Risk factors for oligodendroglial tumors: a pooled international study
McCarthy BJ , Rankin KM , Aldape K , Bondy ML , Brannstrom T , Broholm H , Feychting M , Il'yasova D , Inskip PD , Johansen C , Melin BS , Ruder AM , Butler MA , Scheurer ME , Schuz J , Schwartzbaum JA , Wrensch MR , Davis FG . Neuro Oncol 2010 13 (2) 242-50 Oligodendroglial tumors are rare subtypes of brain tumors and are often combined with other glial tumors in epidemiological analyses. However, different demographic associations and clinical characteristics suggest potentially different risk factors. The purpose of this study was to investigate possible risk factors for oligodendroglial tumors (including oligodendroglioma, anaplastic oligodendroglioma, and mixed glioma). Data from 7 case-control studies (5 US and 2 Scandinavian) were pooled. Unconditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for age group, gender, and study site. Data on 617 cases and 1260 controls were available for analyses. Using data from all 7 studies, history of allergies and/or asthma was associated with a decreased risk of anaplastic oligodendroglioma (OR = 0.6; 95% CI: 0.4-0.9), and history of asthma only was associated with a decreased risk of oligodendroglioma (OR = 0.5; 95% CI: 0.3-0.9) and anaplastic oligodendroglioma (OR = 0.3; 95% CI: 0.1-0.9). A family history of brain tumors was associated with an increased risk of anaplastic oligodendroglioma (OR = 2.2; 95% CI: 1.1-4.5). Having had chicken pox was associated with a decreased risk of oligodendroglioma (OR = 0.6; 95% CI: 0.4-0.9) and anaplastic oligodendroglioma (OR = 0.5; 95% CI: 0.3-0.9) in the US studies. Although there is some overlap in risk factors between oligodendroglial tumors and gliomas as a group, it is likely that additional factors specific to oligodendroglial tumors have yet to be identified. Large, multi-institution international studies will be necessary to better characterize these etiological risk factors. |
What factors determine the severity of hepatitis A-related acute liver failure?
Ajmera V , Xia G , Vaughan G , Forbi JC , Ganova-Raeva LM , Khudyakov Y , Opio CK , Taylor R , Restrepo R , Munoz S , Fontana RJ , Lee WM . J Viral Hepat 2010 18 (7) e167-74 Summary: The reason(s) that hepatitis A virus (HAV) infection may progress infrequently to acute liver failure are poorly understood. We examined host and viral factors in 29 consecutive adult patients with HAV-associated acute liver failure enrolled at 10 sites participating in the US ALF Study Group. Eighteen of twenty-four acute liver failure sera were PCR positive while six had no detectable virus. HAV genotype was determined using phylogenetic analysis and the full-length genome sequences of the HAV from a cute liver failure sera were compared to those from self-limited acute HAV cases selected from the CDC database. We found that rates of nucleotide substitution did not vary significantly between the liver failure and non-liver failure cases and there was no significant variation in amino acid sequences between the two groups. Four of 18 HAV isolates were sub-genotype IB, acquired from the same study site over a 3.5-year period. Sub-genotype IB was found more frequently among acute liver failure cases compared to the non-liver failure cases (chi-square test, P < 0.01). At another centre, a mother and her son presented with HAV and liver failure within 1 month of each other. Predictors of spontaneous survival included detectable serum HAV RNA, while age, gender, HAV genotype and nucleotide substitutions were not associated with outcome. The more frequent appearance of rapid viral clearance and its association with poor outcomes in acute liver failure as well as the finding of familial cases imply a possible host genetic predisposition that contributes to a fulminant course. Recurrent cases of the rare sub-genotype IB over several years at a single centre imply a community reservoir of infection and possible increased pathogenicity of certain infrequent viral genotypes. |
Prevalence and clustering of metabolic risk factors for type 2 diabetes among Chinese adults in Shanghai, China
Xu H , Song Y , You NC , Zhang ZF , Greenland S , Ford ES , He L , Liu S . BMC Public Health 2010 10 683 BACKGROUND: Type 2 diabetes is becoming an epidemic in China. To evaluate the prevalence, clustering of metabolic risk factors and their impact on type 2 diabetes, we conducted a population-based study in Shanghai, China's largest metropolitan area. METHODS: From 2006 to 2007, 2,113 type 2 diabetes cases and 2,458 comparable controls of adults aged 40 to 79 years were enrolled. Demographic, lifestyle, and dietary factors were assessed via standardized questionnaires. Plasma, red and white blood cells were collected and stored for future studies. Anthropometric indices and biochemical intermediates (including blood pressure, fasting glucose, glycosylated hemoglobin, and blood lipids) were measured. The prevalence of metabolic syndrome were also compared following two criteria recommended by the Chinese Diabetes Society (CDS, 2004) and the National Cholesterol Education Program's Adult Treatment Panel III (ATP III, 2002). RESULTS: Prevalence of metabolic syndrome (62% vs. 15% using CDS criteria) and its individual components, including obesity (51% vs. 42%), hypertension (54% vs. 41%), hypertriglyceridemia (42% vs. 32%), and low high-density lipoprotein-cholesterol (HDL) levels (36% vs. 25%) were higher in diabetes cases than controls. Regardless of criteria used, those with impaired fasting glucose (IFG) had similarly high prevalence of metabolic syndrome as did diabetes cases. In a multiple logistic regression model adjusted for demographics and lifestyle risk factors, the odds ratios of diabetes (95% CI) were 1.23 (1.04-1.45) for overweight (28 >= BMI >= 24), 1.81 (1.45-2.25) for obesity (BMI > 28), 1.53 (1.30-1.80) for central obesity (waist circumference > 80 cm for woman or waist circumference > 85 cm for man), 1.36 (1.17-1.59) for hypertension (sbp/dbp >= 140/90 mmHg), 1.55 (1.32-1.82) for high triglycerides (triglycerides > 1.70 mmol/l) and 1.52 (1.23-1.79) for low HDL-C (HDL-C < 1.04 mmol/L). CONCLUSIONS: These data indicate that multiple metabolic risk factors--individually or jointly--were more prevalent in diabetes patients than in controls. Further research will examine hypotheses concerning the high prevalence of IFG, family history, and central obesity, aiding development of multifaceted preventive strategies specific to this population. |
Is chronic hepatitis B being undertreated in the United States?
Cohen C , Holmberg SD , McMahon BJ , Block JM , Brosgart CL , Gish RG , London WT , Block TM . J Viral Hepat 2010 18 (6) 377-83 SUMMARY: Chronic infection with the hepatitis B virus (HBV) is a major risk factor for development of end-stage liver disease, including cirrhosis, liver failure and primary liver cancer. There are now seven antiviral agents approved by the United States Food and Drug Administration (FDA) for the management of chronic HBV infection. Despite the fact that there are between 1.4 and 2 million chronic HBV infections in the United States, fewer than 50 000 people per year receive prescriptions for HBV antiviral medications. This report discusses possible explanations for the disparity between the number of people who are chronically infected and the number of people who receive treatment. Explanations for this incongruence include the potentially large number of infected persons who are unscreened and thus remain undiagnosed, and lack of access, including insurance, education and referral to appropriate medical care, particularly for disproportionately infected populations. |
Cystatin C and long-term mortality among subjects with normal creatinine-based estimated glomerular filtration rates: NHANES III (Third National Health and Nutrition Examination Survey)
Wu CK , Lin JW , Caffrey JL , Chang MH , Hwang JJ , Lin YS . J Am Coll Cardiol 2010 56 (23) 1930-6 OBJECTIVES: The objective was to test the association of cystatin C (Cys-C) with long-term mortality risk in the subjects with normal creatinine-based estimated glomerular filtration rates (eGFR). BACKGROUND: Cys-C has been proposed as a sensitive indicator of renal dysfunction that is associated with cardiovascular events. The predictive value of Cys-C for mortality risk (both cardiovascular and noncardiovascular) and its utility among persons with normal kidney function remains unclear. METHODS: The analysis included 2,990 subjects over 40 years of age with normal eGFR who participated in NHANES III (Third National Health and Nutrition Examination Survey). Normal eGFR was defined by Modification of Diet in Renal Disease (MDRD) equation ≥60 ml/min/1.73 m(2). Serum Cys-C was categorized as high, medium, or low. In 1 analysis, the high and low groups were the top and bottom 10%, and in the second analysis, they were the upper and lower thirds. All-cause and cause-specific mortality were obtained from the NHANES III-linked follow-up file through December 31, 2006. Multivariate Cox regression models were applied to assess the association of interest. RESULTS: Within an average of 13.7 years follow-up, 488 cardiovascular and 719 noncardiovascular deaths occurred. When the first and last deciles were compared, the relative risks were all increased statistically as follows: all-cause, 4.36 (95% confidence interval [CI]: 2.52 to 7.82); cardiovascular, 7.44 (95% CI: 3.06 to 18.1); cancer, 2.45 (95% CI: 0.85 to 7.04); and noncardiovascular 3.15 (95% CI: 1.53 to 6.49) mortalities. Relative risks all moderated to lower values when the comparisons were expanded to include the upper and lower thirds. Similar associations were still present when Cys-C was modeled on a continuous scale, suggesting a linear relationship between Cys-C and mortality outcomes. CONCLUSIONS: Serum Cys-C is prognostic of long-term mortality in the subjects with relatively normal renal function, independent of MDRD eGFR and albuminuria. |
Dual resistance to adamantanes and oseltamivir among seasonal influenza A(H1N1) viruses: 2008-2010
Sheu TG , Fry AM , Garten RJ , Deyde VM , Shwe T , Bullion L , Peebles PJ , Li Y , Klimov AI , Gubareva LV . J Infect Dis 2011 203 (1) 13-7 Two distinct genetic clades of seasonal influenza A(H1N1) viruses have cocirculated in the recent seasons: clade 2B oseltamivir-resistant and adamantane-susceptible viruses, and clade 2C viruses that are resistant to adamantanes and susceptible to oseltamivir. We tested seasonal influenza A(H1N1) viruses collected in 2008-2010 from the United States and globally for resistance to antivirals approved by the Food and Drug Administration. We report 28 viruses with both adamantane and oseltamivir (dual) resistance from 5 countries belonging to 4 distinct genotypes. Because of limited options for antiviral treatment, emergence of dual-resistant influenza viruses poses a public health concern, and their circulation needs to be closely monitored. |
Tuberculosis deaths averted by implementation of the DOTS strategy in Kazakhstan
Favorov M , Belilovsky E , Aitmagambetova I , Ismailov S , White ME , Chorba T . Int J Tuberc Lung Dis 2010 14 (12) 1582-8 SETTING: Kazakhstan began implementing the DOTS strategy for tuberculosis (TB) in 1998. OBJECTIVE: Data were analyzed 1) to determine if changes in TB mortality rate (MR) and case fatality rate (CFR) in Kazakhstan for 1998-2003 differed from those of Uzbekistan and four adjacent Russian Federation (RF) oblasts that had not yet implemented DOTS, and 2) to estimate the number of deaths averted in Kazakhstan as a result of DOTS. DESIGN: Observed MRs were calculated, and predicted MRs for Kazakhstan were approximated by linear regression based on average slope of MRs from 1998 through 2003 in adjacent non-DOTS-implementing territories. Deaths averted were calculated by comparing predicted MRs to actual MRs by converting rate differences to numbers of deaths. RESULTS: TB MRs in Kazakhstan decreased markedly, but remained stable or increased in the neighboring territories. CFRs decreased markedly in Kazakhstan and marginally in Uzbekistan, and increased in the neighboring RF oblasts. From 1998 to 2004, DOTS appears to have helped avert approximately 17 800 deaths in Kazakhstan. CONCLUSION: DOTS has contributed markedly to a decrease in TB mortality in Kazakhstan. In settings where mortality data are relatively complete, deaths averted can be another indicator of DOTS effectiveness. |
Measurements of airborne influenza virus in aerosol particles from human coughs
Lindsley WG , Blachere FM , Thewlis RE , Vishnu A , Davis KA , Cao G , Palmer JE , Clark KE , Fisher MA , Khakoo R , Beezhold DH . PLoS One 2010 5 (11) e15100 Influenza is thought to be communicated from person to person by multiple pathways. However, the relative importance of different routes of influenza transmission is unclear. To better understand the potential for the airborne spread of influenza, we measured the amount and size of aerosol particles containing influenza virus that were produced by coughing. Subjects were recruited from patients presenting at a student health clinic with influenza-like symptoms. Nasopharyngeal swabs were collected from the volunteers and they were asked to cough three times into a spirometer. After each cough, the cough-generated aerosol was collected using a NIOSH two-stage bioaerosol cyclone sampler or an SKC BioSampler. The amount of influenza viral RNA contained in the samplers was analyzed using quantitative real-time reverse-transcription PCR (qPCR) targeting the matrix gene M1. For half of the subjects, viral plaque assays were performed on the nasopharyngeal swabs and cough aerosol samples to determine if viable virus was present. Fifty-eight subjects were tested, of whom 47 were positive for influenza virus by qPCR. Influenza viral RNA was detected in coughs from 38 of these subjects (81%). Thirty-five percent of the influenza RNA was contained in particles >4 microm in aerodynamic diameter, while 23% was in particles 1 to 4 microm and 42% in particles <1 microm. Viable influenza virus was detected in the cough aerosols from 2 of 21 subjects with influenza. These results show that coughing by influenza patients emits aerosol particles containing influenza virus and that much of the viral RNA is contained within particles in the respirable size range. The results support the idea that the airborne route may be a pathway for influenza transmission, especially in the immediate vicinity of an influenza patient. Further research is needed on the viability of airborne influenza viruses and the risk of transmission. |
HIV/AIDS and global health in 2010: from the old to the old and the new
De Cock KM . Int J Tuberc Lung Dis 2010 14 (12) 1500-3 JANUARY 2011 will mark the start not only of a new | year but of a new decade, evidence that we are truly | launched into the new century and millennium. The | Roman god Janus, after whom the month of January is | named, had two heads, allowing him to look forwards | as well as backwards. This short end-of-year review | highlights some recent scientifi c developments as well | as examining broader trends that stretch into the future. 2010 was the bookend to a decade characterized | by extraordinary expansion in global health fi nancing | and activities, but it ends with concerns about the international fi nancial downturn and its implications. |
Infectious syphilis among adolescent and young adult men: implications for human immunodeficiency virus transmission and public health interventions
Brewer TH , Schillinger J , Lewis FM , Blank S , Pathela P , Jordahl L , Schmitt K , Peterman TA . Sex Transm Dis 2010 38 (5) 367-71 BACKGROUND: In 2008, an increase in syphilis among young black men was noted in New York City (NYC), Miami-Fort Lauderdale, and Philadelphia. To explore this trend, we examined infectious syphilis cases from 2000 to 2008 among adolescent and young adult men in these areas. METHODS: Descriptive analysis of male infectious syphilis cases reported to public health authorities in NYC, FL, and Philadelphia. RESULTS: From 2000 to 2008, infectious syphilis cases among males increased in NYC (107-1027 cases), Miami-Fort Lauderdale (109-374), and Philadelphia (41-142). This increase was largely attributable to cases among men who have sex with men. Rates among black adolescent males (15-19 years) increased in NYC ([2.6-43.0]/100,000), Miami-Fort Lauderdale ([5.5-48.1]/100,000), and Philadelphia (]8.3-40.3]/100,000). Among males with infectious syphilis in 2008 in NYC, 9.1% of blacks and 6.6% of Hispanics were adolescents compared with 1.6% of whites (P < 0.001). In Miami-Fort Lauderdale, 12.2% of black males were adolescents compared to 2.0% of whites (P < 0.01) and 2.7% of Hispanics (P < 0.01). Black males dominated all age groups in Philadelphia, but were more likely to be <25 years of age than whites (P = 0.02). Human immunodeficiency virus coinfection rates were 14.8% among adolescent males in NYC, 15.4% in Philadelphia, and 25.0% in Miami-Fort Lauderdale. CONCLUSIONS: Very young black males have emerged as a risk group for syphilis in these 3 areas, as have young Hispanic males in NYC. Many are men who have sex with men and some are already human immunodeficiency virus-infected. Targeted risk reduction interventions for these populations are critical. |
Influenza A virus transmission: contributing factors and clinical implications
Belser JA , Maines TR , Tumpey TM , Katz JM . Expert Rev Mol Med 2010 12 e39 Efficient human-to-human transmission is a necessary property for the generation of a pandemic influenza virus. To date, only influenza A viruses within the H1-H3 subtypes have achieved this capacity. However, sporadic cases of severe disease in individuals following infection with avian influenza A viruses over the past decade, and the emergence of a pandemic H1N1 swine-origin virus in 2009, underscore the need to better understand how influenza viruses acquire the ability to transmit efficiently. In this review, we discuss the biological constraints and molecular features known to affect virus transmissibility to and among humans. Factors influencing the behaviour of aerosols in the environment are described, and the mammalian models used to study virus transmission are presented. Recent progress in understanding the molecular determinants that confer efficient transmission has identified crucial roles for the haemagglutinin and polymerase proteins; nevertheless, influenza virus transmission remains a polygenic trait that is not completely understood. The clinical implications of this research, including methods currently under investigation to mitigate influenza virus human-to-human transmission, are discussed. A better understanding of the viral determinants necessary for efficient transmission will allow us to identify avian influenza viruses with pandemic potential. |
The burden of hospitalized lower respiratory tract Infection due to respiratory syncytial virus in rural Thailand
Fry AM , Chittaganpitch M , Baggett HC , Peret TC , Dare RK , Sawatwong P , Thamthitiwat S , Areerat P , Sanasuttipun W , Fischer J , Maloney SA , Erdman DD , Olsen SJ . PLoS One 2010 5 (11) e15098 BACKGROUND: We describe the epidemiology of hospitalized RSV infections for all age groups from population-based surveillance in two rural provinces in Thailand. METHODS: From September 1, 2003 through December 31, 2007, we enrolled hospitalized patients with acute lower respiratory tract illness, who had a chest radiograph ordered by the physician, from all hospitals in SaKaeo and Nakhom Phanom Provinces. We tested nasopharyngeal specimens for RSV with reverse transcriptase polymerase chain reaction (RT-PCR) assays and paired-sera from a subset of patients with IgG enzyme immunoassay. Rates were adjusted for enrollment. RESULTS: Among 11,097 enrolled patients, 987 (8.9%) had RSV infection. Rates of hospitalized RSV infection overall (and radiographically-confirmed pneumonia) were highest among children aged <1 year: 1,067/100,000 (534/100,000 radiographically-confirmed pneumonia) and 1-4 year: 403/100,000 (222/100,000), but low among enrolled adults aged ≥65 years: 42/100,000. Age <1 year (adjusted odds ratio [aOR] = 13.2, 95% confidence interval [CI] 7.7, 22.5) and 1-4 year (aOR = 8.3, 95% CI 5.0, 13.9) were independent predictors of hospitalized RSV infection. CONCLUSIONS: The incidence of hospitalized RSV lower respiratory tract illness among children <5 years was high in rural Thailand. Efforts to prevent RSV infection could substantially reduce the pneumonia burden in children aged <5 years. |
Comprehensive assessment of 2009 pandemic influenza A (H1N1) virus drug susceptibility in vitro
Gubareva LV , Trujillo AA , Okomo-Adhiambo M , Mishin VP , Deyde VM , Sleeman K , Nguyen HT , Sheu TG , Garten RJ , Shaw MW , Fry AM , Klimov AI . Antivir Ther 2010 15 (8) 1151-9 BACKGROUND: Antiviral drugs are an important option for managing infections caused by influenza viruses. This study assessed the drug susceptibility of 2009 pandemic influenza A (H1N1) viruses collected globally between April 2009 and January 2010. METHODS: Virus isolates were tested for adamantane susceptibility, using pyrosequencing to detect the S31N marker of adamantane resistance in the M2 protein and biological assays to assess viral replication in cell culture. To assess neuraminidase (NA) inhibitor (NAI) susceptibility, virus isolates were tested in chemiluminescent NA inhibition assays and by pyrosequencing to detect the H275Y (H274Y in N2 numbering) marker of oseltamivir resistance in the NA. RESULTS: With the exception of three, all viruses that were tested for adamantane susceptibility (n=3,362) were resistant to this class of drugs. All viruses tested for NAI susceptibility (n=3,359) were sensitive to two US Food and Drug Administration-approved NAIs, oseltamivir (mean +/-sd 50% inhibitory concentration [IC(50)] 0.25 +/-0.12 nM) and zanamivir (mean IC(50) 0.29 +/-0.09 nM), except 23 (0.7%), which were resistant to oseltamivir, but sensitive to zanamivir. Oseltamivir-resistant viruses had the H275Y mutation in their NA and were detected in patients exposed to the drug through prophylaxis or treatment. NA activity of all viruses was inhibited by the NAIs peramivir, laninamivir (R-125489) and A-315675, except for H275Y variants, which exhibited approximately 100-fold reduction in peramivir susceptibility. CONCLUSIONS: This report provides data regarding antiviral susceptibility of 2009 pandemic influenza A (H1N1) surveillance viruses, the majority of which were resistant to adamantanes and sensitive to NAIs. These findings provide information essential for antiviral resistance monitoring and development of novel diagnostic tests for detecting influenza antiviral resistance. |
Costs and consequences of additional chest X-ray in a tuberculosis prevention program in Botswana
Samandari T , Bishai D , Luteijn M , Mosimaneotsile B , Motsamai O , Postma M , Hubben G . Am J Respir Crit Care Med 2010 183 (8) 1103-11 RATIONALE: Isoniazid preventive therapy (IPT) is effective in reducing the risk of tuberculosis (TB) in persons living with HIV (PLWH), however screening must exclude TB disease prior to initiating therapy. Symptom screening alone may be insufficient to exclude TB disease in PLWH because some PLWH with TB disease have no symptoms. The addition of chest radiography (CXR) may improve disease detection. OBJECTIVES: The objective of the present analysis was to compare the costs and effects of the addition of CXR to the symptom screening process against the costs and effects of symptom screening alone. METHODS: Using data from Botswana, a decision analytic model was used to compare a 'Symptom only' policy against a 'Symptom+CXR' policy. The outcomes of interest were cost, death, isoniazid- and multidrug-resistant TB in a hypothetical cohort of 10,000 PLWH. MEASUREMENTS AND MAIN RESULTS: A 'Symptom+CXR' policy prevented 16 isoniazid- and 0.3 multidrug-resistant TB cases, however due to attrition from the screening process, there were 98 excess cases of TB, 15 excess deaths and an additional cost of US$127,100. 'Symptom+CXR' policy reduced deaths only if attrition were close to zero, however in order to eliminate attrition the cost would be US$2.8 million per death averted. These findings did not change in best- and worst-case scenario analysis. CONCLUSIONS: In Botswana, a policy with symptom screening only preceding IPT initiation, prevents more TB and TB-related deaths, and uses fewer resources than a policy that uses both CXR and symptom screening. |
Urban focus of Rickettsia typhi and Rickettsia felis in Los Angeles, California
Abramowicz KF , Rood MP , Krueger L , Eremeeva ME . Vector Borne Zoonotic Dis 2010 11 (7) 979-84 Classic murine typhus, caused by Rickettsia typhi, is endemic in the continental United States in areas of Texas and southern California. We conducted an environmental investigation in an urban area of Los Angeles identified as the probable exposure site for a case of murine typhus. Four Rattus norvegicus heavily infested with Xenopsylla cheopis (average 32.5 fleas per animal, range 20-42) were trapped, and fleas, blood, and tissues were collected. DNAs from all specimens were tested for R. typhi and Rickettsia felis using a TaqMan assay targeting the rickettsial citrate synthase gene. Although rickettsiemia was not detected, DNA of R. felis was detected in at least one tissue from each rat. Tissues from 3 rats were also positive for R. typhi DNA. R. typhi and R. felis DNAs were detected in fleas collected from each animal with average minimal infection rates of 10% and 32.3%, respectively. Although R. typhi still circulates in urban Los Angeles in the classic Oriental flea-rat cycle, R. felis is more prevalent, even in this association. |
Source water quality effects on monochloramine inactivation of adenovirus, coxsackievirus, echovirus, and murine norovirus
Kahler AM , Cromeans TL , Roberts JM , Hill VR . Water Res 2010 45 (4) 1745-51 There is a need for more information regarding monochloramine disinfection efficacy for viruses in water. In this study, monochloramine disinfection efficacy was investigated for coxsackievirus B5 (CVB5), echovirus 11 (E11), murine norovirus (MNV), and human adenovirus 2 (HAdV2) in one untreated ground water and two partially treated surface waters. Duplicate disinfection experiments were completed at pH 7 and 8 in source water at concentrations of 1 and 3 mg/L monochloramine at 5 and 15 degrees C. The Efficiency Factor Hom (EFH) model was used to calculate CT values (mg-min/L) required to achieve 2-, 3-, and 4-log(10) reductions in viral titers. In all water types, monochloramine disinfection was most effective for MNV, with 3-log(10) CT values at 5 degrees C ranging from 27 to 110. Monochloramine disinfection was least effective for HAdV2 and E11, depending on water type, with 3-log(10) CT values at 5 degrees C ranging from 1200 to 3300 and 810 to 2300, respectively. Overall, disinfection proceeded faster at 15 degrees C and pH 7 for all water types. Inactivation of the study viruses was significantly different between water types, but there was no indication that overall disinfection efficacy was enhanced or inhibited in any one water type. CT values for HAdV2 in two types of source water exceeded federal CT value recommendations in the US. The results of this study demonstrate that water quality impacts the inactivation of viruses and should be considered when developing chloramination plans. |
Integrated disease investigations and surveillance planning: a systems approach to strengthening national surveillance and detection of events of public health importance in support of the International Health Regulations
Taboy CH , Chapman W , Albetkova A , Kennedy S , Rayfield MA . BMC Public Health 2010 10 S6 The international community continues to define common strategic themes of actions to improve global partnership and international collaborations in order to protect our populations. The International Health Regulations (IHR[2005]) offer one of these strategic themes whereby World Health Organization (WHO) Member States and global partners engaged in biosecurity, biosurveillance and public health can define commonalities and leverage their respective missions and resources to optimize interventions. The U.S. Defense Threat Reduction Agency's Cooperative Biologica Engagement Program (CBEP) works with partner countries across clinical, veterinary, epidemiological, and laboratory communities to enhance national disease surveillance, detection, diagnostic, and reporting capabilities. CBEP, like many other capacity building programs, has wrestled with ways to improve partner country buy-in and ownership and to develop sustainable solutions that impact integrated disease surveillance outcomes. Designing successful implementation strategies represents a complex and challenging exercise and requires robust and transparent collaboration at the country level. To address this challenge, the Laboratory Systems Development Branch of the U.S. Centers for Disease Control and Prevention (CDC) and CBEP have partnered to create a set of tools that brings together key leadership of the surveillance system into a deliberate system design process. This process takes into account strengths and limitations of the existing system, how the components inter-connect and relate to one another, and how they can be systematically refined within the local context. The planning tools encourage cross-disciplinary thinking, critical evaluation and analysis of existing capabilities, and discussions across organizational and departmental lines toward a shared course of action and purpose. The underlying concepts and methodology of these tools are presented here. |
Awareness and utilization of BRCA1/2 testing among U.S. primary care physicians.
Bellcross CA , Kolor K , Goddard KA , Coates RJ , Reyes M , Khoury MJ . Am J Prev Med 2011 40 (1) 61-6 BACKGROUND: Testing for mutations in the breast and ovarian cancer susceptibility genes BRCA1 and BRCA2 (BRCA) has been commercially available since 1996. PURPOSE: This study sought to determine, among U.S. primary care physicians, the level of awareness and utilization of BRCA testing and the 2005 U.S. Preventive Services Task Force (USPSTF) recommendations. METHODS: In 2009, data were analyzed on 1500 physician respondents to the 2007 DocStyles national survey (515 family practitioners, 485 internists, 250 pediatricians, and 250 obstetricians/gynecologists). RESULTS: Overall, 87% of physicians were aware of BRCA testing, and 25% reported having ordered testing for at least one patient in the past year. Ordering tests was most prevalent among obstetricians/gynecologists in practice for more than 10 years, with more affluent patients. Physicians were asked to select indications for BRCA testing from seven different clinical scenarios representing increased (4) or low-risk (3) situations consistent with the USPSTF guidelines. Among ordering physicians (pediatricians excluded), 45% chose at least one low-risk scenario as an indication for BRCA testing. Only 19% correctly selected all of the increased-risk and none of the low-risk scenarios. CONCLUSIONS: A substantial majority of primary care physicians are aware of BRCA testing and many report having ordered at least one test within the past year. A minority, however, appear to consistently recognize the family history patterns identified by the USPSTF as appropriate indications for BRCA evaluation. These results suggest the need to improve providers' knowledge about existing recommendations-particularly in this era of increased BRCA direct-to-consumer marketing. |
Inflammation gene variants and susceptibility to albuminuria in the U.S. population: analysis in the Third National Health and Nutrition Examination Survey (NHANES III), 1991-1994.
Ned RM , Yesupriya A , Imperatore G , Smelser DT , Moonesinghe R , Chang MH , Dowling NF . BMC Med Genet 2010 11 155 BACKGROUND: Albuminuria, a common marker of kidney damage, serves as an important predictive factor for the progression of kidney disease and for the development of cardiovascular disease. While the underlying etiology is unclear, chronic, low-grade inflammation is a suspected key factor. Genetic variants within genes involved in inflammatory processes may, therefore, contribute to the development of albuminuria. METHODS: We evaluated 60 polymorphisms within 27 inflammatory response genes in participants from the second phase (1991-1994) of the Third National Health and Nutrition Examination Survey (NHANES III), a population-based and nationally representative survey of the United States. Albuminuria was evaluated as logarithm-transformed albumin-to-creatinine ratio (ACR), as ACR ≥ 30 mg/g, and as ACR above sex-specific thresholds. Multivariable linear regression and haplotype trend analyses were conducted to test for genetic associations in 5321 participants aged 20 years or older. Differences in allele and genotype distributions among non-Hispanic whites, non-Hispanic blacks, and Mexican Americans were tested in additive and codominant genetic models. RESULTS: Variants in several genes were found to be marginally associated (uncorrected P value < 0.05) with log(ACR) in at least one race/ethnic group, but none remained significant in crude or fully-adjusted models when correcting for the false-discovery rate (FDR). In analyses of sex-specific albuminuria, IL1B (rs1143623) among Mexican Americans remained significantly associated with increased odds, while IL1B (rs1143623), CRP (rs1800947) and NOS3 (rs2070744) were significantly associated with ACR ≥ 30 mg/g in this population (additive models, FDR-P < 0.05). In contrast, no variants were found to be associated with albuminuria among non-Hispanic blacks after adjustment for multiple testing. The only variant among non-Hispanic whites significantly associated with any outcome was TNF rs1800750, which failed the test for Hardy-Weinberg proportions in this population. Haplotypes within MBL2, CRP, ADRB2, IL4R, NOS3, and VDR were significantly associated (FDR-P < 0.05) with log(ACR) or albuminuria in at least one race/ethnic group. CONCLUSIONS: Our findings suggest a small role for genetic variation within inflammation-related genes to the susceptibility to albuminuria. Additional studies are needed to further assess whether genetic variation in these, and untested, inflammation genes alter the susceptibility to kidney damage. |
Group differences in risk across three domains using an expanded measure of sexual orientation
Loosier PS , Dittus PJ . J Prim Prev 2010 31 261-72 The purpose of this study was to highlight associations between sexual orientation and risk outcomes in late adolescence and early adulthood using an expanded measure of sexual orientation. Recent data indicate higher levels of risk behavior in a newly identified population, mostly heterosexuals, as compared to heterosexuals. Comparisons among groups using an expanded measure of sexual orientation such as this, however, often do not include all possible groups or may restrict comparisons between groups. Data were derived from the National Longitudinal Study of Adolescent Health (Add Health); participants identified as heterosexual, mostly heterosexual, bisexual, mostly gay, or gay. Main risk outcomes were parental mistreatment, home displacement, thoughts of suicide, depressive symptoms, frequency of drinking, and delinquency. A priori planned comparisons examined differences between: (a) heterosexual vs. mostly heterosexual, (b) gay vs. mostly gay, (c) mostly heterosexual vs. bisexual, (d) mostly gay vs. bisexual, (e) mostly heterosexual vs. mostly gay, (f) heterosexual vs. gay, (g) heterosexual vs. bisexual, and (h) gay vs. bisexual. Mostly heterosexual youth were at significantly greater risk than heterosexual youth on all outcomes but did not differ from bisexual or mostly gay youth. Heterosexuals were at lower risk as compared to mostly heterosexuals and bisexuals. This study provides further evidence of differential risk associations for sexual minorities. |
HIV risk and the overlap of injecting drug use and high-risk sexual behaviours among men who have sex with men in Zanzibar (Unguja), Tanzania
Johnston LG , Holman A , Dahoma M , Miller LA , Kim E , Mussa M , Othman AA , Kim A , Kendall C , Sabin K . Int J Drug Policy 2010 21 (6) 485-92 BACKGROUND: Men who have sex with men and inject drugs (MSM-IDU) are particularly vulnerable to HIV infection and have the potential to transmit HIV across multiple populations through their male and female sexual partners and injection drug-using partners. METHODS: Respondent-driven sampling was used to recruit men who reported engaging in anal sex with another man in the past 3 months, aged ≥15 years, and living in Unguja, Zanzibar. Participants responded to a face-to-face interview about their HIV and injecting risk behaviours and were tested for HIV, Hepatitis B (HBV) and C (HCV) and syphilis. RESULTS: Among the 509 MSM who enrolled in the survey, 14% (n=66) reported injecting drugs in the past 3 months among which 66% used heroin, 60% used a needle after someone else had and 68% passed a needle to someone else after using it. MSM-IDU were significantly more likely to have two or more non-paying male receptive sex partners and to have engaged in group sex in the past month, to have symptoms of a sexually transmitted infection in past 6 months, to have been arrested or beaten in the past 12 months and to be infected with HIV and co-infected with HIV and HCV compared to MSM who did not inject drugs. MSM-IDU were less likely to have used a condom at last sex with a non-paid female partner, to know where to get a confidential HIV test and to have ever been tested for HIV compared to MSM who did not inject drugs. CONCLUSION: MSM-IDU, and MSM in general, in Unguja practice multiple high-risk behaviours that put them at risk for blood-borne and sexual transmission of HIV and HCV infection. Targeted interventions for MSM-IDU must account for the overlap of high-risk sexual and drug-using networks and integrate injection drug use and HIV services. |
Parental attitudes toward human papillomavirus vaccination: evaluation of an educational intervention, 2008
Kennedy A , Sapsis KF , Stokley S , Curtis CR , Gust D . J Health Commun 2010 16 (3) 1-14 The authors' objectives were to improve human papillomavirus (HPV) vaccine educational materials and to determine whether parents who received those materials had improved attitudes about the vaccine. Pretests were sent to 411 parents of girls 11-18 years of age who had not yet received the HPV vaccine. The authors then randomly assigned 270 respondents to an intervention (educational flyer and posttest) or comparison (posttest only) group. The authors conducted a mixed-method analysis of intervention group feedback on improving the flyer and used paired t tests and analysis of covariance to describe within- and between-group attitude changes. The overall posttest response rate was 76%. Among intervention group respondents (n = 131), 88% had a positive impression of the flyer, and 43% reported that it made them more likely to vaccinate their daughters with HPV vaccine in the future. Parents who received the flyer also showed a statistically significant increase in mean attitude scores regarding perceived HPV vaccine safety and access to HPV vaccine information; mean scores also increased among the comparison group, but the changes were not statistically significant. Educational materials improved HPV vaccine knowledge and attitudes among parents and might have helped motivate some parents to have their daughters vaccinated. |
Total serum IgE levels in systemic lupus erythematosus and associations with childhood onset allergies
Parks C , Biagini R , Cooper G , Gilkeson G , Dooley M . Lupus 2010 19 (14) 1614-22 Elevated serum IgE has been described in systemic lupus erythematosus (SLE), but associations with disease risk and characteristics remain unresolved. We assessed total serum IgE levels and atopy (IgE > 100 IU/ml) in recently diagnosed SLE patients (n = 228) compared with population controls (n = 293) and in relation to disease activity, autoantibodies, clinical features, total immunoglobulins, C-reactive protein, and allergy history. Multivariate models estimated determinants of IgE and atopy in patients and controls, and associations of SLE with allergy and atopy. Total IgE levels were higher in patients than controls (median = 42 vs. 29 IU/ml); 32% of patients and 25% of controls were atopic (p = 0.06). IgE levels were significantly higher in non-Whites and patients reporting childhood onset (<18 years) asthma and hives, and in controls reporting childhood asthma, hay fever, eczema, and adult onset hives. After accounting for racial differences, atopy was not associated with SLE, nephritis, or other clinical and laboratory parameters. In sum, our findings provide limited evidence of a direct association between total serum IgE and SLE overall or with other disease characteristics after adjusting for demographic characteristics and allergy history. Future studies may want to explore potentially shared risk factors for development of allergy, atopy, and SLE. |
Safety and effectiveness of a 2009 H1N1 vaccine in Beijing
Wu J , Xu F , Lu L , Lu M , Miao L , Gao T , Ji W , Suo L , Liu D , Ma R , Yu R , Zhangzhu J , Liu W , Zeng Y , Li X , Zhang X , Pang X , Deng Y . N Engl J Med 2010 363 (25) 2416-23 BACKGROUND: After the first monovalent 2009 pandemic influenza A (H1N1) vaccine became available in September 2009, Chinese officials conducted a mass vaccination program in Beijing. We evaluated the safety and effectiveness of the vaccine. METHODS: During a 5-day period in September 2009, a total of 95,244 children and adults received the PANFLU.1 vaccine (Sinovac Biotech), a monovalent split-virion vaccine of 15 mug of hemagglutinin antigen without adjuvant. We assessed adverse events after immunization through an enhanced passive-surveillance system and through active surveillance, using diary cards and telephone interviews. Active surveillance for neurologic diseases was implemented in hospitals citywide. To assess vaccine effectiveness, we compared the rates of reported laboratory-confirmed cases of 2009 H1N1 virus infection in students who received the vaccine with the rates in those who did not receive the vaccine, starting 2 weeks after the mass vaccination. RESULTS: As of December 31, 2009, adverse events were reported by 193 vaccine recipients. Through hospital-based active surveillance, 362 cases of incident neurologic diseases were identified within 10 weeks after the mass vaccination, including 27 cases of the Guillain-Barre syndrome. None of the neurologic conditions occurred among vaccine recipients. From 245 schools, 25,037 students participated in the mass vaccination and 244,091 did not. During the period from October 9 through November 15, 2009, the incidence of confirmed cases of 2009 H1N1 virus infection per 100,000 students was 35.9 (9 of 25,037) among vaccinated students and 281.4 (687 of 244,091) among unvaccinated students. Thus, the estimated vaccine effectiveness was 87.3% (95% confidence interval, 75.4 to 93.4). CONCLUSIONS: Among 95,244 children and adults in Beijing, the PANFLU.1 vaccine had a safety profile similar to those of seasonal influenza vaccines and appeared to be effective against confirmed H1N1 virus infection in school-age children. (Funded by the Beijing Municipal Health Bureau.). |
The safety of immunizing with tetanus-diphtheria-acellular pertussis vaccine (Tdap) less than 2 years following previous tetanus vaccination: Experience during a mass vaccination campaign of healthcare personnel during a respiratory illness outbreak
Talbot EA , Brown KH , Kirkland KB , Baughman AL , Halperin SA , Broder KR . Vaccine 2010 28 (50) 8001-7 BACKGROUND: Tdap is recommended for health care personnel (HCP) aged <65 years who received tetanus diphtheria or tetanus toxoid immunization (Td/TT) ≥2 years earlier. During a medical center Tdap vaccination campaign, we assessed the safety of use of a Td/TT to Tdap interval <2 years in HCP. We also describe reactogenicity in HCP who were aged ≥65 years or pregnant. METHODS: HCP vaccinated with Tdap were surveyed to assess time since last Td/TT (≥2 years vs. <2 years), age, pregnancy status, and injection site adverse events (AEs) during the 2 weeks after Tdap. AE rates were calculated and compared by non-inferiority analysis using a predetermined margin of 10%. We searched clinic logbooks to assess for clinically important adverse events during the 2 months after Tdap. RESULTS: Of the 4524 vaccinated HCP, 2221 (49.1%) completed a safety survey which met criteria for analysis. Non-inferiority analysis found that rates of moderate and/or severe injection site AEs were not significantly greater in those vaccinated <2 years than in those vaccinated ≥2 years after previous Td/TT. Three serious adverse events were reported during the 2 months after vaccination, none in persons who were ≥65 years, pregnant or received Td/TT <2 years before. CONCLUSIONS: Our findings add to the body of evidence that a short interval between Td/TT and a single dose of Tdap is safe. |
NS-based live attenuated H1N1 pandemic vaccines protect mice and ferrets
Zhou B , Li Y , Belser JA , Pearce MB , Schmolke M , Subba AX , Shi Z , Zaki SR , Blau DM , Garcia-Sastre A , Tumpey TM , Wentworth DE . Vaccine 2010 28 (50) 8015-25 Although vaccines against influenza A virus are the most effective method to combat infection, it is clear that their production needs to be accelerated and their efficacy improved. We generated live attenuated human influenza A vaccines (LAIVs) by rationally engineering mutations directly into the genome of a pandemic-H1N1 virus. Two LAIVs (NS1-73 and NS1-126) were based on the success of LAIVs for animal influenza A viruses. A third candidate (NSDelta5) is a unique NS-mutant that has never been used as a LAIV. The vaccine potential of each LAIV was determined through analysis of attenuation, interferon production, immunogenicity, and their ability to protect mice and ferrets. This study demonstrates that NSDelta5 is an ideal LAIV candidate, provides important information on the effects that different NS mutations have on the pandemic-H1N1 virus and shows that LAIVs can be engineered directly from the genomes of emerging/circulating influenza A viruses. |
Molecular determination of H antigens of Salmonella by use of a microsphere-based liquid array.
McQuiston JR , Waters RJ , Dinsmore BA , Mikoleit ML , Fields PI . J Clin Microbiol 2010 49 (2) 565-573 Serotyping of Salmonella has been an invaluable subtyping method for epidemiologic studies for more than 70 years. Technical difficulties of serotyping, primarily in antisera production and quality control, can be overcome with modern molecular methods. We developed a DNA based assay targeting the genes encoding the flagellar antigens (fliC and fljB) of the Kauffmann-White serotyping scheme. Fifteen H antigens (H:a; b; c; d; d/j; e,h; i; k; r; y; z; z10; z29;z35 and z6), five complex major antigens (H:G; EN; Z4; 1 and L) and 16 complex secondary antigens (H:2; 5; 6; 7; f; m/g,m; m/m,t; p; s; t/m,t; v; x; z15; z24; z28 and z51) were targeted in the assay. DNA probes targeting these antigens were designed and evaluated on 500 isolates tested in parallel with traditional serotyping methods. The assay correctly identified 461 (92.2%) isolates based on the 36 antigens detected in the assay. Among the isolates considered correctly identified, 47 (9.4%) were partially serotyped because probes corresponding to some antigens in the strains were not in the assay, and 13 (2.6%) were monophasic or nonmotile strains that possessed flagellar antigen genes that were not expressed but were detected in the assay. The 39 (7.8%) strains that were not correctly identified possessed an antigen that should have been detected by the assay, but was not. Apparent false negative results may be attributed to allelic divergence. The molecular assay provided results that paralleled traditional methods with a much greater throughput, while maintaining the integrity of the Kauffmann White serotyping scheme, thus providing backwards compatible epidemiologic data. This assay should greatly enhance the ability of clinical and public health laboratories to serotype of Salmonella. |
Infection with highly pathogenic h7 influenza viruses results in an attenuated proinflammatory cytokine and chemokine response early after infection
Belser JA , Zeng H , Katz JM , Tumpey TM . J Infect Dis 2011 203 (1) 40-8 Avian influenza A viruses of the H7 subtype have resulted in more than 100 cases of human infection since 2002. Highly pathogenic avian influenza (HPAI) H7 viruses have the capacity to cause severe respiratory disease and even death; however, the induction of the human innate immune response to H7 virus infection has not been well characterized. To better understand H7 virus pathogenesis in the human respiratory tract, we employed a polarized human bronchial epithelial cell model and primary human monocyte-derived macrophages. Here, we show that infection with HPAI H7 viruses resulted in a delayed and weakened production of cytokines, including the type I interferon response, compared with infections of other influenza A subtypes, including H7 viruses of low pathogenicity. These studies revealed that H7 viruses vary greatly in their ability to activate host innate responses and may contribute to the virulence of these viruses observed in humans. |
Novel point-of-care test for simultaneous detection of nontreponemal and treponemal antibodies in patients with syphilis
Castro AR , Esfandiari J , Kumar S , Ashton M , Kikkert SE , Park MM , Ballard RC . J Clin Microbiol 2010 48 (12) 4615-9 We describe a point-of-care immunochromatographic test for the simultaneous detection of both nontreponemal and treponemal antibodies in the sera of patients with syphilis that acts as both a screening and a confirmatory test. A total of 1,601 banked serum samples were examined by the dual test, and the results were compared to those obtained using a quantitative rapid plasma reagin (RPR) test and the Treponema pallidum passive particle agglutination (TP-PA) assay. Compared to the RPR test, the reactive concordance of the dual test nontreponemal line was 98.4% when the RPR titers of sera were ≥1:2 and the nonreactive concordance was 98.6%. Compared to the TP-PA assay, the reactive and nonreactive concordances of the treponemal line were 96.5% and 95.5%, respectively. These results indicate that the dual test could be used for the serological diagnosis of syphilis in primary health care clinics or resource-poor settings and therefore improve rates of treatment where patients may fail to return for their laboratory results. |
Evaluation of a rapid and completely automated real-time reverse transcriptase polymerase chain reaction assay for the diagnosis of enteroviral meningitis
Nolte FS , Rogers BB , Tang YW , Oberste MS , Robinson CC , Kehl KS , Rand KA , Rotbart HA , Romero JR , Nyquist AC , Persing DH . J Clin Microbiol 2010 49 (2) 528-33 Nucleic acid amplification tests (NAATs) for enterovirus RNA in cerebrospinal fluid (CSF) have emerged as the new gold standard for diagnosis of enteroviral meningitis and their use can improve the management and decrease the costs for caring for children with enteroviral meningitis. The Xpert(TM) EV Assay (Cepheid, Sunnyvale, CA) is a rapid, fully-automated real-time polymerase chain reaction test for the detection of enterovirus RNA that was approved by the FDA for in vitro diagnostic use in March, 2007. In this multicenter trial we established the clinical performance characteristics of the Xpert(TM) EV Assay in patients presenting with meningitis symptoms relative to clinical truth. Clinical truth for enteroviral meningitis was defined as clinical evidence of meningitis, the absence of another detectable pathogen in CSF, and detection of enterovirus in CSF either by two reference NAATs or by viral culture. A total of 199 prospectively and 235 retrospectively collected specimens were eligible for inclusion in this study. The overall prevalence of enteroviral meningitis was 26.04%. The Xpert EV Assay had a sensitivity of 94.69% (90% CI, 89.79 to 97.66%), specificity of 100% (90% CI, 99.07 to 100%), positive predictive value of 100%, negative predictive value of 98.17, and an accuracy of 98.62% relative to clinical truth. The Xpert EV Assay demonstrated a high degree of accuracy for diagnosis of enteroviral meningitis. The simplicity and on-demand capability of the Xpert EV Assay should prove to be a valuable adjunct to the evaluation of suspected meningitis cases. |
Arginase activities and global arginine bioavailability in wild-type and apoE-deficient mice: responses to high fat and high cholesterol diets
Erdely A , Kepka-Lenhart D , Salmen-Muniz R , Chapman R , Hulderman T , Kashon M , Simeonova PP , Morris SM . PLoS One 2010 5 (12) e15253 Increased catabolism of arginine by arginase is increasingly viewed as an important pathophysiological factor in cardiovascular disease, including atherosclerosis induced by high cholesterol diets. Whereas previous studies have focused primarily on effects of high cholesterol diets on arginase expression and arginine metabolism in specific blood vessels, there is no information regarding the impact of lipid diets on arginase activity or arginine bioavailability at a systemic level. We, therefore, evaluated the effects of high fat (HF) and high fat-high cholesterol (HC) diets on arginase activity in plasma and tissues and on global arginine bioavailability (defined as the ratio of plasma arginine to ornithine + citrulline) in apoE(-/-) and wild-type C57BL/6J mice. HC and HF diets led to reduced global arginine bioavailability in both strains. The HC diet resulted in significantly elevated plasma arginase in both strains, but the HF diet increased plasma arginase only in apoE(-/-) mice. Elevated plasma arginase activity correlated closely with increased alanine aminotransferase levels, indicating that liver damage was primarily responsible for elevated plasma arginase. The HC diet, which promotes atherogenesis, also resulted in increased arginase activity and expression of the type II isozyme of arginase in multiple tissues of apoE(-/-) mice only. These results raise the possibility that systemic changes in arginase activity and global arginine bioavailability may be contributing factors in the initiation and/or progression of cardiovascular disease. |
Cyanidin-3-glucoside inhibits ethanol-induced invasion of breast cancer cells overexpressing ErbB2
Xu M , Bower KA , Wang S , Frank JA , Chen G , Ding M , Shi X , Ke Z , Luo J . Mol Cancer 2010 9 285 BACKGROUND: Ethanol is a tumor promoter. Both epidemiological and experimental studies suggest that ethanol may enhance the metastasis of breast cancer cells. We have previously demonstrated that ethanol increased the migration/invasion of breast cancer cells expressing high levels of ErbB2. Amplification of ErbB2 is found in 20-30% of breast cancer patients and is associated with poor prognosis. We sought to identify agents that can prevent or ameliorate ethanol-induced invasion of breast cancer cells. Cyanidin-3-glucoside (C3G), an anthocyanin present in many vegetables and fruits, is a potent natural antioxidant. Ethanol exposure causes the accumulation of intracellular reactive oxygen species (ROS). This study evaluated the effect of C3G on ethanol-induced breast cancer cell migration/invasion. RESULTS: C3G attenuated ethanol-induced migration/invasion of breast cancer cells expressing high levels of ErbB2 (BT474, MDA-MB231 and MCF7(ErbB2)) in a concentration dependent manner. C3G decreased ethanol-mediated cell adhesion to the extracellular matrix (ECM) as well as the amount of focal adhesions and the formation of lamellipodial protrusion. It inhibited ethanol-stimulated phosphorylation of ErbB2, cSrc, FAK and p130(Cas), as well as interactions among these proteins. C3G abolished ethanol-mediated p130(Cas)/JNK interaction. CONCLUSIONS: C3G blocks ethanol-induced activation of the ErbB2/cSrc/FAK pathway which is necessary for cell migration/invasion. C3G may be beneficial in preventing/reducing ethanol-induced breast cancer metastasis. |
Diabetes Antibody Standardization Program: evaluation of assays for insulin autoantibodies
Schlosser M , Mueller PW , Torn C , Bonifacio E , Bingley PJ . Diabetologia 2010 53 (12) 2611-20 AIMS/HYPOTHESIS: Insulin autoantibodies (IAA) are important in type 1 diabetes risk assessment. However, their determination varies more between laboratories than other diabetes autoantibodies. The Diabetes Antibody Standardization Program (DASP) aims to improve and standardise measurement of autoantibodies associated with type 1 diabetes. We report the results of measurement of IAA from DASP workshops in 2002, 2003 and 2005. METHODS: Up to 32 laboratories in 14 countries participated in each workshop. Aliquots of coded sera from 50 patients with newly diagnosed type 1 diabetes and 100 blood donor controls were circulated to participating laboratories. Reported results were analysed using receiver operator characteristic (ROC) curves. We compared concordance of antibody levels by ranking, IAA and insulin antibody (IA) indices and units derived from an IA standard curve. RESULTS: In all three workshops IAA assay performance had improved compared with DASP 2000. The median area under the ROC curve was 0.73 in DASP 2002, 0.78 in 2003 and 0.80 in 2005 (p = 0.0012), and median laboratory-assigned sensitivity was 26% in 2002, 36% in 2003 and 45% in 2005 (p < 0.0001). There was, however, marked variation between assays. The range of AUC was 0.36-0.91 and that of laboratory-assigned sensitivity was 22-57%. Concordance of ranking of patient serum samples was related to AUC (p < 0.001). Using an index related to common IAA and IA-positive or -negative control sera improved the concordance between assays (p < 0.0001). CONCLUSIONS/INTERPRETATION: The overall performance of IAA assays has improved but there is still wide variation between laboratories. Concordance between assays would be improved by the use of a common reference reagent. |
Incidence of neonatal herpes simplex virus infections in the United States, 2006
Flagg EW , Weinstock H . Pediatrics 2010 127 (1) e1-8 OBJECTIVES: Neonatal herpes simplex virus (nHSV) infections, although relatively rare, cause significant morbidity and mortality. Estimates of nHSV incidence across the United States vary widely and have been derived by using a variety of methods. We estimated the incidence of nHSV infections for the United States during 2006, as well as demographic-specific rates, by using nationally and regionally weighted estimates from a population-based sample of inpatient data. METHODS: We examined inpatient records of infants aged 60 days or younger at admission using the Healthcare Cost and Utilization Project Kids' Inpatient Database. Patients with a length of stay that exceeded 7 days (or deceased during hospitalization) were identified at discharge from the International Classification of Diseases, Ninth Revision, Clinical Modification codes for herpes simplex (054.0-054.9). Cases for which patients had been transferred from another hospital or readmitted were excluded from case counts. RESULTS: We found an overall US incidence of 9.6 per 100 000 births in 2006. Rates per 100 000 births among US regions were 8.2 in the Northeast, 12.9 in the Midwest, 8.9 in the South, and 8.8 in the West. Rates of 13.8, 9.9, and 7.5 were observed for black, white, and Hispanic newborns, respectively; these differences were not statistically significant. Rates were significantly higher among cases for which the expected primary payer was Medicaid (15.1) compared with private insurance or managed health care (5.4). Median age at admission was 10 days; 25% of admissions were on the day of birth. CONCLUSIONS: This description of regional and demographic-specific nHSV incidence rates for the United States provides important new information on the extent of this potentially devastating disease. |
Physiological responses to wearing a prototype firefighter ensemble compared with a standard ensemble
Williams WJ , Coca A , Roberge R , Shepherd A , Powell J , Shaffer RE . J Occup Environ Hyg 2011 8 (1) 49-57 This study investigated the physiological responses to wearing a standard firefighter ensemble (SE) and a prototype ensemble (PE) modified from the SE that contained additional features, such as magnetic ring enclosures at the glove-sleeve interface, integrated boot-pant interface, integrated hood-SCBA facepiece interface, and a novel hose arrangement that rerouted self-contained breathing apparatus (SCBA) exhaust gases back into the upper portion of the jacket. Although the features of the PE increased the level of encapsulation of the wearer that could lead to increased physiological stress compared with the SE, it was hypothesized that the rerouted exhaust gases provided by the PE hose assembly would (1) provide convective cooling to the upper torso, (2) reduce the thermal stress experienced by the wearer, and (3) reduce the overall physiological stress imposed by the PE such that it would be either less or not significantly different from the SE. Ten subjects (seven male, three female) performed treadmill exercise in an environmental chamber (22 degrees C, 50% RH) at 50% [image omitted]O(2max) while wearing either the SE with an SCBA or the PE with an SCBA either with or without the hose attached (designated PEWH and PENH, respectively). Heart rate (HR), rectal and intestinal temperatures (T(re), T(in)), sweat loss, and endurance time were measured. All subjects completed at least 20 min of treadmill exercise during the testing. At the end of exercise, there was no difference in T(re) (p = 0.45) or T(in) (p = 0.42), HR, or total sweat loss between the SE and either PEWH or PENH (p = 0.59). However, T(sk) was greater in PEWH and PENH compared with SE (p < 0.05). Total endurance time in SE was greater than in either PEWH or PENH (p < 0.05). Thus, it was concluded that the rerouting of exhaust gases to the jacket did not provide significant convective cooling or reduce thermal stress compared with the SE under the mild conditions selected, and the data did not support the hypotheses of the present study. |
Evaluation of nano- and submicron particle penetration through ten nonwoven fabrics using a wind-driven approach
Gao P , Jaques PA , Hsiao TC , Shepherd A , Eimer BC , Yang M , Miller A , Gupta B , Shaffer R . J Occup Environ Hyg 2011 8 (1) 13-22 Existing face mask and respirator test methods draw particles through materials under vacuum to measure particle penetration. However, these filtration-based methods may not simulate conditions under which protective clothing operates in the workplace, where airborne particles are primarily driven by wind and other factors instead of being limited to a downstream vacuum. This study was focused on the design and characterization of a method simulating typical wind-driven conditions for evaluating the performance of materials used in the construction of protective clothing. Ten nonwoven fabrics were selected, and physical properties including fiber diameter, fabric thickness, air permeability, porosity, pore volume, and pore size were determined. Each fabric was sealed flat across the wide opening of a cone-shaped penetration cell that was then housed in a recirculation aerosol wind tunnel. The flow rate naturally driven by wind through the fabric was measured, and the sampling flow rate of the Scanning Mobility Particle Sizer used to measure the downstream particle size distribution and concentrations was then adjusted to minimize filtration effects. Particle penetration levels were measured under different face velocities by the wind-driven method and compared with a filtration-based method using the TSI 3160 automated filter tester. The experimental results show that particle penetration increased with increasing face velocity, and penetration also increased with increasing particle size up to about 300 to 500 nm. Penetrations measured by the wind-driven method were lower than those obtained with the filtration method for most of the fabrics selected, and the relative penetration performances of the fabrics were very different due to the vastly different pore structures. |
Evaluation of the filtration performance of NIOSH-approved N95 filtering facepiece respirators by photometric and number-based test methods
Rengasamy S , Miller A , Eimer BC . J Occup Environ Hyg 2011 8 (1) 23-30 N95 particulate filtering facepiece respirators are certified by measuring penetration levels photometrically with a presumed severe case test method using charge neutralized NaCl aerosols at 85 L/min. However, penetration values obtained by photometric methods have not been compared with count-based methods using contemporary respirators composed of electrostatic filter media and challenged with both generated and ambient aerosols. To better understand the effects of key test parameters (e.g., particle charge, detection method), initial penetration levels for five N95 model filtering facepiece respirators were measured using NaCl aerosols with the aerosol challenge and test equipment employed in the NIOSH respirator certification method (photometric) and compared with an ultrafine condensation particle counter method (count based) for the same NaCl aerosols as well as for ambient room air particles. Penetrations using the NIOSH test method were several-fold less than the penetrations obtained by the ultrafine condensation particle counter for NaCl aerosols as well as for room particles indicating that penetration measurement based on particle counting offers a more difficult challenge than the photometric method, which lacks sensitivity for particles < 100 nm. All five N95 models showed the most penetrating particle size around 50 nm for room air particles with or without charge neutralization, and at 200 nm for singly charged NaCl monodisperse particles. Room air with fewer charged particles and an overwhelming number of neutral particles contributed to the most penetrating particle size in the 50 nm range, indicating that the charge state for the majority of test particles determines the MPPS. Data suggest that the NIOSH respirator certification protocol employing the photometric method may not be a more challenging aerosol test method. Filter penetrations can vary among workplaces with different particle size distributions, which suggests the need for the development of new or revised "more challenging" aerosol test methods for NIOSH certification of respirators. |
Comparison of stainless and mild steel welding fumes in generation of reactive oxygen species
Leonard SS , Chen BT , Stone SG , Schwegler-Berry D , Kenyon AJ , Frazer D , Antonini JM . Part Fibre Toxicol 2010 7 32 BACKGROUND: Welding fumes consist of a wide range of complex metal oxide particles which can be deposited in all regions of the respiratory tract. The welding aerosol is not homogeneous and is generated mostly from the electrode/wire. Over 390,000 welders were reported in the U.S. in 2008 while over 1 million full-time welders were working worldwide. Many health effects are presently under investigation from exposure to welding fumes. Welding fume pulmonary effects have been associated with bronchitis, metal fume fever, cancer and functional changes in the lung. Our investigation focused on the generation of free radicals and reactive oxygen species from stainless and mild steel welding fumes generated by a gas metal arc robotic welder. An inhalation exposure chamber located at NIOSH was used to collect the welding fume particles. RESULTS: Our results show that hydroxyl radicals (.OH) were generated from reactions with H2O2 and after exposure to cells. Catalase reduced the generation of .OH from exposed cells indicating the involvement of H2O2. The welding fume suspension also showed the ability to cause lipid peroxidation, effect O2 consumption, induce H2O2 generation in cells, and cause DNA damage. CONCLUSION: Increase in oxidative damage observed in the cellular exposures correlated well with .OH generation in size and type of welding fumes, indicating the influence of metal type and transition state on radical production as well as associated damage. Our results demonstrate that both types of welding fumes are able to generate ROS and ROS-related damage over a range of particle sizes; however, the stainless steel fumes consistently showed a significantly higher reactivity and radical generation capacity. The chemical composition of the steel had a significant impact on the ROS generation capacity with the stainless steel containing Cr and Ni causing more damage than the mild steel. Our results suggest that welding fumes may cause acute lung injury. Since type of fume generated, particle size, and elapsed time after generation of the welding exposure are significant factors in radical generation and particle deposition these factors should be considered when developing protective strategies. |
Stochastic modeling of gob gas venthole production performances in active and completed longwall panels of coal mines
Karacan CO , Luxbacher K . Int J Coal Geol 2010 84 (2) 125-140 Gob gas ventholes (GGVs) are an integral part of longwall coal mining operations, enhancing safety by controlling methane in underground workings. As in many disciplines in earth sciences, uncertainties due to the heterogeneity of geologic formations exist. These uncertainties, and the wide range of mining and venthole operation parameters, lead to performance variability in GGVs. Random variations in parameters affecting GGV performance and influencing parameters that cannot be quantified sufficiently due to lack of information limit deterministic GGV models and even introduce error in severe cases. Therefore, evaluation of GGV performance data and the uncertainty in input parameters is valuable for understanding the variability in GGV production and for designing them accordingly. This paper describes a practical approach for implementing stochastic determination of GGV production performances and for generalizing the prediction capability of deterministic models. Deterministic site-specific models were derived by using the GGV module in the recently developed MCP (Methane Control and Prediction) software suite. These models were generated using multi-parameter regression techniques and were then improved by inclusion of extra input parameters that eliminated the site dependency and improved the predictions. Statistical distributions of input parameters in these models were quantified and tested with the Kolmogorov-Smirnov goodness-of-fit technique. Next, Monte Carlo simulations were performed using these distributions and generalized results for GGV performances were generated. The results of this work indicate that this approach is a promising method of representing the variability in GGV performances and to improve the limited and site-specific character of the deterministic models. Published by Elsevier B.V. |
Excess lung function decline in gold miners following pulmonary tuberculosis
Ross J , Ehrlich RI , Hnizdo E , White N , Churchyard GJ . Thorax 2010 65 (11) 1010-5 BACKGROUND: Few if any studies of the association between pulmonary tuberculosis (TB) and lung function loss have had access to premorbid lung function values. METHODS: Using a retrospective cohort design, the study recruited employed South African gold miners who had undergone a pulmonary function test (PFT) between January 1995 and August 1996. The 'exposed' group comprised 185 miners treated for pulmonary TB after the initial PFT and the 'unexposed' group comprised 185 age-matched miners without TB. All participants had a follow-up PFT between April and June 2000. The outcome of interest was decline in lung function during the follow-up period as measured by forced vital capacity (FVC) and forced expiratory volume in 1 s(FEV(1)). RESULTS: After controlling for age, height, baseline lung function, silicosis, years of employment, smoking and other respiratory diagnoses, pulmonary TB during the follow-up period was associated with a mean excess loss of 40.3 ml/year in FEV(1) (95% CI 25.4 to 55.1) and 42.7 ml/year in FVC (95% CI 27.0 to 58.5). Lung function loss was greater among those with more severe or later clinical presentation of TB. Breathlessness was twice as common among TB cases (OR 2.20, 95% CI 1.18 to 4.11). CONCLUSION: There is a need for greater clinical recognition of the long-term respiratory consequences of treated pulmonary TB. Early detection of TB would help to reduce these sequelae and remains a priority, particularly in a workforce already subject to silica dust disease. However, strategies such as dust control, worker education about TB and dust and TB preventive therapy are also needed to avert the disease itself. |
Strengthening public health surveillance and response using the health systems strengthening agenda in developing countries
Nsubuga P , Nwanyanwu O , Nkengasong JN , Mukanga D , Trostle M . BMC Public Health 2010 10 S5 There is increased interest in strengthening health systems for developing countries. However, at present, there is common uncertainty about how to accomplish this task. Specifically, several nations are faced with an immense challenge of revamping an entire system. To accomplish this, it is essential to first identify the components of the system that require modification. The World Health Organization (WHO) has proposed health system building blocks, which are now widely recognized as essential components of health systems strengthening. With increased travel and urbanization, the threat of emerging diseases of pandemic potential is increasing alongside endemic diseases such as human immunodeficiency virus (HIV), tuberculosis (TB), malaria, and hepatitis virus infections. At the same time, the epidemiologic patterns are shifting, giving rise to a concurrent increase in disease burden due to non-communicable diseases. These diseases can be addressed by public health surveillance and response systems that are operated by competent public health workers in core public health positions at national and sub-national levels with a focus on disease prevention. We describe two ways that health ministries in developing countries could leverage President Obama's Global Health Initiative (GHI) to build public health surveillance and response systems using proven models for public health systems strengthening and to create the public health workforce to operate those systems. We also offer suggestions for how health ministries could strengthen public health systems within the broad health systems strengthening agenda. Existing programs (e.g., the Global Vaccine Alliance [GAVI] and the Global Fund Against Tuberculosis, AIDS, and Malaria [GFTAM]) can also adapt their current health systems strengthening programs to build sustainable public health systems. |
U.S. Government engagement in support of global disease surveillance
Katz RL , Lopez LM , Annelli JF , Arthur RR , Carroll D , Chapman LW , Cole K , Gay CG , Lowe DL , Resnick G , Russell KL . BMC Public Health 2010 10 S13 Global cooperation is essential for coordinated planning and response to public health emergencies, as well as for building sufficient capacity around the world to detect, assess and respond to health events. The United States is committed to, and actively engaged in, supporting disease surveillance capacity building around the world. We recognize that there are many agencies involved in this effort, which can become confusing to partner countries and other public health entities. This paper aims to describe the agencies and offices working directly on global disease surveillance capacity building in order to clarify the United States Government interagency efforts in this space. |
Planning for exercises of chemical, biological, radiological, and nuclear (CBRN) forensic capabilities
Reutter D , Schutzer SE , Craft CM , Fletcher J , Fricke FL , Holowachuk SA , Johnson RC , Keim PS , Pearson JL , Sibert RW , Velsko S . Biosecur Bioterror 2010 8 (4) 343-355 A forensic capability to help identify perpetrators and exclude innocent people should be an integral part of a strategy against terrorist attacks. Exercises have been conducted to increase our preparedness and response capabilities to chemical, biological, radiological, and nuclear (CBRN) terrorist attacks. However, incorporating forensic components into these exercises has been deficient. CBRN investigations rely on forensic results, so the need to integrate a forensic component and forensics experts into comprehensive exercises is paramount. This article provides guidance for planning and executing exercises at local, state, federal, and international levels that test the effectiveness of forensic capabilities for CBRN threats. The guidelines presented here apply both to situations where forensics is only a component of a more general exercise and where forensics is the primary focus of the exercise. |
Connecticut competency-based point of dispensing worker training needs assessment
Durante A , Melchreit R , Sullivan K , Degutis L . Disaster Med Public Health Prep 2010 4 (4) 306-11 OBJECTIVES: In April 2006, Connecticut conducted an exercise that tested its ability to receive and dispense antibiotics from the Strategic National Stockpile. In conjunction with the exercise, a competency-based assessment was performed to determine the training needs of point of dispensing (POD) workers. METHODS: POD core competencies were developed by adapting existing preparedness materials. They were used to assess the training needs of more than 250 people who staffed a POD during the exercise. The assessment measured their confidence in their ability to perform 17 competency-based tasks. RESULTS: The vast majority needed training on 5 or fewer tasks, suggesting that they were fairly well trained. Pharmacists were particularly likely to need training on at least 5 tasks. Given their role in a POD operation, they should be a focus of further training. Almost one third of participants needed additional training on at least 1 of the 3 basic POD Incident Command System tasks. Additional training is also needed on competencies concerning POD safety and security, liability protections, and family preparedness. POD workers who are concerned about these matters may be less willing or able to staff a POD. People who participated in training both before and on the day of the exercise were best prepared to staff the POD, indicating that both types of training have value. CONCLUSIONS: When compared with the competencies, POD workers possessed many of the necessary skills to staff a POD; however, training with emphasis on areas of weakness revealed by the assessment could improve willingness to report for duty and performance. |
Developing national standards for public health emergency preparedness with a limited evidence base
Nelson C , Chan E , Chandra A , Sorensen P , Willis HH , Dulin S , Leuschner K . Disaster Med Public Health Prep 2010 4 (4) 285-90 OBJECTIVE: The paucity of evidence and wide variation among communities creates challenges for developing congressionally mandated national performance standards for public health preparedness. Using countermeasure dispensing as an example, we present an approach for developing standards that balances national uniformity and local flexibility, consistent with the quality of evidence available. METHODS: We used multiple methods, including a survey of community practices, mathematical modeling, and expert panel discussion.RESULTS: The article presents recommended dispensing standards, along with a general framework that can be used to analyze tradeoffs involved in developing other preparedness standards. CONCLUSIONS: Standards can be developed using existing evidence, but would be helped immensely by a stronger evidence base. |
Expanded safety and acceptability of the candidate vaginal microbicide Carraguard in South Africa
Altini L , Blanchard K , Coetzee N , De Kock A , Elias C , Ellertson C , Friedland B , Hoosen A , Jones HE , Kilmarx PH , Marumo M , McGrory E , Monedi C , Ndlovu G , Nkompala B , Pistorius A , Ramjee G , Sebola M , Sorhaindo A , Norris Turner A , Tweedy K , Van De Wijgert J , Williams MM , Winikoff B . Contraception 2010 82 (6) (6) 563-571 BACKGROUND: Carraguard's safety and acceptability was assessed among women in Gugulethu and Ga-Rankuwa, South Africa. STUDY DESIGN: A randomized, placebo-controlled, triple-blind trial was conducted in HIV-negative, nonpregnant women who inserted Carraguard or placebo at least three times a week, including before vaginal sex, for 6 to 12 months. Monthly visits included pelvic examination, sexually transmitted infection (STI) testing/treatment and HIV counseling/testing. Acceptability was assessed quarterly. RESULTS: Of 400 women (205 Carraguard, 195 placebo) enrolled, 328 (77%) completed at least 6 months. Incidence of genital epithelial disruption was similar between the Carraguard (13.6 per 100 woman-years) and placebo (21.3 per 100 woman-years) groups (relative risk, 0.64; 95% confidence interval, 0.37-1.10); there were no significant differences in rates of HIV/STI, though the study was not powered to determine effectiveness. Only 2% of adverse events were judged possibly related to (either) gel. More than 94% of women reported at least once liking the gel very much. CONCLUSIONS: Carraguard was not associated with more vaginal, cervical or external genital irritation than placebo, and it was acceptable when used approximately 3.5 times per week, including during sex. 2010 Elsevier Inc. |
A proposal to change existing virus species names to non-Latinized binomials
Van Regenmortel MH , Burke DS , Calisher CH , Dietzgen RG , Fauquet CM , Ghabrial SA , Jahrling PB , Johnson KM , Holbrook MR , Horzinek MC , Keil GM , Kuhn JH , Mahy BW , Martelli GP , Pringle C , Rybicki EP , Skern T , Tesh RB , Wahl-Jensen V , Walker PJ , Weaver SC . Arch Virol 2010 155 (11) 1909-19 A proposal has been posted on the ICTV website (2011.001aG.N.v1.binomial-sp-names) to replace virus species names by non-Latinized binomial names consisting of the current italicized species name with the terminal word "virus" replaced by the italicized and non-capitalized genus name to which the species belongs. If implemented, the current italicized species name Measles virus, for instance, would become Measles morbillivirus while the current virus name measles virus and its abbreviation MeV would remain unchanged. The rationale for the proposed change is presented. |
Preface
Rolka HR . Stat Med 2010 30 (5) 401-2 The Twelfth Biennial Symposium on Statistical Methods was held in Decatur, Georgia April 6–8, 2009 and sponsored by the Centers for Disease Control and Prevention (CDC) and the American Statistical Association (ASA). The theme, ‘Info-fusion: Utilization of Multi-source Data’, was selected to focus attention on the exchange and use of data and information from diverse sources in extracting evidence for public health program and policy decisions. The success of the public health mission including, but not limited to, emergency preparedness and response is highly dependent on having a sound information supply chain. Maintaining adequate information and using it for good decisions transcends scientific disciplines. By themselves, information products support, but do not ensure, correct decisions; we generally have to take action with only partial information. Drawing conclusions using induction or the process of inference involves uncertainty that is generally best characterized using probability concepts and statistical reasoning. The characterization of uncertainty using probability is a common thread in the use of integrated data for decision support. This symposium was designed to draw from statistical and related information sciences across various areas of application, disciplines, and information technology concepts, which relate to integrating data and information for use in public health and included 230 participants. |
2010 ACVIM small animal consensus statement on leptospirosis: diagnosis, epidemiology, treatment, and prevention
Sykes JE , Hartmann K , Lunn KF , Moore GE , Stoddard RA , Goldstein RE . J Vet Intern Med 2010 25 (1) 1-13 This report offers a consensus opinion on the diagnosis, epidemiology, treatment, and prevention of leptospirosis in dogs, an important zoonosis. Clinical signs of leptospirosis in dogs relate to development of renal disease, hepatic disease, uveitis, and pulmonary hemorrhage. Disease may follow periods of high rainfall, and can occur in dogs roaming in proximity to water sources, farm animals, or wildlife, or dogs residing in suburban environments. Diagnosis is based on acute and convalescent phase antibody titers by the microscopic agglutination test (MAT), with or without use of polymerase chain reaction assays. There is considerable interlaboratory variation in MAT results, and the MAT does not accurately predict the infecting serogroup. The recommended treatment for optimal clearance of the organism from renal tubules is doxycycline, 5 mg/kg PO q12h, for 14 days. Annual vaccination can prevent leptospirosis caused by serovars included in the vaccine and is recommended for dogs at risk of infection. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Disease Reservoirs and Vectors
- Environmental Health
- Epidemiology and Surveillance
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- Maternal and Child Health
- Occupational Safety and Health
- Occupational Safety and Health - Mining
- Public Health Leadership and Management
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- Sciences, General
- Statistics as Topic
- Veterinary Medicine
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