A public health framework for rare blood disorders.
Grosse SD , James AH , Lloyd-Puryear MA , Atrash HK . Am J Prev Med 2011 41 S319-23 The public health system encompasses governments, healthcare providers, and others working to improve population health. The IOM in 1988 identified three core functions of public health: assessment, policy development, and assurance.1 In 1994, the Core Public Health Functions Steering Committee, which included representatives from U.S. Public Health Service agencies and other major public health organizations, developed the framework for the ten essential services for public health.2 This framework of generic goals and strategies is used by public health programs and systems to address health challenges facing the population or community as a whole, notably environmental hazards, injuries, infections, and common chronic diseases, but has also been applied to blood disorders.3, 4 | The papers in this supplement to the American Journal of Preventive Medicine4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 address various facets of blood disorders and public health. Specifically, the majority of the papers focus on blood disorders that are considered rare in North America or Western Europe. Because of their rarity, rare disorders often are not considered to fall under the purview of the public health system even though, collectively, rare disorders do affect large numbers of people. However, a public health framework is needed to address public health services and functions for all rare disorders, including blood disorders, regardless of the incidence or prevalence of a given disorder. |
Sickle cell disease in Africa: a neglected cause of early childhood mortality.
Grosse SD , Odame I , Atrash HK , Amendah DD , Piel FB , Williams TN . Am J Prev Med 2011 41 S398-405 Sickle cell disease (SCD) is common throughout much of sub-Saharan Africa, affecting up to 3% of births in some parts of the continent. Nevertheless, it remains a low priority for many health ministries. The most common form of SCD is caused by homozygosity for the beta-globin S gene mutation (SS disease). It is widely believed that this condition is associated with very high child mortality, but reliable contemporary data are lacking. We have reviewed available African data on mortality associated with SS disease from published and unpublished sources, with an emphasis on two types of studies: cross-sectional population surveys and cohort studies. We have concluded that, although current data are inadequate to support definitive statements, they are consistent with an early-life mortality of 50%-90% among children born in Africa with SS disease. Inclusion of SCD interventions in child survival policies and programs in Africa could benefit from more precise estimates of numbers of deaths among children with SCD. A simple, representative, and affordable approach to estimate SCD child mortality is to test blood specimens already collected through large population surveys targeting conditions such as HIV, malaria, and malnutrition, and covering children of varying ages. Thus, although there is enough evidence to justify investments in screening, prophylaxis, and treatment for African children with SCD, better data are needed to estimate the numbers of child deaths preventable by such interventions and their cost effectiveness. |
Iron overload: what is the role of public health?
Hulihan MM , Sayers CA , Grosse SD , Garrison C , Grant AM . Am J Prev Med 2011 41 S422-7 Hereditary hemochromatosis type 1, also known as hereditary hemochromatosis classical (HHC), is an iron overload disorder associated, in most cases, with mutations of the hemochromatosis (HFE) gene. Although suggested algorithms for diagnosing iron overload are available, there are still questions about options for genetic and biochemical screening for hemochromatosis and duration of treatment. This article provides a summary of an expert workgroup meeting convened on September 24-25, 2009, entitled "Iron Overload: What is the Role of Public Health?" The purpose of the meeting was to enable subject matter experts to share their most recent clinical and scientific iron overload information and to facilitate the discussion of future endeavors, with special emphasis on the role of public health in this field. The two main topics were the research priorities of the field, including clinical, genetic, and public health issues, and the concerns about the validity of current screening recommendations for the condition. |
Screening U.S. college athletes for their sickle cell disease carrier status.
Jordan LB , Smith-Whitley K , Treadwell MJ , Telfair J , Grant AM , Ohene-Frempong K . Am J Prev Med 2011 41 S406-12 There are many issues surrounding the screening of collegiate athletes for their sickle cell disease carrier status (or sickle cell trait), a genetic condition. This paper summarizes the establishment of expert advice given to the Secretary's Advisory Committee on Heritable Disorders in Newborns and Children (SACHDNC) on the issue. The SACHDNC has developed a report to advise the Secretary of the USDHHS about the 2010 rule of the National Collegiate Athletic Association (NCAA) requiring testing for sickle cell trait in all incoming Division I student athletes. The SACHDNC does not support the NCAA's rule to screen collegiate athletes for sickle cell trait. |
Racial differences in knee osteoarthritis pain: potential contribution of occupational and household tasks
Allen KD , Chen JC , Callahan LF , Golightly YM , Helmick CG , Renner JB , Schwartz TA , Jordan JM . J Rheumatol 2011 39 (2) 337-44 OBJECTIVE: We examined whether occupational and household tasks contributed to differences in pain between African Americans and whites with radiographic knee osteoarthritis (OA). METHODS: Participants from the Johnston County Osteoarthritis Project self-reported the frequency (often/always vs never/seldom/sometimes) of performing 9 occupational tasks involving lower extremity joint loading at their longest job (N = 868) and current job (N = 273), as well as 8 household tasks ever performed (N = 811) and currently being performed (N = 767). The associations of the numbers of occupational or household tasks with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale were first examined in simple linear regression models. If significantly associated with greater pain, each of these was included in adjusted linear regression models to examine whether the association of race with pain remained statistically significant. RESULTS: African Americans reported significantly greater WOMAC pain scores than whites. Exposures to more occupational tasks at the longest job and the current job were associated with greater WOMAC pain scores (p < 0.01). The association of race with greater pain scores remained statistically significant when controlling for occupational tasks at the longest job, but was reduced by 26% and no longer significant when controlling for the number of current occupational tasks. Exposures to an increasing number of household tasks were associated with lower pain scores and were not further analyzed. CONCLUSION: Current performance of physically demanding occupational tasks contributed to racial differences in pain severity among individuals with knee OA. Better workplace policies to accommodate OA-related limitations may help to reduce racial differences in pain. |
Sickle cell disease the need for a public health agenda
Yusuf HR , Lloyd-Puryear MA , Grant AM , Parker CS , Creary MS , Atrash HK . Am J Prev Med 2011 41 S376-83 Sickle cell disease (SCD) is a collection of inherited blood disorders that affect a substantial number of people in the U.S., particularly African Americans. People with SCD have an abnormal type of hemoglobin, Hb S, which polymerizes when deoxygenated, causing the red blood cells to become misshapen and rigid. Individuals with SCD are at higher risk of morbidity and mortality from infections, vaso-occlusive pain crises, acute chest syndrome, and other complications. Addressing the public health needs related to SCD is an important step toward improving outcomes and maintaining health for those affected by the disorder. The objective of this study was to review public health activities focusing on SCD and define the need to address it more comprehensively from a public health perspective. We found that there has been some progress in the development of SCD-related public health activities. Such activities include establishing newborn screening (NBS) for SCD with all states currently having universal NBS programs. However, additional areas needing focus include strengthening surveillance and monitoring of disease occurrence and health outcomes, enhancing adherence to health maintenance guidelines, increasing knowledge and awareness among those affected, and improving healthcare access and utilization. These and other activities discussed in this paper can help strengthen public health efforts to address SCD. |
Smoothed percentage body fat percentiles for U.S. children and adolescents, 1999-2004
Ogden CL , Li Y , Freedman DS , Borrud LG , Flegal KM . Natl Health Stat Report 2011 (43) 1-7 BACKGROUND: The high prevalence of obesity (defined by body mass index) among children and adolescents in the United States and elsewhere has prompted increased attention to body fat in childhood and adolescence. OBJECTIVE: This report provides smoothed estimates of major percentiles of percentage body fat for boys and girls aged 8-19 years in the United States. METHODS: Percentage body fat was obtained from whole-body, dual-energy x-ray absorptiometry (DXA) scans conducted during the 1999-2004 National Health and Nutrition Examination Survey. A nonparametric double-kernel method was employed to smooth percentile curves for the DXA data. RESULTS: The pattern of body fat development differs between boys and girls aged 8-19 years. In most age groups, girls have a higher percentage of body fat than boys. Among boys, there is a drop in body fat percentage in early adolescence that is especially pronounced at the higher percentiles. Among girls this pattern is not seen; percentage body fat increases slightly with age. CONCLUSIONS: These results provide a smoothed reference distribution of percentage body fat for U.S. children and adolescents aged 8-19 years. |
Physical functioning in boys with hemophilia in the U.S.
Monahan PE , Baker JR , Riske B , Soucie JM . Am J Prev Med 2011 41 S360-8 BACKGROUND: Hemophilia is the most common inherited severe bleeding disorder. Although the most frequent complication of repeated hemorrhages is a crippling joint disease that begins in childhood, the extent of resultant joint functional impairment varies widely within the hemophilia population. PURPOSE: The goal of this exploratory analysis was to examine a national database that collects information on boys with hemophilia, an X-linked severe congenital bleeding disorder, to determine characteristics associated with increased risk of developing limitations in physical functioning as an outcome of recurrent hemorrhages. METHODS: A standard set of data is collected annually at approximately 130 U.S. comprehensive hemophilia treatment centers (HTCs) in a voluntary surveillance program called the Universal Data Collection (UDC) program. Fifteen potential predictors for poor outcomes of physical functioning related to bleeding were examined for boys (aged ≤18 years) from 1998 to 2008. Bivariate and multivariate analyses of these predictors performed in 2009 examined associations with self-reported limitation of activities, absenteeism from work or school, and reliance on assistive devices for ambulation and mobility. RESULTS: Multiple characteristics of underlying hemophilia severity and disease chronicity (in particular, increasing age, presence of joint bleeding, and inhibitor antibodies) were independently associated with increased risk of limitations of physical function. Nonwhite race/ethnicity was associated with each of the poorer functional outcomes in bivariate analyses. After controlling for the potential confounding effects of the multiple population characteristics on race, only African-American race was independently associated with activity restrictions, and African-American and Asian/Pacific Island ethnicity with absenteeism. With the exception of indicators of underlying disease severity, only obesity and medical insurance coverage with Medicaid rather than commercial insurance were independently associated with multiple poor outcomes. CONCLUSIONS: Interventions focused on eliminating inhibitors, improving outcomes for African-American children with hemophilia, and maintaining healthy body weight are warranted. In addition, strategies are needed to assure adequate insurance coverage for all people with hemophilia to eliminate economic barriers to optimal functional outcomes. |
Public health implications of sickle cell trait: a report of the CDC meeting
Grant AM , Parker CS , Jordan LB , Hulihan MM , Creary MS , Lloyd-Puryear MA , Goldsmith JC , Atrash HK . Am J Prev Med 2011 41 S435-9 Although the issue of whether sickle cell trait (SCT) is clinically benign or a significant health concern has not yet been resolved, the potential health risk to affected individuals is of vital importance and represents a tremendous challenge in protecting, promoting, and improving the health of the approximately 300 million people worldwide and 3 million people in the U.S. who possess the trait. In response to a request by the Sickle Cell Disease Association of America, in December 2009, the CDC convened a meeting of partners, stakeholders, and experts to identify the gaps in public health, clinical health services, epidemiologic research, and community-based outreach strategies and to develop an agenda for future initiatives. Through facilitated discussion and presentations in four topic areas, participants discussed pertinent issues, synthesized clinical research findings, and developed a coherent framework for establishing an agenda for future initiatives. A primary outcome of the meeting was to provide the first step of an iterative process to move toward agreement regarding appropriate counseling, care, and, potentially, treatment of people with SCT. |
Glycaemia and correlates of patient-reported outcomes in ACCORD trial participants
Ali MK , Feeney P , Hire D , Simmons DL , O'Connor PJ , Ganz-Lord F , Goff D Jr , Zhang P , Andersen R , V Narayan KM , Sullivan MD . Diabet Med 2011 29 (7) e67-74 AIMS: Post-hoc evaluation of relationships between first-year change in glycaemic control (HbA(1c) ) and change in patient-reported outcomes among ACCORD health-related quality of life (HRQoL) substudy participants. METHODS: Data from 2053 glycaemia-trial subjects were analysed. We assessed physical and mental health status (36-Item Short Form Health Survey, Version-2), symptom count and severity (Diabetes Symptoms Distress Checklist) and treatment satisfaction (Diabetes Treatment Satisfaction Questionnaire). Linear mixed models were used to test relationships between 1-year changes in HbA(1c) and, patient reported outcomes sequentially adjusting for correlates (baseline characteristics, baseline patient reported outcomes, treatment assignment, frequency of clinical contact and post-randomization weight change plus new complications). RESULTS: Poorer baseline control of HbA(1c) and cardiovascular disease risk factors predicted greater one-year improvements in treatment satisfaction. Similarly, poorer baseline patient reported outcome scores all individually predicted greater 1-year improvement in that same outcome. Accounting for baseline and post-randomization characteristics and treatment arm, 1-year change in HbA(1c) was unrelated to changes in overall physical or mental health; however, every one percentage-point (10.9 mmol/mol) reduction in HbA(1c) was associated with lower symptom count (beta = 0.599; P = 0.012), lower symptom distress (beta = 0.051; P = 0.001), and higher treatment satisfaction (beta = -2.514; P < 0.001). CONCLUSIONS: Independent of all relevant covariates, better glycaemic control over 1 year was associated with reduced patient-reported diabetes symptoms and symptom distress, and increased treatment satisfaction, but not overall physical and mental health. Further investigation is required to understand the specific psychosocial mechanisms that affect how patients value health and treatments. ((c) 2011 The Authors. Diabetic Medicine(c) 2011 Diabetes UK). |
Insurance, home therapy, and prophylaxis in U.S. youth with severe hemophilia
Baker JR , Riske B , Voutsis M , Cutter S , Presley R . Am J Prev Med 2011 41 S338-45 BACKGROUND: Home infusion therapy, particularly on a prophylactic regimen, is linked with reduced morbidity among youth with severe hemophilia. However, the association of insurance coverage with these home therapies is unknown. PURPOSE: This study explores the connections among insurance, home infusion therapy, and prophylaxis treatment in a nationwide cohort of 3380 boys and young men (aged 2 to 20 years) with severe hemophilia. These youth obtained care at one of 129 federally supported hemophilia treatment centers (HTCs), and enrolled in the CDC's bleeding disorder surveillance project. METHODS: Multiple regression was used to analyze the independent association among risk factors, including insurance, and both home infusion and prophylaxis. Data were obtained between January 1, 2008, and December 31, 2010, and analyzed in 2011. RESULTS: Ninety percent used home therapy and 78% a prophylaxis regimen. Only 2% were uninsured. Health insurance was significantly associated with prophylaxis, but not with home therapy. Lower prophylaxis utilization rates were independently associated with having Medicaid, "other," and no insurance as compared to having private insurance. Race, age, inhibitor status, and HTC utilization were also independently associated with both home therapy and prophylaxis. CONCLUSIONS: Youth with severe hemophilia who annually obtain care within the U.S. HTC network had a high level of health insurance, home therapy, and prophylaxis. Exploration of factors associated with insurance coverage and yearly HTC utilization, and interventions to optimize home infusion and prophylaxis among youth of African-American and "other" race/ethnic backgrounds are warranted. |
Knowledge and therapeutic gaps: a public health problem in the rare coagulation disorders population
Shapiro AD , Soucie JM , Peyvandi F , Aschman DJ , Dimichele DM . Am J Prev Med 2011 41 S324-31 Rare coagulation disorders (RCDs) present a considerable and multifaceted public health risk. Although inherited RCDs affect a minor segment of any local healthcare delivery system, their global impact is major and highlight the challenges of delivering healthcare services to any rare disease population. These include but are not limited to: (1) a general lack of knowledge about and familiarity with the genetic and clinical implications of the disorder among affected patients, and both urgent and specialty care providers; (2) the potential for preventable morbidity and mortality related to delayed diagnosis and treatment; (3) the lack of safe and effective therapies; and (4) minimal research activity to establish and improve standards of care. A multiagency national partnership has established an approach to address these problems through development of a clinical, genetic, and treatment-related web-based data-collection tool that will: (1) generate a reliable, sufficient knowledge base for these disorders; (2) facilitate new product licensure through subject identification and access to comparative historical treatment data; and (3) serve as an effective tool for outcomes research and post-licensure product surveillance. To maximize impact, this database is being harmonized with a European data-collection effort. Database development and harmonization is in progress. A resource library was completed and disseminated to major national and international bleeding disorder websites to provide state-of-the-art patient and provider education on each RCD. We believe that this model is effective and adaptable to other rare conditions. |
Disability among individuals with sickle cell disease: literature review from a public health perspective
Swanson ME , Grosse SD , Kulkarni R . Am J Prev Med 2011 41 S390-7 CONTEXT: Young people with blood disorders face challenges in maintaining their physical health as they age. Sickle cell disease has well-documented complications in various organ systems. Increasingly, professionals, consumers, and advocates involved in blood disorders are concerned about the cumulative and ongoing effect of organ-specific complications on function and participation. EVIDENCE ACQUISITION: Publications were identified that looked at the relationship between sickle cell disease and associated impairments and restrictions in participation as defined by the International Classification of Function, Disability, and Health (ICF). EVIDENCE SYNTHESIS: This article organizes a literature review in PubMed using ICF terms that define functional limitations and participation restrictions in sickle cell disease. CONCLUSIONS: Individuals with sickle cell disease experience complications in multiple organ systems that affect related functions and, consequently, participation in community living. The effects begin early in childhood and accumulate across the life course into adulthood. Intervention research is needed to understand how contextual factors can promote optimal function and participation in the face of mounting impairments. |
Divergent trends for gastric cancer incidence by anatomical subsite in US adults
Camargo MC , Anderson WF , King JB , Correa P , Thomas CC , Rosenberg PS , Eheman CR , Rabkin CS . Gut 2011 60 (12) 1644-9 BACKGROUND AND AIM: Age-specific analyses of non-cardia gastric cancer incidence reveal divergent trends among US whites: rates are declining in individuals aged 40 years and older but rising in younger persons. To investigate this heterogeneity further, incidence trends were evaluated by anatomical subsite. METHODS: Gastric cancer incidence data for 1976-2007 were obtained from the US National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program and the US Centers for Disease Control and Prevention's National Program of Cancer Registries (NPCR). Incidence rates and estimated annual percentage change were calculated by age group (25-39, 40-59 and 60-84 years), race/ethnicity and subsite. RESULTS: Based on data from the nine oldest SEER registries (covering approximately 10% of the US population), rates for all non-cardia subsites decreased in whites and blacks, except for corpus cancer, which increased between 1976 and 2007 with estimated annual percentage changes of 1.0% (95% CI 0.1% to 1.9%) for whites and 3.5% (95% CI 1.8% to 5.2%) for blacks. In contrast, rates for all non-cardia subsites including corpus cancer declined among other races. In combined data from NPCR and SEER registries (covering 89% of the US population), corpus cancer significantly increased between 1999 and 2007 among younger and middle-aged whites; in ethnic-specific analyses, rates significantly increased among the same age groups in non-Hispanic whites and were stable among Hispanic whites. Age-specific rates for all subsites declined or were stable in this period among blacks and other races. CONCLUSIONS: Long- and short-term incidence trends for gastric cancers indicate a shifting distribution by anatomical subsite. Corpus cancer may have distinctive aetiology and changing risk factor exposures, warranting further investigation. |
Differential microRNA expression and virulence of avian, 1918 reassortant, and reconstructed 1918 influenza A viruses.
Li Y , Li J , Belisle S , Baskin CR , Tumpey TM , Katze MG . Virology 2011 421 (2) 105-13 Infections with highly pathogenic H5N1 avian (HPAI) and 1918 pandemic H1N1 influenza viruses cause uncontrolled local and systemic inflammation. The mechanism for this response is poorly understood, despite its importance as a determinant of virulence. Therefore we profiled cellular microRNAs of lung tissue from cynomolgus macaques (Macaca fascicularis) infected with a HPAI and a less pathogenic 1918 H1N1 reassortant virus to understand microRNA contribution to host response. We identified 23 microRNAs associated with the extreme virulence of HPAI, with expression patterns inversely correlated with that of predicted gene targets. Pathway analyses confirmed that these targets were associated with aberrant and uncontrolled inflammatory responses and increased cell death. Importantly, similar microRNAs were associated with lethal 1918 pandemic virus infections in mice. This study suggests that virulence of highly pathogenic influenza viruses may be mediated in part by cellular microRNA through dysregulation of genes critical to the inflammatory process. |
A review of Nipah and Hendra viruses with an historical aside
Ksiazek TG , Rota PA , Rollin PE . Virus Res 2011 162 173-83 The emergence of Hendra and Nipah viruses in the 1990s has been followed by the further emergence of these viruses in the tropical Old World. The history and current knowledge of the disease, the viruses and their epidemiology is reviewed in this article. A historical aside summarizes the role that Dr. Brian W.J. Mahy played at critical junctures in the early stories of these viruses. |
Serological response to Bartonella species in febrile patients from Nepal
Myint KS , Gibbons RV , Iverson J , Shrestha SK , Pavlin JA , Mongkolsirichaikul D , Kosoy MY . Trans R Soc Trop Med Hyg 2011 105 (12) 740-2 The Bartonella-associated illnesses are spread world-wide and involve a broad spectrum of signs and symptoms in humans. Several Bartonella species have been shown to be responsible for cases of febrile illnesses. Little information exists on distribution of Bartonella species and their role in human diseases in Nepal. Our preliminary study, a retrospective serological survey of archived specimens, suggests that Bartonella antibodies are prevalent among febrile patients in the Kathmandu Valley of Nepal. |
Tuberculosis among children in Kenya: epidemiology and impact of HIV in two provinces
Cavanaugh J , Genga K , Marigu I , Laserson K , Ackers M , Cain K . J Trop Pediatr 2011 58 (4) 292-6 We collected clinical register data on children in two provinces of Kenya and conducted bivariate and multivariate analyses to assess characteristics associated with death. Among 987 children with tuberculosis (TB), pulmonary disease was diagnosed in 689 (70%) children. Final outcomes were known for 830 children, 40 (5%) of whom died during TB treatment. HIV test results were available for 670 (68%) children; 371 (55%) of whom tested positive. Only 63 of 134 (47%) of children <1 year were tested for HIV. There were no data on CD4 or anti-retroviral use. The relative risk for death for HIV-infected children compared to HIV-uninfected children was 9.3 for children <1 year [95% confidence interval (CI) 1.2-69.2], 3.9 for children aged 1-4 (95% CI 0.9-17.7) and 0.9 for children aged 5-14 (95% CI 0.3-2.6). In Kenya, HIV infection in children with TB is common, and our data suggest that HIV is particularly deadly in TB patients <1 year, the group with the lowest rate of testing. Poor data recording and reporting limit our understanding of TB in this age group. Expansion of HIV testing may improve survival, and more complete data recording and reporting will enhance our understanding of pediatric TB. |
Voluntary medical male circumcision: translating research into the rapid expansion of services in Kenya, 2008-2011
Mwandi Z , Murphy A , Reed J , Chesang K , Njeuhmeli E , Agot K , Llewellyn E , Kirui C , Serrem K , Abuya I , Loolpapit M , Mbayaki R , Kiriro N , Cherutich P , Muraguri N , Motoku J , Kioko J , Knight N , Bock N . PLoS Med 2011 8 (11) e1001130 Since the World Health Organization and the Joint United Nations Programme on HIV/AIDS recommended implementation of medical male circumcision (MC) as part of HIV prevention in areas with low MC and high HIV prevalence rates in 2007, the government of Kenya has developed a strategy to circumcise 80% of uncircumcised men within five years. To facilitate the quick translation of research to practice, a national MC task force was formed in 2007, a medical MC policy was implemented in early 2008, and Nyanza Province, the region with the highest HIV burden and low rates of circumcision, was prioritized for services under the direction of a provincial voluntary medical male circumcision (VMMC) task force. The government's early and continuous engagement with community leaders/elders, politicians, youth, and women's groups has led to the rapid endorsement and acceptance of VMMC. In addition, several innovative approaches have helped to optimize VMMC scale-up. Since October 2008, the Kenyan VMMC program has circumcised approximately 290,000 men, mainly in Nyanza Province, an accomplishment made possible through a combination of governmental leadership, a documented implementation strategy, and the adoption of appropriate and innovative approaches. Kenya's success provides a model for others planning VMMC scale-up programs. |
Estimating the burden of tuberculosis among foreign-born persons acquired prior to entering the U.S., 2005-2009
Ricks PM , Cain KP , Oeltmann JE , Kammerer JS , Moonan PK . PLoS One 2011 6 (11) e27405 BACKGROUND: The true burden of reactivation of remote latent tuberculosis infection (reactivation TB) among foreign-born persons with tuberculosis (TB) within the United States is not known. Our study objectives were to estimate the proportion of foreign-born persons with TB due reactivation TB and to describe characteristics of foreign-born persons with reactivation TB. METHODS: We conducted a cross-sectional study of patients with an M. tuberculosis isolate genotyped by the U.S. National TB Genotyping Service, 2005-2009. TB cases were attributed to reactivation TB if they were not a member of a localized cluster of cases. Localized clusters were determined by a spatial scan statistic of cases with isolates with matching TB genotype results. Crude odds ratios and 95% confidence intervals were used to assess relations between reactivation TB and select factors among foreign-born persons. MAIN RESULTS: Among the 36,860 cases with genotyping and surveillance data reported, 22,151 (60%) were foreign-born. Among foreign-born persons with TB, 18,540 (83.7%) were attributed to reactivation TB. Reactivation TB among foreign-born persons was associated with increasing age at arrival, incidence of TB in the country of origin, and decreased time in the U.S. at the time of TB diagnosis. CONCLUSIONS: Four out of five TB cases among foreign-born persons can be attributed to reactivation TB and present the largest challenge to TB elimination in the U.S. TB control strategies among foreign-born persons should focus on finding and treating latent tuberculosis infection prior to or shortly after arrival to the United States and on reducing the burden of LTBI through improvements in global TB control. |
A family cluster of infections by a newly recognized Bunyavirus in eastern China, 2007: further evidence of person-to-person transmission
Bao CJ , Guo XL , Qi X , Hu JL , Zhou MH , Varma JK , Cui LB , Yang HT , Jiao YJ , Klena JD , Li LX , Tao WY , Li X , Chen Y , Zhu Z , Xu K , Shen AH , Wu T , Peng HY , Li ZF , Shan J , Shi ZY , Wang H . Clin Infect Dis 2011 53 (12) 1208-14 BACKGROUND: Seven persons in one family living in eastern China developed fever and thrombocytopenia during May 2007, but the initial investigation failed to identify an infectious etiology. In December 2009, a novel bunyavirus (designated severe fever with thrombocytopenia syndrome bunyavirus [SFTSV]) was identified as the cause of illness in patients with similar clinical manifestations in China. We reexamined this family cluster for SFTSV infection. METHODS: We analyzed epidemiological and clinical data for the index patient and 6 secondary patients. We tested stored blood specimens from the 6 secondary patients using real time reverse transcription polymerase chain reaction (RT-PCR), viral culture, genetic sequencing, micro-neutralization assay (MNA), and indirect immunofluorescence assay (IFA). RESULTS: An 80-year-old woman with fever, leucopenia, and thrombocytopenia died on 27 April 2007. Between 3 and 7 May 2007, another 6 patients from her family were admitted to a local county hospital with fever and other similar symptoms. Serum specimens collected in 2007 from these 6 patients were positive for SFTS viral RNA through RT-PCR and for antibody to SFTSV through MNA and IFA. SFTSV was isolated from 1 preserved serum specimen. The only shared characteristic between secondary patients was personal contact with the index patient; none reported exposure to suspected animals or vectors. CONCLUSIONS: Clinical and laboratory evidence confirmed that the patients of fever and thrombocytopenia occurring in a family cluster in eastern China in 2007 were caused by a newly recognized bunyavirus, SFTSV. Epidemiological investigation strongly suggests that infection of secondary patients was transmitted to family members by personal contact. |
Hantavirus pulmonary syndrome
Macneil A , Nichol ST , Spiropoulou CF . Virus Res 2011 162 138-47 Hantavirus pulmonary syndrome (HPS) is a severe disease characterized by a rapid onset of pulmonary edema followed by respiratory failure and cardiogenic shock. The HPS associated viruses are members of the genus Hantavirus, family Bunyaviridae. Hantaviruses have a worldwide distribution and are broadly split into the New World hantaviruses, which includes those causing HPS, and the Old World hantaviruses [including the prototype Hantaan virus (HTNV)], which are associated with a different disease, hemorrhagic fever with renal syndrome (HFRS). Sin Nombre virus (SNV) and Andes virus (ANDV) are the most common causes of HPS in North and South America, respectively. Case fatality of HPS is approximately 40%. Pathogenic New World hantaviruses infect the lung microvascular endothelium without causing any virus induced cytopathic effect. However, virus infection results in microvascular leakage, which is the hallmark of HPS. This article briefly reviews the knowledge on HPS-associated hantaviruses accumulated since their discovery, less than 20 years ago. |
Are dual-method messages undermining STI/HIV prevention?
O'Leary A . Infect Dis Obstet Gynecol 2011 2011 691210 Adolescent girls and young women who are at risk for unplanned pregnancy and sexually transmitted infection (STI), including HIV, are frequently counseled to use a hormonal contraceptive to protect against the former and condoms to protect against the latter, for exampe, American College of Obstetricians and Gynecologists, 2011. The present paper reviews the literature on multiple risk messages, compliance with this dual-use recommendation, predictors of dual use, and interventions developed to encourage dual use. Data indicate that simultaneous use of these two methods is not common, and that efforts to encourage dual use have not yielded promising results. An alternative is to recommend condom use alone, since condoms protect very well against STI and HIV, and quite well against pregnancy when used consistently and correctly. The availability of emergency contraception is relevant here. Research utilizing a randomized controlled trial is recommended. |
Correlates of mother-to-child transmission of HIV in the United States and Puerto Rico
Whitmore SK , Taylor AW , Espinoza L , Shouse RL , Lampe MA , Nesheim S . Pediatrics 2011 129 (1) e74-81 OBJECTIVE: The goal of this study was to examine associations between demographic, behavioral, and clinical variables and mother-to-child HIV transmission in 15 US jurisdictions for birth years 2005 through 2008. METHODS: The study used Enhanced Perinatal Surveillance system data for HIV-infected women who gave birth to live infants. Multivariable logistic regression was used to assess variables associated with mother-to-child transmission. RESULTS: Among 8054 births, 179 infants (2.2%) were diagnosed with HIV infection. Half of the births had at least 1 missed prevention opportunity: 74.3% of infected infants, 52.1% of uninfected infants. Among 7757 mother-infant pairs with sufficient data for analysis, the odds of having an HIV-infected infant were higher for women who received late testing or no prenatal antiretroviral medications (odds ratio: 2.5 [95% confidence interval (CI): 1.5-4.0] and 3.5 [95% CI: 2.0-6.4], respectively). The odds for mothers who breastfed were 4.6 times (95% CI: 2.2-9.8) the odds for those who did not breastfeed. The adjusted odds for women with CD4 counts <200 cells per microliter were 2.4 times (95% CI: 1.4-4.2) those for women with CD4 counts ≥500 cells per microliter. The odds for women who abused substances were twice (95% CI: 1.4-2.9) those for women who did not. CONCLUSIONS: The odds of having an HIV-infected infant were higher among HIV-infected women who were tested late, had no antiretroviral medications, abused substances, breastfed, or had lower CD4 cell counts. Increases in earlier HIV diagnosis, substance abuse treatment, avoidance of breastfeeding, and use of prenatal antiretroviral medications are critical in eliminating perinatal HIV infections in the United States. |
Spatial stability of adult Aedes aegypti populations
Barrera R . Am J Trop Med Hyg 2011 85 (6) 1087-92 Vector control programs could be more efficient by identifying the location of highly productive sites of Aedes aegypti. This study explored if the number of female adults of Ae. aegypti in BG-Sentinel traps was clustered and if their spatial distribution changed in time in two neighborhoods in San Juan, Puerto Rico. Traps were uniformly distributed across each neighborhood (130 m from each other), and samples were taken every 3 weeks. Global and local spatial autocorrelations were explored. Spatial stability existed if the rank order of trap captures was kept in time. There was lack of global autocorrelation in both neighborhoods, precluding their stratification for control purposes. Hot and cold spots were identified, revealing the highly focal nature of Ae. aegypti. There was significant spatial stability throughout the study in both locations. The consistency in trap productivity in time could be used to increase the effectiveness of vector and dengue control programs. |
Elimination of Borrelia burgdorferi and Anaplasma phagocytophilum in rodent reservoirs and Ixodes scapularis ticks using a doxycycline hyclate-laden bait
Dolan MC , Schulze TL , Jordan RA , Dietrich G , Schulze CJ , Hojgaard A , Ullmann AJ , Sackal C , Zeidner NS , Piesman J . Am J Trop Med Hyg 2011 85 (6) 1114-20 A field trial was conducted in a Lyme disease-endemic area of New Jersey to determine the efficacy of a doxycyline hyclate rodent bait to prophylactically protect and cure small-mammal reservoirs and reduce infection rates in questing Ixodes scapularis ticks for Borrelia burgdorferi and Anaplasma phagocytophilum. The doxycycline-laden bait was formulated at a concentration of 500 mg/kg and delivered during the immature tick feeding season in rodent-targeted bait boxes. The percentage of infected small mammals recovered from treated areas after 2 years of treatment was reduced by 86.9% for B. burgdorferi and 74% for A. phagocytophilum. Infection rates in questing nymphal ticks for both B. burgdorferi and A. phagocytophilum were reduced by 94.3% and 92%, respectively. Results from this study indicate that doxycycline-impregnated bait is an effective means of reducing infection rates for B. burgdorferi and A. phagocytophilum in both rodent reservoirs and questing I. scapularis ticks. |
Envelope and pre-membrane protein structural amino acid mutations mediate diminished avian growth and virulence of a Mexican West Nile virus isolate
Langevin SA , Bowen RA , Ramey WN , Sanders TA , Maharaj PD , Fang Y , Cornelius J , Barker CM , Reisen WK , Beasley DW , Barrett AD , Kinney RM , Huang CY , Brault AC . J Gen Virol 2011 92 2810-20 The hallmark attribute of North American West Nile virus (WNV) strains has been high pathogenicity in certain bird species. Surprisingly, this avian virulent WNV phenotype has not been observed during its geographical expansion into the Caribbean, Central America and South America. One WNV variant (TM171-03-pp1) isolated in Mexico has demonstrated an attenuated phenotype in two widely distributed North American bird species, American crows (AMCRs) and house sparrows (HOSPs). In order to identify genetic determinants associated with attenuated avian replication of the TM171-03-pp1 variant, chimeric viruses between the NY99 and Mexican strains were generated, and their replicative capacity was assessed in cell culture and in AMCR, HOSP and house finch avian hosts. The results demonstrated that mutations in both the pre-membrane (prM-I141T) and envelope (E-S156P) genes mediated the attenuation phenotype of the WNV TM171-03-pp1 variant in a chicken macrophage cell line and in all three avian species assayed. Inclusion of the prM-I141T and E-S156P TM171-03-pp1 mutations in the NY99 backbone was necessary to achieve the avian attenuation level of the Mexican virus. Furthermore, reciprocal incorporation of both prM-T141I and E-P156S substitutions into the Mexican virus genome was necessary to generate a virus that exhibited avian virulence equivalent to the NY99 virus. These structural changes may indicate the presence of new evolutionary pressures exerted on WNV populations circulating in Latin America or may signify a genetic bottleneck that has constrained their epiornitic potential in alternative geographical locations. |
Libby vermiculite exposure and risk of developing asbestos-related lung and pleural diseases
Antao VC , Larson TC , Horton DK . Curr Opin Pulm Med 2011 18 (2) 161-7 PURPOSE OF REVIEW: The vermiculite ore formerly mined in Libby, Montana, contains asbestiform amphibole fibers of winchite, richterite, and tremolite asbestos. Because of the public health impact of widespread occupational and nonoccupational exposure to amphiboles in Libby vermiculite, numerous related studies have been published in recent years. Here we review current research related to this issue. RECENT FINDINGS: Excess morbidity and mortality classically associated with asbestos exposure have been well documented among persons exposed to Libby vermiculite. Excess morbidity and mortality have likewise been documented among persons with only nonoccupational exposure. A strong exposure-response relationship exists for many malignant and nonmalignant outcomes and the most common outcome, pleural plaques, may occur at low lifetime cumulative exposures. SUMMARY: The public health situation related to Libby, Montana, has led to huge investments in public health actions and research. The resulting studies have added much to the body of knowledge concerning health effects of exposures to Libby amphibole fibers specifically and asbestos exposure in general. |
Race and rickettsiae: a United States perspective
Dahlgren FS , Moonesinghe R , McQuiston JH . Am J Trop Med Hyg 2011 85 (6) 1124-5 US surveillance programs for Rocky Mountain spotted fever (RMSF), ehrlichiosis, and anaplasmosis collect demographic data on patients, including race and ethnicity. Reporting of these diseases among race groups is not uniform across the United States. Because a laboratory confirmation is required to meet the national surveillance case definition, reporting may be influenced by a patient's access to healthcare. Determining the association between race and ethnicity with incidence of rickettsial infections requires targeted, active surveillance. |
Low usage of government healthcare facilities for acute respiratory infections in Guatemala: implications for influenza surveillance
Lindblade KA , Johnson AJ , Arvelo W , Zhang X , Jordan HT , Reyes L , Fry AM , Padilla N . BMC Public Health 2011 11 (1) 885 BACKGROUND: Sentinel surveillance for severe acute respiratory infections in hospitals and influenza-like illness in ambulatory clinics is recommended to assist in global pandemic influenza preparedness. Healthcare utilization patterns will affect the generalizability of data from sentinel sites and the potential to use them to estimate burden of disease. The objective of this study was to measure healthcare utilization patterns in Guatemala to inform the establishment of a sentinel surveillance system for influenza and other respiratory infections, and allow estimation of disease burden. METHODS: We used a stratified, two-stage cluster survey sample to select 1200 households from the Department of Santa Rosa. Trained interviewers screened household residents for self-reported pneumonia in the last year and influenza-like illness (ILI) in the last month and asked about healthcare utilization for each illness episode. RESULTS: We surveyed 1131 (94%) households and 5449 residents between October and December 2006 and identified 323 (6%) cases of pneumonia and 628 (13%) cases of ILI. Treatment for pneumonia outside the home was sought by 92% of the children <5 years old and 73% of the persons aged five years and older. For both children <5 years old (53%) and persons aged five years and older (31%) who reported pneumonia, private clinics were the most frequently reported source of care. For ILI, treatment was sought outside the home by 81% of children <5 years old and 65% of persons aged five years and older. Government ambulatory clinics were the most frequently sought source of care for ILI both for children <5 years old (41%) and persons aged five years and older (36%). CONCLUSIONS: Sentinel surveillance for influenza and other respiratory infections based in government health facilities in Guatemala will significantly underestimate the burden of disease. Adjustment for healthcare utilization practices will permit more accurate estimation of the incidence of influenza and other respiratory pathogens in the community. |
Detection of pelvic inflammatory disease: development of an automated case-finding algorithm using administrative data
Satterwhite CL , Yu O , Raebel MA , Berman S , Howards PP , Weinstock H , Kleinbaum D , Scholes D . Infect Dis Obstet Gynecol 2011 2011 428351 ICD-9 codes are conventionally used to identify pelvic inflammatory disease (PID) from administrative data for surveillance purposes. This approach may include non-PID cases. To refine PID case identification among women with ICD-9 codes suggestive of PID, a case-finding algorithm was developed using additional variables. Potential PID cases were identified among women aged 15-44 years at Group Health (GH) and Kaiser Permanente Colorado (KPCO) and verified by medical record review. A classification and regression tree analysis was used to develop the algorithm at GH; validation occurred at KPCO. The positive predictive value (PPV) for using ICD-9 codes alone to identify clinical PID cases was 79%. The algorithm identified PID appropriate treatment and age 15-25 years as predictors. Algorithm sensitivity (GH = 96.4%; KPCO = 90.3%) and PPV (GH = 86.9%; KPCO = 84.5%) were high, but specificity was poor (GH = 45.9%; KPCO = 37.0%). In GH, the algorithm offered a practical alternative to medical record review to further improve PID case identification. |
Developing public health surveillance for deep vein thrombosis and pulmonary embolism
Beckman MG , Grosse SD , Kenney KM , Grant AM , Atrash HK . Am J Prev Med 2011 41 S428-34 Deep vein thrombosis (DVT) and pulmonary embolism (PE), collectively known as venous thromboembolism (VTE), are an important and growing public health issue, associated with considerable morbidity and mortality. Presently, there is no national surveillance for DVT and PE. This article provides a summary of an expert workgroup meeting convened January 12, 2010, by the CDC. The purpose of the meeting was to inform CDC on the development of U.S. population-based public health surveillance activities for DVT/PE. Topics discussed included: (1) stakeholders, needs, gaps, and target populations; (2) requirements of surveillance systems; (3) challenges, limitations, and potential barriers to implementation of surveillance activities; and (4) integration of research and education with surveillance activities. |
Variants in ABCB1, TGFB1, and XRCC1 genes and susceptibility to viral hepatitis A infection in Mexican Americans.
Zhang L , Yesupriya A , Hu DJ , Chang MH , Dowling NF , Ned RM , Udhayakumar V , Lindegren ML , Khudyakov Y . Hepatology 2011 55 (4) 1008-18 Hepatitis A vaccination has dramatically reduced the incidence of hepatitis A virus (HAV) infection, but new infections continue to occur. To identify human genetic variants conferring a risk for HAV infection among the three major racial/ethnic populations in the United States, we assess associations between 67 genetic variants (single nucleotide polymorphisms, 'SNPs') among 31 candidate genes and serologic evidence of prior HAV infection using a population-based, cross-sectional study of 6779 participants, including 2619 non-Hispanic whites, 2095 non-Hispanic blacks, and 2065 Mexican Americans, enrolled in phase 2 (1991-1994) of the Third National Health and Nutrition Examination Survey. Among the three racial/ethnic groups, the number (weighted frequency) of seropositivity for antibody to HAV (anti-HAV) was 958 (24.9%), 802 (39.2%), and 1540 (71.5%), respectively. No significant associations with any of the 67 SNPs were observed among non-Hispanic whites or non-Hispanic blacks. In contrast, among Mexican Americans, variants in two genes were found to be associated with an increased risk of HAV infection: TGFB1 rs1800469 (adjusted odds ratio [OR] = 1.38; 95% confidence interval [CI], 1.14-1.68; p-value adjusted for false discovery rate [FDR-P] = 0.017) and XRCC1 rs1799782 (OR = 1.57; 95% CI, 1.27-1.94; FDR-P = 0.0007). A decreased risk was found with ABCB1 rs1045642 (OR = 0.79; 95% CI, 0.71-0.89; FDR-P = 0.0007). CONCLUSIONS: Genetic variants in ABCB1, TGFB1, and XRCC1 appear to be associated with susceptibility to HAV infection among Mexican Americans. Replication studies involving larger population samples are warranted. (HEPATOLOGY 2011). |
DNA priming and influenza vaccine immunogenicity: two phase 1 open label randomised clinical trials.
Ledgerwood JE , Wei CJ , Hu Z , Gordon IJ , Enama ME , Hendel CS , McTamney PM , Pearce MB , Yassine HM , Boyington JC , Bailer R , Tumpey TM , Koup RA , Mascola JR , Nabel GJ , Graham BS . Lancet Infect Dis 2011 11 (12) 916-924 BACKGROUND: Because the general population is largely naive to H5N1 influenza, antibodies generated to H5 allow analysis of novel influenza vaccines independent of background immunity from previous infection. We assessed the safety and immunogenicity of DNA encoding H5 as a priming vaccine to improve antibody responses to inactivated influenza vaccination. METHODS: In VRC 306 and VRC 310, two sequentially enrolled phase 1, open-label, randomised clinical trials, healthy adults (age 18-60 years) were randomly assigned to receive intramuscular H5 DNA (4 mg) at day 0 or twice, at day 0 and week 4, followed by H5N1 monovalent inactivated vaccine (MIV; 90 mcg) at 4 or 24 weeks, and compared with a two-dose regimen of H5N1 MIV with either a 4 or 24 week interval. Antibody responses were assessed by haemagglutination inhibition (HAI), ELISA, neutralisation (ID(80)), and immunoassays for stem-directed antibodies. T cell responses were assessed by intracellular cytokine staining. After enrolment, investigators and individuals were not masked to group assignment. VRC 306 and VRC 310 are registered with ClinicalTrials.gov, numbers NCT00776711 and NCT01086657, respectively. FINDINGS: In VRC 306, 60 individuals were randomly assigned to the four groups (15 in each) and 59 received the vaccinations. In VRC 310, of the 21 individuals enrolled, 20 received the vaccinations (nine received a two-dose regimen of H5N1 MIV and 11 received H5 DNA at day 0 followed by H5N1 MIV at week 24). H5 DNA priming was safe and enhanced H5-specific antibody titres following an H5N1 MIV boost, especially when the interval between DNA prime and MIV boost was extended to 24 weeks. In the two studies, DNA priming with a 24-week MIV boost interval induced protective HAI titres in 21 (81%) of 26 of individuals, with an increase in geometric mean titre (GMT) of more than four times that of individuals given the MIV-MIV regimen at 4 or 24 weeks (GMT 103-206 vs GMT 27-33). Additionally, neutralising antibodies directed to the conserved stem region of H5 were induced by this prime-boost regimen in several individuals. No vaccine-related serious adverse events were recorded. INTERPRETATION: DNA priming 24 weeks in advance of influenza vaccine boosting increased the magnitude of protective antibody responses (HAI) and in some cases induced haemagglutinin-stem-specific neutralising antibodies. A DNA-MIV vaccine regimen could enhance the efficacy of H5 or other influenza vaccines and shows that anti-stem antibodies can be elicited by vaccination in man. FUNDING: National Institutes of Health. |
Timing of adolescent meningococcal conjugate vaccination: attitudes and practices of pediatricians and family medicine physicians
Allison MA , Cohn AC , Stokley S , Crane LA , O'Leary ST , Hurley LP , Babbel CI , Dong F , Gahm C , Temte JL , Kempe A . Am J Prev Med 2011 41 (6) 581-7 BACKGROUND: The meningococcal conjugate vaccine (MCV4) was recommended for those aged 11-18 years in 2005. Initial supply issues led to an emphasis on immunizing older adolescents. When supply improved in 2007, routine immunization was recommended for those aged 11-12 years. PURPOSE: Among a U.S. sample of pediatricians and family medicine physicians, describe (1) recommendation and administration practices for MCV4; (2) preferences regarding MCV4 administration; and (3) attitudes and characteristics associated with recommendation for those aged >12 years. METHODS: A mail and Internet survey in a nationally representative sample of physicians was conducted between December 2009 and March 2010. Analysis was conducted between March 2010 and October 2010, including a multivariable analysis to examine factors associated with deferring MCV4 to ages >12 years. RESULTS: Response rates were 88% (pediatricians 367/419) and 63% (family medicine physicians 268/423). In all, 95% of pediatricians and 73% of family medicine physicians reported administering MCV4 routinely to those aged 11-18 years (p<0.0001); 83% (pediatricians) and 45% (family medicine physicians) reported strongly recommending MCV4 for those aged 11-12 years (p<0.0001); 27% (pediatricians) and 40% (family medicine physicians) preferred to administer MCV4 to those aged >12 years (p<0.0001). Compared with those who strongly recommend for those aged 11-12 years, physicians who do not regularly stock MCV4, family medicine physicians, and physicians concerned about waning immunity were more likely to defer their recommendation, whereas physicians practicing in the Northeast and those with more Latino patients were less likely to defer. CONCLUSIONS: Most pediatricians and family medicine physicians administer MCV4, but many, especially family medicine physicians and those concerned about waning immunity, defer their recommendation for MCV4 to patients aged >12 years. |
Effects of a nationwide Hib vaccine shortage on vaccination coverage in the United States
Santibanez TA , Shefer A , Briere EC , Cohn A , Groom AV . Vaccine 2011 30 (5) 941-7 BACKGROUND: A shortage of Haemophilus influenzae type b (Hib) vaccine that occurred in the United States during December 2007 to September 2009 resulted in an interim recommendation to defer the booster dose, but to continue to vaccinate as recommended with the primary series during the first year of life. OBJECTIVES: To quantify effects of the Hib shortage on vaccination coverage and to determine if any demographic subgroups were disproportionately affected. METHODS: Data from the 2009 National Immunization Survey (NIS) were divided based on child's age at the onset of the shortage. Comparisons were made in primary series coverage by 9 months between children <7 months versus ≥7 months at the start of the shortage. Comparisons in primary series plus booster dose completion by 19 months were made between children who were <12 months versus ≥12 months at the start of the shortage. RESULTS: Nationally, there was a difference in Hib primary series completion by 9 months among children age <7 months versus ≥7 months at the start of the shortage (73.9% versus 81.2%, P<0.001). There was a large difference in the percentage of children fully vaccinated with the primary series plus booster dose by 19 months among children age <12 months versus ≥12 months at the start of the shortage (39.5% versus 66.0%, P<.001). There were differential effects of the shortage on primary series coverage among states and for some demographic characteristics. CONCLUSIONS: As expected booster dose coverage was reduced consistent with interim recommendations, but primary series coverage was also reduced by 7 percentage points nationally. |
First results of phase 3 trial of RTS,S/AS01 malaria vaccine in African children
Agnandji ST , Lell B , Soulanoudjingar SS , Fernandes JF , Abossolo BP , Conzelmann C , Methogo BG , Doucka Y , Flamen A , Mordmüller B , Issifou S , Kremsner PG , Sacarlal J , Aide P , Lanaspa M , Aponte JJ , Nhamuave A , Quelhas D , Bassat Q , Mandjate S , Macete E , Alonso P , Abdulla S , Salim N , Juma O , Shomari M , Shubis K , Machera F , Hamad AS , Minja R , Mtoro A , Sykes A , Ahmed S , Urassa AM , Ali AM , Mwangoka G , Tanner M , Tinto H , D'Alessandro U , Sorgho H , Valea I , Tahita MC , Kaboré W , Ouédraogo S , Sandrine Y , Guiguemdé RT , Ouédraogo JB , Hamel MJ , Kariuki S , Odero C , Oneko M , Otieno K , Awino N , Omoto J , Williamson J , Muturi-Kioi V , Laserson KF , Slutsker L , Otieno W , Otieno L , Nekoye O , Gondi S , Otieno A , Ogutu B , Wasuna R , Owira V , Jones D , Onyango AA , Njuguna P , Chilengi R , Akoo P , Kerubo C , Gitaka J , Maingi C , Lang T , Olotu A , Tsofa B , Bejon P , Peshu N , Marsh K , Owusu-Agyei S , Asante KP , Osei-Kwakye K , Boahen O , Ayamba S , Kayan K , Owusu-Ofori R , Dosoo D , Asante I , Adjei G , Adjei G , Chandramohan D , Greenwood B , Lusingu J , Gesase S , Malabeja A , Abdul O , Kilavo H , Mahende C , Liheluka E , Lemnge M , Theander T , Drakeley C , Ansong D , Agbenyega T , Adjei S , Boateng HO , Rettig T , Bawa J , Sylverken J , Sambian D , Agyekum A , Owusu L , Martinson F , Hoffman I , Mvalo T , Kamthunzi P , Nkomo R , Msika A , Jumbe A , Chome N , Nyakuipa D , Chintedza J , Ballou WR , Bruls M , Cohen J , Guerra Y , Jongert E , Lapierre D , Leach A , Lievens M , Ofori-Anyinam O , Vekemans J , Carter T , Leboulleux D , Loucq C , Radford A , Savarese B , Schellenberg D , Sillman M , Vansadia P . N Engl J Med 2011 365 (20) 1863-75 BACKGROUND: An ongoing phase 3 study of the efficacy, safety, and immunogenicity of candidate malaria vaccine RTS,S/AS01 is being conducted in seven African countries. METHODS: From March 2009 through January 2011, we enrolled 15,460 children in two age categories--6 to 12 weeks of age and 5 to 17 months of age--for vaccination with either RTS,S/AS01 or a non-malaria comparator vaccine. The primary end point of the analysis was vaccine efficacy against clinical malaria during the 12 months after vaccination in the first 6000 children 5 to 17 months of age at enrollment who received all three doses of vaccine according to protocol. After 250 children had an episode of severe malaria, we evaluated vaccine efficacy against severe malaria in both age categories. RESULTS: In the 14 months after the first dose of vaccine, the incidence of first episodes of clinical malaria in the first 6000 children in the older age category was 0.32 episodes per person-year in the RTS,S/AS01 group and 0.55 episodes per person-year in the control group, for an efficacy of 50.4% (95% confidence interval [CI], 45.8 to 54.6) in the intention-to-treat population and 55.8% (97.5% CI, 50.6 to 60.4) in the per-protocol population. Vaccine efficacy against severe malaria was 45.1% (95% CI, 23.8 to 60.5) in the intention-to-treat population and 47.3% (95% CI, 22.4 to 64.2) in the per-protocol population. Vaccine efficacy against severe malaria in the combined age categories was 34.8% (95% CI, 16.2 to 49.2) in the per-protocol population during an average follow-up of 11 months. Serious adverse events occurred with a similar frequency in the two study groups. Among children in the older age category, the rate of generalized convulsive seizures after RTS,S/AS01 vaccination was 1.04 per 1000 doses (95% CI, 0.62 to 1.64). CONCLUSIONS: The RTS,S/AS01 vaccine provided protection against both clinical and severe malaria in African children. (Funded by GlaxoSmithKline Biologicals and the PATH Malaria Vaccine Initiative; RTS,S ClinicalTrials.gov number, NCT00866619 .) |
Medical costs attributable to child maltreatment: a systematic review of short- and long-term effects
Brown DS , Fang X , Florence CS . Am J Prev Med 2011 41 (6) 627-35 CONTEXT: Child maltreatment is a serious and prevalent public health problem, which has been shown to be associated with numerous short- and long-term effects on mental and physical health. Few estimates of the medical costs of these effects have been published to date. To determine the range and quality of currently available estimates and identify the gaps and needs for future research, this article reviews research on medical costs of child maltreatment. EVIDENCE ACQUISITION: Peer-reviewed literature on child maltreatment and medical costs was identified by searching major databases. Twelve articles on the medical costs of child maltreatment were identified. EVIDENCE SYNTHESIS: Eight studies describe short-term costs among children; four describe adult, long-term costs. Most studies used convenience samples, captured a partial share of the total costs, and did not follow best practices for econometric analysis of medical costs. CONCLUSIONS: Child maltreatment is associated with substantial medical costs in childhood and adulthood, but estimates vary widely because of differences in research designs, types of cost data, and study quality. Econometric estimates of the annual medical costs in adulthood range from zero to about $800. Per-episode estimates of child costs, based on mean comparisons, range from $0 to >$24,000. |
Human T-cell lymphotropic virus type 3 (HTLV-3)- and HTLV-4-derived antisense transcripts encode proteins with similar Tax-inhibiting functions but distinct subcellular localization.
Larocque E , Halin M , Landry S , Marriott SJ , Switzer WM , Barbeau B . J Virol 2011 85 (23) 12673-85 The human T-cell lymphotropic virus (HTLV) retrovirus family is composed of the well-known HTLV type 1 (HTLV-1) and HTLV-2 and the most recently discovered HTLV-3 and HTLV-4. Like other retroviruses, HTLV-1 and HTLV-2 gene expression has been thought to be orchestrated through a single transcript. However, recent reports have demonstrated the unique potential of both HTLV-1 and HTLV-2 to produce an antisense transcript. Furthermore, these unexpected and newly identified transcripts lead to the synthesis of viral proteins termed HBZ (HTLV-1 basic leucine zipper) and APH-2 (antisense protein of HTLV-2), respectively. As potential open reading frames are present on the antisense strand of HTLV-3 and HTLV-4, we tested whether in vitro antisense transcription occurred in these viruses and whether these transcripts had a coding potential. Using HTLV-3 and HTLV-4 proviral DNA constructs, antisense transcripts were detected by reverse transcriptase PCR. These transcripts are spliced and polyadenylated and initiate at multiple sites from the 3' long terminal repeat (LTR). The resulting proteins, termed APH-3 and APH-4, are devoid of a typical basic leucine zipper domain but contain basic amino acid-rich regions. Confocal microscopy and Western blotting experiments demonstrated a nucleus-restricted pattern for APH-4, while APH-3 was localized both in the cytoplasm and in the nucleus. Both proteins showed partial colocalization with nucleoli and HBZ-associated structures. Finally, both proteins inhibited Tax1- and Tax3-mediated HTLV-1 and HTLV-3 LTR activation. These results further demonstrate that retroviral antisense transcription is not exclusive to HTLV-1 and HTLV-2 and that APH-3 and APH-4 could impact HTLV-3 and HTLV-4 replication. |
First NDM-positive Salmonella sp. strain identified in the United States.
Savard P , Gopinath R , Zhu W , Kitchel B , Rasheed JK , Tekle T , Roberts A , Ross T , Razeq J , Landrum BM , Wilson LE , Limbago B , Perl TM , Carroll KC . Antimicrob Agents Chemother 2011 55 (12) 5957-8 microbial resistance among Enterobacteriaceae is growing, largely due to β-lactamase production. NDM, carried on the blaNDM gene, is the latest addition to this bacterial armamentarium and is a worrisome resistance mechanism (9). Increasing resistance to antimicrobials has been reported for Salmonella spp., due in part to extended-spectrum β-lactamase (ESBL) and AmpC production, often combined with other resistance mechanisms (4, 7). Carbapenemase production in Salmonella spp. has rarely been reported (5), and neither the blaNDM gene nor any other metallo-beta-lactamase (MBL) in Salmonella spp. has been described yet. We report the first case to our knowledge of NDM-producing Salmonella spp. likely acquired in India but detected in the United States. | On 25 January 2011, a sixty-year-old American was transferred from India by air ambulance to a hospital in Maryland. The patient was originally hospitalized in late December 2010 with a catastrophic intracranial bleed in India. Less than 24 h after his arrival at the U.S. hospital, he sustained a fever of 38.5°C; urine, blood, and endotracheal secretions were cultured. His sputum grew a carbapenem-resistant Klebsiella pneumoniae, positive for carbapenemase production by the modified Hodge test using meropenem (3), and the Etest MBL (AB bioMérieux, Durham, NC) revealed MBL production as per the package insert (1). The organism was susceptible to colistin only (MIC of 0.12 μg/liter by broth macrodilution) (Table 1) (3) and was sent to both the Maryland Department of Health and Mental Hygiene (MDHMH) and Centers for Disease Control and Prevention (CDC) for confirmation. The blaNDM gene was identified in the K. pneumoniae isolate by real-time PCR at the CDC (http://www.cdc.gov/HAI/settings/lab/kpc-ndm1-lab-protocol.html). |
Development of a high-throughput microsphere-based molecular assay to identify 15 common bloodmeal hosts of Culex mosquitoes.
Thiemann TC , Brault AC , Ernest HB , Reisen WK . Mol Ecol Resour 2011 12 (2) 238-46 For vectorborne infections, host selection by bloodfeeding arthropods dictates the interaction between host and pathogen. Because Culex mosquitoes that transmit West Nile virus (WNV) feed both on mammalian and avian hosts with varying competence, understanding the bloodfeeding patterns of these mosquitoes is important for understanding the transmission dynamics of WNV. Herein, we describe a new microsphere-based assay using Luminex xMAP((R)) technology to rapidly identify 15 common hosts of Culex mosquitoes at our California study sites. The assay was verified with over 100 known vertebrate species samples and was used in conjunction with DNA sequencing to identify over 125 avian and mammalian host species from unknown Culex bloodmeals, more quickly and with less expense than sequencing alone. In addition, with multiplexed labelled probes, this microsphere array identified mixed bloodmeals that were difficult to discern with traditional sequencing. The microsphere set was easily expanded or reduced according to host range in a specific area, and this assay has made it possible to rapidly screen thousands of Culex spp. bloodmeals to extend our understanding of WNV transmission patterns. |
Short report: Molecular insights for Giardia, Cryptosporidium, and soil-transmitted helminths from a facility-based surveillance system in Guatemala.
Velasquez DE , Arvelo W , Cama VA , Lopez B , Reyes L , Roellig DM , Kahn GD , Lindblade KA . Am J Trop Med Hyg 2011 85 (6) 1141-1143 We molecularly characterized samples with Giardia, Cryptosporidium, and soil-transmitted helminths from a facility-based surveillance system for diarrhea in Santa Rosa, Guatemala. The DNA sequence analysis determined the presence of Giardia assemblages A (N = 7) and B (N = 12) and, Cryptosporidium hominis (N = 2) and Cryptosporidium parvum (N = 2), suggestive of different transmission cycles. All 41 samples with soil-transmitted helminths did not have the beta-tubulin mutation described for benzimidazole resistance, suggesting potential usefulness in mass drug administration campaigns. |
New approach for near-real-time measurement of elemental composition of aerosol using laser-induced breakdown spectroscopy
Diwakar P , Kulkarni P , Birch ME . Aerosol Sci Technol 2012 46 (3) 316-332 A new approach has been developed for making near-real-time measurement of elemental composition of aerosols using plasma spectroscopy. The method allows preconcentration of miniscule particle mass (pg to ng) directly from the sampled aerosol stream through electrostatic deposition of charged particles (30-900 nm) onto a flat-tip microneedle electrode. The collected material is subsequently ablated from the electrode and monitored by laser-induced breakdown spectroscopy. Atomic emission spectra were collected using a broadband spectrometer with a wavelength range of 200-980 nm. A single-sensor delay time of 1.3 mcs was used in the spectrometer for all elements to allow simultaneous measurement of multiple elements. The system was calibrated for various elements including Cd, Cr, Cu, Mn, Na, and Ti. The absolute mass detection limits for these elements were experimentally determined and found to be in the range of 0.018-5 ng. The electrostatic collection technique has many advantages over other substrate-based methods involving aerosol collection on a filter or its focused deposition using an aerodynamic lens. Because the particle mass is collected over a very small area that is smaller than the spatial extent of the laser-induced plasma, the entire mass is available for analysis. This considerably improves reliability of the calibration and enhances measurement accuracy and precision. Further, the aerosol collection technique involves very low pressure drop, thereby allowing higher sample flow rates with much smaller pumps-a desirable feature for portable instrumentation. Higher flow rates also make it feasible to measure trace element concentrations at part per trillion levels. Detection limits in the range of 18-670 ng m(-3) can be achieved for most of the elements studied at a flow rate of 1.5 L min(-1) with sampling times of 5 min. |
Evaluation of surface-enhanced laser desorption time-of-flight mass spectroscopy in the development of biomarkers of occupational acrylamide exposure
Mathias PI , Cheever KL . Am Lab 2011 43 (11) 34-+ Surface-enhanced laser desorption time-of-flight mass spectroscopy (SELDI-TOF-MS) is a bioanalytical technique used for the rapid examination of intact protein or protein mixtures to exploit the biochemical or biophysical characteristics of intact molecules to separate a complex protein mixture or isolate specific protein classes. Surface-enhanced laser desorption time-of-flight mass spectroscopy allows for rapid examination of protein components of body fluids or cell lysates without extensive extraction or preparative measures. The levels and composition of proteins found in blood and urine may change after exposure to toxic agents.1,2 Such potential changes make the proteins found in these easily obtained fluids a desirable source of new or altered proteins that indicate toxic exposure. This article describes the use of SELDI-TOF to examine urinary proteins or hemoglobin present in erythrocyte lysates. | Acrylamide is a widely used industrial chemical intermediate with many applications,3 such as a polymerizing agent in grouts and in the preparation of laboratory gels for protein and nucleic acid electrophoresis. Low levels of acrylamide present in baked, fried, and roasted foods and in tobacco smoke are common sources of human exposure.4 Acrylamide is a potent neurotoxin5 and is a probable human carcinogen that makes exposure a concern for human health.6 |
Evidence for an increased risk of transmission of simian immunodeficiency virus and malaria in a rhesus macaque coinfection model
Trott KA , Chau JY , Hudgens MG , Fine J , Mfalila CK , Tarara RP , Collins WE , Sullivan J , Luckhart S , Abel K . J Virol 2011 85 (22) 11655-63 In sub-Saharan Africa, HIV-1 infection frequently occurs in the context of other coinfecting pathogens, most importantly, Mycobacterium tuberculosis and malaria parasites. The consequences are often devastating, resulting in enhanced morbidity and mortality. Due to the large number of confounding factors influencing pathogenesis in coinfected people, we sought to develop a nonhuman primate model of simian immunodeficiency virus (SIV)-malaria coinfection. In sub-Saharan Africa, Plasmodium falciparum is the most common malaria parasite and is responsible for most malaria-induced deaths. The simian malaria parasite Plasmodium fragile can induce clinical symptoms, including cerebral malaria in rhesus macaques, that resemble those of P. falciparum infection in humans. Thus, based on the well-characterized rhesus macaque model of SIV infection, this study reports the development of a novel rhesus macaque SIV-P. fragile coinfection model to study human HIV-P. falciparum coinfection. Using this model, we show that coinfection is associated with an increased, although transient, risk of both HIV and malaria transmission. Specifically, SIV-P. fragile coinfected macaques experienced an increase in SIV viremia that was temporarily associated with an increase in potential SIV target cells and systemic immune activation during acute parasitemia. Conversely, primary parasitemia in SIV-P. fragile coinfected animals resulted in higher gametocytemia that subsequently translated into higher oocyst development in mosquitoes. To our knowledge, this is the first animal model able to recapitulate the increased transmission risk of both HIV and malaria in coinfected humans. Therefore, this model could serve as an essential tool to elucidate distinct immunological, virological, and/or parasitological parameters underlying disease exacerbation in HIV-malaria coinfected people. |
A historical and proteomic analysis of botulinum neurotoxin type/G
Terilli RR , Moura H , Woolfitt AR , Rees J , Schieltz DM , Barr JR . BMC Microbiol 2011 11 232 BACKGROUND: Clostridium botulinum is the taxonomic designation for at least six diverse species that produce botulinum neurotoxins (BoNTs). There are seven known serotypes of BoNTs (/A through/G), all of which are potent toxins classified as category A bioterrorism agents. BoNT/G is the least studied of the seven serotypes. In an effort to further characterize the holotoxin and neurotoxin-associated proteins (NAPs), we conducted an in silico and proteomic analysis of commercial BoNT/G complex. We describe the relative quantification of the proteins present in the/G complex and confirm our ability to detect the toxin activity in vitro. In addition, we review previous literature to provide a complete description of the BoNT/G complex. RESULTS: An in-depth comparison of protein sequences indicated that BoNT/G shares the most sequence similarity with the/B serotype. A temperature-modified Endopep-MS activity assay was successful in the detection of BoNT/G activity. Gel electrophoresis and in gel digestions, followed by MS/MS analysis of/G complex, revealed the presence of four proteins in the complexes: neurotoxin (BoNT) and three NAPs--nontoxic-nonhemagglutinin (NTNH) and two hemagglutinins (HA70 and HA17). Rapid high-temperature in-solution tryptic digestions, coupled with MS/MS analysis, generated higher than previously reported sequence coverages for all proteins associated with the complex: BoNT 66%, NTNH 57%, HA70 91%, and HA17 99%. Label-free relative quantification determined that the complex contains 30% BoNT, 38% NTNH, 28% HA70, and 4% HA17 by weight comparison and 17% BoNT, 23% NTNH, 42% HA70, and 17% HA17 by molecular comparison. CONCLUSIONS: The in silico protein sequence comparisons established that the/G complex is phenetically related to the other six serotypes of C. botulinum. Proteomic analyses and Endopep-MS confirmed the presence of BoNT and NAPs, along with the activity of the commercial/G complex. The use of data-independent MSE data analysis, coupled to label-free quantification software, suggested that the weight ratio BoNT:NAPs is 1:3, whereas the molar ratio of BoNT:NTNH:HA70:HA17 is 1:1:2:1, within the BoNT/G progenitor toxin. |
Imatinib-sensitive tyrosine kinases regulate mycobacterial pathogenesis and represent therapeutic targets against tuberculosis
Napier RJ , Rafi W , Cheruvu M , Powell KR , Zaunbrecher MA , Bornmann W , Salgame P , Shinnick TM , Kalman D . Cell Host Microbe 2011 10 (5) 475-85 The lengthy course of treatment with currently used antimycobacterial drugs and the resulting emergence of drug-resistant strains have intensified the need for alternative therapies against Mycobacterium tuberculosis (Mtb), the etiologic agent of tuberculosis. We show that Mtb and Mycobacterium marinum use ABL and related tyrosine kinases for entry and intracellular survival in macrophages. In mice, the ABL family tyrosine kinase inhibitor, imatinib (Gleevec), when administered prophylactically or therapeutically, reduced both the number of granulomatous lesions and bacterial load in infected organs and was also effective against a rifampicin-resistant strain. Further, when coadministered with current first-line drugs, rifampicin or rifabutin, imatinib acted synergistically. These data implicate host tyrosine kinases in entry and intracellular survival of mycobacteria and suggest that imatinib may have therapeutic efficacy against Mtb. Because imatinib targets host, it is less likely to engender resistance compared to conventional antibiotics and may decrease the development of resistance against coadministered drugs. |
Comparison of four commercial IgM and IgG ELISA kits for diagnosing brucellosis
Fadeel MA , Hoffmaster AR , Shi J , Pimentel G , Stoddard RA . J Med Microbiol 2011 60 1767-73 Brucellosis is a worldwide zoonotic disease that often requires serology for diagnosis. The serum agglutination test is the gold standard assay, but ELISAs are used by many laboratories. Many commercial ELISAs are available, but few studies have compared their performance. This study compared the ability of four commercially available ELISA kits (from Bio-Quant, Immuno-Biological Laboratories - America, Vircell and Euroimmun) to diagnose brucellosis in patients from Egypt and the USA. The sensitivities for all kits tested, except the Vircell kit, were >90 %, whilst the specificities were variable, with the Bio-Quant assay having a specificity of <40 %. Detection of IgG antibody was more sensitive than detection of IgM antibody for diagnosing brucellosis cases, but the specificity was comparable. Overall, there was good agreement between all of the kits except for the Bio-Quant kit. None of the diagnostic assays was 100 % reliable for diagnosing brucellosis; therefore, serology results need to be considered in tandem with patient history, clinical signs and other test results. |
Trends in cytogenetic testing and identification of chromosomal abnormalities among pregnancies and children with birth defects, metropolitan Atlanta, 1968-2005.
Jackson JM , Crider KS , Rasmussen SA , Cragan JD , Olney RS . Am J Med Genet A 2011 158A (1) 116-23 The purpose of this study was to examine changes in the use of cytogenetic testing and identification of chromosomal abnormalities among pregnancies and children with birth defects. Utilizing data from 1968 to 2005 from the Metropolitan Atlanta Congenital Defects Program, we analyzed trends in the frequency and timing (prenatal or postnatal) of cytogenetic testing and the prevalence of recognized chromosome abnormalities among pregnancies and children with birth defects (n = 51,424). Cytogenetic testing of pregnancies and children with birth defects increased from 7.2% in 1968 to 25.0% in 2005, as did the identification of chromosomal abnormalities (2.2% in 1968 to 6.8% in 2005). The use of prenatal cytogenetic testing decreased from 1996 to 2005 among women aged ≥35 years. Identification of chromosomal abnormalities in pregnancies and children with birth defects increased from 1968 to 2005, possibly due to increased testing, improved diagnostic techniques, or increasing maternal age. The decline in prenatal cytogenetic testing observed among mothers aged ≥35 years may be related to the availability of improved prenatal screening techniques, resulting in a reduction in the utilization of invasive diagnostic tests. Published 2011. This article is a U.S. Government work and is in the public domain in the USA. |
Prepregnancy body mass index and gestational weight gain in relation to child body mass index among siblings
Branum AM , Parker JD , Keim SA , Schempf AH . Am J Epidemiol 2011 174 (10) 1159-65 There is increasing evidence that in utero effects of excessive gestational weight gain may result in increased weight in children; however, studies have not controlled for shared genetic or environmental factors between mothers and children. Using 2,758 family groups from the Collaborative Perinatal Project, the authors examined the association of maternal prepregnancy body mass index (BMI) and gestational weight gain on child BMI at age 4 years using both conventional generalized estimating equations and fixed-effects models that account for shared familial factors. With generalized estimating equations, prepregnancy BMI and gestational weight gain had similar associations with the child BMI z score (beta = 0.09 units, 95% confidence interval (CI): 0.08, 0.11; and beta = 0.07 units, 95% CI: 0.04, 0.11, respectively. However, fixed effects resulted in null associations for both prepregnancy BMI (beta = 0.03 units, 95% CI: -0.01, 0.07) and gestational weight gain (beta = 0.03 units, 95% CI: -0.02, 0.08) with child BMI z score at age 4 years. The positive association between gestational weight gain and child BMI at age 4 years may be explained by shared family characteristics (e.g., genetic, behavioral, and environmental factors) rather than in utero programming. Future studies should continue to evaluate the relative roles of important familial and environmental factors that may influence BMI and obesity in children. |
Preschool vision testing by health providers in the United States: findings from the 2006-2007 Medical Expenditure Panel Survey
Kemper AR , Wallace DK , Patel N , Crews JE . J AAPOS 2011 15 (5) 480-3 BACKGROUND: Few data are available regarding the rate of preschool vision screening. The purpose of this study is to estimate the current rate of vision testing among children ages 3 through 6 years by any health care provider and to the characterize the children reported to have been tested. METHODS: We conducted a cross-sectional analysis of the 4,237 children aged 3 through 6 years included in either the 2006 or 2007 Medical Expenditure Panel Survey. Household respondents were asked whether selected children ever had vision testing by a doctor or other health provider. Data were weighted to make estimates representative of the civilian noninstitutionalized population. RESULTS: Overall, 64.9% (95% CI, 62.9%-66.9%) of children 3 through 6 years of age were reported to have ever had vision testing. The likelihood of previous reported testing increased with age, from 42.9% among 3-year-olds to 79.4% among 6-year-olds (P < 0.001). After adjusting for age, family income, insurance status, whether the child had a regular health care provider, and whether the child had special health care needs, we found that lower odds of testing were reported among non-Hispanic white children (odds ratio [OR], 0.73; 95% CI, 0.55-0.97) and among Hispanic children (OR, 0.62; 95% CI, 0.47-0.82) compared with non-Hispanic black children (OR, 1). CONCLUSIONS: These findings highlight the gaps in the delivery of preschool vision screening. Improved population-level surveillance of children's vision and methods to track use of vision-related health services are needed to inform policy makers to develop new strategies to improve care. |
Examining the use of oral rehydration salts and other oral rehydration therapy for childhood diarrhea in Kenya
Blum LS , Oria PA , Olson CK , Breiman RF , Ram PK . Am J Trop Med Hyg 2011 85 (6) 1126-33 Reductions in the use of oral rehydration therapy (ORT) in sub-Saharan Africa highlight the need to examine caregiver perceptions of ORT during diarrheal episodes. Qualitative research involving group discussions with childcare providers and in-depth interviews with 45 caregivers of children < 5 years of age who had experienced diarrhea was conducted in one rural and urban site in Kenya during July-December 2007. Diarrhea was considered a dangerous condition that can kill young children. Caregivers preferred to treat diarrhea with Western drugs believed to be more effective in stopping diarrhea than ORT. Inconsistent recommendations from health workers regarding use of oral rehydration solution (ORS) caused confusion about when ORS is appropriate and whether it requires a medical prescription. In the rural community, causal explanations about diarrhea, beliefs in herbal remedies, cost, and distance to health facilities presented additional barriers to ORS use. Health communication is needed to clarify the function of ORT in preventing dehydration. |
Footwear and locomotor skill performance in preschoolers
Robinson LE , Rudisill ME , Weimar WH , Breslin CM , Shroyer JF , Morera M . Percept Mot Skills 2011 113 (2) 534-538 The effect of footwear on locomotor skill performance was examined. 12 children (4 boys, 8 girls; M age = 56.3 mo., SD = 3.3) served as participants. Participants were randomly assigned to perform the locomotor subscale of Ulrich's Test of Gross Motor Development in two shoe conditions (Condition 1: Stride Rite(R) athletic shoes, and Condition 2: flip flop sandals). Children scored significantly higher when wearing athletic shoes than flip-flop sandals. This finding is relevant for motor performance and safety in physical education and movement programs. |
Geographic variation in trends and characteristics of teen childbearing among American Indians and Alaska Natives, 1990-2007
Wingo PA , Lesesne CA , Smith RA , de Ravello L , Espey DK , Arambula Solomon TG , Tucker M , Thierry J . Matern Child Health J 2011 16 (9) 1779-90 To study teen birth rates, trends, and socio-demographic and pregnancy characteristics of AI/AN across geographic regions in the US. The birth rate for US teenagers 15-19 years reached a historic low in 2009 (39.1 per 1,000) and yet remains one of the highest teen birth rates among industrialized nations. In the US, teen birth rates among Hispanic, non-Hispanic black, and American Indian/Alaska Native (AI/AN) youth are consistently two to three times the rate among non-Hispanic white teens. Birth certificate data for females younger than age 20 were used to calculate birth rates (live births per 1,000 women) and joinpoint regression to describe trends in teen birth rates by age (<15, 15-17, 18-19) and region (Aberdeen, Alaska, Bemidji, Billings, California, Nashville, Oklahoma, Portland, Southwest). Birth rates for AI/AN teens varied across geographic regions. Among 15-19-year-old AI/AN, rates ranged from 24.35 (California) to 123.24 (Aberdeen). AI/AN teen birth rates declined from the early 1990s into the 2000s for all three age groups. Among 15-17-year-olds, trends were approximately level during the early 2000s-2007 in six regions and declined in the others. Among 18-19-year-olds, trends were significantly increasing during the early 2000s-2007 in three regions, significantly decreasing in one, and were level in the remaining regions. Among AI/AN, cesarean section rates were lower in Alaska (4.1%) than in other regions (16.4-26.6%). This is the first national study to describe regional variation in AI/AN teen birth rates. These data may be used to target limited resources for teen pregnancy intervention programs and guide research. |
Advancing a midwifery perspective in health systems and human resources
Riley Patricia L . Afr J Midwifery Womens Health 2011 5 (4) 162-162 Prior to her untimely death earlier | this year, in her final editorial in | AJM, Professor Helen Igobeko Lugina | exhorted midwives to be proactive in ‘closing | the gap between research and action’ (Lugina, | 2011). In recognizing that many African | countries face weakened health systems that | include human resource shortages, Professor | Lugina laid out a visionary role that midwives be well versed in both the substance | and science of these issues and engage in | the related activities of policy and decisionmaking. Professor Lugina foresaw midwifery’s | role—if not its obligation—to participate in | the health care system discussion and advocate | for appropriate change. | As we recognize the loss of this ardent supporter of nursing, midwifery, and maternal, | newborn and child health (MNCH), there | is no better tribute than acquainting midwives with the latest science, policies, and | programmes in the complementary fields of | health systems (HS) and human resources for | health (HRH). Today’s global midwife practitioner needs to gain professional skills that go | beyond clinical proficiency in the provision of | health services, or even sound management | of local health care programmes and services. | Relevant engagement of Africa’s midwives also | involves understanding of the components | that comprise a health system and acquiring | the analytic capabilities for assessing, designing, and evaluating appropriate interventions. | Since nearly every country in Africa is experiencing a critical shortage of health care | providers, professional competency for midwifery leaders also requires technical abilities | in HRH to diagnose the underlying causes of | HRH attrition, outmigration, low retention, | and absenteeism and to apply evidence-based | solutions. Effecting positive change in these | areas also involves interdisciplinary collaboration and communication, both seen as essential skill sets for working with a diverse range | of national stakeholders in a variety of settings | (Joint Learning Initiative, 2004; Reich et al, | 2008; Institute of Medicine, 2010a). |
Community case management of childhood diarrhea in a setting with declining use of oral rehydration therapy: findings from cross-sectional studies among primary household caregivers, Kenya, 2007
Olson CK , Blum LS , Patel KN , Oria PA , Feikin DR , Laserson KF , Wamae AW , Bartlett AV , Breiman RF , Ram PK . Am J Trop Med Hyg 2011 85 (6) 1134-1140 We sought to determine factors associated with appropriate diarrhea case management in Kenya. We conducted a cross-sectional survey of caregivers of children < 5 years of age with diarrhea in rural Asembo and urban Kibera. In Asembo, 61% of respondents provided oral rehydration therapy (ORT), 45% oral rehydration solution (ORS), and 64% continued feeding. In Kibera, 75% provided ORT, 43% ORS, and 46% continued feeding. Seeking care at a health facility, risk perception regarding death from diarrhea, and treating a child with oral medications were associated with ORT and ORS use. Availability of oral medication was negatively associated. A minority of caregivers reported that ORS is available in nearby shops. In Kenya, household case management of diarrhea remains inadequate for a substantial proportion of children. Health workers have a critical role in empowering caregivers regarding early treatment with ORT and continued feeding. Increasing community ORS availability is essential to improving diarrhea management. |
Geostatistical modeling of the gas emission zone and its in-place gas content for Pittsburgh-seam mines using sequential Gaussian simulation
Karacan CO , Olea RA , Goodman G . Int J Coal Geol 2011 90-91 50-71 Determination of the size of the gas emission zone, the locations of gas sources within, and especially the amount of gas retained in those zones is one of the most important steps for designing a successful methane control strategy and an efficient ventilation system in longwall coal mining. The formation of the gas emission zone and the potential amount of gas-in-place (GIP) that might be available for migration into a mine are factors of local geology and rock properties that usually show spatial variability in continuity and may also show geometric anisotropy. Geostatistical methods are used here for modeling and prediction of gas amounts and for assessing their associated uncertainty in gas emission zones of longwall mines for methane control. This study used core data obtained from 276 vertical exploration boreholes drilled from the surface to the bottom of the Pittsburgh coal seam in a mining district in the Northern Appalachian basin. After identifying important coal and non-coal layers for the gas emission zone, univariate statistical and semivariogram analyses were conducted for data from different formations to define the distribution and continuity of various attributes. Sequential simulations performed stochastic assessment of these attributes, such as gas content, strata thickness, and strata displacement. These analyses were followed by calculations of gas-in-place and their uncertainties in the Pittsburgh seam caved zone and fractured zone of longwall mines in this mining district. Grid blanking was used to isolate the volume over the actual panels from the entire modeled district and to calculate gas amounts that were directly related to the emissions in longwall mines. Results indicated that gas-in-place in the Pittsburgh seam, in the caved zone and in the fractured zone, as well as displacements in major rock units, showed spatial correlations that could be modeled and estimated using geostatistical methods. This study showed that GIP volumes may change up to 3 MMscf per acre and, in a multi-panel district, may total 9 Bcf of methane within the gas emission zone. Therefore, ventilation and gas capture systems should be designed accordingly. In addition, rock displacements within the gas emission zone are spatially distributed. From an engineering and practical point of view, spatial distributions of GIP and distributions of rock displacements should be correlated with in-mine emissions and gob gas venthole productions. |
Prevalence of malaria among patients attending public health facilities in Maputo City, Mozambique
Macedo de Oliveira A , Mutemba R , Morgan J , Streat E , Roberts J , Menon M , Mabunda S . Am J Trop Med Hyg 2011 85 (6) 1002-7 We conducted a health facility-based survey to estimate the prevalence of malaria among febrile patients at health facilities (HFs) in Maputo City. Patients answered a questionnaire on malaria risk factors and underwent malaria testing. A malaria case was defined as a positive result for malaria by microscopy in a patient with fever or history of fever in the previous 24 hours. Among 706 patients with complete information, 111 (15.7%) cases were identified: 105 were positive for Plasmodium falciparum only, two for Plasmodium ovale only, and four for both P. falciparum and P. ovale. Fever documented at study enrollment, age ≥ 5 years, rural HF, and travel outside Maputo City were statistically significantly associated with malaria by multivariate analysis. We found a high prevalence of laboratory-confirmed malaria among febrile patients in Maputo City. Further studies are needed to relate these findings with mosquito density to better support malaria prevention and control. |
The combination of indoor residual spraying and insecticide-treated nets provides added protection against malaria compared with insecticide-treated nets alone
Hamel MJ , Otieno P , Bayoh N , Kariuki S , Were V , Marwanga D , Laserson KF , Williamson J , Slutsker L , Gimnig J . Am J Trop Med Hyg 2011 85 (6) 1080-6 Both insecticide-treated bed nets (ITNs) and indoor residual spraying (IRS) reduce malaria in high malaria transmission areas. The combined effect of these interventions is unknown. We conducted a non-randomized prospective cohort study to determine protective efficacy of IRS with ITNs (ITN + IRS) compared with ITNs alone (ITN only) in preventing Plasmodium falciparum parasitemia. At baseline, participants provided blood samples for malaria smears, were presumptively treated for malaria, and received ITNs. Blood smears were made monthly and at sick visits. In total, 1,804 participants were enrolled. Incidence of P. falciparum parasitemia in the ITN + IRS and ITN only groups was 18 and 44 infections per 100 persons-years at risk, respectively (unadjusted rate ratio = 0.41; 95% confidence interval [CI] = 0.31-0.56). Adjusted protective efficacy of ITN + IRS compared with ITN only was 62% (95% CI = 0.50-0.72). The combination of IRS and ITN might be a feasible strategy to further reduce malaria transmission in areas of persistent perennial malaria transmission. |
Using law to strengthen health professions: frameworks and practice
Verani A , Shayo P , Howse G . Afr J Midwifery Womens Health 2011 5 (4) 181-184 The lack of sufficient, high-quality health workers is one of the primary barriers to improving health in sub-Saharan Africa. An approach to address this challenge is for public health practitioners to increase their cooperation with public health lawyers, regulators and other policymakers in order to develop strengthened health workforce laws, regulations, and policies that are vigorously implemented and enforced. Conceptual frameworks can help clarify the meaning of health system governance and the pathways between law and health. International recommendations for policy interventions governing health workers provide countries with valuable guidance for domestic reforms. Monitoring and evaluation of legal, regulatory, and other policy interventions are required to ascertain their public health impact. At the intersection of law and public health, professionals from both fields can collaborate in concrete ways such as those discussed here to improve laws and policies governing health. |
Strengthening nursing and midwifery regulations and standards in Africa
Gross J , McCarthy C , Kelley M . Afr J Midwifery Womens Health 2011 5 (4) 185-188 Health professional boards have a mandate to regulate the training, licensure and practice of health workers; however, regulatory bodies, professional associations and academic institutions have not been widely involved in efforts to advance health worker education and practice. The African Health Profession Regulatory Collaborative (ARC) for Nurses and Midwives is a four-year initiative aimed at strengthening regional standards, regulatory frameworks, organizational capacity, and nursing leadership, in the East, Central and Southern Africa (ESCA) region. ARC convenes regional meetings of nursing and midwifery leaders, awards grants to support national regulation improvement projects, and provides technical assistance to country teams to address identified regulatory issues. During year one, ARC convened three regional meetings, awarded five grants to support regulation improvement projects, and provided targeted technical assistance to eight country teams. As ARC continues to evaluate its proof of concept, key strengths that have emerged include an investment in health systems strengthening, strong country ownership, and the value of south-to-south collaboration. This article describes an approach to strengthening nursing and midwifery regulation through collaborative improvement cycles that could serve as a model for strengthening health workforce regulation among additional cadres and regions. |
Contraceptive sterilization among married adults: national data on who chooses vasectomy and tubal sterilization
Anderson JE , Jamieson DJ , Warner L , Kissin DM , Nangia AK , Macaluso M . Contraception 2011 85 (6) 552-7 BACKGROUND: Vasectomy has been found to be a highly cost-effective contraceptive method. For couples, tubal sterilization and vasectomy have the same result, but the two methods are used by different segments of the population. STUDY DESIGN: We conducted an analysis of data from male and female samples of the 2006-2008 National Survey of Family Growth, nationally representative samples of men and women in the United States aged 15-44 years. RESULTS: Among married men, 13.1% reported vasectomies (95% confidence interval 10.4%-16.3%), compared to 21.1% (17.8%-24.9%) of married women who reported tubal sterilizations. Men with higher education and income had greater prevalence of vasectomy than those less educated, while women with lower education and income had the highest prevalence of tubal sterilization. CONCLUSIONS: Efforts to promote vasectomy use need to understand the reasons behind these differences. Increasing the availability and use of vasectomy will require education about its benefits. |
State-level socioeconomic factors are associated with current depression among U.S. adults in 2006 and 2008
Fan AZ , Strasser S , Zhang XY , Dhingra S , McKnight-Eily L , Holt J , Balluz L . J Public Health Epidemiol 2011 3 (10) 462-470 This study investigated whether state-level socioeconomic deprivation and income inequality are associated with depression prevalence. Current depressive symptoms within a two-week timeframe were assessed using the patient health questionnaire-2 from the 2006 and 2008 behavioral risk factor surveillance system (BRFSS) administered in selected states. State socio-economic deprivation indexes (percent of people below poverty level; employment/population ratio for the population 16 to 64 years old; median household income) were obtained from the 2006 and 2008 American community survey (ACS). State Gini indexes (indicating income inequality) were obtained from 2000 U.S. Census. After controlling for age, sex, race/ethnicity, marital status, educational attainment, annual household income, and chronic physical health condition index, adults residing in states with median household income in the lowest quintile (OR (95% CI)=1.18 (1.16 to 1.20) vs. others), in states with population below poverty line greater than the fourth quintile (OR (95% CI)=1.22 (1.20 to 1.24), vs. others), in states with employment/population ratios in the lowest quintile (OR(95% CI)=1.31 (1.29 to 1.34), vs. others), and in states with higher income inequality (GINI index >0.452) (OR(95% CI)=1.22 (1.21-1.24), vs. others) had higher odds of current depression. The results suggest that state-level socioeconomic factors are associated with depression prevalence among U.S. adults beyond individual level socioeconomic characteristics. |
Utility and delivery of behavioural interventions to prevent sexually transmitted infections
Aral SO . Sex Transm Infect 2011 87 ii31-ii33 This article discusses the issues related to the utility of behavioural interventions, including questions around feasibility of implementation, scale-up and maintenance, and suggests new directions for planning, implementation, evaluation and continuous improvement of social and behavioural interventions in the context of sexually transmitted infection and HIV prevention programmes. |
Finding shelter: two-year housing trajectories among homeless youth
Tevendale HD , Comulada WS , Lightfoot MA . J Adolesc Health 2011 49 (6) 615-20 PURPOSE: The aim of this study was to (1) identify trajectories of homeless youth remaining sheltered or returning to shelter over a period of 2 years, and (2) to identify predictors of these trajectories. METHOD: A sample of 426 individuals aged 14-24 years receiving services at homeless youth serving agencies completed six assessments over 2 years. Latent class growth analysis was applied to the reports of whether youth had been inconsistently sheltered (i.e., living on the street or in a squat, abandoned building, or automobile) or consistently sheltered (i.e., not living in any of those settings) during the past 3 months. RESULTS: Three trajectories of homeless youth remaining sheltered or returning to shelter were identified: consistently sheltered (approximately 41% of the sample); inconsistently sheltered, short-term (approximately 20%); and inconsistently sheltered, long-term (approximately 39%). Being able to go home and having not left of one's own accord predicted greater likelihood of membership in the short-term versus the long-term inconsistently sheltered trajectory. Younger age, not using drugs other than alcohol or marijuana, less involvement in informal sector activities, being able to go home, and having been homeless for <1 year predicted membership in the consistently sheltered groups versus the long-term inconsistently sheltered groups in the multivariate analyses. CONCLUSIONS: Findings suggest that being able to return home is more important than the degree of individual impairment (e.g., substance use or mental health problems) when determining the likelihood that a homeless youth follows a more or a less chronically homeless pathway. |
Menthol cigarette use: the challenge to improve measurement and monitoring among adolescent smokers
Rock VJ , Davis SP , Thorne SL , Caraballo RS . Nicotine Tob Res 2011 14 (2) 251–252 This letter is in response to Dr. Polednak’s comments regarding our study entitled, “Menthol Cigarette Use Among Racial and Ethnic Groups in the United States, 2004–2008” (Rock, Davis, Thorne, Asman, & Caraballo, 2010). We appreciate Dr. Polednak’s interest in the article and his critical examination of the issue of misclassification and potential underreporting of menthol cigarette use in the U.S. population, particularly among African American youth. Specifically, Dr. Polednak highlights discrepancies in self-reported menthol cigarette use and self-reported cigarette brand smoked (i.e., menthol/non-menthol) at the time of data collection. This issue has been discussed and examined in published scientific literature (Giovino et al., 2004; Hersey, Nonnemaker, & Homsi, 2010; Hyland, Garten, Giovino, & Cummings, 2002) and in unpublished scientific presentations and reports submitted to the Food and Drug Administration Tobacco Products Scientific Advisory Committee (FDA TPSAC) (FDA TPSAC, 2011). The scientific evidence indeed suggests that self-reports of type or brand of cigarette smoked are subject to bias. This may be especially true for menthol cigarette use among adolescents who are first trying or experimenting with smoking and among those who do not normally purchase their own cigarettes. That is why our study addressed the need to improve accurate monitoring of menthol cigarette smoking among youth and adults in order to improve the validity of self-reports. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Disease Reservoirs and Vectors
- Environmental Health
- Epidemiology and Surveillance
- Genetics and Genomics
- Immunity and Immunization
- Injury and Violence
- Laboratory Sciences
- Maternal and Child Health
- Occupational Safety and Health - Mining
- Parasitic Diseases
- Public Health Law
- Public Health Leadership and Management
- Reproductive Health
- Social and Behavioral Sciences
- Substance Use and Abuse
About
CDC Science Clips is an online, continuously updated, searchable database of scientific literature published by CDC authors. Each article features an Altmetric Attention Score to track social and mainstream media mentions. If you are aware of a CDC-authored publication that does not appear in this database, please let us know.
- Page last reviewed:Feb 1, 2024
- Page last updated:Sep 03, 2024
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