Norovirus gastroenteritis
Glass RI , Parashar UD , Estes MK . N Engl J Med 2009 361 (18) 1776-85 The Norwalk agent was the first virus that was identified as causing gastroenteritis in humans, but recognition of its importance as a pathogen has been limited because of the lack of available, sensitive, and routine diagnostic methods. Recent advances in understanding the molecular biology of the noroviruses, coupled with applications of novel diagnostic techniques, have radically altered our appreciation of their impact. Noroviruses are now recognized as being the leading cause of epidemics of gastroenteritis and an important cause of sporadic gastroenteritis in both children and adults. Although norovirus gastroenteritis is generally mild and of short duration, new evidence suggests that the illness can be severe and sometimes fatal, especially among vulnerable populations — young children and the elderly — and is a common cause of hospitalization for gastroenteritis. Routine diagnostic methods are still unavailable to most clinicians, but epidemiologic studies have identified both rapid local transmission and the emergence of novel norovirus strains that spread in a global fashion, similar to the epochal patterns of influenza. Controlling outbreaks of norovirus poses major challenges.1 |
Oral pre-exposure prophylaxis for HIV prevention
Garcia-Lerma JG , Paxton L , Kilmarx PH , Heneine W . Trends Pharmacol Sci 2009 31 (2) 74-81 In the absence of an effective vaccine, HIV continues to spread worldwide, emphasizing the need for new biomedical interventions to limit its transmission. Appreciation of the challenges that HIV has to face to initiate an infection mucosally has spurred interest in evaluating the use of antiretroviral drugs to prevent infection. Recent animal studies using macaques or humanized mice models of mucosal transmission of SIV or HIV have shown that daily or intermittent pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) can exploit early virus vulnerabilities and effectively prevent establishment of infection. These preclinical findings have fueled interest in evaluating the safety and efficacy of PrEP in humans. We provide an overview of the rationale behind PrEP and discuss the next steps in PrEP research, including the need to better define the ability of current drugs to reach and accumulate in mucosal tissues and protect cells that are primary targets during early HIV infection. |
Outbreak of antiviral drug-resistant influenza a in long-term care facility, Illinois, USA, 2008
Dharan NJ , Patton M , Siston AM , Morita J , Ramirez E , Wallis TR , Deyde V , Gubareva LV , Klimov AI , Bresee JS , Fry AM . Emerg Infect Dis 2009 15 (12) 1973-6 An outbreak of oseltamivir-resistant influenza A (H1N1) occurred in a long-term care facility. Eight (47%) of 17 and 1 (6%) of 16 residents in 2 wards had oseltamivir-resistant influenza A virus (H1N1) infections. Initial outbreak response included treatment and prophylaxis with oseltamivir. The outbreak abated, likely because of infection control measures. |
Pandemic influenza as 21st century urban public health crisis
Bell DM , Weisfuse IB , Hernandez-Avila M , Del Rio C , Bustamante X , Rodier G . Emerg Infect Dis 2009 15 (12) 1963-9 The percentage of the world's population living in urban areas will increase from 50% in 2008 to 70% (4.9 billion) in 2025. Crowded urban areas in developing and industrialized countries are uniquely vulnerable to public health crises and face daunting challenges in surveillance, response, and public communication. The revised International Health Regulations require all countries to have core surveillance and response capacity by 2012. Innovative approaches are needed because traditional local-level strategies may not be easily scalable upward to meet the needs of huge, densely populated cities, especially in developing countries. The responses of Mexico City and New York City to the initial appearance of influenza A pandemic (H1N1) 2009 virus during spring 2009 illustrate some of the new challenges and creative response strategies that will increasingly be needed in cities worldwide. |
Pandemic influenza preparedness and vulnerable populations in tribal communities
Groom AV , Jim C , Laroque M , Mason C , McLaughlin J , Neel L , Powell T , Weiser T , Bryan RT . Am J Public Health 2009 99 S271-8 American Indian and Alaska Native (AIAN) governments are sovereign entities with inherent authority to establish and administer public health programs within their communities and will be critical partners in national efforts to prepare for pandemic influenza. Within AIAN communities, some subpopulations will be particularly vulnerable during an influenza pandemic because of their underlying health conditions, whereas others will be at increased risk because of limited access to prevention or treatment interventions.We outline potential issues to consider in identifying and providing appropriate services for selected vulnerable populations within tribal communities. We also highlight pandemic influenza preparedness resources available to tribal leaders and their partners in state and local health departments, academia, community-based organizations, and the private sector. |
Predictors of suboptimal virologic response to highly active antiretroviral therapy among human immunodeficiency virus-infected adolescents: analyses of the reaching for excellence in adolescent care and health (REACH) project
Ding H , Wilson CM , Modjarrad K , McGwin G Jr , Tang J , Vermund SH . Arch Pediatr Adolesc Med 2009 163 (12) 1100-5 OBJECTIVE: To examine the prevalence and biopsychosocial predictors of suboptimal virologic response to highly active antiretroviral therapy (HAART) among human immunodeficiency virus-infected adolescents. DESIGN: Population-based cohort study. SETTING: Sixteen academic medical centers across 13 cities in the United States. PARTICIPANTS: One hundred fifty-four human immunodeficiency virus-infected adolescents who presented for at least 2 consecutive visits after initiation of HAART. MAIN OUTCOME MEASURES: Viral load (plasma concentration of human immunodeficiency virus RNA) and CD4(+) lymphocyte count. RESULTS: Of the 154 adolescents enrolled in the study, 50 (32.5%) demonstrated early and sustained virologic suppression while receiving HAART. The remaining 104 adolescents (67.5%) had a poor virologic response. Adequate adherence (>50%)-reported by 70.8% of respondents-was associated with 60% reduced odds of suboptimal virologic suppression in a multivariable logistic regression model (adjusted odds ratio = 0.4; 95% confidence interval, 0.2-1.0). Exposure to suboptimal antiretroviral therapy prior to HAART, on the other hand, was associated with more than 2-fold increased odds of suboptimal virologic response (adjusted odds ratio = 2.6; 95% confidence interval, 1.1-5.7). CONCLUSIONS: Fully two-thirds of human immunodeficiency virus-infected adolescents in the current study demonstrated a suboptimal virologic response to HAART. Nonadherence and prior single or dual antiretroviral therapy were associated with subsequent poor virologic responses to HAART. These predictors of HAART failure echo findings in pediatric and adult populations. Given the unique developmental stage of adolescence, age-specific interventions are indicated to address high rates of nonadherence and therapeutic failure. |
Addition of extended zidovudine to extended nevirapine prophylaxis reduces nevirapine resistance in infants who were HIV-infected in utero
Lidstrom J , Li Q , Hoover DR , Kafulafula G , Mofenson LM , Fowler MG , Thigpen MC , Kumwenda N , Taha TE , Eshleman SH . AIDS 2009 24 (3) 381-6 BACKGROUND: In the Post-Exposure Prophylaxis of Infants (PEPI)-Malawi trial, most women received single-dose nevirapine (NVP) at delivery, and infants in the extended study arms received single-dose NVP along with 1 week of daily zidovudine (ZDV), followed by either extended daily NVP or extended daily NVP and ZDV up to 14 weeks of age. Although extended NVP prophylaxis reduces the risk of postnatal HIV transmission, it may increase the risk of NVP resistance among infants who are HIV-infected despite prophylaxis. METHODS: We analyzed 88 infants in the PEPI-Malawi trial who were HIV-infected in utero and who received prophylaxis for a median of 6 weeks prior to HIV diagnosis. HIV genotyping was performed using the ViroSeq HIV Genotyping System. RESULTS: At 14 weeks of age, the proportion of infants with NVP resistance was lower in the extended NVP and ZDV arm than in the extended NVP arm (28/45, 62.2% vs. 37/43, 86.0%; P = 0.015). None of the infants had ZDV resistance. Addition of extended ZDV to extended NVP was associated with reduced risk of NVP resistance at 14 weeks if prophylaxis was stopped by 6 weeks (54.5 vs. 85.7%, P = 0.007) but not if prophylaxis was continued beyond 6 weeks (83.3 vs. 87.5%, P = 1.00). CONCLUSION: Addition of extended ZDV to extended NVP prophylaxis significantly reduced the risk of NVP resistance at 14 weeks in infants who were HIV-infected in utero, provided that HIV infection was diagnosed and the prophylaxis was stopped by 6 weeks of age. |
An early warning sign: sexually transmissible infections among young African American women and the need for preemptive, combination HIV prevention
Fasula AM , Miller KS , Sutton MY . Sex Health 2009 6 (4) 261-263 This editorial discusses the need and strategies to prevent HIV transmission through the combination prevention approach (integrates biomedical, behavioural and structural elements of prevention) targeting the pre-risk phase in young African American women (aged 13-29 years), the group with the 2nd highest rates of HIV infection among the race/ethnic and gender groups and the highest proportion of new HIV infections among the age groups. |
High mortality in a cholera outbreak in western Kenya after post-election violence in 2008
Shikanga OT , Mutonga D , Abade M , Amwayi S , Ope M , Limo H , Mintz ED , Quick RE , Breiman RF , Feikin DR . Am J Trop Med Hyg 2009 81 (6) 1085-90 In 2008, a cholera outbreak with unusually high mortality occurred in western Kenya during civil unrest after disputed presidential elections. Through active case finding, we found a 200% increase in fatal cases and a 37% increase in surviving cases over passively reported cases; the case-fatality ratio increased from 5.5% to 11.4%. In conditional logistic regression of a matched case-control study of fatal versus non-fatal cholera infection, home antibiotic treatment (odds ratio [OR] 0.049; 95% CI: < 0.001-0.43), hospitalization (OR, 0.066; 95% CI, 0.001-0.54), treatment in government-operated health facilities (OR, 0.15; 95% CI, 0.015-0.73), and receiving education about cholera by health workers (OR, 0.19; 95% CI, 0.018-0.96) were protective against death. Among 13 hospitalized fatal cases, chart review showed inadequate intravenous and oral hydration and substantial staff and supply shortages at the time of admission. Cholera mortality was under-reported and very high, in part because of factors exacerbated by widespread post-election violence. |
The impact of HIV scale-up on health systems: a priority research agenda
Rabkin M , El-Sadr WM , De Cock KM , Bellagio HIV Health Systems Working Group . J Acquir Immune Defic Syndr 2009 52 S6-11 Although much has been learned about the implementation of HIV prevention, care, and treatment services in resource-limited settings, the broader impact of the rapid scale-up of HIV programs on fragile health systems has only recently been explored. A high-level working group identified priority research questions regarding the impact of HIV scale-up on key elements of health systems: service delivery; management; information, evidence, and strategic planning; medical products, vaccines, and technologies; health financing and payments; leadership and governance; and the behaviors of providers, consumers, and communities. Rigorous multisectoral studies are needed if HIV program expansion to the millions still needing care and treatment is to continue, and if the synergies between vertically funded HIV programs and the health systems of which they are a part are to be maximized to strengthen nations' ability to meet all their health challenges. |
Total blood mercury concentrations in the U.S. population: 1999-2006
Caldwell KL , Mortensen ME , Jones RL , Caudill SP , Osterloh JD . Int J Hyg Environ Health 2009 212 (6) 588-98 We describe the distribution and demographic characteristics of total blood Hg levels in the U.S. general population among persons ages 1 year and older who participated in the 2003-2006 National Health and Nutrition Examination Survey (NHANES). We also describe trends in the total blood Hg of children ages 1-5 (n=3456) and females ages 16-49 during 1999-2006 (n=7245). In the combined 2003-2006 survey periods, the geometric means for non-Hispanic blacks, 0.853microg/L (95% confidence interval [CI], 0.766-0.950microg/L), and non-Hispanic whites, 0.833microg/L (95% CI, 0.752-0.922microg/L), were higher than the geometric mean for Mexican Americans, 0.580microg/L (95% CI, 0.522-0.645microg/L). Also in 2003-2006, regression analysis of log total blood Hg with age, race/ethnicity and gender showed that total blood Hg levels in the population exhibited a quadratic increase with age (p<0.0001), peaking at ages 50-59 in non-Hispanic blacks and whites, at ages 40-49 in Mexican Americans, and then declining at older ages. Over the four survey periods (1999-2006), regression analysis showed that total blood Hg levels increased slightly for non-Hispanic white children and decreased slightly for non-Hispanic black and Mexican American children. Over the same four survey periods, female children had slightly higher total blood Hg levels than males (0.356 vs. 0.313microg/L, p=0.0050) and total blood Hg levels in non-Hispanic black women aged 16-49 years were significantly higher than in non-Hispanic white women (1.081 vs. 0.850microg/L, p<0.0001) and in Mexican American women (1.081 vs. 0.70microg/L, p<0.0001). |
Multicenter GeoSentinel analysis of rickettsial diseases in international travelers, 1996-2008
Jensenius M , Davis X , von Sonnenburg F , Schwartz E , Keystone JS , Leder K , Lopez-Velez R , Caumes E , Cramer JP , Chen L , Parola P , GeoSentinel Surveillance Network . Emerg Infect Dis 2009 15 (11) 1791-8 We investigated epidemiologic and clinical aspects of rickettsial diseases in 280 international travelers reported to the GeoSentinel surveillance Network during 1996-2008. Of these 280 travelers, 231 (82.5%) had spotted fever (SFG) rickettsiosis, 16 (5.7%) scrub typhus, 11 (3.9%) Q fever, 10 (3.6%) typhus group (TG) rickettsiosis, 7 (2.5%) bartonellosis, 4 (1.4%) indeterminable SFG/TG rickettsiosis, and 1 (0.4%) human granulocytic anaplasmosis. One hundred ninety-seven (87.6%) SFG rickettsiosis cases were acquired in sub-Saharan Africa and were associated with higher age, male gender, travel to southern Africa, late summer season travel, and travel for tourism. More than 90% of patients with rickettsial disease were treated with doxycycline, 43 (15.4%) were hospitalized, and 4 had a complicated course, including 1 fatal case of scrub typhus encephalitis acquired in Thailand. |
The epidemiology of hospitalization with diarrhea in rural Kenya: the utility of existing health facility data in developing countries
Tornheim JA , Manya AS , Oyando N , Kabaka S , O'Reilly CE , Breiman RF , Feikin DR . Int J Infect Dis 2009 14 (6) e499-505 OBJECTIVES: In developing countries where prospective surveillance is resource-intensive, existing hospital data can define incidence, mortality, and risk factors that can help target interventions and track trends in disease burden. METHODS: We reviewed hospitalizations from 2001 to 2003 at all inpatient facilities in Bondo District, Kenya. RESULTS: Diarrhea was responsible for 11.2% (n=2158) of hospitalizations. The annual incidence was 550 and 216 per 100000 persons aged <5 and ≥5 years, respectively. The incidence was highest in infants (1138 per 100000 persons), decreased in older children, peaked again among 20-29-year-olds (341 per 100000), and declined among those ≥65 years (157 per 100000). Female adults had higher incidence than males (rate ratio=1.84, 95% CI 1.61-2.10). Incidence decreased with distance from the district referral hospital (4.5% per kilometer, p<0.0001) and from the nearest inpatient facility (6.6% per kilometer, p=0.012). Case-fatality was high (8.0%), and was higher among adults than young children. Co-diagnosis with malaria, pneumonia, HIV, and tuberculosis was common. Peak diarrhea incidence fell one to two months after heavy rains. CONCLUSIONS: The trends revealed here provide useful data for public health priority setting and planning, including preventative interventions. The utility of such data justifies renewed efforts to establish and strengthen health management information systems in developing countries. |
Recipes for foodborne outbreaks: a scheme for categorizing and grouping implicated foods
Painter JA , Ayers T , Woodruff R , Blanton E , Perez N , Hoekstra RM , Griffin PM , Braden C . Foodborne Pathog Dis 2009 6 (10) 1259-64 BACKGROUND: To better understand the sources of foodborne illness, we propose a scheme for categorizing foods implicated in investigations of outbreaks of foodborne diseases. Because nearly 2000 foods have been reported as causing outbreaks in the United States, foods must be grouped for meaningful analyses. METHODS: We defined a hierarchy of 17 mutually exclusive food commodities. We defined the following three commodity groups from which nearly all food is derived: aquatic animals, land animals, and plants. We defined three commodities in aquatic animals, six in land animals, and eight in plants. We considered each food as a set of ingredients composed of one or more commodities. We defined a simple food as one made of ingredients that are all in one commodity and a complex food as one containing ingredients in more than one commodity. We determined likely ingredients using a panel of epidemiologists and a web-based search process. RESULTS: We assigned 1709 (95%) of the 1794 foods implicated in outbreaks of foodborne diseases reported to Centers for Disease Control and Prevention from 1973 to 2006. Of those, 987 (57%) were simple foods and 722 (43%) were complex foods. DISCUSSION: This categorization may serve as an input for modeling the attribution of human illness to specific food commodities and could be used by policy makers, health officials, regulatory agencies, and consumer groups to evaluate the contribution of various food commodities to illness. |
Health systems exist for real people. Introduction
El-Sadr WM , De Cock KM . J Acquir Immune Defic Syndr 2009 52 S1-2 Action always leads to reaction, a fundamental law of nature. The recent unprecedented investment in combating the HIV/AIDS pandemic has led to marvel at the effects of antiretroviral therapy, to constructive questioning about impact on health systems and, at one extreme, to frank hostility.1,2 Central to the debate has been the question of whether the disease-specific efforts of initiatives such as the United States President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria have strengthened or undermined national health systems in low- and middle-income countries.3 Regrettably, discussions have sometimes become polarized and antagonistic, drawing attention from the specifics of the enormous tasks at hand in global health. This supplement of the Journal examines the impact of HIV scale-up on health systems in a diverse array of countries and contexts, building on discussions that took place at a meeting at the Rockefeller Foundation Bellagio Center in September 2008 that focused on these issues. | These discussions are rooted in documents now decades old: the 1978 Declaration of Alma-Ata4 and the 1993 World Development Report entitled “Investing in Health.”5 These important documents illustrate that discussions about health systems have been ongoing at the highest levels for some time but that bringing the necessary financing to bear lagged far behind. In 2001, the Commission on Macroeconomics and Health published its conclusion that better health for the world's poor is not only a right but an important priority for development and poverty reduction.6 Influential academics had been speaking out since the 1990s on sub-Saharan Africa's disproportionate burden of infectious and poverty-related diseases, and more specifically on the dominant impact of malaria, tuberculosis, and HIV.7 |
Socio-cultural predictors of health-seeking behaviour for febrile under-five children in Mwanza-Neno district, Malawi
Chibwana AI , Mathanga DP , Chinkhumba J , Campbell CH Jr . Malar J 2009 8 219 BACKGROUND: Prompt access to effective treatment for malaria is unacceptably low in Malawi. Less than 20% of children under the age of five with fever receive appropriate anti-malarial treatment within 24 hours of fever onset. This study assessed socio-cultural factors associated with delayed treatment of children with fever in Mwanza district, Malawi. METHODOLOGY: It was a qualitative study using focus group discussions and key informant interviews. RESULTS: A total of 151 caregivers and 46 health workers participated in the focus group discussions. The majority of caregivers were able to recognize fever and link it to malaria. Despite high knowledge of malaria, prompt treatment and health-seeking behaviour were poor, with the majority of children first being managed at home with treatment regimens other than effective anti-malarials. Traditional beliefs about causes of fever, unavailability of anti-malarial drugs within the community, barriers to accessing the formal health care system, and trust in traditional medicine were all associated with delays in seeking appropriate treatment for fever. CONCLUSION: The study has demonstrated important social cultural factors that negatively influence for caregivers of children under five. To facilitate prompt and appropriate health-seeking behaviour, behavioral change messages must address the prevailing local beliefs about causes of fever and the socio-economic barriers to accessing health care. |
Dogs are talking: San Francisco's social marketing campaign to increase syphilis screening
Stephens SC , Bernstein KT , McCright JE , Klausner JD . Sex Transm Dis 2009 37 (3) 173-6 To promote regular syphilis testing among men who have sex with men in San Francisco, a social marketing campaign, Dogs Are Talking, was created. An evaluation of the campaign found no difference in syphilis testing among men who recalled the campaign and those that did not. A significant difference was seen among HIV-infected men. |
Chikungunya virus: possible impact on transfusion medicine
Petersen LR , Stramer SL , Powers AM . Transfus Med Rev 2010 24 (1) 15-21 In recent years, large chikungunya virus (CHIKV) outbreaks originating in Kenya have spread to islands of the Indian Ocean and parts of India, Southeast Asia, and Europe. Concern of transfusion transmission has been heightened for this mosquito-borne arbovirus because of high population infection incidence during outbreaks and the high-titer viremia lasting approximately 6 days. The virus has not circulated in the Americas; however, the abundant presence of competent mosquito vectors suggests large outbreaks are possible should the virus be introduced and autochthonous transmission occur. Chikungunya virus produces a fever-arthralgia syndrome resulting in considerable morbidity and some mortality, particularly among older age groups and/or those with pre-existing conditions. Estimated transfusion risks range as high as 150 per 10 000 donations during outbreaks. Possible measures to prevent possible CHIKV transfusion transmission include deferral of symptomatic donors, discontinuing blood collections in affected areas, and CHIKV nucleic acid screening of donations. Even a relatively small outbreak in Italy resulted in considerable adverse impact on blood collections and economic consequence. Assays suitable for testing donations for CHIKV RNA are not yet available, and given the highly geographically and temporally sporadic nature of CHIKV outbreaks, there may be considerable reluctance to develop and implement them. |
Twenty-five year epidemiology of invasive methicillin-resistant Staphylococcus aureus (MRSA) isolates recovered at a burn center
Murray CK , Holmes RL , Ellis MW , Mende K , Wolf SE , McDougal LK , Guymon CH , Hospenthal DR . Burns 2009 35 (8) 1112-7 Over the past two decades, an epidemiologic emergence of methicillin-resistant Staphylococcus aureus (MRSA) infections has occurred from that of primarily hospital-associated to community-associated. This emergence change has involved MRSA of different pulsed-field types (PFT), with different virulence genes and antimicrobial resistance patterns. In this study we, evaluate the changes in PFT and antimicrobial resistance epidemiology of invasive MRSA isolates over 25 years at a single burn unit. Isolates were tested by pulsed-field gel electrophoresis (PFGE), broth microdilution antimicrobial susceptibility testing, and PCR for the virulence factors Panton-Valentine leukocidin (PVL) and arginine catabolic mobile element (ACME), and the resistance marker staphylococcal chromosomal cassette mec (SCCmec). Forty isolates were screened, revealing stable vancomycin susceptibility MIC without changes over time but decreasing susceptibility to clindamycin and ciprofloxacin. The majority of PFGE types were MRSA USA800 carrying the SCCmec I element and USA100 carrying the SCCmec II element. No strains typically associated with community-associated MRSA, USA300 or USA400, were found. USA800 isolates were predominately found in the 1980s, USA600 isolates were primarily found in the 1990s, and USA100 isolates were found in the 2000s. The PVL gene was present in only one isolate, the sole USA500 isolate, from 1987. The virulence marker ACME was not detected in any of the isolates. Overall, a transition was found in hospital-associated MRSA isolates over the 25 years, but no introduction of community-associated MRSA isolates into this burn unit. Continued active surveillance and aggressive infection control strategies are recommended to prevent the spread of community-acquired MRSA to this burn unit. |
Nasopharyngeal carriage of streptococcus pneumoniae in Gambian children who participated in a 9-valent pneumococcal conjugate vaccine trial and in their younger siblings
Cheung YB , Zaman SM , Nsekpong ED , Van Beneden CA , Adegbola RA , Greenwood B , Cutts FT . Pediatr Infect Dis J 2009 28 (11) 990-995 BACKGROUND: Nasopharyngeal carriage of Streptococcus pneumoniae is extremely prevalent in The Gambia. We studied the effects of vaccination with pneumococcal conjugate vaccines on the carriage of individual serotypes and on antimicrobial resistance in vaccinated children and their younger siblings. METHODS: A longitudinal study of a subsample of children (n = 2342) who participated in a randomized, placebo controlled trial of a 9-valent pneumococcal conjugate vaccines (PCV-9) in The Gambia, and a cross-sectional study of non-PCV-9-vaccinated younger siblings (n = 675). RESULTS: Recipients of PCV-9 were less likely to carry vaccine serotypes 4, 6B, 9V, 14, 19F, and 23F but more likely to carry vaccine-associated 19A and 9 nonvaccine serotypes at approximately 6 months postvaccination (age, 12 months) than were controls (each P < 0.05). At approximately 16 months postvaccination, carriage of vaccine-associated-serotype 6A was also significantly reduced (P < 0.01) while 3 other nonvaccine serotypes were more prevalent in the PCV-9 recipients (each P < 0.05). At 16 months, but not 6 months, postvaccination PCV-9 recipients had lower rate of carrying isolates resistant to tetracycline and trimethoprim-sulfamethoxazole (TMP-SMZ) than controls (risk ratio: 0.90 and 0.95, respectively; each P < 0.05). There was no difference in patterns of carriage of pneumococci in younger siblings of PCV-9 or placebo recipients. CONCLUSIONS: The effects of 9-valent pneumococcal conjugate vaccines on carriage of pneumococci persisted for at least 16 months postvaccination in Gambian children. Vaccination had no indirect effect on carriage in younger siblings and there was limited impact on antibiotic resistance. |
Efficacy and safety of intermittent preventive treatment with sulfadoxine-pyrimethamine for malaria in African infants: a pooled analysis of six randomised, placebo-controlled trials
Aponte JJ , Schellenberg D , Egan A , Breckenridge A , Carneiro I , Critchley J , Danquah I , Dodoo A , Kobbe R , Lell B , May J , Premji Z , Sanz S , Sevene E , Soulaymani-Becheikh R , Winstanley P , Adjei S , Anemana S , Chandramohan D , Issifou S , Mockenhaupt F , Owusu-Agyei S , Greenwood B , Grobusch MP , Kremsner PG , Macete E , Mshinda H , Newman RD , Slutsker L , Tanner M , Alonso P , Menendez C . Lancet 2009 374 (9700) 1533-42 BACKGROUND: Intermittent preventive treatment (IPT) is a promising strategy for malaria control in infants. We undertook a pooled analysis of the safety and efficacy of IPT in infants (IPTi) with sulfadoxine-pyrimethamine in Africa. METHODS: We pooled data from six double-blind, randomised, placebo-controlled trials (undertaken one each in Tanzania, Mozambique, and Gabon, and three in Ghana) that assessed the efficacy of IPTi with sulfadoxine-pyrimethamine. In all trials, IPTi or placebo was given to infants at the time of routine vaccinations delivered by WHO's Expanded Program on Immunization. Data from the trials for incidence of clinical malaria, risk of anaemia (packed-cell volume <25% or haemoglobin <80 g/L), and incidence of hospital admissions and adverse events in infants up to 12 months of age were reanalysed by use of standard outcome definitions and time periods. Analysis was by modified intention to treat, including all infants who received at least one dose of IPTi or placebo. FINDINGS: The six trials provided data for 7930 infants (IPTi, n=3958; placebo, n=3972). IPTi had a protective efficacy of 30.3% (95% CI 19.8-39.4, p<0.0001) against clinical malaria, 21.3% (8.2-32.5, p=0.002) against the risk of anaemia, 38.1% (12.5-56.2, p=0.007) against hospital admissions associated with malaria parasitaemia, and 22.9% (10.0-34.0, p=0.001) against all-cause hospital admissions. There were 56 deaths in the IPTi group compared with 53 in the placebo group (rate ratio 1.05, 95% CI 0.72-1.54, p=0.79). One death, judged as possibly related to IPTi because it occurred 19 days after a treatment dose, was subsequently attributed to probable sepsis. Four of 676 non-fatal hospital admissions in the IPTi group were deemed related to study treatment compared with five of 860 in the placebo group. None of three serious dermatological adverse events in the IPTi group were judged related to study treatment compared with one of 13 in the placebo group. INTERPRETATION: IPTi with sulfadoxine-pyrimethamine was safe and efficacious across a range of malaria transmission settings, suggesting that this intervention is a useful contribution to malaria control. FUNDING: Bill & Melinda Gates Foundation. |
Evaluation of self-reported and registry-based influenza vaccination status in a Wisconsin cohort
Irving SA , Donahue JG , Shay DK , Ellis-Coyle TL , Belongia EA . Vaccine 2009 27 (47) 6546-9 We evaluated influenza vaccination status as determined by self-report and a regional, real-time immunization registry during two influenza seasons when subjects were enrolled in a study to estimate vaccine effectiveness. We enrolled 2907 patients during the two consecutive seasons. The sensitivity and specificity of self-reported influenza vaccination when compared to immunization registry records were 95% and 90%, respectively. The positive predictive value of self-reported vaccination was 89% and negative predictive value was 96%. In our study population, self-reported influenza vaccine status was a sensitive and fairly specific indicator of actual vaccine status. Misclassification was more common among young children. |
Impact of rotavirus vaccination: the importance of monitoring strains
Gentsch JR , Parashar UD , Glass RI . Future Microbiol 2009 4 (10) 1231-4 In an article in this issue of Future Microbiology, Matthijnssens et al. review recent data on the impact of the two new rotavirus vaccines, RotaTeq™ and Rotarix™, on disease burden and highlight the importance of monitoring the effect of vaccination on rotavirus strains [1]. The authors point out that data becoming available from postlicensure studies in the USA, Australia and elsewhere suggest that vaccine usage has caused a substantial reduction of rotavirus gastroenteritis cases and hospitalizations [2,3]. While these vaccine effectiveness (VE) results are highly encouraging, Matthijnssens et al. remind readers that the long-term impact of immunization with rotavirus vaccines on strain evolution has not been studied and suggest that the large diversity of rotavirus serotypes, distinct from those of the two vaccines, and the potential for rapid viral evolution through genetic reassortment [4–6] could challenge the effectiveness of the two vaccines through the emergence of strains that evade immunity. Consequently, the authors believe it will be important to continue surveillance during the postintroduction period to monitor strains. | Immunity to rotavirus is thought to have both serotype-specific (homotypic) and cross-reactive (heterotypic) components. For example, challenge studies in piglets demonstrate that primary infection elicits predominantly serotype-specific protection against both VP4 (P) and VP7 (G) antigens (for a review see [7]). Similarly, in a study of natural rotavirus infection, children who developed threshold levels of neutralizing antibodies to serotype G3 were subsequently protected against re-infection with the same serotype, suggesting that protection was homotypic. Protection elicited in recipients of a serotype G3 vaccine also appeared to be largely homotypic, as indicated by much higher efficacy against human G3 than non-G3 strains. Repeat rotavirus infections acquired naturally, or by vaccination, broaden protective immunity to include multiple serotypes, as indicated by development of cross-neutralizing antibodies and cross-reactive epitope-blocking antibodies specific for the VP4 and VP7 serotype antigens, suggesting that a stronger heterotypic response is generated during re-infection [7]. |
Invasive pneumococcal infections among vaccinated children in the United States
Park SY , Van Beneden CA , Pilishvili T , Martin M , Facklam RR , Whitney CG , Active Bacterial Core surveillance team . J Pediatr 2009 156 (3) 478-483.e2 OBJECTIVE: Because 7-valent pneumococcal conjugate vaccine (PCV7) is highly efficacious, pneumococcal infections in vaccinated children raise concerns about immunologic disorders. We characterized a case series of US children in whom invasive pneumococcal infections developed despite vaccination. STUDY DESIGN: We reviewed invasive (sterile site) pneumococcal infections in children aged <5 years who had received ≥1 PCV7 dose as identified from October 2001 to February 2004 through national passive surveillance and the Centers for Disease Control and Prevention's Active Bacterial Core surveillance. Vaccine serotype infections were considered breakthrough cases; the subset of breakthrough cases occurring in children who completed an age-appropriate vaccination series were considered PCV7 failures. RESULTS: We identified 753 invasive infections; 155 infections (21%) were breakthrough cases, predominantly caused by serotypes 6B (n = 50, 32%) and 19F (n = 45, 29%). The proportion of breakthrough cases decreased with the increasing number of PCV7 doses received (P < .001, X(2) for linear trend). Children with co-morbid conditions accounted for 31% of breakthrough infections. Twenty-seven cases (4%) were classified as vaccine failures. Most failures (71%) occurred in children who were vaccinated according to catch-up schedules; 37% had co-morbid conditions. CONCLUSION: Invasive pneumococcal infections identified in vaccinated U.S. children were primarily caused by disease resulting from serotypes not covered with PCV7, rather than failure of the vaccine. Incomplete vaccination and co-morbid conditions likely contribute to breakthrough vaccine-type pneumococcal infections. |
Molecular identification of Salp15, a key salivary gland protein in the transmission of lyme disease spirochetes, from Ixodes persulcatus and Ixodes pacificus (Acari: Ixodidae)
Hojgaard A , Biketov SF , Shtannikov AV , Zeidner NS , Piesman J . J Med Entomol 2009 46 (6) 1458-63 Salp15 is a multifunctional protein, vital to the tick in its need to obtain vertebrate host blood without stimulating a host inflammatory and immune response. The Salpl5 protein from both Ixodes scapularis Say and Ixodes ricinus (L.), the principal vectors of the Lyme disease spirochete in eastern North America and Europe, respectively, have been well characterized and found to bind the murine CD4 receptor, DC-SIGN, and the OspC protein of Borrelia burgdorferi. In the current study, we characterized the full salp15 gene in Ixodes pacificus Cooley & Kohls and Ixodes persulcatus Schulze, the principal vectors of Lyme disease spirochetes in western North America and Asia, respectively. In comparing the Salp15 protein of all four principal vector ticks of public health importance for the transmission of Lyme disease spirochetes, we find the 53 C-terminal amino acids to have a high degree of similarity. There are at least three clades in the tree of Salp15 and its homologues, probably representing a multigene family. |
Authentication scheme for routine verification of genetically similar laboratory colonies: a trial with Anopheles gambiae
Wilkins EE , Marcet PL , Sutcliffe AC , Howell PI . BMC Biotechnol 2009 9 91 BACKGROUND: When rearing morphologically indistinguishable laboratory strains concurrently, the threat of unintentional genetic contamination is constant. Avoidance of accidental mixing of strains is difficult due to the use of common equipment, technician error, or the possibility of self relocation by adult mosquitoes ("free fliers"). In many cases, laboratory strains are difficult to distinguish because of morphological and genetic similarity, especially when laboratory colonies are isolates of certain traits from the same parental strain, such as eye color mutants, individuals with certain chromosomal arrangements or high levels of insecticide resistance. Thus, proving genetic integrity could seem incredibly time-consuming or impossible. On the other hand, lacking proof of genetically isolated laboratory strains could question the validity of research results. RESULTS: We present a method for establishing authentication matrices to routinely distinguish and confirm that laboratory strains have not become physically or genetically mixed through contamination events in the laboratory. We show a specific example with application to Anopheles gambiae sensu stricto strains at the Malaria Research and Reference Reagent Resource Center. This authentication matrix is essentially a series of tests yielding a strain-specific combination of results. CONCLUSION: These matrix-based methodologies are useful for several mosquito and insect populations but must be specifically tailored and altered for each laboratory based on the potential contaminants available at any given time. The desired resulting authentication plan would utilize the least amount of routine effort possible while ensuring the integrity of the strains. |
Detection of Bartonella spp. in wild rodents in Israel using HRM real-time PCR
Morick D , Baneth G , Avidor B , Kosoy MY , Mumcuoglu KY , Mintz D , Eyal O , Goethe R , Mietze A , Shpigel N , Harrus S . Vet Microbiol 2009 139 293-7 The prevalence of Bartonella spp. in wild rodents was studied in 19 geographical locations in Israel. One hundred and twelve rodents belonging to five species (Mus musculus, Rattus rattus, Microtus socialis, Acomys cahirinus and Apodemus sylvaticus) were included in the survey. In addition, 156 ectoparasites were collected from the rodents. Spleen sample from each rodent and the ectoparasites were examined for the presence of Bartonella DNA using high resolution melt (HRM) real-time PCR. The method was designed for the simultaneous detection and differentiation of eight Bartonella spp. according to the nucleotide variation in each of two gene fragments (rpoB and gltA) and the 16S-23S intergenic spacer (ITS) locus, using the same PCR protocol which allowed the simultaneous amplification of the three different loci. Bartonella DNA was detected in spleen samples of 19 out of 79 (24%) black rats (R. rattus) and in 1 of 4 (25%) Cairo spiny mice (A. cahirinus). In addition, 15 of 34 (44%) flea pools harbored Bartonella DNA. Only rat flea (Xenopsyla cheopis) pools collected from black rats (R. rattus) were positive for Bartonella DNA. The Bartonella sp. detected in spleen samples from black rats (R. rattus) was closely related to both B. tribocorum and B. elizabethae. The species detected in the Cairo spiny mouse (A. cahirinus) spleen sample was closely related to the zoonotic pathogen, B. elizabethae. These results indicate that Bartonella species are highly prevalent in suburban rodent populations and their ectoparasites in Israel. Further investigation of the prevalence and zoonotic potential of the Bartonella species detected in the black rats and the Cairo spiny mouse is warranted. |
Evaluation of IgM antibody capture enzyme-linked immunosorbent assay kits for detection of IgM against Japanese encephalitis virus in cerebrospinal fluid samples
Ravi V , Robinson JS , Russell BJ , Desai A , Ramamurty N , Featherstone D , Johnson BW . Am J Trop Med Hyg 2009 81 (6) 1144-50 Infection with Japanese encephalitis virus (JEV) is a major public health problem in Asia. Detection of JEV-specific IgM in serum and cerebrospinal fluid (CSF) by the IgM antibody capture enzyme-linked immunosorbent assay (MAC-ELISA) is currently the most widely used diagnostic method to detect JEV infection. Because of the possible presence of IgM cross-reactivity with other flaviviruses in serum and the high ratio of inapparent-to-apparent JEV infections, a positive result in serum only suggests a recent infection and not necessarily an encephalitic illness caused by JEV. Consequently, detection of JEV-specific IgM in CSF assumes great diagnostic relevance. We evaluated two commercial JEV MAC-ELISA kits using 60 CSF samples obtained from patients with acute encephalitis syndrome. The Panbio and XCyton kits had sensitivities of 65-80% and 95% and specificities of 90% and 97.5%, respectively. Performance information on these commercial JEV MAC-ELISA kits for CSF should assist in laboratory-based JE surveillance programs. |
Immunogenetic risk and protective factors for the development of L-tryptophan-associated eosinophilia-myalgia syndrome and associated symptoms
Okada S , Kamb ML , Pandey JP , Philen RM , Love LA , Miller FW . Arthritis Rheum 2009 61 (10) 1305-11 OBJECTIVE: To assess L-tryptophan (LT) dose, age, sex, and immunogenetic markers as possible risk or protective factors for the development of LT-associated eosinophilia-myalgia syndrome (EMS) and related clinical findings. METHODS: HLA-DRB1 and DQA1 allele typing and Gm/Km phenotyping were performed on a cohort of 94 white subjects with documented LT ingestion and standardized evaluations. Multivariate analyses compared LT dose, age, sex, and alleles among groups of subjects who ingested LT and subsequently developed surveillance criteria for EMS, developed EMS or characteristic features of EMS (EMS spectrum disorder), or developed no features of EMS (unaffected). RESULTS: Considering all sources of LT, higher LT dose (odds ratio [OR] 1.4, 95% confidence interval [95% CI] 1.1-1.8), age >45 years (OR 3.0, 95% CI 1.0-8.8), and HLA-DRB1*03 (OR 3.9, 95% CI 1.2-15.2), DRB1*04 (OR 3.9, 95% CI 1.1-16.4), and DQA1*0601 (OR 13.7, 95% CI 1.3-1.8) were risk factors for the development of EMS, whereas DRB1*07 (OR 0.12, 95% CI 0.02-0.48) and DQA1*0501 (OR 0.23, 95% CI 0.05-0.85) were protective. Similar risk and protective factors were seen for developing EMS following ingestion of implicated LT, except that DRB1*03 was not a risk factor and DQA1*0201 was an additional protective factor. EMS spectrum disorder also showed similar findings, but with DRB1*04 being a risk factor and DRB1*07 and DQA1*0201 being protective. There were no differences in sex distribution, Gm/Km allotypes, or Gm/Km phenotypes among any groups. CONCLUSION: In addition to the xenobiotic dose and subject age, polymorphisms in immune response genes may underlie the development of certain xenobiotic-induced immune-mediated disorders, and these findings may have implications for future related epidemics. |
In vitro antiviral activity of V-073 against polioviruses
Oberste MS , Moore D , Anderson B , Pallansch MA , Pevear DC , Collett MS . Antimicrob Agents Chemother 2009 53 (10) 4501-3 V-073, an enterovirus capsid inhibitor, was evaluated for its spectrum of antipoliovirus activity. V-073 inhibited all 45 polioviruses tested in a virus-induced cytopathic effect protection assay, with 50% effective concentration (EC50) values ranging from 0.003 to 0.126 microM. Ninety percent of the polioviruses tested were inhibited at EC(50)s of < or = 0.076 microM (MIC90 = 32 ng/ml). V-073 is a promising antiviral candidate for the posteradication management of poliovirus incidents. |
Prenatal radiation exposure: background material for counseling pregnant patients following exposure to radiation
Donnelly EH , Smith JM , Farfan EB , Ozcan I . Disaster Med Public Health Prep 2009 5 (1) 62-8 Fetal sensitivity to radiation-induced health effects is related to gestational age, and it is highly dependent on fetal dose. Typical fetal doses from diagnostic radiology are usually below any level of concern. Although rare, significant fetal radiation doses can result from interventional medical exposures (fluoroscopically guided techniques), radiation therapy, or radiological or nuclear incidents, including terrorism. The potential health effects from these large radiation doses (possibly large enough to result in acute radiation syndrome in the expectant mother) include growth retardation, malformations, impaired brain function, and neoplasia. If exposure occurs during blastogenesis (and the embryo survives), there is a low risk for congenital abnormalities. (In all stages of gestation, radiation-induced noncancer health effects have not been reported for fetal doses below about 0.05 Gy [5 rad].) The additional risk for childhood cancer from prenatal radiation exposure is about 12% per Gy (0.12%/rad) above the background incidence. |
Nutrient content of carob pod (Ceratonia siliqua L.) flour prepared commercially and domestically
Ayaz FA , Torun H , Glew RH , Bak ZD , Chuang LT , Presley JM , Andrews R . Plant Foods Hum Nutr 2009 64 (4) 286-292 Although the fruit of the carob tree (Ceratonia siliqua L. Fabaceae) is nutritious and widely available in Turkey, especially in West and South Anatolia, much remains to be learned about its nutrient composition. The main goal of our study was to determine if there are differences in the content of certain nutrients in commercially-prepared carob flour (CPCP) and domestic or home-prepared carob powder (HPCP). Sucrose was the main sugar in CPCP and HPCP. Total protein was 40% lower in CPCP than HPCP due mainly to decreases in the content of several essential amino acids. However, except for lysine in CPCP, HPCP and CPCP compared favourably to a WHO protein standard. There were large differences in terms of their content of the two essential fatty acids, linoleic and alpha-linolenic acid, and the linoleic acid/alpha-linolenic acid ratio was 3.6 for CPCP, and 6.1 for HPCP. Manganese and iron were 2.5-fold higher in HPCP than CPCP. This study demonstrates that carob flour prepared in either the household or industrially is a good source of many, but not all essential nutrients, and that commercial processing of carob fruit into flour seems to affect its content of several important nutrients. |
Endotoxin exposure and inflammation markers among agricultural workers in Colorado and Nebraska
Burch JB , Svendsen E , Siegel PD , Wagner SE , von Essen S , Keefe T , Mehaffy J , Martinez AS , Bradford M , Baker L , Cranmer B , Saito R , Tessari J , Linda P , Andersen C , Christensen O , Koehncke N , Reynolds SJ . J Toxicol Environ Health A 2010 73 (1) 5-22 The adverse respiratory effects of agricultural dust inhalation are mediated in part by endotoxin, a constituent of gram-negative bacterial cell walls. This study quantified personal work-shift exposures to inhalable dust, endotoxin, and its reactive 3-hydroxy fatty acid (3-OHFA) constituents among workers in grain elevators, cattle feedlots, dairies, and on corn farms. Exposures were compared with post-work-shift nasal lavage fluid inflammation markers and respiratory symptoms. Breathing-zone personal air monitoring was performed over one work shift to quantify inhalable dust (Institute of Medicine samplers), endotoxin (recombinant factor C [rFC] assay), and 3-OHFA (gas chromatography/mass spectrometry). Post-shift nasal lavage fluids were assayed for polymorphonuclear neutrophils (PMN), myeloperoxidase (MPO), interleukin 8 (IL-8), albumin, and eosinophilic cation protein (ECP) concentrations. The geometric mean (GSD) of endotoxin exposure (rFC assay) among the 125 male participants was 888 +/- (6.5) EU/m(3), and 93% exceeded the proposed exposure limit (50 EU/m(3)). Mean PMN, MPO, albumin, and ECP levels were two- to threefold higher among workers in the upper quartile of 3-OHFA exposure compared to the lowest exposure quartile. Even numbered 3-OHFA were most strongly associated with nasal inflammation. Symptom prevalence was not elevated among exposed workers, possibly due to endotoxin tolerance or a healthy worker effect in this population. This is the first study to evaluate the relationship between endotoxin's 3-OHFA constituents in agricultural dust and nasal airway inflammation. More research is needed to characterize the extent to which these agents contribute to respiratory disease among agricultural workers. |
Machine safety: developing an operator presence system
Powers Jr JR , Ammons DE , Brand I . Prof Saf 2009 54 (11) 28-31 Most hydraulic stump cutters do not have an operator presence system, which could help prevent injuries that can occur when an operator approaches the cutter wheel with the clutch still engaged. NIOSH and Vermeer Corp. partnered to develop a technology to detect the operator at the machine's controls. The development of this safety system provides an example of how a research to practice partnership can benefit all. |
Prevention through design in health care settings
Heidel DS , Collins JW , Stewart EJ . Synergist (Akron) 2009 20 (10) 27-31 Health care is the second-fastest-growing sector of the U.S. economy, employing more than 12 million workers. Health-care workers are exposed to infectious agents; chemical agents, including hazardous drugs and anesthetic gases; physical agents, including ionizing radiation; ergonomic hazards associated with lifting and repetitive tasks; and workplace violence. Health-care workers also experience higher rates of occupational injuries and illnesses than workers in all private industry. Recordable and lost-time injury rates for health-care workers in hospitals and nursing and residential care are particularly high. A number of initiatives provide compelling evidence that the health care and social assistance sector presents significant opportunities for injury and illness reduction from PtD (Prevention Through Design). |
Recombinant factor C (rFC) assay and gas chromatography/mass spectrometry (GC/MS) analysis of endotoxin variability in four agricultural dusts
Saito R , Cranmer BK , Tessari JD , Larsson L , Mehaffy JM , Keefe TJ , Reynolds SJ . Ann Occup Hyg 2009 53 (7) 713-22 Endotoxin exposure is a significant concern in agricultural environments due to relatively high exposure levels. The goals of this study were to determine patterns of 3-hydroxy fatty acid (3-OHFA) distribution in dusts from four types of agricultural environments (dairy, cattle feedlot, grain elevator, and corn farm) and to evaluate correlations between the results of gas chromatography/mass spectrometry (GC/MS) analysis (total endotoxin) and biological recombinant factor C (rFC) assay (free bioactive endotoxin). An existing GC/MS-MS method (for house dust) was modified to reduce sample handling and optimized for small amount (<1 mg) of agricultural dusts using GC/EI-MS. A total of 134 breathing zone samples using Institute of Occupational Medicine (IOM) inhalable samplers were collected from agricultural workers in Colorado and Nebraska. Livestock dusts contained approximately two times higher concentrations of 3-OHFAs than grain dusts. Patterns of 3-OHFA distribution and proportion of each individual 3-OHFA varied by dust type. The rank order of Pearson correlations between the biological rFC assay and the modified GC/EI-MS results was feedlot (0.72) > dairy (0.53) > corn farm (0.33) > grain elevator (0.11). In livestock environments, both odd- and even-numbered carbon chain length 3-OHFAs correlated with rFC assay response. The GC/EI-MS method should be especially useful for identification of specific 3-OHFAs for endotoxins from various agricultural environments and may provide useful information for evaluating the relationship between bacterial exposure and respiratory disease among agricultural workers. |
Youth living on Hispanic-operated farms: injuries and population estimates in the U.S., 2000
Layne LA , Goldcamp EM , Myers JR , Hendricks KJ . J Agric Saf Health 2009 15 (4) 377-88 A dearth of information exists in public health surveillance on the injury burden among Hispanic farm youth in the U.S. In this study, data were collected via a telephone survey with Hispanic farm operators sampled from the 1991 Census of Agriculture active list of farms. There were an estimated 307 nonfatal injuries among an estimated 21,631 youth less than 20 years old living on Hispanic-operated farms in the U.S., 2000. Males accounted for 73% of the injuries and had an injury rate of 20.2 compared to 8.2 per 1,000 for females. Injury rates were higher for work-related incidents than for nonwork, and this relationship was true for both males and females. Work and nonwork injury rates were also similar for youth < 10 and 10-15 years old, but for youth 16-19 years of age, the risk of injury for work-related incidents was higher than for nonwork. Livestock operations had a larger number of injuries and higher injury rates compared to crop operations. These data provide previously unavailable descriptive statistics for both the nonfatal injury burden and population estimate for youth on Hispanic-operated farms. |
Environmental and biological assessment of environmental tobacco smoke exposure among casino dealers
Achutan C , West C , Mueller CA , Boudreau AY , Mead KR . Int J Occup Environ Health 2009 15 (4) 417 Between January and April 2005, NIOSH received confidential | requests for HHEs from NP casino dealers at Bally’s, Paris, and | Caesars Palace casinos in Las Vegas, Nevada. These casino dealers | were concerned that exposure to ETS in their workplace was | causing a variety of acute and long-term health effects. | In response to these requests, NIOSH investigators conducted | three onsite evaluations at Bally’s, Paris, and Caesars Palace | casinos. The first onsite evaluation was conducted July 22–24, | 2005, during which we interviewed employees, reviewed OSHA | Forms 200 and 300 (Log of Work Related Injuries and Illnesses), | and administered a screening questionnaire. The screening | questionnaire was used to select potential participants to take | a subsequent health symptom questionnaire and undergo | environmental and biological monitoring. During the second | site visit, from August 21–24, 2005, additional screening | questionnaires were distributed to NP casino dealers. A health | symptom questionnaire was mailed January 6, 2006, and we | conducted biological and environmental monitoring on our final | site visit from January 19–22, 2006 |
Walking and body mass index in a Portuguese sample of adults: a multilevel analysis
Santos R , Pratt M , Ribeiro JC , Santos MP , Carvalho J , Mota J . Eur J Clin Nutr 2009 63 (10) 1260-2 Physical inactivity is an important risk factor for many chronic diseases. The purpose of this study was to investigate the cross-sectional associations between walking and body mass index (BMI). This study comprised 9991 adults (5723 women), aged 37.8+/-9.5 years, from the 2004 Azorean Physical Activity and Health Study. Walking was assessed with the International Physical Activity Questionnaire, and expressed as minutes per week. BMI was calculated from self-reported weight and height. A series of multilevel linear regression models were fitted to assess regression coefficients and s.e. predicting BMI. Results show that, in both genders, and after adjustments for potential confounders, walking was not a significant predictor of BMI. Therefore, our analysis does not extend the findings of earlier studies as it shows no significant associations between walking and BMI, after adjustments for potential confounders. Nevertheless, among Azoreans walking should be encouraged, as walking has other health benefits, beyond controlling obesity. |
Undiagnosed cases of fatal clostridium-associated toxic shock in Californian women of childbearing age
Ho CS , Bhatnagar J , Cohen AL , Hacker JK , Zane SB , Reagan S , Fischer M , Shieh WJ , Guarner J , Ahmad S , Zaki SR , McDonald LC . Am J Obstet Gynecol 2009 201 (5) 459 e1-7 OBJECTIVE: In 2005, 4 Clostridium sordellii-associated toxic shock fatalities were reported in young Californian women after medical abortions. The true incidence of this rare disease is unknown, and a population-based study has never been performed. Additional clostridia-associated deaths were sought to describe associated clinical characteristics. STUDY DESIGN: Population-based death certificate review and a clinical case definition for clostridial-associated toxic shock identified women with likelihood of dying from a Clostridium infection. Formalin-fixed autopsy tissues underwent immunohistochemical and polymerase chain reaction assays. RESULTS: Thirty-eight women were suspected of having C sordellii-associated death. Five tested positive for Clostridium species: 3 for Clostridium perfringens, 1 for C sordellii, and 1 for both. Deaths occurred after the medical procedures for cervical dysplasia (n = 2), surgical abortion (n = 1), stillborn delivery (n = 1), and term live birth (n = 1). None had a medical abortion. CONCLUSION: C sordellii and C perfringens are associated with undiagnosed catastrophic infectious gynecologic illnesses among women of childbearing age. |
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