Self-management education participation among US adults with arthritis: Who's attending?
Murphy LB , Brady TJ , Boring MA , Theis KA , Barbour KE , Qin J , Helmick CG . Arthritis Care Res (Hoboken) 2016 69 (9) 1322-1330 OBJECTIVE: Self-management education (SME) programs teach people with chronic conditions skills to manage their health conditions. We examined patterns in SME program participation among US adults with arthritis age ≥ 18 years. METHODS: Respondents with arthritis were those who reported ever being diagnosed with arthritis by a doctor or health care provider. We analyzed 2014 National Health Interview Survey (NHIS) data to estimate: 1) percentage (unadjusted and age-standardized) who ever attended a SME program overall and for selected subgroups, 2) representativeness of SME participants relative to all adults with arthritis, and 3) trends in SME course participation. RESULTS: In 2014, 1 in 9 US adults with arthritis (percentage=11.3; 95% CI=10.4-12.3); age-standardized percentage=11.4; [95% CI=10.0-12.9]) had ever participated in a SME program. SME participation (age-standardized) was highest among those with ≥ 8 health care provider visits in the past 12 months (16.0%; 95% CI=13.1 - 19.4). Since 2002, the number of adults with arthritis who have ever participated in SME has increased by 1.7 million but the percentage has remained constant. CONCLUSION: Despite its many benefits, SME participation among US adults with arthritis remains persistently low. By recommending that their patients attend SME programs, health care providers can increase the likelihood that their patients experience SME program benefits. This article is protected by copyright. All rights reserved. |
Opportunities to expand colorectal cancer screening participation
Cooper CP , Gelb CA . J Womens Health (Larchmt) 2016 25 (10) 990-995 The Centers for Disease Control and Prevention's Screen for Life: National Colorectal Cancer Action Campaign has operated continuously since 1999 to promote colorectal cancer screening. The campaign's most recent formative research cycle was conducted in 2015 and included 16 focus groups in four United States cities with adults aged 50-75 years who had not received colorectal cancer screening as recommended. The most common reason for screening nonparticipation was aversion to some aspect of colonoscopy, such as preparation, the invasive nature of the test, or the possibility of complications. Other reasons for screening nonparticipation were absence of symptoms, lack of screening awareness/provider recommendation, and lack of family history. Screening promotion messages that resonated with participants included the following: multiple screening tests are available; colorectal cancer may not cause symptoms; screening should begin at age 50; and most cases of colorectal cancer occur in individuals with no family history of the disease. Efforts to increase colorectal cancer screening participation may be supported by disseminating messages that counter common concerns about screening. Raising awareness of the range of colorectal cancer screening options may be especially critical given that many unscreened individuals were unwilling to undergo a colonoscopy. |
The impact of neighborhoods on CV risk
Diez Roux AV , Mujahid MS , Hirsch JA , Moore K , Moore LV . Glob Heart 2016 11 (3) 353-363 Cardiovascular disease (CVD) continues to be the leading cause of death and a major source of health disparities in the Unites States and globally. Efforts to reduce CVD risk and eliminate cardiovascular health disparities have increasingly emphasized the importance of the social determinants of health. Neighborhood environments have emerged as a possible target for prevention and policy efforts. Hence there is a need to better understand the role of neighborhood environments in shaping cardiovascular risk. The MESA (Multi-Ethnic Study of Atherosclerosis) Neighborhood Study provided a unique opportunity to build a comprehensive place-based resource for investigations of associations between specific features of neighborhood physical and social environments and cardiovascular risk factors and outcomes. This review summarizes the approaches used to characterize residential neighborhood environments in the MESA cohort, provides an overview of key findings to date, and discusses challenges and opportunities in neighborhood health effects research. Results to date suggest that neighborhood physical and social environments are related to behavioral and biomedical risk factors for CVD and that cardiovascular prevention efforts may benefit from taking neighborhood context into account. |
Reactions and receptivity to framing HIV prevention message concepts about pre-exposure prophylaxis for black and Latino men who have sex with men in three urban US cities
Mimiaga MJ , Closson EF , Battle S , Herbst JH , Denson D , Pitts N , Holman J , Landers S , Mansergh G . AIDS Patient Care STDS 2016 30 (10) 484-489 Men who have sex with men (MSM) of color are disproportionately affected by HIV in the United States. Pre-exposure prophylaxis (PrEP) using antiretroviral medications is a newer biomedical prevention modality with established efficacy for reducing the risk of acquiring HIV. We conducted formative qualitative research to explore audience reactions and receptivity to message concepts on PrEP as part of the development of prevention messages to promote PrEP awareness among black and Latino MSM in the United States. In 2013, 48 black and 42 Latino (total study sample = 90) mixed HIV serostatus MSM from Chicago, Ft. Lauderdale, and Kansas City participated in either an individual interview or focus group discussion. Men were recruited online and at community-based organizations in each city. We elicited feedback on the comprehensibility, credibility, and relevance of two draft messages on PrEP. The messages included efficacy estimates from iPrEx, a phase III clinical trial to ascertain whether the antiretroviral medication tenofovir/emtricitabine disoproxil fumarate (commercially known as Truvada(R)) could safely and effectively prevent HIV acquisition through sex among MSM and transgender women. With participants' consent, the interviews and focus groups were recorded and transcribed. The data were then summarized and analyzed using a qualitative descriptive approach. The majority of men were unfamiliar with PrEP. It was suggested that additional information about the medication and clinical trials establishing efficacy was needed to enhance the legitimacy and relevancy of the messages. Participants sought to form an opinion of PrEP that was grounded in their own interpretation of the efficacy data. However, confusion about nonadherence among clinical trial subjects and individual versus average risk limited comprehension of these messages. Thematic overlaps suggest that message believability was connected to participants' ability to derive meaning from the PrEP efficacy data. Despite being concerned that other MSM would interpret the messages to mean that condom use was unnecessary while taking PrEP, participants themselves primarily understood PrEP as a supplement rather than a replacement for condoms. Based on their experience with taking antiretroviral medication, HIV-positive men considered condom use a more feasible form of HIV prevention than PrEP. Participants' responses suggest that more information about PrEP and the clinical trial would support the legitimacy of PrEP and the messages as a whole. These details may enhance believability in the concept of PrEP and reinforce confidence in the validity of the efficacy result. |
Temporally varying relative risks for infectious diseases: implications for infectious disease control
Goldstein E , Pitzer VE , O'Hagan JJ , Lipsitch M . Epidemiology 2016 28 (1) 136-144 Risks for disease in some population groups relative to others (relative risks) are usually considered to be consistent over time, though they are often modified by other, non-temporal factors. For infectious diseases, in which overall incidence often varies substantially over time, the patterns of temporal changes in relative risks can inform our understanding of basic epidemiologic questions. For example, recent work suggests that temporal changes in relative risks of infection over the course of an epidemic cycle can both be used to identify population groups that drive infectious disease outbreaks, and help elucidate differences in the effect of vaccination against infection (that is relevant to transmission control) compared with its effect against disease episodes (that reflects individual protection). Patterns of change in the in age groups affected over the course of seasonal outbreaks can provide clues to the types of pathogens that could be responsible for diseases for which an infectious cause is suspected. Changing apparent efficacy of vaccines during trials may provide clues to the vaccine's mode of action and/or indicate risk heterogeneity in the trial population. Declining importance of unusual behavioral risk factors may be a signal of increased local transmission of an infection. We review these developments and the related public health implications. |
Norovirus in Latin America: systematic review and meta-analysis
O'Ryan M , Riera-Montes M , Lopman B . Pediatr Infect Dis J 2016 36 (2) 127-134 BACKGROUND: Noroviruses are increasingly recognized as a major cause of sporadic and epidemic acute gastroenteritis. Although there have been multiple studies published on norovirus epidemiology in Latin America, no comprehensive assessment of the role of norovirus has been conducted in the region. We aim to estimate the role of norovirus in the Latin American region through a systematic review and meta-analysis of the existing literature. METHODS: We carried out a literature search in Medline, SciELO and LILACS. We included papers that provided information on the prevalence or incidence of norovirus (including seroprevalence studies and outbreaks), with a recruitment and/or follow up period of at least 12 months and where the diagnosis of norovirus was confirmed by RT-PCR. The data were pooled for meta-analysis to estimate the prevalence of norovirus acute gastroenteritis (AGE) and norovirus asymptomatic infection with 95% confidence intervals. RESULTS: Thirty-eight studies were included in the review. Overall, the prevalence of norovirus among AGE cases was 15% (95%CI 13 - 18). By location, it was 15% in the community (95% CI 11 - 21%), 14% in outpatient settings (95% CI 10 - 19%) and 16% in hospital settings (95% CI 12 - 21%). The prevalence of norovirus among asymptomatic subjects was 8% (95% CI 4 - 13). Norovirus GII.4 strains were associated with 37 to 100% of norovirus AGE cases, but only 7% of norovirus asymptomatic detections. CONCLUSIONS: Noroviruses are associated with almost one out of every six hospitalizations due to acute diarrhea in children younger than 5 years of age in Latin America. |
Perinatal antiretroviral exposure and prevented mother-to-child HIV infections in the era of antiretroviral prophylaxis in the United States, 1994-2010
Little KM , Taylor AW , Borkowf CB , Mendoza MC , Lampe MA , Weidle PJ , Nesheim SR . Pediatr Infect Dis J 2016 36 (1) 66-71 OBJECTIVE: Using published, nationally representative estimates, we calculated the total number of perinatally HIV-exposed and -infected infants born during 1978-2010, the number of perinatal HIV cases prevented by interventions designed for the prevention of mother-to-child transmission (PMTCT), and the number of infants exposed to antiretroviral drugs during the prenatal and intrapartum periods. DESIGN: We calculated the number of infants exposed to antiretroviral drugs since 1994, and the number of cases of mother-to-child HIV transmission prevented from 1994-2010 using published data. We generated confidence limits for our estimates by performing a simulation study. METHODS: Data were obtained from published, nationally-representative estimates from CDC. Model parameters included the annual numbers of HIV-infected pregnant women, the annual numbers of perinatally-infected infants, the annual proportions of infants exposed to antiretroviral drugs during the prenatal and intrapartum period, and the estimated mother-to-child transmission (MTCT) rate in the absence of preventive interventions. For the simulation study, model parameters were assigned distributions and we performed 1,000,000 repetitions. RESULTS: Between 1978 and 2010, an estimated 186,157 (95% CI: 185,312-187,003) HIV-exposed infants and approximately 21,003 (95% CI: 20.179-21,288) infected infants were born in the United States. Between 1994 and 2010, an estimated 124,342 (95% CI: 123,651-125,034) HIV-exposed infants were born in the U.S., and approximately 6,083 (95% CI: 5,931-6,236) infants were perinatally infected with HIV. During this same period about 100,207 (95% CI: 99,374-101,028) infants were prenatally exposed to antiretroviral drugs. As a result of PMTCT interventions, an estimated 21,956 (95% CI: 20,191-23,759) MTCT HIV cases have been prevented in the US since 1994. CONCLUSION: Though continued vigilance is needed to eliminate mother-to-child HIV transmission, PMTCT interventions have prevented nearly 22,000 cases of perinatal HIV transmission in the United States since 1994. |
Investigating rare risk factors for Nipah virus in Bangladesh: 2001-2012
Hegde ST , Sazzad HM , Hossain MJ , Alam MU , Kenah E , Daszak P , Rollin P , Rahman M , Luby SP , Gurley ES . Ecohealth 2016 13 (4) 720-728 Human Nipah encephalitis outbreaks have been identified almost yearly in Bangladesh since 2001. Though raw date palm sap consumption and person-to-person contact are recognized as major transmission pathways, alternative pathways of transmission are plausible and may not have been identified due to limited statistical power in each outbreak. We conducted a risk factor analysis using all 157 cases and 632 controls surveyed in previous investigations during 2004-2012 to identify exposures independently associated with Nipah, since date palm sap was first asked about as an exposure in 2004. To further explore possible rare exposures, we also conducted in-depth interviews with all cases, or proxies, since 2001 that reported no exposure to date palm sap or contact with another case. Cases were 4.9 (95% 3.2-7.7) times more likely to consume raw date palm sap and 7.3 (95% 4.0-13.4) times more likely to have contact with a Nipah case than controls. In-depth interviews revealed that 39/182 (21%) of Nipah cases reporting neither date palm sap consumption nor contact with another case were misclassified. Prevention efforts should be focused on interventions to interrupt transmission through date palm sap consumption and person-to-person contact. Furthermore, pooling outbreak investigation data is a good method for assessing rare exposures. |
Children and alternative service delivery models: a case for inclusion
Mirkovic KR , Rivadeneira ED , Broyles LN . AIDS 2016 30 (16) 2569-2570 The global commitment to reach the United Nations 90-90-90 targets will require a tremendous effort to almost double the number of HIV-infected individuals receiving antiretroviral treatment (ART), from 15.8 to 29.9 million, in the next 4 years [1]. In sub-Saharan Africa alone, ART initiation for an additional 6.2 million persons will be needed to reach this target. Given the infrastructure constraints and healthcare worker shortages in many resource-limited settings, there is increasing recognition that traditional facility-based models of clinician-led HIV service delivery will not be feasible with the increase in patient volume. In response, multiple proposed alternative service delivery models have been developed that center on transitioning at least some aspects of care out of health facilities into the community to decongest clinics and maximize the use of limited healthcare worker resources [2]. | Several commonly employed service delivery modifications have documented success in improving patient outcomes. One of the most common focuses on multimonth prescribing in which pharmacies dispense more than a month's supply of ART, requiring fewer patient visits to collect medications [2]. Another employs alternative ART delivery points; for example, HIV-infected patients can collect their ART at a community pharmacy/drug delivery site or have ART delivered to their homes by a cadre of lay workers [3]. A third model reduces the number of required follow-up visits for certain patients, most often those considered ‘stable’ by criteria such as time on ART and/or viral load suppression. These patients are seen at the facility by medical staff only once or twice per year [4]. Other models employ community adherence clubs, where groups of HIV-infected individuals receive all of their medication and care in the community on a particular day [5]. Finally, community ART groups rely on the member of the group to collect monthly antiretrovirals (ARVs) for all members while visiting the health facility for their yearly/biyearly visit [6]. This list is not exhaustive, and new strategies ideally suited for specific populations are continuing to be implemented. However, one commonality among most alternative models of ART service delivery is that children have almost uniformly been excluded. |
Prevalence of antimicrobial use and opportunities to improve prescribing practices in U.S. nursing homes
Thompson ND , LaPlace L , Epstein L , Thompson D , Dumyati G , Concannon C , Quinlan G , Witten T , Warnke L , Lynfield R , Maloney M , Melchreit R , Stone ND . J Am Med Dir Assoc 2016 17 (12) 1151-1153 OBJECTIVES: To describe the prevalence and epidemiology of antimicrobial use (AU) in nursing home residents. DESIGN: One-day point prevalence survey. SETTING AND PARTICIPANTS: Nine nursing homes in four states; 1,272 eligible residents. MEASUREMENT: Frequency of antimicrobials prescribed, drug name, start date, duration, route, rationale, and treatment site. AU prevalence per 100 residents overall and by resident characteristic. RESULTS: AU prevalence was 11.1% (95% confidence interval, 9.4%-12.9%) and varied by resident characteristics. Most (32%) antimicrobials were given for urinary tract infection. For 38% of AU, key prescribing information was not documented. CONCLUSION: Opportunities to improve AU documentation and prescribing exist in nursing homes. |
Prenatal phthalate biomarker concentrations and performance on the Bayley Scales of Infant Development-II in a population of young urban children
Doherty BT , Engel SM , Buckley JP , Silva MJ , Calafat AM , Wolff MS . Environ Res 2016 152 51-58 INTRODUCTION: Evidence suggests prenatal phthalate exposures may have neurodevelopmental consequences. Our objective was to investigate prenatal exposure to phthalates and cognitive development in a cohort of young urban children. MATERIALS AND METHODS: We recruited pregnant women in New York City from 1998 to 2002 and measured concentrations of nine phthalate metabolites in urine collected in late pregnancy. We administered a neurodevelopmental screening instrument, the Bayley Scales of Infant Development II (BSID-II), to children who returned for follow-up at approximately 24 months (n=276). We estimated associations between phthalate metabolite concentrations in maternal urine and BSID-II indices (Mental Development Index (MDI), Psychomotor Development Index (PDI)). RESULTS: We observed no associations between phthalate metabolite concentrations and performance on the MDI or PDI in boys and girls combined. We did, however, observe evidence of effect measure modification by sex. We observed several negative associations between metabolite concentrations and both MDI and PDI scores among girls, suggesting poorer performance across multiple metabolites, with estimates equal to a 2-3 point decrease in score per ln-unit increase in creatinine-standardized metabolite concentration. Conversely, we observed multiple weakly positive associations among boys, equal to a 1-2 point increase in score per ln-unit increase in metabolite concentration. The strongest associations were for the metabolites mono-n-butyl phthalate, mono-isobutyl phthalate, monobenzyl phthalate, and mono(3-carboxylpropyl) phthalate (MCPP). CONCLUSIONS: Girls of mothers with higher urinary concentrations of MCPP and metabolites of dibutyl phthalates had lower MDI scores on the BSID-II. These same biomarker concentrations were often associated with improved scores among boys. We observed similar results for MnBP, MCPP, and MBzP on the PDI. Given the prevalence of phthalate exposures in reproductive aged women, the implications of potential neurotoxicity warrant further investigation. |
Epidemiology of restaurant-associated foodborne disease outbreaks, United States, 1998-2013
Angelo KM , Nisler AL , Hall AJ , Brown LG , Gould LH . Epidemiol Infect 2016 145 (3) 1-12 Although contamination of food can occur at any point from farm to table, restaurant food workers are a common source of foodborne illness. We describe the characteristics of restaurant-associated foodborne disease outbreaks and explore the role of food workers by analysing outbreaks associated with restaurants from 1998 to 2013 reported to the Centers for Disease Control and Prevention's Foodborne Disease Outbreak Surveillance System. We identified 9788 restaurant-associated outbreaks. The median annual number of outbreaks was 620 (interquartile range 618-629). In 3072 outbreaks with a single confirmed aetiology reported, norovirus caused the largest number of outbreaks (1425, 46%). Of outbreaks with a single food reported and a confirmed aetiology, fish (254 outbreaks, 34%) was most commonly implicated, and these outbreaks were commonly caused by scombroid toxin (219 outbreaks, 86% of fish outbreaks). Most outbreaks (79%) occurred at sit-down establishments. The most commonly reported contributing factors were those related to food handling and preparation practices in the restaurant (2955 outbreaks, 61%). Food workers contributed to 2415 (25%) outbreaks. Knowledge of the foods, aetiologies, and contributing factors that result in foodborne disease restaurant outbreaks can help guide efforts to prevent foodborne illness. |
Botulism mortality in the USA, 1975-2009
Jackson KA , Mahon BE , Copeland J , Fagan RP . Botulinum J 2016 3 (1) 6-17 Botulism had mortality rates >60% before the 1950s. We reviewed confirmed botulism cases in the USA during 1975-2009 including infant, foodborne, wound, and other/unknown acquisition categories, and calculated mortality ratios. We created a multivariate logistic regression model for non-infant cases (foodborne, wound, and other/unknown). Overall mortality was 3.0% with 109 botulism-related deaths among 3,618 botulism cases [18 (>1%) deaths among 2,352 infant botulism cases, 61 (7.1%) deaths among 854 foodborne botulism cases, 18 (5.0%) deaths among 359 wound botulism cases, and 12 (22.6%) deaths among 53 other/unknown botulism cases]. Mortality among all cases increased with age; it was lowest among infants (0.8%) and highest among persons ≤80 years old (34.4%). Toxin type F had higher mortality (13.8%) than types A, B, or E (range, 1.4% to 4.1%). Efforts to reduce botulism mortality should target non-infant transmission categories and older adults. |
Importance of economic evaluation of cancer registration in the resource limited setting: Laying the groundwork for surveillance systems
Saraiya M , Tangka FK , Asma S , Richardson LC . Cancer Epidemiol 2016 45 Suppl 1 S1-S3 All governments have approved the Global Monitoring Framework on Non-communicable Diseases (NCDs), which includes a commitment to reduce premature NCD (including cancer-related) deaths by 25% by 2025. The global monitoring framework requires WHO member states to collect cancer incidence, by type of cancer per 100,000 population – one of 25 indicators to monitor progress toward the 25 by 25 targets [1]. Population-based cancer registries are units that collect and report high quality data on cancer incidence. The data generated by population-based cancer registries are essential for informing health programs, policies and strategies regarding cancer screening and treatment, and for evaluating the impact of national programs for cancer prevention, screening, and treatment [2,3]. However, there are large differences in the existence, coverage and quality of cancer registration across the world. The percentage of the population covered by cancer registries that meet the quality standards for inclusion in global statistics (Cancer Incidence in Five Continents – CI5) ranges from near-complete coverage in North America to less than 10% coverage in Asia, Central and South America, and Africa [4] (See Fig. 1). |
ADHD: Insurance and mental health service use
Pastor PN , Simon AE , Reuben CA . Clin Pediatr (Phila) 2016 56 (8) 729-736 We describe mental health service use by insurance among children aged 4 to 17 with diagnosed attention-deficit/ hyperactivity disorder (ADHD). Using parent reports from 2010-2013 National Health Interview Survey, we estimate the percentage that received services for emotional and behavioral difficulties (EBD): medication, other nonmedication services, and none (neither medication nor other nonmedication services). Among children with diagnosed ADHD, 56.0% had used medication for EBD, 39.8% had contact with a mental health professional, 32.2% had contact with a general doctor about the child's EBD, and 20.4% received special education services for EBD. Medication use was more often reported for privately or publicly insured children than uninsured children (P < .001), and uninsured children more often received no services (P < .001). Publicly insured children were more likely than privately insured children to receive other nonmedication services (P < .001). Less than a third (28.9%) of all children received no services as compared to almost half (48.8%) of uninsured children. |
Notes from the field: Mycobacterium chimaera contamination of heater-cooler devices used in cardiac surgery - United States
Perkins KM , Lawsin A , Hasan NA , Strong M , Halpin AL , Rodger RR , Moulton-Meissner H , Crist MB , Schwartz S , Marders J , Daley CL , Salfinger M , Perz JF . MMWR Morb Mortal Wkly Rep 2016 65 (40) 1117-1118 In the spring of 2015, investigators in Switzerland reported a cluster of six patients with invasive infection with Mycobacterium chimaera, a species of nontuberculous mycobacterium ubiquitous in soil and water. The infected patients had undergone open-heart surgery that used contaminated heater-cooler devices during extracorporeal circulation (1). In July 2015, a Pennsylvania hospital also identified a cluster of invasive nontuberculous mycobacterial infections among open-heart surgery patients. Similar to the Swiss report, a field investigation by the Pennsylvania Department of Health, with assistance from CDC, used both epidemiologic and laboratory evidence to identify an association between invasive Mycobacterium avium complex, including M. chimaera, infections and exposure to contaminated Stockert 3T heater-cooler devices, all manufactured by LivaNova PLC (formerly Sorin Group Deutschland GmbH) (2). M. chimaera was described as a distinct species of M. avium complex in 2004 (3). The results of the field investigation prompted notification of approximately 1,300 potentially exposed patients.* Although heater-cooler devices are used to regulate patients' blood temperature during cardiopulmonary bypass through water circuits that are closed, these reports suggest that aerosolized M. chimaera from the devices resulted in the invasive infections (1,2). The Food and Drug Administration (FDA) and CDC have issued alerts regarding the need to follow updated manufacturer's instructions for use of the devices, evaluate the devices for contamination, remain vigilant for new infections, and continue to monitor reports from the United States and overseas (2). |
Using the 4 pillars practice transformation program to increase pneumococcal immunizations for older adults: A cluster-randomized trial
Zimmerman RK , Brown AE , Pavlik VN , Moehling KK , Raviotta JM , Lin CJ , Zhang S , Hawk M , Kyle S , Patel S , Ahmed F , Nowalk MP . J Am Geriatr Soc 2016 65 (1) 114-122 OBJECTIVES: To test the effectiveness of a step-by step, evidence-based guide, the 4 Pillars Practice Transformation Program, to increase adult pneumococcal vaccination. DESIGN: Randomized controlled cluster trial (RCCT) in Year 1 (June 1, 2013 to May 31, 2014) and pre-post study in Year 2 (June 1, 2014 to January 31, 2015) with data analyzed in 2016. Baseline year was June 1, 2012, to May 31, 2013. Demographic and vaccination data were derived from deidentified electronic medical record extractions. SETTING: Primary care practices (n = 25) stratified according to metropolitan area (Houston, Pittsburgh), location (rural, urban, suburban), and type (family medicine, internal medicine), randomized to receive the intervention in Year 1 (n = 13) or Year 2 (n = 12). PARTICIPANTS: Individuals aged 65 and older at baseline (N = 18,107; mean age 74.2; 60.7% female, 16.5% non-white, 15.7% Hispanic). INTERVENTION: The 4 Pillars Program, provider education, and one-on-one coaching of practice-based immunization champions. Outcome measures were 23-valent pneumococcal polysaccharide vaccine (PPSV) and pneumococcal conjugate vaccine (PCV) vaccination rates and percentage point (PP) changes in vaccination rates. RESULTS: In the Year 1 RCCT, PPSV vaccination rates increased significantly in all intervention and control groups, with average increases ranging from 6.5 to 8.7 PP (P < .001). The intervention was not related to greater likelihood of PPSV vaccination. In the Year 2 pre-post study, the likelihood of PPSV and PCV vaccination was significantly higher in the active intervention sites than the maintenance sites in Pittsburgh but not in Houston. CONCLUSION: In a RCCT, PPSV vaccination rates increased in the intervention and control groups in Year 1. In a pre-post study, private primary care practices actively participating in the 4 Pillars Practice Transformation Program improved PPSV and PCV uptake significantly more than practices that were in the maintenance phase of the study. |
Efficacy of a Russian-backbone live attenuated influenza vaccine among children in Senegal: A randomised, double-blind, placebo-controlled trial
Victor JC , Lewis KD , Diallo A , Niang MN , Diarra B , Dia N , Ortiz JR , Widdowson MA , Feser J , Hoagland R , Emery SL , Lafond KE , Neuzil KM . Lancet Glob Health 2016 4 (12) e955-e965 BACKGROUND: Live attenuated influenza vaccines have been shown to significantly reduce influenza in diverse populations of children, but no efficacy studies have been done in resource-poor tropical settings. In Senegal, we assessed the efficacy and safety of a live attenuated influenza vaccine based on Russian-derived master donor viruses and licensed as a single dose. METHODS: In this double-blind, placebo-controlled, parallel group, single-centre trial done near Niakhar, Senegal, generally healthy children aged 2-5 years were randomly allocated (2:1) to receive a single intranasal dose of masked trivalent live attenuated influenza vaccine or placebo. The allocation sequence was computer-generated by PATH with block sizes of three. The manufacturer provided vaccine and placebo in coded vials to preserve blinding. Participants were monitored through the predictable influenza season in Senegal for adverse events and signs and symptoms of influenza using weekly home visits and surveillance in clinics. The primary outcome was symptomatic laboratory-confirmed influenza caused by any strain and occurring from 15 days post-vaccination to the end of the study. The primary analysis was per protocol. This study is registered with ClinicalTrials.gov, number NCT01854632. FINDINGS: Between May 23, and July 1, 2013, 1761 children were randomly assigned, 1174 to receive live attenuated influenza vaccine and 587 to receive placebo. The per-protocol set included 1173 vaccinees and 584 placebo recipients followed up to Dec 20, 2013. Symptomatic influenza was laboratory-confirmed in 210 (18%) of 1173 recipients of live attenuated influenza vaccine and 105 (18%) of placebo recipients, giving a vaccine efficacy of 0.0% (95% CI -26.4 to 20.9). Adverse events were balanced between the study groups. Two girls who had received live attenuated influenza vaccine died, one due to anasarca 12 days postvaccination and one due to malnutrition 70 days postvaccination. INTERPRETATION: Live attenuated influenza vaccine was well tolerated in young children in Senegal, but did not provide protection against influenza. Further study in such populations, which might experience extended periods of influenza circulation, is warranted. FUNDING: US Centers for Disease Control and Prevention and Bill & Melinda Gates Foundation. |
Efficacy of a Russian-backbone live attenuated influenza vaccine among young children in Bangladesh: a randomised, double-blind, placebo-controlled trial
Brooks WA , Zaman K , Lewis KD , Ortiz JR , Goswami D , Feser J , Sharmeen AT , Nahar K , Rahman M , Rahman MZ , Barin B , Yunus M , Fry AM , Bresee J , Azim T , Neuzil KM . Lancet Glob Health 2016 4 (12) e946-e954 BACKGROUND: The rates of influenza illness and associated complications are high among children in Bangladesh. We assessed the clinical efficacy and safety of a Russian-backbone live attenuated influenza vaccine (LAIV) at two field sites in Bangladesh. METHODS: Between Feb 27 and April 9, 2013, children aged 2-4 years in urban Kamalapur and rural Matlab, Bangladesh, were randomly assigned in a 2:1 ratio, according to a computer-generated schedule, to receive one intranasal dose of LAIV or placebo. After vaccination, we monitored children in weekly home visits until Dec 31, 2013, with study clinic surveillance for influenza illness. The primary outcome was symptomatic, laboratory-confirmed influenza illness due to vaccine-matched strains. Analysis was per protocol. The trial is registered with ClinicalTrials.gov, number NCT01797029. FINDINGS: Of 1761 children enrolled, 1174 received LAIV and 587 received placebo. Laboratory-confirmed influenza illness due to vaccine-matched strains was seen in 93 (15.8%) children in the placebo group and 79 (6.7%) in the LAIV group. Vaccine efficacy of LAIV for vaccine-matched strains was 57.5% (95% CI 43.6-68.0). The vaccine was well tolerated, and adverse events were balanced between the groups. The most frequent adverse events were tachypnoea (n=86 in the LAIV group and n=54 in the placebo group), cough (n=73 and n=43), and runny nose (n=68 and n=39), most of which were mild. INTERPRETATION: This single-dose Russian-backbone LAIV was safe and efficacious at preventing symptomatic laboratory-confirmed influenza illness due to vaccine-matched strains. LAIV programmes might reduce the burden of influenza illness in Bangladesh. FUNDING: The Bill & Melinda Gates Foundation. |
Epidemiology of hepatitis B virus infection and impact of vaccination on disease
Nelson NP , Easterbrook PJ , McMahon BJ . Clin Liver Dis 2016 20 (4) 607-628 Integration of hepatitis B vaccination into national immunization programs has resulted in substantial reductions of hepatitis B virus (HBV) transmission in previously high endemic countries. The key strategy for control of the HBV epidemic is birth dose and infant vaccination. Additional measures include use of hepatitis B immunoglobulin (HBIG) and diagnosis of mothers at high risk of transmitting HBV and use of antiviral agents during pregnancy to decrease maternal DNA concentrations to undetectable concentrations. Despite the substantial decrease in HBV cases since vaccination introduction, implementation of birth dose vaccination in low-income and middle-income countries and vaccination of high-risk adults remain challenging. |
Evaluation of scanning 2D barcoded vaccines to improve data accuracy of vaccines administered
Daily A , Kennedy ED , Fierro LA , Reed JH , Greene M , Williams WW , Evanson HV , Cox R , Koeppl P , Gerlach K . Vaccine 2016 34 (47) 5802-5807 BACKGROUND AND OBJECTIVE: Accurately recording vaccine lot number, expiration date, and product identifiers, in patient records is an important step in improving supply chain management and patient safety in the event of a recall. These data are being encoded on two-dimensional (2D) barcodes on most vaccine vials and syringes. Using electronic vaccine administration records, we evaluated the accuracy of lot number and expiration date entered using 2D barcode scanning compared to traditional manual or drop-down list entry methods. METHODS: We analyzed 128,573 electronic records of vaccines administered at 32 facilities. We compared the accuracy of records entered using 2D barcode scanning with those entered using traditional methods using chi-square tests and multilevel logistic regression. RESULTS: When 2D barcodes were scanned, lot number data accuracy was 1.8 percentage points higher (94.3-96.1%, P<0.001) and expiration date data accuracy was 11 percentage points higher (84.8-95.8%, P<0.001) compared with traditional methods. In multivariate analysis, lot number was more likely to be accurate (aOR=1.75; 99% CI, 1.57-1.96) as was expiration date (aOR=2.39; 99% CI, 2.12-2.68). When controlling for scanning and other factors, manufacturer, month vaccine was administered, and vaccine type were associated with variation in accuracy for both lot number and expiration date. CONCLUSION: Two-dimensional barcode scanning shows promise for improving data accuracy of vaccine lot number and expiration date records. Adapting systems to further integrate with 2D barcoding could help increase adoption of 2D barcode scanning technology. |
Improving hepatitis B birth dose in rural Lao People's Democratic Republic through the use of mobile phones to facilitate communication
Xeuatvongsa A , Datta SS , Moturi E , Wannemuehler K , Philakong P , Vongxay V , Vilayvone V , Patel MK . Vaccine 2016 34 (47) 5777-5784 BACKGROUND: Hepatitis B vaccine birth dose (HepB-BD) was introduced in Lao People's Democratic Republic to prevent perinatal hepatitis B virus transmission in 2008; high coverage is challenging since only 38% of births occur in a health facility. Healthcare workers report being unaware of home births and thus unable to conduct timely postnatal care (PNC) home visits. A quasi-experimental pilot study was conducted wherein mobile phones and phone credits were provided to village health volunteers (VHV) and healthcare workers (HCWs) to assess whether this could improve HepB-BD administration, as well as birth notification and increase home visits. METHODS: From April to September 2014, VHVs and HCWs in four selected intervention districts were trained, supervised, received outreach per diem for conducting home visits, and received mobile phones and phone credits. In three comparison districts, VHVs and HCWs were trained, supervised, and received outreach per diem for conducting home visits. A post-study survey compared HepB-BD coverage among children born during the study and children born one year before. HCWs and VHVs were interviewed about the study. FINDINGS: Among intervention districts, 463 study children and 406 pre-study children were enrolled in the survey; in comparison districts, 347 study children and 309 pre-study children were enrolled. In both arms, there was a significant improvement in the proportion of children reportedly receiving a PNC home visit (intervention p<0.0001, comparison p=0.04). The median difference in village level HepB-BD coverage (study cohort minus pre-study cohort), was 57% (interquartile range [IQR] 32-88%, p<0.0001) in intervention districts, compared with 20% (IQR 0-50%, p<0.0001) in comparison districts. The improvement in the intervention districts was greater than in the comparison districts (p=0.0009). CONCLUSION: Our findings suggest that the provision of phones and phone credits might be one important factor for increasing coverage. However, reasons for improvement in both arms are multifactorial and discussed. |
Acceptance of multiple injectable vaccines in a single immunization visit in the Gambia pre and post introduction of inactivated polio vaccine
Idoko OT , Hampton LM , Mboizi RB , Agbla SC , Wallace AS , Harris JB , Sowe D , Ehlman DC , Kampmann B , Ota MO , Hyde TB . Vaccine 2016 34 (41) 5034-9 BACKGROUND: As the World Health Organization (WHO) currently recommends that children be protected against 11 different pathogens, it is becoming increasingly necessary to administer multiple injectable vaccines during a single immunization visit. In this study we assess Gambian healthcare providers' and infant caregivers' attitudes and practices related to the administration of multiple injectable vaccines to a child at a single immunization visit before and after the 2015 introduction of inactivated polio vaccine (IPV). IPV introduction increased the number of injectable vaccines recommended for the 4-month immunization visit from two to three in The Gambia. METHODS: We conducted a cross-sectional questionnaire-based survey before and after the introduction of IPV at 4months of age in a representative sample of all health facilities providing immunizations in The Gambia. Healthcare providers who administer vaccines at the selected health facilities and caregivers who brought infants for their 4month immunization visit were surveyed. FINDINGS: Prior to IPV introduction, 9.9% of healthcare providers and 35.7% of infant caregivers expressed concern about a child receiving more than 2 injections in a single visit. Nevertheless, 98.8% and 90.9% of infants received all required vaccinations for the visit before and after IPV introduction, respectively. The only reason why vaccines were not received was vaccine stock-outs. Infant caregivers generally agreed that vaccinators could be trusted to provide accurate information regarding the number of vaccines that a child needed. CONCLUSION: Healthcare providers and infant caregivers in this resource limited setting accepted an increase in the number of injectable vaccines administered at a single visit even though some expressed concerns about the increase. |
A national standards-based assessment on functionality of electronic medical records systems used in Kenyan public-sector health facilities
Kang'a S , Puttkammer N , Wanyee S , Kimanga D , Madrano J , Muthee V , Odawo P , Sharma A , Oluoch T , Robinson K , Kwach J , Lober WB . Int J Med Inform 2017 97 68-75 Background Variations in the functionality, content and form of electronic medical record systems (EMRs) challenge national roll-out of these systems as part of a national strategy to monitor HIV response. To enforce the EMRs minimum requirements for delivery of quality HIV services, the Kenya Ministry of Health (MoH) developed EMRs standards and guidelines. The standards guided the recommendation of EMRs that met a preset threshold for national roll-out. Methods Using a standards-based checklist, six review teams formed by the MoH EMRs Technical Working Group rated a total of 17 unique EMRs in 28 heath facilities selected by individual owners for their optimal EMR implementation. EMRs with an aggregate score of 60% against checklist criteria were identified by the MoH as suitable for upgrading and rollout to Kenyan public health facilities. Results In Kenya, existing EMRs scored highly in health information and reporting (mean score=71.8%), followed by security, system features, core clinical information, and order entry criteria (mean score=58.1%55.9%), and lowest against clinical decision support (mean score=17.6%) and interoperability criteria (mean score=14.3%). Four EMRs met the 60.0% threshold: OpenMRS, IQ-Care, C-PAD and Funsoft. On the basis of the review, the MoH provided EMRs upgrade plans to owners of all the 17 systems reviewed. Conclusion The standards-based review in Kenya represents an effort to determine level of conformance to the EMRs standards and prioritize EMRs for enhancement and rollout. The results support concentrated use of resources towards development of the four recommended EMRs. Further review should be conducted to determine the effect of the EMR-specific upgrade plans on the other 13 EMRs that participated in the review exercise. |
Sentinel events preceding youth firearm violence: An investigation of administrative data in Delaware
Sumner SA , Maenner MJ , Socias CM , Mercy JA , Silverman P , Medinilla SP , Martin SS , Xu L , Hillis SD . Am J Prev Med 2016 51 (5) 647-655 INTRODUCTION: Accurately identifying youth at highest risk of firearm violence involvement could permit delivery of focused, comprehensive prevention services. This study explored whether readily available city and state administrative data covering life events before youth firearm violence could elucidate patterns preceding such violence. METHODS: Four hundred twenty-one individuals arrested for homicide, attempted homicide, aggravated assault, or robbery with a firearm committed in Wilmington, Delaware, from January 1, 2009 to May 21, 2014, were matched 1:3 to 1,259 Wilmington resident controls on birth year and sex. In 2015, descriptive statistics and a conditional logistic regression model using Delaware healthcare, child welfare, juvenile services, labor, and education administrative data examined associations between preceding life events and subsequent firearm violence. RESULTS: In a multivariable adjusted model, experiencing a prior gunshot wound injury (AOR=11.4, 95% CI=2.7, 48.1) and being subject to community probation (AOR=13.2, 95% CI=5.7, 30.3) were associated with the highest risk of subsequent firearm violence perpetration, though multiple other sentinel events were informative. The mean number of sentinel events experienced by youth committing firearm violence was 13.0 versus 1.9 among controls (p<0.0001). Within the sample, 84.1% of youth experiencing a sentinel event in all five studied domains ultimately committed firearm violence. CONCLUSIONS: Youth who commit firearm violence have preceding patterns of life events that markedly differ from youth not involved in firearm violence. This information is readily available from administrative data, demonstrating the potential of data sharing across city and state institutions to focus prevention strategies on those at greatest risk. |
Suicide among military personnel and veterans aged 18-35 years by county-16 states
Logan JE , Fowler KA , Patel NP , Holland KM . Am J Prev Med 2016 51 S197-s208 INTRODUCTION: Suicide among military personnel and young Veterans remains a health concern. This study examined stateside distribution of suicides by U.S. county to help focus prevention efforts. METHODS: Using 2005-2012 National Violent Death Reporting System data from 16 states (963 counties, or county-equivalent entities), this study mapped the county-level distribution of suicides among current military and Veteran decedents aged 18-35 years. This study also compared incident circumstances of death between decedents in high-density counties (i.e., counties with the highest proportion of deaths) versus those in medium/low-density counties to better understand the precipitators of suicide in counties most affected. Last, this study identified potential military and Veteran Health Administration intervention sites. All analyses were conducted in 2015. RESULTS: Within the National Violent Death Reporting System participating states, an estimated 262 (33%) current military suicides occurred in just ten (1.0%) counties, and 391 (33%) Veteran suicides occurred in 33 (3.4%) counties. Mental health and intimate partner problems were common precipitating circumstances, and some circumstances differed between cases in high- versus those in medium/low-density counties. Multiple potential intervention sites were identified in high-density counties. CONCLUSIONS: These findings suggest that military and Veteran suicides are concentrated in a small number of counties. Increased efforts at these locales might be beneficial. |
Mixed methods analysis of sex differences in life stressors of middle-aged suicides
Stone DM , Holland KM , Schiff LB , McIntosh WL . Am J Prev Med 2016 51 S209-s218 INTRODUCTION: Between 1999 and 2013, rates of suicide in mid-life increased more than 30%. The purpose of this study is to examine life stressors impacting middle-aged suicide, to determine whether these stressors vary by sex, and to explore their co-occurrence. METHODS: A random sample of 315 men and 315 women aged 35-64 years was selected from 17 states implementing the National Violent Death Reporting System from its inception in 2003 to 2011. Data collection took place between 2003 and 2011 and analysis occurred in 2015. Analysis included coding circumstances of death noted in the law enforcement and coroner/medical examiner reports using an investigator-designed coding instrument. Using the most commonly cited life stressors as a basis, thematic analyses were conducted for cases. Quantitative comparisons of the most common circumstances by sex were calculated via multivariable logistic regression. RESULTS: The five most common life stressors of suicide included intimate partner, job/financial, health, family, and criminal/legal problems. In adjusted analyses, job/financial problems and criminal/legal problems were more common among men, whereas health and family problems were more common among women. Men and women had similar rates of intimate partner problems. Life stressors also co-occurred, as found per qualitative and quantitative analyses. CONCLUSIONS: Men and women in mid-life have both common and unique circumstances preceding suicide. Prevention strategies that consider these circumstances and co-occurring circumstances are warranted. |
The National Violent Death Reporting System: Past, present, and future
Crosby AE , Mercy JA , Houry D . Am J Prev Med 2016 51 S169-s172 Each and every day in the U.S., more than 160 people die as a result of violence due to homicides and suicides.1 These violent deaths constitute an urgent public health problem. Homicide and suicide, taken together, were the fourth leading cause of years of potential life lost in the U.S. in 2014.2 Each year, more than 55,000 people die in the U.S. as a result of violence-related injuries.3 In 2014, suicide was the tenth leading cause of death, claiming more than 42,000 lives1 and resulting in an economic cost estimated to be $53.2 billion, largely associated with lost work productivity.4,5 From 2005 to 2014, the national suicide rate rose for 9 straight years from 10.9 per 100,000 in 2005 to 13.0 per 100,000 in 2014, an increase of more than 18%,6 and now ranks as the second leading cause of death among adolescents and young adults.7,8 Homicide rates in the U.S. have declined over the long term, but are still a major problem resulting in an economic cost estimated at $26.4 billion.2,5 Among high-income nations, the U.S. historically has the highest homicide rate.9 Homicides disproportionately affect boys and men, adolescents and young adults, and certain racial/ethnic groups, such as non-Hispanic blacks, non-Hispanic American Indian/Alaska Natives, and Hispanics.10 These groups have not experienced the same level of decline and, in some cases, rates have increased.11 Homicide is the third leading cause of death for 10- to 24-year-olds in the U.S. and the leading cause of death for male and female African Americans aged 10–34 years.1 Suicide and homicide are preventable, but to address this problem as efficiently and effectively as possible, practitioners need data that are both timely and provide information that is useful in guiding preventive actions. |
Occupational homicides of law enforcement officers, 2003-2013: Data From the National Violent Death Reporting System
Blair JM , Fowler KA , Betz CJ , Baumgardner JL . Am J Prev Med 2016 51 S188-s196 INTRODUCTION: Law enforcement officers (LEOs) in the U.S. are at an increased risk for homicide. The purpose of this study is to describe the characteristics of homicides of LEOs in 17 U.S. states participating in the National Violent Death Reporting System. This active surveillance system uses data from death certificates, coroner/medical examiner reports, and law enforcement reports. METHODS: This study used quantitative and qualitative methods to analyze National Violent Death Reporting System data for 2003-2013. Deaths of LEOs feloniously killed in the line of duty were selected for analysis. LEO homicides and the circumstances preceding or occurring during the incident were characterized. Analyses were conducted October 2015-June 2016. RESULTS: A total of 128 officer homicides from 121 incidents were identified. Most (93.7%) LEO victims were male, 60.9% were aged 30-49 years (average age, 40.9 years). Approximately 21.9% of LEOs were killed during an ambush, and 19.5% were killed during traffic stops or pursuits. Of the 14.1% of LEOs killed responding to domestic disturbances, most disturbances were intimate partner violence related. More than half (57.0%) of homicides were precipitated by another crime, and of these, 71.2% involved crimes in progress. Most suspects were male. Ninety-one percent of homicides of LEOs were committed with a firearm. CONCLUSIONS: This information is critical to help describe encounter situations faced by LEOs. The results of this study can be used to help educate and train LEOs on hazards, inform prevention efforts designed to promote LEO safety, and prevent homicide among this population. |
Improved ascertainment of pregnancy-associated suicides and homicides in North Carolina
Austin AE , Vladutiu CJ , Jones-Vessey KA , Norwood TS , Proescholdbell SK , Menard MK . Am J Prev Med 2016 51 S234-s240 INTRODUCTION: Injuries, including those resulting from violence, are a leading cause of death during pregnancy and the postpartum period. North Carolina, along with other states, has implemented surveillance systems to improve reporting of maternal deaths, but their ability to capture violent deaths is unknown. The purpose of this study was to quantify the improvement in ascertainment of pregnancy-associated suicides and homicides by linking data from the North Carolina Violent Death Reporting System (NC-VDRS) to traditional maternal mortality surveillance files. METHODS: Enhanced case ascertainment was used to identify suicides and homicides that occurred during or up to 1 year after pregnancy from 2005 to 2011 in North Carolina. NC-VDRS data were linked to traditional maternal mortality surveillance files (i.e., death certificates with any mention of pregnancy or matched to a live birth or fetal death record and hospital discharge records for women who died in the hospital with a pregnancy-related diagnosis). Mortality ratios were calculated by case ascertainment method. Analyses were conducted in 2015. RESULTS: A total of 29 suicides and 55 homicides were identified among pregnant and postpartum women through enhanced case ascertainment as compared with 20 and 34, respectively, from traditional case ascertainment. Linkage to NC-VDRS captured 55.6% more pregnancy-associated violent deaths than traditional surveillance alone, resulting in higher mortality ratios for suicide (2.3 vs 3.3 deaths per 100,000 live births) and homicide (3.9 vs 6.2 deaths per 100,000 live births). CONCLUSIONS: Linking traditional maternal mortality files to NC-VDRS provided a notable improvement in ascertainment of pregnancy-associated violent deaths. |
Behavioral and mental health correlates of youth stalking victimization: A latent class approach
Reidy DE , Smith-Darden JP , Kernsmith PD . Am J Prev Med 2016 51 (6) 1007-1014 INTRODUCTION: Although recognized as a public health problem, little attention has been paid to the problem of stalking among youth. Latent profile analysis was used to identify latent groups of adolescent stalking victims and their behavioral and mental health correlates. METHODS: A cross-sectional sample of 1,236 youths were randomly selected from 13 schools stratified by community risk level (i.e., low, moderate, and high risk) and gender. Students completed surveys assessing behavioral indicators of stalking victimization, as well as substance use, sexual behavior, dating violence, and psychiatric symptoms. Data were collected in 2013 and data analyses were performed in 2015. RESULTS: Analysis indicated the presence of a non-victim class, a minimal exposure class, and a victim class for boys and girls alike. Approximately 14% of girls and 13% of boys were in the stalking victim class. Adolescents in the victim class reported more symptoms of post-traumatic stress, mood disorder, and hopelessness, as well as more instances of alcohol use, binge drinking, and physical dating violence victimization. Girls in the victim class also reported engaging in sexting behaviors and oral sex with significantly more partners than their non-victim peers. CONCLUSIONS: These findings provide valuable knowledge of the prevalence and pertinent health correlates of stalking victimization in adolescence. The data suggest a substantial proportion of adolescents are victims of stalking and are likewise at risk for a number of deleterious health outcomes. As such, this population merits further attention by prevention researchers and practitioners. |
Deaths due to use of lethal force by law enforcement: Findings from the National Violent Death Reporting System, 17 U.S. states, 2009-2012
DeGue S , Fowler KA , Calkins C . Am J Prev Med 2016 51 S173-s187 INTRODUCTION: Several high-profile cases in the U.S. have drawn public attention to the use of lethal force by law enforcement (LE), yet research on such fatalities is limited. Using data from a public health surveillance system, this study examined the characteristics and circumstances of these violent deaths to inform prevention. METHODS: All fatalities (N=812) resulting from use of lethal force by on-duty LE from 2009 to 2012 in 17 U.S. states were examined using National Violent Death Reporting System data. Case narratives were coded for additional incident circumstances. RESULTS: Victims were majority white (52%) but disproportionately black (32%) with a fatality rate 2.8 times higher among blacks than whites. Most victims were reported to be armed (83%); however, black victims were more likely to be unarmed (14.8%) than white (9.4%) or Hispanic (5.8%) victims. Fatality rates among military veterans/active duty service members were 1.4 times greater than among their civilian counterparts. Four case subtypes were examined based on themes that emerged in incident narratives: about 22% of cases were mental health related; 18% were suspected "suicide by cop" incidents, with white victims more likely than black or Hispanic victims to die in these circumstances; 14% involved intimate partner violence; and about 6% were unintentional deaths due to LE action. Another 53% of cases were unclassified and did not fall into a coded subtype. Regression analyses identified victim and incident characteristics associated with each case subtype and unclassified cases. CONCLUSIONS: Knowledge about circumstances of deaths due to the use of lethal force can inform the development of prevention strategies, improve risk assessment, and modify LE response to increase the safety of communities and officers and prevent fatalities associated with LE intervention. |
Time until emergence of HIV test reactivity following infection with HIV-1: Implications for interpreting test results and retesting after exposure.
Delaney KP , Hanson DL , Masciotra S , Ethridge SF , Wesolowski L , Owen SM . Clin Infect Dis 2016 64 (1) 53-59 BACKGROUND: Understanding the period of time between an exposure resulting in infection with HIV and when a test can reliably detect the presence of that infection, i.e. the test window period, may benefit testing programs and clinicians in counseling patients about when the clinician and the patient can be confident a suspected exposure did not result in HIV infection. METHODS: We evaluated the intervals between reactivity of the Aptima HIV-1 RNA nucleic acid test (Aptima) and 20 FDA-approved HIV immunoassays using 222 longitudinally collected plasma specimens from HIV-1 seroconverters from the United States. A multi-model framework based upon two general approaches, interval-censored survival and binomial regression, was implemented to estimate the relative emergence of test reactivity, referred to in this report as an inter-test reactivity interval (ITRI). We then combined ITRI results with simulated data for the eclipse period, the time between exposure and detection of HIV virus by Aptima, to develop estimates of the window period for each test. RESULTS: The estimated ITRIs were shorter with each new class of HIV tests, ranging from 5.9 to 24.8 days. The 99th percentiles of the window period probability distribution ranged from 44 days for laboratory screening tests that detect both antigen and antibody to 65 days for the Western blot test. CONCLUSIONS: Our directly comparable estimates of the emergence of reactivity for 20 immunoassays are valuable to testing providers for interpreting negative HIV test results obtained shortly after exposure, and for counseling individuals on when to retest after an exposure. |
Opportunities to enhance laboratory professionals' role on the diagnostic team
Taylor JR , Thompson PJ , Genzen JR , Hickner J , Marques MB . Lab Med 2016 48 (1) 97-103 BACKGROUND: The 2015 Institue of Medicine report Improving Diagnosis in Health Care highlighted that diagnostic errors cause patient harm and that improvement in the diagnostic process requires better collaboration among physicians and laboratory professionals. The purpose of this study is to understand why physicians do not contact laboratory professionals when facing diagnostic challenges and identify opportunities for laboratory professionals to become more recognized members of the clinical care team. METHODS: A random sample of 31,689 physicians from the American Medical Association Masterfile were surveyed about diagnostic challenges in laboratory test ordering and results interpretation, solutions to these challenges, and interactions with laboratory professionals. RESULTS: We received responses from 1768 physicians (5.6%). When faced with diagnostic challenges, they reported using electronic resources because they find it difficult and time-consuming to contact the laboratory. Only 20% had an effective way to access laboratory professionals, mostly seeking help for logistical but less for clinical issues. Continuing medical education, professional articles, and updates from the laboratory were helpful. CONCLUSIONS: Laboratory professionals have an opportunity to play a greater role in the diagnostic process by becoming active members of the clinical care team, beyond providing results. This study provides strategies to increase laboratory professionals' role in the diagnostic process. |
Osteopontin is upregulated in human and murine acute schistosomiasis mansoni
Pereira TA , Syn WK , Amancio FF , Cunha PH , Caporali JF , Trindade GV , Santos ET , Souza MM , Andrade ZA , Witek RP , Secor WE , Pereira FE , Lambertucci JR , Diehl AM . PLoS Negl Trop Dis 2016 10 (10) e0005057 BACKGROUND: Symptomatic acute schistosomiasis mansoni is a systemic hypersensitivity reaction against the migrating schistosomula and mature eggs after a primary infection. The mechanisms involved in the pathogenesis of acute schistosomiasis are not fully elucidated. Osteopontin has been implicated in granulomatous reactions and in acute hepatic injury. Our aims were to evaluate if osteopontin plays a role in acute Schistosoma mansoni infection in both human and experimentally infected mice and if circulating OPN levels could be a novel biomarker of this infection. METHODOLOGY/PRINCIPAL FINDINGS: Serum/plasma osteopontin levels were measured by ELISA in patients with acute (n = 28), hepatointestinal (n = 26), hepatosplenic (n = 39) schistosomiasis and in uninfected controls (n = 21). Liver osteopontin was assessed by immunohistochemistry in needle biopsies of 5 patients. Sera and hepatic osteopontin were quantified in the murine model of schistosomiasis mansoni during acute (7 and 8 weeks post infection, n = 10) and chronic (30 weeks post infection, n = 8) phase. Circulating osteopontin levels are increased in patients with acute schistosomiasis (p = 0.0001). The highest levels of OPN were observed during the peak of clinical symptoms (7-11 weeks post infection), returning to baseline level once the granulomas were modulated (>12 weeks post infection). The plasma levels in acute schistosomiasis were even higher than in hepatosplenic patients. The murine model mirrored the human disease. Macrophages were the major source of OPN in human and murine acute schistosomiasis, while the ductular reaction maintains OPN production in hepatosplenic disease. Soluble egg antigens from S. mansoni induced OPN expression in primary human kupffer cells. CONCLUSIONS/SIGNIFICANCE: S. mansoni egg antigens induce the production of OPN by macrophages in the necrotic-exudative granulomas characteristic of acute schistosomiasis mansoni. Circulating OPN levels are upregulated in human and murine acute schistosomiasis and could be a non-invasive biomarker of this form of disease. |
Preterm birth: Case definition & guidelines for data collection, analysis, and presentation of immunisation safety data
Quinn JA , Munoz FM , Gonik B , Frau L , Cutland C , Mallett-Moore T , Kissou A , Wittke F , Das M , Nunes T , Pye S , Watson W , Ramos AA , Cordero JF , Huang WT , Kocchar S , Buttery J . Vaccine 2016 34 (49) 6047-6056 Preterm birth is commonly defined as any birth before 37 weeks completed weeks of gestation. An estimated 15 million infants are born preterm globally, disproportionately affecting low and middle income countries (LMIC). It contributes directly to estimated one million neonatal deaths annually and is a significant contributor to childhood morbidity. However, in many clinical settings, the information available to calculate completed weeks of gestation varies widely. Accurate dating of the last menstrual period (LMP), as well as access to clinical and ultrasonographic evaluation are important components of gestational age assessment antenatally. This case definition assign levels of confidence to categorisation of births as preterm, utilising assessment modalities which may be available across different settings. These are designed to enable systematic safety evaluation of vaccine clinical trials and post-implementation programmes of immunisations in pregnancy. |
Anthrax vaccine and the risk of rheumatoid arthritis and systemic lupus erythematosus in the U.S. military: A case-control study
Bardenheier BH , Duffy J , Duderstadt SK , Higgs JB , Keith MP , Papadopoulos PJ , Gilliland WR , McNeil MM . Mil Med 2016 181 (10) 1348-1356 U.S. military personnel assigned to areas deemed to be at high risk for anthrax attack receive Anthrax Vaccine Adsorbed (AVA). Few cases of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) have been reported in persons who received AVA. Using a matched case-control study design, we assessed the relationship of RA and SLE with AVA vaccination using the Defense Medical Surveillance System. We identified potential cases using International Classification of Diseases, 9th Revision, Clinical Modification codes and confirmed cases with medical record review and rheumatologist adjudication. Using conditional logistic regression, we estimated odds ratios (OR) for AVA exposure during time intervals ranging from 90 to 1,095 days before disease onset. Among 77 RA cases, 13 (17%) had ever received AVA. RA cases were no more likely than controls to have received AVA when looking back 1,095 days (OR: 1.03; 95% confidence interval [CI]: 0.48-2.19) but had greater odds of exposure in the prior 90 days (OR: 3.93; 95% CI: 1.08-14.27). Among the 39 SLE cases, 5 (13%) had ever received AVA; no significant difference in receipt of AVA was found when compared with controls (OR: 0.91; 95% CI: 0.26-3.25). AVA was associated with recent onset RA, but did not increase the risk of developing RA in the long term. |
Synthetic biology and occupational risk
Howard J , Murashov V , Schulte P . J Occup Environ Hyg 2016 14 (3) 0 Synthetic biology is an emerging interdisciplinary field of biotechnology that involves applying the principles of engineering and chemical design to biological systems. Biosafety professionals have done an excellent job in addressing research laboratory safety as synthetic biology and gene editing have emerged from the larger field of biotechnology. Despite these efforts, risks posed by synthetic biology are of increasing concern as research procedures scale up to industrial processes in the larger bioeconomy. A greater number and variety of workers will be exposed to commercial synthetic biology risks in the future, including risks to a variety of workers from the use of lentiviral vectors as gene transfer devices. There is a need to review and enhance current protection measures in the field of synthetic biology, whether in experimental laboratories where new advances are being researched, in health care settings where treatments using viral vectors as gene delivery systems are increasingly being used, or in the industrial bioeconomy. Enhanced worker protection measures should include increased injury and illness surveillance of the synthetic biology workforce; proactive risk assessment and management of synthetic biology products; research on the relative effectiveness of extrinsic and intrinsic biocontainment methods; specific safety guidance for synthetic biology industrial processes; determination of appropriate medical mitigation measures for lentiviral vector exposure incidents; and greater awareness and involvement in synthetic biology safety by the general occupational safety and health community as well as by government occupational safety and health research and regulatory agencies. |
Wildland fire fighter deaths in the United States: A comparison of existing surveillance systems
Butler C , Marsh S , Domitrovich JW , Helmkamp J . J Occup Environ Hyg 2016 14 (4) 258-270 BACKGROUND: Wildland fire fighting is a high-risk occupation requiring considerable physical and psychological demands. Multiple agencies publish fatality summaries for wildland fire fighters; however, the reported number and types vary. At least five different surveillance systems capture deaths, each with varying case definitions and case inclusion/exclusion criteria. Four are population-level systems and one is case-based. System differences create challenges to accurately characterize fatalities. METHODS: Data within each of the five surveillance systems were examined to better understand the types of wildland fire fighter data collected, to assess each system's utility in characterizing wildland fire fighter fatalities, and to determine each system's potential to inform prevention strategies. To describe similarities and differences in how data were recorded and characterized, wildland fire deaths for three of the population-based systems were matched and individual fatalities across systems were compared. RESULTS: Between 2001 and 2012, 247 unique deaths were captured among the systems; 73% of these were captured in all three systems. Most common causes of death in all systems were associated with aviation, vehicles, medical events, and entrapments/burnovers. The data show that, although the three systems often report similar annual summary statistics, events captured in each system vary each year depending on the types of events that the system is designed to track, such as inclusion/exclusion of fatalities associated with the Hometown Heroes Survivor Benefits Act of 2003. CONCLUSIONS: The overarching and central goal of each system is to collect accurate and timely information to improve wildland fire fighter safety and health. Each system is unique and has varying inclusion and exclusion criteria for capturing and tracking different subsets of wildland fire fighter tasks and duties. Use of a common case definition and better descriptions and interpretations of the data and the results would help to more accurately characterize wildland fire fighter traumatic injuries and illnesses, lessen the likelihood for misinterpretation of wildland fire fighter fatality data, and assist with defining the true occupational injury burden within this high-risk population. |
Worker health and safety and climate change in the Americas: issues and research needs
Keifer M , Rodriquez-Guzman J , Watson J , van Wendel de Joode B , Mergler D , Soares da Silva A . Rev Panam Salud Publica 2016 40 (3) 192-197 This report summarizes and discusses current knowledge on the impact that climate change can have on occupational safety and health (OSH), with a particular focus on the Americas. Worker safety and health issues are presented on topics related to specific stressors (e.g., temperature extremes), climate associated impacts (e.g., ice melt in the Arctic), and a health condition associated with climate change (chronic kidney disease of non-traditional etiology). The article discusses research needs, including hazards, surveillance, and risk assessment activities to better characterize and understand how OSH may be associated with climate change events. Also discussed are the actions that OSH professionals can take to ensure worker health and safety in the face of climate change. |
Mortality in a combined cohort of uranium enrichment workers
Yiin JH , Anderson JL , Daniels RD , Bertke SJ , Fleming DA , Tollerud DJ , Tseng CY , Chen PH , Waters KM . Am J Ind Med 2016 60 (1) 96-108 OBJECTIVE: To examine the patterns of cause-specific mortality and relationship between internal exposure to uranium and specific causes in a pooled cohort of 29,303 workers employed at three former uranium enrichment facilities in the United States with follow-up through 2011. METHODS: Cause-specific standardized mortality ratios (SMRs) for the full cohort were calculated with the U.S. population as referent. Internal comparison of the dose-response relation between selected outcomes and estimated organ doses was evaluated using regression models. RESULTS: External comparison with the U.S. population showed significantly lower SMRs in most diseases in the pooled cohort. Internal comparison showed positive associations of absorbed organ doses with multiple myeloma, and to a lesser degree with kidney cancer. CONCLUSION: In general, these gaseous diffusion plant workers had significantly lower SMRs than the U.S. POPULATION: The internal comparison however, showed associations between internal organ doses and diseases associated with uranium exposure in previous studies. |
Foundational workplace safety and health competencies for the emerging workforce
Okun Andrea H , Guerin Rebecca J , Schulte Paul A . J Safety Res 2016 59 43-51 Introduction Young workers (aged 15–24) suffer disproportionately from workplace injuries, with a nonfatal injury rate estimated to be two times higher than among workers age 25 or over. These workers make up approximately 9% of the U.S. workforce and studies have shown that nearly 80% of high school students work at some point during high school. Although young worker injuries are a pressing public health problem, the critical knowledge and skills needed to prepare youth for safe and healthy work are missing from most frameworks used to prepare the emerging U.S. workforce. Methods A framework of foundational workplace safety and health knowledge and skills (the NIOSH 8 Core Competencies) was developed. The framework was aligned with the Health Belief Model (HBM) and the Core Competencies were mapped to the individual HBM constructs. Results The proposed NIOSH Core Competencies utilize the HBM to provide a framework for foundational workplace safety and health knowledge and skills. An examination of how these competencies and the HBM apply to actions that workers take to protect themselves is provided. The social and physical environments that influence these actions are also discussed. Conclusions The NIOSH 8 Core Competencies, aligned with one of the most widely used conceptual frameworks in health behavior practice, fill a critical gap in preparing the emerging U.S. workforce to be cognizant of workplace risks and to participate in, and benefit from, safe and healthy work. Practical applications Integration of the NIOSH 8 Core Competencies into school curricula is one way to ensure that every young person, before he or she enters the workforce, has the foundational workplace safety and health knowledge and skills to be cognizant of risks on the job and to participate in, and benefit from, safe and healthy work. |
Assessing risk of indium lung disease to workers in downstream industries
Harvey RR , Virji MA , Cummings KJ . Am J Ind Med 2016 60 (3) 310-311 Choi et al. [2015] recently evaluated Korean workers exposed to indium compounds to assess health outcomes indicative of interstitial lung disease. They found meaningful associations between serum indium concentration and the biomarkers Krebs von den Lungen-6 (KL-6) and surfactant protein-D (SP-D), as well as interstitial changes on high-resolution computed tomography (HRCT). Work sites assessed in their study included indium-tin oxide (ITO) target manufacturing facilities, indium reclaim factories, and display panel manufacturing plants. | We reported similar relationships between health outcomes and indium exposure in workers at an ITO production facility that also reclaimed indium in the United States [Cummings et al., 2014]. Absent from our study, but included in the Korean assessment, were data from workers downstream to the manufacturing of ITO targets, such as display panel manufacturing plants that utilize the ITO targets to apply a thin film of ITO by sputtering. The extent of occupational exposure to ITO and other indium-containing compounds in these downstream industries in the United States remains largely unknown. Hines et al. [2013] found that workers at ITO thin film deposition companies were exposed to indium between sputtering runs when ITO targets were resurfaced or during cleaning of chamber interiors and shields. In fact, personal indium air concentration reached 5.4 mg/m3 for cleaning sputter or evaporation chambers [Hines et al., 2013], which is orders of magnitude above the Japanese respirable exposure limit of 0.3 mg/m3 [MHLW, 2010]. |
Validation of temperature and humidity thermal model of 23-person tent-type refuge alternative
Yan L , Yantek D , Klein M , Bissert P , Matetic R . Min Eng 2016 68 (9) 97-103 U.S. Mine Safety and Health Administration (MSHA) regulations require underground coal mines to use refuge alternatives (RAs) to provide a breathable air environment for 96 hours. One of the main concerns with the use of mobile RAs is heat and humidity buildup inside the RA. The accumulation of heat and humidity can result in miners suffering heat stress or even death. MSHA regulations require that the apparent temperature in an occupied RA not exceed 95 °F. To investigate this, the U.S. National Institute for Occupational Safety and Health (NIOSH) conducted testing on a 23-person tent-type RA in its Experimental Mine in a test area that was isolated from the mine ventilation system. The test results showed that the average measured air temperature within the RA increased by 9.4 °C (17 °F) and the relative humidity approached 94 percent at the end of a 96-hour test. The test results were used to benchmark a thermal simulation model of the tested RA. The validated thermal simulation model predicted the volume-weighted average air temperature inside the RA tent at the end of 96 hours to within 0.06 °C (0.1 °F) of the average measured air temperature. |
First report of gender based violence as a deterrent to methadone access among females who use heroin in Dar es Salaam, Tanzania
Balaji D , Mlunde LB , Tran OC , Lambdin B , Mbwambo J , Nyandindi C , Matiko E , Copenhaver M , Douglas Bruce R . AIDS Behav 2016 21 (7) 2093-2100 High prevalence of human immunodeficiency virus (HIV) among females who use drugs in Dar es Salaam, Tanzania, contrasts strikingly with their low enrollment in HIV risk reduction services such as methadone assisted therapy (MAT). We conducted a case-control study to examine factors associated with non-enrollment in MAT, with a focus on gender-based violence. We interviewed 202 female heroin users not enrolled in MAT as cases and 93 females enrolled in MAT. We fitted logistic regression models with MAT enrollment as the outcome of interest. The likelihood of MAT enrollment decreased upon being in a violent relationship [odds ratio (OR) 0.23; 95 % CI 0.11-0.40], with experience of discrimination by a healthcare provider (OR 0.11; 95 % CI 0.04-0.35), and having a partner who also uses drugs (OR 0.05; 95 % CI 0.01-0.26). The results indicate that violence and discrimination are major impediments to MAT enrollment, necessitating implementation of interventions to address them. |
Alcohol electronic screening and brief intervention: A Community Guide systematic review
Tansil KA , Esser MB , Sandhu P , Reynolds JA , Elder RW , Williamson RS , Chattopadhyay SK , Bohm MK , Brewer RD , McKnight-Eily LR , Hungerford DW , Toomey TL , Hingson RW , Fielding JE . Am J Prev Med 2016 51 (5) 801-811 CONTEXT: Excessive drinking is responsible for one in ten deaths among working-age adults in the U.S. annually. Alcohol screening and brief intervention is an effective but underutilized intervention for reducing excessive drinking among adults. Electronic screening and brief intervention (e-SBI) uses electronic devices to deliver key elements of alcohol screening and brief intervention, with the potential to expand population reach. EVIDENCE ACQUISITION: Using Community Guide methods, a systematic review of the scientific literature on the effectiveness of e-SBI for reducing excessive alcohol consumption and related harms was conducted. The search covered studies published from 1967 to October 2011. A total of 31 studies with 36 study arms met quality criteria and were included in the review. Analyses were conducted in 2012. EVIDENCE SYNTHESIS: Twenty-four studies (28 study arms) provided results for excessive drinkers only and seven studies (eight study arms) reported results for all drinkers. Nearly all studies found that e-SBI reduced excessive alcohol consumption and related harms: nine study arms reported a median 23.9% reduction in binge-drinking intensity (maximum drinks/binge episode) and nine study arms reported a median 16.5% reduction in binge-drinking frequency. Reductions in drinking measures were sustained for up to 12 months. CONCLUSIONS: According to Community Guide rules of evidence, e-SBI is an effective method for reducing excessive alcohol consumption and related harms among intervention participants. Implementation of e-SBI could complement population-level strategies previously recommended by the Community Preventive Services Task Force for reducing excessive drinking (e.g., increasing alcohol taxes and regulating alcohol outlet density). |
The SARE tool for rabies control: Current experience in Ethiopia
Coetzer A , Kidane AH , Bekele M , Hundera AD , Pieracci EG , Shiferaw ML , Wallace R , Nel LH . Antiviral Res 2016 135 74-80 The Stepwise Approach towards Rabies Elimination (SARE) tool was developed through a joint effort of the Food and Agriculture Organization (FAO) of the United Nations and the Global Alliance for Rabies Control (GARC), to provide a standard mechanism for countries to assess their rabies situation and measure progress in eliminating the disease. Because the African continent has the highest per capita death rate from rabies, and Ethiopia is estimated to have the second largest number of rabies deaths of all African countries, Ethiopia undertook a self-assessment by means of the Stepwise Approach towards Rabies Elimination (SARE) tool. In February 2016, the Ethiopian government hosted an intersectoral consultative meeting in an effort to assess the progress that has been made towards the control and elimination of canine rabies. The SARE assessment identified a number of critical gaps, including poor inter-sectoral collaboration and limited availability and access to dog vaccine, while the existence of a surveillance system for rabies and legislation for outbreak declaration and response were among the strengths identified. The SARE tool enabled key criteria to be prioritized, thereby accelerating the National Strategy and ensuring that Ethiopia will progress rapidly in line with the goals set by the global community for the elimination of human rabies deaths by 2030. Although the analysis showed that Ethiopia is still in the early stages of rabies control (Stage 0.5/5), the country shows great promise in terms of developing a SARE-guided National Rabies Prevention and Control Strategy. |
Activity patterns of St. Louis Encephalitis and West Nile viruses in free ranging birds during a human encephalitis outbreak in Argentina
Diaz LA , Quaglia AI , Konigheim BS , Boris AS , Aguilar JJ , Komar N , Contigiani MS . PLoS One 2016 11 (8) e0161871 St. Louis encephalitis virus (SLEV) (Flavivirus) is a reemerging arbovirus in the southern cone of South America. In 2005, an outbreak of SLEV in central Argentina resulted in 47 human cases with 9 deaths. In Argentina, the ecology of SLEV is poorly understood. Because certain birds are the primary amplifiers in North America, we hypothesized that birds amplify SLEV in Argentina as well. We compared avian SLEV seroprevalence in a variety of ecosystems in and around Cordoba city from 2004 (before the epidemic) and 2005 (during the epidemic). We also explored spatial patterns to better understand the local ecology of SLEV transmission. Because West Nile virus (WNV) was also detected in Argentina in 2005, all analyses were also conducted for WNV. A total of 980 birds were sampled for detection of SLEV and WNV neutralizing antibodies. SLEV seroprevalence in birds increased 11-fold from 2004 to 2005. Our study demonstrated that a high proportion (99.3%) of local birds were susceptible to SLEV infection immediately prior to the 2005 outbreak, indicating that the vertebrate host population was primed to amplify SLEV. SLEV was found distributed in a variety of environments throughout the city of Cordoba. However, the force of viral transmission varied among sites. Fine scale differences in populations of vectors and vertebrate hosts would explain this variation. In summary, we showed that in 2005, both SLEV and to a lesser extent WNV circulated in the avian population. Eared Dove, Picui Ground-Dove and Great Kiskadee are strong candidates to amplify SLEV because of their exposure to the pathogen at the population level, and their widespread abundance. For the same reasons, Rufous Hornero may be an important maintenance host for WNV in central Argentina. Competence studies and vector feeding studies are needed to confirm these relationships. |
Assessment of domestic goats as models for experimental and natural infection with the North American isolate of Rickettsia slovaca
Lukovsky-Akhsanov N , Keating MK , Spivey P , Lathrop GW Jr , Powell N , Levin ML . PLoS One 2016 11 (10) e0165007 Rickettsia slovaca is a tick-borne human pathogen that is associated with scalp eschars and neck lymphadenopathy known as tick-borne lymphadenopathy (TIBOLA) or Dermacentor-borne necrosis erythema and lymphadenopathy (DEBONEL). Originally, R. slovaca was described in Eastern Europe, but since recognition of its pathogenicity, human cases have been reported throughout Europe. European vertebrate reservoirs of R. slovaca remain unknown, but feral swine and domestic goats have been found infected or seropositive for this pathogen. Recently, a rickettsial pathogen identical to R. slovaca was identified in, and isolated from, the American dog tick, Dermacentor variabilis. In previous experimental studies, this organism was found infectious to guinea pigs and transovarially transmissible in ticks. In this study, domestic goats (Capra hircus) were experimentally inoculated with the North American isolate of this R. slovaca-like agent to assess their reservoir competence-the ability to acquire the pathogens and maintain transmission between infected and uninfected ticks. Goats were susceptible to infection as demonstrated by detection of the pathogen in skin biopsies and multiple internal tissues, but the only clinical sign of illness was transient fever noted in three out of four goats, and reactive lymphoid hyperplasia. On average, less than 5% of uninfected ticks acquired the pathogen while feeding upon infected goats. Although domestic goats are susceptible to the newly described North American isolate of R. slovaca, they are likely to play a minor role in the natural transmission cycle of this pathogen. Our results suggest that goats do not propagate the North American isolate of R. slovaca in peridomestic environments and clinical diagnosis of infection could be difficult due to the brevity and mildness of clinical signs. Further research is needed to elucidate the natural transmission cycle of R. slovaca both in Europe and North America, as well as to identify a more suitable laboratory model. |
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