Selected diagnosed chronic conditions by sexual orientation: A national study of US Adults, 2013
Ward BW , Joestl SS , Galinsky AM , Dahlhamer JM . Prev Chronic Dis 2015 12 E192 INTRODUCTION: Research is needed on chronic health conditions among lesbian, gay, and bisexual populations. The objective of this study was to examine 10 diagnosed chronic conditions, and multiple (≥2) chronic conditions (MCC), by sexual orientation among US adults. METHODS: The 2013 National Health Interview Survey was used to generate age-adjusted prevalence rates and adjusted odds ratios of diagnosed chronic conditions and MCC for civilian, noninstitutionalized US adults who identified as gay/lesbian, straight, or bisexual, and separately for men and women. Chronic conditions were selected for this study on the basis of previous research. RESULTS: Hypertension and arthritis were the most prevalent conditions for all groups. Gay/lesbian adults had a 4.7 percentage-point higher prevalence of cancer than bisexual adults, and a 5.6 percentage-point higher prevalence of arthritis and a 2.9 percentage point higher prevalence of hepatitis than straight adults. The prevalence of chronic obstructive pulmonary disease was 8.1 percentage points higher among bisexual adults than among gay/lesbian adults and 7.0 percentage points higher than among straight adults. These differences remained in the multivariate analyses. Additional differences were found in the sex-stratified analyses. No significant differences were found in MCC by sexual orientation. CONCLUSION: After age adjustment and controlling for sociodemographic characteristics, only a few significant health disparities for diagnosed chronic conditions were found by sexual orientation, and none for MCC. However, for conditions where differences were found, magnitudes were relatively large. Further examination of these differences among gay/lesbian and bisexual adults could yield a better understanding of why these disparities exist. |
Obstetrician-gynecologists' beliefs about performing less cervical cancer screening: the pendulum swings
Schneider A , Henderson JT , Harper CC , Hsu A , Saraiya M , Sawaya GF . Am J Obstet Gynecol 2015 213 (5) 744-5 In 2002, major US guideline groups recommended cervical cancer screening discontinuation in 2 groups of low-risk women: those >65 years old with previous normal Papanicolaou test results and those with no previous cervical neoplasia who have had a total hysterectomy.1,2 A survey administered to obstetrician-gynecologists around that time indicated that only 1 in 5 would not screen these women.3 To investigate whether screening practices have changed over time, we surveyed obstetrician-gynecologists about their practices and examined characteristics that are associated with adhering to screening guidelines. |
Policy, systems, and environmental approaches to obesity prevention: translating and disseminating evidence from practice
Leeman J , Aycock N , Paxton-Aiken A , Lowe-Wilson A , Sommers J , Farris R , Thompson D , Ammerman A . Public Health Rep 2015 130 (6) 616-22 To reduce obesity prevalence, public health practitioners are intervening to change health behaviors as well as the policies, systems, and environments (PSEs) that support healthy behaviors. Although the number of recommended PSE intervention strategies continues to grow, limited guidance is available on how to implement those strategies in practice. This article describes the University of North Carolina at Chapel Hill, Center for Training and Research Translation's (Center TRT's) approach to reviewing, translating, and disseminating practitioner-developed interventions, with the goal of providing more practical guidance on how to implement PSE intervention strategies in real-world practice. As of August 2014, Center TRT had disseminated 30 practice-based PSE interventions. This article provides an overview of Center TRT's process for reviewing, translating, and disseminating practice-based interventions and offers key lessons learned during the nine years that Center TRT has engaged in this work. |
Potential environmental factors in amyotrophic lateral sclerosis
Oskarsson B , Horton DK , Mitsumoto H . Neurol Clin 2015 33 (4) 877-88 The causes of amyotrophic lateral sclerosis (ALS) are largely unknown, and may always be multiple, including environmental factors. Monogenetic determinants of ALS are involved in roughly 20% of all cases (including 10% familial cases). Less well understood multigenetic causes may contribute to another 20% to 80%. Environmental factors likely play a role in the development of ALS in susceptible individuals, but proved causation remains elusive. This article discusses the possible factors of male gender (males are selectively exposed to different influences, or genetically predisposed to be susceptible), smoking, military service, exercise, electrical exposure, heavy metals, agricultural chemicals, and geographic clusters. |
Preventive aspirin and other antiplatelet medication use among U.S. adults aged ≥40 years: data from the National Health and Nutrition Examination Survey, 2011-2012
Gu Q , Dillon CF , Eberhardt MS , Wright JD , Burt VL . Public Health Rep 2015 130 (6) 643-54 OBJECTIVE: We estimated the prevalence of preventive aspirin and/or other antiplatelet medication use and the dosage of aspirin use in the U.S. adult population. METHODS: We conducted cross-sectional analyses of a representative sample (n=3,599) of U.S. adults aged ≥40 years from the National Health and Nutrition Examination Survey, 2011-2012. RESULTS: In 2011-2012, one-third of U.S. adults aged ≥40 years reported taking preventive aspirin and/or other antiplatelet medications, 97% of whom indicated preventive aspirin use. Preventive aspirin use increased with age (from 11% of those aged 40-49 years to 54% of those ≥80 years of age, p<0.001). Non-Hispanic white (35%) and black (30%) adults were more likely to take preventive aspirin than non-Hispanic Asian (20%, p<0.001) and Hispanic (22%, p=0.013) adults. Adults with, compared with those without health insurance, and adults with ≥2 doctor visits in the past year, diagnosed diabetes, hypertension, or high cholesterol were twice as likely to take preventive aspirin. Among those with cardiovascular disease, 76% reported taking preventive aspirin and/or other antiplatelet medications, of whom 91% were taking preventive aspirin. Among adults without cardiovascular disease, 28% reported taking preventive aspirin. Adherence rates to medically recommended aspirin use were 82% overall, 91% for secondary prevention, and 79% for primary prevention. Among current preventive aspirin users, 70% were taking 81 milligrams (mg) of aspirin daily and 13% were taking 325 mg of aspirin daily. CONCLUSION: The vast majority of antiplatelet therapy is preventive aspirin use. A health-care provider's recommendation to take preventive aspirin is an important determinant of current preventive aspirin use. |
Economic evaluation of combined diet and physical activity promotion programs to prevent type 2 diabetes among persons at increased risk: A systematic review for the Community Preventive Services Task Force
Li R , Qu S , Zhang P , Chattopadhyay S , Gregg EW , Albright A , Hopkins D , Pronk NP . Ann Intern Med 2015 163 (6) 452-60 BACKGROUND: Diabetes is a highly prevalent and costly disease. Studies indicate that combined diet and physical activity promotion programs can prevent type 2 diabetes among persons at increased risk. PURPOSE: To systematically evaluate the evidence on cost, cost-effectiveness, and cost-benefit estimates of diet and physical activity promotion programs. DATA SOURCES: Cochrane Library, EMBASE, MEDLINE, PsycINFO, Sociological Abstracts, Web of Science, EconLit, and CINAHL through 7 April 2015. STUDY SELECTION: English-language studies from high-income countries that provided data on cost, cost-effectiveness, or cost-benefit ratios of diet and physical activity promotion programs with at least 2 sessions over at least 3 months delivered to persons at increased risk for type 2 diabetes. DATA EXTRACTION: Dual abstraction and assessment of relevant study details. DATA SYNTHESIS: Twenty-eight studies were included. Costs were expressed in 2013 U.S. dollars. The median program cost per participant was $653. Costs were lower for group-based programs (median, $417) and programs implemented in community or primary care settings (median, $424) than for the U.S. DPP (Diabetes Prevention Program) trial and the DPP Outcomes Study ($5881). Twenty-two studies assessed the incremental cost-effectiveness ratios (ICERs) of the programs. From a health system perspective, 16 studies reported a median ICER of $13 761 per quality-adjusted life-year (QALY) saved. Group-based programs were more cost-effective (median, $1819 per QALY) than those that used individual sessions (median, $15 846 per QALY). No cost-benefit studies were identified. LIMITATION: Information on recruitment costs and cost-effectiveness of translational programs implemented in community and primary care settings was limited. CONCLUSION: Diet and physical activity promotion programs to prevent type 2 diabetes are cost-effective among persons at increased risk. Costs are lower when programs are delivered to groups in community or primary care settings. PRIMARY FUNDING SOURCE: None. |
Hearing in older adults with exfoliation syndrome/exfoliation glaucoma or primary open-angle glaucoma
Tryggvason G , Jonasson F , Cotch MF , Li CM , Hoffman HJ , Themann CL , Eiriksdottir G , Sverrisdottir JE , Harris TB , Launer LJ , Gudnason V , Petersen H . Acta Ophthalmol 2015 94 (2) 140-6 PURPOSE: To determine whether adults, aged 66-96 years, with exfoliation syndrome (XFS)/exfoliation glaucoma (XFG), or primary open-angle glaucoma (POAG) have poorer hearing than controls of similar age. METHODS: Case (XFS/XFG and POAG) and control status was diagnosed in the Reykjavik Glaucoma Studies (RGS) using slit-lamp examination, visual field testing and optic disc photographs; the RGS data were merged with the Age, Gene/Environment Susceptibility-Reykjavik Study that collected hearing data using air-conduction, pure-tone thresholds obtained at 0.5, 1, 2, 3, 4, 6 and 8 kHz categorized by better ear and worse ear, based on pure-tone averages (PTAs) calculated separately for low and middle frequencies (PTA512 - mean of thresholds at 0.5, 1 and 2 kHz) and high frequencies (PTA3468 - mean of thresholds at 3, 4, 6 and 8 kHz). Multivariable linear regression was used to test for differences in PTAs between cases and controls. RESULTS: The mean age for 158 XFS/XFG cases (30.4% male) was 77.4 years, 95 POAG cases (35.8% male) was 77.9 years, and 123 controls (46.3% male) was 76.8 years. Using multivariable linear regression analysis, there were no consistent, statistically significant differences in PTAs between the two case groups and controls in either the low- or high-frequency range, even when stratified by age group. CONCLUSION: Among the older individuals examined in this study hearing loss is highly prevalent and strongly associated with male gender and increasing age. As we did not find consistent statistically significant difference in hearing between cases and controls the diagnosis of XFS/XFG or POAG does not as such routinely call for audiological evaluation. |
Chronic liver disease-associated hospitalizations among adults with diabetes, national inpatient sample, 2001-2012
Byrd KK , Mehal JM , Schillie SF , Holman RC , Haberling D , Murphy T . Public Health Rep 2015 130 (6) 693-703 OBJECTIVE: Many people with diabetes have a variety of diabetes-related complications. Among the variety of conditions associated with diabetes, however, liver diseases are less well recognized. As such, we aimed to describe chronic liver disease (CLD)-associated hospitalization rates among U.S. adults with diabetes from 2001-2012. METHODS: We used a nationally representative database of hospitalizations, the National Inpatient Sample, to determine CLD-associated hospitalization rates among U.S. adults aged ≥18 years with and without diabetes, from 2001-2012. Hospitalizations listing an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for CLD on the discharge record were selected for analysis and were further classified by diabetes status based on concurrent presence of a diabetes ICD-9-CM code. We calculated average annual age-adjusted hospitalization rates and 95% confidence intervals (CIs), and conducted a test for trend. RESULTS: For 2001-2012, the total age-adjusted CLD-associated hospitalization rate among adults with diabetes (1,680.9 per 100,000 population; 95% CI 1,577.2, 1,784.6) was approximately four times the rate of adults without diabetes (424.2 per 100,000 population; 95% CI 413.4, 435.1). Total age-adjusted hospitalization rates of adults with and without diabetes increased 59% and 48%, respectively, from 2001-2002 to 2011-2012 (p<0.001). Hepatitis C- and chronic hepatitis and cirrhosis-associated hospitalizations comprised the largest proportion of total CLD-associated hospitalizations among adults with and without diabetes. CONCLUSION: Providers should be aware of the potential existence of CLD among adults with diabetes and counsel patients on preventive methods to avoid progressive liver damage. |
Development and demonstration of a state model for the estimation of incidence of partly undetected chronic diseases
Brinks R , Bardenheier BH , Hoyer A , Lin J , Landwehr S , Gregg EW . BMC Med Res Methodol 2015 15 98 BACKGROUND: Estimation of incidence of the state of undiagnosed chronic disease provides a crucial missing link for the monitoring of chronic disease epidemics and determining the degree to which changes in prevalence are affected or biased by detection. METHODS: We developed a four-part compartment model for undiagnosed cases of irreversible chronic diseases with a preclinical state that precedes the diagnosis. Applicability of the model is tested in a simulation study of a hypothetical chronic disease and using diabetes data from the Health and Retirement Study (HRS). RESULTS: A two dimensional system of partial differential equations forms the basis for estimating incidence of the undiagnosed and diagnosed disease states from the prevalence of the associated states. In the simulation study we reach very good agreement between the estimates and the true values. Application to the HRS data demonstrates practical relevance of the methods. DISCUSSION: We have demonstrated the applicability of the modeling framework in a simulation study and in the analysis of the Health and Retirement Study. The model provides insight into the epidemiology of undiagnosed chronic diseases. |
A Field-Validated Approach Using Surveillance and Genotyping Data to Estimate Tuberculosis Attributable to Recent Transmission in the United States.
France AM , Grant J , Kammerer JS , Navin TR . Am J Epidemiol 2015 182 (9) 799-807 Tuberculosis genotyping data are frequently used to estimate the proportion of tuberculosis cases in a population that are attributable to recent transmission (RT). Multiple factors influence genotype-based estimates of RT and limit the comparison of estimates over time and across geographic units. Additionally, methods used for these estimates have not been validated against field-based epidemiologic assessments of RT. Here we describe a novel genotype-based approach to estimation of RT based on the identification of plausible-source cases, which facilitates systematic comparisons over time and across geographic areas. We compared this and other genotype-based RT estimation approaches with the gold standard of field-based assessment of RT based on epidemiologic investigation in Arkansas, Maryland, and Massachusetts during 1996-2000. We calculated the sensitivity and specificity of each approach for epidemiologic evidence of RT and calculated the accuracy of each approach across a range of hypothetical RT prevalence rates plausible for the United States. The sensitivity, specificity, and accuracy of genotype-based RT estimates varied by approach. At an RT prevalence of 10%, accuracy ranged from 88.5% for state-based clustering to 94.4% with our novel approach. Our novel, field-validated approach allows for systematic assessments over time and across public health jurisdictions of varying geographic size, with an established level of accuracy. |
Chronic Infection With Camelid Hepatitis E Virus in a Liver-transplant Recipient Who Regularly Consumes Camel Meat and Milk.
Lee GH , Tan BH , Teo EC , Lim SG , Dan YY , Wee A , Aw PP , Zhu Y , Hibberd ML , Tan CK , Purdy MA , Teo CG . Gastroenterology 2015 150 (2) 355-7 e3 There have been increasing reports of food-borne zoonotic transmission of hepatitis E virus (HEV) genotype 3, which causes chronic infections in immunosuppressed patients. We performed phylogenetic analyses of the HEV sequence (partial and full-length) from 1 patient from the Middle East who underwent liver transplantation, and compared these with other orthohepevirus A sequences. We found the patient to be infected by camelid HEV. This patient regularly consumed camel meat and milk, so camelid HEV, which is genotype 7, might infect humans. Our finding links consumption of camel-derived food products to post-transplantation hepatitis E, which, if detected at early stages, can be cured with antiviral therapy and reduced administration of immunosuppressive agents. |
Molecular analysis allows inference into HIV transmission among young men who have sex with men in the United States.
Whiteside YO , Song R , Wertheim JO , Oster AM . AIDS 2015 29 (18) 2517-22 OBJECTIVE: The objective of this study is to understand the spread of HIV among and between age and racial/ethnic groups of men who engage in male-to-male sexual contact (MSM) in the United States. DESIGN: An analysis of HIV-1 pol sequences for MSM collected through the US National HIV Surveillance System (NHSS) during 2001-2012. METHODS: Pairwise genetic distance was calculated to determine potential transmission partners (those with very closely related nucleotide sequences, i.e. distance ≤1.5%). We described race/ethnicity and age of potential transmission partners of MSM. RESULTS: Of 23 048 MSM with HIV sequences submitted to NHSS during 2000-2012, we identified potential transmission partners for 8880 (39%). Most potential transmission partners were of the same race/ethnicity (78% for blacks/African-Americans, 64% for whites and 49% for Hispanics/Latinos). This assortative mixing was even more pronounced in the youngest age groups. Significantly fewer young black/African-American and Hispanic/Latino MSM had older potential transmission partners than young white MSM. CONCLUSION: Black/African-American MSM, who are more profoundly affected by HIV, were more likely to have potential HIV transmission partners who were of the same race/ethnicity and similar in age, suggesting that disparities in HIV infections are in large part not due to age-disassortative relationships. Concerted efforts to increase access to preexposure prophylaxis, quality HIV care and effective treatment are needed to interrupt transmission chains among young, black/African-American MSM. |
Rotavirus G and P types in children with acute diarrhea in Cairo, Egypt, 2011-2012
Shoeib AR , Hull JJ , Jiang B . J Egypt Public Health Assoc 2015 90 (3) 121-4 BACKGROUND: The WHO estimated the annual rotavirus-related mortality among children below 5 years old in Egypt in 2004 to be 30 deaths per 100 000, or out of an estimated 2616 deaths, 3.9% were because of rotavirus infection. The aim of this article was to study the epidemiology and circulating genotypes of rotaviruses in Cairo from 2011 to 2012. MATERIALS AND METHODS: A total of 197 stool samples were collected from 130 inpatient children at the Cairo University Children Hospital and 67 outpatient children at the Al-Saff Children Clinic. The collected stool samples were then screened for rotavirus using enzyme immunoassay, followed by a screening for G-type and P-type using RT-PCR, and confirmation by sequence analysis. RESULTS: Rotavirus was detected in 39.1% (77/197) of the children, with a higher rate in inpatients (43.9%, 57/130) than in outpatients (29.9%, 20/67). There was an increase of rotavirus infection in the winter season. The majority of rotavirus cases (85.7%) occurred during the first year of life. The predominant genotypes identified during this study were G3P[8] (37.7%) and G1P[8] (19.5%), but uncommon genotypes G1P[6] (3.9%), G9P[6] (1.3%), G8P[14] (1.3%), and G12P[6] (2.6%) were also detected. CONCLUSION AND RECOMMENDATIONS: The change in genotype distribution, compared with previous studies, along with the high burden of rotavirus-associated diarrhea among Egyptian children below 2 years old, emphasizes the importance of continuing strain surveillance and the need of developing and introducing rotavirus vaccine in Egypt. |
Using high-impact HIV prevention to achieve the national HIV/AIDS strategic goals in Miami-Dade County, Florida: a case study
Carey J , LaLota M , Villamizar K , McElroy T , Wilson MM , Garcia J , Sandrock R , Taveras J , Candio D , Flores SA . J Public Health Manag Pract 2015 21 (6) 584-593 In response to the release of the National HIV/AIDS Strategy, the Centers for Disease Control and Prevention developed the “Enhanced Comprehensive HIV Prevention Planning” (ECHPP) project, which provided support to health departments in 12 Metropolitan Statistical Areas with the highest AIDS prevalence to strengthen local HIV programs. We describe a case study of how one MSA, Miami-Dade County, developed and implemented a locally tailored plan. Examples include actions to reinforce local partnerships and identify neighborhoods with highest unmet needs; an improved condom distribution system to assist local HIV care providers; collaboration with local stakeholders to establish a new walk-in center for transgender client needs; and overcoming incompatibilities in health department and Ryan White program computer record systems to facilitate faster and more efficient patient services. These examples show how jurisdictions both within Florida and elsewhere can create low-cost and sustainable activities tailored to improve local HIV prevention needs. |
Late diagnosis of HIV infection in metropolitan areas of the United States and Puerto Rico
Hall HI , Tang T , Espinoza L . AIDS Behav 2015 20 (5) 967-72 The majority of persons infected with HIV live in large metropolitan areas and many such areas have implemented intensified HIV testing programs. A national indicator of HIV testing outcomes is late diagnosis of HIV infection (stage 3, AIDS). Based on National HIV Surveillance System data, 23.3 % of persons with HIV diagnosed in 2012 had a late diagnosis in large MSAs, 26.3 % in smaller MSAs, and 29.6 % in non-metropolitan areas. In the 105 large MSAs, the percentage diagnosed late ranged from 13.2 to 47.4 %. During 2003-2012, the percentage diagnosed late decreased in large MSAs (32.2-23.3 %), with significant decreases in 41 of 105 MSAs overall and among men who have sex with men. Sustained testing efforts may help to continue the decreasing trend in late-stage HIV diagnosis and provide opportunities for early care and treatment and potential reduction in HIV transmission. |
Meningococcal disease among men who have sex with men - United States, January 2012-June 2015
Kamiya H , MacNeil J , Blain A , Patel M , Martin S , Weiss D , Ngai S , Ezeoke I , Mascola L , Civen R , Ngo V , Black S , Kemble S , Chugh R , Murphy E , Petit C , Harriman K , Winter K , Beron A , Clegg W , Conover C , Misegades L . MMWR Morb Mortal Wkly Rep 2015 64 (44) 1256-1257 Since 2012, three clusters of serogroup C meningococcal disease among men who have sex with men (MSM) have been reported in the United States. During 2012, 13 cases of meningococcal disease among MSM were reported by the New York City Department of Health and Mental Hygiene (1); over a 5-month period during 2012-2013, the Los Angeles County Department of Public Health reported four cases among MSM; and during May-June 2015, the Chicago Department of Public Health reported seven cases of meningococcal disease among MSM in the greater Chicago area. MSM have not previously been considered at increased risk for meningococcal disease. Determining outbreak thresholds* for special populations of unknown size (such as MSM) can be difficult. The New York City health department declared an outbreak based on an estimated increased risk for meningococcal infection in 2012 among MSM and human immunodeficiency virus (HIV)-infected MSM compared with city residents who were not MSM or for whom MSM status was unknown (1). The Chicago Department of Public Health also declared an outbreak based on an increase in case counts and thresholds calculated using population estimates of MSM and HIV-infected MSM. Local public health response included increasing awareness among MSM, conducting contact tracing and providing chemoprophylaxis to close contacts, and offering vaccination to the population at risk (1-3). To better understand the epidemiology and burden of meningococcal disease in MSM populations in the United States and to inform recommendations, CDC analyzed data from a retrospective review of reported cases from January 2012 through June 2015. |
Obesity is associated with greater inflammation and monocyte activation among HIV-infected adults receiving antiretroviral therapy
Conley LJ , Bush TJ , Rupert AW , Sereti I , Patel P , Brooks JT , Baker JV . AIDS 2015 29 (16) 2201-7 OBJECTIVES: Among virally suppressed HIV-infected persons, we examined the relationship between obesity and alterations in key clinical markers of immune activation and inflammation. These markers have also been associated with excess HIV-related cardiovascular disease and mortality. METHODS: We evaluated data from virally suppressed participants in the Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy, including inflammatory biomarkers (interleukin-6 and highly sensitive C-reactive protein), monocyte biomarkers [soluble CD163 (sCD163), sCD14], and monocyte immunophenotypes. We assessed associations with these immunologic measures and obesity, via logistic regression preadjustment and postadjustment for demographic and clinical factors, homeostatic model assessment of insulin resistance, and leptin levels. RESULTS: Among 452 evaluable participants, median (interquartile range) age was 41 (36-48) years, CD4 cell count was 475 (308-697) cells/mul, and 21% were obese (BMI ≥ 30 kg/m). In univariable models, obesity, smoking, and lower CD4 cell count were associated with higher measures of inflammation and monocyte activation. After adjustment, obesity remained independently associated with elevated levels (highest vs. lower two tertiles) of interleukin-6 [odds ratio (OR) 1.96; P = 0.02], highly sensitive C-reactive protein (OR 2.79; P < 0.001) and sCD163 (OR 1.94; P = 0.02), and elevated frequency of CD14CD16 (OR 1.77; P = 0.03) and CD14dimCD16 (OR 1.97; P = 0.01). Adjusting for homeostatic model assessment of insulin resistance and leptin modestly affected associations for obesity with inflammation and monocyte activation. CONCLUSION: Obesity was prevalent and independently associated with greater monocyte activation and systemic inflammation. Research is needed to determine how adipose tissue excess is functionally related to persistent immunologic abnormalities among HIV-infected persons with viral suppression. |
Patterns and trends of newly diagnosed HIV infections among adults and adolescents in correctional and noncorrectional facilities, United States, 2008-2011
Barskey AE , Surendera Babu A , Hernandez A , Espinoza L . Am J Public Health 2015 106 (1) e1-e7 OBJECTIVES: We aimed to determine whether the patterns and trends of HIV infections newly diagnosed within correctional and noncorrectional facilities differ. METHODS: We classified persons newly diagnosed with HIV infection in the United States between 2008 and 2011 (n = 181 710) by correctional and noncorrectional facilities where diagnoses were first made, and stratified by sex, age group, race/ethnicity, transmission category, and diagnosis year. RESULTS: An estimated 9187 persons were newly diagnosed with HIV infection in 2008 to 2011 while incarcerated, representing approximately 5.1% of the 181 710 HIV infections diagnosed in the United States during this period. Of these incarcerated persons, 84% were male, 30% were aged 30 to 39 years, 59% were Black/African American, and 51% of the men had been exposed through male-to-male sexual contact. Yearly numbers of diagnoses declined by 9.9% in correctional versus 0.3% in noncorrectional facilities. The percentage with a late HIV diagnosis was significantly lower in correctional than in noncorrectional facilities (prevalence ratio = 0.52; 95% confidence interval = 0.49, 0.55). CONCLUSIONS: Initial HIV diagnosis occurred sooner after HIV infection onset in correctional than in noncorrectional settings, pointing to the need for efficient referral systems after release. |
Prevalence of anal human papillomavirus vaccine types in the Bangkok men who have sex with men cohort study
Cranston RD , Althouse AD , van Griensven F , Janocko L , Curlin ME , Chaikummao S , Chonwattana W , Siegel A , Holtz TH , McGowan I . Sex Transm Dis 2015 42 (12) 671-676 BACKGROUND: The quadrivalent human papillomavirus (qHPV) and 9 valent (nHPV) vaccine are licensed for males to prevent anal HPV-associated dysplasia and cancer caused by HPV types 6, 11, 16, and 18 (qHPV) and additional types 33, 35, 45, 52, and 58 (nHPV), respectively. Both conditions are common in HIV-infected and HIV-uninfected men who have sex with men (MSM). It is not well documented which anal HPV vaccine types are most prevalent in Southeast Asia. METHODS: A convenience sample of 400 anal swabs were obtained from 200 HIV-infected and 200 HIV-uninfected sexually active Bangkok MSM Cohort Study participants. After swab collection in PreservCyt (Cytyc Corp, Marlborough, MA), the media was stored at -80 degrees C until processing. DNA was extracted, amplified by polymerase chain reaction, denatured, and then hybridized to probes for 37 HPV types and beta-globin. RESULTS: The mean participant age was 25.6 years (range, 18-55 years); the mean CD4 T-cell count was 410 cells/mm in the HIV-infected participants. Among all swab samples, 386 (192 HIV-positive and 194 HIV-negative) had adequate beta-globin for HPV genotype testing. Anal HPV type was detected in 44.3% of participants whose samples underwent genotype testing. Both qHPV and nHPV types were more frequently detected in HIV-infected compared with HIV-uninfected (42.2% vs. 23.2% [P < 0.01], 50.0% vs. 24.2% [P < 0.01]), respectively). There were no significant relationships between social behaviors (alcohol use, drug use) or sexual behaviors (number of partners, condom usage, sexual positioning) and anal HPV prevalence. CONCLUSIONS: The prevalence of anal vaccine HPV types in Thai MSM was similar to that reported in MSM from Western populations and has a similar distribution by HIV status. Targeting young MSM with vaccination could offer protection against HPV vaccine types. |
Progress toward regional measles elimination - worldwide, 2000-2014
Perry RT , Murray JS , Gacic-Dobo M , Dabbagh A , Mulders MN , Strebel PM , Okwo-Bele JM , Rota PA , Goodson JL . MMWR Morb Mortal Wkly Rep 2015 64 (44) 1246-1251 In 2000, the United Nations General Assembly adopted the Millennium Development Goals (MDG), with MDG4 being a two-thirds reduction in child mortality by 2015, and with measles vaccination coverage being one of the three indicators of progress toward this goal.* In 2010, the World Health Assembly established three milestones for measles control by 2015: 1) increase routine coverage with the first dose of measles-containing vaccine (MCV1) for children aged 1 year to >/=90% nationally and >/=80% in every district; 2) reduce global annual measles incidence to fewer than five cases per million population; and 3) reduce global measles mortality by 95% from the 2000 estimate (1).dagger In 2012, the World Health Assembly endorsed the Global Vaccine Action Plan section sign with the objective to eliminate measles in four World Health Organization (WHO) regions by 2015. WHO member states in all six WHO regions have adopted measles elimination goals. This report updates the 2000-2013 report (2) and describes progress toward global control and regional measles elimination during 2000-2014. During this period, annual reported measles incidence declined 73% worldwide, from 146 to 40 cases per million population, and annual estimated measles deaths declined 79%, from 546,800 to 114,900. However, progress toward the 2015 milestones and elimination goals has slowed markedly since 2010. To resume progress toward milestones and goals for measles elimination, a review of current strategies and challenges to improving program performance is needed, and countries and their partners need to raise the visibility of measles elimination, address barriers to measles vaccination, and make substantial and sustained additional investments in strengthening health systems. |
Progress towards poliomyelitis eradication: Afghanistan, January 2014-August 2015
Chukwuma M , Saatcioglu A , Tangermann RH , Hadler S , Ehrhardt D . Wkly Epidemiol Rec 2015 90 (43) 581-8 Despite recent progress towards global polio eradication, endemic transmission of wild poliovirus type 1 | (WPV1) continues in Afghanistan and Pakistan.1, 2 The Afghanistan programme will need to overcome many | challenges to remain on track towards achieving the | objectives set in the 2013–2018 Strategic Plan of the | Global Polio Eradication Initiative.3 | Cross-border | transmission of WPV1 continues to occur to and from | Pakistan.4 | The country’s routine immunization system | remains weak and unable to reach recommended | benchmarks in most regions; hence, the national Polio | Eradication Initiative relies mainly on targeting children aged <5 years with supplementary oral polio | vaccine (OPV) immunization activities (SIAs). Due to | ongoing conflict and insecurity, some children continue | to be missed during SIAs in areas that are not under | government control; however, the majority of children | are still missed during SIAs in accessible areas, due to | failure to plan, implement and supervise efficient SIAs. |
Effectiveness of hormonal contraception in HIV-infected women using antiretroviral therapy
Pyra M , Heffron R , Mugo NR , Nanda K , Thomas KK , Celum C , Kourtis AP , Were E , Rees H , Bukusi E , Baeten JM . AIDS 2015 29 (17) 2353-9 OBJECTIVE: The objective of this study is to assess whether antiretroviral therapy (ART) may diminish the effectiveness of hormonal contraceptive methods. METHODS: Using data from 5153 HIV-infected women followed prospectively for 1-3 years in three HIV prevention studies in Africa, we compared incident pregnancy rates by contraceptive method (implant, injectable, oral or none) and ART use. Multivariable Cox regression models were used to determine adjusted hazard ratios (aHRs) and test interactions between each method and ART use. RESULTS: During follow-up, 9% of women ever used implants, 40% used injectables and 14% used oral contraceptives; 31% of women ever used ART, mostly nevirapine (75% of ART users) or efavirenz-based (15%). Among women not using contraception, pregnancy rates were 13.2 and 22.5 per 100 women-years for those on and not on ART, respectively. Implants greatly reduced the incidence of pregnancy among both women on ART [aHR 0.06, 95% confidence interval (95% CI) 0.01-0.45] and not on ART (aHR 0.05, 95% CI 0.02-0.11). Injectables (aHR 0.18 on ART and aHR 0.20 not on ART) and oral contraceptives (aHR 0.37 on ART and aHR 0.36 not on ART) also reduced pregnancy risk, though by lesser degrees. ART use did not significantly diminish contraceptive effectiveness, although all methods showed nonstatistically significant reduced effectiveness when concurrently using efavirenz. CONCLUSION: Hormonal contraceptive methods are highly effective in reducing pregnancy risk in HIV-infected women, including those concurrently using ART. Studies of potential interactions between ART and contraceptives should evaluate real-world effectiveness of contraceptive methods; in this study, implants were the most effective method to prevent pregnancy, even during ART use. |
Effects of brief messaging about undiagnosed infections detected through HIV testing among black and Latino men who have sex with men in the United States
Mansergh G , Miller P , Herbst JH , Mimiaga MJ , Holman J . Sex Transm Dis 2015 42 (12) 691-693 We examined intent to get tested for HIV infection and use condoms among n = 604 uninfected black and Latino men who have sex with men after receiving brief information messaging that 1 in 10 minority men who have sex with men had HIV infection and did not know it. Information awareness, newness, believability, HIV testing cost willingness, and associated demographic variables were also assessed. |
Implementation and operational research: Strengthening HIV Test Access and Treatment Uptake Study (Project STATUS): A randomized trial of HIV testing and counseling interventions
McNaghten AD , Schilsky Mneimneh A , Farirai T , Wamai N , Ntiro M , Sabatier J , Makhunga-Ramfolo N , Mwanasalli S , Awor A , Moore J . J Acquir Immune Defic Syndr 2015 70 (4) e140-6 OBJECTIVE: To determine which of 3 HIV testing and counseling (HTC) models in outpatient departments (OPDs) increases HIV testing and entry of newly identified HIV-infected patients into care. DESIGN: Randomized trial of HTC interventions. METHODS: Thirty-six OPDs in South Africa, Tanzania, and Uganda were randomly assigned to 3 different HTC models: (A) health care providers referred eligible patients (aged 18-49, not tested in the past year, not known HIV positive) to on-site voluntary counseling and testing for HTC offered and provided by voluntary counseling and testing counselors after clinical consultation; (B) health care providers offered and provided HTC to eligible patients during clinical consultation; and (C) nurse or lay counselors offered and provided HTC to eligible patients before clinical consultation. Data were collected from October 2011 to September 2012. We describe testing eligibility and acceptance, HIV prevalence, and referral and entry into care. Chi-square analyses were conducted to examine differences by model. RESULTS: Of 79,910 patients, 45% were age eligible and 16,099 (45%) age eligibles were tested. Ten percent tested HIV positive. Significant differences were found in percent tested by model. The proportion of age eligible patients tested by Project STATUS was highest for model C (54.1%, 95% confidence interval [CI]: 42.4 to 65.9), followed by model A (41.7%, 95% CI: 30.7 to 52.8), and then model B (33.9%, 95% CI: 25.7 to 42.1). Of the 1596 newly identified HIV positive patients, 94% were referred to care (96.1% in model A, 94.7% in model B, and 94.9% in model C), and 58% entered on-site care (74.4% in model A, 54.8% in model B, and 55.6% in model C) with no significant differences in referrals or care entry by model. CONCLUSIONS: Model C resulted in the highest proportion of all age-eligible patients receiving a test. Although 94% of STATUS patients with a positive test result were referred to care, only 58% entered care. We found no differences in patients entering care by HTC model. Routine HTC in OPDs is acceptable to patients and effective for identifying HIV-infected persons, but additional efforts are needed to increase entry to care. |
Addressing contact tracing challenges - critical to halting Ebola virus disease transmission
Greiner AL , Angelo KM , McCollum AM , Mirkovic K , Arthur R , Angulo FJ . Int J Infect Dis 2015 41 53-5 OBJECTIVES: Delayed and ineffective contact tracing contributed to the extensive transmission of Ebola virus disease (EVD) in the 2014-2015 West African outbreak. Understanding and addressing the challenges to implementing and managing contact tracing is essential to stopping EVD transmission and preventing large-scale EVD outbreaks in the future. METHODS: Interviews were conducted with United States Centers for Disease Control and Prevention staff members engaged in contact tracing activities in the affected West African countries of Sierra Leone, Guinea, Liberia, Senegal, Nigeria, and Mali from September through December, 2014. Two staff members from each country were interviewed. The five most frequently cited contact tracing challenges were identified. RESULTS: Challenges have been evident in every step of the contact tracing process from implementation to management, including identifying, locating, and enrolling contact-persons, as well as managing personnel and ensuring contact tracing performance. Common themes observed in all the affected West African countries have included fear, stigma, and community misperceptions regarding EVD. Countries that have overcome these challenges, ensuring immediate and comprehensive contact tracing, have been successful in halting EVD transmission. CONCLUSIONS: Addressing challenges to contact tracing implementation and management in the West African EVD outbreak is essential to stopping ongoing transmission. |
Adverse drug reactions reported to a National HIV & Tuberculosis Health Care Worker Hotline in South Africa: description and prospective follow-up of reports
Njuguna C , Stewart A , Mouton JP , Blockman M , Maartens G , Swart A , Chisholm B , Jones J , Dheda M , Igumbor EU , Cohen K . Drug Saf 2015 39 (2) 159-69 INTRODUCTION: The National HIV & Tuberculosis Health Care Worker (HCW) Hotline provides advice on the management of suspected adverse drug reactions (ADRs). We describe suspected ADRs reported to the hotline by HCWs, concordance with advice, and patient outcomes. METHODS: We reviewed suspected ADRs in HIV-infected patients, patients taking antiretrovirals and patients taking anti-tuberculosis therapy reported from May 2013 to October 2014. We performed causality assessment using the World Health Organization Uppsala Monitoring Centre (WHO-UMC) criteria. We included suspected ADRs categorized as certain, probable or possible in further analysis. RESULTS: We received 772 ADR reports, of which 87/772 (11.3 %) were classified as certain, 176/772 (22.8 %) as probable, 361/772 (46.8 %) as possible, and 148/772 (19.2 %) as unlikely or unassessable. The most frequent ADRs were rash, drug-induced liver injury (DILI) and kidney injury, comprising 110/624 (17.6 %), 87/624 (13.9 %), and 77/624 (12.3 %), respectively. The ADR was severe in 27.3 % of rashes, 36.4 % of kidney injury reports and 88.5 % of DILI reports. Most frequently implicated drugs, either alone or in combination with other potentially causative drugs, were efavirenz (rashes), efavirenz and anti-tuberculosis drugs (DILI) and tenofovir (kidney injury). In 383 cases with HCW follow-up, 254 (66.3 %) improved, 9 (2.3 %) had complete resolution, 32 (8.4 %) remained unchanged, 6 (1.6 %) deteriorated, 10 (2.6 %) died and 72 (18.8 %) had unknown outcome. Advice provided was followed in 93.2 % of these cases. Of 223 ADRs with preventability data, 40 (17.9 %) were preventable. CONCLUSION: Queries about rashes, DILIs and kidney injuries were common. Detection and management of these ADRs should be included in HCW training. In cases with follow-up, concordance with advice was high, and HCWs reported improvement in the majority. |
Completeness of methicillin-resistant Staphylococcus aureus bloodstream infection reporting from outpatient hemodialysis facilities to the National Healthcare Safety Network, 2013
Nguyen DB , See I , Gualandi N , Shugart A , Lines C , Bamberg W , Dumyati G , Harrison LH , Lesher L , Nadle J , Petit S , Ray SM , Schaffner W , Townes J , Njord L , Sievert D , Thompson ND , Patel PR . Infect Control Hosp Epidemiol 2015 37 (2) 1-3 Reports of bloodstream infections caused by methicillin-resistant Staphylococcus aureus among chronic hemodialysis patients to 2 Centers for Disease Control and Prevention surveillance systems (National Healthcare Safety Network Dialysis Event and Emerging Infections Program) were compared to evaluate completeness of reporting. Many methicillin-resistant S. aureus bloodstream infections identified in hospitals were not reported to National Healthcare Safety Network Dialysis Event. |
Continuing need for sexually transmitted disease clinics after the Affordable Care Act
Hoover KW , Parsell BW , Leichliter JS , Habel MA , Tao G , Pearson WS , Gift TL . Am J Public Health 2015 105 Suppl 5 S690-5 OBJECTIVES: We assessed the characteristics of sexually transmitted disease (STD) clinic patients, their reasons for seeking health services in STD clinics, and their access to health care in other venues. METHODS: In 2013, we surveyed persons who used publicly funded STD clinics in 21 US cities with the highest STD morbidity. RESULTS: Of the 4364 STD clinic patients we surveyed, 58.5% were younger than 30 years, 72.5% were non-White, and 49.9% were uninsured. They visited the clinic for STD symptoms (18.9%), STD screening (33.8%), and HIV testing (13.6%). Patients chose STD clinics because of walk-in, same-day appointments (49.5%), low cost (23.9%), and expert care (8.3%). Among STD clinic patients, 60.4% had access to another type of venue for sick care, and 58.5% had access to another type of venue for preventive care. Most insured patients (51.6%) were willing to use insurance to pay for care at the STD clinic. CONCLUSIONS: Despite access to other health care settings, patients chose STD clinics for sexual health care because of convenient, low-cost, and expert care. Policy Implication. STD clinics play an important role in STD prevention by offering walk-in care to uninsured patients. |
Delivery of an Ebola virus-positive stillborn infant in a rural community health center, Sierra Leone, January 2015
Bower H , Grass JE , Veltus E , Brault A , Campbell S , Basile AJ , Wang D , Paddock CD , Erickson BR , Salzer JS , Belser J , Chege E , Seneca D , Saffa G , Stroeher U , Decroo T , Caleo GM . Am J Trop Med Hyg 2015 94 (2) 417-9 We report the case of an Ebola virus (EBOV) RNA-negative pregnant woman who delivered an EBOV RNA-positive stillborn infant at a community health center in rural Sierra Leone, 1 month after the mother's last possible exposure. The mother was later found to be immunoglobulins M and G positive indicating previous infection. The apparent absence of Ebola symptoms and not recognizing that the woman had previous contact with an Ebola patient led health workers performing the delivery to wear only minimal personal protection, potentially exposing them to a high risk of EBOV infection. This case emphasizes the importance of screening for epidemiological risk factors as well as classic and atypical symptoms of Ebola when caring for pregnant women, even once they have passed the typical time frame for exposure and incubation expected in nonpregnant adults. It also illustrates the need for health-care workers to use appropriate personal protection equipment when caring for pregnant women in an Ebola setting. |
Government response to the discovery of a rabies virus reservoir species on a previously designated rabies-free island, Taiwan, 1999-2014
Chang SS , Tsai HJ , Chang FY , Lee TS , Huang KC , Fang KY , Wallace RM , Inoue S , Fei CY . Zoonoses Public Health 2015 63 (5) 396-402 Taiwan had been considered rabies free since 1961. In 2013, Taiwan confirmed the detection of rabies virus in wild Taiwan ferret-badgers. Up to December 2014, there have been 423 rabies-confirmed ferret-badgers and three cases of spillover infection into non-reservoir hosts. Genetic analysis indicates that TFBV is distinct from all other known rabies virus variants. To date, ferret-badger rabies is known to occur only in China and Taiwan. The temporal dynamics of rabid ferret-badgers in Taiwan suggests that the epizootic appears to have subsided to enzootic levels as of December 2014. According to the current epidemiologic data, there is only one TFBV strain in Taiwan. TFBV is still sequestered to the mountainous regions. Humans are at risk mainly through exposure to the virus from infected domestic meso-carnivores, mainly dogs and cats. Dogs and cats should be vaccinated to establish an immunological barrier to stop the spread of the disease from mountainous regions to domestic meso-carnivores. |
Threat of secondary chemical contamination of emergency departments and personnel: an uncommon but recurrent problem
Larson TC , Orr MF , Auf der Heide E , Wu J , Mukhopadhyay S , Kevin Horton D . Disaster Med Public Health Prep 2015 10 (2) 1-4 OBJECTIVE: To analyze acute hazardous substance release surveillance data for events involving secondary contamination of hospital emergency departments (EDs). Secondary contamination of EDs may occur when a patient exposed to a hazardous chemical is not decontaminated before arrival at the ED and when ED staff are not wearing appropriate personal protective equipment. This can result in adverse health outcomes among department personnel, other patients, and visitors. Even events without actual secondary contamination risk can be real in their consequences and require the decontamination of the ED or its occupants, evacuation, or temporary shutdown of the ED. METHODS: Events involving secondary contamination were identified by using the Hazardous Substances Emergency Events Surveillance system and the National Toxic Substance Incidents Program from 2007 to 2013. RESULTS: Five incidents involving the threat of secondary contamination (0.02% of all events reported to the surveillance systems [n=33,001]) were detected and are described. Four incidents involved suspected secondary contamination in which the facility was evacuated or shut down. CONCLUSIONS: These results suggest that although rare, incidents involving secondary contamination continue to present a hazard for emergency departments. Suggested best practices to avoid secondary contamination have been described. Hospitals should be made aware of the risks associated with secondary contamination and the need to proactively train and equip staff to perform decontamination. |
Perceptions of health communication, water treatment and sanitation in Artibonite Department, Haiti, March-April 2012
Williams HA , Gaines J , Patrick M , Berendes D , Fitter D , Handzel T . PLoS One 2015 10 (11) e0142778 The international response to Haiti's ongoing cholera outbreak has been multifaceted, including health education efforts by community health workers and the distribution of free water treatment products. Artibonite Department was the first region affected by the outbreak. Numerous organizations have been involved in cholera response efforts in Haiti with many focusing on efforts to improve water, sanitation, and hygiene (WASH). Multiple types of water treatment products have been distributed, creating the potential for confusion over correct dosage and water treatment methods. We utilized qualitative methods in Artibonite to determine the population's response to WASH messages, use and acceptability of water treatment products, and water treatment and sanitation knowledge, attitudes and practices at the household level. We conducted eighteen focus group discussions (FGDs): 17 FGDs were held with community members (nine among females, eight among males); one FGD was held with community health workers. Health messages related to WASH were well-retained, with reported improvements in hand-washing. Community health workers were identified as valued sources of health information. Most participants noted a paucity of water-treatment products. Sanitation, specifically the construction of latrines, was the most commonly identified need. Lack of funds was the primary reason given for not constructing a latrine. The construction and maintenance of potable water and sanitation services is needed to ensure a sustainable change. |
Predominance and distribution of a persistent Listeria monocytogenes clone in a commercial fresh mushroom processing environment
Murugesan L , Kucerova Z , Knabel SJ , LaBorde LF . J Food Prot 2015 78 (11) 1988-98 A longitudinal study was conducted to determine the prevalence of Listeria spp. in a commercial fresh mushroom slicing and packaging environment. Samples were collected at three different sampling periods within a 13-month time interval. Of the 255 environmental samples collected, 18.8% tested positive for L. monocytogenes, 4.3% for L. innocua, and 2.0% for L. grayi. L. monocytogenes was most often found on wet floors within the washing and slicing and packaging areas. Each of the 171 L. monocytogenes isolates found in the environment could be placed into one of three different serotypes; 1/2c was predominant (93.6%), followed by 1/2b (3.5%) and 1/2a (2.9%). Of 58 isolates subtyped using multi-virulence-locus sequence typing, all 1/2c isolates were identified as virulence type (VT) 11 (VT11), all 1/2b isolates were VT105, and 1/2a isolates were either VT107 or VT56. VT11 was designated as the predominant and persistent clone in the environment because it was isolated repeatedly at numerous locations throughout the study. The overall predominance and persistence of VT11 indicates that it likely colonized the mushroom processing environment. Areas adjacent to the trench drain in the washing and slicing area and a floor crack in the packaging area may represent primary harborage sites (reservoirs) for VT11. Improvements made to sanitation procedures by company management after period 2 coincided with a significant (P ≤ 0.001) reduction in the prevalence of L. monocytogenes from 17.8% in period 1 and 30.7% in period 2 to 8.5% in period 3. This suggests that targeted cleaning and sanitizing procedures can be effective in minimizing the occurrence of L. monocytogenes contamination in processing facilities. Additional research is needed to understand why VT11 was predominant and persistent in the mushroom processing environment. |
Precision Public Health for the Era of Precision Medicine.
Khoury MJ , Iademarco MF , Riley WT . Am J Prev Med 2015 50 (3) 398-401 The Precision Medicine Initiative1 promises a new healthcare era. A proposed 1 million—person cohort could create a deeper understanding of disease causation. Improvements in quality of sequencing, reduction in price, and advances in “omic” fields and biotechnology promise a new era, variably labeled personalized or precision medicine. Although genomics is one driver of precision health care, other factors may be as important (e.g., health information technology). | Both excitement and skepticism met the announcement. 2 Public health experts are concerned about the disproportionate emphasis on genes, drugs, and disease, while neglecting strategies to address social determinants of health. A prime concern for public health is promoting health, preventing disease, and reducing health disparities by focusing on modifiable morbidity and mortality. In 2014, CDC estimated the annual number of potentially preventable deaths from the top five causes in the U.S.3 Data suggest that at least one third of deaths are potentially preventable by reducing prevalence of known risk factors (e.g., smoking, poor diet, and inadequate physical activity). |
Representativeness of Tuberculosis Genotyping Surveillance in the United States, 2009-2010.
Shak EB , France AM , Cowan L , Starks AM , Grant J . Public Health Rep 2015 130 (6) 596-601 Genotyping of Mycobacterium tuberculosis isolates contributes to tuberculosis (TB) control through detection of possible outbreaks. However, 20% of U.S. cases do not have an isolate for testing, and 10% of cases with isolates do not have a genotype reported. TB outbreaks in populations with incomplete genotyping data might be missed by genotyping-based outbreak detection. Therefore, we assessed the representativeness of TB genotyping data by comparing characteristics of cases reported during January 1, 2009-December 31, 2010, that had a genotype result with those cases that did not. Of 22,476 cases, 14,922 (66%) had a genotype result. Cases without genotype results were more likely to be patients <19 years of age, with unknown HIV status, of female sex, U.S.-born, and with no recent history of homelessness or substance abuse. Although cases with a genotype result are largely representative of all reported U.S. TB cases, outbreak detection methods that rely solely on genotyping data may underestimate TB transmission among certain groups. |
Efficacy of a brief intervention to reduce substance use and human immunodeficiency virus infection risk among Latino youth
Estrada Y , Rosen A , Huang S , Tapia M , Sutton M , Willis L , Quevedo A , Condo C , Vidot DC , Pantin H , Prado G . J Adolesc Health 2015 PURPOSE: Familias Unidas is an efficacious and effective family-based intervention for preventing and reducing substance use and unsafe sexual behaviors among Latino youth. To facilitate its dissemination, Familias Unidas was shortened from a 12-week intervention to a 6-week intervention and evaluated. We hypothesized that brief Familias Unidas would be efficacious in reducing substance use and unsafe sexual behaviors relative to a comparison condition. METHODS: We randomized 160 ninth-grade Latino adolescents and their families to brief Familias Unidas or a community practice control condition. Adolescents were surveyed at baseline and 6, 12, and 24 months after baseline. RESULTS: At 24 months, youth randomized to brief Familias Unidas had a significantly lower sexual initiation rate (34.0%) relative to control (55.0%), p = .02. Brief Familias Unidas also increased positive parenting. Moderation analyses revealed that brief Familias Unidas was significantly associated with decreased substance use initiation among girls (30.4% vs. 64.0%, respectively; p = .02), but not boys (28.0% vs. 26.7%, respectively; p = .91). Brief Familias Unidas was also significantly associated with reduced unsafe sex among adolescents aged 15 years or less (p < .001), but not among older adolescents (p = .37). Moderating effects were also found for family-level variables. CONCLUSIONS: Brief Familias Unidas was efficacious in reducing sex initiation and improving positive parenting. Moderation analyses suggested that brief Familias Unidas was efficacious in reducing substance use initiation and unsafe sex for certain Hispanic adolescent subgroups, highlighting the importance of conducting moderation analyses, and of targeting interventions for specific subgroups. |
A population-based estimate of the economic burden of influenza in Peru, 2009-2010
Tinoco YO , Azziz-Baumgartner E , Razuri H , Kasper MR , Romero C , Ortiz E , Gomez J , Widdowson MA , Uyeki TM , Gilman RH , Bausch DG , Montgomery JM . Influenza Other Respir Viruses 2015 10 (4) 301-9 INTRODUCTION: Influenza disease burden and economic impact data are needed to assess the potential value of interventions. Such information is limited from resource-limited settings. We therefore studied the cost of influenza in Peru. METHODS: We used data collected during June 2009-December 2010 from laboratory-confirmed influenza cases identified through a household cohort in Peru. We determined the self-reported direct and indirect costs of self-treatment, outpatient care, emergency ward care and hospitalizations through standardized questionnaires. We recorded costs accrued 15-day from illness onset. Direct costs represented medication, consultation, diagnostic fees, and health-related expenses such as transportation and phone calls. Indirect costs represented lost productivity during days of illness by both cases and caregivers. We estimated the annual economic cost and the impact of a case of influenza on a household. RESULTS: There were 1,321 confirmed influenza cases, of which 47% sought healthcare. Influenza case-patients paid a median of $13 (IQR 5-26) for self-treatment, $19 (IQR 9-34) for ambulatory non-medical attended illness, $29 (IQR 14-51) for ambulatory medical attended illness, and $171 (IQR 113-258) for hospitalizations. Overall, the projected national cost of an influenza illness was $83-$85 millions. Costs per influenza illness represented 14% of the monthly household income of the lowest income quartile (compared to 3% of the highest quartile). CONCLUSION: Influenza virus infection causes an important economic burden, particularly among the poorest families and those hospitalized. Prevention strategies such as annual influenza vaccination program targeting SAGE population at risk could reduce the overall economic impact of seasonal influenza. |
Estimating the size and cost of the STD prevention services safety net
Gift TL , Haderxhanaj LT , Torrone EA , Behl AS , Romaguera RA , Leichliter JS . Public Health Rep 2015 130 (6) 602-9 The Patient Protection and Affordable Care Act is expected to reduce the number of uninsured people in the United States during the next eight years, but more than 10% are expected to remain uninsured. Uninsured people are one of the main populations using publicly funded safety net sexually transmitted disease (STD) prevention services. Estimating the proportion of the uninsured population expected to need STD services could help identify the potential demand for safety net STD services and improve program planning. In 2013, an estimated 8.27 million people met the criteria for being in need of STD services. In 2023, 4.70 million uninsured people are expected to meet the criteria for being in need of STD services. As an example, the cost in 2014 U.S. dollars of providing chlamydia screening to these people was an estimated $271.1 million in 2013 and is estimated to be $153.8 million in 2023. A substantial need will continue to exist for safety net STD prevention services in coming years. |
Big differences in state tobacco-control spending
Juang G , Walton K , Gerzoff RB , King BA , Chalupka FJ . Oncol Times 2015 37 (18) 58-60 3p Evidence-based, statewide tobacco control programs that are comprehensive, sustained, and accountable reduce smoking rates and tobacco-related diseases and deaths.1,2 States that made larger investments in tobacco prevention and control have seen larger declines in cigarettes sales than in the United States as a whole,3 and the prevalence of smoking has declined faster as spending for tobacco-control programs has increased.4,5 | CDC's Best Practices for Comprehensive Tobacco Control Programs (Best Practices) outlines the elements of an evidence-based state tobacco-control program and provides recommended state funding levels to substantially reduce tobacco-related disease, disability, and death.1,2 | To analyze states' spending in relation to program components outlined within Best Practices, CDC assessed state tobacco control programs' expenditures for fiscal year 2011 (the most recent year for which full data are available). In 2011, states spent approximately $658 million on tobacco control and prevention, which accounts for less than three percent of the states' revenues from the sale of tobacco products and only 17.8 percent of the level recommended by CDC. Evidence suggests that funding tobacco prevention and control efforts at the levels recommended in Best Practices could achieve larger and more rapid reductions in tobacco use and associated morbidity and mortality.2,3 |
Uptake of influenza vaccination and missed opportunities among adults with high-risk conditions, United States, 2013
Lu PJ , O'Halloran A , Ding H , Srivastav A , Williams WW . Am J Med 2015 129 (6) 636 e1-636 e11 BACKGROUND: Since 1960, the Advisory Committee on Immunization Practices (ACIP) has recommended influenza vaccination for adults with certain high-risk conditions because of increased risk for complications from influenza infection. We assessed national influenza vaccination among persons 18-64 years with high-risk conditions. METHODS: We analyzed data from the 2012 and 2013 National Health Interview Survey (NHIS). The Kaplan-Meier survival analysis procedure was used to estimate the cumulative proportion of influenza vaccination among adults 18-64 years with high-risk conditions. Potential missed opportunities for influenza vaccination were also evaluated. Multivariable logistic regression and predictive marginal analyses were conducted to identify factors independently associated with vaccination. RESULTS: Overall, 39.9 million adults 18-64 years (18.9%) had at least one high-risk condition. For adults 18-64 years with high-risk conditions, overall influenza vaccination coverage was 49.5%. Coverage among adults 50-64 years was significantly higher compared with those 18-49 years (59.3% vs. 39.0%; p<0.05). Among adults 18-64 years, coverage was 46.2% for those with chronic lung diseases, 50.5% for those with heart disease, 58.0% for those with diabetes, 62.5% for those with renal disease, and 56.4% for those with cancer. Overall, 90.1% reported at least one visit to a health care setting where vaccination could have been provided. Among adults 18-64 years with high-risk conditions, older age, being female, Hispanic ethnicity or Asian race, having one or more physician visits, a regular physician for health care, health insurance, and having ever received pneumococcal vaccination were independently associated with a higher likelihood of influenza vaccination. Being widowed/divorced/separated or never married and not being employed were independently associated with a lower likelihood of influenza vaccination. CONCLUSIONS: Influenza vaccination coverage varies substantially by age and high-risk conditions but remains low. Approximately 50% of those with high-risk conditions remain unvaccinated. Healthcare providers should ensure they routinely assess influenza vaccination status, recommend and offer vaccines to those with high-risk conditions. |
Lessons learned from enhancing vaccine pharmacovigilance activities during PsA-TT introduction in African countries, 2010-2013
Diomande FV , Yameogo TM , Vannice KS , Preziosi MP , Viviani S , Ouandaogo CR , Keita M , Djingarey MH , Mbakuliyemo N , Akanmori BD , Sow SO , Zuber PL . Clin Infect Dis 2015 61 Suppl 5 S459-66 BACKGROUND: The rollout of the group A meningococcal vaccine, PsA-TT, in Africa's meningitis belt countries represented the first introduction of a vaccine specifically designed for this part of the world. During the first year alone, the number of people who received the vaccine through mass vaccination campaigns was several hundredfold higher than that of subjects who participated in the closely monitored clinical trials. Implementation of a system to identify rare but potentially serious vaccine reactions was therefore a high priority in the design and implementation of those campaigns. METHODS: National authorities and their technical partners set up effective vaccine pharmacovigilance systems, including conducting active surveillance projects. RESULTS: Implementation of national expert advisory groups to review serious adverse events following immunization in all countries and active monitoring of conditions of interest in 3 early-adopter countries did not identify particular concerns with the safety profile of PsA-TT, which had already provided tremendous public health benefits. CONCLUSIONS: Lessons learned from this experience will help to improve preparations for future vaccine introductions in resource-poor settings and capitalize on such efforts to advance vaccine safety systems in the future. |
Mass vaccination with a two-dose oral cholera vaccine in a long-standing refugee camp, Thailand
Phares CR , Date K , Travers P , Deglise C , Wongjindanon N , Ortega L , Bhuket PR . Vaccine 2015 34 (1) 128-33 BACKGROUND: During 2005-2012, surveillance in Maela refugee camp, Thailand, identified four cholera outbreaks, with rates up to 10.7 cases per 1000 refugees. In 2013, the Thailand Ministry of Public Health sponsored a two-dose oral cholera vaccine (OCV) campaign for the approximately 46,000 refugees living in Maela. METHODS: We enumerated the target population (refugees living in Maela who are ≥1 year old and not pregnant) in a census three months before the campaign and issued barcoded OCV cards to each individual. We conducted the campaign using a fixed-post strategy during two eight-day rounds plus one two-day round for persons who had missed their second dose and recorded vaccine status for each individual. To identify factors associated with no vaccination (versus at least one dose) and those associated with adverse events following immunization (AEFI), we used separate marginal log-binomial regression models with robust variance estimates to account for household clustering. RESULTS: A total of 63,057 OCV doses were administered to a target population of 43,485 refugees. An estimated 35,399 (81%) refugees received at least one dose and 27,658 (64%) received two doses. A total of 993 additional doses (1.5%) were wasted including 297 that were spat out. Only 0.05% of refugees, mostly children, could not be vaccinated due to repeated spitting. Characteristics associated with no vaccination (versus at least one dose) included age ≥15 years (versus 1-14 years), Karen ethnicity (versus any other ethnicity) and, only among adults 15-64 years old, male sex. Passive surveillance identified 84 refugees who experienced 108 AEFI including three serious but coincidental events. The most frequent AEFI were nausea (49%), dizziness (38%), and fever (30%). Overall, AEFI were more prevalent among young children and older adults. CONCLUSIONS: Our results suggest that mass vaccination in refugee camps with a two-dose OCV is readily achievable and AEFI are few. |
Neisseria meningitidis Group A IgG1 and IgG2 subclass immune response in African children aged 12-23 months following meningococcal vaccination
Holme D , Findlow H , Sow SO , Idoko OT , Preziosi MP , Carlone G , Plikaytis BD , Borrow R . Clin Infect Dis 2015 61 Suppl 5 S563-9 BACKGROUND: A group A meningococcal conjugate vaccine, PsA-TT, was licensed in 2010 and was previously studied in a phase 2 clinical trial to evaluate its safety and immunogenicity in African children 12-23 months of age. METHODS: Subjects received either PsA-TT; meningococcal group A, C, W, Y polysaccharide vaccine (PsACWY); or Haemophilus influenzae type b conjugate vaccine (Hib-TT). Forty weeks following primary vaccination, the 3 groups were further randomized to receive either PsA-TT, one-fifth dose of PsACWY, or Hib-TT. Group A-specific immunoglobulin G (IgG) subclass response was characterized using an enzyme-linked immunosorbent assay. RESULTS: The predominant IgG subclass response, regardless of vaccine, was IgG1. One month following primary vaccination, the geometric mean concentrations (GMCs) of IgG1 and IgG2 in the PsA-TT group were 21.73 microg/mL and 6.27 microg/mL, whereas in the PsACWY group the mean GMCs were 2.01 microg/mL and 0.97 microg/mL, respectively (P < .0001). Group A-specific IgG1 and IgG2 GMCs remained greater in the PsA-TT group than in the PsACWY group 40 weeks following primary vaccination (P < .0001). One week following revaccination, those given 2 doses of PsA-TT had the greatest IgG1 and IgG2 GMCs of 125.23 microg/mL and 36.12 microg/mL, respectively (P = .0008), and demonstrated a significant increase in IgG1:IgG2 mean ratio, indicative of the T-cell-dependent response associated with conjugate vaccines. CONCLUSIONS: Vaccination of African children aged 12-24 months with either PsA-TT or PsACWY elicited a predominantly IgG1 response. The IgG1:IgG2 mean ratio decreased following successive vaccination with PsACWY, indicating a shift toward IgG2, suggestive of the T-cell-independent immune response commonly associated with polysaccharide antigens. CLINICAL TRIALS REGISTRATION: SRCTN78147026. |
A phase 3, double-blind, randomized, active controlled study to evaluate the safety of MenAfriVac in healthy Malians
Tapia MD , Sow SO , Haidara FC , Diallo F , Doumbia M , Enwere GC , Paranjape G , Herve J , Bouma E , Parulekar V , Martellet L , Chaumont J , Plikaytis BD , Tang Y , Kulkarni PS , Hartmann K , Preziosi MP . Clin Infect Dis 2015 61 Suppl 5 S507-13 BACKGROUND: A safe, affordable, and highly immunogenic meningococcal A conjugate vaccine (PsA-TT, MenAfriVac) was developed to control epidemic group A meningitis in Africa. Documentation of the safety specifications of the PsA-TT vaccine was warranted, with sufficient exposure to detect potential rare vaccine-related adverse reactions. METHODS: This phase 3, double-blind, randomized, active controlled clinical study was designed to evaluate the safety-primarily vaccine-related serious adverse events (SAEs)-up to 3 months after administration of a single dose of the PsA-TT vaccine to subjects aged 1-29 years in Mali. Safety outcomes were also compared to those following a single dose of a licensed meningococcal ACWY polysaccharide vaccine (PsACWY). RESULTS: No vaccine-related SAEs occurred during the 3 months of follow-up of 4004 subjects vaccinated with a single dose of PsA-TT. When compared to PsACWY (1996 subjects), tenderness at the injection site appeared to be more frequent in the PsA-TT group. However, rates of local induration, systemic reactions, adverse events (AEs), and SAEs were similar in both groups, and unsolicited AEs and SAEs were all unrelated to the study vaccines. CONCLUSIONS: The study confirmed on a large scale the excellent safety profile of a single dose of PsA-TT when administered to its entire target population of 1-29 years of age. |
Public health impact after the introduction of PsA-TT: the first 4 years
Diomande FV , Djingarey MH , Daugla DM , Novak RT , Kristiansen PA , Collard JM , Gamougam K , Kandolo D , Mbakuliyemo N , Mayer L , Stuart J , Clark T , Tevi-Benissan C , Perea WA , Preziosi MP , Marc LaForce F , Caugant D , Messonnier N , Walker O , Greenwood B . Clin Infect Dis 2015 61 Suppl 5 S467-72 BACKGROUND: During the first introduction of a group A meningococcal vaccine (PsA-TT) in 2010-2011 and its rollout from 2011 to 2013, >150 million eligible people, representing 12 hyperendemic meningitis countries, have been vaccinated. METHODS: The new vaccine effectiveness evaluation framework was established by the World Health Organization and partners. Meningitis case-based surveillance was strengthened in PsA-TT first-introducer countries, and several evaluation studies were conducted to estimate the vaccination coverage and to measure the impact of vaccine introduction on meningococcal carriage and disease incidence. RESULTS: PsA-TT implementation achieved high vaccination coverage, and results from studies conducted showed significant decrease of disease incidence as well as significant reduction of oropharyngeal carriage of group A meningococci in vaccinated and unvaccinated individuals, demonstrating the vaccine's ability to generate herd protection and prevent group A epidemics. CONCLUSIONS: Lessons learned from this experience provide useful insights in how to guide and better prepare for future new vaccine introductions in resource-limited settings. |
Environmental enteropathy, oral vaccine failure and growth faltering in infants in Bangladesh
Naylor C , Lu M , Haque R , Mondal D , Buonomo E , Nayak U , Mychaleckyj JC , Kirkpatrick B , Colgate R , Carmolli M , Dickson D , van der Klis F , Weldon W , Oberste SM , Ma JZ , Petri WA . EBioMedicine 2015 2 (11) 1759-66 Background: Environmental enteropathy (EE) is a subclinical enteric condition found in low-income countries that is characterized by intestinal inflammation, reduced intestinal absorption, and gut barrier dysfunction. We aimed to assess if EE impairs the success of oral polio and rotavirus vaccines in infants in Bangladesh. Methods: We conducted a prospective observational study of 700 infants from an urban slum of Dhaka, Bangladesh from May 2011 to November 2014. Infants were enrolled in the first week of life and followed to age one year through biweekly home visits with EPI vaccines administered and growth monitored. EE was operationally defied as enteric inflammation measured by any one of the fecal biomarkers reg1B, alpha-1-antitrypsin, MPO, calprotectin, or neopterin. Oral polio vaccine success was evaluated by immunogenicity, and rotavirus vaccine response was evaluated by immunogenicity and protection from disease. This study is registered with ClinicalTrials.gov, number NCT01375647. Findings: EE was present in greater than 80% of infants by 12. weeks of age. Oral poliovirus and rotavirus vaccines failed in 20.2% and 68.5% of the infants respectively, and 28.6% were malnourished (HAZ. <. -2) at one year of age. In contrast, 0%, 9.0%, 7.9% and 3.8% of infants lacked protective levels of antibody from tetanus, Haemophilus influenzae type b, diphtheria and measles vaccines respectively. EE was negatively associated with oral polio and rotavirus response but not parenteral vaccine immunogenicity. Biomarkers of systemic inflammation and measures of maternal health were additionally predictive of both oral vaccine failure and malnutrition. The selected biomarkers from multivariable analysis accounted for 46.3% variation in delta HAZ. 24% of Rotarix® IgA positive individuals can be attributed to the selected biomarkers. Interpretation: EE as well as systemic inflammation and poor maternal health were associated with oral but not parenteral vaccine underperformance and risk for future growth faltering. These results offer a potential explanation for the burden of these problems in low-income problems, allow early identification of infants at risk, and suggest pathways for intervention. Funding: The Bill and Melinda Gates Foundation (OPP1017093). © 2015 The Authors. |
Global routine vaccination coverage, 2014
Subaiya S , Dumolard L , Lydon P , Gacic-Dobo M , Eggers R , Conklin L . MMWR Morb Mortal Wkly Rep 2015 64 (44) 1252-1255 The year 2014 marked the 40th anniversary of the World Health Organization's (WHO) Expanded Program on Immunization, which was established to ensure equitable access to routine immunization services (1). Since 1974, global coverage with the four core vaccines (Bacille Calmette- Guerin vaccine [BCG; for protection against tuberculosis], diphtheria-tetanus-pertussis [DTP] vaccine, poliovirus vaccine, and measles vaccine) has increased from <5% to >/=85%, and additional vaccines have been added to the recommended schedule. Coverage with the 3rd dose of DTP vaccine (DTP3) by age 12 months is an indicator of immunization program performance because it reflects completion of the basic infant immunization schedule; coverage with other vaccines, including the 3rd dose of poliovirus vaccine (polio3); the 1st dose of measles-containing vaccine (MCV1) is also assessed. Estimated global DTP3 coverage has remained at 84%-86% since 2009, with estimated 2014 coverage at 86%. Estimated global coverage for the 2nd routine dose of measles-containing vaccine (MCV2) was 38% by age 24 months and 56% when older age groups were included, similar to levels reported in 2013 (36% and 55%, respectively). To reach and sustain high immunization coverage in all countries, adequate vaccine stock management and additional opportunities for immunization, such as through routine visits in the second year of life, are integral components to strengthening immunization programs and reducing morbidity and mortality from vaccine preventable diseases. |
Human complement bactericidal responses to a group A meningococcal conjugate vaccine in Africans and comparison to responses measured by 2 other group A immunoassays
Price GA , Hollander AM , Plikaytis BD , Mocca BT , Carlone G , Findlow H , Borrow R , Sow SO , Diallo A , Idoko OT , Enwere GC , Elie C , Preziosi MP , Kulkarni PS , Bash MC . Clin Infect Dis 2015 61 Suppl 5 S554-62 BACKGROUND: PsA-TT (MenAfriVac) is a conjugated polysaccharide vaccine developed to eliminate group A meningococcal disease in Africa. Vaccination of African study participants with 1 dose of PsA-TT led to the production of anti-A polysaccharide antibodies and increased serum bactericidal activity measured using rabbit complement (rSBA). Bactericidal responses measured with human complement (hSBA) are presented here. METHODS: Sera collected before and at 28 days and 1 year after vaccination with either PsA-TT or quadrivalent polysaccharide vaccine (PsACWY) from a random, age-distributed 360-subject subset of the Meningitis Vaccine Project study of PsA-TT in Africans aged 2-29 years were tested for hSBA. Geometric mean titer, fold-rise, and threshold analyses were compared between vaccine groups and age groups. hSBA, rSBA, and immunoglobulin G (IgG) enzyme-linked immunosorbent assay (ELISA) results were compared and assay correlation and agreement determined. RESULTS: hSBA responses to PsA-TT were substantially higher than those to PsACWY at 28 days and 1 year following immunization, similar to previously reported rSBA and IgG results. The hSBA and IgG ELISA results identified differences between age groups that were not evident by rSBA. The rSBA data indicated sustained high titers 1 year after immunization, whereas hSBA GMTs at 1 year approached 4 in young children. CONCLUSIONS: The high level of protection following PsA-TT immunization campaigns is consistent with the strong hSBA immune responses observed here. Future implementation decisions will likely depend on immunologic data and their long-term correlation with disease and carriage prevention. Expanded immunologic and epidemiologic surveillance may improve the interpretation of differences between these immunoassays. |
Immunogenicity of yellow fever vaccine coadministered with MenAfriVac in healthy infants in Ghana and Mali
Roy Chowdhury P , Meier C , Laraway H , Tang Y , Hodgson A , Sow SO , Enwere GC , Plikaytis BD , Kulkarni PS , Preziosi MP , Niedrig M . Clin Infect Dis 2015 61 Suppl 5 S586-93 BACKGROUND: Yellow fever (YF) is still a major public health problem in endemic regions of Africa and South America. In Africa, one of the main control strategies is routine vaccination within the Expanded Programme on Immunization (EPI). A new meningococcal A conjugate vaccine (PsA-TT) is about to be introduced in the EPI of countries in the African meningitis belt, and this study reports on the immunogenicity of the YF-17D vaccines in infants when administered concomitantly with measles vaccine and PsA-TT. METHODS: Two clinical studies were conducted in Ghana and in Mali among infants who received PsA-TT concomitantly with measles and YF vaccines at 9 months of age. YF neutralizing antibody titers were measured using a microneutralization assay. RESULTS: In both studies, the PsA-TT did not adversely affect the immune response to the concomitantly administered YF vaccine at the age of 9 months. The magnitude of the immune response was different between the 2 studies, with higher seroconversion and seroprotection rates found in Mali vs Ghana. CONCLUSIONS: Immunogenicity to YF vaccine is unaffected when coadministered with PsA-TT at 9 months of age. Further studies are warranted to better understand the determinants of the immune response to YF vaccine in infancy.. |
Influence of age on antibody response and persistence following immunization with MenAfriVac
Tang Y , Plikaytis BD , Preziosi MP , Borrow R . Clin Infect Dis 2015 61 Suppl 5 S531-9 BACKGROUND: A meningococcal group A conjugate vaccine, PsA-TT (MenAfriVac), developed through the Meningitis Vaccine Project and manufactured by the Serum Institute of India, Ltd, was tested in multiple clinical trials conducted mainly in Africa. The impact of age at which subjects were vaccinated on immune response and persistence postimmunization with PsA-TT was the main focus of the current analysis. METHODS: Subjects who were vaccinated with a single dose of 10 microg of PsA-TT at 12-23 months or 22-33 months of age in study A conducted in Mali and The Gambia; at 2-10 years, 11-17 years, or 18-29 years of age in study B conducted in Mali, The Gambia, and Senegal; and at 14-18 weeks, 9-12 months, or 12-18 months of age in study C conducted in Ghana are included in the current analysis. Immunogenicity was measured by group A serum bactericidal antibody (SBA) titer with baby rabbit complement. RESULTS: Significant differences in SBA titers were found among the age groups in studies B and C both 28 days and 1 year postimmunization. A significant difference in SBA titers between age groups 12-23 months and 22-33 months was only observed 1 year postimmunization in study A. Antibody titers remained at similar levels from 1 to 2 years postimmunization for subjects vaccinated at 12-23 months in study A and at 9-12 months or 12-18 months of age in study C. CONCLUSIONS: Subjects immunized at different ages had different postimmunization immune responses as measured by SBA titers. Toddlers tended to have higher immune responses than infants. This pattern persisted at least 1 year postimmunization. |
Introduction and rollout of a new group a meningococcal conjugate vaccine (PsA-TT) in African meningitis belt countries, 2010-2014
Djingarey MH , Diomande FV , Barry R , Kandolo D , Shirehwa F , Lingani C , Novak RT , Tevi-Benissan C , Perea W , Preziosi MP , LaForce FM . Clin Infect Dis 2015 61 Suppl 5 S434-41 BACKGROUND: A group A meningococcal conjugate vaccine (PsA-TT) was developed specifically for the African "meningitis belt" and was prequalified by the World Health Organization (WHO) in June 2010. The vaccine was first used widely in Burkina Faso, Mali, and Niger in December 2010 with great success. The remaining 23 meningitis belt countries wished to use this new vaccine. METHODS: With the help of African countries, WHO developed a prioritization scheme and used or adapted existing immunization guidelines to mount PsA-TT vaccination campaigns. Vaccine requirements were harmonized with the Serum Institute of India, Ltd. RESULTS: Burkina Faso was the first country to fully immunize its 1- to 29-year-old population in December 2010. Over the next 4 years, vaccine coverage was extended to 217 million Africans living in 15 meningitis belt countries. CONCLUSIONS: The new group A meningococcal conjugate vaccine was well received, with country coverage rates ranging from 85% to 95%. The rollout proceeded smoothly because countries at highest risk were immunized first while attention was paid to geographic contiguity to maximize herd protection. Community participation was exemplary. |
Absence of venous thromboembolism risk following quadrivalent human papillomavirus vaccination, Vaccine Safety Datalink, 2008-2011
Naleway AL , Crane B , Smith N , Daley MF , Donahue J , Gee J , Greene SK , Harrington T , Jackson LA , Klein NP , Tseng HF , Vellozzi C , Weintraub ES . Vaccine 2015 34 (1) 167-71 BACKGROUND: To investigate concerns about a potential association between quadrivalent human papillomavirus vaccination (HPV4) and venous thromboembolism (VTE), we conducted a self-controlled case series study in adolescents and young adults 9-26 years of age in the Vaccine Safety Datalink. METHODS: We identified potential VTE cases diagnosed in 2008 through 2011 who had also received at least one HPV4 dose during that period. We confirmed each presumptive diagnosis by medical record review. We calculated incidence rate ratios (IRRs) and 95% confidence intervals (CI) to estimate the risk in the 1-60 day period following HPV4 exposure and in subsets of that period. IRRs were stratified by age, gender, hormonal contraceptive use, and recent surgery or trauma. RESULTS: We identified 313 potential cases of VTE among HPV4 vaccinees, and 291 (93%) had sufficient medical records for review. Of these, we confirmed 156 (54%) cases. VTE was uncommon among males (n=3) and 9-12 year olds (n=4). Nearly all confirmed cases (97%) had at least one known risk factor for VTE, including hormonal contraceptive use, obesity, and hypercoagulability. Sixteen (10%) confirmed cases occurred in the 1-60 days following HPV4 exposure. The risk of VTE varied from 1.47 (95% CI: 0.47-4.64) in the 1-7 days following HPV4 exposure to 0.92 (95% CI: 0.54-1.57) in the 1-60 days following vaccination. It was not possible to calculate a stratified IRR for males due to small sample size; the other risk factors evaluated did not significantly affect the risk of VTE after HPV4 exposure. CONCLUSION: The risk of developing VTE among 9- to 26-year-olds was not elevated following HPV4 exposure. Sample size limited our ability to rigorously evaluate potential effect modifiers, such as gender, through stratified analysis. |
Active surveillance for adverse events after a mass vaccination campaign with a group A meningococcal conjugate vaccine (PsA-TT) in Mali
Vannice KS , Keita M , Sow SO , Durbin AP , Omer SB , Moulton LH , Yameogo TM , Zuber PL , Onwuchekwa U , Sacko M , Diomande FV , Halsey NA . Clin Infect Dis 2015 61 Suppl 5 S493-500 BACKGROUND: The monovalent meningococcal A conjugate vaccine (PsA-TT, MenAfriVac) was developed for use in the "meningitis belt" of sub-Saharan Africa. Mali was 1 of 3 countries selected for early introduction. As this is a new vaccine, postlicensure surveillance is particularly important to identify and characterize possible safety issues. METHODS: The national vaccination campaign was phased from September 2010 to November 2011. We conducted postlicensure safety surveillance for PsA-TT in 40 government clinics from southern Mali serving approximately 400 000 people 1-29 years of age. We conducted analyses with individual-level data and population-level data, and we calculated rates of adverse events using the conditional exact test, a modified vaccine cohort risk interval method, and a modified self-controlled case series method for each outcome of interest, including 18 prespecified adverse events and 18 syndromic categories. RESULTS: An increased rate of clinic visits for fever within 3 days after vaccination was found using multiple methods for all age groups. Although other signals were found with some methods, complete assessment of all other prespecified outcomes and syndromic categories did not reveal that PsA-TT was consistently associated with any other health problem. CONCLUSIONS: No new safety concerns were identified in this study. These results are consistent with prelicensure data and other studies indicating that PsA-TT is safe. The approach presented could serve as a model for future active postlicensure vaccine safety monitoring associated with large-scale immunization campaigns in low-income countries. |
Antibody persistence 1-5 years following vaccination with MenAfriVac in African children vaccinated at 12-23 months of age
Tapia MD , Findlow H , Idoko OT , Preziosi MP , Kulkarni PS , Enwere GC , Elie C , Parulekar V , Sow SO , Haidara FC , Diallo F , Doumbia M , Akinsola AK , Adegbola RA , Kampmann B , Chaumont J , Martellet L , Marchetti E , Viviani S , Tang Y , Plikaytis BD , Marc LaForce F , Carlone G , Borrow R . Clin Infect Dis 2015 61 Suppl 5 S514-20 BACKGROUND: Following mass vaccination campaigns in the African meningitis belt with group A meningococcal conjugate vaccine, MenAfriVac (PsA-TT), disease due to group A meningococci has nearly disappeared. Antibody persistence in healthy African toddlers was investigated. METHODS: African children vaccinated at 12-23 months of age with PsA-TT were followed for evaluation of antibody persistence up to 5 years after primary vaccination. Antibody persistence was evaluated by measuring group A serum bactericidal antibody (SBA) with rabbit complement and by a group A-specific IgG enzyme-linked immunosorbent assay (ELISA). RESULTS: Group A antibodies measured by SBA and ELISA were shown to decline in the year following vaccination and plateaued at levels significantly above baseline for up to 5 years following primary vaccination. CONCLUSIONS: A single dose of PsA-TT induces long-term sustained levels of group A meningococcal antibodies for up to 5 years after vaccination. |
Antibody persistence at 1 and 4 years following a single dose of MenAfriVac or quadrivalent polysaccharide vaccine in healthy subjects aged 2-29 years
Diallo A , Sow SO , Idoko OT , Hirve S , Findlow H , Preziosi MP , Elie C , Kulkarni PS , Parulekar V , Diarra B , Cheick Haidara F , Diallo F , Tapia M , Akinsola AK , Adegbola RA , Bavdekar A , Juvekar S , Chaumont J , Martellet L , Marchetti E , LaForce MF , Plikaytis BD , Enwere GC , Tang Y , Borrow R , Carlone G , Viviani S . Clin Infect Dis 2015 61 Suppl 5 S521-30 BACKGROUND: Mass vaccination campaigns of the population aged 1-29 years with 1 dose of group A meningococcal (MenA) conjugate vaccine (PsA-TT, MenAfriVac) in African meningitis belt countries has resulted in the near-disappearance of MenA. The vaccine was tested in clinical trials in Africa and in India and found to be safe and highly immunogenic compared with the group A component of the licensed quadrivalent polysaccharide vaccine (PsACWY). Antibody persistence in Africa and in India was investigated. METHODS: A total of 900 subjects aged 2-29 years were followed up for 4 years in Senegal, Mali, and The Gambia (study A). A total of 340 subjects aged 2-10 years were followed up for 1 year in India (study B). In study A, subjects were randomized in a 2:1 ratio, and in study B a 1:1 ratio to receive either PsA-TT or PsACWY. Immunogenicity was evaluated by measuring MenA serum bactericidal antibody (SBA) with rabbit complement and by a group A-specific immunoglobulin G (IgG) enzyme-linked immunosorbent assay. RESULTS: In both studies, substantial SBA decay was observed at 6 months postvaccination in both vaccine groups, although more marked in the PsACWY group. At 1 year and 4 years (only for study A) postvaccination, SBA titers were relatively sustained in the PsA-TT group, whereas a slight increasing trend, more pronounced among the youngest, was observed in the participants aged <18 years in the PsACWY groups. The SBA titers were significantly higher in the PsA-TT group than in the PsACWY group at any time point, and the majority of subjects in the PsA-TT group had SBA titers ≥128 and group A-specific IgG concentrations ≥2 microg/mL at any point in time in both the African and Indian study populations. CONCLUSIONS: Four years after vaccination with a single dose of PsA-TT vaccine in Africa, most subjects are considered protected from MenA disease. CLINICAL TRIALS REGISTRATION: PsA-TT-003 (ISRCTN87739946); PsA-TT-003a (ISRCTN46335400). |
Association of older sister's HPV vaccination status on HPV vaccine receipt by adolescents
Clark SJ , Cowan AE , Filipp SL , Fisher AM , Stokley S . J Am Board Fam Med 2015 28 (6) 816-8 OBJECTIVE: Efforts to increase human papillomavirus (HPV) vaccine coverage rates in adolescents include finding ways to improve discussions between clinicians and parents. One potentially important piece of information for these discussions is the HPV vaccination status of older siblings. METHODS: A nationally representative online panel was used to conduct a cross-sectional survey of parents of children aged 9 to 17 years in October 2012. RESULTS: Overall, 768 adolescents (35%) had ≥1 older sister aged 10 to 26 years. Male and female adolescents with an older sister who had received no HPV vaccine doses demonstrated higher rates of having no doses themselves, compared with those who had no older sister or those who had an older sister who had received ≥1 HPV vaccine dose. CONCLUSIONS: Discussing the HPV vaccination status of older sisters may be a useful strategy for providers to differentiate HPV vaccine messages to parents of unvaccinated younger siblings. |
Comparing Israeli and Palestinian polio vaccination policies and the challenges of silent entry of wild poliovirus in 2013-14: a 'natural experiment'
Flahault A , Orenstein W , Garon J , Kew O , Bickford J , Tulchinsky T . Int J Public Health 2015 60 (7) 765-6 Eradication of poliomyelitis has been a long time global challenge and is currently reaching the final end stages (Moturi et al. 2014). The potential for reappearance of both wild poliovirus (WPV) and other vaccine-related polioviruses has impacted policy development and influenced strategies implemented worldwide (World Health Organization 2013; Mundel and Orenstein 2013). | This commentary views the use of a combined oral polio vaccine (OPV) and inactivated polio vaccine (IPV) schedule in comparison to IPV-alone polio immunization programs in limiting the spread of imported WPV. In 2013, type 1 wild poliovirus (WPV1) entered highly immunized Israel and Palestinian Territories from Egypt and circulated for more than a year (Anis et al. 2013; Manor et al. 2014). | During the 1970s, Gaza and the West Bank experienced high levels of clinical poliomyelitis with many cases occurring among children who had received multiple doses of OPV. In the early 1980s, polio was eliminated in both areas using a combination of OPV and IPV (Goldblum et al. 1994). |
Multi-college bystander intervention evaluation for violence prevention
Coker AL , Bush HM , Fisher BS , Swan SC , Williams CM , Clear ER , DeGue S . Am J Prev Med 2015 50 (3) 295-302 INTRODUCTION: The 2013 Campus Sexual Violence Elimination Act requires U.S. colleges to provide bystander-based training to reduce sexual violence, but little is known about the efficacy of such programs for preventing violent behavior. This study provides the first multiyear evaluation of a bystander intervention's campus-level impact on reducing interpersonal violence victimization and perpetration behavior on college campuses. METHODS: First-year students attending three similarly sized public university campuses were randomly selected and invited to complete online surveys in the spring terms of 2010-2013. On one campus, the Green Dot bystander intervention was implemented in 2008 (Intervention, n=2,979) and two comparison campuses had no bystander programming at baseline (Comparison, n=4,132). Data analyses conducted in 2014-2015 compared violence rates by condition over the four survey periods. Multivariable logistic regression was used to estimate violence risk on Intervention relative to Comparison campuses, adjusting for demographic factors and time (2010-2013). RESULTS: Interpersonal violence victimization rates (measured in the past academic year) were 17% lower among students attending the Intervention (46.4%) relative to Comparison (55.7%) campuses (adjusted rate ratio=0.83; 95% CI=0.79, 0.88); a similar pattern held for interpersonal violence perpetration (25.5% in Intervention; 32.2% in Comparison; adjusted rate ratio=0.79; 95% CI=0.71, 0.86). Violence rates were lower on Intervention versus Comparison campuses for unwanted sexual victimization, sexual harassment, stalking, and psychological dating violence victimization and perpetration (p<0.01). CONCLUSIONS: Green Dot may be an efficacious intervention to reduce violence at the community level and meet Campus Sexual Violence Elimination Act bystander training requirements. |
Acute and chronic risk preceding suicidal crises among middle-aged men without known mental health and/or substance abuse problems
Schiff LB , Holland KM , Stone DM , Logan J , Marshall KJ , Martell B , Bartholow B . Crisis 2015 36 (5) 304-15 BACKGROUND: Suicides among men aged 35-64 years increased by 27% between 1999 and 2013, yet little research exists to examine the nature of the suicide risk within this population. Many men do not seek help if they have mental health problems and suicides may occur in reaction to stressful circumstances. AIMS: We examined the precipitating circumstances of 600 suicides without known mental health or substance abuse (MH/SA) problems and with a recent crisis. Whether these suicides occurred within the context of an acute crisis only or in the context of chronic circumstances was observed. METHOD: Using data from the National Violent Death Reporting System and employing mixed-methods analysis, we examined the circumstances and context of a census of middle-aged male suicides (n = 600) in seven states between 2005 and 2010. RESULTS: Precipitating circumstances among this group involved intimate partner problems (IPP; 58.3%), criminal/legal problems (50.7%), job/financial problems (22.5%), and health problems (13.5%). Men with IPP and criminal/legal issues were more likely than men with health and/or job/financial issues to experience suicide in the context of an acute crisis only. CONCLUSION: Suicides occurring in reaction to an acute crisis only or in the context of acute and chronic circumstances lend themselves to opportunities for intervention. Further implications are discussed. |
Simultaneous Detection of Major Drug Resistance Mutations of HIV-1 Subtype B Viruses from Dried Blood Spot Specimens by Multiplex Allele-specific Assay.
Zhang G , Cai F , de Rivera IL , Zhou Z , Zhang J , Nkengasong J , Gao F , Yang C . J Clin Microbiol 2015 54 (1) 220-2 A multiplex allele-specific (MAS) assay has been developed for the detection of HIV-1 subtype C drug resistance mutations (DRMs). We now optimized the MAS assay to determine subtype B DRMs in dried blood spots (DBS) collected from patients on antiretroviral therapy. The new assay accurately detected DRMs, including low-abundance mutations that were often missed by Sanger sequencing. |
Relationship of estimated SHIV acquisition time points during the menstrual cycle and thinning of vaginal epithelial layers in pigtail macaques
Kersh EN , Ritter J , Butler K , Ostergaard SD , Hanson D , Ellis S , Zaki S , McNicholl JM . Sex Transm Dis 2015 42 (12) 694-701 BACKGROUND: HIV acquisition in the female genital tract remains incompletely understood. Quantitative data on biological HIV risk factors, the influence of reproductive hormones, and infection risk are lacking. We evaluated vaginal epithelial thickness during the menstrual cycle in pigtail macaques (Macaca nemestrina). This model previously revealed increased susceptibility to vaginal infection during and after progesterone-dominated periods in the menstrual cycle. METHODS: Nucleated and nonnucleated (superficial) epithelial layers were quantitated throughout the menstrual cycle of 16 macaques. We examined the relationship with previously estimated vaginal SHIVSF162P3 acquisition time points in the cycle of 43 different animals repeatedly exposed to low virus doses. RESULTS: In the luteal phase (days 17 to cycle end), the mean vaginal epithelium thinned to 66% of mean follicular thickness (days 1-16; P = 0.007, Mann-Whitney test). Analyzing 4-day segments, the epithelium was thickest on days 9 to 12 and thinned to 31% thereof on days 29 to 32, with reductions of nucleated and nonnucleated layers to 36% and 15% of their previous thickness, respectively. The proportion of animals with estimated SHIV acquisition in each cycle segment correlated with nonnucleated layer thinning (Pearson r = 0.7, P < 0.05, linear regression analysis), but not nucleated layer thinning (Pearson r = 0.6, P = 0.15). CONCLUSIONS: These data provide a detailed picture of dynamic cycle-related changes in the vaginal epithelium of pigtail macaques. Substantial thinning occurred in the superficial, nonnucleated layer, which maintains the vaginal microbiome. The findings support vaginal tissue architecture as susceptibility factor for infection and contribute to our understanding of innate resistance to SHIV infection. |
Study of contact characteristics between a respirator and a headform
Cai M , Shen S , Li H , Zhang X , Ma Y , Lei Z . J Occup Environ Hyg 2015 13 (3) D50-60 This paper presents a computational study on contact characteristics of contact pressure and resultant deformation between an N95 filtering facepiece respirator and a newly developed digital headform. The geometry of the headform model is obtained based on computed tomography scanning of a volunteer. The segmentation and reconstruction of the headform model is performed by Mimics v16.0 (Materialise, Leuven, Belgium), which is a medical image processing software. The respirator model is obtained by scanning the surface of a 3MTM 8210 N95 respirator using a 3D digitizer and then the model is transformed by Geomagic Studio v12.0 (3D system, California, USA), a reverse engineering software. The headform model contains a soft tissue layer, a skull layer and a separate nose. The respirator model contains two layers (an inner face sealing layer and an outer layer) and a nose clip. Both the headform and respirator are modeled as solid elements and are deformable. The commercial software, LS-DYNA (LSTC, Livermore, California), is used to simulate the contact between the respirator and headform. Contact pressures and resultant deformation of the headform are investigated. Effects of respirator stiffness on contact characteristics are also studied. A Matlab (MathWorks, Natick, MA, USA) program is developed to calculate local gaps between the headform and respirator in the stable wearing state. |
Multicenter study of epidemiological cutoff values and detection of resistance in Candida spp. to anidulafungin, caspofungin, and micafungin using the Sensititre Yeast One colorimetric method
Espinel-Ingroff A , Alvarez-Fernandez M , Canton E , Carver PL , Chen SC , Eschenauer G , Getsinger DL , Gonzalez GM , Govender NP , Grancini A , Hanson KE , Kidd SE , Klinker K , Kubin CJ , Kus JV , Lockhart SR , Meletiadis J , Morris AJ , Pelaez T , Quindos G , Rodriguez-Iglesias M , Sanchez-Reus F , Shoham S , Wengenack NL , Borrell Sole N , Echeverria J , Esperalba J , Gomez Gde la Pedrosa E , Garcia Garcia I , Linares MJ , Marco F , Merino P , Peman J , Perez Del Molino L , Rosello Mayans E , Rubio Calvo C , Ruiz Perez de Pipaon M , Yague G , Garcia-Effron G , Guinea J , Perlin DS , Sanguinetti M , Shields R , Turnidge J . Antimicrob Agents Chemother 2015 59 (11) 6725-32 Neither breakpoints (BPs) nor epidemiological cutoff values (ECVs) have been established for Candida spp. with anidulafungin, caspofungin, and micafungin when using the Sensititre YeastOne (SYO) broth dilution colorimetric method. In addition, reference caspofungin MICs have so far proven to be unreliable. Candida species wild-type (WT) MIC distributions (for microorganisms in a species/drug combination with no detectable phenotypic resistance) were established for 6,007 Candida albicans, 186 C. dubliniensis, 3,188 C. glabrata complex, 119 C. guilliermondii, 493 C. krusei, 205 C. lusitaniae, 3,136 C. parapsilosis complex, and 1,016 C. tropicalis isolates. SYO MIC data gathered from 38 laboratories in Australia, Canada, Europe, Mexico, New Zealand, South Africa, and the United States were pooled to statistically define SYO ECVs. ECVs for anidulafungin, caspofungin, and micafungin encompassing ≥97.5% of the statistically modeled population were, respectively, 0.12, 0.25, and 0.06 mug/ml for C. albicans, 0.12, 0.25, and 0.03 mug/ml for C. glabrata complex, 4, 2, and 4 mug/ml for C. parapsilosis complex, 0.5, 0.25, and 0.06 mug/ml for C. tropicalis, 0.25, 1, and 0.25 mug/ml for C. krusei, 0.25, 1, and 0.12 mug/ml for C. lusitaniae, 4, 2, and 2 mug/ml for C. guilliermondii, and 0.25, 0.25, and 0.12 mug/ml for C. dubliniensis. Species-specific SYO ECVs for anidulafungin, caspofungin, and micafungin correctly classified 72 (88.9%), 74 (91.4%), 76 (93.8%), respectively, of 81 Candida isolates with identified fks mutations. SYO ECVs may aid in detecting non-WT isolates with reduced susceptibility to anidulafungin, micafungin, and especially caspofungin, since testing the susceptibilities of Candida spp. to caspofungin by reference methodologies is not recommended. |
Acrylamide and glycidamide hemoglobin adduct levels and endometrial cancer risk: A nested case-control study in nonsmoking postmenopausal women from the EPIC cohort
Obon-Santacana M , Freisling H , Peeters PH , Lujan-Barroso L , Ferrari P , Boutron-Ruault MC , Mesrine S , Baglietto L , Turzanski-Fortner R , Katzke VA , Boeing H , Quiros JR , Molina-Portillo E , Larranaga N , Chirlaque MD , Barricarte A , Khaw KT , Wareham N , Travis RC , Merritt MA , Gunter MJ , Trichopoulou A , Lagiou P , Naska A , Palli D , Sieri S , Tumino R , Fiano V , Galassom R , Bueno-de-Mesquita HB , Onland-Moret NC , Idahl A , Lundin E , Weiderpass E , Vesper H , Riboli E , Duell EJ . Int J Cancer 2015 138 (5) 1129-38 Acrylamide, classified in 1994 by IARC as "probably carcinogenic to humans," was discovered in 2002 in some heat-treated, carbohydrate-rich foods. Four prospective studies have evaluated the association between dietary acrylamide intake and endometrial cancer (EC) risk with inconsistent results. The purpose of this nested case-control study, based on the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, was to evaluate, for the first time, the association between hemoglobin adducts of acrylamide (HbAA) and glycidamide (HbGA) and the risk of developing EC in non-smoking postmenopausal women. Hemoglobin adducts were measured in red blood cells by HPLC/MS/MS. Four exposure variables were evaluated: HbAA, HbGA, their sum (HbAA+HbGA), and their ratio (HbGA/HbAA). The association between hemoglobin adducts and EC was evaluated using unconditional multivariable logistic regression models, and included 383 EC cases (171 were type-I EC), and 385 controls. Exposure variables were analyzed in quintiles based on control distributions. None of the biomarker variables had an effect on overall EC (HRHbAA;Q5vsQ1 : 0.84, 95%CI: 0.49-1.48; HRHbGA;Q5vsQ1 : 0.94, 95%CI: 0.54-1.63) or type-I EC risk. Additionally, none of the subgroups investigated (BMI < 25 vs. ≥25 kg m-2 , alcohol drinkers vs. never drinkers, oral contraceptive users vs. non-users) demonstrated effect measure modification. Hemoglobin adducts of acrylamide or glycidamide were not associated with EC or type-I EC risk in 768 nonsmoking postmenopausal women from the EPIC cohort. |
Bias due to composite reference standards in diagnostic accuracy studies
Schiller I , van Smeden M , Hadgu A , Libman M , Reitsma JB , Dendukuri N . Stat Med 2015 35 (9) 1454-70 Composite reference standards (CRSs) have been advocated in diagnostic accuracy studies in the absence of a perfect reference standard. The rationale is that combining results of multiple imperfect tests leads to a more accurate reference than any one test in isolation. Focusing on a CRS that classifies subjects as disease positive if at least one component test is positive, we derive algebraic expressions for sensitivity and specificity of this CRS, sensitivity and specificity of a new (index) test compared with this CRS, as well as the CRS-based prevalence. We use as a motivating example the problem of evaluating a new test for Chlamydia trachomatis, an asymptomatic disease for which no gold-standard test exists. As the number of component tests increases, sensitivity of this CRS increases at the expense specificity, unless all tests have perfect specificity. Therefore, such a CRS can lead to significantly biased accuracy estimates of the index test. The bias depends on disease prevalence and accuracy of the CRS. Further, conditional dependence between the CRS and index test can lead to over-estimation of index test accuracy estimates. This commonly-used CRS combines results from multiple imperfect tests in a way that ignores information and therefore is not guaranteed to improve over a single imperfect reference unless each component test has perfect specificity, and the CRS is conditionally independent of the index test. When these conditions are not met, as in the case of C. trachomatis testing, more realistic statistical models should be researched instead of relying on such CRSs. |
Capacity building in national influenza laboratories - use of laboratory assessments to drive progress
Johnson LE , Muir-Paulik SA , Kennedy P , Lindstrom S , Balish A , Aden T , Moen AC . BMC Infect Dis 2015 15 (1) 501 BACKGROUND: Laboratory testing is a fundamental component of influenza surveillance for detecting novel strains with pandemic potential and informing biannual vaccine strain selection. The United States (U.S.) Centers for Disease Control and Prevention (CDC), under the auspices of its WHO Collaborating Center for Influenza, is one of the major public health agencies which provides support globally to build national capacity for influenza surveillance. Our main objective was to determine if laboratory assessments supported capacity building efforts for improved global influenza surveillance. METHODS: In 2010, 35 national influenza laboratories were assessed in 34 countries, using a standardized tool. Post-assessment, each laboratory received a report with a list of recommendations for improvement. Uptake of recommendations were reviewed 3.2 mean years after the initial assessments and categorized as complete, in-progress, no action or no update. This was a retrospective study; follow-up took place through routine project management rather than at a set time-point post-assessment. WHO data on National Influenza Centre (NIC) designation, External Quality Assessment Project (EQAP) participation and FluNet reporting was used to measure laboratory capacity longitudinally and independently of the assessments. All data was further stratified by World Bank country income category. RESULTS: At follow-up, 81 % of 614 recommendations were either complete (350) or in-progress (145) for 32 laboratories (91 % response rate). The number of countries reporting to FluNet and the number of specimens they reported annually increased between 2005, when they were first funded by CDC, and 2010, the assessment year (p < 0.01). Improvements were also seen in EQAP participation and NIC designation over time and more so for low and lower-middle income countries. CONCLUSIONS: Assessments using a standardized tool have been beneficial to improving laboratory-based influenza surveillance. Specific recommendations helped countries identify and prioritize areas for improvement. Data from assessments helped CDC focus its technical assistance by country and region. Low and lower-middle income countries made greater improvements in their laboratories compared with upper-middle income countries. Future research could include an analysis of annual funding and technical assistance by country. Our approach serves as an example for capacity building for other diseases. |
Capture of 0.1-mum aerosol particles containing viable H1N1 influenza virus by N95 filtering facepiece respirators
Harnish DA , Heimbuch BK , Balzli C , Choe M , Lumley AE , Shaffer RE , Wander JD . J Occup Environ Hyg 2015 13 (3) 1-10 Nosocomial infections pose an escalating threat to both patients and healthcare workers (HCWs). A widely recommended device for individual respiratory protection, the N95 filtering facepiece respirator (FFR) has been shown to provide efficient filtration of inert particles larger and smaller than the nominal most-penetrating particle size (MPPS) range, 0.03-0.3 mum. Humans generate respiratory aerosols in the MPPS range, suggesting that short-range disease transmission could occur via small infectious particles. Data presented here show that the N95 FFR will afford a significant measure of protection against infectious particles as small as a bare H1N1 influenza virion, and that the capture mechanism does not discriminate in favor of or against biological particles. |
Detecting burrowing owl bloodmeals in Pulex irritans (Siphonaptera: Pulicidae)
Graham CB , Eisen RJ , Belthoff JR . J Med Entomol 2015 53 (2) 446-50 Pulex irritans L. is a cosmopolitan flea species that infests a wide variety of hosts. In North America it generally parasitizes large wild mammals, but in the Pacific Northwest an association has emerged between P. irritans and the western burrowing owl (Athene cunicularia hypugaea). While investigators have recognized this association for decades, it has not been clear if P. irritans feeds on burrowing owls, or if the owls serve exclusively as phoretic hosts. Here we describe using a real-time assay that was originally developed to identify bloodmeals in Ugandan cat fleas (Ctenocephalides felis Bouche) to detect burrowing owl DNA in P. irritans collected from burrowing owls in southern Idaho. Of 50 fleas tested, 12 had no detectable vertebrate bloodmeal. The remaining 38 (76%) contained burrowing owl DNA. The assay did not detect vertebrate DNA in unfed fleas exposed to owl or mouse pelts and is therefore unlikely to detect DNA in fleas from vertebrates that have served exclusively as phoretic hosts. We conclude that P. irritans feeds on burrowing owls. We discuss the potential implications of this finding for burrowing owl conservation and enzootic plague dynamics. |
Lower respiratory tract infection hospitalizations among American Indian/Alaska Native children and the general United States child population
Foote EM , Singleton RJ , Holman RC , Seeman SM , Steiner CA , Bartholomew M , Hennessy TW . Int J Circumpolar Health 2015 74 29256 BACKGROUND: The lower respiratory tract infection (LRTI)-associated hospitalization rate in American Indian and Alaska Native (AI/AN) children aged <5 years declined during 1998-2008, yet remained 1.6 times higher than the general US child population in 2006-2008. PURPOSE: Describe the change in LRTI-associated hospitalization rates for AI/AN children and for the general US child population aged <5 years. METHODS: A retrospective analysis of hospitalizations with discharge ICD-9-CM codes for LRTI for AI/AN children and for the general US child population <5 years during 2009-2011 was conducted using Indian Health Service direct and contract care inpatient data and the Nationwide Inpatient Sample, respectively. We calculated hospitalization rates and made comparisons to previously published 1998-1999 rates prior to pneumococcal conjugate vaccine introduction. RESULTS: The average annual LRTI-associated hospitalization rate declined from 1998-1999 to 2009-2011 in AI/AN (35%, p<0.01) and the general US child population (19%, SE: 4.5%, p<0.01). The 2009-2011 AI/AN child average annual LRTI-associated hospitalization rate was 20.7 per 1,000, 1.5 times higher than the US child rate (13.7 95% CI: 12.6-14.8). The Alaska (38.9) and Southwest regions (27.3) had the highest rates. The disparity was greatest for infant (<1 year) pneumonia-associated and 2009-2010 H1N1 influenza-associated hospitalizations. CONCLUSIONS: Although the LRTI-associated hospitalization rate declined, the 2009-2011 AI/AN child rate remained higher than the US child rate, especially in the Alaska and Southwest regions. The residual disparity is likely multi-factorial and partly related to household crowding, indoor smoke exposure, lack of piped water and poverty. Implementation of interventions proven to reduce LRTI is needed among AI/AN children. |
Predictors of treatment attrition and treatment length in parent-child interaction therapy in Taiwanese families
Chen YC , Fortson BL . Child Youth Serv Rev 2015 59 28-37 Parent-Child Interaction Therapy (PCIT) has been used successfully in the United States and in other countries around the world, but its use in Asian countries has been more limited. The present study is the first of its kind to examine the predictors of treatment attrition and length in a sample of Taiwanese caregivers and their children. It is also the first to examine PCIT outcomes in Taiwanese families. Maladaptive personality characteristics of the caregiver were the best predictor of attrition, followed by single-parent, removal of the child from the home, and lower levels of caregiver education. Treatment length was predicted by child minority status and parent-child interactions (i.e., parent commands and negative parent talk). In terms of outcomes, statistically significant treatment changes were noted for all treatment outcome variables at post-treatment and at 3-month follow-up. These findings suggest that PCIT is a promising intervention for this population. The predictors of treatment attrition and length can be used when Taiwanese caregiver-child dyads present for services so that additional assistance can be provided prior to or during treatment to increase adherence to the recommended number of treatment sessions for maximal impact. Future studies may replicate the present study with a larger clinical sample to examine the long-term effects of PCIT and to include a no-treatment control condition to afford a more robust empirical evaluation. |
Increase in incidence of congenital syphilis - United States, 2012-2014
Bowen V , Su J , Torrone E , Kidd S , Weinstock H . MMWR Morb Mortal Wkly Rep 2015 64 (44) 1241-1245 Congenital syphilis (CS) occurs when a mother infected with syphilis transmits the infection to her child during pregnancy. CS can cause severe illness, miscarriage, stillbirth, and early infant death. However, among pregnant women with syphilis who deliver after 20 weeks gestation, maternal treatment with penicillin is 98% effective at preventing CS (1). In the United States, the rate of CS decreased during 1991-2005 but increased slightly during 2005-2008 (2). To assess recent trends in CS, CDC analyzed national surveillance data reported during 2008-2014, calculated rates, and described selected characteristics of infants with CS and their mothers. The overall rate of reported CS decreased from 10.5 to 8.4 cases per 100,000 live births during 2008-2012, and then increased to 11.6 cases per 100,000 live births in 2014, the highest CS rate reported since 2001. From 2012 to 2014, reported cases and rates of CS increased across all regions of the United States. To reduce CS, the timely identification of and response to increases in syphilis among women of reproductive age and men who have sex with women are essential. All women should have access to quality prenatal care, including syphilis screening and adequate treatment, during pregnancy (3). |
Assessing the practices of population-based birth defects surveillance programs using the CDC Strategic Framework, 2012
Mai CT , Correa A , Kirby RS , Rosenberg D , Petros M , Fagen MC . Public Health Rep 2015 130 (6) 722-30 OBJECTIVE: We assessed the practices of U.S. population-based birth defects surveillance programs in addressing current and emergent public health needs. METHODS: Using the CDC Strategic Framework considerations for public health surveillance (i.e., lexicon and standards, legal authority, technological advances, workforce, and analytic capacity), during 2012 and 2013, we conducted a survey of all U.S. operational birth defects programs (n=43) soliciting information on legal authorities, case definition and clinical information collected, types of data sources, and workforce staffing. In addition, we conducted semi-structured interviews with nine program directors to further understand how programs are addressing current and emergent needs. RESULTS: Three-quarters of birth defects surveillance programs used national guidelines for case definition. Most birth defects surveillance programs (86%) had a legislative mandate to conduct surveillance, and many relied on a range of prenatal, postnatal, public health, and pediatric data sources for case ascertainment. Programs reported that the transition from paper to electronic formats was altering the information collected, offering an opportunity for remote access to improve timeliness for case review and verification. Programs also reported the growth of pooled, multistate data collaborations as a positive development. Needs identified included ongoing workforce development to improve information technology and analytic skills, more emphasis on data utility and birth defects-specific standards for health information exchange, and support to develop channels for sharing ideas on data interpretation and dissemination. CONCLUSION: The CDC Strategic Framework provided a useful tool to determine the birth defects surveillance areas with positive developments, such as multi-state collaborative epidemiologic studies, and areas for improvement, such as preparation for health information exchanges and workforce database and analytic skills. Our findings may inform strategic deliberations for enhancing the effectiveness of birth defects surveillance programs. |
Assessment of YouTube videos as a source of information on medication use in pregnancy
Hansen C , Interrante JD , Ailes EC , Frey MT , Broussard CS , Godoshian VJ , Lewis C , Polen KN , Garcia AP , Gilboa SM . Pharmacoepidemiol Drug Saf 2015 25 (1) 35-44 BACKGROUND: When making decisions about medication use in pregnancy, women consult many information sources, including the Internet. The aim of this study was to assess the content of publicly accessible YouTube videos that discuss medication use in pregnancy. METHODS: Using 2023 distinct combinations of search terms related to medications and pregnancy, we extracted metadata from YouTube videos using a YouTube video Application Programming Interface. Relevant videos were defined as those with a medication search term and a pregnancy-related search term in either the video title or description. We viewed relevant videos and abstracted content from each video into a database. We documented whether videos implied each medication to be "safe" or "unsafe" in pregnancy and compared that assessment with the medication's Teratogen Information System (TERIS) rating. RESULTS: After viewing 651 videos, 314 videos with information about medication use in pregnancy were available for the final analyses. The majority of videos were from law firms (67%), television segments (10%), or physicians (8%). Selective serotonin reuptake inhibitors (SSRIs) were the most common medication class named (225 videos, 72%), and 88% of videos about SSRIs indicated that they were unsafe for use in pregnancy. However, the TERIS ratings for medication products in this class range from "unlikely" to "minimal" teratogenic risk. CONCLUSION: For the majority of medications, current YouTube video content does not adequately reflect what is known about the safety of their use in pregnancy and should be interpreted cautiously. However, YouTube could serve as a platform for communicating evidence-based medication safety information. |
Working safely with robot workers: recommendations for the new workplace
Murashov V , Hearl F , Howard J . J Occup Environ Hyg 2015 13 (3) 1-34 The increasing use of robots in performing tasks alongside or together with human co-workers raises novel occupational safety and health issues. The new 21st century workplace will be one in which occupational robotics plays an increasing role. This paper describes the increasing complexity of robots and proposes a number of recommendations for the practice of safe occupational robotics. |
Predictors of adherence to safe handling practices for antineoplastic drugs: a survey of hospital nurses
Silver SR , Steege AL , Boiano JM . J Occup Environ Hyg 2015 13 (3) 1-29 BACKGROUND: Despite growing awareness of the hazards of exposure to antineoplastic drugs (ADs), surveys continue to find incomplete adherence to recommended safe handling guidelines. A 2011 survey of healthcare workers presents an opportunity to examine factors associated with adherence among 1094 hospital nurses who administered ADs. METHODS: Data for these hypothesis-generating analyses were taken from an anonymous, web-based survey of healthcare workers. Regression modeling was used to examine associations between a number of predictors (engineering controls, work practices, nurse perceptions, and nurse and hospital characteristics) and three outcomes reported by nurses: use of personal protective equipment (PPE); activities performed with gloves previously worn to administer ADs; and spills of ADs. RESULTS: Adherence to safe handling guidelines was not universal, and AD spills were reported by 9.5% of nurses during the week prior to the survey. Familiarity with safe handling guidelines and training in safe handling were associated with more reported PPE use. Nurse-perceived availability of PPE was associated with more reported PPE use and lower odds of reported spills. Use of closed system drug-transfer devices and luer-lock fittings also decreased the odds of self-reported AD spills, while more frequent AD administration increased the risk. AD administration frequency was also associated with performing more activities with gloves previously worn to administer ADs, and nurse perception of having adequate time for taking safety precautions with fewer such activities. CONCLUSIONS: The results suggest that training and familiarity with guidelines for safe handling of ADs, adequate time to adhere to guidelines, and availability of PPE and certain engineering controls are key to ensuring adherence to safe handling practices. Further assessment of training components and engineering controls would be useful for tailoring interventions targeting these areas. |
Face shields for infection control: a review
Roberge RJ . J Occup Environ Hyg 2015 13 (4) 1-28 Face shields are personal protective equipment devices that are used by many workers (e.g., medical, dental, veterinary) for protection of the facial area and associated mucous membranes (eyes, nose, mouth) from splashes, sprays and spatter of body fluids. Face shields are generally not used alone, but in conjunction with other protective equipment and are therefore classified as adjunctive personal protective equipment. Although there are millions of potential users of face shields, guidelines for their use vary between governmental agencies and professional societies and little research is available regarding their efficacy. |
Hydroxylated polycyclic aromatic hydrocarbons as biomarkers of exposure to wood smoke in wildland firefighters
Adetona O , Simpson CD , Li Z , Sjodin A , Calafat AM , Naeher LP . J Expo Sci Environ Epidemiol 2015 27 (1) 78-83 Wildland firefighter's exposure to wildland fire or vegetative biomass smoke has mostly been assessed by personal monitoring to airborne pollutants. However, the use of biomarkers may accurately reflect the internal (systemic) dose received by the firefighter. In this study, we assessed occupational exposure to wildland fire smoke in 14 wildland firefighters working at prescribed burns at the Savannah River Site, South Carolina by measuring the urinary concentrations of nine hydroxylated metabolites of polycyclic aromatic hydrocarbons (OH-PAHs). Except for 1-hydroxynaphthalene, preshift median concentrations of the OH-PAHs were higher compared with the median concentrations reported among the US general population, indicating elevated exposures to PAHs among the wildland firefighters during the prescribed burn season. The postshift concentrations of OH-PAHs were 83-323% (P<0.0001) higher compared with the preshift concentrations. Higher postshift concentrations of individual OH-PAHs were observed in 49 (87.5%) to 53 (94.6%) of all the 56 pre-post sample pairs. Additionally, the cross-shift (pre- to postshift) increase in 4-hydroxy-phenanthrene urinary concentration was marginally associated (P<0.1) with work shift exposure to PM2.5 and significantly associated (P<0.05) with levoglucosan, which is a marker of wildland fire or vegetative biomass smoke. These results suggest that OH-PAHs, especially 4PHE, may be useful biomarkers of wildland fire smoke exposure. |
Advances in inhalation dosimetry models and methods for occupational risk assessment and exposure limit derivation
Kuempel ED , Sweeney LM , Morris JB , Jarabek AM . J Occup Environ Hyg 2015 12 Suppl 1 S18-40 The purpose of this article is to provide an overview and practical guide to occupational health professionals concerning the derivation and use of dose estimates in risk assessment for development of occupational exposure limits (OELs) for inhaled substances. Dosimetry is the study and practice of measuring or estimating the internal dose of a substance in individuals or a population. Dosimetry thus provides an essential link to understanding the relationship between an external exposure and a biological response. Use of dosimetry principles and tools can improve the accuracy of risk assessment, and reduce the uncertainty, by providing reliable estimates of the internal dose at the target tissue. This is accomplished through specific measurement data or predictive models, when available, or the use of basic dosimetry principles for broad classes of materials. Accurate dose estimation is essential not only for dose-response assessment, but also for interspecies extrapolation and for risk characterization at given exposures. Inhalation dosimetry is the focus of this paper since it is a major route of exposure in the workplace. Practical examples of dose estimation and OEL derivation are provided for inhaled gases and particulates. |
Promoting early exposure monitoring for respirable crystalline silica: taking the laboratory to the mine site
Cauda E , Miller A , Drake P . J Occup Environ Hyg 2015 13 (3) 1-22 The exposure to respirable crystalline silica (RCS) in the mining industry is a recognized occupational hazard. The assessment and monitoring of the exposure to RCS is limited by two main factors: (1) variability of the silica percent in the mining dust and (2) lengthy off-site laboratory analysis of collected samples. The monitoring of respirable dust via traditional or real-time techniques is not adequate. A solution for on-site quantification of RCS in dust samples is being investigated by the Office of Mine Safety and Health Research, a division of the National Institute for Occupational Safety and Health. The use of portable Fourier transform infrared analyzers in conjunction with a direct-on-filter analysis approach is proposed. The progress made so far, the necessary steps in progress, and the application of the monitoring solution to a small data set is presented. When developed, the solution will allow operators to estimate RCS immediately after sampling, resulting in timelier monitoring of RCS for self-assessment of compliance at the end of the shift, more effective engineering monitoring, and better evaluation of control technologies. |
Outcomes of in vitro fertilization with preimplantation genetic diagnosis: an analysis of the Unites States Assisted Reproductive Technology Surveillance Data, 2011-2012.
Chang J , Boulet SL , Jeng G , Flowers L , Kissin DM . Fertil Steril 2015 105 (2) 394-400 OBJECTIVE: To assess the characteristics of IVF cycles for which preimplantation genetic diagnosis (PGD) was used and to evaluate indications for PGD and treatment outcomes associated with this procedure as compared with cycles without PGD with the data from the U.S. National ART Surveillance System. DESIGN: Retrospective cohort study. SETTING: None. PATIENT(S): Fresh autologous cycles that involved transfer of at least one embryo at blastocyst when available. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): PGD indications and age-specific reproductive outcomes. RESULT(S): There were a total of 97,069 non-PGD cycles and 9,833 PGD cycles: 55.6% were performed for aneuploidy screening (PGD Aneuploidy), 29.1% for other reasons (PGD Other), and 15.3% for genetic testing (PGD Genetic). In comparison to non-PGD cycles, PGD Aneuploidy cycles showed a decreased odds of miscarriage among women 35-37 years (adjusted odds ratio [aOR] 0.62; 95% CI, 0.45-0.87) and women >37 years (aOR 0.55; 95% CI, 0.43-0.70); and an increased odds of clinical pregnancy (aOR 1.18; 95% CI, 1.05-1.34), live-birth delivery (aOR 1.43; 95% CI, 1.26-1.62), and multiple-birth delivery (aOR 1.98; 95% CI, 1.52-2.57) among women >37 years. CONCLUSION(S): Aneuploidy screening was the most common indication for PGD. Use of PGD was not observed to be associated with an increased odds of clinical pregnancy or live birth for women <35 years. PGD for aneuploidy was associated with a decreased odds of miscarriage for women >35 years, but an increased odds of a live-birth and a multiple live-birth delivery among women >37 years. |
Safety data for levonorgestrel, ulipristal acetate and Yuzpe regimens for emergency contraception
Jatlaoui TC , Riley H , Curtis KM . Contraception 2015 93 (2) 93-112 The World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC) provide recommendations for use of emergency contraceptive pills (ECPs), including levonorgestrel (LNG) and combined oral contraceptives (COC). A new ECP formulation, ulipristal acetate (UPA), is now available worldwide. To determine whether LNG, UPA or COC (Yuzpe) ECPs are safe for women with certain characteristics or medical conditions, we searched the PubMed and Cochrane databases for articles published from date of inception until May 2015 pertaining to the safety of LNG, UPA or Yuzpe ECP use. For direct evidence, we considered studies that looked at safety outcomes among women with certain medical conditions or characteristics taking ECPs compared with women not taking ECPs. For indirect evidence, we considered studies that reported pharmacokinetic data for ECP use among women with certain medical conditions or characteristics and studies that reported safety outcomes among healthy women taking ECPs. Five studies provided direct evidence; of these five studies, four examined LNG or Yuzpe use among pregnant or breastfeeding women, and one reported risk of ectopic pregnancy among women repeatedly using LNG ECPs. Poor pregnancy outcomes were rare among pregnant women who used LNG or Yuzpe ECPs during the conception cycle or early pregnancy. Breastfeeding outcomes did not differ between women exposed to LNG ECP and those unexposed, and there was no increased risk of ectopic pregnancy versus intrauterine pregnancy after repeated use of LNG ECPs compared with non-use. Forty-five studies provided indirect evidence. One pharmacokinetic study demonstrated that LNG passes into breastmilk, but in minimal quantities. Additionally, nine studies examined pregnancy outcomes following ECP failure among healthy women and 35 articles reported adverse events. Studies suggest serious adverse events are rare among women taking any of these ECP formulations. |
What is new in prevention of perinatal human immunodeficiency virus transmission? Best articles from the past year
Jamieson DJ . Obstet Gynecol 2015 126 (6) 1303-1304 This month we focus on current research in perinatal human immunodeficiency virus transmission. Dr. Jamieson discusses four recent publications, which are concluded with a "bottom line" that is the take-home message. The complete reference for each can be found in Box 1 on this page, along with direct links to the abstracts. |
Contraceptive use among women with medical conditions in a nationwide privately insured population
Champaloux SW , Tepper NK , Curtis KM , Zapata LB , Whiteman MK , Marchbanks PA , Jamieson DJ . Obstet Gynecol 2015 126 (6) 1151-1159 OBJECTIVE: To examine contraceptive use among women with selected medical conditions. METHODS: We used a nationwide health care claims database to identify women aged 15-44 years continuously enrolled in private insurance during 2004-2011 with and without selected medical conditions. We assessed current permanent and reversible prescription contraceptive use during October 1, 2010, to September 30, 2011, with diagnosis, procedure, and pharmacy codes and calculated prevalence by age and condition. We used polytomous logistic regression to calculate odds of female sterilization or reversible prescription methods compared with neither. Among users of reversible methods, we used logistic regression to calculate odds of using long-acting reversible contraceptives compared with shorter acting methods. RESULTS: A low proportion of women with medical conditions were using sterilization or reversible prescription methods (45% and 30% of women aged 15-34 and 35-44 years, respectively), and this proportion was consistently lower among the older age group across all medical conditions. Across both age groups, sterilization and long-acting reversible contraceptives were used less frequently than shorter acting methods (injectable, pill, patch, or ring). The odds of sterilization were higher among women with any compared with no condition for women aged 15-34 years (odds ratio [OR] 4.9, 95% confidence interval [CI], 4.5-5.3) and 35-44 years (OR 1.2, 95% CI, 1.1-1.2). Among women using reversible prescription methods, the odds of using long-acting reversible contraceptives were increased among those with any compared with no condition for women aged 15-34 years (OR 2.2, 95% CI, 2.1-2.5) and 35-44 years (OR 1.1, 95% CI, 1.1-1.2). CONCLUSION: Despite the potential for serious maternal and fetal pregnancy-associated risks, contraceptive use was not optimal among women with medical conditions. LEVEL OF EVIDENCE: III. |
Openness to using non-cigarette tobacco products among U.S. young adults
Mays D , Arrazola RA , Tworek C , Rolle IV , Neff LJ , Portnoy DB . Am J Prev Med 2015 50 (4) 528-534 INTRODUCTION: National data indicate that the prevalence of non-cigarette tobacco product use is highest among young adults; however, little is known about their openness to use these products in the future and associated risk factors. This study sought to characterize openness to using non-cigarette tobacco products and associated factors among U.S. young adults. METHODS: In 2014, National Adult Tobacco Survey data (2012-2013) were analyzed to characterize openness to using the following tobacco products among all young adults aged 18-29 years (N=5,985): cigars; electronic cigarettes ("e-cigarettes"); hookah; pipe tobacco; chew, snuff, or dip; snus; and dissolvables. Among those who were not current users of each product, multivariable logistic regression was used to examine associations between demographics, cigarette smoking status, lifetime use of other non-cigarette products, perceived harm and addictiveness of smoking, and receipt of tobacco industry promotions and openness to using each product. RESULTS: Among all young adults, openness to using non-cigarette tobacco products was greatest for hookah (28.2%); e-cigarettes (25.5%); and cigars (19.1%). In multivariable analyses, which included non-current users of each product, non-current ever, current, and former smokers were more likely than never smokers to be open to using most examined products, as were men and adults aged 18-24 years. Receipt of tobacco industry promotions was associated with openness to using e-cigarettes; chew, snuff, or dip; and snus. CONCLUSIONS: There is substantial openness to trying non-cigarette tobacco products among U.S. young adults. Young adults are an important population to consider for interventions targeting non-cigarette tobacco product use. |
An outbreak of acute delirium from exposure to the synthetic cannabinoid AB-CHMINACA
Tyndall JA , Gerona R , De Portu G , Trecki J , Elie MC , Lucas J , Slish J , Rand K , Bazydlo L , Holder M , Ryan MF , Myers P , Iovine N , Plourde M , Weeks E , Hanley JR , Endres G , Germaine DS , Dobrowolski PJ , Schwartz M . Clin Toxicol (Phila) 2015 53 (10) 1-7 BACKGROUND: Synthetic cannabinoid containing products are a public health threat as reflected by a number of outbreaks of serious adverse health effects over the past 4 years. The designer drug epidemic is characterized by the rapid turnover of synthetic cannabinoid compounds on the market which creates a challenge in identifying the particular etiology of an outbreak, confirming exposure in cases, and providing current information to law enforcement. RESULTS: Between 28 May 2014 and 8 June 2014, 35 patients were evaluated and treated at the University of Florida Health Medical Center in Gainesville following reported exposure to a synthetic cannabinoid containing product obtained from a common source. Patients demonstrated acute delirium (24) and seizures (14), and five required ventilator support and ICU-level care; none died. The presence of N-[(1S)-1-(aminocarbonyl)-2-methylpropyl]-1-(cyclohexylmethyl)-1H-indazole-3-carb oxamide (AB-CHMINACA), or one of its predicted metabolites was confirmed in 15 of 21 cases. A rapid public health response and aggressive public messaging prevented further morbidity, identified the source, and led to law enforcement seizure of the implicated product. DISCUSSION: The significance of this outbreak lies as much in the rapid occurrence of unpredictable, life-threatening adverse health effects from a newly identified synthetic cannabinoid compound as it does in the multidisciplinary investigation and novel partnership between local public health, the laboratory, and the chemical industry, resulting in termination of the outbreak. CONCLUSION: A coordinated response and collaboration between law enforcement, the local public health, emergency medical services and Health Center staff, were all key interventions in preventing a more substantial public health outbreak resulting from use of a novel synthetic cannabinoid compound. Real time collaborations between toxicology laboratories, suppliers of analytical standards and the public health system may be useful in the face of future novel chemical exposures. |
Elevated soluble CD14 and lower D-dimer are associated with cigarette smoking and heavy episodic alcohol use in persons living with HIV
Cioe PA , Baker J , Kojic EM , Onen N , Hammer J , Patel P , Kahler CW . J Acquir Immune Defic Syndr 2015 70 (4) 400-5 BACKGROUND: Persons living with HIV are at increased risk for cardiovascular disease in part because of persistent inflammation and coagulation activation. METHODS: We examined whether smoking and heavy episodic alcohol use (defined as 5 or more drinks on one occasion) were associated with greater monocyte activation (soluble CD14) and coagulation (D-dimer) in participants in the Study to Understand the Natural History of HIV and AIDS in the Era of Effective Therapy (the "SUN" Study), a prospective observational cohort. RESULTS: Using regression analysis (n = 689), current smoking compared with nonsmoking was associated with significantly elevated soluble CD14 (B = 135.57, 95% confidence interval: 84.95 to 186.19, P < 0.001), whereas heavy alcohol use compared with nonheavy use was associated with significantly lower D-dimer levels (B = -0.059, 95% confidence interval: -0.102 to -0.016, P = 0.007). CONCLUSIONS: Smoking cessation should be encouraged by HIV care providers to improve mortality outcomes from all causes of death, particularly cardiovascular disease. |
Hormonal contraception among electronic cigarette users and cardiovascular risk: a systematic review
Riley HE , Berry-Bibee E , England LJ , Jamieson DJ , Marchbanks PA , Curtis KM . Contraception 2015 93 (3) 190-208 BACKGROUND: Women who use combined hormonal contraceptives and cigarettes have an increased risk for cardiovascular (CV) events. We reviewed the literature to determine whether women who use hormonal contraceptives (HC) and electronic cigarettes (e-cigarettes) also have an increased risk. STUDY DESIGN: Systematic review. METHODS: We searched for articles reporting myocardial infarction (MI), stroke, venous thromboembolism, peripheral arterial disease, or changes to CV markers in women using e-cigarettes and HC. We also searched for indirect evidence, such as CV outcomes among e-cigarette users in the general population and among HC users exposed to nicotine, propylene glycol, or glycerol. RESULTS: No articles reported on outcomes among e-cigarette users using HC. Among the general population, 13 articles reported on heart rate or blood pressure after e-cigarette use. These markers generally remained normal, even when significant changes were observed. In 3 studies, changes were less pronounced after e-cigarette use than cigarette use. One MI was reported among 1,012 people exposed to e-cigarettes in these studies. One article on nicotine and HC exposure found both exposures to be significantly associated with acute changes to heart rate, though mean heart rate remained normal. No articles on propylene glycol or glycerol and HC exposure were identified. CONCLUSION: We identified no evidence on CV outcomes among e-cigarette users using HC. Limited data reporting mostly acute outcomes suggested that CV events are rare among e-cigarettes users in the general population, and that e-cigarettes may affect heart rate and blood pressure less than conventional cigarettes. There is a need for research assessing joint HC and e-cigarette exposure on clinical CV outcomes. |
Current cigarette smoking among adults - United States, 2005-2014
Jamal A , Homa DM , O'Connor E , Babb SD , Caraballo RS , Singh T , Hu SS , King BA . MMWR Morb Mortal Wkly Rep 2015 64 (44) 1233-1240 Tobacco smoking is the leading cause of preventable disease and death in the United States, resulting in approximately 480,000 premature deaths and more than $300 billion in direct health care expenditures and productivity losses each year (1). To assess progress toward achieving the Healthy People 2020 objective of reducing the percentage of U.S. adults who smoke cigarettes to </=12.0%,* CDC assessed the most recent national estimates of smoking prevalence among adults aged >/=18 years using data from the 2014 National Health Interview Survey (NHIS). The percentage of U.S. adults who smoke cigarettes declined from 20.9% in 2005 to 16.8% in 2014. Among daily cigarette smokers, declines were observed in the percentage who smoked 20-29 cigarettes per day (from 34.9% to 27.4%) or >/=30 cigarettes per day (from 12.7% to 6.9%). In 2014, prevalence of cigarette smoking was higher among males, adults aged 25-44 years, multiracial persons and American Indian/Alaska Natives, persons who have a General Education Development certificate, live below the federal poverty level, live in the Midwest, are insured through Medicaid or are uninsured, have a disability or limitation, or are lesbian, gay, or bisexual. Proven population-based interventions, including tobacco price increases, comprehensive smoke-free laws, high impact mass media campaigns, and barrier-free access to quitting assistance, are critical to reduce cigarette smoking and smoking-related disease and death among U.S. adults. |
The dose-response relationship between tobacco education advertising and calls to quitlines in the United States, March-June, 2012
Davis KC , Alexander RL Jr , Shafer P , Mann N , Malarcher A , Zhang L . Prev Chronic Dis 2015 12 E191 INTRODUCTION: We estimated changes in call volume in the United States in response to increases in advertising doses of the Tips From Former Smokers (Tips) campaign, the first federal national tobacco education campaign, which aired for 12 weeks from March 19 to June 10, 2012. We also measured the effectiveness of ad taglines that promoted calls directly with a quitline number (1-800-QUIT-NOW) and indirectly with a cessation help website (Smokefree.gov). METHODS: Multivariate regressions estimated the weekly number of calls to 1-800-QUIT-NOW by area code as a function of weekly market-level gross rating points (GRPs) from CDC's Tips campaign in 2012. The number of quitline calls attributable solely to Tips was predicted. RESULTS: For quitline-tagged ads, an additional 100 television GRPs per week was associated with an increase of 89 calls per week in a typical area code in the United States (P < .001). The same unit increase in advertising GRPs for ads tagged with Smokefree.gov was associated with an increase of 29 calls per week in any given area code (P < .001). We estimated that the Tips campaign was responsible for more than 170,000 additional calls to 1-800-QUIT-NOW during the campaign and that it would have generated approximately 140,000 additional calls if all ads were tagged with 1-800-QUIT-NOW. CONCLUSION: For campaign planners, these results make it possible to estimate 1) the likely impact of tobacco prevention media buys and 2) the additional quitline capacity needed at the national level should future campaigns of similar scale use 1-800-QUIT-NOW taglines exclusively. |
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