Deep sequencing of HIV-1 reveals extensive subtype variation and drug resistance after failure of first-line antiretroviral regimens in Nigeria.
ElBouzidi K , Datir RP , Kwaghe V , Roy S , Frampton D , Breuer J , Ogbanufe O , Murtala-Ibrahim F , Charurat M , Dakum P , Sabin CA , Ndembi N , Gupta RK . J Antimicrob Chemother 2022 77 (2) 474-482 BACKGROUND: Deep sequencing could improve understanding of HIV treatment failure and viral population dynamics. However, this tool is often inaccessible in low- and middle-income countries. OBJECTIVES: To determine the genetic patterns of resistance emerging in West African HIV-1 subtypes during first-line virological failure, and the implications for future antiretroviral options. PATIENTS AND METHODS: Participants were selected from a Nigerian cohort of people living with HIV who had failed first-line ART and subsequently switched to second-line therapy. Whole HIV-1 genome sequences were generated from first-line virological failure samples with Illumina MiSeq. Mutations detected at 2% frequency were analysed and compared by subtype. RESULTS: HIV-1 sequences were obtained from 101 participants (65% female, median age 30 years, median 32.9 months of nevirapine- or efavirenz-based ART). Thymidine analogue mutations (TAMs) were detected in 61%, other core NRTI mutations in 92% and NNRTI mutations in 99%. Minority variants (<20% frequency) comprised 18% of all mutations. K65R was more prevalent in CRF02_AG than G subtypes (33% versus 7%; P=0.002), and 3 TAMs were more common in G than CRF02_AG (52% versus 24%; P=0.004). Subtype G viruses also contained more RT cleavage site mutations. Cross-resistance to at least one of the newer NNRTIs, doravirine, etravirine or rilpivirine, was predicted in 81% of participants. CONCLUSIONS: Extensive drug resistance had accumulated in people with West African HIV-1 subtypes, prior to second-line ART. Deep sequencing significantly increased the detection of resistance-associated mutations. Caution should be used if considering newer-generation NNRTI agents in this setting. |
Quantification of multidrug-resistant M. tuberculosis bacilli in sputum during the first 8 weeks of treatment
Smith-Jeffcoat SE , Eisenach KD , Joloba M , Ssengooba W , Namaganda C , Nsereko M , Okware B , Cavanaugh JS , Cegielski JP . Int J Tuberc Lung Dis 2022 26 (11) 1058-1064 SETTING: Mulago Hospital, Kampala, Uganda.OBJECTIVE: To quantify Mycobacterium tuberculosis in sputum during the first 8 weeks of pulmonary multidrug-resistant TB (MDR-TB) treatment.DESIGN: We enrolled consecutive adults with pulmonary MDR-TB treated according to national guidelines. We collected overnight sputum samples before treatment and weekly. Sputum samples were cultured on Middlebrook 7H11S agar to measure colony-forming units per mL (cfu/mL) and in MGIT™ 960™ media to measure time to detection (TTD). Linear mixed-effects regression was used to estimate the relational change in log(10) cfu/mL and TTD.RESULTS: Twelve adults (median age: 27 years) were enrolled. Half were women, and two-thirds were HIV-positive. At baseline, median log(10) cfu/mL was 5.1, decreasing by 0.29 log(10) cfu/mL/week. The median TTD was 116.5 h, increasing in TTD by 36.97 h/week. The weekly change was greater in the first 2 weeks (-1.04 log(10) cfu/mL/week and 120.02 h/week) than in the remaining 6 weeks (-0.17 log(10) cfu/mL/week and 26.11 h/week).CONCLUSION: Serial quantitative culture measures indicate a slow, uneven rate of decline in sputum M. tuberculosis over 8 weeks of standardized pulmonary MDR-TB treatment. |
Interleukin-11 receptor subunit alpha-1 is required for maximal airway responsiveness to methacholine following acute exposure to ozone.
Johnston RA , Atkins CL , Siddiqui SR , Jackson WT , Mitchell NC , Spencer CY , Pilkington AWth , Kashon ML , Haque IU . Am J Physiol Regul Integr Comp Physiol 2022 323 (6) R921-R934 Interleukin (IL)-11, a multi-functional cytokine, contributes to numerous biological processes, including adipogenesis, hematopoiesis, and inflammation. Asthma, a respiratory disease, is notably characterized by reversible airway obstruction, persistent lung inflammation, and airway hyperresponsiveness (AHR). Nasal insufflation of IL-11 causes AHR in wild-type mice while lung inflammation induced by antigen sensitization and challenge, which mimics features of atopic asthma in humans, is attenuated in mice genetically deficient in IL-11 receptor subunit alpha-1 (IL-11Rα1-deficient mice), a transmembrane receptor that is required conjointly with glycoprotein 130 to transduce IL-11 signaling. Nevertheless, the contribution of IL-11Rα1 to characteristics of non-atopic asthma is unknown. Thus, based on the aforementioned observations, we hypothesized that genetic deficiency of IL-11Rα1 would attenuate lung inflammation and increases in airway responsiveness following acute inhalation exposure to ozone (O(3)), a criteria pollutant and non-atopic asthma stimulus. Accordingly, four- and/or twenty-four hours following cessation of exposure to filtered room air or O(3), we assessed lung inflammation and airway responsiveness in wild-type and IL-11Rα1-deficient mice. With the exception of bronchoalveolar lavage macrophages and adiponectin, which were significantly increased and decreased, respectively, in O(3)-exposed IL-11Rα1-deficient as compared to O(3)-exposed wild-type mice, no other genotype-related differences in lung inflammation indices that we quantified were observed in O(3)-exposed mice. However, airway responsiveness to acetyl-β-methylcholine chloride (methacholine) was significantly diminished in IL-11Rα1-deficient as compared to wild-type mice following O(3) exposure. In conclusion, these results demonstrate that IL-11Rα1 minimally contributes to lung inflammation but is required for maximal airway responsiveness to methacholine in a mouse model of non-atopic asthma. |
Differences in receipt of recommended eye examinations by comorbidity status and healthcare utilization among nonelderly adults with diabetes
Cai CX , Kim M , Lundeen EA , Benoit SR . J Diabetes 2022 14 (11) 749-757 BACKGROUND: To evaluate the effect of diabetes comorbidities by baseline healthcare utilization on receipt of recommended eye examinations. METHODS: Retrospective analysis of 310691 nonelderly adults with type 2 diabetes in the IBM MarketScan Commercial Database from 2016 to 2019. Patients were grouped based on diabetes-concordant (related) or -discordant (unrelated) comorbidities. Logistic regression was used to estimate the prevalence ratio (PR) for eye examinations by comorbidity status, healthcare utilization, and an interaction between comorbidities and utilization, controlling for age, sex, region, and major eye disease. RESULTS: Prevalence of biennial eye examinations varied by the four comorbidity groups: 43.5% (diabetes only), 52.7% (concordant+discordant comorbidities), 48.0% (concordant comorbidities only), and 45.3% (discordant comorbidities only). In the lowest healthcare utilization tertile, the concordant-only and concordant+discordant groups had lower prevalence of examinations compared to diabetes only (PR 0.95 [95% CI 0.92-0.98] and PR 0.91 [95% CI 0.88-0.95], respectively). In the medium utilization tertile, the discordant-only and concordant+discordant groups had lower prevalence of examinations (PR 0.89 [0.83-0.95] and PR 0.94 [0.90-0.98], respectively). In the highest utilization tertile, the concordant-only and concordant+discordant groups had higher prevalence of examinations. CONCLUSIONS: Among patients with low healthcare utilization, having comorbid conditions is associated with lower prevalence of eye examinations. Among those with medium healthcare utilization, patients with diabetes-discordant comorbidities are particularly vulnerable. This study highlights populations of diabetes patients who would benefit from increased assistance in receiving vision-preserving eye examinations. |
Food insecurity, diet quality, and suboptimal diabetes management among US adults with diabetes
Casagrande SS , Bullard KM , Siegel KR , Lawrence JM . BMJ Open Diabetes Res Care 2022 10 (5) INTRODUCTION: A healthy diet is recommended to support diabetes management, including HbA1c, blood pressure, and cholesterol (ABC) control, but food insecurity is a barrier to consuming a healthy diet. We determined the prevalence of food insecurity and diet quality among US adults with diabetes and the associations with ABC management. RESEARCH DESIGN AND METHODS: Cross-sectional analyses were conducted among 2075 adults ≥20 years with diagnosed diabetes who participated in the 2013-2018 National Health and Nutrition Examination Surveys. Food insecurity was assessed using a standard questionnaire and diet quality was assessed using quartiles of the 2015 Healthy Eating Index. Adjusted ORs (aOR, 95% CI) were calculated from logistic regression models to determine the association between household food insecurity/diet quality and the ABCs while controlling for sociodemographic characteristics, healthcare utilization, smoking, medication for diabetes, blood pressure, or cholesterol, and body mass index. RESULTS: Overall, 17.6% of adults had food insecurity/low diet quality; 14.2% had food insecurity/high diet quality; 33.1% had food security/low diet quality; and 35.2% had food security/high diet quality. Compared with adults with food security/high diet quality, those with food insecurity/low diet quality were significantly more likely to have HbA1c ≥7.0% (aOR=1.85, 95% CI 1.23 to 2.80) and HbA1c ≥8.0% (aOR=1.79, 95% CI 1.04 to 3.08); food insecurity/high diet quality was significantly associated with elevated HbA1c; and food security/low diet quality with elevated A1c. CONCLUSIONS: Food insecurity, regardless of diet quality, was significantly associated with elevated A1c. For people with food insecurity, providing resources to reduce food insecurity could strengthen the overall approach to optimal diabetes management. |
Meningococcal disease in North America: Updates from the Global Meningococcal Initiative.
Asturias EJ , Bai X , Bettinger JA , Borrow R , Castillo DN , Caugant DA , Chacon GC , Dinleyici EC , Aviles GE , Garcia L , Glennie L , Harrison LH , Howie RL , Itsko M , Lucidarme J , Marin JEO , Marjuki H , McNamara LA , Mustapha MM , Robinson JL , Romeu B , Sadarangani M , Sáez-Llorens X , Sáfadi MAP , Stephens DS , Stuart JM , Taha MK , Tsang RSW , Vazquez J , De Wals P . J Infect 2022 85 (6) 611-622 This review summarizes the recent Global Meningococcal Initiative (GMI) regional meeting, which explored meningococcal disease in North America. Invasive meningococcal disease (IMD) cases are documented through both passive and active surveillance networks. IMD appears to be decreasing in many areas, such as the Dominican Republic (2016: 18 cases; 2021: 2 cases) and Panama (2008: 1 case/100,000; 2021: <0.1 cases/100,000); however, there is notable regional and temporal variation. Outbreaks persist in at-risk subpopulations, such as people experiencing homelessness in the US and migrants in Mexico. The recent emergence of β-lactamase-positive and ciprofloxacin-resistant meningococci in the US is a major concern. While vaccination practices vary across North America, vaccine uptake remains relatively high. Monovalent and multivalent conjugate vaccines (which many countries in North America primarily use) can provide herd protection. However, there is no evidence that group B vaccines reduce meningococcal carriage. The coronavirus pandemic illustrates that following public health crises, enhanced surveillance of disease epidemiology and catch-up vaccine schedules is key. Whole genome sequencing is a key epidemiological tool for identifying IMD strain emergence and the evaluation of vaccine strain coverage. The Global Roadmap on Defeating Meningitis by 2030 remains a focus of the GMI. |
Severe Acute Respiratory Infection-Preparedness: Protocol for a Multicenter Prospective Cohort Study of Viral Respiratory Infections.
Postelnicu R , Srivastava A , Bhatraju PK , Wurfelc MM , Anesi GL , Gonzalez M , Andrews A , Lutrick K , Kumar VK , Uyeki TM , Cobb PJ , Segal LN , Brett-Major D , Liebler JM , Kratochvil CJ , Mukherjee V , Broadhurst MJ , Lee R , Wyles D , Sevransky JE , Evans L , Landsittel D . Crit Care Explor 2022 4 (10) e0773 Respiratory virus infections cause significant morbidity and mortality ranging from mild uncomplicated acute respiratory illness to severe complications, such as acute respiratory distress syndrome, multiple organ failure, and death during epidemics and pandemics. We present a protocol to systematically study patients with severe acute respiratory infection (SARI), including severe acute respiratory syndrome coronavirus 2, due to respiratory viral pathogens to evaluate the natural history, prognostic biomarkers, and characteristics, including hospital stress, associated with clinical outcomes and severity. DESIGN: Prospective cohort study. SETTING: Multicenter cohort of patients admitted to an acute care ward or ICU from at least 15 hospitals representing diverse geographic regions across the United States. PATIENTS: Patients with SARI caused by infection with respiratory viruses that can cause outbreaks, epidemics, and pandemics. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Measurements include patient demographics, signs, symptoms, and medications; microbiology, imaging, and associated tests; mechanical ventilation, hospital procedures, and other interventions; and clinical outcomes and hospital stress, with specimens collected on days 0, 3, and 7-14 after enrollment and at discharge. The primary outcome measure is the number of consecutive days alive and free of mechanical ventilation (VFD) in the first 30 days after hospital admission. Important secondary outcomes include organ failure-free days before acute kidney injury, shock, hepatic failure, disseminated intravascular coagulation, 28-day mortality, adaptive immunity, as well as immunologic and microbiologic outcomes. CONCLUSIONS: SARI-Preparedness is a multicenter study under the collaboration of the Society of Critical Care Medicine Discovery, Resilience Intelligence Network, and National Emerging Special Pathogen Training and Education Center, which seeks to improve understanding of prognostic factors associated with worse outcomes and increased resource utilization. This can lead to interventions to mitigate the clinical impact of respiratory virus infections associated with SARI. |
Childcare and School Acute Gastroenteritis Outbreaks: 2009-2020.
Mattison CP , Calderwood LE , Marsh ZA , Wikswo ME , Balachandran N , Kambhampati AK , Gleason ME , Lawinger H , Mirza SA . Pediatrics 2022 150 (5) OBJECTIVES: Acute gastroenteritis (AGE) outbreaks commonly occur in congregate settings, including schools and childcare facilities. These outbreaks disrupt institutions, causing absences and temporary facility closures. This study analyzed the epidemiology of school and childcare AGE outbreaks in the United States. METHODS: We analyzed AGE outbreaks occurring in kindergarten to grade 12 schools and childcare facilities reported via the National Outbreak Reporting System in the United States from 2009 to 2019 and compared this information to 2020 data. Outbreak and case characteristics were compared using the Kruskal-Wallis rank sum test, 2 goodness-of-fit test, and Fisher exact test. RESULTS: From 2009 to 2019, there were 2623 school, 1972 childcare, and 38 school and childcare outbreaks. School outbreaks were larger (median, 29 cases) than childcare outbreaks (median, 10 cases). Childcare outbreaks were longer (median, 15 days) than school outbreaks (median, 9 days). Norovirus (2383 outbreaks; 110190 illnesses) and Shigella spp. (756 outbreaks; 9123 illnesses) were the most reported etiologies. Norovirus was the leading etiology in schools; norovirus and Shigella spp. were dominant etiologies in childcare centers. Most (85.7%) outbreaks were spread via person-to-person contact. In 2020, 123 outbreaks were reported, 85% in the first quarter. CONCLUSIONS: Schools and childcare centers are common AGE outbreak settings in the United States. Most outbreaks were caused by norovirus and Shigella spp. and spread via person-to-person transmission. Fewer outbreaks were reported in 2020 from the COVID-19 pandemic. Prevention and control efforts should focus on interrupting transmission, including environmental disinfection, proper handwashing, safe diapering, and exclusion of ill persons. |
Tuberculosis prevalence, incidence and prevention in a South African cohort of children living with HIV
Anyalechi GE , Bain R , Kindra G , Mogashoa M , Sogaula N , Mutiti A , Arpadi S , Rivadeneira E , Abrams EJ , Teasdale CA . J Trop Pediatr 2022 68 (6) BACKGROUND: We describe tuberculosis (TB) disease among antiretroviral treatment (ART) eligible children living with HIV (CLHIV) in South Africa to highlight TB prevention opportunities. METHODS: In our secondary analysis among 0- to 12-year-old ART-eligible CLHIV in five Eastern Cape Province health facilities from 2012 to 2015, prevalent TB occurred 90 days before or after enrollment; incident TB occurred >90 days after enrollment. Characteristics associated with TB were assessed using logistic and Cox proportional hazards regression with generalized estimating equations. RESULTS: Of 397 enrolled children, 114 (28.7%) had prevalent TB. Higher-income proxy [adjusted odds ratio (aOR) 1.8 [95% confidence interval (CI) 1.3-2.6] for the highest, 1.6 (95% CI 1.6-1.7) for intermediate]; CD4+ cell count <350 cells/µl [aOR 1.6 (95% CI 1.1-2.2)]; and malnutrition [aOR 1.6 (95% CI 1.1-2.6)] were associated with prevalent TB. Incident TB was 5.2 per 100 person-years and was associated with delayed ART initiation [hazard ratio (HR) 4.7 (95% CI 2.3-9.4)], malnutrition [HR 1.8 (95% CI 1.1-2.7)] and absence of cotrimoxazole [HR 2.3 (95% CI 1.0-4.9)]. Among 362 children with data, 8.6% received TB preventive treatment. CONCLUSIONS: Among these CLHIV, prevalent and incident TB were common. Early ART, cotrimoxazole and addressing malnutrition may prevent TB in these children. | BACKGROUND: We describe tuberculosis (TB) in children living with HIV (CLHIV) eligible for HIV treatment in South Africa to highlight opportunities to prevent TB. METHODS: We analyzed additional data from our original study of CLHIV who were 0–12 years old and due to start HIV treatment in five health facilities in Eastern Cape Province from 2012 to 2015 and assessed characteristics associated with existing and new TB. RESULTS: Of 397 enrolled children, 114 (28.7%) had existing TB. Children with a higher measure of household income had higher odds of existing TB. CD4+ cell count <350 cells/µl and malnutrition were also associated with existing TB. There were 5.2 new cases of TB for every 100 child-years. New TB was 4.7 times more likely for children with delayed HIV treatment start, 1.8 times more likely for children with malnutrition and 2.3 times more likely for children who did not get cotrimoxazole. Among 362 children with data, 8.6% received treatment to prevent TB. CONCLUSIONS: Among these CLHIV, existing and new TB were common. Early HIV treatment, cotrimoxazole and addressing malnutrition may prevent TB in these children. | eng |
Ocular Monkeypox - United States, July-September 2022
Cash-Goldwasser S , Labuda SM , McCormick DW , Rao AK , McCollum AM , Petersen BW , Chodosh J , Brown CM , Chan-Colenbrander SY , Dugdale CM , Fischer M , Forrester A , Griffith J , Harold R , Furness BW , Huang V , Kaufman AR , Kitchell E , Lee R , Lehnertz N , Lynfield R , Marsh KJ , Madoff LC , Nicolasora N , Patel D , Pineda R2nd , Powrzanas T , Roberts A , Seville MT , Shah A , Wong JM , Ritter JM , Schrodt CA , Raizes E , Morris SB , Gold JAW . MMWR Morb Mortal Wkly Rep 2022 71 (42) 1343-1347 As of October 11, 2022, a total of 26,577 monkeypox cases had been reported in the United States.* Although most cases of monkeypox are self-limited, lesions that involve anatomically vulnerable sites can cause complications. Ocular monkeypox can occur when Monkeypox virus (MPXV) is introduced into the eye (e.g., from autoinoculation), potentially causing conjunctivitis, blepharitis, keratitis, and loss of vision (1). This report describes five patients who acquired ocular monkeypox during July-September 2022. All patients received treatment with tecovirimat (Tpoxx)(†); four also received topical trifluridine (Viroptic).(§) Two patients had HIV-associated immunocompromise and experienced delays between clinical presentation with monkeypox and initiation of monkeypox-directed treatment. Four patients were hospitalized, and one experienced marked vision impairment. To decrease the risk for autoinoculation, persons with monkeypox should be advised to practice hand hygiene and to avoid touching their eyes, which includes refraining from using contact lenses (2). Health care providers and public health practitioners should be aware that ocular monkeypox, although rare, is a sight-threatening condition. Patients with signs and symptoms compatible with ocular monkeypox should be considered for urgent ophthalmologic evaluation and initiation of monkeypox-directed treatment. Public health officials should be promptly notified of cases of ocular monkeypox. Increased clinician awareness of ocular monkeypox and of approaches to prevention, diagnosis, and treatment might reduce associated morbidity. |
Estimated mortality due to seasonal influenza in southeast of Iran, 2006/2007 to 2011/2012 influenza seasons
Khajehkazemi R , Baneshi MR , Iuliano AD , Roguski KM , Sharifi H , Bresee J , Haghdoost A . Influenza Other Respir Viruses 2022 17 (1) e13061 BACKGROUND: Global estimates showed an estimate of up to 650,000 seasonal influenza-associated respiratory deaths annually. However, the mortality rate of seasonal influenza is unknown for most countries in the WHO Eastern Mediterranean Region, including Iran. We aimed to estimate the excess mortality attributable to seasonal influenza in Kerman province, southeast Iran for the influenza seasons 2006/2007-2011/2012. METHODS: We applied a Serfling model to the weekly total pneumonia and influenza (PI) mortality rate during winter to define the epidemic periods and to the weekly age-specific PI, respiratory, circulatory, and all-cause deaths during non-epidemic periods to estimate baseline mortality. The excess mortality was calculated as the difference between observed and predicted mortality. Country estimates were obtained by multiplying the estimated annual excess death rates by the populations of Iran. RESULTS: We estimated an annual average excess of 40 PI, 100 respiratory, 94 circulatory, and 306 all-cause deaths attributable to seasonal influenza in Kerman; corresponding to annual rates of 1.4 (95% confidence interval [CI] 1.1-1.8) PI, 3.6 (95% CI 2.6-4.8) respiratory, 3.4 (95% CI 2.1-5.2) circulatory, and 11.0 (95% CI 7.3-15.6) all-cause deaths per 100,000 population. Adults ≥75 years accounted for 56% and 53% of all excess respiratory and circulatory deaths, respectively. At country level, we would expect an annual of 1119 PI to 8792 all-cause deaths attributable to seasonal influenza. CONCLUSIONS: Our findings help to define the mortality burden of seasonal influenza, most of which affects adults aged ≥75 years. This study supports influenza prevention and vaccination programs in older adults. |
Progress toward poliomyelitis eradication - Pakistan, January 2021-July 2022
Mbaeyi C , Baig S , Safdar MR , Khan Z , Young H , Jorba J , Wadood ZM , Jafari H , Alam MM , Franka R . MMWR Morb Mortal Wkly Rep 2022 71 (42) 1313-1318 After reporting a single wild poliovirus (WPV) type 1 (WPV1) case in 2021, Pakistan reported 14 cases during April 1-July 31, 2022. Pakistan and Afghanistan are the only countries where endemic WPV transmission has never been interrupted (1). In its current 5-year strategic plan, the Global Polio Eradication Initiative (GPEI) has set a goal of interrupting all WPV1 transmission by the end of 2023 (1-3). The reemergence of WPV cases in Pakistan after 14 months with no case detection has uncovered transmission in southern Khyber Pakhtunkhwa province, the most historically challenging area. This report describes Pakistan's progress toward polio eradication during January 2021-July 2022 and updates previous reports (4,5). As of August 20, 2022, all but one of the 14 WPV1 cases in Pakistan during 2022 have been reported from North Waziristan district in Khyber Pakhtunkhwa. In underimmunized populations, excretion of vaccine virus can, during a period of 12-18 months, lead to reversion to neurovirulence, resulting in circulating vaccine-derived polioviruses (cVDPVs), which can cause paralysis and outbreaks. An outbreak of cVDPV type 2 (cVDPV2), which began in Pakistan in 2019, has been successfully contained; the last case occurred in April 2021 (1,6). Despite program improvements, 400,000-500,000 children continue to be missed during nationwide polio supplementary immunization activities (SIAs),* and recent isolation of poliovirus from sewage samples collected in other provinces suggests wider WPV1 circulation during the ongoing high transmission season. Although vaccination efforts have been recently complicated by months of flooding during the summer of 2022, to successfully interrupt WPV1 transmission in the core reservoirs in southern Khyber Pakhtunkhwa and reach the GPEI goal, emphasis should be placed on further improving microplanning and supervision of SIAs and on systematic tracking and vaccination of persistently missed children in these reservoir areas of Pakistan. |
Key population size estimation to guide HIV epidemic responses in Nigeria: Bayesian analysis of 3-source capture-recapture data
McIntyre AF , Mitchell A , Stafford KA , Nwafor SU , Lo J , Sebastian V , Schwitters A , Swaminathan M , Dalhatu I , Charurat M . JMIR Public Health Surveill 2022 8 (10) e34555 BACKGROUND: Nigeria has the fourth largest burden of HIV globally. Key populations, including female sex workers, men who have sex with men, and people who inject drugs, are more vulnerable to HIV than the general population due to stigmatized and criminalized behaviors. Reliable key population size estimates are needed to guide HIV epidemic response efforts. OBJECTIVE: The objective of our study was to use empirical methods for sampling and analysis to improve the quality of population size estimates of female sex workers, men who have sex with men, and people who inject drugs in 7 states (Akwa Ibom, Benue, Cross River, Lagos, Nasarawa, Rivers, and the Federal Capital Territory) of Nigeria for program planning and to demonstrate improved statistical estimation methods. METHODS: From October to December 2018, we used 3-source capture-recapture to produce population size estimates in 7 states in Nigeria. Hotspots were mapped before 3-source capture-recapture started. We sampled female sex workers, men who have sex with men, and people who inject drugs during 3 independent captures about one week apart. During hotspot encounters, key population members were offered inexpensive, memorable objects unique to each capture round. In subsequent rounds, key population members were offered an object and asked to identify objects received during previous rounds (if any). Correct responses were tallied and recorded on tablets. Data were aggregated by key population and state for analysis. Median population size estimates were derived using Bayesian nonparametric latent-class models with 80% highest density intervals. RESULTS: Overall, we sampled approximately 310,000 persons at 9015 hotspots during 3 independent captures. Population size estimates for female sex workers ranged from 14,500 to 64,300; population size estimates for men who have sex with men ranged from 3200 to 41,400; and population size estimates for people who inject drugs ranged from 3400 to 30,400. CONCLUSIONS: This was the first implementation of these 3-source capture-recapture methods in Nigeria. Our population size estimates were larger than previously documented for each key population in all states. The Bayesian models account for factors, such as social visibility, that influence heterogeneous capture probabilities, resulting in more reliable population size estimates. The larger population size estimates suggest a need for programmatic scale-up to reach these populations, which are at highest risk for HIV. |
Modifications to student quarantine policies in K-12 schools implementing multiple COVID-19 prevention strategies restores in-person education without increasing SARS-CoV-2 transmission risk, January-March 2021.
Dawson P , Worrell MC , Malone S , Fritz SA , McLaughlin HP , Montgomery BK , Boyle M , Gomel A , Hayes S , Maricque B , Lai AM , Neidich JA , Tinker SC , Lee JS , Tong S , Orscheln RC , Charney R , Rebmann T , Mooney J , Rains C , Yoon N , Petit M , Towns K , Goddard C , Schmidt S , Barrios LC , Neatherlin JC , Salzer JS , Newland JG . PLoS One 2022 17 (10) e0266292 OBJECTIVE: To determine whether modified K-12 student quarantine policies that allow some students to continue in-person education during their quarantine period increase schoolwide SARS-CoV-2 transmission risk following the increase in cases in winter 2020-2021. METHODS: We conducted a prospective cohort study of COVID-19 cases and close contacts among students and staff (n = 65,621) in 103 Missouri public schools. Participants were offered free, saliva-based RT-PCR testing. The projected number of school-based transmission events among untested close contacts was extrapolated from the percentage of events detected among tested asymptomatic close contacts and summed with the number of detected events for a projected total. An adjusted Cox regression model compared hazard rates of school-based SARS-CoV-2 infections between schools with a modified versus standard quarantine policy. RESULTS: From January-March 2021, a projected 23 (1%) school-based transmission events occurred among 1,636 school close contacts. There was no difference in the adjusted hazard rates of school-based SARS-CoV-2 infections between schools with a modified versus standard quarantine policy (hazard ratio = 1.00; 95% confidence interval: 0.97-1.03). DISCUSSION: School-based SARS-CoV-2 transmission was rare in 103 K-12 schools implementing multiple COVID-19 prevention strategies. Modified student quarantine policies were not associated with increased school incidence of COVID-19. Modifications to student quarantine policies may be a useful strategy for K-12 schools to safely reduce disruptions to in-person education during times of increased COVID-19 community incidence. |
Insecticidal effects of some selected plant extracts against Anopheles stephensi (Culicidae: Diptera).
Muhammed M , Dugassa S , Belina M , Zohdy S , Irish SR , Gebresilassie A . Malar J 2022 21 (1) 295 BACKGROUND: The use of synthetic insecticides against mosquitoes may lead to resistance development and potential health hazards in humans and the environment. Consequently, a paradigm needs to shift towards the alternative use of botanical insecticides that could strengthen an insecticide resistance management programme. This study aimed to assess the insecticidal effects aqueous, hexane, and methanol crude leaf extracts of Calpurnia aurea, Momordica foetida, and Zehneria scabra on an insectary colony of Anopheles stephensi larvae and adults. METHODS: Fresh leaves of C. aurea, M. foetida and Z. scabra were collected and dried, then separately ground to powder. Powdered leaves of test plants were extracted using sonication with aqueous, hexane, and methanol solvents. The extracts were concentrated, and a stock solution was prepared. For comparison, Temephos (Abate®) and control solutions (a mixture of water and emulsifier) were used as the positive and negative controls, respectively. Different test concentrations for the larvae and the adults were prepared and tested according to WHO (2005) and CDC (2010) guidelines to determine lethal concentration (LC) values. Mortality was observed after 24 h exposure. The statistical analyses were performed using Statistical Package for the Social Sciences (SPSS) software (Kruskal-Wallis test) and R software (a generalized linear model was used to determine LC(50) and LC(90) values of the extracts). RESULTS: The lowest LC(50) values were observed in aqueous extracts of M. foetida followed by Z. scabra extract and C. aurea leaves at 34.61, 35.85, and 38.69 ppm, respectively, against the larvae. Larval mortality was not observed from the hexane extracts and negative control, while the standard larvicide (temephos) achieved 100% mortality. Further, the adulticidal efficacy was greatest for aqueous extract of Z. scabra with LC(50) = 176.20 ppm followed by aqueous extract of C. aurea (LC(50) = 297.75 ppm). CONCLUSION: The results suggest that the leaf extracts of the three test plants have the potential of being used for the control of vector An. stephensi larvae and adult instead of synthetic mosquitocides. Further studies need to be conducted to identify the active ingredients and their mode of action. |
Genomic Basis for Individual Differences in Susceptibility to the Neurotoxic Effects of Diesel Exhaust.
No , l A , Ashbrook DG , Xu F , Cormier SA , Lu L , O'Callaghan JP , Menon SK , Zhao W , Penn AL , Jones BC . Int J Mol Sci 2022 23 (20) 12461 Air pollution is a known environmental health hazard. A major source of air pollution includes diesel exhaust (DE). Initially, research on DE focused on respiratory morbidities; however, more recently, exposures to DE have been associated with neurological developmental disorders and neurodegeneration. In this study, we investigated the effects of sub-chronic inhalation exposure to DE on neuroinflammatory markers in two inbred mouse strains and both sexes, including whole transcriptome examination of the medial prefrontal cortex. We exposed aged male and female C57BL/6J (B6) and DBA/2J (D2) mice to DE, which was cooled and diluted with HEPA-filtered compressed air for 2 h per day, 5 days a week, for 4 weeks. Control animals were exposed to HEPA-filtered air on the same schedule as DE-exposed animals. The prefrontal cortex was harvested and analyzed for proinflammatory cytokine gene expression (Il1ß, Il6, Tnfa) and transcriptome-wide response by RNA-seq. We observed differential cytokine gene expression between strains and sexes in the DE-exposed vs. control-exposed groups for Il1ß, Tnfa, and Il6. For RNA-seq, we identified 150 differentially expressed genes between air and DE treatment related to natural killer cell-mediated cytotoxicity per Kyoto Encyclopedia of Genes and Genomes pathways. Overall, our data show differential strain-related effects of DE on neuroinflammation and neurotoxicity and demonstrate that B6 are more susceptible than D2 to gene expression changes due to DE exposures than D2. These results are important because B6 mice are often used as the default mouse model for DE studies and strain-related effects of DE neurotoxicity warrant expanded studies. |
Dual use of antifungals in medicine and agriculture: How do we help prevent resistance developing in human pathogens?
Verweij PE , Arendrup MC , Alastruey-Izquierdo A , Gold JAW , Lockhart SR , Chiller T , White PL . Drug Resist Updat 2022 65 100885 Azole resistance in Aspergillus fumigatus is a One Health resistance threat, where azole fungicide exposure compromises the efficacy of medical azoles. The use of the recently authorized fungicide ipflufenoquin, which shares its mode-of-action with a new antifungal olorofim, underscores the need for risk assessment for dual use of antifungals. |
Secondhand smoke exposure inside the home among adults in eight countries in Sub-Saharan Africa: Global Adult Tobacco Survey, 2012-2018
Mbulo L , Palipudi K , Smith T , Owusu D , Williams F , Dean AK , Mamudu HM . Nicotine Tob Res 2022 25 (4) 828-837 INTRODUCTION: Secondhand tobacco smoke (SHS) exposure causes diseases and death in adults and children. Evidence indicates that most SHS exposures occur at home and in workplace. Therefore, home is a major place where adults and children can be effectively protected from SHS. This study examined the magnitude of SHS exposure at home and associated factors in eight sub-Saharan African countries. METHODS: We analyzed 2012-2018 Global Adult Tobacco Survey data for Botswana, Cameroon, Ethiopia, Kenya, Nigeria, Senegal, Tanzania, and Uganda. We computed prevalence estimates of self-reported monthly SHS exposure at home reported as anyone smoke inside their home daily, weekly or monthly. We calculated SHS exposure at home prevalence and applied multivariable logistic regression models to identify related factors. RESULTS: Overall median prevalence of SHS exposure at home was 13.8% in the eight countries; ranging from 6.6% (95% CI: 5.7%, 7.6%) in Nigeria to 21.6% (95% CI: 19.4%, 24.0%) in Senegal. In multivariable analysis across the countries, SHS exposure at home was associated with living with a smoker, ranging from an adjusted odds ratio (aOR) of 4.6 (95% CI: 3.6, 5.8) in Botswana to 27.6 (95% CI: 20.1, 37.8) in Nigeria. SHS exposure at home was significantly associated with lower education attainment (Kenya, and Ethiopia), and lower wealth index (Uganda, Senegal, and Botswana). CONCLUSION: SHS exposure in homes was associated with the presence of a smoker in the home and lower socioeconomic status. |
Foodborne illness outbreaks linked to unpasteurized milk and relationship to changes in state laws - United States, 1998-2018
Koski L , Kisselburgh H , Landsman L , Hulkower R , Howard-Williams M , Salah Z , Kim S , Bruce BB , Bazaco MC , Batz MB , Parker CC , Leonard CL , Datta AR , Williams EN , Stapleton GS , Penn M , Whitham HK , Nichols M . Epidemiol Infect 2022 150 1-34 Consumption of unpasteurised milk in the United States has presented a public health challenge for decades because of the increased risk of pathogen transmission causing illness outbreaks. We analysed Foodborne Disease Outbreak Surveillance System data to characterise unpasteurised milk outbreaks. Using Poisson and negative binomial regression, we compared the number of outbreaks and outbreak-associated illnesses between jurisdictions grouped by legal status of unpasteurised milk sale based on a May 2019 survey of state laws. During 2013-2018, 75 outbreaks with 675 illnesses occurred that were linked to unpasteurised milk; of these, 325 illnesses (48%) were among people aged 0-19 years. Of 74 single-state outbreaks, 58 (78%) occurred in states where the sale of unpasteurised milk was expressly allowed. Compared with jurisdictions where retail sales were prohibited (n = 24), those where sales were expressly allowed (n = 27) were estimated to have 3.2 (95% CI 1.4-7.6) times greater number of outbreaks; of these, jurisdictions where sale was allowed in retail stores (n = 14) had 3.6 (95% CI 1.3-9.6) times greater number of outbreaks compared with those where sale was allowed on-farm only (n = 13). This study supports findings of previously published reports indicating that state laws resulting in increased availability of unpasteurised milk are associated with more outbreak-associated illnesses and outbreaks. |
SOPHIE: Viral outbreak investigation and transmission history reconstruction in a joint phylogenetic and network theory framework.
Skums P , Mohebbi F , Tsyvina V , Baykal PI , Nemira A , Ramachandran S , Khudyakov Y . Cell Syst 2022 13 (10) 844-856.e4 Genomic epidemiology is now widely used for viral outbreak investigations. Still, this methodology faces many challenges. First, few methods account for intra-host viral diversity. Second, maximum parsimony principle continues to be employed for phylogenetic inference of transmission histories, even though maximum likelihood or Bayesian models are usually more consistent. Third, many methods utilize case-specific data, such as sampling times or infection exposure intervals. This impedes study of persistent infections in vulnerable groups, where such information has a limited use. Finally, most methods implicitly assume that transmission events are independent, although common source outbreaks violate this assumption. We propose a maximum likelihood framework, SOPHIE, based on the integration of phylogenetic and random graph models. It infers transmission networks from viral phylogenies and expected properties of inter-host social networks modeled as random graphs with given expected degree distributions. SOPHIE is scalable, accounts for intra-host diversity, and accurately infers transmissions without case-specific epidemiological data. |
Tips for health care providers on talking with patients who have intellectual and developmental disabilities about COVID-19.
Flores Alina L , Holt Sidney , Lynch Molly McKnight , Squiers Linda , Walker Kathleen , Ligon Jillian . J Commun Healthc 2022 15 (4) 1-5 Background | One in four American adults reports having at least one disability. The COVID-19 pandemic has disproportionately impacted people with disabilities and widened already-existing health disparities and inequities. For many people with intellectual and developmental disabilities (IDD), these disparities are compounded by literacy limitations that make it challenging to access, understand, and act upon critical COVID-19 prevention information. | Methods | Using a design thinking framework, we conducted interviews with 27 caregivers of adults with IDD who also have extreme low literacy (ELL) to assess COVID-19 information needs and recommendations for how health care providers could best provide COVID-19 information. Based on our findings, we developed a draft tip sheet to help health care providers communicate with adults with IDD/ELL about COVID-19. We then tested the tip sheet with six health care providers via a focus group discussion. We refined and finalized the tip sheet based on our focus group findings. | Results | Caregivers noted the importance of visual aids, repetition, empathy and addressing the person with IDD/ELL directly when discussing COVID-19. Many health care providers indicated that the tip sheet would be most helpful for those with limited experience with patients with IDD/ELL and specific instructions for implementing the tips would be important. | Conclusions | We developed an evidence-informed tip sheet to facilitate communication between health care providers and adults with IDD/ELL and their caregivers, particularly around COVID-19. |
Trends and factors associated with change in COVID-19 vaccination intent among residents and staff in six Seattle homeless shelters, March 2020 to August 2021.
Cox SN , Rogers JH , Thuo NB , Meehan A , Link AC , Lo NK , Manns BJ , Chow EJ , Al Achkar M , Hughes JP , Rolfes MA , Mosites E , Chu HY . Vaccine X 2022 12 100232 INTRODUCTION: Achieving high COVID-19 vaccination coverage in homeless shelters is critical in preventing morbidity, mortality, and outbreaks, however, vaccination coverage remains lower among people experiencing homelessness (PEH) than the general population. METHODS: We conducted a cross-sectional study to retrospectively describe attitudes and identify factors associated with change in COVID-19 vaccination intent among shelter residents and staff during March 2020 - August 2021. To identify factors associated with change in COVID-19 vaccine intent becoming more positive overall compared to other attitudes, we utilized a Poisson model to calculate Risk Ratios with robust standard errors, adjusting for confounding by shelter site and demographic variables determined a priori. RESULTS: From July 12 - August 2, 2021, 97 residents and 20 staff participated in surveys across six shelters in Seattle King County, Washington. Intent to be vaccinated against COVID-19 increased from 45.3% (n=53) when recalling attitudes in March 2020 to 74.4% (n=87) as of August 2021, and was similar among residents and staff. Many participants (43.6%, n=51) indicated feeling increasingly accepting about receiving a COVID-19 vaccine since March 2020, while 13.7% (n=16) changed back and forth, 10.3% (n=12) became more hesitant, and 32.5% (n=38) had no change in intent. In the model examining the relationship between becoming more positive about receiving a COVID-19 vaccine compared to all other attitudes (n=116), we found a 57.2% increase in vaccine acceptability (RR 1.57; 95% CI: 1.01, 2.45) among those who reported worsening mental health since the start of the pandemic. CONCLUSIONS: Findings highlight opportunities to improve communication with residents and staff about COVID-19 vaccination and support a need for continued dialogue and a person-centered approach to understanding the sociocultural complexities and dynamism of vaccine attitudes at shelters.Clinical Trial Registry Number: NCT04141917. |
Effectiveness of COVID-19 mRNA Vaccines Against COVID-19-Associated Hospitalizations Among Immunocompromised Adults During SARS-CoV-2 Omicron Predominance - VISION Network, 10 States, December 2021-August 2022.
Britton A , Embi PJ , Levy ME , Gaglani M , DeSilva MB , Dixon BE , Dascomb K , Patel P , Schrader KE , Klein NP , Ong TC , Natarajan K , Hartmann E , Kharbanda AB , Irving SA , Dickerson M , Dunne MM , Raiyani C , Grannis SJ , Stenehjem E , Zerbo O , Rao S , Han J , Sloan-Aagard C , Griggs EP , Weber ZA , Murthy K , Fadel WF , Grisel N , McEvoy C , Lewis N , Barron MA , Nanez J , Reese SE , Mamawala M , Valvi NR , Arndorfer J , Goddard K , Yang DH , Fireman B , Ball SW , Link-Gelles R , Naleway AL , Tenforde MW . MMWR Morb Mortal Wkly Rep 2022 71 (42) 1335-1342 Persons with moderate-to-severe immunocompromising conditions might have reduced protection after COVID-19 vaccination, compared with persons without immunocompromising conditions (1-3). On August 13, 2021, the Advisory Committee on Immunization Practices (ACIP) recommended that adults with immunocompromising conditions receive an expanded primary series of 3 doses of an mRNA COVID-19 vaccine. ACIP followed with recommendations on September 23, 2021, for a fourth (booster) dose and on September 1, 2022, for a new bivalent mRNA COVID-19 vaccine booster dose, containing components of the BA.4 and BA.5 sublineages of the Omicron (B.1.1.529) variant (4). Data on vaccine effectiveness (VE) of monovalent COVID-19 vaccines among persons with immunocompromising conditions since the emergence of the Omicron variant in December 2021 are limited. In the multistate VISION Network,(§) monovalent 2-, 3-, and 4-dose mRNA VE against COVID-19-related hospitalization were estimated among adults with immunocompromising conditions(¶) hospitalized with COVID-19-like illness,** using a test-negative design comparing odds of previous vaccination among persons with a positive or negative molecular test result (case-patients and control-patients) for SARS-CoV-2 (the virus that causes COVID-19). During December 16, 2021-August 20, 2022, among SARS-CoV-2 test-positive case-patients, 1,815 (36.3%), 1,387 (27.7%), 1,552 (31.0%), and 251 (5.0%) received 0, 2, 3, and 4 mRNA COVID-19 vaccine doses, respectively. Among test-negative control-patients during this period, 6,928 (23.7%), 7,411 (25.4%), 12,734 (43.6%), and 2,142 (7.3%) received these respective doses. Overall, VE against COVID-19-related hospitalization among adults with immunocompromising conditions hospitalized for COVID-like illness during Omicron predominance was 36% ≥14 days after dose 2, 69% 7-89 days after dose 3, and 44% ≥90 days after dose 3. Restricting the analysis to later periods when Omicron sublineages BA.2/BA.2.12.1 and BA.4/BA.5 were predominant and 3-dose recipients were eligible to receive a fourth dose, VE was 32% ≥90 days after dose 3 and 43% ≥7 days after dose 4. Protection offered by vaccination among persons with immunocompromising conditions during Omicron predominance was moderate even after a 3-dose monovalent primary series or booster dose. Given the incomplete protection against hospitalization afforded by monovalent COVID-19 vaccines, persons with immunocompromising conditions might benefit from updated bivalent vaccine booster doses that target recently circulating Omicron sublineages, in line with ACIP recommendations. Further, additional protective recommendations for persons with immunocompromising conditions, including the use of prophylactic antibody therapy, early access to and use of antivirals, and enhanced nonpharmaceutical interventions such as well-fitting masks or respirators, should also be considered. |
Effectiveness of Monovalent mRNA Vaccines Against COVID-19-Associated Hospitalization Among Immunocompetent Adults During BA.1/BA.2 and BA.4/BA.5 Predominant Periods of SARS-CoV-2 Omicron Variant in the United States - IVY Network, 18 States, December 26, 2021-August 31, 2022.
Surie D , Bonnell L , Adams K , Gaglani M , Ginde AA , Douin DJ , Talbot HK , Casey JD , Mohr NM , Zepeski A , McNeal T , Ghamande S , Gibbs KW , Files DC , Hager DN , Shehu A , Frosch AP , Erickson HL , Gong MN , Mohamed A , Johnson NJ , Srinivasan V , Steingrub JS , Peltan ID , Brown SM , Martin ET , Khan A , Bender WS , Duggal A , Wilson JG , Qadir N , Chang SY , Mallow C , Rivas C , Kwon JH , Exline MC , Lauring AS , Shapiro NI , Halasa N , Chappell JD , Grijalva CG , Rice TW , Stubblefield WB , Baughman A , Womack KN , Hart KW , Swan SA , Zhu Y , DeCuir J , Tenforde MW , Patel MM , McMorrow ML , Self WH . MMWR Morb Mortal Wkly Rep 2022 71 (42) 1327-1334 The SARS-CoV-2 Omicron variant (B.1.1.529 or BA.1) became predominant in the United States by late December 2021 (1). BA.1 has since been replaced by emerging lineages BA.2 (including BA.2.12.1) in March 2022, followed by BA.4 and BA.5, which have accounted for a majority of SARS-CoV-2 infections since late June 2022 (1). Data on the effectiveness of monovalent mRNA COVID-19 vaccines against BA.4/BA.5-associated hospitalizations are limited, and their interpretation is complicated by waning of vaccine-induced immunity (2-5). Further, infections with earlier Omicron lineages, including BA.1 and BA.2, reduce vaccine effectiveness (VE) estimates because certain persons in the referent unvaccinated group have protection from infection-induced immunity. The IVY Network(†) assessed effectiveness of 2, 3, and 4 doses of monovalent mRNA vaccines compared with no vaccination against COVID-19-associated hospitalization among immunocompetent adults aged ≥18 years during December 26, 2021-August 31, 2022. During the BA.1/BA.2 period, VE 14-150 days after a second dose was 63% and decreased to 34% after 150 days. Similarly, VE 7-120 days after a third dose was 79% and decreased to 41% after 120 days. VE 7-120 days after a fourth dose was 61%. During the BA.4/BA.5 period, similar trends were observed, although CIs for VE estimates between categories of time since the last dose overlapped. VE 14-150 days and >150 days after a second dose was 83% and 37%, respectively. VE 7-120 days and >120 days after a third dose was 60%and 29%, respectively. VE 7-120 days after the fourth dose was 61%. Protection against COVID-19-associated hospitalization waned even after a third dose. The newly authorized bivalent COVID-19 vaccines include mRNA from the ancestral SARS-CoV-2 strain and from shared mRNA components between BA.4 and BA.5 lineages and are expected to be more immunogenic against BA.4/BA.5 than monovalent mRNA COVID-19 vaccines (6-8). All eligible adults aged ≥18 years(§) should receive a booster dose, which currently consists of a bivalent mRNA vaccine, to maximize protection against BA.4/BA.5 and prevent COVID-19-associated hospitalization. |
Influenza and COVID-19 Vaccination Coverage Among Health Care Personnel - United States, 2021-22.
Razzaghi H , Srivastav A , de Perio MA , Laney AS , Black CL . MMWR Morb Mortal Wkly Rep 2022 71 (42) 1319-1326 The Advisory Committee on Immunization Practices (ACIP) and CDC recommend that all health care personnel (HCP) receive annual influenza vaccination to reduce influenza-related morbidity and mortality among these personnel and their patients (1). ACIP also recommends that all persons aged ≥6 months, including HCP, be vaccinated with COVID-19 vaccines and remain up to date (2,3). During March 29-April 19, 2022, CDC conducted an opt-in Internet panel survey of 3,618 U.S. HCP to estimate influenza vaccination coverage during the 2021-22 influenza season as well as receipt of the primary COVID-19 vaccination series and a booster dose. Influenza vaccination coverage was 79.9% during the 2021-22 season, and 87.3% of HCP reported having completed the primary COVID-19 vaccination series; among these HCP, 67.1% reported receiving a COVID-19 booster dose. Among HCP, influenza, COVID-19 primary series, and COVID-19 booster dose vaccination coverage were lowest among assistants and aides, those working in long-term care (LTC) or home health care settings, and those whose employer neither required nor recommended the vaccines. Overall, employer requirements for influenza and COVID-19 primary series vaccines were reported by 43.9% and 59.9% of HCP, respectively; among HCP who completed the primary series of COVID-19 vaccines, 23.5% reported employer requirements for COVID-19 booster vaccines. Vaccination coverage for all three vaccine measures was higher among HCP who reported employer vaccination requirements and ranged from 95.8% to 97.3% for influenza, 90.2% to 95.1% for COVID-19 primary series, and 76.4% to 87.8% for COVID-19 booster vaccinations among HCP who completed the primary series of COVID-19 vaccines, by work setting. Implementing workplace strategies demonstrated to improve vaccination coverage among HCP, including vaccination requirements or active promotion of vaccination, can increase influenza and COVID-19 vaccination coverage among HCP and reduce influenza and COVID-19-related morbidity and mortality among HCP and their patients (4). |
Pediatric Infection-Induced SARS-CoV-2 Seroprevalence Increases and Seroprevalence by Type of Clinical Care-September 2021-February 2022.
Clarke KEN , Kim Y , Jones J , Lee A , Deng Y , Nycz E , Iachan R , Gundlapalli AV , MacNeil A , Hall A . J Infect Dis 2022 227 (3) 364-370 BACKGROUND AND OBJECTIVES: Trends in estimates of US pediatric SARS-CoV-2 infection-induced seroprevalence from commercial laboratory specimens may overrepresent children with frequent healthcare needs. We examined seroprevalence trends and compared seroprevalence estimates by testing type and diagnostic coding. METHODS: Cross-sectional convenience samples of residual sera between September 2021 and February 2022 from 52 U.S. jurisdictions were assayed for infection-induced SARS-CoV-2 antibodies; monthly seroprevalence estimates were calculated by age group. Multivariate logistic analyses compared seroprevalence estimates for specimens associated with ICD-10 codes and laboratory orders indicating well-child care with estimates for other pediatric specimens. RESULTS: Infection-induced SARS-CoV-2 seroprevalence increased in each age group; from 30% to 68% (1-4 years), 38% to 77% (5-11 years), and 40% to 74% (12-17 years). On multivariate analysis, patients with well-child ICD-10 codes were seropositive more often than other patients aged 1-17 years (adjusted prevalence ratio [aPR] 1.04; 95% CI 1.02-1.07); children aged 9-11 years receiving standard lipid screening were seropositive more often than those receiving other laboratory tests (1.05; 1.02-1.08). CONCLUSIONS: Infection-induced seroprevalence more than doubled among children under 12 between September 2021 and February 2022, and increased 85% in adolescents. Differences in seroprevalence by care type did not substantially impact US pediatric seroprevalence estimates. |
Where are children ages 5-17 years receiving their COVID-19 vaccinations? Variations over time and by sociodemographic characteristics, United States.
Santibanez TA , Black CL , Vogt TM , Chatham-Stephens K , Zhou T , Lendon JP , Singleton JA . Vaccine 2022 40 (48) 6917-6923 BACKGROUND: Knowing the settings where children ages 5-17 years received COVID-19 vaccination in the United States, and how settings changed over time and varied by socio-demographics, is of interest for planning and implementing vaccination programs. METHODS: Data from the National Immunization Survey-Child COVID-19 Module (NIS-CCM) were analyzed to assess place of COVID-19 vaccination among vaccinated children ages 5-17 years. Interviews from July 2021 thru May 2022 were included in the analyses for a total of n = 39,286 vaccinated children. The percentage of children receiving their COVID-19 vaccine at each type of setting was calculated overall, by sociodemographic characteristics, and by month of receipt of COVID-19 vaccine. RESULTS: Among vaccinated children ages 5-11 years, 46.9 % were vaccinated at a medical place, 37.1 % at a pharmacy, 8.1 % at a school, 4.7 % at a mass vaccination site, and 3.2 % at some other non-medical place. Among vaccinated children ages 12-17 years, 35.1 % were vaccinated at a medical place, 47.9 % at a pharmacy, 8.3 % at a mass vaccination site, 4.8 % at a school, and 4.0 % at some other non-medical place. The place varied by time among children ages 12-17 years but minimally for children ages 5-11 years. There was variability in the place of COVID-19 vaccination by age, race/ethnicity, health insurance, urbanicity, and region. CONCLUSION: Children ages 5-17 years predominantly received their COVID-19 vaccinations at pharmacies and medical places. The large proportion of vaccinated children receiving vaccination at pharmacies is indicative of the success in the United States of expanding the available settings where children could be vaccinated. Medical places continue to play a large role in vaccinating children, especially younger children, and should continue to stock COVID-19 vaccine to keep it available for those who are not yet vaccinated, including the newly recommended group of children < 5 years. |
Report of the 2nd workshop of the International Collaboration on advanced vaccinology training.
Duclos P , MacDonald NE , Dochez C , Thacker N , Steffen CA , Nohynek H , Lambert PH , Wharton M . Vaccine 2022 40 (47) 6689-6699 At a workshop on 22-24 March 2022, leaders of 33 advanced vaccinology courses were invited to meet with partners to further the aims of the International Collaboration on Advanced Vaccinology Training (ICAVT) initiated in 2018 to assist courses in addressing challenges in priority areas and facilitate interactions and exchange of information. This included: an update to the landscape analysis of advanced vaccinology courses conducted in 2018, sharing experiences and good practices in the implementation of virtual training, reviewing the training needs of target audiences, informing courses of the principles, challenges, and added value of accreditation, discussing course evaluations and measurement of course impact, reviewing principles and support needed for quality cascade training, reviewing COVID-19 impact on training and identifying remaining related training needs, and identifying solutions to facilitate refresher courses and ways to facilitate networking of courses' alumni (particularly for virtual courses). The aims were to identify needs and impediments and implement necessary actions to facilitate sharing of information and resources between courses, to identify need for further developments of the e-Portal of the Collaboration (icavt.org) established to facilitate communication between the different courses and assist future course participants identify the most suitable course for them, and to discuss the formalization of the Collaboration. During the workshop, participants looked at several reports of surveys completed by courses and courses' alumni or partners. The COVID-19 pandemic impacted the delivery of some vaccinology courses leading to postponement, delivery online or hybrid training events. Lack of sustainable funding remained a major constraint for advanced vaccinology training and needs to be addressed. The Collaboration was consolidated with responsibilities and benefits for the members better defined. There was strong support for the Collaboration to continue with the organization of educational sessions at future workshops. The meeting re-enforced the view that there was much enthusiasm and commitment for the Global Collaboration and its core values. |
Development of antibody-dependent cellular cytotoxicity in response to recombinant and live-attenuated herpes zoster vaccines
Park SY , Levin MJ , Canniff J , Johnson M , Schmid DS , Weinberg A . NPJ Vaccines 2022 7 (1) 123 Zoster vaccines generate antibody responses against varicella-zoster virus (VZV). We compared antibody-dependent cell cytotoxicity (ADCC) elicited by zoster vaccine live (ZVL) and recombinant zoster vaccine (RZV). ADCC mediated by antibodies against VZV lysate (VZV-ADCC) and recombinant glycoprotein E (gE-ADCC) was measured using plasma from 20 RZV- and 20 ZVL-recipients, including half 50-60-years-old and half 70-years-old. Solid phase-bound anti-VZV antibodies stimulated TNF in NK cells as measured by flow cytometry or ELISA. VZV-ADCC pre- and post-immunization was higher in younger vaccinees. ZVL did not appreciably increase VZV-ADCC, whereas RZV increased VZV-ADCC in older vaccinees. ELISA-measured gE-ADCC was similar across groups pre-immunization; significantly increased after ZVL; and RZV and was higher in younger RZV than ZVL recipients. IgG3 antibodies increased after RZV and ZVL, with greater anti-gE than anti-VZV responses. Moreover, gE-ADCC strongly correlated with anti-gE antibody avidity, but there were no appreciable correlations between VZV-ADCC and avidity. NK cells stimulated by anti-gE antibodies showed increased IFN and CD107a expression, which was not observed with anti-VZV antibodies. In conclusion, anti-gE antibodies generated more robust ADCC than anti-VZV antibodies. RZV induced higher ADCC antibodies than ZVL depending on the antigen and age of vaccinees. Older adults had lower ADCC antibodies before and after vaccination than younger adults. |
Child maltreatment reporting during the initial weeks of COVID-19 in the US: Findings from NCANDS.
Shusterman GR , Fluke JD , Nunez JJ , Fettig NB , Kebede BK . Child Abuse Negl 2022 134 105929 BACKGROUND: After the national COVID-19 emergency declaration in the U.S. in March 2020, child welfare agencies observed large reductions in maltreatment reporting. OBJECTIVE: To quantify the impact of the COVID-19 pandemic on child maltreatment reporting nationally to inform policy for future emergencies. PARTICIPANTS AND SETTING: Administrative data from the National Child Abuse and Neglect Data System (NCANDS) for 48 states for federal fiscal years (FFYs) 2017 through 2020. METHODS: Analyses focused on reports to child protective services (CPS) between weeks 12 and 24 of calendar years 2017 through 2020 (mid-March through mid-June). Report sources of screened in and substantiated reports were compared with those during the prior year. Likelihood of a report being substantiated in 2020 compared with 2019 based on report source was calculated using odds ratios. RESULTS: In 2020, CPS screened in 39% fewer reports than during the same period in 2019 and the proportion of reports substantiated increased from 18 to 22%. Reports from all report sources decreased, especially from education personnel (90% decrease) and child daycare providers (65% decrease). The odds for substantiation were significantly higher during 2020 than in 2019 for reports from all but three sources. CONCLUSION: During the initial weeks following the national COVID-19 emergency declaration, the number of reports to CPS declined sharply at the national level and across all states, primarily in association with a large reduction in referrals from education sentinels. Explanations for the increase in percent of substantiation in the context of reduction of reports are considered. |
How the Global Violence Against Children and Youth surveys help improve pediatric global health
Agathis NT , Annor FB , Mercy J , Chiang L , de Barros RB , Massetti GM . Pediatrics 2022 150 (5) Violence against children is a prevalent, impactful, yet preventable global public health problem. At least half of all children in the world experience violence (physical, sexual, or emotional) every year.1 Aside from its ethical implications and the immediate physical and emotional harm it causes, childhood violence is strongly associated with poor short- and long-term health: increased odds of mental health problems, noncommunicable diseases, sexual and reproductive health problems, health risk behaviors, and experiencing and perpetrating violence in adulthood.2 Childhood violence is also associated with increased risk of HIV acquisition and reduced odds of engagement in HIV clinical prevention services, testing, treatment, and care among youth in high HIV-incidence settings.3–5 |
Variant APOL1 protein in plasma associates with larger particles in humans and mouse models of kidney injury.
Andrews M , Yoshida T , Henderson CM , Pflaum H , McGregor A , Lieberman JA , de Boer IH , Vaisar T , Himmelfarb J , Kestenbaum B , Chung JY , Hewitt SM , Santo BA , Ginley B , Sarder P , Rosenberg AZ , Murakami T , Kopp JB , Kuklenyik Z , Hoofnagle AN . PLoS One 2022 17 (10) e0276649 BACKGROUND: Genetic variants in apolipoprotein L1 (APOL1), a protein that protects humans from infection with African trypanosomes, explain a substantial proportion of the excess risk of chronic kidney disease affecting individuals with sub-Saharan ancestry. The mechanisms by which risk variants damage kidney cells remain incompletely understood. In preclinical models, APOL1 expressed in podocytes can lead to significant kidney injury. In humans, studies in kidney transplant suggest that the effects of APOL1 variants are predominantly driven by donor genotype. Less attention has been paid to a possible role for circulating APOL1 in kidney injury. METHODS: Using liquid chromatography-tandem mass spectrometry, the concentrations of APOL1 were measured in plasma and urine from participants in the Seattle Kidney Study. Asymmetric flow field-flow fractionation was used to evaluate the size of APOL1-containing lipoprotein particles in plasma. Transgenic mice that express wild-type or risk variant APOL1 from an albumin promoter were treated to cause kidney injury and evaluated for renal disease and pathology. RESULTS: In human participants, urine concentrations of APOL1 were correlated with plasma concentrations and reduced kidney function. Risk variant APOL1 was enriched in larger particles. In mice, circulating risk variant APOL1-G1 promoted kidney damage and reduced podocyte density without renal expression of APOL1. CONCLUSIONS: These results suggest that plasma APOL1 is dynamic and contributes to the progression of kidney disease in humans, which may have implications for treatment of APOL1-associated kidney disease and for kidney transplantation. |
Breast Milk Feeding of Infants at Birth Among People With Confirmed SARS-CoV-2 Infection in Pregnancy: SET-NET, 5 States, March 29, 2020-December 31, 2020.
Lewis EL , Smoots AN , Woodworth KR , Olsen EO , Roth NM , Yazdy M , Shephard H , Sizemore L , Wingate H , Dzimira P , Reynolds B , Lush M , Fuchs EL , Ojo K , Siebman S , Hall AJ , Azziz-Baumgartner E , Perrine C , Hsia J , Ellington S , Tong VT , Gilboa SM . Am J Public Health 2022 112 S787-s796 Objectives. To describe prevalence of breast milk feeding among people with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy and examine associations between breast milk feeding, timing of maternal infection before delivery, and rooming-in status during delivery hospitalization. Methods. We performed a retrospective cohort study using data from Massachusetts, Minnesota, Nebraska, Pennsylvania, and Tennessee of whether people with confirmed SARS-CoV-2 infection during pregnancy in 2020 initiated breast milk feeding at birth. Results. Among 11114 (weighted number) people with SARS-CoV-2 infection in pregnancy, 86.5% (95% confidence interval [CI]=82.4%, 87.6%) initiated breast milk feeding during birth hospitalization. People with infection within 14 days before delivery had significantly lower prevalence of breast milk feeding (adjusted prevalence ratio [APR]=0.88; 95% CI=0.83, 0.94) than did those with infection at least 14 days before delivery. When stratified by rooming-in status, the association between timing of infection and breast milk feeding remained only among infants who did not room in with their mother (APR=0.77; 95% CI=0.68, 0.88). Conclusions. Pregnant and postpartum people with SARS-CoV-2 infection should have access to lactation support and be advised about the importance of breast milk feeding and how to safely feed their infants in the same room. (Am J Public Health. 2022;112(S8):S787-S796. https://doi.org/10.2105/AJPH.2022.307023). |
Leveraging federal, state, and facility-level early care and education systems and providers toward optimal child nutrition in the first 1000 days
Dooyema CA , Hall K , Tovar A , Bauer KW , Lowry-Warnock A , Blanck HM . Am J Public Health 2022 112 S779-s784 Early childhood is a critical period in the development, growth, and health of children. Many infants and toddlers in the United States spend time in nonparental early care and education (ECE) arrangements, which include care from child-care centers, family child-care homes, family members, and neighbors, or a combination of these providers. As of 2019, 14% of infants (0–12 months of age) and 27% of toddlers (1–2 years) participated in a center-based care arrangement; however, these statistics do not account for children cared for in family child-care homes, which are also an important source of care for this age group.1 |
Timeliness of early identification and referral of infants with social and environmental risks
Fauth RC , Kotake C , Manning SE , Goldberg JL , Easterbrooks MA , Buxton B , Downs K . Prev Sci 2022 24 (1) 1-11 The Early Intervention Parenting Partnerships (EIPP) program is a home visiting program that provides home visits, group services, assessments and screenings, and referrals delivered by a multidisciplinary team to expectant parents and families with infants who experience socioeconomic barriers, emotional and behavioral health challenges, or other stressors. The present study examines whether EIPP successfully meets its aims of screening families for social and environmental factors that may increase the risk of children's developmental delays and connect them to the larger statewide early intervention (EI) system relative to families with similar background characteristics who do not receive EIPP. Coarsened exact matching was used to match EIPP participants who enrolled between 2013 and 2017 to a comparison group of families identified from birth certificates. Primary study outcomes including EI referrals, evaluations, and service receipt for children from 3 months to 3 years were measured using EI program data. Secondary outcomes included EI referral source, EI eligibility criteria (e.g., presence of biological, social, or environmental factors that may increase later risk for developmental delay), and information on service use. Impacts were assessed by fitting weighted regression models adjusted for preterm birth and maternal depression and substance use. EIPP participants were more likely than the comparison group to be referred to, evaluated for, and receive EI services. EIPP facilitated the identification of EI-eligible children who are at risk for developmental delays due to social or environmental factors, such as violence and substance use in the home, child protective services involvement, high levels of parenting stress, and parent chronic illness or disability. EIPP serves as an entry point into the EI system, helping families attain the comprehensive supports they may need to optimize their well-being and enhance children's development. |
Prioritizing health care strategies to reduce childhood mortality
Madewell ZJ , Whitney CG , Velaphi S , Mutevedzi P , Mahtab S , Madhi SA , Fritz A , Swaray-Deen A , Sesay T , Ogbuanu IU , Mannah MT , Xerinda EG , Sitoe A , Mandomando I , Bassat Q , Ajanovic S , Tapia MD , Sow SO , Mehta A , Kotloff KL , Keita AM , Tippett Barr BA , Onyango D , Oele E , Igunza KA , Agaya J , Akelo V , Scott JAG , Madrid L , Kelil YE , Dufera T , Assefa N , Gurley ES , El Arifeen S , Spotts Whitney EA , Seib K , Rees CA , Blau DM . JAMA Netw Open 2022 5 (10) e2237689 IMPORTANCE: Although child mortality trends have decreased worldwide, deaths among children younger than 5 years of age remain high and disproportionately circumscribed to sub-Saharan Africa and Southern Asia. Tailored and innovative approaches are needed to increase access, coverage, and quality of child health care services to reduce mortality, but an understanding of health system deficiencies that may have the greatest impact on mortality among children younger than 5 years is lacking. OBJECTIVE: To investigate which health care and public health improvements could have prevented the most stillbirths and deaths in children younger than 5 years using data from the Child Health and Mortality Prevention Surveillance (CHAMPS) network. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used longitudinal, population-based, and mortality surveillance data collected by CHAMPS to understand preventable causes of death. Overall, 3390 eligible deaths across all 7 CHAMPS sites (Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa) between December 9, 2016, and December 31, 2021 (1190 stillbirths, 1340 neonatal deaths, 860 infant and child deaths), were included. Deaths were investigated using minimally invasive tissue sampling (MITS), a postmortem approach using biopsy needles for sampling key organs and fluids. MAIN OUTCOMES AND MEASURES: For each death, an expert multidisciplinary panel reviewed case data to determine the plausible pathway and causes of death. If the death was deemed preventable, the panel identified which of 10 predetermined health system gaps could have prevented the death. The health system improvements that could have prevented the most deaths were evaluated for each age group: stillbirths, neonatal deaths (aged <28 days), and infant and child deaths (aged 1 month to <5 years). RESULTS: Of 3390 deaths, 1505 (44.4%) were female and 1880 (55.5%) were male; sex was not recorded for 5 deaths. Of all deaths, 3045 (89.8%) occurred in a healthcare facility and 344 (11.9%) in the community. Overall, 2607 (76.9%) were deemed potentially preventable: 883 of 1190 stillbirths (74.2%), 1010 of 1340 neonatal deaths (75.4%), and 714 of 860 infant and child deaths (83.0%). Recommended measures to prevent deaths were improvements in antenatal and obstetric care (recommended for 588 of 1190 stillbirths [49.4%], 496 of 1340 neonatal deaths [37.0%]), clinical management and quality of care (stillbirths, 280 [23.5%]; neonates, 498 [37.2%]; infants and children, 393 of 860 [45.7%]), health-seeking behavior (infants and children, 237 [27.6%]), and health education (infants and children, 262 [30.5%]). CONCLUSIONS AND RELEVANCE: In this cross-sectional study, interventions prioritizing antenatal, intrapartum, and postnatal care could have prevented the most deaths among children younger than 5 years because 75% of deaths among children younger than 5 were stillbirths and neonatal deaths. Measures to reduce mortality in this population should prioritize improving existing systems, such as better access to antenatal care, implementation of standardized clinical protocols, and public education campaigns. |
How to collectively move forward to achieve optimal nutritional status during the first 1000 days
Petersen R . Am J Public Health 2022 112 S750-s753 A critical component of food and nutrition security for all is optimal nutrition during the first 1000 days, a time from pregnancy through a child’s second birthday. This special issue of AJPH sets the stage for what we know about nutrition in the first 1000 days in the United States and what is needed to move forward. This time period is critical because children experience more growth and development in the first 1000 days than at any other time in life. If malnutrition occurs in this window, there may be no recovery in brain development and health.1,2 Unfortunately, nutritious foods are not uniformly and equally available to all. This has unique relevance to the first 1000 days because inequities in childhood growth and development due to poor nutrition can have long-term effects on cognitive development and health throughout that child’s life.1,3,4 |
Iron deficiency in the United States: Limitations in guidelines, data, and monitoring of disparities
Jefferds MED , Mei Z , Addo Y , Hamner HC , Perrine CG , Flores-Ayala R , Pfeiffer CM , Sharma AJ . Am J Public Health 2022 112 S826-s835 Iron deficiency and the more severe sequela, iron deficiency anemia, are public health problems associated with morbidity and mortality, particularly among pregnant women and younger children. The 1998 Centers for Disease Control and Prevention recommendations for prevention and control of iron deficiency in the United States is old and does not reflect recent evidence but is a foundational reference for many federal, clinical, and program guidelines. Surveillance data for iron deficiency are sparse at all levels, with critical gaps for pregnant women and younger children. Anemia, iron deficiency, and iron deficiency anemia are often conflated but should not be. Clinical guidelines for anemia, iron deficiency, and iron deficiency anemia give inconsistent recommendations, causing nonsystematic assessment of iron deficiency. Screening for iron deficiency typically relies on identifying anemia, despite anemia's low sensitivity for iron deficiency. In the National Health and Nutrition Examination Survey, more than 70% of iron deficiency is missed among pregnant women and children by relying on hemoglobin for iron deficiency screening. To improve assessment and diagnosis and strengthen surveillance, better and more complete data and updated foundational guidance on iron deficiency and anemia are needed that consider new evidence for measuring and interpreting laboratory results. (Am J Public Health. 2022;112(S8):S826-S835. https://doi.org/10.2105/AJPH.2022.306998). |
Lost time: COVID-19 indemnity claim reporting and results in the Wisconsin workers' compensation system from March 12 to December 31, 2020.
Modji KKS , Morris CR , Creswell PD , McCoy K , Aiello T , Grajewski B , Tomasallo CD , Pray I , Meiman JG . Am J Ind Med 2022 65 (12) 1006-1021 BACKGROUND: The COVID-19 pandemic introduced a new compensable infectious disease to workplaces. METHODS: This was a descriptive analysis of Wisconsin COVID workers' compensation (WC) claims between March 12 and December 31, 2020. The impact of the presumption law (March 12 to June 10, 2020) was also evaluated. RESULTS: Less than 1% of working-age residents with COVID-19 filed a claim. COVID-19 WC claim rates (per 100,000 FTE) were notably low for frontline industry sectors such as Retail Trade (n = 115), Manufacturing (n = 88), and Wholesale Trade (n = 31). Healthcare workers (764 claims per 100,000 FTE) comprised 73.2% of COVID-19 claims. Most claims (52.8%) were denied and the proportion of denied claims increased significantly after the presumption period for both first responders and other occupations. CONCLUSION: The presumption law made benefits accessible primarily to first responders. Further changes to WC systems are needed to offset the individual and collective costs of infectious diseases. |
Evaluation of advanced curve speed warning system to prevent fire truck rollover crashes.
Simeonov P , Nimbarte A , Hsiao H , Current R , Ammons D , Choi HS , Rahman MM , Weaver D . J Safety Res 2022 83 388-399 Introduction: A disproportionately high number of deadly crash-incidents involve fire-tanker rollovers during emergency response driving. Most of these rollover incidents occur at dangerous horizontal curves (“curves”) due to unsafe speed. This study examined the effects of a curve speed warning system (CSWS) on fire tanker drivers’ emergency response behavior to develop system improvement suggestions. Method: Twenty-four firefighters participated in driving tests using a simulator. A fire tanker model, carrying a full tank of water, was used in emergency driving tests performed with and without CSWS. The CSWS was designed using the algorithm for passenger vehicles with a few initial modifications considering the unique requirements of heavy fire tanker and emergency driving. Results: The results indicated that the CSWS was effective in issuing preemptive warnings when the drivers were approaching curves with unsafe speed during emergency response. Warnings occurred more frequently at curves with smaller radius. Although the CSWS improved driving performance, it did not significantly reduce the number of rollover events. A detailed analysis of the rollover events provided suggestions for improvement of CSWS algorithms. Conclusions: To further improve the CSWS algorithm, the following may be considered: including increased safety speed margin below the rollover critical speed, moving the speed warning trigger from the curve apex to the curve entry point, extending the safe speed-control zone to cover the entire curve, and employing artificial intelligence to accommodate individual driving styles. Practical Applications: Fire tankers continue to be at increased risk of rollover during emergency response due to unsafe negotiation of dangerous curves. Development and use of advanced driver assist systems such as CSWS evaluated in this study may be an effective strategy to prevent deadly rollover crash-incidents. The knowledge generated by this study will be useful for system designers to improve the CSWS specifically designed for heavy emergency vehicles. © 2022 |
The Challenge for industrial hygiene 4.0: A NIOSH perspective on direct-reading methodologies and real-time monitoring in occupational environments
Cauda E , Snawder J , Spinazz , Cattaneo A , Howard J , Cavallo D . Synergist 2022 33 (2) 32-35 Direct-reading methodologies and real-time monitors will play a crucial role in workers' health and safety in the context of the Fourth Industrial Revolution. This article proposes that these technologies and other advancements will lead to a new stage of industrial hygiene, which may be called IH4.0. The Fourth Industrial Revolution is a way of describing the blurring of boundaries between the physical, digital, and biological worlds. There are several definitions for this revolution, but they all recognize the critical importance of data. Everyday life is already affected by data generated in different environments, some occupational and some not. The impact of data will become even more significant in the future, considering the characteristics of what is known as "Big Data." These characteristics are the high volume of data; the elevated velocity with which the data is generated; the variety of data of different natures; and the usefulness or value of collecting and modeling data. Even as IH4.0, industrial hygiene will continue to be organized according to the principles of anticipation, recognition, evaluation, and control (AREC). But like many other workplace activities, such as production, management, and quality control, industrial hygiene will be revolutionized by data. The profession has an opportunity and a responsibility to evolve because of a new understanding of data. |
Monkeypox virus infection resulting from an occupational needlestick - florida, 2022
Mendoza R , Petras JK , Jenkins P , Gorensek MJ , Mableson S , Lee PA , Carpenter A , Jones H , de Perio MA , Chisty Z , Brueck S , Rao AK , Salzer JS , Stanek D , Blackmore C . MMWR Morb Mortal Wkly Rep 2022 71 (42) 1348-1349 In August 2022, the Florida Department of Health notified CDC of a nurse who acquired monkeypox through an occupational exposure while providing care to a patient with monkeypox. To date, occupationally acquired Monkeypox virus (MPXV) infections in health care personnel (HCP) have been rarely reported during the 2022 multinational outbreak (1,2). This report describes the first reported U.S. case and recommends approaches for preventing occupationally acquired MPXV infections in HCP. |
End-stage renal disease incidence in a cohort of US firefighters from San Francisco, Chicago, and Philadelphia
Pinkerton LE , Bertke S , Dahm MM , Kubale TL , Siegel MR , Hales TR , Yiin JH , Purdue MP , Beaumont JJ , Daniels RD . Am J Ind Med 2022 65 (12) 975-984 BACKGROUND: Firefighters perform strenuous work in hot environments, which may increase their risk of chronic kidney disease. The purpose of this study was to evaluate the risk of end-stage renal disease (ESRD) and types of ESRD among a cohort of US firefighters compared to the US general population, and to examine exposure-response relationships. METHODS: ESRD from 1977 through 2014 was identified through linkage with Medicare data. ESRD incidence in the cohort compared to the US population was evaluated using life table analyses. Associations of all ESRD, systemic ESRD, hypertensive ESRD, and diabetic ESRD with exposure surrogates (exposed days, fire runs, and fire hours) were examined in Cox proportional hazards models adjusted for attained age (the time scale), race, birth date, fire department, and employment duration. RESULTS: The incidence of all ESRD was less than expected (standardized incidence ratio (SIR) = 0.79; 95% confidence interval = 0.69-0.89, observed = 247). SIRs for ESRD types were not significantly increased. Positive associations of all ESRD, systemic ESRD, and hypertensive ESRD with exposed days were observed: however, 95% confidence intervals included one. CONCLUSIONS: We found little evidence of increased risk of ESRD among this cohort of firefighters. Limitations included the inability to evaluate exposure-response relationships for some ESRD types due to small observed numbers, the limitations of the surrogates of exposure, and the lack of information on more sensitive outcome measures for potential kidney effects. |
Deciphering fatigue risk management system: a holistic approach to mitigating work-related fatigue
Sprajcer M , Wong I , Dawson D . Synergist 2022 33 (10) 26-29 Approximately 40 million workers in the United States (nearly 30 percent of the workforce) are employed in nonstandard work schedules such as shiftwork and extended work hours. These types of schedules are common and often required in industries such as transport, healthcare, mining, oil and gas, utilities, public safety, and information technology. Fatigue can reduce attention and concentration, impair communication skills, and limit decision-making ability, increasing the risk for safety-critical incidents such as injuries and motor vehicle crashes. For example, studies have shown that the risk of fatigue and safety-critical incidents not only increases over the course of a night shift, but it also increases dramatically over successive night shifts. Therefore, organizations that use shiftwork schedules need to manage the risk associated with fatigue to keep their workers safe and productive. Limiting hours worked has been the traditional way of managing fatigue in some industries. This often means creating rules based on the number of consecutive shifts, break minima, shift length, or the maximum number of hours worked in a week or month. However, fatigue can stem from a number of sources such as extended time on task, heavy physical or mental workloads, monotony, exposure to hot or noisy environments, night work, and impaired sleep. For these reasons, managing fatigue in the workplace requires a holistic approach that recognizes its many sources and creates a framework to mitigate the risks. A fatigue risk management system (FRMS) is a set of management practices for identifying and controlling fatigue-related risks. The use of this approach has been widely adopted internationally in the last two decades. More recently, in the U.S., FRMSs have been effectively incorporated by the Federal Aviation Administration and the Federal Railroad Administration. To effectively manage work-related fatigue, we need to recognize not only the likelihood of fatigue, but also its related consequences. A unique aspect of an FRMS is that it recognizes that fatigue should be considered on a continuum, not a cut-point, and the risk for a safety-critical event relates the level of fatigue with the level of effort needed for the occupational task. Acknowledging that fatigue is impossible to eliminate entirely is a critical first step in identifying and controlling fatigue-related risk. This approach has been successfully adopted across a number of international jurisdictions and within key U.S. transport industries. Fatigue-proofing the workplace by reducing the likelihood or consequence of a fatigue-related error has clearly been shown as a method to reduce the risk associated with a fatigue-related error. This risk-based approach to fatigue management generally allows a greater degree of operational flexibility. It is usually more accepted by workers because it doesn't mean a complete stoppage of work and resulting loss in pay, as would happen with work hour limitations. This is not to say that work can or should continue indefinitely without breaks within the context of an FRMS, but rather that decisions about working time arrangements should be made based on an assessment of risk, not on arbitrary limitations to work hours. |
Keeping pace with the AI revolution: considerations for OHS professionals
Vietas JA . Synergist 2022 33 (6) 20-23 AI and autonomous systems are already part of everyday life, and the pace of change is only expected to increase. According to Stanford's 2021 AI Index Report, 101,000 AI-related patents were issued in 2019, up from 78,000 in 2018. In 2020, AI startup companies received more than $40 billion in private investment across the globe, including almost $24 billion in the United States, an increase of 9.3 percent since 2019. Furthermore, AI is becoming more affordable due to increases in computer speed and storage space. For example, the cost per entrant for image recognition, which refers to a computer's ability to identify and categorize an image, decreased from $1,100 in 2015 to $7.43 in 2020. AI can improve the efficiency of tasks performed by programming and recognition tools, many of which are integrated seamlessly into everyday life. Can't decide what movie or show to watch? AI technology can suggest one for you. Don't have the time to vacuum the living room? An AI-controlled robotic vacuum can take care of that. The same technology displays advertisements catering to your interests as you use social media, browse the web, or use smartphone apps. While some people welcome and appreciate these applications of technology, others might find targeted advertising and the intrusion of advanced technologies into their lives unnerving, unwelcome, and discomforting. So, why should occupational health and safety (OHS) professionals be aware of this technology? NIOSH and other safety and health organizations recognize that AI is increasingly becoming part of many operations in the workplace. Accordingly, OHS research is beginning to focus on how AI may influence work practices and impact the safety, health, and well-being of workers. |
Evaluation of propylene glycol methyl ether as a potential challenge agent for leak detection of liquid and headspace from closed system drug transfer devices using Fourier transform infrared spectroscopy
Westbrook EG , Doepke A , Streicher RP . Anal Methods 2022 14 (43) 4393-4407 Choosing an appropriate surrogate of hazardous drugs for use in testing Closed System Drug-Transfer Devices (CSTDs) is a challenging endeavor with many factors that must be considered. It was suggested that the compound propylene glycol methyl ether (PGME) may meet many of the criteria we considered important in a suitable surrogate. Criteria included sufficient volatility to evaporate from aqueous liquid leaks efficiently, a Henry's constant which produced sufficient vapor phase concentrations to make headspace leaks detectable, and suitability for detection using a low-cost detection system. We evaluated the measurement of vapors from solutions containing PGME released inside a closed chamber. We present data used to quantify limits of detection, limits of quantification, bias, precision, and accuracy of Fourier Transform Infrared Spectroscopy (FTIR) measurements of vapors from 2.5 M PGME solutions. The effects of ethanol as a component of the PGME solution were also evaluated. Liquid drops of PGME solutions and headspace vapors above PGME solutions were released to simulate leaks from CSTDs. Using a calibration apparatus, an instrumental limit of detection (LOD) of 0.25 ppmv and a limit of quantitation (LOQ) of 0.8 ppmv were determined for PGME vapor. A LOD of 1.1 μL and a LOQ of 3.5 μL were determined for liquid aliquots of 2.5 M PGME solution released in a closed chamber. Accurate quantitation of liquid leaks required complete evaporation of droplets. With the upper end of the useable quantitation range limited by slow evaporation of relatively large droplets and the lower end defined by the method LOQ, the method evaluated in this research had a narrow quantitative range for liquid droplets. Displacement of 45 mL of vial headspace containing PGME vapor is the largest amount expected when using the draft NIOSH testing protocol. Release of an unfiltered 45 mL headspace aliquot within the NIOSH chamber was calculated to produce a concentration of 0.8 ppmv based on the Henry's constant, which is right at the instrumental LOQ. Therefore, the sensitivity of the method was not adequate to determine leaks of PGME vapor from a headspace release through an air filtering CSTD when using the draft NIOSH testing protocols with an FTIR analyzer. |
Estimation of occupational noise-induced hearing loss using kurtosis-adjusted noise exposure levels
Zhang M , Gao X , Murphy WJ , Kardous CA , Sun X , Hu W , Gong W , Li J , Qiu W . Ear Hear 2022 43 (6) 1881-1892 OBJECTIVES: Studies have shown that in addition to energy, kurtosis plays an important role in the assessment of hearing loss caused by complex noise. The objective of this study was to investigate how to use noise recordings and audiometry collected from workers in industrial environments to find an optimal kurtosis-adjusted algorithm to better evaluate hearing loss caused by both continuous noise and complex noise. DESIGN: In this study, the combined effects of energy and kurtosis on noise-induced hearing loss (NIHL) were investigated using data collected from 2601 Chinese workers exposed to various industrial noises. The cohort was divided into three subgroups based on three kurtosis (β) levels (K 1 : 3 ≤ β ≤ 10, K 2 : 10 <β ≤ 50, and K 3 : β > 50). Noise-induced permanent threshold shift at test frequencies 3, 4, and 6 kHz (NIPTS 346 ) was used as the indicator of NIHL. Predicted NIPTS 346 was calculated using the ISO 1999 model for each participant, and the actual NIPTS was obtained by correcting for age and sex using non-noise-exposed Chinese workers (n = 1297). A kurtosis-adjusted A-weighted sound pressure level normalized to a nominal 8-hour working day (L Aeq,8h ) was developed based on the kurtosis categorized group data sets using multiple linear regression. Using the NIPTS 346 and the L Aeq.8h metric, a dose-response relationship for three kurtosis groups was constructed, and the combined effect of noise level and kurtosis on NIHL was investigated. RESULTS: An optimal kurtosis-adjusted L Aeq,8h formula with a kurtosis adjustment coefficient of 6.5 was established by using the worker data. The kurtosis-adjusted L Aeq,8h better estimated hearing loss caused by various complex noises. The analysis of the dose-response relationships among the three kurtosis groups showed that the NIPTS of K 2 and K 3 groups was significantly higher than that of K 1 group in the range of 70 dBA ≤ L Aeq,8h < 85 dBA. For 85 dBA ≤ L Aeq,8h ≤ 95 dBA, the NIPTS 346 of the three groups showed an obvious K 3 > K 2 > K 1 . For L Aeq,8h >95 dBA, the NIPTS 346 of the K 2 group tended to be consistent with that of the K 1 group, while the NIPTS 346 of the K 3 group was significantly larger than that of the K 1 and K 2 groups. When L Aeq,8h is below 70 dBA, neither continuous noise nor complex noise produced significant NIPTS 346 . CONCLUSIONS: Because non-Gaussian complex noise is ubiquitous in many industries, the temporal characteristics of noise (i.e., kurtosis) must be taken into account in evaluating occupational NIHL. A kurtosis-adjusted L Aeq,8h with an adjustment coefficient of 6.5 allows a more accurate prediction of high-frequency NIHL. Relying on a single value (i.e., 85 dBA) as a recommended exposure limit does not appear to be sufficient to protect the hearing of workers exposed to complex noise. |
Investigating gripping force during lifting tasks using a pressure sensing glove system
Zhou G , Lu ML , Yu D . Appl Ergon 2022 107 103917 Lifting tasks remain one of the leading causes of musculoskeletal disorders (MSDs), primarily in the low back region. Lifting analysis tools are, therefore, designed for assessing the risk of low back pain. Shoulder musculoskeletal problems have emerged as common MSDs associated with manual handling tasks. It is hypothesized that gripping force is related to lifting conditions and may be used as a supplementary risk metric for MSDs in the shoulder and low back regions, because it measures additional hand exertions for coupling the lifted object during lifting. We assessed the capability tactile gloves for measuring the gripping force during lifting as a means for assessing different task conditions (lifting weight, lifting height, lifting direction, body rotation, and handle). Thirty participants wore the tactile gloves and performed simulated lifting tasks. Regression models were used to analyze the effects of the task variables on estimating the measured gripping force. Results demonstrated that 58% and 70% of the lifting weight variance were explained by the measured gripping force without and with considering the individual difference, respectively. In addition to the lifting risk measures commonly used by practitioners, this study suggests a potential for using gripping force as a supplementary or additional risk metric for MSDs. |
Isolating and tracking noise sources across an active longwall mine using seismic interferometry
Rabade S , Wu SM , Lin FC , Chambers DJA . Bull Seismol Soc Am 2022 112 (5) 2396-2407 The ability to monitor seismicity and structural integrity of a mine using seismic noise can have great implication for detecting and managing ground-control hazards. The noise wavefield, however, is complicated by induced seismicity and heavy machinery associated with mining operations. In this study, we investigate the nature of time-dependent noise cross-correlations functions (CCFs) across an active underground longwall coal mine. We analyze one month of continuous data recorded by a surface 17 geophone array with an average station spacing of approximately 200 m. To extract coherent seismic signals, we calculate CCFs between all stations for each 5-min window. Close inspection of all 5-min CCFs reveals waveforms that can be categorically separated into two groups, one with strong and coherent 1-5 Hz signals and one without. Using a reference station pair, we statistically isolate time windows within each group based on the correlation coefficient between each 5-min CCF and the monthly stacked CCF. The daily stacked CCFs associated with a high correlation coefficient show a clear temporal variation that is consistent with the progression of mining activity. In contrast, the daily stacked CCFs associated with a low correlation coefficient remain stationary throughout the recording period in line with the expected persistent background noise. To further understand the nature of the high correlation coefficient CCFs, we perform 2D and 3D back projection to determine and track the dominant noise source location. Excellent agreement is observed on both short (5-min) and long (daily) time scales between the CCF determined source locations, the overall migration of the active mining operation, and cataloged seismic event locations. The workflow presented in this study demonstrates an effective way to identify and track mining induced signals, in which CCFs associated with background noise can be isolated and used for further temporal structural integrity investigation. |
Review of filters for air sampling and chemical analysis in mining workplaces
Chow JC , Watson JG , Wang X , Abbasi B , Reed WR , Parks D . Minerals 2022 12 (10) 1314 This review considers the use of filters to sample air in mining workplace environments for dust concentration measurement and subsequent analysis of hazardous contaminants, especially respirable crystalline silica (RCS) on filters compatible with wearable personal dust monitors (PDM). The review summarizes filter vendors, sizes, costs, chemical and physical properties, and information available on filter modeling, laboratory testing, and field performance. Filter media testing and selection should consider the characteristics required for mass by gravimetry in addition to RCS quantification by Fourier-transform infrared (FTIR) or Raman spectroscopic analysis. For mass determination, the filters need to have high filtration efficiency (≥99% for the most penetrable particle sizes) and a reasonable pressure drop (up to 16.7 kPa) to accommodate high dust loading. Additional requirements include: negligible uptake of water vapor and gaseous volatile compounds; adequate particle adhesion as a function of particle loading; sufficient particle loading capacity to form a stable particle deposit layer during sampling in wet and dusty environments; mechanical strength to withstand vibrations and pressure drops across the filter; and appropriate filter mass compatible with the tapered element oscillating microbalance. FTIR and Raman measurements require filters to be free of spectral interference. Furthermore, because the irradiated area does not completely cover the sample deposit, particles should be uniformly deposited on the filter. |
The choice of reference chart affects the strength of the association between malaria in pregnancy and small for gestational age: an individual participant data meta-analysis comparing the Intergrowth-21 with a Tanzanian birthweight chart
Mtove G , Minja DTR , Abdul O , Gesase S , Maleta K , Divala TH , Patson N , Ashorn U , Laufer MK , Madanitsa M , Ashorn P , Mathanga D , Chinkhumba J , Gutman JR , TerKuile FO , Mller SL , Bygbjerg IC , Alifrangis M , Theander T , Lusingu JPA , Schmiegelow C . Malar J 2022 21 (1) 292 BACKGROUND: The prevalence of small for gestational age (SGA) may vary depending on the chosen weight-for-gestational-age reference chart. An individual participant data meta-analysis was conducted to assess the implications of using a local reference (STOPPAM) instead of a universal reference (Intergrowth-21) on the association between malaria in pregnancy and SGA. METHODS: Individual participant data of 6,236 newborns were pooled from seven conveniently identified studies conducted in Tanzania and Malawi from 2003-2018 with data on malaria in pregnancy, birthweight, and ultrasound estimated gestational age. Mixed-effects regression models were used to compare the association between malaria in pregnancy and SGA when using the STOPPAM and the Intergrowth-21 references, respectively. RESULTS: The 10th percentile for birthweights-for-gestational age was lower for STOPPAM than for Intergrowth-21, leading to a prevalence of SGA(STOPPAM) of 14.2% and SGA(IG21) of 18.0%, p<0.001. The association between malaria in pregnancy and SGA was stronger for STOPPAM (adjusted odds ratio (aOR) 1.30 [1.09-1.56], p<0.01) than for Intergrowth-21 (aOR 1.19 [1.00-1.40], p=0.04), particularly among paucigravidae (SGA(STOPPAM) aOR 1.36 [1.09-1.71], p<0.01 vs SGA(IG21) aOR 1.21 [0.97-1.50], p=0.08). CONCLUSIONS: The prevalence of SGA may be overestimated and the impact of malaria in pregnancy underestimated when using Intergrowth-21. Comparing local reference charts to global references when assessing and interpreting the impact of malaria in pregnancy may be appropriate. |
Rapid virtual training and field deployment for COVID-19 surveillance officers: experiences from Ethiopia.
Wang SH , Yimer G , Bisesi M , Lisawork L , Sugerman D , Alayu M , Wossen M , Abayneh SA , Endashaw T , Kubinson H , Kanter T , Gallagher K , Gebreyes W . Pan Afr Med J 2022 43 23 Rapid scale-up of surveillance activities is the key to successful coronavirus disease 2019 (COVID-19) pandemic prevention and mitigation. Ethiopia did not have a sufficient number of active surveillance officers for the public health COVID-19 response. Training of surveillance officers was needed urgently to fill the gap in the workforce needed. Subject-matter experts from the United States and Ethiopia developed applicable training modules including background on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), contact investigation, and communications. The training modules were delivered live in real-time via web-based virtual presentation. Seventy-seven health surveillance officers were hired, trained, and deployed in two weeks to assist with surveillance activities in Ethiopia. Electronic capacity building is needed in order to improve Web-based training in resource-limited settings where internet access is limited or unreliable. Web-based synchronously delivered course was an effective platform for COVID-19 surveillance training. However, strengthening public and private information technology capacity, literacy, and internet availability will improve Web-based education platforms in resource-limited countries. Copyright © 2022, African Field Epidemiology Network. All rights reserved. |
Will clinical standards not be part of the choir Harmonization between the HL7 gender harmony project model and the NASEM measuring sex, gender identity, and sexual orientation report in the United States
Baker KE , Compton D , Fechter-Leggett ED , Grasso C , Kronk CA . J Am Med Inform Assoc 2022 30 (1) 83-93 OBJECTIVES: To propose an approach for semantic and functional data harmonization related to sex and gender constructs in electronic health records (EHRs) and other clinical systems for implementors, as outlined in the National Academies of Sciences, Engineering, and Medicine (NASEM) report Measuring Sex, Gender Identity, and Sexual Orientation and the Health Level 7 (HL7) Gender Harmony Project (GHP) product brief "Gender Harmony-Modeling Sex and Gender Representation, Release 1." MATERIALS AND METHODS: Authors from both publications contributed to a plan for data harmonization based upon fundamental principles in informatics, including privacy, openness, access, legitimate infringement, least intrusive alternatives, and accountability. RESULTS: We propose construct entities and value sets that best align with both publications to allow the implementation of EHR data elements on gender identity, recorded sex or gender, and sex for clinical use in the United States. We include usability- and interoperability-focused reasoning for each of these decisions, as well as suggestions for cross-tabulation for populations. DISCUSSION AND CONCLUSION: Both publications agree on core approaches to conceptualization and measurement of sex- and gender-related constructs. However, some clarifications could improve our ability to assess gender modality, alignment (or lack thereof) between gender identity and assigned gender at birth, and address both individual-level and population-level health inequities. By bridging the GHP and NASEM recommendations, we provide a path forward for implementation of sex- and gender-related EHR elements. Suggestions for implementation of gender identity, recorded sex or gender, and sex for clinical use are provided, along with semantic and functional justifications. |
Multiple lineages of monkeypox virus detected in the United States, 2021-2022.
Gigante CM , Korber B , Seabolt MH , Wilkins K , Davidson W , Rao AK , Zhao H , Smith TG , Hughes CM , Minhaj F , Waltenburg MA , Theiler J , Smole S , Gallagher GR , Blythe D , Myers R , Schulte J , Stringer J , Lee P , Mendoza RM , Griffin-Thomas LA , Crain J , Murray J , Atkinson A , Gonzalez AH , Nash J , Batra D , Damon I , McQuiston J , Hutson CL , McCollum AM , Li Y . Science 2022 378 (6619) eadd4153 Monkeypox is a viral zoonotic disease endemic in Central and West Africa. In May 2022, dozens of non-endemic countries reported hundreds of monkeypox cases, most with no epidemiological link to Africa. We identified two lineages of monkeypox virus (MPXV) among two 2021 and seven 2022 U.S. monkeypox cases: the major 2022 outbreak variant, B.1, and a minor contemporaneously sampled variant called A.2. Analyses of mutations among these two variants revealed an extreme preference for GA-to-AA mutations indicative of human APOBEC3 cytosine deaminase activity among Clade IIb MPXV (previously West African, Nigeria) sampled since 2017. Such mutations were not enriched within other MPXV clades. These findings suggest that APOBEC3 editing may be a recurrent and a dominant driver of MPXV evolution within the current outbreak. |
Building the capacity of West African countries in Aedes surveillance: inaugural meeting of the West African Aedes Surveillance Network (WAASuN)
Dadzie SK , Akorli J , Coulibaly MB , Ahadji-Dabla KM , Baber I , Bobanga T , Boukhary Aoms , Canelas T , Facchinelli L , Gonalves A , Guelbeogo M , Kamgang B , Keita IK , Konan L , Levine R , Dzuris N , Lenhart A . Parasit Vectors 2022 15 (1) 381 Arboviral diseases such as dengue, Zika and chikungunya transmitted by Aedes mosquitoes have been reported in 34 African countries. Available data indicate that in recent years there have been dengue and chikungunya outbreaks in the West Africa subregion, in countries including Cte d'Ivoire, Burkina Faso, Gabon, Senegal, and Benin. These viral diseases are causing an increased public health burden, which impedes poverty reduction and sustainable development. Aedes surveillance and control capacity, which are key to reducing the prevalence of arboviral infections, need to be strengthened in West Africa, to provide information essential for the formulation of effective vector control strategies and the prediction of arboviral disease outbreaks. In line with these objectives, the West African Aedes Surveillance Network (WAASuN) was created in 2017 at a meeting held in Sierra Leone comprising African scientists working on Aedes mosquitoes. This manuscript describes the proceedings and discusses key highlights of the meeting. |
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