Patching a leaky pipe: the cascade of HIV care
Kilmarx PH , Mutasa-Apollo T . Curr Opin HIV AIDS 2013 8 (1) 59-64 PURPOSE OF REVIEW: We reviewed recent literature on the cascade of HIV care from HIV testing to suppression of viral load, which has emerged as a critical focus as HIV treatment programs have scaled up. RECENT FINDINGS: In low- and middle-income countries, HIV testing and diagnosis of people living with HIV (PLHIV), although rapidly expanding, are generally relatively low. Linkage and retention in care are global challenges, with substantial attrition between diagnosis, laboratory or clinical staging, and antiretroviral therapy (ART) initiation, and additional substantial attrition on ART due to loss to follow-up and death. ART coverage is rapidly expanding but is still relatively low, especially when considered as a percentage of all PLHIV. Adherence is also suboptimal and virological suppression is incomplete. SUMMARY: Taken together, the attrition at each step of the cascade of care results in overall low levels of viral load suppression in the total population of PLHIV. More robust monitoring from the facility to global levels and implementation of established and emerging interventions are needed at each step of the cascade to enhance HIV diagnosis, linkage to and retention in care, ART use, and adherence, and ultimately reduce viral load, improve clinical outcomes, and reduce HIV transmission. |
Virulence and clinical outcomes in Clostridium difficile infection: a complex business
McDonald LC . Clin Infect Dis 2012 56 (6) 906-7 The epidemiology of Clostridium difficile infection (CDI) and role of particular strain types in clinical outcome is complex. Walk et al conclude that the polymerase chain reaction (PCR) ribotypes 027 and 078 are not independent predictors of severe outcome when adjusted by the patient's leukocyte count and albumin level [1]. Although the albumin level more clearly reflects underlying host status, a leukocyte count measured within 72 hours of CDI diagnosis reflects both underlying host status and any strain-specific host response to infection that may exist. Adjustment for an intermediate such as leukocytosis does not necessarily estimate a direct effect, in this case between strain type and outcome; unmeasured confounders in the relationship between leukocytosis and outcome may lead to the direct effect between strain type and outcome being obscured [2]. An important potential confounder in the relationship between leukocytosis (and therefore strain type) and outcome that was not included in the study by Walk et al is the treatment that patients received. Given recent guidelines [3], it is likely treatment decisions were influenced by the finding of leukocytosis; more intensive treatment would hopefully attenuate the association between leukocytosis and outcome and thereby obscure any direct effect of strain type on outcome. Contrary to both the discussion by Walk et al and the accompanying editorial by Barbut and Rupnik [4], there is compelling, albeit inconsistent, epidemiologic evidence for 027 being more virulent than many other strains, at least from a public health, if not clinical, standpoint. The emergence of 027 as a cause of epidemic and endemic CDI has been temporally associated in multiple regions with apparent increases in disease burden and severity [5, 6]; declines in these outcomes have also been temporally associated with decline in the prevalence of 027 [7]. In a large national survey adjusted by age but not by treatment or other host factors, more severe outcomes were associated with 027 [8]. Compared with other strains, PCR ribotype 027 has a higher infection-to-colonization ratio [9], and, most recently, this strain has been associated with a poorer response to therapy and higher recurrence rate—an effect observed across treatment types and despite lack of demonstrable resistance in vitro [10]. Nonetheless, no association between 027 and more severe clinical outcome has been identified in the several studies highlighted by both Walk et al [1] and Barbut and Rupnik [4]. Some of this inconsistency may reflect small sample sizes and the multiple confounders present; however, as pointed out by Barbut and Rupnik, additional consideration should be given to interactions between strain type and environmental factors, including predisposing antibiotic and other medication use (eg, proton pump inhibitor). Where we can currently most agree is that 027 and 078 strain status does not add to host leukocyte count and serum albumin level in predicting clinical outcomes among patients treated for CDI in the study hospital. Further studies that control for the therapy received will be necessary to extend this conclusion to other patient populations. |
HIV/AIDS and associated conditions among HIV-infected refugees in Minnesota, 2000-2007
Lowther SA , Johnson G , Hendel-Paterson B , Nelson K , Mamo B , Krohn K , Pessoa-Brandao L , O'Fallon A , Stauffer W . Int J Environ Res Public Health 2012 9 (11) 4197-209 In 2010, the requirement for human immunodeficiency virus (HIV) testing of adult refugees prior to US resettlement was removed, thus leading to a potential for missed diagnosis. We reviewed refugee health assessment data and medical charts to evaluate the health status of HIV-infected refugees who arrived in Minnesota during 2000-2007, prior to this 2010 policy change. Among 19,292 resettled adults, 174 were HIV-infected; 169 (97%) were African (median age 26.4 (range: 17-76) years). Charts were abstracted for 157 (124 (79%) with ≥1 year of follow-up). At initial presentation, two of 74 (3%) women were pregnant; 27% became pregnant during follow-up. HIV clinical stage varied (59%, asymptomatic; 11%, mild symptoms; 10%, advanced symptoms; 3%, severe symptoms; 17%, unknown); coinfections were common (51 tuberculosis, 13 hepatitis B, 13 parasites, four syphilis). Prior to arrival 4% had received antiretrovirals. Opportunistic infections were diagnosed among 13%; 2% died from AIDS-related causes. Arrival screening may be needed to identify these HIV-infected refugees and prevent HIV-related morbidity and mortality. |
Incidence of influenza-associated mortality and hospitalizations in Argentina during 2002-2009
Azziz-Baumgartner E , Cabrera AM , Cheng PY , Garcia E , Kusznierz G , Calli R , Baez C , Buyayisqui MP , Poyard E , Perez E , Basurto-Davila R , Palekar R , Oliva O , Alencar AP , de Souza R , Dos Santos T , Shay DK , Widdowson MA , Breese J , Echenique H . Influenza Other Respir Viruses 2012 7 (5) 710-7 BACKGROUND: We estimated rates of influenza-associated deaths and hospitalizations in Argentina, a country that recommends annual influenza vaccination for persons at high risk of complications from influenza illness. METHODS: We identified hospitalized persons and deaths in persons diagnosed with pneumonia and influenza (P&I, ICD-10 codes J10-J18) and respiratory and circulatory illness (R&C, codes I00-I99 and J00-J99). We defined the influenza season as the months when the proportion of samples that tested positive for influenza exceeded the annual median. We used hospitalizations and deaths during the influenza off-season to estimate, using linear regression, the number of excess deaths that occurred during the influenza season. To explore whether excess mortality varied by sex and whether people were age <65 or ≥65 years, we used Poisson regression of the influenza-associated rates. RESULTS: During 2002-2009, 2411 P&I and 8527 R&C mean excess deaths occurred annually from May to October. If all of these excess deaths were associated with influenza, the influenza-associated mortality rate was 6/100 000 person-years (95% CI 4-8/100,000 person-years for P&I and 21/100,000 person-years (95% CI 12-31/100,000 person-years) for R&C. During 2005-2008, we identified an average of 7868 P&I excess hospitalizations and 22,994 R&C hospitalizations per year, resulting in an influenza-associated hospitalization rate of 2/10,000 person-years (95% CI 1-3/10,000 person-years) for P&I and 6/10,000 person-years (95% CI 3-8/10 000 person-years) for R&C. CONCLUSION: Our findings suggest that annual rates of influenza-associated hospitalizations and death in Argentina were substantial and similar to neighboring Brazil. |
Invasive Haemophilus influenzae in the United States, 1999-2008: epidemiology and outcomes
Livorsi DJ , MacNeil JR , Cohn AC , Bareta J , Zansky S , Petit S , Gershman K , Harrison LH , Lynfield R , Reingold A , Schaffner W , Thomas A , Farley MM . J Infect 2012 65 (6) 496-504 OBJECTIVES: Introduction of the Haemophilus influenzae type b (Hib) conjugate vaccine has resulted in a dramatic reduction of Hib disease in the U.S. and an increase in the relative importance of infections caused by nontypeable strains. The current project describes the characteristics and clinical outcomes of pediatric and adult patients with invasive H. influenzae (HI) and, through multivariable analysis, identifies risk factors for in-hospital mortality. METHODS: HI cases were identified during 1999-2008 through active surveillance as part of Active Bacterial Core surveillance (ABCs). Multivariable analysis was performed with logistic regression to identify factors predictive of in-hospital death. RESULTS: 4839 cases of HI were identified from 1999-2008. Children accounted for 17.1% of cases and adults 82.9%. Underlying conditions were present in 20.7% of children and 74.8% of adults. In-hospital mortality was highest in cases ≥65 years (21.9%) and <3 months (16.2%). The risk of in-hospital death in children <1 year was higher among those who were prematurely-born (<28 weeks, OR 7.1, 95% CI 3.2-15.6; 28-36 weeks OR 2.1, 95% CI 0.9-4.8) and, among children aged 1-17 years, higher in those with healthcare-associated onset and dialysis (OR 5.66, 95% CI 1.84-17.39; OR 18.11, 95% CI 2.77-118.65). In adults, age ≥40 was associated with death in nontypeable, but not encapsulated, infections. Infections with nontypeable strains increased the risk of death in cases ≥65 years (OR 1.81, 95% CI 1.31-2.52). Healthcare-associated HI, bacteremia without identifiable focus, bacteremic pneumonia, associated cirrhosis, cerebrovascular accident, dialysis, heart failure, and non-hematologic malignancy also increased the risk of death in adults. CONCLUSION: Prematurity in infants, advanced age and certain chronic diseases in adults were associated with an increased risk of in-hospital death. Nontypeable HI was associated with higher mortality in the elderly. |
Bronchiolitis outbreak caused by respiratory syncytial virus in southwest Bangladesh, 2010
Haque F , Husain MM , Ameen KM , Rahima R , Hossain MJ , Alamgir AS , Rahman M , Rahman M , Luby SP . Int J Infect Dis 2012 16 (12) e866-71 BACKGROUND: During July 2010, newspapers reported a respiratory disease outbreak in southwestern Bangladesh resulting in the admission of children to a secondary care hospital. We investigated this outbreak to determine the etiology and explore possible risk factors. METHODS: The hospital's physician diagnosed children aged <2 years with cough, tachypnea or dyspnea, and expiratory wheeze as having acute bronchiolitis. We reviewed the hospital records and listed case patients admitted between 26 June and 26 July 2010. We surveyed the case patients and collected nasal and throat swabs to test for respiratory viruses. RESULTS: We identified 101 admitted acute bronchiolitis case patients. Fifty-nine (58%) of these were admitted between 16 and 20 July. Among the 29 case patients surveyed, the median age was 4 months and 65% were males. We identified respiratory syncytial virus (RSV) in 91% (21/23) of the samples, 43% of which had a dual viral infection. Most case patients (90%) were treated with broad-spectrum antibiotics. There were no reported deaths. CONCLUSIONS: The sudden increase in admitted acute bronchiolitis case patients, their median age, and identification of RSV in the majority of samples suggest an outbreak of RSV bronchiolitis. Research to identify strategies to prevent respiratory infections including RSV in low-income settings should be prioritized. Factors that perpetuate antibiotic use in managing this viral syndrome should also be explored. |
Cryptococcal antigen screening and preemptive therapy in patients initiating antiretroviral therapy in resource-limited settings: a proposed algorithm for clinical implementation
Jarvis JN , Govender N , Chiller T , Park BJ , Longley N , Meintjes G , Bekker LG , Wood R , Lawn SD , Harrison TS . J Int Assoc Physicians AIDS Care (Chic) 2012 11 (6) 374-9 HIV-associated cryptococcal meningitis (CM) is estimated to cause over half a million deaths annually in Africa. Many of these deaths are preventable. Screening patients for subclinical cryptococcal infection at the time of entry into antiretroviral therapy programs using cryptococcal antigen (CRAG) immunoassays is highly effective in identifying patients at risk of developing CM, allowing these patients to then be targeted with "preemptive" therapy to prevent the development of severe disease. Such CRAG screening programs are currently being implemented in a number of countries; however, a strong evidence base and clear guidance on how to manage patients with subclinical cryptococcal infection identified by screening are lacking. We review the available evidence and propose a treatment algorithm for the management of patients with asymptomatic cryptococcal antigenemia. |
Host selection of potential West Nile virus vectors in Puerto Barrios, Guatemala, 2007
Kading RC , Reiche AS , Morales-Betoulle ME , Komar N . Am J Trop Med Hyg 2012 88 (1) 108-15 The selection of vertebrate hosts by Culex mosquitoes relative to West Nile virus (WNV) transmission in neotropical countries such as Guatemala is not described. This study determined the feeding patterns of Cx. quinquefasciatus and Cx. nigripalpus and estimated the relative contribution of two common and frequently infected wild bird species, Turdus grayi and Quiscalus mexicanus, to WNV transmission. Engorged mosquitoes were collected from rural and urban habitats after the dry and wet seasons in the Department of Izabal in 2007. Host selection by Cx. nigripalpus varied significantly between urban and rural habitats. Both Cx. quinquefasciatus and Cx. nigripalpus fed predominantly on chickens and other domestic animals. Blood meals from wild birds were rare, accounting for 1.1% of blood meals identified from Cx. quinquefasciatus and 6.5% of blood meals from Cx. nigripalpus. Transmission of WNV by these two mosquito species may be dampened by extensive feeding on reservoir-incompetent hosts. |
Blood meal identification in off-host cat fleas (Ctenocephalides felis) from a plague-endemic region of Uganda
Graham CB , Borchert JN , Black WC4th , Atiku LA , Mpanga JT , Boegler KA , Moore SM , Gage KL , Eisen RJ . Am J Trop Med Hyg 2012 88 (2) 381-9 The cat flea, Ctenocephalides felis, is an inefficient vector of the plague bacterium (Yersinia pestis) and is the predominant off-host flea species in human habitations in the West Nile region, an established plague focus in northwest Uganda. To determine if C. felis might serve as a Y. pestis bridging vector in the West Nile region, we collected on- and off-host fleas from human habitations and used a real-time polymerase chain reaction-based assay to estimate the proportion of off-host C. felis that had fed on humans and the proportion that had fed on potentially infectious rodents or shrews. Our findings indicate that cat fleas in human habitations in the West Nile region feed primarily on domesticated species. We conclude that C. felis is unlikely to serve as a Y. pestis bridging vector in this region. |
Clarification about hazardous drugs
Connor TH , Mackenzie BA , Debord DG . Am J Health Syst Pharm 2012 69 (22) 1949-50 We read with interest the article by Traynor1 that appeared in the September 1 issue of AJHP and would like to clarify a potential misconception—that the National Institute for Occupational Safety and Health (NIOSH) recommends all hazardous drugs be handled in the same manner, regardless of dosage form. The 2004 NIOSH alert on this topic recommends a “universal” or “standard” precautions approach to safe handling but does not recommend that all formulations be handled in the same manner.2 | The NIOSH alert reflects an understanding that many factors affect the determination of handling procedures for hazardous drugs. The purpose of the list of hazardous drugs provided in the alert, updated in 2010 and 2012, is to identify hazardous drugs and assist health care facilities in developing their own risk management procedures based on the drugs and formulations used in their facility. The most recent update to the hazardous-drugs list states the following3: | Some drugs defined as hazardous may not pose a significant risk of direct occupational exposure because of their dosage formulation (for example, coated tablets or capsules—solid, intact medications that are administered to patients without modifying the formulation). Uncoated tablets may present a risk of exposure from dust by skin contact and/or inhalation when the tablets are counted and if solid drug formulations are altered, such as by crushing tablets or making solutions from them. |
Outbreak of cryptosporidiosis associated with a man-made chlorinated lake--Tarrant County, Texas, 2008
Cantey PT , Kurian AK , Jefferson D , Moerbe MM , Marshall K , Blankenship WR , Rothbarth GR , Hwang J , Hall R , Yoder J , Brunkard J , Johnston S , Xiao L , Hill VR , Sarisky J , Zarate-Bermudez MA , Otto C , Hlavsa MC . J Environ Health 2012 75 (4) 14-19 In July 2008, clusters of laboratory-confirmed cryptosporidiosis cases and reports of gastrointestinal illness in persons who visited a lake were reported to Tarrant County Public Health. In response, epidemiologic, laboratory, and environmental health investigations were initiated. A matched case-control study determined that swallowing the lake water was associated with illness (adjusted odds ratio = 16.3; 95% confidence interval: 2.5-infinity). The environmental health investigation narrowed down the potential sources of contamination. Laboratory testing detected Cryptosporidium hominis in case-patient stool specimens and Cryptosporidium species in lake water. It was only through the joint effort that epidemiologic, laboratory, and environmental health investigators could determine that >1 human diarrheal fecal incidents in the lake likely led to contamination of the water. This same collaborative effort will be needed to develop and maintain an effective national Model Aquatic Health Code. |
Cumulative Risk Assessment (CRA): transforming the way we assess health risks
Williams PR , Dotson GS , Maier A . Environ Sci Technol 2012 46 (20) 10868-74 Human health risk assessments continue to evolve and now focus on the need for cumulative risk assessment (CRA). CRA involves assessing the combined risk from coexposure to multiple chemical and nonchemical stressors for varying health effects. CRAs are broader in scope than traditional chemical risk assessments because they allow for a more comprehensive evaluation of the interaction between different stressors and their combined impact on human health. Future directions of CRA include greater emphasis on local-level community-based assessments; integrating environmental, occupational, community, and individual risk factors; and identifying and implementing common frameworks and risk metrics for incorporating multiple stressors. |
Respondent driven sampling--where we are and where should we be going?
White RG , Lansky A , Goel S , Wilson D , Hladik W , Hakim A , Frost SD . Sex Transm Infect 2012 88 (6) 397-9 Respondent Driven Sampling (RDS) is a novel variant of link tracing sampling that has primarily been used to estimate the characteristics of hard-to-reach groups, such as the HIV prevalence of drug users.1 ‘Seeds’ are selected by convenience from a population of interest (target population) and given coupons. Seeds then use these coupons to recruit other people, who themselves become recruiters. Recruits are given compensation, usually money, for taking part in the survey and also an incentive for recruiting others. This process continues in recruitment ‘waves’ until the survey is stopped. Estimation methods are then applied to account for the biased recruitment, for example, the presumed over-recruitment of people with more acquaintances, in an attempt to generate estimates for the underlying population. RDS has quickly become popular and relied on by major public health organisations, including the US Centers for Disease Control and Prevention and Family Health International, chiefly because it is often found to be an efficient method of recruitment in hard-to-reach groups, but also because of the availability of custom written software incorporating inference methods that are designed to generate estimates that are representative of the wider population of interest, despite the biased sampling. | As demonstrated by RDS's popularity,1 there was a clear need for new methods of data collection on hard-to-reach groups. However, RDS has not been without its critics. Its reliance on the target population for recruitment introduced ethicalw1 and sampling concerns.w2 If RDS estimates are overly biased or the variance is unacceptably high, then RDS will be little more than another method of convenience sampling. If these errors can be minimised however, then RDS has the potential to become a very useful survey methodology. |
Success of program linking data sources to monitor H1N1 vaccine safety points to potential for even broader safety surveillance
Salmon D , Yih WK , Lee G , Rosofsky R , Brown J , Vannice K , Tokars J , Roddy J , Ball R , Gellin B , Lurie N , Koh H , Platt R , Lieu T . Health Aff (Millwood) 2012 31 (11) 2518-2527 In response to the 2009 H1N1 pandemic and subsequent vaccination program, the Department of Health and Human Services and collaborators developed the Post-Licensure Rapid Immunization Safety Monitoring (PRISM) Program as a demonstration project to detect rare adverse events rapidly. The program monitored three million people who had received the H1N1 vaccine by linking data from large private health plans and from public immunization registries that had originally not been designed to share data, and on a larger scale than had been previously attempted. The program generated safety data in two weeks rather than three to six months-the standard time frame achievable using health plan data. PRISM substantially contributed to the understanding of the safety of H1N1 vaccines. Its use in the case of H1N1 highlights the necessity of proactive planning, scalable infrastructure, and public-private partnerships in tracking adverse events after vaccination in epidemics. It also illustrates how data could be integrated to produce policy-relevant information for other medical products. |
Nationwide outbreak of Salmonella Montevideo infections associated with contaminated imported black and red pepper: warehouse membership cards provide critical clues to identify the source
Gieraltowski L , Julian E , Pringle J , Macdonald K , Quilliam D , Marsden-Haug N , Saathoff-Huber L , Von Stein D , Kissler B , Parish M , Elder D , Howard-King V , Besser J , Sodha S , Loharikar A , Dalton S , Williams I , Barton Behravesh C . Epidemiol Infect 2012 141 (6) 1-9 SUMMARY: In November 2009, we initiated a multistate investigation of Salmonella Montevideo infections with pulsed-field gel electrophoresis pattern JIXX01.0011. We identified 272 cases in 44 states with illness onset dates ranging from 1 July 2009 to 14 April 2010. To help generate hypotheses, warehouse store membership card information was collected to identify products consumed by cases. These records identified 19 ill persons who purchased company A salami products before onset of illness. A case-control study was conducted. Ready-to-eat salami consumption was significantly associated with illness (matched odds ratio 8.5, 95% confidence interval 2.1-75.9). The outbreak strain was isolated from company A salami products from an environmental sample from one manufacturing plant, and sealed containers of black and red pepper at the facility. This outbreak illustrates the importance of using membership card information to assist in identifying suspect vehicles, the potential for spices to contaminate ready-to-eat products, and preventing raw ingredient contamination of these products. |
Characteristics of US counties with no mammography capacity
Peipins LA , Miller J , Richards TB , Bobo JK , Liu T , White MC , Joseph D , Tangka F , Ekwueme DU . J Community Health 2012 37 (6) 1239-48 Access to screening mammography may be limited by the availability of facilities and machines, and nationwide mammography capacity has been declining. We assessed nationwide capacity at state and county levels from 2003 to 2009, the most recent year for which complete data were available. Using mammography facility certification and inspection data from the Food and Drug Administration, we geocoded all mammography facilities in the United States and determined the total number of fully accredited mammography machines in each US County. We categorized mammography capacity as counties with zero capacity (i.e., 0 machines) or counties with capacity (i.e.,≥1 machines), and then compared those two categories by sociodemographic, health care, and geographic characteristics. We found that mammography capacity was not distributed equally across counties within states and that more than 27 % of counties had zero capacity. Although the number of mammography facilities and machines decreased slightly from 2003 to 2009, the percentage of counties with zero capacity changed little. In adjusted analyses, having zero mammography capacity was most strongly associated with low population density (OR = 11.0; 95 % CI 7.7-15.9), low primary care physician density (OR = 8.9; 95 % CI 6.8-11.7), and a low percentage of insured residents (OR = 3.3; 95 % CI 2.5-4.3) when compared with counties having at least one mammography machine. Mammography capacity has been and remains a concern for a portion of the US population-a population that is mostly but not entirely rural. |
Restaurant food cooling practices
Brown LG , Ripley D , Blade H , Reimann D , Everstine K , Nicholas D , Egan J , Koktavy N , Quilliam DN . J Food Prot 2012 75 (12) 2172-8 Improper food cooling practices are a significant cause of foodborne illness, yet little is known about restaurant food cooling practices. This study was conducted to examine food cooling practices in restaurants. Specifically, the study assesses the frequency with which restaurants meet U.S. Food and Drug Administration (FDA) recommendations aimed at reducing pathogen proliferation during food cooling. Members of the Centers for Disease Control and Prevention's Environmental Health Specialists Network collected data on food cooling practices in 420 restaurants. The data collected indicate that many restaurants are not meeting FDA recommendations concerning cooling. Although most restaurant kitchen managers report that they have formal cooling processes (86%) and provide training to food workers on proper cooling (91%), many managers said that they do not have tested and verified cooling processes (39%), do not monitor time or temperature during cooling processes (41%), or do not calibrate thermometers used for monitoring temperatures (15%). Indeed, 86% of managers reported cooling processes that did not incorporate all FDA-recommended components. Additionally, restaurants do not always follow recommendations concerning specific cooling methods, such as refrigerating cooling food at shallow depths, ventilating cooling food, providing open-air space around the tops and sides of cooling food containers, and refraining from stacking cooling food containers on top of each other. Data from this study could be used by food safety programs and the restaurant industry to target training and intervention efforts concerning cooling practices. These efforts should focus on the most frequent poor cooling practices, as identified by this study. |
Whole genome sequence typing to investigate the Apophysomyces outbreak following a tornado in Joplin, Missouri, 2011.
Etienne KA , Gillece J , Hilsabeck R , Schupp JM , Colman R , Lockhart SR , Gade L , Thompson EH , Sutton DA , Neblett-Fanfair R , Park BJ , Turabelidze G , Keim P , Brandt ME , Deak E , Engelthaler DM . PLoS One 2012 7 (11) e49989 Case reports of Apophysomyces spp. in immunocompetent hosts have been a result of traumatic deep implantation of Apophysomyces spp. spore-contaminated soil or debris. On May 22, 2011 a tornado occurred in Joplin, MO, leaving 13 tornado victims with Apophysomyces trapeziformis infections as a result of lacerations from airborne material. We used whole genome sequence typing (WGST) for high-resolution phylogenetic SNP analysis of 17 outbreak Apophysomyces isolates and five additional temporally and spatially diverse Apophysomyces control isolates (three A. trapeziformis and two A. variabilis isolates). Whole genome SNP phylogenetic analysis revealed three clusters of genotypically related or identical A. trapeziformis isolates and multiple distinct isolates among the Joplin group; this indicated multiple genotypes from a single or multiple sources. Though no linkage between genotype and location of exposure was observed, WGST analysis determined that the Joplin isolates were more closely related to each other than to the control isolates, suggesting local population structure. Additionally, species delineation based on WGST demonstrated the need to reassess currently accepted taxonomic classifications of phylogenetic species within the genus Apophysomyces. |
Paternal influences on adolescent sexual risk behaviors: a structured literature review
Guilamo-Ramos V , Bouris A , Lee J , McCarthy K , Michael SL , Pitt-Barnes S , Dittus P . Pediatrics 2012 130 (5) e1313-25 BACKGROUND AND OBJECTIVE: To date, most parent-based research has neglected the role of fathers in shaping adolescent sexual behavior and has focused on mothers. The objective of this study was to conduct a structured review to assess the role of paternal influence on adolescent sexual behavior and to assess the methodological quality of the paternal influence literature related to adolescent sexual behavior. METHODS: We searched electronic databases: PubMed, PsychINFO, Social Services Abstracts, Family Studies Abstracts, Sociological Abstracts, and the Cumulative Index to Nursing and Allied Health Literature. Studies published between 1980 and 2011 that targeted adolescents 11 to 18 years and focused on paternal parenting processes were included. Methodological quality was assessed by using an 11-item scoring system. RESULTS: Thirteen articles were identified and reviewed. Findings suggest paternal factors are independently associated with adolescent sexual behavior relative to maternal factors. The most commonly studied paternal influence was emotional qualities of the father-adolescent relationship. Paternal communication about sex was most consistently associated with adolescent sexual behavior, whereas paternal attitudes about sex was least associated. Methodological limitations include a tendency to rely on cross-sectional design, nonprobability sampling methods, and focus on sexual debut versus broader sexual behavior. CONCLUSIONS: Existing research preliminarily suggests fathers influence the sexual behavior of their adolescent children; however, more rigorous research examining diverse facets of paternal influence on adolescent sexual behavior is needed. We provide recommendations for primary care providers and public health practitioners to better incorporate fathers into interventions designed to reduce adolescent sexual risk behavior. |
Stand-alone mass media campaigns to increase physical activity: updated findings from the Community Preventive Services Task Force
Community Preventive Services Task Force , Brown DR . Am J Prev Med 2012 43 (5) 562-4 SUMMARY: The Community Preventive Services Task Force concludes there is insufficient evidence to determine the effectiveness of stand-alone mass media campaigns to increase physical activity at the population level. Additional research is needed to determine effectiveness. |
HealthCall: technology-based extension of motivational interviewing to reduce non-injection drug use in HIV primary care patients - a pilot study
Aharonovich E , Greenstein E , O'Leary A , Johnston B , Seol SG , Hasin DS . AIDS Care 2012 24 (12) 1461-9 To reduce non-injection drug use (NIDU) among HIV primary care patients, more than a single brief intervention may be needed, but clinic resources are often too limited for extended interventions. To extend brief motivational interviewing (MI) to reduce NIDU, we designed and conducted a pilot study of "HealthCall," consisting of brief (1-3 minutes) daily patient calls reporting NIDU and health behaviors to a telephone-based interactive voice response (IVR) system, which provided data for subsequent personalized feedback. Urban HIV adult clinic patients reporting ≥4 days of NIDU in the previous month were randomized to two groups: MI-only (n=20) and MI+HealthCall (n=20). At 30 and 60 days, patients were assessed and briefly discussed their NIDU behaviors with their counselors. The outcome was the number of days patients used their primary drug in the prior 30 days. Medical marijuana issues precluded HealthCall with patients whose primary substance was marijuana (n=7); excluding these, 33 remained, of whom 28 patients (MI-only n=17; MI+HealthCall n=11) provided post-treatment data for analysis. Time significantly predicted reduction in "days used" in both groups (p<0.0001). At 60 days, between-group differences approached trend level, with an effect size of 0.62 favoring the MI+HealthCall arm. This pilot study suggests that HealthCall is feasible and acceptable to patients in resource-limited HIV primary care settings and can extend patient involvement in brief intervention with little additional staff time. A larger efficacy trial of HealthCall for NIDU-reduction in such settings is warranted. |
A randomized, double-blind, controlled trial of the 17D yellow fever virus vaccine given in combination with immune globulin or placebo: comparative viremia and immunogenicity
Edupuganti S , Eidex RB , Keyserling H , Akondy RS , Lanciotti R , Orenstein W , Del Rio C , Pan Y , Querec T , Lipman H , Barrett A , Ahmed R , Teuwen D , Cetron M , Mulligan MJ . Am J Trop Med Hyg 2012 88 (1) 172-7 We evaluated whether coadministration of the yellow fever (YF) virus vaccine with human immunoglobulin (Ig) that contained YF virus-neutralizing antibodies would reduce post-vaccination viremia without compromising immunogenicity and thus, potentially mitigate YF vaccine-associated adverse events. We randomized 80 participants to receive either YF vaccine and Ig or YF vaccine and saline placebo. Participants were followed for 91 days for safety and assessments of viremia and immunogenicity. There were no differences found between the two groups in the proportion of vaccinated participants who developed viremia, seroconversion, CD8(+) and CD4(+) T-cell responses, and cytokine responses. These results argue against one putative explanation for the increased reporting of YF vaccine side effects in recent years (i.e., a change in travel clinic practice after 1996 when hepatitis A prophylaxis with vaccine replaced routine use of pre-travel Ig), thus potentially removing an incidental YF vaccine-attenuating effect of anti-YF virus antibodies present in Ig. (ClinicalTrials.gov identifier: NCT00254826.) |
Validity of vaccination cards and parental recall to estimate vaccination coverage: a systematic review of the literature
Miles M , Ryman TK , Dietz V , Zell E , Luman ET . Vaccine 2012 31 (12) 1560-8 Immunization programs frequently rely on household vaccination cards, parental recall, or both to calculate vaccination coverage. This information is used at both the global and national level for planning and allocating performance-based funds. However, the validity of household-derived coverage sources has not yet been widely assessed or discussed. To advance knowledge on the validity of different sources of immunization coverage, we undertook a global review of literature. We assessed concordance, sensitivity, specificity, positive and negative predictive value, and coverage percentage point difference when subtracting household vaccination source from a medical provider source. Median coverage difference per paper ranged from -61 to +1 percentage points between card versus provider sources and -58 to +45 percentage points between recall versus provider source. When card and recall sources were combined, median coverage difference ranged from -40 to +56 percentage points. Overall, concordance, sensitivity, specificity, positive and negative predictive value showed poor agreement, providing evidence that household vaccination information may not be reliable, and should be interpreted with care. While only 5 papers (11%) included in this review were from low-income countries, low-income countries often rely more heavily on household vaccination information for decision making. Recommended actions include strengthening quality of child-level data and increasing investments to improve vaccination card availability and card marking. There is also an urgent need for additional validation studies of vaccine coverage in low and middle income countries. |
Long-term immunogenicity of hepatitis A vaccine in Alaska 17 years after initial childhood series
Raczniak GA , Bulkow L , Bruce MG , Zanis C , Baum R , Snowball M , Byrd KK , Sharapov UM , Hennessy TW , McMahon BJ . J Infect Dis 2012 207 (3) 493-6 CDC recommends hepatitis A vaccination for all children at age 1 year and high risk adults. The vaccine is highly effective; however, protection duration is unknown. We report hepatitis A antibody concentrations 17 years after childhood immunization, demonstrating protective antibody levels remain and have stabilized over the past 7 years. |
Monitoring HPV vaccine impact: early results and ongoing challenges
Hariri S , Markowitz L . J Infect Dis 2012 206 (11) 1633-5 In this issue of the Journal of Infectious Diseases, Tabrizi and colleagues present new data from Australia on genital human papillomavirus (HPV) infection prevalence in the periods immediately before and after HPV vaccine introduction [1]. Based on cross-sectional studies of women aged 18–24 years who received Papanicolaou screening in selected family planning clinics throughout the country, the authors report a 20% decrease in overall genital HPV prevalence and a more dramatic decrease of 77% in HPV types targeted by the quadrivalent vaccine (HPV types 6, 11, 16, and 18) from the 2 years before (2005–2007) to the 2 years after (2009–2010) the vaccine was widely implemented through a government-funded program. In addition to comparing HPV prevalence trends across periods, Tabrizi et al obtained HPV vaccination history from participants to more directly evaluate the effect of vaccination on HPV prevalence. Their results indicate significantly lower vaccine-type HPV prevalence among vaccinated women in the postvaccine sample (5.0%) compared with both unvaccinated women from the same period (15.8%) and women from the prevaccine period (28.7%). Using the age-adjusted HPV prevalence ratio of vaccinated to unvaccinated women, the authors calculate a vaccine effectiveness of 73% against infection with any of the 4 vaccine types. |
Pandemic H1N1 influenza surveillance in Haiti, July-December 2009
Fitter DL , Freeman NM , Buteau J , Magloire R , Sessions WM , Guo L , Katz MA , Boncy J . Influenza Other Respir Viruses 2012 7 (5) 772-5 From June 2009 through December 2009, Haiti conducted sentinel surveillance for influenza. 499 samples were collected and tested using real-time RT-PCR. 197 (39.5%) were positive for influenza, including 95 (48%) pandemic (H1N1) 2009, 57 (29%) seasonal influenza A and 45 (23%) influenza B. The median age of pandemic (H1N1) 2009 cases was 21.7; two-thirds of pandemic (H1N1) 2009 cases were in patients aged 6 years - 35 years. Pandemic activity peaked in September and co-circulated with other influenza subtypes. The age distribution and seasonality of pandemic (H1N1) 2009 in Haiti were similar to other countries in the Caribbean region. |
The potential economic value of a human norovirus vaccine for the United States
Bartsch SM , Lopman BA , Hall AJ , Parashar UD , Lee BY . Vaccine 2012 30 (49) 7097-104 Vaccines against human norovirus are currently under development. We developed a simulation model to determine their potential economic value. Vaccination prevented 100-6125 norovirus gastroenteritis cases per 10,000 vaccinees. Low vaccine cost (≤$50) garnered cost-savings and a more expensive vaccine led to costs per case averted comparable to other vaccines. In the US, vaccination could avert approximately 1.0-2.2 million cases (efficacy 50%, 12month duration), costing an additional $400 million to $1.0 billion, but could save ≤$2.1 billion (48month duration). Human norovirus vaccination can offer economic value while averting clinical outcomes, depending on price, efficacy, and protection duration. |
Human papillomavirus vaccine introduction - the first five years
Markowitz LE , Tsu V , Deeks SL , Cubie H , Wang SA , Vicari AS , Brotherton JM . Vaccine 2012 30 Suppl 5 F139-48 The availability of prophylactic human papillomavirus (HPV) vaccines has provided powerful tools for primary prevention of cervical cancer and other HPV-associated diseases. Since 2006, the quadrivalent and bivalent vaccines have each been licensed in over 100 countries. By the beginning of 2012, HPV vaccine had been introduced into national immunization programs in at least 40 countries. Australia, the United Kingdom, the United States, and Canada were among the first countries to introduce HPV vaccination. In Europe, the number of countries having introduced vaccine increased from 3 in 2007 to 22 at the beginning of 2012. While all country programs target young adolescent girls, specific target age groups vary as do catch-up recommendations. Different health care systems and infrastructure have resulted in varied implementation strategies, with some countries delivering vaccine in schools and others through health centers or primary care providers. Within the first 5 years after vaccines became available, few low- or middle-income countries had introduced HPV vaccine. The main reason was budgetary constraints due to the high vaccine cost. Bhutan and Rwanda implemented national immunization after receiving vaccine through donation programs in 2010 and 2011, respectively. The GAVI Alliance decision in 2011 to support HPV vaccination should increase implementation in low-income countries. Evaluation of vaccination programs includes monitoring of coverage, safety, and impact. Vaccine safety monitoring is part of routine activities in many countries. Safety evaluations are important and communication about vaccine safety is critical, as events temporally associated with vaccination can be falsely attributed to vaccination. Anti-vaccination efforts, in part related to concerns about safety, have been mounted in several countries. In the 5 years since HPV vaccines were licensed, there have been successes as well as challenges with vaccine introduction and implementation. Further progress is anticipated in the coming years, especially in low- and middle-income countries where the need for vaccine is greatest. This article forms part of a special supplement entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012. |
Human papillomavirus vaccine practices in the USA: do primary care providers use sexual history and cervical cancer screening results to make HPV vaccine recommendations?
Kepka D , Berkowitz Z , Yabroff KR , Roland K , Saraiya M . Sex Transm Infect 2012 88 (6) 433-5 OBJECTIVES: Guidelines recommend against the use of Papanicolaou (Pap) or human papillomavirus (HPV) testing when determining eligibility for the HPV vaccine. Optimally, the HPV vaccine should be administered before sexual initiation. Guidelines recommend that age-eligible women with past exposure to HPV should still be vaccinated. Little is known about how primary care providers (PCPs) use sexual history and HPV and Pap tests in their HPV vaccine recommendations. METHODS: Data from the 2007 Cervical Cancer Screening Supplement (CCSS) administered with the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) were used to assess HPV vaccination recommendations. The CCSS investigates cervical cancer screening practices, HPV testing and HPV vaccine recommendations among PCPs. A summary measure of compliance with guidelines was defined as rarely or never using the number of sexual partners and HPV tests and Pap tests to determine vaccine receipt. A total of 421 PCPs completed the CCSS in 2007. RESULTS: Among NAMCS and NHAMCS providers who recommend the HPV vaccine, only 53% (95% CI 42% to 63%) reported making guideline-consistent recommendations. The majority reported sometimes to always recommending the HPV vaccine to women with a history of an abnormal Pap result (85%; 95% CI 75% to 91%) and a positive HPV test (79%; 95% CI 70% to 86%). CONCLUSIONS: A large proportion of providers report practices that are inconsistent with guidelines. Providers may also be recommending the vaccine to women who may receive little benefit from the vaccine. Provider and system-level efforts to improve guideline-consistent practices are needed. |
Deletion of specific immune-modulatory genes from modified vaccinia virus Ankara-based HIV vaccines engenders improved immunogenicity in rhesus macaques.
Garber DA , O'Mara LA , Gangadhara S , McQuoid M , Zhang X , Zheng R , Gill K , Verma M , Yu T , Johnson B , Li B , Derdeyn CA , Ibegbu C , Altman JD , Hunter E , Feinberg MB . J Virol 2012 86 (23) 12605-15 Modified vaccinia virus Ankara (MVA) is a safe, attenuated orthopoxvirus that is being developed as a vaccine vector but has demonstrated limited immunogenicity in several early-phase clinical trials. Our objective was to rationally improve the immunogenicity of MVA-based HIV/AIDS vaccines via the targeted deletion of specific poxvirus immune-modulatory genes. Vaccines expressing codon-optimized HIV subtype C consensus Env and Gag antigens were generated from MVA vector backbones that (i) harbor simultaneous deletions of four viral immune-modulatory genes, encoding an interleukin-18 (IL-18) binding protein, an IL-1beta receptor, a dominant negative Toll/IL-1 signaling adapter, and CC-chemokine binding protein (MVADelta4-HIV); (ii) harbor a deletion of an additional (fifth) viral gene, encoding uracil-DNA glycosylase (MVADelta5-HIV); or (iii) represent the parental MVA backbone as a control (MVA-HIV). We performed head-to-head comparisons of the cellular and humoral immune responses that were elicited by these vectors during homologous prime-boost immunization regimens utilizing either high-dose (2 x 10(8) PFU) or low-dose (1 x 10(7) PFU) intramuscular immunization of rhesus macaques. At all time points, a majority of the HIV-specific T cell responses, elicited by all vectors, were directed against Env, rather than Gag, determinants, as previously observed with other vector systems. Both modified vectors elicited up to 6-fold-higher frequencies of HIV-specific CD8 and CD4 T cell responses and up to 25-fold-higher titers of Env (gp120)-specific binding (nonneutralizing) antibody responses that were relatively transient in nature. While the correlates of protection against HIV infection remain incompletely defined, our results indicate that the rational deletion of specific genes from MVA vectors can positively alter their cellular and humoral immunogenicity profiles in nonhuman primates. |
Genotyping of rubella virus RNA in sera and dried blood spots collected during routine surveillance and in archival sera.
Zheng Q , Abernathy ES , Sun H , Zhu Z , de Filippis A , Akoua-Koffi C , Ahmed H , Morris-Glasgow V , Quist-Therson M , Icenogle JP . J Virol Methods 2012 187 (2) 284-7 Information on the molecular epidemiology of rubella has been valuable in supporting efforts to control and eliminate rubella in several countries. The preferred samples for virus isolation or RNA detection, such as throat swabs, are often not available making it difficult to obtain a robust database of rubella virus sequences. A method for obtaining rubella virus genotypes from more commonly collected samples such as sera or dried blood spots using real-time RT-PCR to screen samples followed by nested set amplification is described. Rubella genotypes were obtained from dried blood spots and recent and archival sera collections. Eighteen percent of the RNAs extracted from the archival sera were real-time RT-PCR positive, and 44% of these RNAs were amplified successfully by nested RT-PCR and sequenced. Implementation of this technique could provide another tool to improve global rubella molecular surveillance. |
Spread of a distinct Stx2-encoding phage prototype among Escherichia coli O104:H4 strains from outbreaks in Germany, Norway, and Georgia
Beutin L , Hammerl JA , Strauch E , Reetz J , Dieckmann R , Kelner-Burgos Y , Martin A , Miko A , Strockbine NA , Lindstedt BA , Horn D , Monse H , Huettel B , Muller I , Stuber K , Reinhardt R . J Virol 2012 86 (19) 10444-55 Shiga toxin 2 (Stx2)-producing Escherichia coli (STEC) O104:H4 caused one of the world's largest outbreaks of hemorrhagic colitis and hemolytic uremic syndrome in Germany in 2011. These strains have evolved from enteroaggregative E. coli (EAEC) by the acquisition of the Stx2 genes and have been designated enteroaggregative hemorrhagic E. coli. Nucleotide sequencing has shown that the Stx2 gene is carried by prophages integrated into the chromosome of STEC O104:H4. We studied the properties of Stx2-encoding bacteriophages which are responsible for the emergence of this new type of E. coli pathogen. For this, we analyzed Stx bacteriophages from STEC O104:H4 strains from Germany (in 2001 and 2011), Norway (2006), and the Republic of Georgia (2009). Viable Stx2-encoding bacteriophages could be isolated from all STEC strains except for the Norwegian strain. The Stx2 phages formed lysogens on E. coli K-12 by integration into the wrbA locus, resulting in Stx2 production. The nucleotide sequence of the Stx2 phage P13374 of a German STEC O104:H4 outbreak was determined. From the bioinformatic analyses of the prophage sequence of 60,894 bp, 79 open reading frames were inferred. Interestingly, the Stx2 phages from the German 2001 and 2011 outbreak strains were found to be identical and closely related to the Stx2 phages from the Georgian 2009 isolates. Major proteins of the virion particles were analyzed by mass spectrometry. Stx2 production in STEC O104:H4 strains was inducible by mitomycin C and was compared to Stx2 production of E. coli K-12 lysogens. |
Structure, function, and evolution of the Crimean-Congo hemorrhagic fever virus nucleocapsid protein
Carter SD , Surtees R , Walter CT , Ariza A , Bergeron E , Nichol ST , Hiscox JA , Edwards TA , Barr JN . J Virol 2012 86 (20) 10914-23 Crimean-Congo hemorrhagic fever virus (CCHFV) is an emerging tick-borne virus of the Bunyaviridae family that is responsible for a fatal human disease for which preventative or therapeutic measures do not exist. We solved the crystal structure of the CCHFV strain Baghdad-12 nucleocapsid protein (N), a potential therapeutic target, at a resolution of 2.1 A. N comprises a large globular domain composed of both N- and C-terminal sequences, likely involved in RNA binding, and a protruding arm domain with a conserved DEVD caspase-3 cleavage site at its apex. Alignment of our structure with that of the recently reported N protein from strain YL04057 shows a close correspondence of all folds but significant transposition of the arm through a rotation of 180 degrees and a translation of 40 A. These observations suggest a structural flexibility that may provide the basis for switching between alternative N protein conformations during important functions such as RNA binding and oligomerization. Our structure reveals surfaces likely involved in RNA binding and oligomerization, and functionally critical residues within these domains were identified using a minigenome system able to recapitulate CCHFV-specific RNA synthesis in cells. Caspase-3 cleaves the polypeptide chain at the exposed DEVD motif; however, the cleaved N protein remains an intact unit, likely due to the intimate association of N- and C-terminal fragments in the globular domain. Structural alignment with existing N proteins reveals that the closest CCHFV relative is not another bunyavirus but the arenavirus Lassa virus instead, suggesting that current segmented negative-strand RNA virus taxonomy may need revision. |
Modeling bacteriophage amplification as a predictive tool for optimized MALDI-TOF MS-based bacterial detection
Cox CR , Rees JC , Voorhees KJ . J Mass Spectrom 2012 47 (11) 1435-1441 Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) is a valuable tool for rapid bacterial detection and identification but is limited by the need for relatively high cell count samples, which have been grown under strictly controlled conditions. These requirements can be eliminated by the natural infection of a viable bacterial species of interest with a host-specific phage. This produces a rapid increase in phage protein concentrations in comparison to bacterial concentrations, which can in turn be exploited as a method for signal amplification during MALDI-TOF MS. One drawback to this approach is the requirement for repetitive, time-consuming sample preparation and analysis applied over the course of a phage infection to monitor phage concentrations as a function of time to determine the MALDI-TOF MS detection limit. To reduce the requirement for repeated preparation and analysis, a modified phage therapy model was investigated as a means for predicting the time during a given phage infection when a detectable signal would occur. The modified model used a series of three differential equations composed of predetermined experimental parameters including phage burst size and burst time to predict progeny phage concentrations as a function of time. Using Yersinia pestis with plague diagnostic phage A1122 and Escherichia coli with phage MS2 as two separate, well-characterized model phage-host pairs, we conducted in silico modeling of the infection process and compared it with experimental infections monitored in real time by MALDI-TOF MS. Significant agreement between mathematically calculated phage growth curves and those experimentally obtained by MALDI-TOF MS was observed, thus verifying this method's utility for significant time and labor reduction. (Copyright 2012 John Wiley Sons, Ltd.) |
Enhanced identification and characterization of non-O157 shiga toxin-producing Escherichia coli: a six-year study
Mingle LA , Garcia DL , Root TP , Halse TA , Quinlan TM , Armstrong LR , Chiefari AK , Schoonmaker-Bopp DJ , Dumas NB , Limberger RJ , Musser KA . Foodborne Pathog Dis 2012 9 (11) 1028-36 Non-O157 Shiga toxin-producing Escherichia coli (STEC) are emerging pathogens with the potential to cause serious illness and impact public health due to diagnostic challenges. Between 2005 and 2010, the Wadsworth Center (WC), the public health laboratory of the New York State (NYS) Department of Health, requested that Shiga toxin enzyme immunoassay (EIA)-positive stool enrichment broths and/or stool specimens be submitted by clinical and commercial reference laboratories testing NYS patient specimens. A total of 798 EIA-positive specimens were received for confirmation and serotyping, and additionally a subset of STEC was assessed for the presence of six virulence genes (stx1, stx2, eaeA, hlyA, nleA, and nleB) by real-time polymerase chain reaction. We confirmed 591 specimens as STEC, 164 (28%) as O157 STEC, and 427 (72%) as non-O157 STEC. Of the non-O157 STEC serogroups identified, over 70% were O103, O26, O111, O45, O121, or O145. During this time period, WC identified and characterized a total of 1282 STEC received as E. coli isolates, stool specimens, or EIA broths. Overall, the STEC testing identified 59% as O157 STEC and 41% as non-O157 STEC; however, out of 600 isolates submitted to the WC as E. coli cultures, 543 (90%) were identified as O157 STEC. This report summarizes a 6-year study utilizing enhanced STEC testing that resulted in increased identification and characterization of non-O157 STEC in NYS. Continued utilization of enhanced STEC testing may lead to effective and timely outbreak response and improve monitoring of trends in STEC disease epidemiology. |
Isotope-dilution liquid chromatography/tandem mass spectrometry candidate reference method for total testosterone in human serum
Botelho JC , Shacklady C , Cooper HC , Tai SS , Van Uytfanghe K , Thienpont LM , Vesper HW . Clin Chem 2012 59 (2) 372-80 BACKGROUND: We developed and evaluated a candidate reference measurement procedure (RMP) to standardize testosterone measurements, provide highly accurate and precise value assignments for the CDC Hormone Standardization Program, and ensure accurate and comparable results across testing systems and laboratories. METHODS: After 2 liquid/liquid extractions of serum with a combination of ethyl acetate and hexane, we quantified testosterone by isotope-dilution liquid chromatography/tandem mass spectrometry with electrospray ionization in the positive ion mode monitoring 289-->97 m/z (testosterone) and 292-->112 m/z ((3)C(13) testosterone). We used calibrator bracketing and gravimetric measurements to give higher specificity and accuracy to serum value assignments. The candidate RMP was evaluated for accuracy by use of NIST-certified reference material SRM971 and validated by split-sample comparison to established RMPs. We evaluated intraassay and interassay imprecision, measurement uncertainty, potential interferences, and matrix effects. RESULTS: A weighted Deming regression comparison of the candidate RMP to established RMPs showed agreement with no statistical difference (slope 0.99, 95% CI 0.98-1.00, intercept 0.54, 95% CI -1.24 to 2.32) and a bias of ≤0.3% for NIST SRM971. The candidate RMP gave maximum intraassay, interassay, and total percent CVs of 1.5%, 1.4%, and 1.7% across the concentrations of testosterone typically found in healthy men and women. We tested structural analogs of testosterone and 125 serum samples and found no interferences with the measurement. CONCLUSIONS: This RMP for testosterone can serve as a higher-order standard for measurement traceability and can be used to provide an accuracy base to which routine methods can be compared in the CDC Hormone Standardization Program. |
The 31-kDa antigen of Angiostrongylus cantonensis comprises distinct antigenic glycoproteins
Morassutti AL , Levert K , Perelygin A , da Silva AJ , Wilkins P , Graeff-Teixeira C . Vector Borne Zoonotic Dis 2012 12 (11) 961-8 Human angiostrongyliasis results from accidental infection with Angiostrongylus, an intra-arterial nematode. Angiostrongylus cantonensis infections result in eosinophilic meningitis, and A. costaricensis infections cause eosinophilic enteritis. Immunological methodologies are critical to the diagnosis of both infections, since these parasites cannot be isolated from fecal matter and are rarely found in cerebrospinal fluid samples. A. costaricensis and A. cantonensis share common antigenic epitopes which elicit antibodies that recognize proteins present in either species. Detection of antibodies to a 31-kDa A. cantonensis protein present in crude adult worm extracts is a sensitive and specific method for immunodiagnosis of cerebral angiostrongyliasis. The objective of the present work was to isolate and characterize the 31-kDa proteins using soluble protein extracts derived from adult female worms using both one- (1DE) and two-dimensional (2DE) gel electrophoresis. Separated proteins were blotted onto nitrocellulose and probed using sera from infected and non-infected controls. The 31-kDa band present in 1DE gels and the 4 spots identified in 2DE gels were excised and analyzed by electrospray ionization mass spectrometry. Using the highest scores obtained following Mascot analysis, amino acid sequences were obtained that matched four unique proteins: tropomyosin, the 14-3-3 phosphoserine-binding protein, a protein containing a nascent polypeptide-associated complex domain, and the putative epsilon subunit of coatomer protein complex isoform 2. Oxidative cleavage of diols using sodium m-periodate demonstrated that carbohydrate moieties are essential for the antigenicity of all four spots of the 31-kDa antigen. In this article we describe the identification of the 31-kDa antigen, and provide DNA sequencing of the targets. In conclusion, these data suggest that reactivity to the 31-kDa proteins may represent antibody recognition of more than one protein, and recombinant protein-based assays for cerebral angiostrongyliasis diagnosis may require eukaryotic expression systems to maintain antigenicity. |
Chlamydial infection in vitamin D receptor knockout mice is more intense and prolonged than in wild-type mice
He Q , Ananaba GA , Patrickson J , Pitts S , Yi Y , Yan F , Eko FO , Lyn D , Black CM , Igietseme JU , Thierry-Palmer M . J Steroid Biochem Mol Biol 2012 135 7-14 Vitamin D hormone (1,25-dihydroxyvitamin D) is involved in innate immunity and induces host defense peptides in epithelial cells, suggesting its involvement in mucosal defense against infections. Chlamydia trachomatis is a major cause of bacterial sexually transmitted disease worldwide. We tested the hypothesis that the vitamin D endocrine system would attenuate chlamydial infection. Vitamin D receptor knock-out mice (VDR(-/-)) and wild-type mice (VDR(+/+)) were infected with 10(3) inclusion forming units of Chlamydia muridarum and cervical epithelial cells (HeLa cells) were infected with C. muridarum at multiplicity of infection 5:1 in the presence and absence of 1,25-dihydroxyvitamin D(3). VDR(-/-) mice exhibited significantly higher bacterial loading than wild-type VDR(+/+) mice (P < 0.01) and cleared the chlamydial infection in 39 days, compared with 18 days for VDR(+/+) mice. Monocytes and neutrophils were more numerous in the uterus and oviduct of VDR(-/-) mice than in VDR(+/+) mice (P < 0.05) at d 45 after infection. Pre-treatment of HeLa cells with 10 or 100nM 1,25-dihydroxyvitamin D(3) decreased the infectivity of C. muridarum (P < 0.001). Several differentially expressed protein spots were detected by proteomic analysis of chlamydial-infected HeLa cells pre-treated with 1,25-dihydroxyvitamin D(3). Leukocyte elastase inhibitor (LEI), an anti-inflammatory protein, was up-regulated. Expression of LEI in the ovary and oviduct of infected VDR(+/+) mice was greater than that of infected VDR(-/-) mice. We conclude that the vitamin D endocrine system reduces the risk for prolonged chlamydial infections through regulation of several proteins and that LEI is involved in its anti-inflammatory activity. |
Crystal structures of two subtype N10 neuraminidase-like proteins from bat influenza A viruses reveal a diverged putative active site
Zhu X , Yang H , Guo Z , Yu W , Carney PJ , Li Y , Chen LM , Paulson JC , Donis RO , Tong S , Stevens J , Wilson IA . Proc Natl Acad Sci U S A 2012 109 (46) 18903-8 Recently, we reported a unique influenza A virus subtype H17N10 from little yellow-shouldered bats. Its neuraminidase (NA) gene encodes a protein that appears to be highly divergent from all known influenza NAs and was assigned as a new subtype N10. To provide structural and functional insights on the bat H17N10 virus, X-ray structures were determined for N10 NA proteins from influenza A viruses A/little yellow-shouldered bat/Guatemala/164/2009 (GU09-164) in two crystal forms at 1.95 A and 2.5 A resolution and A/little yellow-shouldered bat/Guatemala/060/2010 (GU10-060) at 2.0 A. The overall N10 structures are similar to each other and to other known influenza NA structures, with a single highly conserved calcium binding site in each monomer. However, the region corresponding to the highly conserved active site of influenza A N1-N9 NA subtypes and influenza B NA differs substantially. In particular, most of the amino acid residues required for NA activity are substituted, and the putative active site is much wider because of displacement of the 150-loop and 430-loop. These structural features and the fact that the recombinant N10 protein exhibits no, or extremely low, NA activity suggest that it may have a different function than the NA proteins of other influenza viruses. Accordingly, we propose that the N10 protein be termed an NA-like protein until its function is elucidated. |
WIC participation and breastfeeding among white and black mothers: data from Mississippi
Marshall C , Gavin L , Bish C , Winter A , Williams L , Wesley M , Zhang L . Matern Child Health J 2012 17 (10) 1784-92 Participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has been associated with lower rates of breastfeeding; studies have suggested this relationship may be modified by race. The purpose of this study is to examine the association between WIC participation and breastfeeding behaviors among white and black women in Mississippi. Using data from the 2004-2008 Mississippi Pregnancy Risk Assessment Monitoring System, we calculated multivariable prevalence and hazard ratios to assess the relationships among WIC participation during pregnancy and breastfeeding initiation and duration through 10 weeks postpartum. Stratified analyses were performed for white and black women. 52.2 % of white and 82.1 % of black women participated in WIC. 60.4 % of white and 39.7 % of black women initiated breastfeeding, and 26.5 % and 21.9 %, respectively, were breastfeeding at 10 weeks postpartum. WIC participation was negatively associated with breastfeeding initiation among whites (APR: 0.87; 95 % CI 0.77-0.99), but not blacks (APR: 0.99; 95 % CI 0.28-1.21). WIC participation was not associated with breastfeeding duration for women of either race (white: AHR: 1.05, 95 % CI 0.80-1.38; black: AHR: 0.91, 95 % CI 0.65-1.26). The results among white women suggest that Mississippi WIC might benefit from an in depth evaluation of the program's breastfeeding promotional activities to determine if aspects of the program are undermining breastfeeding initiation. High rates of participation in the WIC program among black women, and the overall low rates of breastfeeding in this population point to the potential the program has to increase breastfeeding rates among blacks. |
Excess gestational weight gain is associated with child adiposity among mothers with normal and overweight prepregnancy weight status
Hinkle SN , Sharma AJ , Swan DW , Schieve LA , Ramakrishnan U , Stein AD . J Nutr 2012 142 (10) 1851-8 There are inconsistencies in the literature regarding the association between gestational weight gain (GWG) and child adiposity. GWG is hypothesized to act on child adiposity directly through intrauterine programming and indirectly through birth weight. It is unclear if the relative importance of these pathways differs by prepregnancy BMI status. We analyzed data from 3600 participants of the nationally representative Early Childhood Longitudinal Study-Birth Cohort. Child BMI Z-score was calculated from height and weight measured at 5 y. Using linear regression, controlling for sociodemographics and family lifestyle, we examined prepregnancy BMI-specific associations between GWG and child BMI Z-score. There was a nonlinear association among normal (P < 0.001) and overweight mothers only (P = 0.013), such that GWG beyond the midpoint of the 2009 Institute of Medicine recommendations was associated with a significant increase in child BMI Z-score. After the addition of birth-weight-for-gestational-age and breastfeeding to the model, the association remained among normal-weight mothers (P = 0.005) and was slightly attenuated among overweight mothers (P = 0.09). No significant association was observed between GWG and child BMI Z-score among underweight or obese mothers. We used path analysis to decompose the total effect into direct and indirect effects. This indicated the presence of a stronger direct than indirect effect. In conclusion, low GWG is not associated with BMI Z-score among any prepregnancy BMI group. Excess GWG is associated with an increase in child BMI Z-score among normal and overweight mothers only. Prevention of excess GWG may be a strategy to prevent childhood obesity. |
Expanding and enhancing federal, state, tribal, and academic partnerships to advance the field of maternal and child health
Kroelinger CD , Barfield WD , Callaghan WM . Matern Child Health J 2012 16 Suppl 2 189-92 Collaboration is the foundation for producing sound programmatic and scientific work in public health. As far back as the late 1800s, when the field of public health was in its infancy in the United States, collaboration and partnership among existing agencies including the American Public Health Association, Congress, state and city boards of health, and state legislatures provided the basis for development of fundamental policies including sanitation, the standardization of laboratory methodologies, vaccination protocols, and implementation of quarantine measures during disease outbreaks [1, 2]. In the mid to late twentieth century, international eradication of smallpox and in the early twenty-first century near global eradication of polio announced by agencies included in the World Health Assembly are examples of how collaboration in science and medicine impact health at the population level on a large scale [3, 4]. | In the field of maternal and child health (MCH), there are a multitude of examples which demonstrate how collaboration has propelled research and practice forward, including development of regionalized systems of care for at-risk neonates, understanding the link between human papilloma virus and cervical cancer, and determining the effects of obesity on development of chronic conditions among women of reproductive age [5, 6]. With the dynamic health care environment, public health has adapted to changing systems and focused on the quality of care; but the foundational importance of collaboration and partnership has remained the same. This Maternal and Child Health Journal Supplement describes model partnerships and collaborative efforts among federal, state, tribal, and academic agencies, including a partnership between the Centers for Disease Control and Prevention (CDC) and the University of Illinois at Chicago (UIC) to implement a multi-year distance-based initiative that resulted in analyses of complex sample surveys in women’s health, children’s health, and access to care that was fundamental to supporting efforts to address key MCH issues including (1) research to highlight disparities among specific populations, (2) development of national strategies and application of existing models to reduce fetal and infant mortality in states; and (3) the advancement of MCH leadership and innovation in developing the workforce, with perspectives provided to move the field forward. |
Highly active antiretroviral therapy and adverse birth outcomes among HIV-infected women in Botswana
Chen JY , Ribaudo HJ , Souda S , Parekh N , Ogwu A , Lockman S , Powis K , Dryden-Peterson S , Creek T , Jimbo W , Madidimalo T , Makhema J , Essex M , Shapiro RL . J Infect Dis 2012 206 (11) 1695-705 BACKGROUND: It is unknown whether adverse birth outcomes are associated with maternal highly active antiretroviral therapy (HAART) in pregnancy, particularly in resource-limited settings. METHODS: We abstracted obstetrical records at 6 sites in Botswana for 24 months. Outcomes included stillbirths (SBs), preterm delivery (PTD), small for gestational age (SGA), and neonatal death (NND). Among human immunodeficiency virus (HIV)-infected women, comparisons were limited to HAART exposure status at conception, and those with similar opportunities for outcomes. Comparisons were adjusted for CD4(+) lymphocyte cell count. RESULTS: Of 33,148 women, 32,113 (97%) were tested for HIV, of whom 9504 (30%) were HIV infected. Maternal HIV was significantly associated with SB, PTD, SGA, and NND. Compared with all other HIV-infected women, those continuing HAART from before pregnancy had higher odds of PTD (adjusted odds ratio [AOR], 1.2; 95% confidence interval [CI], 1.1, 1.4), SGA (AOR, 1.8; 95% CI, 1.6, 2.1) and SB (AOR, 1.5; 95% CI, 1.2, 1.8). Among women initiating antiretroviral therapy in pregnancy, HAART use (vs zidovudine) was associated with higher odds of PTD (AOR, 1.4; 95% CI, 1.2, 1.8), SGA (AOR, 1.5; 95% CI, 1.2, 1.9), and SB (AOR, 2.5; 95% CI, 1.6, 3.9). Low CD4(+) was independently associated with SB and SGA, and maternal hypertension during pregnancy with PTD, SGA, and SB. CONCLUSIONS: HAART receipt during pregnancy was associated with increased PTD, SGA, and SB. |
Prevention of cognitive impairment: physician perceptions and practices
Day KL , Friedman DB , Laditka JN , Anderson LA , Hunter R , Laditka SB , Wu B , McGuire LC , Coy MC . J Appl Gerontol 2012 31 (6) 743-754 The public is increasingly inundated with suggestions on how they can reduce their risk of developing cognitive impairment or dementia and are turning to physicians for advice. This study examines physicians’ perceptions and practices related to reducing cognitive impairment or dementia risk. Data from Porter Novelli’s 2008 DocStyles survey are used to examine physicians’ perceptions and practices related to this issue. About 40% of physicians reported discussing concerns about cognitive impairment often or very often with adult patients without dementia. The majority advised patients to reduce risk through physical activity, mental stimulation, and healthy diet. These data shed light on physicians’ perceptions and practices related to reducing cognitive impairmentrisk among their patients. Increased information about this issue may inform development of and access to educational materials to meet physicians’ needs to address patient concerns related to reducing cognitive impairment or dementia risk. |
Exposure models for the prior distribution in bayesian decision analysis for occupational hygiene decision making.
Lee EG , Kim SW , Feigley CE , Harper M . J Occup Environ Hyg 2012 10 (2) 97-108 This study introduces two semi-quantitative methods, Structured Subjective Assessment (SSA) and Control of Substances Hazardous to Health (COSHH) Essentials, in conjunction with 2-dimensional Monte Carlo simulations for determining prior probabilities. Prior distribution using expert judgment was included for comparison. Practical applications of the proposed methods were demonstrated using personal exposure measurements of isoamyl acetate in an electronics manufacturing facility and of isopropanol in a printing shop. Applicability of these methods in real workplaces was discussed based on the advantages and disadvantages of each method. Although these methods could not be completely independent of expert judgments, this study demonstrated a methodological improvement in the estimation of the prior distribution for the Bayesian decision analysis tool. The proposed methods provide a logical basis for the decision process by considering determinants of worker exposure. [Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Occupational and Environmental Hygiene for the following free supplementary resource: Coding of the MC Simulation (SSA Method)] |
Skin and respiratory symptoms in peanut inspectors with peanut dust and endotoxin exposure
Tapp L , Sylvain D . J Occup Environ Hyg 2012 10 (2) D19-24 The National Institute for Occupational Safety and Health (NIOSH) provided technical assistance at a peanut grading room in response to a request from a state health department for an evaluation of respiratory and skin symptoms among peanut inspectors. Reported symptoms included dermal (skin rash, burning/itching skin); respiratory (cough, shortness of breath, respiratory tract irritation, nosebleeds); and flu-like symptoms after being exposed to “bad” peanuts. We evaluated the workplace during two site visits 10 months apart. |
Occupational nanosafety considerations for carbon nanotubes and carbon nanofibers
Castranova V , Schulte PA , Zumwalde RD . Acc Chem Res 2012 46 (3) 642-9 Carbon nanotubes (CNTs) are carbon atoms arranged in a crystalline graphene lattice with a tubular morphology. CNTs exhibit high tensile strength, possess unique electrical properties, are durable, and can be functionalized. These properties allow applications as structural materials, in electronics, as heating elements, in batteries, in the production of stain-resistant fabric, for bone grafting and dental implants, and for targeted drug delivery. Carbon nanofibers (CNFs) are strong, flexible fibers that are currently used to produce composite materials. Agitation can lead to aerosolized CNTs and CNFs, and peak airborne particulate concentrations are associated with workplace activities such as weighing, transferring, mixing, blending, or sonication. Most airborne CNTs or CNFs found in workplaces are loose agglomerates of micrometer diameter. However, due to their low density, they linger in workplace air for a considerable time, and a large fraction of these structures are respirable. In rat and mouse models, pulmonary exposure to single-walled carbon nanotubes (SWCNTs), multi-walled carbon nanotubes (MWCNTs), or CNFs causes the following pulmonary reactions: acute pulmonary inflammation and injury, rapid and persistent formation of granulomatous lesions at deposition sites of large CNT agglomerates, and rapid and progressive alveolar interstitial fibrosis at deposition sites of more dispersed CNT or CNF structures. Pulmonary exposure to SWCNTs can induce oxidant stress in aortic tissue and increases plaque formation in an atherosclerotic mouse model. Pulmonary exposure to MWCNTs depresses the ability of coronary arterioles to respond to dilators. These cardiovascular effects may result from neurogenic signals from sensory irritant receptors in the lung. Pulmonary exposure to MWCNTs also upregulates mRNA for inflammatory mediators in selected brain regions, and pulmonary exposure to SWCNTs upregulates the baroreceptor reflex. In addition, pulmonary exposure to MWCNTs may induce levels of inflammatory mediators in the blood, which may affect the cardiovascular system. Intraperitoneal instillation of MWCNTs in mice has been associated with abdominal mesothelioma. MWCNTs deposited in the distal alveoli can migrate to the intrapleural space, and MWCNTs injected in the intrapleural space can cause lesions at the parietal pleura. However, further studies are required to determine whether pulmonary exposure to MWCNTs can induce pleural lesions or mesothelioma. In light of the anticipated growth in the production and use of CNTs and CNFs, worker exposure is possible. Because pulmonary exposure to CNTs and CNFs causes inflammatory and fibrotic reactions in the rodent lung, adverse health effects in workers represent a concern. NIOSH has conducted a risk assessment using available animal exposure-response data and is developing a recommended exposure limit for CNTs and CNFs. Evidence indicates that engineering controls and personal protective equipment can significantly decrease workplace exposure to CNTs and CNFs. Considering the available data on health risks, it appears prudent to develop prevention strategies to minimize workplace exposure. These strategies would include engineering controls (enclosure, exhaust ventilation), worker training, administrative controls, implementation of good handling practices, and the use of personal protective equipment (such as respirators) when necessary. NIOSH has published a document containing recommendations for the safe handling of nanomaterials. |
Penetration of fiber versus spherical particles through filter media and faceseal leakage of N95 filtering facepiece respirators with cyclic flow
Cho KJ , Turkevich L , Miller M , McKay R , Grinshpun SA , Ha KC , Reponen T . J Occup Environ Hyg 2012 10 (3) 109-15 This study investigated differences in penetration between fibers and spherical particles through faceseal leakage of an N95 filtering facepiece respirator. Three cyclic breathing flows were generated corresponding to mean inspiratory flow rates (MIF) of 15, 30, and 85 L/min. Fibers had a mean diameter of 1 um and a median length of 4.9 um (calculated aerodynamic diameter, d(ae) = 1.73 um). Monodisperse polystyrene spheres with a mean physical diameter of 1.01 um (PSI) and 1.54 um (PSII) were used for comparison (calculated d(ae) = 1.05 and 1.58 um, respectively). Two optical particle counters simultaneously determined concentrations inside and outside the respirator. Geometric means (GMs) for filter penetration of the fibers were 0.06, 0.09, and 0.08% at MIF of 15, 30, and 85 L/min, respectively. Corresponding values for PSI were 0.07, 0.12, and 0.12%. GMs for faceseal penetration of fibers were 0.40, 0.14, and 0.09% at MIF of 15, 30, and 85 L/min, respectively. Corresponding values for PSI were 0.96, 0.41, and 0.17%. Faceseal penetration decreased with increased breathing rate for both types of particles (p≤0.001). GMs of filter and faceseal penetration of PSII at an MIF of 30 L/min were 0.14% and 0.36%, respectively. Filter penetration and faceseal penetration of fibers were significantly lower than those of PSI (p < 0.001) and PSII (p < 0.003). This confirmed that higher penetration of PSI was not due to slightly smaller aerodynamic diameter, indicating that the shape of fibers rather than their calculated mean aerodynamic diameter is a prevailing factor on deposition mechanisms through the tested respirator. In conclusion, faceseal penetration of fibers and spherical particles decreased with increasing breathing rate, which can be explained by increased capture by impaction. Spherical particles had 2.0-2.8 times higher penetration through faceseal leaks and 1.1-1.5 higher penetration through filter media than fibers, which can be attributed to differences in interception losses. |
Evaluation of air sampling methods for abrasive blasting
Ceballos D , Sylvain D , Kiefer M . J Occup Environ Hyg 2012 10 (3) D34-9 The National Institute for Occupational Safety and Health (NIOSH) investigators compared methods for collecting personal breathing zone (PBZ) air samples for particulates during abrasive blasting at a shipyard. Abrasive blasting is the cleaning or finishing of surfaces by the use of an abrasive carried in a strong current of air. The U.S. government has provided regulatory requirements and guidelines for ventilation, enclosures, and personal protective equipment during abrasive blasting [NIOSH 1987; OSHA 2012a]. However, current Occupational Safety and Health Administration (OSHA) sampling and analytical methods can overestimate worker exposures to airborne metals and other particulate contaminants during abrasive blasting [NIOSH 1994; NIOSH 1998; OSHA 2012b]. | Shielding the 37-mm filter cassette inlet to exclude non-inhalable particles, mounting the PBZ air sampler behind the employee's head to protect the sampler from rebounding abrasive materials, and using the Institute of Medicine inhalable dust sampler, have been proposed as alternatives to assess exposure. All were found to be impractical or ineffective in abrasive blasting environments [NIOSH 1994, 1998]. Sampling simultaneously inside and outside the employees' abrasive blast hood has shown that the lower air concentrations inside the abrasive blast hood produce less overloading of the 37-mm cassettes [NIOSH 1998]; however, sampling inside PPE is not accepted by OSHA for compliance purposes [OSHA 2012a, b]. | Aizenberg et al. [2000] used a Button Aerosol Sampler® (BAS) (part number 225–360, SKC Inc., Eighty Four, Pennsylvania) with a prototype shield to evaluate PBZ exposures during abrasive blasting operations. The investigators reported that the protective shield prevented non-inhalable particles from overloading the filter and did not interfere with sampling smaller particles; however, the researchers did not determine whether the prototype protective shield altered the collection efficiency of the BAS. Following the Aizenberg et al. [2000] study, SKC Inc. designed a snap-on dome-shaped stainless steel protective secondary shield for use with the BAS when sampling during abrasive blasting (Abrasive Blasting Sampler for Heavy Metals kit, part number 225–367, SKC Inc., Eighty Four, Pennsylvania). This shield differed in size, shape, and screen opening from the prototype screen tested by Aizenberg et al. [2000]. Due to uncertainty about possible effects that shielding may have on the performance characteristics of the BAS, the objectives of this evaluation were to: (1) compare the commercially available BAS (with and without the shield) with the conventional 37-mm cassette sampler in an abrasive blasting environment and (2) evaluate whether the protective shield designed for the BAS prevented inertia-driven particles from entering and possibly overloading the sampler [NIOSH 2012a]. |
Expanding control banding for workplace silica exposures throughout the Americas
Beaucham CC , Lentz TJ , Rice FL . Int J Occup Environ Health 2012 18 (4) 344-347 BACKGROUND: Silicosis, a lung disease caused by inhaling respirable crystalline silica dust, is an occupational illness affecting millions of workers worldwide. The National Institute for Occupational Safety and Health (NIOSH) has partnered with the World Health Organization, the International Labour Organization, and multiple agencies in the Americas to implement the program "The Elimination of Silicosis in the Americas". OBJECTIVES: One component of this program is control banding, a qualitative risk assessment and management strategy that allows non-experts to use task-based hazard data and potential exposure information to determine appropriate controls. RESULTS: From 2005 to the present, NIOSH occupational health researchers have worked with experts in Chile, Peru, Colombia, and Brazil to assess, implement, and provide tools to evaluate the use of control banding methodology. |
Verifying elimination programs with a special emphasis on cysticercosis endpoints and postelimination surveillance
Handali S , Pawitan Y . J Parasitol Res 2012 2012 974950 Methods are needed for determining program endpoints or postprogram surveillance for any elimination program. Cysticercosis has the necessary effective strategies and diagnostic tools for establishing an elimination program; however, tools to verify program endpoints have not been determined. Using a statistical approach, the present study proposed that taeniasis and porcine cysticercosis antibody assays could be used to determine with a high statistical confidence whether an area is free of disease. Confidence would be improved by using secondary tests such as the taeniasis coproantigen assay and necropsy of the sentinel pigs. |
Treatment of bleeding irregularities in women with copper-containing IUDs: a systematic review
Godfrey EM , Folger SG , Jeng G , Jamieson DJ , Curtis KM . Contraception 2012 87 (5) 549-66 BACKGROUND: Bleeding irregularities, such as intermenstrual spotting or heavy or prolonged menstrual bleeding, are common among copper-containing intrauterine device (Cu-IUD) users and are one of the leading reasons for method discontinuation. This review evaluates the evidence for effective therapeutic and preventive treatments for bleeding irregularities during Cu-IUD use. STUDY DESIGN: We searched the PubMed database for peer-reviewed articles that were published in any language from inception of the database through March 2012 and were relevant to treatments for irregular bleeding during Cu-IUD use. We used standard abstract forms and grading systems to summarize and assess the quality of the evidence. RESULTS: From 1470 articles, we identified 17 articles that met our inclusion criteria. Evidence from two studies of poor quality demonstrated that antifibrinolytic agents or nonsteroidal anti-inflammatory drugs (NSAIDs) have been used for intermenstrual bleeding or spotting among a small number of Cu-IUD users with mixed results. Evidence from 10 studies of fair to poor quality suggested that some NSAIDs may significantly reduce menstrual blood loss or bleeding duration among Cu-IUD users with heavy or prolonged menstrual bleeding. Antifibrinolytic drugs or antidiuretics may also help reduce blood loss. High-dose aspirin was shown to increase blood loss among those with baseline menorrhagia. Evidence from five studies of fair to poor quality suggested that bleeding irregularities among new Cu-IUD users may be prevented with NSAIDs, although one large study of good quality suggested that prophylactic treatment with ibuprofen does not affect continuation of Cu-IUD use. Evidence from two studies of fair to poor quality suggested that antifibrinolytic agents might be helpful in preventing heavy or prolonged menstrual bleeding among new Cu-IUD users. CONCLUSIONS: Limited evidence suggests that NSAIDs may be effective treatments for bleeding irregularities associated with Cu-IUD use; antifibrinolytic agents and antidiuretics have also been studied as possible treatments in a small number of subjects, but their safety has not been well documented. NSAIDs and antifibrinolytics may also prevent bleeding irregularities among new CU-IUD users. Preventive NSAID use, however, does not impact Cu-IUD continuation. |
Trends in use of medical abortion in the United States: reanalysis of surveillance data from the Centers for Disease Control and Prevention, 2001-2008
Pazol K , Creanga AA , Zane SB . Contraception 2012 86 (6) 746-51 BACKGROUND: With changing patterns and increasing use of medical abortion in the United States, it is important to have accurate statistics on the use of this method regularly available. This study assesses the accuracy of medical abortion data reported annually to the Centers for Disease Control and Prevention (CDC) and describes trends over time in the use of medical abortion relative to other methods. STUDY DESIGN: This analysis included data reported to CDC for 2001-2008. Year-specific analyses included all states that monitored medical abortion for a given year, while trend analyses were restricted to states that monitored medical abortion continuously from 2001 to 2008. Data quality and completeness were assessed by (a) examining abortions reported with an unspecified method type within the gestational age limit for medical abortion (med-eligible abortions) and (b) comparing the percentage of all abortions and med-eligible abortions reported to CDC as medical abortions with estimates based on published mifepristone sales data for the United States from 2001 to 2007. RESULTS: During 2001-2008, the percentage of med-eligible abortions reported to CDC with an unspecified method type remained low (1.0%-2.2%); CDC data and mifepristone sales estimates for 2001-2007 demonstrated strong agreement [all abortions: intraclass correlation coefficient (ICC)=0.983; med-eligible abortions: ICC=0.988]. During 2001-2008, the percentage of abortions reported to CDC as medical abortions increased (p<.001 for all abortions and for med-eligible abortions). Among states that reported medical abortions for 2008, 15% of all abortions and 23% of med-eligible abortions were reported as medical abortions. CONCLUSION: CDC's Abortion Surveillance System provides an important annual data source that accurately describes the use of medical abortion relative to other methods in the United States. |
Racial and ethnic differences in health status and health behavior among breast cancer survivors-Behavioral Risk Factor Surveillance System, 2009
White A , Pollack LA , Smith JL , Thompson T , Underwood JM , Fairley T . J Cancer Surviv 2012 7 (1) 93-103 PURPOSE: Differences in health status and behavioral risk factors may explain racial/ethnic breast cancer disparities. We examined racial/ethnic differences in health status and behaviors among female breast cancer survivors compared to females without breast cancer. METHODS: Using cross-sectional data from the 2009 Behavioral Risk Factor Surveillance System, a national state-based, random sample telephone survey, we explored differences in self-rated health, obesity and selected behaviors (physical activity, smoking, alcohol use, fruit, and vegetable consumption) among females aged 18 years and older, who reported a previous breast cancer diagnosis (survivors, n = 10,035) and those who reported no breast cancer history (n = 234,375) by race/ethnicity. Adjusted prevalences of health status and behaviors, accounting for sociodemographics, comorbidities and health care access, were estimated by race/ethnicity. RESULTS: Compared to all other racial/ethnic groups, more white females reported heavy alcohol consumption and more black females reported obesity regardless of their breast cancer status. Among breast cancer survivors, more whites (33.7 %) were former smokers compared to blacks (24.5 %), "others" (20.5 %), and Hispanics (16.2 %) (p = 0.001). Racial/ethnic differences in obesity also varied by reported time since diagnosis (p value = 0.018). Among long-term survivors (diagnosed >5 years before interview), more black survivors (34.8 %) reported obesity compared to white survivors (23.0 %). Also, among "other" race survivors, long-term survivors (22.0 %) reported more obesity than survivors diagnosed less than 5 years before interview (7.8 %). CONCLUSIONS: These findings suggest opportunities to increase health behaviors and reduce racial disparities among breast cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS: Engaging in healthy behaviors can play a significant role in enhancing health outcomes and quality of life of breast cancer survivors. More research is needed to better understand racial differences in obesity, smoking and alcohol consumption in order to develop effective, culturally appropriate interventions to promote a healthy lifestyle after a breast cancer diagnosis. |
Systems, strategies, and interventions for sustainable long-term care and protection of children with a history of living outside of family care
Fluke JD , Goldman PS , Shriberg J , Hillis SD , Yun K , Allison S , Light E . Child Abuse Negl 2012 36 (10) 722-31 OBJECTIVES: This article reviews the available evidence regarding the efficacy, effectiveness, ethics, and sustainability of approaches to strengthen systems to care for and protect children living outside family care in low- and middle-income countries. METHOD: For trafficked children, children of and on the street, children of conflict/disaster, and institutionalized children, a systems framework approach was used to organize the topic of sustainable approaches in low- and middle-income countries and addresses the following: legislation, policies, and regulations; system structures and functions (formal and informal); and continuum of care and services. The article draws on the findings of a focal group convened by the U.S. Government Evidence Summit: Protecting Children Outside of Family Care (December 12-13, 2011, Washington, DC), tasked with reviewing the literature on systems, strategies, and interventions for sustainable long-term care and protection of children with a history of living outside of family care in low- and middle-income country contexts. The specific methodology for the review is described in the commentary paper (Higgs, Zlidar, & Balster, 2012) that accompanies these papers. RESULTS: For the most part, the evidence base in support of sustainable long-term care for the populations of interest is relatively weak, with some stronger but unreplicated studies. Some populations have been studied more thoroughly than others, and there are many gaps. Most of the existing studies identify population characteristics, needs, and consequences of a lack of systemic services to promote family-like care. There is some evidence of the effectiveness of laws and policies, as well as some evidence of service effectiveness, in improving outcomes for children outside of family care. CONCLUSIONS: Despite the weaknesses and gaps of the existing research, there is a foundation of research for going forward, which should focus on developing and implementing systems for these most vulnerable children. The evidence reviewed indicates that child protection systems should aim for appropriate, permanent family care (including reunification, adoption, kinship care, or kafalah) for children in order to secure the best environment for a child's developmental prospects. Evidence also suggests that the quality and duration of care, including both permanent family care and alternative care, are important regardless of setting. The diversity of political, socioeconomic, historical, regional, community, and cultural contexts in which child protection systems operate need to be taken into account during programming and research design. |
Health-related quality of life among participants in the SMART weight loss trial
Styn MA , Wang J , Acharya SD , Yang K , Chasens ER , Choo J , Ye L , Burke LE . Appl Nurs Res 2012 25 (4) 276-9 Obesity has been associated with a decreased health-related quality of life (HRQoL); however, the association between weight change and HRQoL is unclear. This secondary analysis of the SMART (Self Monitoring And Recording using Technology) trial, a clinical trial of behavioral weight loss treatment, provides evidence that quality of life improves with weight loss. |
Serological evidence for Eastern equine encephalitis virus activity in white-tailed deer, Odocoileus virginianus, in Vermont, 2010
Berl E , Eisen RJ , Macmillan K , Swope BN , Saxton-Shaw KD , Graham AC , Turmel JP , Mutebi JP . Am J Trop Med Hyg 2012 88 (1) 103-7 Serum samples from 489 free-ranging white-tailed deer (Odocoileus virginianus) were screened for antibodies against the Eastern equine encephalitis virus (EEEV) using plaque reduction neutralization tests (PRNTs). EEEV antibodies were detected in 10.2% of serum samples. This evidence is the first evidence that EEEV is present in Vermont. Serum was collected from deer in all 14 counties in the state, and positive EEEV sera were found in 12 (85%) of 14 counties, suggesting statewide EEEV activity in Vermont. Analysis of the spatial distribution of PRNT-positive samples revealed a random distribution of EEEV throughout the state. Results indicate widespread EEEV activity in Vermont, and they suggest that EEEV is not a recent introduction in the state but that EEEV activity has not been detected until now. |
An epizootic of Eastern equine encephalitis virus, Maine, USA in 2009: outbreak description and entomological studies
Lubelczyk C , Mutebi JP , Robinson S , Elias SP , Smith LB , Juris SA , Foss K , Lichtenwalner A , Shively KJ , Hoenig DE , Webber L , Sears S , Smith RP Jr . Am J Trop Med Hyg 2012 88 (1) 95-102 From July to September, 2009, an outbreak of Eastern equine encephalitis virus (EEEv) occurred in five counties in Maine. The virus was isolated from 15 horses, 1 llama, and pheasants in three separate captive flocks. One wild turkey, screened before translocation, also showed exposure to the virus in January 2010. Two pools of Culiseta melanura (Coquillett) tested positive for EEEv during routine seasonal surveillance in York County in September, but none of the mosquitoes collected during rapid response surveys tested positive. There were more Cs. melanura in July, August, and September 2009 than in preceding (2006-08) and subsequent (2010-11) years. August and September Cs. melanura abundances were correlated with July rainfall, and abundance of all species combined was correlated with total rainfall for the meteorological summer. This outbreak represents a substantial expansion of the range of EEEv activity in northern New England. |
Correlation between animal nasal carriage and environmental methicillin-resistant Staphylococcus aureus isolates at U.S. horse and cattle farms
Peterson AE , Davis MF , Awantang G , Limbago B , Fosheim GE , Silbergeld EK . Vet Microbiol 2012 160 539-43 Animals on farms may be a potential reservoir and environmental source of methicillin-resistant Staphylococcus aureus (MRSA). Expanded surveillance methods for animal-associated MRSA are needed. To develop an environmental sampling method and to determine the correlation between animal and environmental MRSA positivity in the farm setting, we sampled horses, cattle, and their local environments at several farms in the mid-Atlantic United States. We obtained nasal swabs from 13 racehorses at first visit, and 11 racehorses at the same farm eight weeks later. We also sampled 26 pleasure horses and 26 beef cattle from two additional farm sites. Sterilized electrostatic cloths were used to collect dry dust samples from environmental surfaces in proximity to animals; cloths were cultured using a broth enrichment protocol. We described isolates by genotype and antimicrobial susceptibility phenotype. None of the samples (nasal or environmental) were positive from the pleasure horse farm or the cattle farm. On the racehorse farm, 8/13 (61%) nasal and 5/7 (71%) environmental samples were positive for MRSA at the first visit. Isolates found were indistinguishable by pulsed-field gel electrophoresis (PFGE) genotype. We observed significant positive correlation between nasal carriage of MRSA in animals and our ability to isolate MRSA from dry surface samples of their local environments. The methods presented here may aid in surveillance efforts for equine and other animal MRSA. This study successfully applies existing MRSA surveillance methods for indoor, high animal density settings to outdoor and low-density farms. |
Content Index (Achived Edition)
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