lusher JM , Shapiro AD , Gill JC , Manco-Johnson M , Koerper MA , Abshire TC , DiMichele D , Hoots WK , Mathew P , Nugent DJ , Geraghty S , Evatt BL , Soucie JM . Haemophilia 2016 23 (2) 207-214 AIM: To describe the prevalence and complications in babies ≤2 years with haemophilia. METHODS: We used a standardized collection tool to obtain consented data on eligible babies aged ≤2 years with haemophilia enrolled in the Centers for Disease Control and Prevention Universal Data Collection System surveillance project at US Hemophilia Treatment Centers (HTCs). RESULTS: Of 547 babies, 82% had haemophilia A, and 70% were diagnosed within one month of birth. Diagnosis was prompted by known maternal carrier status (40%), positive family history (23%), bleeding (35%) and unknown 2%; 81% bled during the first two years. The most common events were bleeding (circumcision, soft tissue, oral bleeding) and head injury. There were 46 episodes of intracranial haemorrhage (ICH) in 37 babies (7%): 18 spontaneous, 14 delivery related, 11 traumatic, 2 procedure related and 1 unknown cause. Of the 176 central venous access devices (CVADs) in 148 (27%) babies, there were 137 ports, 22 surgically inserted central catheters and 20 peripherally inserted central catheters. Ports had the lowest complication rates. Inhibitors occurred in 109 (20%) babies who experienced higher rates of ICH (14% vs. 5%; P = 0.002), CVAD placement (61% vs. 19%; P < 0.001) and CVAD complications (44% vs. 26%; P < 0.001). The most common replacement therapy was recombinant clotting factor concentrates. CONCLUSION: Bleeding events in haemophilic babies ≤2 years were common; no detectable difference in the rates of ICH by the mode of delivery was noted. Neonatal factor exposure did not affect the inhibitor rates. Minor head trauma, soft tissue and oropharyngeal bleeding were the leading indications for treatment. |
Shift work, job strain and changes in the body mass index among women: a prospective study
Fujishiro K , Lividoti Hibert E , Schernhammer E , Rich-Edwards JW . Occup Environ Med 2016 74 (6) 410-416 OBJECTIVES: The effects of job strain and shift work on weight gain have not been studied jointly. Cross-sectional and longitudinal studies on shift work and weight gain have reported different results. This study examines potential effect modification by job strain on the link between shift work and weight gain, and concurrent and delayed effects of shift work on weight gain. METHODS: Data came from 52 622 women who participated in the Nurses' Health Study II, a prospective cohort study. Using linear regression, we modelled change in body mass index (BMI) over 4 years as a function of change in job strain, cumulative exposure to rotating night shift previously and during the 4 years (ie, previous and concurrent exposures) and the interaction between job strain and concurrent shift work exposure. Age, race/ethnicity, pregnancy history, baseline BMI, job types and health behaviours at baseline were controlled for. RESULTS: Job strain and rotating shift work, concurrent and previous, all had independent associations with BMI change during the 4-year period. There was no evidence for effect modification by job strain. Concurrent and previous exposures to rotating night shift had different associations with BMI change: an inverted U-shape for concurrent exposure (ranging from 0.01 to 0.14 kg/m2 increase), a dose-response for previous exposure (-0.02 to 0.09 kg/m2). CONCLUSIONS: Job strain and rotating night shift work have independent contributions to weight gain. Reducing job strain and supporting night shift workers are both important intervention goals. |
The impact of perceived intensity and frequency of police work occupational stressors on the cortisol awakening response (CAR): Findings from the BCOPS study
Violanti JM , Fekedulegn D , Andrew ME , Hartley TA , Charles LE , Miller DB , Burchfiel CM . Psychoneuroendocrinology 2016 75 124-131 Police officers encounter unpredictable, evolving, and escalating stressful demands in their work. Utilizing the Spielberger Police Stress Survey (60-item instrument for assessing specific conditions or events considered to be stressors in police work), the present study examined the association of the top five highly rated and bottom five least rated work stressors among police officers with their awakening cortisol pattern. Participants were police officers enrolled in the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study (n=338). For each group, the total stress index (product of rating and frequency of the stressor) was calculated. Participants collected saliva by means of Salivettes at four time points: on awakening, 15, 30 and 45min after waking to examine the cortisol awakening response (CAR). Saliva samples were analyzed for free cortisol concentrations. A slope reflecting the awakening pattern of cortisol over time was estimated by fitting a linear regression model relating cortisol in log-scale to time of collection. The slope served as the outcome variable. Analysis of covariance, regression, and repeated measures models were used to determine if there was an association of the stress index with the waking cortisol pattern. There was a significant negative linear association between total stress index of the five highest stressful events and slope of the awakening cortisol regression line (trend p-value=0.0024). As the stress index increased, the pattern of the awakening cortisol regression line tended to flatten. Officers with a zero stress index showed a steep and steady increase in cortisol from baseline (which is often observed) while officers with a moderate or high stress index showed a dampened or flatter response over time. Conversely, the total stress index of the five least rated events was not significantly associated with the awakening cortisol pattern. The study suggests that police events or conditions considered highly stressful by the officers may be associated with disturbances of the typical awakening cortisol pattern. The results are consistent with previous research where chronic exposure to stressors is associated with a diminished awakening cortisol response pattern. |
Development of a source-exposure matrix for occupational exposure assessment of electromagnetic fields in the INTEROCC study
Vila J , Bowman JD , Figuerola J , Morina D , Kincl L , Richardson L , Cardis E . J Expo Sci Environ Epidemiol 2016 27 (4) 398-408 To estimate occupational exposures to electromagnetic fields (EMF) for the INTEROCC study, a database of source-based measurements extracted from published and unpublished literature resources had been previously constructed. The aim of the current work was to summarize these measurements into a source-exposure matrix (SEM), accounting for their quality and relevance. A novel methodology for combining available measurements was developed, based on order statistics and log-normal distribution characteristics. Arithmetic and geometric means, and estimates of variability and maximum exposure were calculated by EMF source, frequency band and dosimetry type. The mean estimates were weighted by our confidence in the pooled measurements. The SEM contains confidence-weighted mean and maximum estimates for 312 EMF exposure sources (from 0 Hz to 300 GHz). Operator position geometric mean electric field levels for radiofrequency (RF) sources ranged between 0.8 V/m (plasma etcher) and 320 V/m (RF sealer), while magnetic fields ranged from 0.02 A/m (speed radar) to 0.6 A/m (microwave heating). For extremely low frequency sources, electric fields ranged between 0.2 V/m (electric forklift) and 11,700 V/m (high-voltage transmission line-hotsticks), whereas magnetic fields ranged between 0.14 muT (visual display terminals) and 17 muT (tungsten inert gas welding). The methodology developed allowed the construction of the first EMF-SEM and may be used to summarize similar exposure data for other physical or chemical agents. |
Development of noise controls for longwall shearer cutting drums
Camargo HE , Azman AS , Alcorn L . Noise Control Eng J 2016 64 (5) 573-585 Noise-induced hearing loss is the second most pervasive disease in the mining industry. The exposure of miners to noise levels above the permissible exposure level results in hearing loss of approximately 80% of coal miners by retirement age. In addition, between 2002 and 2011, approximately 48% of longwall shearer operators were overexposed in coal mines in the United States. Previous research identified the two rotating cutting drums used by the longwall shearer to extract coal as the most significant sound-radiating components. In this context, the National Institute for Occupational Safety and Health conducted research to develop noise controls for longwall mining systems. To this end, structural and acoustic numerical models of a single cutting drum were developed to assess its dynamic and acoustic response, respectively. Once validated, these models were used to explore various noise control concepts including force isolation, varying structural damping and varying component stiffness. Upon multiple simulations, it was determined that structural modifications to increase the stiffness of the outer vane plates were the most practical and durable approach to reduce the sound radiated by the cutting drums. Furthermore, these modifications did not adversely affect the cutting performance, nor the loading ability of the drums. As a result, these structural modifications were implemented into an actual set of drums for evaluation purposes. Results from the underground evaluation, when the modified cutting drums were used under normal operation conditions, showed noise reduction across the entire frequency spectrum with an overall noise reduction of 3 dB in the sound pressure level at the operator location, confirming the validity of the developed noise controls. |
Associations between physical activity and cognitive functioning among middle-aged and older adults
Miyawaki CE , Bouldin ED , Kumar GS , McGuire LC . J Nutr Health Aging 2016 21 (6) 637-647 Objectives: To describe aerobic physical activity among middle-aged and older adults by their selfreported cognitive decline and their receipt of informal care for declines in cognitive functioning and most common type of physical activity. Design: Cross-sectional study using data from the 2011 Behavioral Risk Factor Surveillance System. Setting: Landline and cellular telephone survey. Participants: 93,082 respondents aged 45 years and older from 21 US states in 2011. Measurements: Subjective cognitive decline (SCD) was defined as experiencing confusion or memory loss that was happening more often or getting worse during the past 12 months. Regular care was defined as always, usually, or sometimes receiving care from family or friends because of SCD. Using the 2008 Physical Activity Guidelines for Americans, respondents were classified as being inactive, insufficiently active, or sufficiently active based on their reported aerobic exercise. We calculated weighted proportions and used chi-square tests for differences across categories by SCD status and receipt of care. We estimated the prevalence ratio (PR) for being inactive, insufficiently active, and sufficiently active using separate log-binomial regression models, adjusting for covariates. Results: 12.3% of respondents reported SCD and 23.1% of those with SCD received regular care. 29.6% (95%CI: 28.9-30.4) of respondents without SCD were inactive compared to 37.1% (95%CI: 34.7-39.5) of those with SCD who did not receive regular care and 50.2% (95%CI: 45.2-55.1) of those with SCD who received regular care. 52.4% (95%CI: 51.6-53.2) of respondents without SCD were sufficiently active compared to 46.4% (95%CI: 43.8-49.0) of respondents with SCD and received no regular care and 30.6% (95%CI: 26.1-35.6) of respondents with SCD who received regular care. After adjusting for demographic and health status differences, people receiving regular care for SCD had a significantly lower prevalence of meeting aerobic guidelines compared to people without SCD (PR=0.80, 95%CI: 0.69-0.93, p=0.005). The most prevalent physical activity was walking for adults aged > 45 years old (41-52%) regardless of SCD status or receipt of care. Conclusion: Overall, the prevalence of inactivity was high, especially among people with SCD. These findings suggest a need to increase activity among middle-aged and older adults, particularly those with SCD who receive care. Examining ways to increase walking, potentially by involving informal caregivers, could be a promising way for people with SCD to reduce inactivity and gain the health benefits associated with meeting physical activity guidelines. |
Effects of maternal age and age-specific preterm birth rates on overall preterm birth rates - United States, 2007 and 2014
Ferre C , Callaghan W , Olson C , Sharma A , Barfield W . MMWR Morb Mortal Wkly Rep 2016 65 (43) 1181-1184 Reductions in births to teens and preterm birth rates are two recent public health successes in the United States (1,2). From 2007 to 2014, the birth rate for females aged 15-19 years declined 42%, from 41.5 to 24.2 per 1,000 females. The preterm birth rate decreased 8.4%, from 10.41% to 9.54% of live births (1). Rates of preterm births vary by maternal age, being higher among the youngest and oldest mothers. It is unknown how changes in the maternal age distribution in the United States have affected preterm birth rates. CDC used birth data to assess the relative contributions of changes in the maternal age distribution and in age-specific preterm birth rates to the overall decrease in preterm birth rates. The preterm birth rate declined in all age groups. The effects of age distribution changes on the preterm birth rate decrease were different in younger and older mothers. The decrease in the proportion of births to mothers aged ≤19 and 20-24 years and reductions in age-specific preterm rates in all age groups contributed to the overall decline in the preterm birth rate. The increase in births to mothers aged ≥30 years had no effect on the overall preterm birth rate decrease. The decline in preterm births from 2007 to 2014 is related, in part, to teen pregnancy prevention and the changing maternal age distribution. Effective public health strategies for further reducing preterm birth rates need to be tailored to different age groups. |
Combined hormonal contraceptive (CHC) use among obese women and contraceptive effectiveness: a systematic review
Dragoman MV , Simmons KB , Paulen ME , Curtis KM . Contraception 2016 95 (2) 117-129 OBJECTIVE: To evaluate from the literature whether combined hormonal contraception (CHC), including combined oral contraception pills (COC), transdermal patch, vaginal ring, or combined injectables, have different effectiveness or failure rates by body weight or body mass index (BMI). STUDY DESIGN: We searched PubMed and the Cochrane Library databases for all articles in all languages published between inception and February 2016, for evidence relevant to body weight or BMI, CHC use and contraceptive effectiveness. The quality of each individual study was assessed using the system for evaluating evidence developed by the United States Preventive Services Task Force. RESULTS: From 2874 articles, we identified 15 reports for inclusion, all of fair to poor quality. Fourteen studies measured the association of obesity status and contraceptive failure among COC users. Three fair quality and one poor quality study reported increased COC failure among a heterogeneous population of overweight and obese women compared with normal weight women, while eight fair quality and two poor quality studies did not find an association. Two fair quality studies reported on contraceptive transdermal patches. One pooled analysis described a higher proportion of pregnancies among women using the patch who weighed≥90 kg; another secondary analysis suggested BMI>30 was associated with increased failure. No studies directly compared contraceptive effectiveness using the combined vaginal ring or combined injectable. CONCLUSION: Current available evidence addressing the risk of CHC failure in obese compared to normal weight women is limited to fair and poor quality studies. Studies of COCs show mixed results, though absolute differences in COC failure by body weight and BMI are small. Based on limited evidence, it appears that increasing body weight and BMI may contribute to decreasing contraceptive patch effectiveness. |
Vital Signs: Disparities in tobacco-related cancer incidence and mortality - United States, 2004-2013
Henley SJ , Thomas CC , Sharapova SR , Momin B , Massetti GM , Winn DM , Armour BS , Richardson LC . MMWR Morb Mortal Wkly Rep 2016 65 (44) 1212-1218 BACKGROUND: Tobacco use causes at least 12 types of cancer and is the leading preventable cause of cancer. METHODS: Data from the United States Cancer Statistics dataset for 2004-2013 were used to assess incidence and death rates and trends for cancers that can be caused by tobacco use (tobacco-related cancers: oral cavity and pharynx; esophagus; stomach; colon and rectum; liver; pancreas; larynx; lung, bronchus, and trachea; kidney and renal pelvis; urinary bladder; cervix; and acute myeloid leukemia) by sex, age, race, ethnicity, state, county-level poverty and educational attainment, and cancer site. RESULTS: Each year during 2009-2013, on average, 660,000 persons in the United States received a diagnosis of a tobacco-related cancer, and 343,000 persons died from these cancers. Tobacco-related cancer incidence and death rates were higher among men than women; highest among black men and women; higher in counties with low proportion of college graduates or high level of poverty; lowest in the West; and differed two-fold among states. During 2004-2013, incidence of tobacco-related cancer decreased 1.3% per year and mortality decreased 1.6% per year, with decreases observed across most groups, but not at the same rate. CONCLUSIONS: Tobacco-related cancer declined during 2004-2013. However, the burden remains high, and disparities persist among certain groups with higher rates or slower declines in rates. IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: The burden of tobacco-related cancers can be reduced through efforts to prevent and control tobacco use and other comprehensive cancer control efforts focused on reducing cancer risk, detecting cancer early, improving cancer treatments, helping more persons survive cancer, improving cancer survivors' quality of life, and better assisting communities disproportionately impacted by cancer. |
Income inequality and U.S. Children's secondhand smoke exposure: Distinct associations by race-ethnicity
Shenassa ED , Rossen LM , Cohen J , Morello-Frosch R , Payne-Sturges DC . Nicotine Tob Res 2016 19 (11) 1292-1299 INTRODUCTION: Prior studies have found considerable racial and ethnic disparities in second-hand smoke exposure. Although a number of individual-level determinants of this disparity have been identified, contextual determinants of racial and ethnic disparities in second-hand smoke exposure remain unexamined. The objective of this study was to examine disparities in serum cotinine in relation to area-level income inequality among 14,649 children from the National Health and Nutrition Examination Survey (NHANES). METHODS: We fit log-normal regression models to examine disparities in serum cotinine in relation to Metropolitan Statistical Areas (MSA) level income inequality among 14,649 non-smoking children aged 3-15 from the NHANES (1999-2012). RESULT: Non-Hispanic black children had significantly lower serum cotinine than non-Hispanic white children (-0.26; 95% CI: -0.38, -0.15) in low income inequality areas, but this difference was attenuated in areas with high income inequality (0.01; 95% CI: -0.16, 0.18). Serum cotinine declined for non-Hispanic white and Mexican American children with increasing income inequality. Serum cotinine did not change as a function of the level of income inequality among non-Hispanic black children. CONCLUSIONS: We have found evidence of differential associations between SHS exposure and income inequality by race and ethnicity. Further examination of environments which engender SHS exposure among children across various racial/ethnic subgroups can foster a better understanding of how area-level income inequality relates to health outcomes such as levels of SHS exposure and how those associations differ by race/ethnicity. IMPLICATIONS: In the US, the association between children's risk of secondhand smoke exposure and income inequality is modified by race/ethnicity in a manner that is inconsistent with theories of income inequality. In overall analysis this association appears to be as predicted by theory. However, race-specific analyses reveal that higher levels of income inequality are associated with lower levels of SHS exposure among white children, while levels of secondhand smoke exposure among non-Hispanic black children are largely invariant to area-level income inequality. Future examination of the link between income inequality and smoking related health outcomes should consider differential associations across racial and ethnic subpopulations. |
Current cigarette smoking among adults - United States, 2005-2015
Jamal A , King BA , Neff LJ , Whitmill J , Babb SD , Graffunder CM . MMWR Morb Mortal Wkly Rep 2016 65 (44) 1205-1211 Tobacco use is the leading cause of preventable disease and death in the United States, and cigarettes are the most commonly used tobacco product among U.S. adults. To assess progress toward achieving the Healthy People 2020 target of reducing the proportion of U.S. adults who smoke cigarettes to ≤12.0% (objective TU1.1), CDC assessed the most recent national estimates of cigarette smoking prevalence among adults aged ≥18 years using data from the 2015 National Health Interview Survey (NHIS). The proportion of U.S. adults who smoke cigarettes declined from 20.9% in 2005 to 15.1% in 2015, and the proportion of daily smokers declined from 16.9% to 11.4%. However, disparities in cigarette smoking persist. In 2015, prevalence of cigarette smoking was higher among adults who were male; were aged 25-44 years; were American Indian/Alaska Native; had a General Education Development certificate (GED); lived below the federal poverty level; lived in the Midwest; were insured through Medicaid or were uninsured; had a disability/limitation; were lesbian, gay, or bisexual; or who had serious psychological distress. Proven population-based interventions, including tobacco price increases, comprehensive smoke-free laws, anti-tobacco mass media campaigns, and barrier-free access to tobacco cessation counseling and medications, are critical to reducing cigarette smoking and smoking-related disease and death among U.S. adults, particularly among subpopulations with the highest smoking prevalences. |
Measuring Haitian children's exposure to chikungunya, dengue and malaria
Poirier MJ , Moss DM , Feeser KR , Streit TG , Chang GJ , Whitney M , Russell BJ , Johnson BW , Basile AJ , Goodman CH , Barry AK , Lammie PJ . Bull World Health Organ 2016 94 (11) 817-825a OBJECTIVE: To differentiate exposure to the newly introduced chikungunya virus from exposure to endemic dengue virus and other pathogens in Haiti. METHODS: We used a multiplex bead assay to detect immunoglobulin G (IgG) responses to a recombinant chikungunya virus antigen, two dengue virus-like particles and three recombinant Plasmodium falciparum antigens. Most (217) of the blood samples investigated were collected longitudinally, from each of 61 children, between 2011 and 2014 but another 127 were collected from a cross-sectional sample of children in 2014. FINDINGS: Of the samples from the longitudinal cohort, none of the 153 collected between 2011 and 2013 but 78.7% (48/61) of those collected in 2014 were positive for IgG responses to the chikungunya virus antigen. In the cross-sectional sample, such responses were detected in 96 (75.6%) of the children and occurred at similar prevalence across all age groups. In the same sample, responses to malarial antigen were only detected in eight children (6.3%) but the prevalence of IgG responses to dengue virus antigens was 60.6% (77/127) overall and increased steadily with age. Spatial analysis indicated that the prevalence of IgG responses to the chikungunya virus and one of the dengue virus-like particles decreased as the sampling site moved away from the city of Leogane and towards the ocean. CONCLUSION: Serological evidence indicates that there had been a rapid and intense dissemination of chikungunya virus in Haiti. The multiplex bead assay appears to be an appropriate serological platform to monitor the seroprevalence of multiple pathogens simultaneously. |
Notes from the Field: Rift Valley Fever Response - Kabale District, Uganda, March 2016
de St Maurice A , Nyakarahuka L , Purpura L , Ervin E , Tumusiime A , Balinandi S , Kayondo J , Mulei S , Namutebi AM , Tusiime P , Wiersma S , Nichol S , Rollin P , Klena J , Knust B , Shoemaker T . MMWR Morb Mortal Wkly Rep 2016 65 (43) 1200-1201 On March 9, 2016, a male butcher from Kabale District, Uganda, aged 45 years, reported to the Kabale Regional Referral Hospital with fever, fatigue, and headache associated with black tarry stools and bleeding from the nose. One day later, a student aged 16 years from a different sub-county in Kabale District developed similar symptoms and was admitted to the same hospital. The student also had a history of contact with livestock. Blood specimens collected from both patients were sent for testing for Marburg virus disease, Ebola virus disease, Rift Valley fever (RVF), and Crimean Congo Hemorrhagic fever at the Uganda Virus Research Institute, as part of the viral hemorrhagic fevers surveillance program. The Uganda Virus Research Institute serves as the national viral hemorrhagic fever reference laboratory and hosts the national surveillance program for viral hemorrhagic fevers, in collaboration with the CDC Viral Special Pathogens Branch and the Uganda Ministry of Health. |
Estimating the burden of Chagas disease in the United States
Manne-Goehler J , Umeh CA , Montgomery SP , Wirtz VJ . PLoS Negl Trop Dis 2016 10 (11) e0005033 BACKGROUND: In recent years, there has been growing awareness of the significant burden of Chagas disease in the United States (US). However, epidemiological data on both prevalence and access to care for this disease are limited. The objective of this study is to provide an updated national estimate of Chagas disease prevalence, the first state-level estimates of cases of T. cruzi infection in the US and to analyze these estimates in the context of data on confirmed cases of infection in the US blood supply. METHODS: In this study, we calculated estimates of the state and national prevalence of Chagas disease. The number of residents originally from Chagas disease endemic countries were computed using data on Foreign-Born Hispanic populations from the American Community Survey, along with recent prevalence estimates for Chagas disease in Latin America from the World Health Organization that were published in 2006 and updated in 2015. We then describe the distribution of estimated cases in each state in relation to the number of infections identified in the donated blood supply per data from the AABB (formerly American Association of Blood Banks). FINDINGS: The results of this analysis offer an updated national estimate of 238,091 cases of T. cruzi infection in the United States as of 2012, using the same method as was used by Bern and Montgomery to estimate cases in 2005. This estimate indicates that there are 62,070 cases less than the most recent prior estimate, though it does not include undocumented immigrants who may account for as many as 109,000 additional cases. The state level results show that four states (California, Texas, Florida and New York) have over 10,000 cases and an additional seven states have over 5,000 cases. Moreover, since 2007, the AABB has reported 1,908 confirmed cases of T. cruzi infection identified through screening of blood donations. CONCLUSIONS: This study demonstrates a substantial burden of Chagas disease in the US, with state variation that reflects the distribution of at risk Latin American immigrant populations. The study lends important new insight into the distribution of this disease in the US and highlights the need for further research quantifying prevalence and incidence to guide interventions for control of Chagas disease across the US. |
Incidence of Zika virus disease by age and sex - Puerto Rico, November 1, 2015-October 20, 2016
Lozier M , Adams L , Febo MF , Torres-Aponte J , Bello-Pagan M , Ryff KR , Munoz-Jordan J , Garcia M , Rivera A , Read JS , Waterman SH , Sharp TM , Rivera-Garcia B . MMWR Morb Mortal Wkly Rep 2016 65 (44) 1219-1223 Zika virus is a flavivirus transmitted primarily by Aedes species mosquitoes; symptoms of infection include rash, arthralgia, fever, and conjunctivitis. Zika virus infection during pregnancy can cause microcephaly and other serious brain anomalies, and in rare cases, Zika virus infection has been associated with Guillain-Barre syndrome and severe thrombocytopenia (3). This report describes the incidence of reported symptomatic Zika virus disease in the U.S. territory of Puerto Rico by age and sex. During November 1, 2015-October 20, 2016, 62,500 suspected Zika virus disease cases were reported to the Puerto Rico Department of Health (PRDH); 29,345 (47%) were confirmed by reverse transcription-polymerase chain reaction (RT-PCR) testing, or were presumptively diagnosed based on serological testing. The highest incidence among confirmed or presumptive cases occurred among persons aged 20-29 years (1,150 cases per 100,000 residents). Among 28,219 (96.2%) nonpregnant patients with confirmed or presumptive Zika virus disease, incidence was higher among women (936 per 100,000 population) than men (576 per 100,000) for all age groups ≥20 years, and the majority (61%) of reported Zika virus disease cases occurred in females. Among suspected Zika virus disease cases in nonpregnant adults aged ≥40 years, the percentage that tested positive among females (52%) was higher than that among males (47%) (p<0.01). Reasons for the higher incidence of Zika virus disease among women aged ≥20 years are not known; serosurveys of persons living near confirmed Zika virus disease cases might help to elucidate these findings. Residents of and travelers to Puerto Rico should remove or cover standing water, practice mosquito abatement, employ mosquito bite avoidance behaviors, take precautions to reduce the risk for sexual transmission, and seek medical care for any acute illness with rash or fever. |
Characterizing the pattern of anomalies in congenital Zika syndrome for pediatric clinicians
Moore CA , Staples JE , Dobyns WB , Pessoa A , Ventura CV , Fonseca EB , Ribeiro EM , Ventura LO , Neto NN , Arena JF , Rasmussen SA . JAMA Pediatr 2016 171 (3) 288-295 Importance: Zika virus infection can be prenatally passed from a pregnant woman to her fetus. There is sufficient evidence to conclude that intrauterine Zika virus infection is a cause of microcephaly and serious brain anomalies, but the full spectrum of anomalies has not been delineated. To inform pediatric clinicians who may be called on to evaluate and treat affected infants and children, we review the most recent evidence to better characterize congenital Zika syndrome. Observations: We reviewed published reports of congenital anomalies occurring in fetuses or infants with presumed or laboratory-confirmed intrauterine Zika virus infection. We conducted a comprehensive search of the English literature using Medline and EMBASE for Zika from inception through September 30, 2016. Congenital anomalies were considered in the context of the presumed pathogenetic mechanism related to the neurotropic properties of the virus. We conclude that congenital Zika syndrome is a recognizable pattern of structural anomalies and functional disabilities secondary to central and, perhaps, peripheral nervous system damage. Although many of the components of this syndrome, such as cognitive, sensory, and motor disabilities, are shared by other congenital infections, there are 5 features that are rarely seen with other congenital infections or are unique to congenital Zika virus infection: (1) severe microcephaly with partially collapsed skull; (2) thin cerebral cortices with subcortical calcifications; (3) macular scarring and focal pigmentary retinal mottling; (4) congenital contractures; and (5) marked early hypertonia and symptoms of extrapyramidal involvement. Conclusions and Relevance: Although the full spectrum of adverse reproductive outcomes caused by Zika virus infection is not yet determined, a distinctive phenotype-the congenital Zika syndrome-has emerged. Recognition of this phenotype by clinicians for infants and children can help ensure appropriate etiologic evaluation and comprehensive clinical investigation to define the range of anomalies in an affected infant as well as determine essential follow-up and ongoing care. |
A cluster-randomized controlled trial to reduce diarrheal disease and dengue entomological risk factors in rural primary schools in Colombia
Overgaard HJ , Alexander N , Matiz MI , Jaramillo JF , Olano VA , Vargas S , Sarmiento D , Lenhart A , Stenstrom TA . PLoS Negl Trop Dis 2016 10 (11) e0005106 BACKGROUND: As many neglected tropical diseases are co-endemic and have common risk factors, integrated control can efficiently reduce disease burden and relieve resource-strained public health budgets. Diarrheal diseases and dengue fever are major global health problems sharing common risk factors in water storage containers. Where provision of clean water is inadequate, water storage is crucial. Fecal contamination of stored water is a common source of diarrheal illness, but stored water also provides breeding sites for dengue vector mosquitoes. Integrating improved water management and educational strategies for both diseases in the school environment can potentially improve the health situation for students and the larger community. The objective of this trial was to investigate whether interventions targeting diarrhea and dengue risk factors would significantly reduce absence due to diarrheal disease and dengue entomological risk factors in schools. METHODOLOGY/PRINCIPAL FINDINGS: A factorial cluster randomized controlled trial was carried out in 34 rural primary schools (1,301 pupils) in La Mesa and Anapoima municipalities, Cundinamarca, Colombia. Schools were randomized to one of four study arms: diarrhea interventions (DIA), dengue interventions (DEN), combined diarrhea and dengue interventions (DIADEN), and control (CON). Interventions had no apparent effect on pupil school absence due to diarrheal disease (p = 0.45) or on adult female Aedes aegypti density (p = 0.32) (primary outcomes). However, the dengue interventions reduced the Breteau Index on average by 78% (p = 0.029), with Breteau indices of 10.8 and 6.2 in the DEN and DIADEN arms, respectively compared to 37.5 and 46.9 in the DIA and CON arms, respectively. The diarrhea interventions improved water quality as assessed by the amount of Escherichia coli colony forming units (CFU); the ratio of Williams mean E. coli CFU being 0.22, or 78% reduction (p = 0.008). CONCLUSIONS/SIGNIFICANCE: Integrated control of dengue and diarrhea has never been conducted before. This trial presents an example for application of control strategies that may affect both diseases and the first study to apply such an approach in school settings. The interventions were well received and highly appreciated by students and teachers. An apparent absence of effect in primary outcome indicators could be the result of pupils being exposed to risk factors outside the school area and mosquitoes flying in from nearby uncontrolled breeding sites. Integrated interventions targeting these diseases in a school context remain promising because of the reduced mosquito breeding and improved water quality, as well as educational benefits. However, to improve outcomes in future integrated approaches, simultaneous interventions in communities, in addition to schools, should be considered; using appropriate combinations of site-specific, effective, acceptable, and affordable interventions. TRIAL REGISTRATION: ClinicalTrials.gov no. ISRCTN40195031. |
Dengue and West Nile virus transmission in children and adults in coastal Kenya
Vu DM , Banda T , Teng CY , Heimbaugh C , Muchiri EM , Mungai PL , Mutuku FM , Brichard J , Gildengorin G , Borland EM , Powers AM , Kitron U , King CH , LaBeaud AD . Am J Trop Med Hyg 2016 96 (1) 141-143 Dengue virus (DENV) and West Nile virus (WNV) are important reemerging arboviruses that are under-recognized in many parts of Africa due to lack of surveillance. As a part of a study on flavivirus, alphavirus, and parasite exposure in coastal Kenya, we measured neutralizing antibody against DENV and, to evaluate assay specificity, WNV in serum samples that tested positive for serum anti-DENV IgG by enzyme-linked immunosorbent assay. Of 830 anti-DENV IgG-positive samples that were tested for neutralizing activity, 488 (58.8%) neutralized DENV and 94 (11.3%) neutralized WNV. Of children ≤ 10 years of age, 23% and 17% had serum neutralizing antibody to DENV and WNV, respectively, indicating that DENV and WNV transmission has occurred in this region within the past decade. The results suggest that ongoing DENV and WNV transmission continues on the coast of Kenya and supports a need for routine arboviral surveillance in the area to detect and respond to future outbreaks. |
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