School-based dental sealant programs prevent cavities and are cost-effective
Griffin S , Naavaal S , Scherrer C , Griffin PM , Harris K , Chattopadhyay S . Health Aff (Millwood) 2016 35 (12) 2233-2240 Untreated cavities can have far-reaching negative consequences for people's ability to eat, speak, and learn. By adolescence, 27 percent of low-income children in the United States will have untreated cavities. School-based sealant programs typically provide dental sealants (a protective coating that adheres to the surface of molars) at little or no cost to students attending schools in areas with low socioeconomic status. These programs have been shown to increase the number of students receiving sealants and to prevent cavities. We analyzed the cost-effectiveness of school sealant programs using data (from school programs in fourteen states between 2013 and 2014) on children's cavity risk, including the effects of untreated cavities on a child's quality of life. We found that providing sealants in school programs to 1,000 children would prevent 485 fillings and 1.59 disability-adjusted life-years. School-based sealant programs saved society money and remained cost-effective across a wide range of reasonable values. |
Trends in total cholesterol, triglycerides, and low-density lipoprotein in US adults, 1999-2014
Rosinger A , Carroll MD , Lacher D , Ogden C . JAMA Cardiol 2016 2 (3) 339-341 Total cholesterol (TC) levels, triglyceride levels, and low-density lipoprotein cholesterol (LDL-C) levels are linked to coronary heart disease.1 Between 1999 and 2010, mean TC, triglycerides, and LDL-C levels declined in the United States, regardless of cholesterol-lowering medication use.2 We used 2013/2014 National Health and Nutrition Examination Survey lipid data in conjunction with 1999 to 2012 data to determine whether earlier trends continued. |
Measuring the quality of haemophilia care across different settings: A set of performance indicators derived from demographics data
Iorio A , Stonebraker JS , Brooker M , Soucie JM . Haemophilia 2016 23 (1) e1-e7 BACKGROUND: Haemophilia is a rare disease for which quality of care varies around the world. We propose data-driven indicators as surrogate measures for the provision of haemophilia care across countries and over time. MATERIALS AND METHODS: The guiding criteria for selection of possible indicators were ease of calculation and direct applicability to a wide range of countries with basic data collection capacities. General population epidemiological data and haemophilia A population data from the World Federation of Hemophilia (WFH) Annual Global Survey (AGS) for the years 2013 and 2010 in a sample of 10 countries were used for this pilot exercise. RESULTS: Three indicators were identified: (i) the percentage difference between the observed and the expected haemophilia A incidence, which would be close to null when all of the people with haemophilia A (PWHA) theoretically expected in a country would be known and reported to the AGS; (ii) the percentage of the total number of PWHA with severe disease; and (iii) the ratio of adults to children among PWHA standardized to the ratio of adults to children for males in the general population, which would be close to one if the survival of PWHA is equal to that of the general population. Country-specific values have been calculated for the 10 countries. CONCLUSIONS: We have identified and evaluated three promising indicators of quality of care in haemophilia. Further evaluation on a wider set of data from the AGS will be needed to confirm their value and further explore their measurement properties. |
Oral health status of children in Los Angeles County and in the United States, 1999-2004
Dye BA , Vargas CM , Fryar CD , Ramos-Gomez F , Isman R . Community Dent Oral Epidemiol 2016 45 (2) 135-144 OBJECTIVE: To ascertain and compare the oral health status and related sociodemographic risk indicators in children in Los Angeles (LA) County with children in the United States. METHODS: Data from the National Health and Nutrition Examination Survey (NHANES) 1999-2004 were used to calculate prevalence estimates for children aged 2-13 years living in LA County and in the United States. Sociodemographic indicators were evaluated using multiple logistic regression modeling. RESULTS: Overall, children in LA County were more likely to experience dental caries than children in the United States in 1999-2004. In the primary dentition, nearly 40% of preschool children residing in LA County had dental caries compared to 28% of same-age children in the United States. Among children aged 6-13, 44% living in LA County had dental caries in the permanent dentition compared to 27% in the United States. Mexican American children in LA County had higher caries experience in permanent teeth (but not in primary teeth) than US Mexican American children. Among children aged 6-9 years, there was no difference in the prevalence of dental sealants in permanent teeth between those living in LA County and in the United States. However, among children aged 10-13 years, dental sealants were more than twice as prevalent in US children (40.8%) than in LA County children (17.5%). Among LA County children, the adjusted odds of having caries experience or untreated dental caries in permanent teeth were not higher among children from lower income families than in lower income children in the United States. CONCLUSIONS: Children residing in LA County had less favorable oral health than children in the United States in 1999-2004. The usual sociodemographic caries risk indicators identified among children in the United States were not consistently observed among children in LA County. Unlike in the wider United States, poverty was not a risk indicator for dental caries in older children in LA County. |
Estimated cost of sunburn-associated visits to US hospital emergency departments
Guy GP Jr , Berkowitz Z , Watson M . JAMA Dermatol 2016 153 (1) 90-92 Sunburn, a clear indicator of overexposure to UV radiation, increases the risk of skin cancer. The estimated prevalence of sunburn in the United States is high; 37.1% of adults and 55.8% of youth reported 1 or more sunburns in the past 12 months.1,2 Our study provides, to our knowledge, the first national estimates of sunburn-associated visits to US emergency departments, as well as their costs. |
Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the Global Burden of Disease Study
Fitzmaurice C , Allen C , Barber RM , Barregard L , Bhutta ZA , Brenner H , Dicker DJ , Chimed-Orchir O , Dandona R , Dandona L , Fleming T , Forouzanfar MH , Hancock J , Hay RJ , Hunter-Merrill R , Huynh C , Hosgood HD , Johnson CO , Jonas JB , Khubchandani J , Kumar GA , Kutz M , Lan Q , Larson HJ , Liang X , Lim SS , Lopez AD , MacIntyre MF , Marczak L , Marquez N , Mokdad AH , Pinho C , Pourmalek F , Salomon JA , Sanabria JR , Sandar L , Sartorius B , Schwartz SM , Shackelford KA , Shibuya K , Stanaway J , Steiner C , Sun J , Takahashi K , Vollset SE , Vos T , Wagner JA , Wang H , Westerman R , Zeeb H , Zoeckler L , Abd-Allah F , Ahmed MB , Alabed S , Alam NK , Aldhahri SF , Alem G , Alemayohu MA , Ali R , Al-Raddadi R , Amare A , Amoako Y , Artaman A , Asayesh H , Atnafu N , Awasthi A , Saleem HB , Barac A , Bedi N , Bensenor I , Berhane A , Bernabe E , Betsu B , Binagwaho A , Boneya D , Campos-Nonato I , Castaneda-Orjuela C , Catala-Lopez F , Chiang P , Chibueze C , Chitheer A , Choi JY , Cowie B , Damtew S , das Neves J , Dey S , Dharmaratne S , Dhillon P , Ding E , Driscoll T , Ekwueme D , Endries AY , Farvid M , Farzadfar F , Fernandes J , Fischer F , GHiwot TT , Gebru A , Gopalani S , Hailu A , Horino M , Horita N , Husseini A , Huybrechts I , Inoue M , Islami F , Jakovljevic M , James S , Javanbakht M , Jee SH , Kasaeian A , Kedir MS , Khader YS , Khang YH , Kim D , Leigh J , Linn S , Lunevicius R , El Razek HM , Malekzadeh R , Malta DC , Marcenes W , Markos D , Melaku YA , Meles KG , Mendoza W , Mengiste DT , Meretoja TJ , Miller TR , Mohammad KA , Mohammadi A , Mohammed S , Moradi-Lakeh M , Nagel G , Nand D , Le Nguyen Q , Nolte S , Ogbo FA , Oladimeji KE , Oren E , Pa M , Park EK , Pereira DM , Plass D , Qorbani M , Radfar A , Rafay A , Rahman M , Rana SM , Soreide K , Satpathy M , Sawhney M , Sepanlou SG , Shaikh MA , She J , Shiue I , Shore HR , Shrime MG , So S , Soneji S , Stathopoulou V , Stroumpoulis K , Sufiyan MB , Sykes BL , Tabares-Seisdedos R , Tadese F , Tedla BA , Tessema GA , Thakur JS , Tran BX , Ukwaja KN , Uzochukwu BS , Vlassov VV , Weiderpass E , Wubshet Terefe M , Yebyo HG , Yimam HH , Yonemoto N , Younis MZ , Yu C , Zaidi Z , Zaki ME , Zenebe ZM , Murray CJ , Naghavi M . JAMA Oncol 2016 3 (4) 524-548 Importance: Cancer is the second leading cause of death worldwide. Current estimates on the burden of cancer are needed for cancer control planning. Objective: To estimate mortality, incidence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 32 cancers in 195 countries and territories from 1990 to 2015. Evidence Review: Cancer mortality was estimated using vital registration system data, cancer registry incidence data (transformed to mortality estimates using separately estimated mortality to incidence [MI] ratios), and verbal autopsy data. Cancer incidence was calculated by dividing mortality estimates through the modeled MI ratios. To calculate cancer prevalence, MI ratios were used to model survival. To calculate YLDs, prevalence estimates were multiplied by disability weights. The YLLs were estimated by multiplying age-specific cancer deaths by the reference life expectancy. DALYs were estimated as the sum of YLDs and YLLs. A sociodemographic index (SDI) was created for each location based on income per capita, educational attainment, and fertility. Countries were categorized by SDI quintiles to summarize results. Findings: In 2015, there were 17.5 million cancer cases worldwide and 8.7 million deaths. Between 2005 and 2015, cancer cases increased by 33%, with population aging contributing 16%, population growth 13%, and changes in age-specific rates contributing 4%. For men, the most common cancer globally was prostate cancer (1.6 million cases). Tracheal, bronchus, and lung cancer was the leading cause of cancer deaths and DALYs in men (1.2 million deaths and 25.9 million DALYs). For women, the most common cancer was breast cancer (2.4 million cases). Breast cancer was also the leading cause of cancer deaths and DALYs for women (523000 deaths and 15.1 million DALYs). Overall, cancer caused 208.3 million DALYs worldwide in 2015 for both sexes combined. Between 2005 and 2015, age-standardized incidence rates for all cancers combined increased in 174 of 195 countries or territories. Age-standardized death rates (ASDRs) for all cancers combined decreased within that timeframe in 140 of 195 countries or territories. Countries with an increase in the ASDR due to all cancers were largely located on the African continent. Of all cancers, deaths between 2005 and 2015 decreased significantly for Hodgkin lymphoma (-6.1% [95% uncertainty interval (UI), -10.6% to -1.3%]). The number of deaths also decreased for esophageal cancer, stomach cancer, and chronic myeloid leukemia, although these results were not statistically significant. Conclusion and Relevance: As part of the epidemiological transition, cancer incidence is expected to increase in the future, further straining limited health care resources. Appropriate allocation of resources for cancer prevention, early diagnosis, and curative and palliative care requires detailed knowledge of the local burden of cancer. The GBD 2015 study results demonstrate that progress is possible in the war against cancer. However, the major findings also highlight an unmet need for cancer prevention efforts, including tobacco control, vaccination, and the promotion of physical activity and a healthy diet. |
A high-cholesterol diet increases 27-hydroxycholesterol and modifies estrogen receptor expression and neurodegeneration in rabbit hippocampus
Brooks SW , Dykes AC , Schreurs BG . J Alzheimers Dis 2016 56 (1) 185-196 Hypercholesterolemia has been implicated in numerous health problems from cardiovascular disease to neurodegeneration. High serum cholesterol levels in midlife have been associated with an increased risk of developing Alzheimer's disease (AD) later in life which suggests that the pathways leading to AD pathology might be activated decades before the symptoms of the disease are detected. Cholesterol-fed animals, particularly cholesterol-fed rabbits, exhibit brain pathology similar to the changes found in brains of AD patients. Dietary cholesterol, which cannot pass the blood-brain barrier, is thought to influence central nervous system homeostasis by increased transport of its circulatory breakdown product, 27-hydroxycholesterol (27-OHC), into the brain. 27-OHC is an endogenous selective estrogen receptor modulator. Estrogen-mediated non-reproductive functions require estrogen receptors (ERs) and include modulation of mitochondrial function and structure, as well as regulation of synaptogenesis in the brain. ERs are located in brain areas affected early in AD pathogenesis, including the hippocampus. Here we report that increase in serum cholesterol, induced by feeding rabbits a high-cholesterol diet, is associated with higher levels of 27-OHC in the brain as well as increased levels of neurodegeneration in the hippocampus. Furthermore, these results are accompanied by changes in expression of ERs in the hippocampus as well as a decrease in hippocampal mitochondria. These findings provide an important insight into one of the possible mechanisms involved in the development of AD, and shed light on the processes that may antedate amyloid-beta and tau phosphorylation changes currently hypothesized to cause AD symptomology and pathology. |
Antihypertensive medication adherence and blood pressure control among central Alabama veterans
Piercefield EW , Howard ME , Robinson MH , Kirk CE , Ragan AP , Reese SD . J Clin Hypertens (Greenwich) 2016 19 (5) 543-549 Medication nonadherence is associated with adverse outcomes. To evaluate antihypertensive medication adherence and its association with blood pressure (BP) control, the authors described population adherence to prescribed antihypertensive medication (proportion of days covered ≥80%) and BP control (mean BP <140/90 mm Hg) among central Alabama veterans during the fiscal year 2015. Overall, 75.1% of patients receiving antihypertensive medication were considered adherent, and 66.1% had adequate BP control. Patients adherent to antihypertensive medication were more likely to have adequate BP control compared with patients classified as nonadherent (67.4% vs 62.0%; adjusted odds ratio 1.33; 95% confidence interval, 1.22-1.44 [P<.0001]). Among patients who had uncontrolled BP, 73.6% were considered adherent to medication. Adherence to antihypertensive medication was associated with adequate BP control; however, a substantial proportion of patients with inadequate BP control were also considered adherent. Interventions to increase BP control could address more aggressive medication management to achieve BP goals. |
The Establishment and Diversification of Epidemic-Associated Serogroup W Meningococcus in the African Meningitis Belt, 1994 to 2012.
Retchless AC , Hu F , Ouedraogo AS , Diarra S , Knipe K , Sheth M , Rowe LA , Sangare L , Ky Ba A , Ouangraoua S , Batra D , Novak RT , Ouedraogo Traore R , Wang X . mSphere 2016 1 (6) Epidemics of invasive meningococcal disease (IMD) caused by meningococcal serogroup A have been eliminated from the sub-Saharan African so-called "meningitis belt" by the meningococcal A conjugate vaccine (MACV), and yet, other serogroups continue to cause epidemics. Neisseria meningitidis serogroup W remains a major cause of disease in the region, with most isolates belonging to clonal complex 11 (CC11). Here, the genetic variation within and between epidemic-associated strains was assessed by sequencing the genomes of 92 N. meningitidis serogroup W isolates collected between 1994 and 2012 from both sporadic and epidemic IMD cases, 85 being from selected meningitis belt countries. The sequenced isolates belonged to either CC175 (n = 9) or CC11 (n = 83). The CC11 N. meningitidis serogroup W isolates belonged to a single lineage comprising four major phylogenetic subclades. Separate CC11 N. meningitidis serogroup W subclades were associated with the 2002 and 2012 Burkina Faso epidemics. The subclade associated with the 2012 epidemic included isolates found in Burkina Faso and Mali during 2011 and 2012, which descended from a strain very similar to the Hajj (Islamic pilgrimage to Mecca)-related Saudi Arabian outbreak strain from 2000. The phylogeny of isolates from 2012 reflected their geographic origin within Burkina Faso, with isolates from the Malian border region being closely related to the isolates from Mali. Evidence of ongoing evolution, international transmission, and strain replacement stresses the importance of maintaining N. meningitidis surveillance in Africa following the MACV implementation. IMPORTANCE Meningococcal disease (meningitis and bloodstream infections) threatens millions of people across the meningitis belt of sub-Saharan Africa. A vaccine introduced in 2010 protects against Africa's then-most common cause of meningococcal disease, N. meningitidis serogroup A. However, other serogroups continue to cause epidemics in the region-including serogroup W. The rapid identification of strains that have been associated with prior outbreaks can improve the assessment of outbreak risk and enable timely preparation of public health responses, including vaccination. Phylogenetic analysis of newly sequenced serogroup W strains isolated from 1994 to 2012 identified two groups of strains linked to large epidemics in Burkina Faso, one being descended from a strain that caused an outbreak during the Hajj pilgrimage in 2000. We find that applying whole-genome sequencing to meningococcal disease surveillance collections improves the discrimination among strains, even within a single nation-wide epidemic, which can be used to better understand pathogen spread. |
Novel activities by ebolavirus and marburgvirus interferon antagonists revealed using a standardized in vitro reporter system.
Guito JC , Albarino CG , Chakrabarti AK , Towner JS . Virology 2016 501 147-165 Filoviruses are highly lethal in humans and nonhuman primates, likely due to potent antagonism of host interferon (IFN) responses early in infection. Filoviral protein VP35 is implicated as the major IFN induction antagonist, while Ebola virus (EBOV) VP24 or Marburg virus (MARV) VP40 are known to block downstream IFN signaling. Despite progress elucidating EBOV and MARV antagonist function, those for most other filoviruses, including Reston (RESTV), Sudan (SUDV), Tai Forest (TAFV), Bundibugyo (BDBV) and Ravn (RAVV) viruses, remain largely neglected. Thus, using standardized vectors and reporter assays, we characterized activities by each IFN antagonist from all known ebolavirus and marburgvirus species side-by-side. We uncover noncanonical suppression of IFN induction by ebolavirus VP24, differing potencies by MARV and RAVV proteins, and intriguingly, weaker antagonism by VP24 of RESTV. These underlying molecular explanations for differential virulence in humans could guide future investigations of more-neglected filoviruses as well as treatment and vaccine studies. |
Increased Mitochondrial Genetic Diversity in Persons Infected With Hepatitis C Virus.
Campo DS , Roh HJ , Pearlman BL , Fierer DS , Ramachandran S , Vaughan G , Hinds A , Dimitrova Z , Skums P , Khudyakov Y . Cell Mol Gastroenterol Hepatol 2016 2 (5) 676-684 Background & Aims: The host genetic environment contributes significantly to the outcomes of hepatitis C virus (HCV) infection and therapy response, but little is known about any effects of HCV infection on the host beyond any changes related to adaptive immune responses. HCV persistence is associated strongly with mitochondrial dysfunction, with liver mitochondrial DNA (mtDNA) genetic diversity linked to disease progression. Methods: We evaluated the genetic diversity of 2 mtDNA genomic regions (hypervariable segments 1 and 2) obtained from sera of 116 persons using next-generation sequencing. Results: Results were as follows: (1) the average diversity among cases with seronegative acute HCV infection was 4.2 times higher than among uninfected controls; (2) the diversity level among cases with chronic HCV infection was 96.1 times higher than among uninfected controls; and (3) the diversity was 23.1 times higher among chronic than acute cases. In 2 patients who were followed up during combined interferon and ribavirin therapy, mtDNA nucleotide diversity decreased dramatically after the completion of therapy in both patients: by 100% in patient A after 54 days and by 70.51% in patient B after 76 days. Conclusions: HCV infection strongly affects mtDNA genetic diversity. A rapid decrease in mtDNA genetic diversity observed after therapy-induced HCV clearance suggests that the effect is reversible, emphasizing dynamic genetic relationships between HCV and mitochondria. The level of mtDNA nucleotide diversity can be used to discriminate recent from past infections, which should facilitate the detection of recent transmission events and thus help identify modes of transmission. |
Rates and predictors of non-adherence to antiretroviral therapy among HIV-positive individuals in Kenya: Results from the second Kenya AIDS Indicator Survey, 2012
Mukui IN , Ng'ang'a L , Williamson J , Wamicwe JN , Vakil S , Katana A , Kim AA . PLoS One 2016 11 (12) e0167465 INTRODUCTION: Understanding the levels and associated factors of non-adherence to antiretroviral therapy (ART) is crucial in designing interventions to improve adherence and health outcomes of ART. We assessed non-adherence to ART among HIV-infected persons reporting ART use in a nationally representative survey in Kenya. METHODS: The Kenya AIDS Indicator Survey 2012 was a population-based, household survey of persons aged 18 months-64 years conducted in 2012-2013. Self-reported information was collected on demographics, sexual behaviour, HIV status, and ART use. Blood was collected for HIV testing, and if HIV infected, CD4 and viral load testing. HIV-positive specimens were tested for the presence of antiretroviral (ARV) drugs using a qualitative ARV assay using liquid chromatography-tandem mass spectrometry. HIV-positive persons who reported receiving ART but did not have the ARV biomarker present were defined as being non-adherent to their ARV medication. We restricted our analysis to HIV-infected persons aged 15-64 years who reported receiving ART and had laboratory-confirmed results from ARV testing. Multivariate logistic regression was used to identify variables associated with non-adherence. RESULTS: A total of 648 (5.6%; CI 4.9-6.3) tested HIV-positive of whom 559 (86.3%) had sufficient volume of blood to be tested for ARV drugs. Of those, 271 (47.7%; CI 41.8-53.6) self-reported HIV-positive status during the interview and 186 (69.1%; CI 62.2-76.0) of those reported taking ART. The ARV biomarker was absent in 18 of 186 individuals (9.4%; CI 4.9-13.8) who thus were defined as being non-adherent to ART. Non-adherence was associated with being aged 15-29 years (AOR 8.39; CI 2.26-31.22, p = 0.002) compared to aged 30-64 years, rural residence (AOR 5.87; CI 1.39-25.61, p = 0.016) compared with urban residence and taking recreational drugs in the past 30 days (AOR 5.89; CI 1.30-26.70, p = 0.022). CONCLUSION: Overall, less than 10% of Kenyans aged 15-64 years on ART were not adhering to their HIV medication, highlighting the success of the Kenyan national ART program. Our findings, however, point to the need for targeted interventions particularly for young persons, those in rural areas to improve adherence outcomes, as well as delivery of treatment programs that include psychosocial support as a preventative measure to minimize substance abuse and the risk of treatment failure. |
Reimagining HIV service delivery: The role of differentiated care from prevention to suppression
Grimsrud A , Bygrave H , Doherty M , Ehrenkranz P , Ellman T , Ferris R , Ford N , Killingo B , Mabote L , Mansell T , Reinisch A , Zulu I , Bekker LG . J Int AIDS Soc 2016 19 (1) 21484 The recently updated World Health Organization (WHO) consolidated guidelines on the use of antiretroviral therapy (ART) recommending to “treat all” mark a paradigm shift in the delivery of HIV treatment: from who is eligible and when to start ART, to how to provide client-centred and high-quality care to all people living with HIV (PLHIV). As part of this shift, the new guidance includes service delivery recommendations based on a “differentiated care framework” [1]. Yet, despite the increased global attention paid to differentiated care [2–4], the concept is not well defined. | There is broad agreement that a “one-size-fits-all” model of HIV services will not succeed in providing sustainable access to ART and support services for the 37 million PLHIV today. Instead, health systems will need to both accelerate ART initiation and support retention and viral suppression, which requires adapting HIV services to specific client populations and contexts [5]. Past discussions have looked at differentiated care through a health system's lens – focusing on what aspects of care are needed, how often they are needed, where care should be delivered and who will provide it [6]. An approach to HIV testing, care and treatment that distinguishes client groups according to broad definitions, however, is more likely to succeed. |
Reply: Understanding local context is necessary for HIV and HCV prevention planning
Van Handel MM , Brooks JT . J Acquir Immune Defic Syndr 2016 74 (3) e84-e85 We appreciate the points that Dr. Westfall makes in his Letter to the Editor and agree that a deeper understanding of the local context is needed for appropriate HIV and hepatitis C virus (HCV) prevention planning. Dr. Westfall identified 2 examples when local context could inform assessment of local vulnerability to rapid spread of HIV or HCV infection: how prison or jail populations may affect infection rates in a community and how travel patterns affect the likelihood someone may be exposed to HIV or HCV infection. | Our analysis was intended to provide a national overview of potential vulnerability to rapid spread of HIV or HCV infection among persons who inject drugs and could not account for all the local contextual factors that may influence vulnerability. For example, our analysis only partially accounts for the location of some institutions, such as prisons or jails, in the United States. However, the first step of the analysis identified factors significantly associated with county-level acute HCV rates as a proxy for unsafe injection drug use. Notification to Centers for Disease Control and Prevention (CDC) of cases of acute HCV infection is based on where the person is staying at the time of disease onset or diagnosis1; thus, the indicators we identified accounted for the characteristics of persons likely engaging in unsterile injection drug use and in need for HIV and HCV prevention or treatment services, irrespective of institutionalization. A county, such as Crowley County, may have a higher rate of acute HCV infection among incarcerated persons than the general population, and a local understanding of that difference could help direct prevention services appropriately. Second, we applied a national estimate of the average daily distance traveled to calculate the average rate of people living with HIV in and around the counties we identified as most vulnerable. States may consider alternatives for calculating this HIV proximity estimate, such as adjusting for local travel patterns or using a different measure such as population density. We agree that state and local health departments should use locally available data to better understand local vulnerability to rapid spread of HIV or HCV infection among persons who inject drugs. We also recommend that local health departments assess the availability of local services, such as Syringe Services Programs. As seen in Figure 1, Syringe Services Programs were typically not available in the vulnerable counties. Information on local data and services is necessary to guide the public health response. |
Tuberculosis among incarcerated Hispanic persons in the United States, 1993-2014
Mindra G , Wortham JM , Haddad MB , Salinas JL , Powell KM , Armstrong LR . J Immigr Minor Health 2016 19 (4) 982-986 We examined the National tuberculosis surveillance system to describe Hispanic persons who were incarcerated at time of tuberculosis (TB) diagnosis and to compare their characteristics with those of non-Hispanic incarcerated TB patients. After declines between 1993 and 2002, the annual proportion of Hispanic TB patients who were incarcerated grew from 4.9% in 2003 to 8.4% in 2014. During 2003-2014, 19% of incarcerated US-born TB patients were Hispanic, and 86% of the foreign-born were Hispanic. Most incarcerated TB patients were in local jails, but about a third of all foreign-born Hispanics were in the facility category that includes Immigration and Customs Enforcement detention centers. Foreign birth and recent U.S. arrival characterized many Hispanic persons receiving a TB diagnosis while incarcerated. Hispanic patients had twice the odds of being in federal prisons. Systematic efforts to identify TB infection and disease might lead to early diagnoses and prevention of future cases. |
Mumps outbreak among a highly vaccinated university community - New York City, NY, January - April 2014
Patel LN , Arciuolo R , Fu J , Giancotti FR , Zucker JR , Rakeman J , Rosen JB . Clin Infect Dis 2016 64 (4) 408-412 BACKGROUND: On January 14, 2014, a vaccinated student presented with parotitis. Mumps IgM testing was negative and reverse-transcription polymerase chain reaction (RT-PCR) testing was not performed, resulting in a missed diagnosis and the start of an outbreak at a New York City (NYC) university. METHODS: Mumps case investigations included patient interviews, medical records review, and laboratory testing including mumps serology and RT-PCR. Cases were considered linked to the outbreak if they attended or had epidemiologic linkage to the university. Epidemiologic, clinical, and laboratory data for outbreak cases residing in NYC were analyzed. RESULTS: Fifty-six NYC residents with mumps were identified with onsets between January 12 and April 30, 2014. Fifty-three cases (95%) were university students, 1 (2%) was a staff member, and 2 (4%) had epidemiologic links to the university. The median age was 20 years (range 18-37 years). All cases had parotitis. Three cases were hospitalized, including one of two cases with orchitis. Fifty-four (96%) cases had received ≥1 mumps-containing vaccine, 1 (2%) was unvaccinated due to religious exemption, and 1 (2%) had unknown vaccination status. Two (5%) of the 44 cases tested by serology were mumps IgM positive, and 27 (68%) of the 40 tested by RT-PCR were positive. CONCLUSIONS: Mumps outbreaks can occur in highly-vaccinated populations. Mumps should be considered in patients with parotitis regardless of vaccination status. RT-PCR is the preferred testing method; providers should not rely on IgM testing alone. High vaccination coverage and control measures likely limited the extent of the outbreak. |
Occult HIV-1 drug resistance to thymidine analogues following failure of first-line tenofovir combined with a cytosine analogue and nevirapine or efavirenz in sub Saharan Africa: A retrospective multi-centre cohort study
Gregson J , Kaleebu P , Marconi VC , van Vuuren C , Ndembi N , Hamers RL , Kanki P , Hoffmann CJ , Lockman S , Pillay D , de Oliveira T , Clumeck N , Hunt G , Kerschberger B , Shafer RW , Yang C , Raizes E , Kantor R , Gupta RK . Lancet Infect Dis 2016 17 (3) 296-304 BACKGROUND: HIV-1 drug resistance to older thymidine analogue nucleoside reverse transcriptase inhibitor drugs has been identified in sub-Saharan Africa in patients with virological failure of first-line combination antiretroviral therapy (ART) containing the modern nucleoside reverse transcriptase inhibitor tenofovir. We aimed to investigate the prevalence and correlates of thymidine analogue mutations (TAM) in patients with virological failure of first-line tenofovir-containing ART. METHODS: We retrospectively analysed patients from 20 studies within the TenoRes collaboration who had locally defined viral failure on first-line therapy with tenofovir plus a cytosine analogue (lamivudine or emtricitabine) plus a non-nucleoside reverse transcriptase inhibitor (NNRTI; nevirapine or efavirenz) in sub-Saharan Africa. Baseline visits in these studies occurred between 2005 and 2013. To assess between-study and within-study associations, we used meta-regression and meta-analyses to compare patients with and without TAMs for the presence of resistance to tenofovir, cytosine analogue, or NNRTIs. FINDINGS: Of 712 individuals with failure of first-line tenofovir-containing regimens, 115 (16%) had at least one TAM. In crude comparisons, patients with TAMs had lower CD4 counts at treatment initiation than did patients without TAMs (60.5 cells per muL [IQR 21.0-128.0] in patients with TAMS vs 95.0 cells per muL [37.0-177.0] in patients without TAMs; p=0.007) and were more likely to have tenofovir resistance (93 [81%] of 115 patients with TAMs vs 352 [59%] of 597 patients without TAMs; p<0.0001), NNRTI resistance (107 [93%] vs 462 [77%]; p<0.0001), and cytosine analogue resistance (100 [87%] vs 378 [63%]; p=0.0002). We detected associations between TAMs and drug resistance mutations both between and within studies; the correlation between the study-level proportion of patients with tenofovir resistance and TAMs was 0.64 (p<0.0001), and the odds ratio for tenofovir resistance comparing patients with and without TAMs was 1.29 (1.13-1.47; p<0.0001) INTERPRETATION: TAMs are common in patients who have failure of first-line tenofovir-containing regimens in sub-Saharan Africa, and are associated with multidrug resistant HIV-1. Effective viral load monitoring and point-of-care resistance tests could help to mitigate the emergence and spread of such strains. FUNDING: The Wellcome Trust. |
Progress with scale-up of HIV viral load monitoring - seven sub-Saharan African countries, January 2015-June 2016
Lecher S , Williams J , Fonjungo PN , Kim AA , Ellenberger D , Zhang G , Toure CA , Agolory S , Appiah-Pippim G , Beard S , Borget MY , Carmona S , Chipungu G , Diallo K , Downer M , Edgil D , Haberman H , Hurlston M , Jadzak S , Kiyaga C , MacLeod W , Makumb B , Muttai H , Mwangi C , Mwangi JW , Mwasekaga M , Naluguza M , Ng'Ang ALw , Nguyen S , Sawadogo S , Sleeman K , Stevens W , Kuritsky J , Hader S , Nkengasong J . MMWR Morb Mortal Wkly Rep 2016 65 (47) 1332-1335 The World Health Organization (WHO) recommends viral load testing as the preferred method for monitoring the clinical response of patients with human immunodeficiency virus (HIV) infection to antiretroviral therapy (ART). Viral load monitoring of patients on ART helps ensure early diagnosis and confirmation of ART failure and enables clinicians to take an appropriate course of action for patient management. When viral suppression is achieved and maintained, HIV transmission is substantially decreased, as is HIV-associated morbidity and mortality. CDC and other U.S. government agencies and international partners are supporting multiple countries in sub-Saharan Africa to provide viral load testing of persons with HIV who are on ART. This report examines current capacity for viral load testing based on equipment provided by manufacturers and progress with viral load monitoring of patients on ART in seven sub-Saharan countries (Cote d'Ivoire, Kenya, Malawi, Namibia, South Africa, Tanzania, and Uganda) during January 2015-June 2016. By June 2016, based on the target numbers for viral load testing set by each country, adequate equipment capacity existed in all but one country. During 2015, two countries tested >85% of patients on ART (Namibia [91%] and South Africa [87%]); four countries tested <25% of patients on ART. In 2015, viral suppression was >80% among those patients who received a viral load test in all countries except Cote d'Ivoire. Sustained country commitment and a coordinated global effort is needed to reach the goal for viral load monitoring of all persons with HIV on ART. |
Evaluation of the activity of lamivudine and zidovudine against Ebola virus
Cong Y , Dyall J , Hart BJ , DeWald LE , Johnson JC , Postnikova E , Zhou H , Gross R , Rojas O , Alexander I , Josleyn N , Zhang T , Michelotti J , Janosko K , Glass PJ , Flint M , McMullan LK , Spiropoulou CF , Mierzwa T , Guha R , Shinn P , Michael S , Klumpp-Thomas C , McKnight C , Thomas C , Eakin AE , O'Loughlin KG , Green CE , Catz P , Mirsalis JC , Honko AN , Olinger GG Jr , Bennett RS , Holbrook MR , Hensley LE , Jahrling PB . PLoS One 2016 11 (11) e0166318 In the fall of 2014, an international news agency reported that patients suffering from Ebola virus disease (EVD) in Liberia were treated successfully with lamivudine, an antiviral drug used to treat human immunodeficiency virus-1 and hepatitis B virus infections. According to the report, 13 out of 15 patients treated with lamivudine survived and were declared free from Ebola virus disease. In this study, the anti-Ebola virus (EBOV) activity of lamivudine and another antiretroviral, zidovudine, were evaluated in a diverse set of cell lines against two variants of wild-type EBOV. Variable assay parameters were assessed to include different multiplicities of infection, lengths of inoculation times, and durations of dosing. At a multiplicity of infection of 1, lamivudine and zidovudine had no effect on EBOV propagation in Vero E6, Hep G2, or HeLa cells, or in primary human monocyte-derived macrophages. At a multiplicity of infection of 0.1, zidovudine demonstrated limited anti-EBOV activity in Huh 7 cells. Under certain conditions, lamivudine had low anti-EBOV activity at the maximum concentration tested (320 muM). However, lamivudine never achieved greater than 30% viral inhibition, and the activity was not consistently reproducible. Combination of lamivudine and zidovudine showed no synergistic antiviral activity. Independently, a set of in vitro experiments testing lamivudine and zidovudine for antiviral activity against an Ebola-enhanced green fluorescent protein reporter virus was performed at the Centers for Disease Control and Prevention. No antiviral activity was observed for either compound. A study evaluating the efficacy of lamivudine in a guinea pig model of EVD found no survival benefit. This lack of benefit was observed despite plasma lamivudine concentrations in guinea pig of about 4 mug/ml obtained in a separately conducted pharmacokinetics study. These studies found no evidence to support the therapeutic use of lamivudine for the treatment of EVD. |
Assessing different partner notification methods for assuring partner treatment for gonorrhea: Looking for the best mix of options
Fleming E , Hogben M . J Public Health Manag Pract 2016 23 (3) 247-254 CONTEXT: Partner notification for gonorrhea is intended to interrupt transmission and to bring people exposed to infection to care. Partner notification may be initiated through public health professionals (disease intervention specialist: DIS referral) or patients (patient referral). In some cases, patients may carry medications or prescriptions for partners (patient-delivered partner therapy: PDPT). OBJECTIVE: To examine how patterns of notifying and treating partners of persons with gonorrhea differ by partner notification approach. DESIGN: From published literature (2005-2012), we extracted 10 estimates of patient referral data from 7 studies (3853 patients, 7490 partners) and 5 estimates of PDPT data from 5 studies (1781 patients, 3125 partners). For DIS referral estimates, we obtained 2010-2012 data from 14 program settings (4581 patients interviewed, 8301 partners). For each approach, we calculated treatment cascades based on the proportion of partners who were notified and treated. We also calculated cascades based on partners notified and treated per patient diagnosed. RESULTS: Proportions of partners notified and treated were, for patient referral, 56% and 34%; for PDPT, 57% and 46%; for DIS referral, 25% and 22%. Notification and treatment estimates for patient referral and PDPT were significantly higher than for DIS referral, but DIS referral was more efficacious than the other methods in assuring treatment among those notified (all Ps < .001). The notification and treatment ratios per patient seen were, for patient referral, 0.96 and 0.61; for PDPT, 0.90 and 0.73; for DIS referral, 0.45 and 0.40. CONCLUSION: Patient-based methods had higher proportions of partners treated overall, but provider referral had the highest proportion treated among those notified. These data may assist programs to align the most efficacious strategies with the most epidemiologically or clinically important cases while assuring the best scalable standard of care for others. |
Assisted partner services for HIV case-finding
Hogben M , Behel S . Lancet HIV 2016 4 (2) e55-e56 Data from sub-Saharan Africa show that a substantial reservoir of undiagnosed HIV infection remains in the area, as well as a large proportion of diagnosed people who are not on treatment. According to UNAIDS, 36·7 million people are living with HIV globally, of whom 25·6 million (70%) are in sub-Saharan Africa where 12·0 million (47%) are on antiretroviral therapy.1 As of 2015, the global gap for the UNAIDS 90-90-90 targets was 10·9 million people living with HIV who did not know their HIV status.2 To achieve the first 90 (diagnosis of HIV), countries need to implement innovative and targeted HIV case-finding approaches. | Delivery of partner services is the process through which a public health system ensures that sex and needle-sharing partners of people infected with HIV are notified of their exposure and subsequently assessed and engaged in care.3 Partner services fit into a model of case-finding through screening because the approach is a type of targeted screening in networks of infected and exposed people.4 Partner services have not been included in HIV prevention programmes in sub-Saharan Africa. Although partner or family testing of individuals diagnosed with HIV and disclosure of infection are within the standard of care, health facilities often take a passive approach and focus on the immediate family or household, and do not routinely follow up patients to ensure that all of their contacts have been tested. Common concerns include loss of confidentiality, the threat of intimate partner violence, stigma, discrimination, and absence of community and political support.5 Despite these barriers, findings from one review6 of partner services in low-income countries showed that most people accepted the principles of partner notification. |
Building capacity for data-driven decision making in African HIV testing programs: field perspectives on data use workshops
Courtenay-Quirk C , Spindler H , Leidich A , Bachanas P . AIDS Educ Prev 2016 28 (6) 472-484 Strategic, high quality HIV testing services (HTS) delivery is an essential step towards reaching the end of AIDS by 2030. We conducted HTS Data Use workshops in five African countries to increase data use for strategic program decision-making. Feedback was collected on the extent to which workshop skills and tools were applied in practice and to identify future capacity-building needs. We later conducted six semistructured phone interviews with workshop planning teams and sent a web-based survey to 92 past participants. The HTS Data Use workshops provided accessible tools that were readily learned by most respondents. While most respondents reported increased confidence in interpreting data and frequency of using such tools over time, planning team representatives indicated ongoing needs for more automated tools that can function across data systems. To achieve ambitious global HIV/AIDS targets, national decision makers may continue to seek tools and skill-building opportunities to monitor programs and identify opportunities to refine strategies. |
Community ART support groups in Mozambique: The potential of patients as partners in care
Jobarteh K , Shiraishi RW , Malimane I , Samo Gudo P , Decroo T , Auld AF , Macome V , Couto A . PLoS One 2016 11 (12) e0166444 BACKGROUND: High rates of attrition are stymying Mozambique's national HIV Program's efforts to achieve 80% treatment coverage. In response, Mozambique implemented a national pilot of Community Adherence and Support Groups (CASG). CASG is a model in which antiretroviral therapy (ART) patients form groups of up to six patients. On a rotating basis one CASG group member collects ART medications at the health facility for all group members, and distributes those medications to the other members in the community. Patients also visit their health facility bi-annually to receive clinical services. METHODS: A matched retrospective cohort study was implemented using routinely collected patient-level data in 68 health facilities with electronic data systems and CASG programs. A total of 129,938 adult ART patients were registered in those facilities. Of the 129,938 patients on ART, 6,760 were CASG members. A propensity score matched analysis was performed to assess differences in mortality and loss to follow-up (LTFU) between matched CASG and non-CASG members. Propensity scores were estimated using a random-effects logistic regression model. The following covariates where included in the model: sex, educational status, WHO stage, year of ART initiation, age, CASG eligibility, CD4 cell count category, weight, and employment status. RESULTS: Non-CASG participants had higher LTFU rates (HR 2.356; p = 0.04) than matched CASG participants; however, there were no significant mortality differences between CASG and non-CASG participants. Compared with the full cohort of non-CASG members, CASG members were more likely to be female (74% vs. 68%), tended to have a lower median CD4 counts at ART initiation (183 cells/m3 vs. 200cells/m3) and be less likely to have a secondary school education (15% vs. 23%). CONCLUSION: ART patients enrolled in CASG were significantly less likely to be LTFU compared to matched patients who did not join CASG. CASG appears to be an effective strategy to decrease LTFU in Mozambique's national ART program. |
Comparison of the estimated incidence of acute leptospirosis in the Kilimanjaro region of Tanzania between 2007-08 and 2012-14
Maze MJ , Biggs HM , Rubach MP , Galloway RL , Cash-Goldwasser S , Allan KJ , Halliday JE , Hertz JT , Saganda W , Lwezaula BF , Cleaveland S , Mmbaga BT , Maro VP , Crump JA . PLoS Negl Trop Dis 2016 10 (12) e0005165 BACKGROUND: The sole report of annual leptospirosis incidence in continental Africa of 75-102 cases per 100,000 population is from a study performed in August 2007 through September 2008 in the Kilimanjaro Region of Tanzania. To evaluate the stability of this estimate over time, we estimated the incidence of acute leptospirosis in Kilimanjaro Region, northern Tanzania for the time period 2012-2014. METHODOLOGY AND PRINCIPAL FINDINGS: Leptospirosis cases were identified among febrile patients at two sentinel hospitals in the Kilimanjaro Region. Leptospirosis was diagnosed by serum microscopic agglutination testing using a panel of 20 Leptospira serovars belonging to 17 separate serogroups. Serum was taken at enrolment and patients were asked to return 4-6 weeks later to provide convalescent serum. Confirmed cases required a 4-fold rise in titre and probable cases required a single titre of ≥800. Findings from a healthcare utilisation survey were used to estimate multipliers to adjust for cases not seen at sentinel hospitals. We identified 19 (1.7%) confirmed or probable cases among 1,115 patients who presented with a febrile illness. Of cases, the predominant reactive serogroups were Australis 8 (42.1%), Sejroe 3 (15.8%), Grippotyphosa 2 (10.5%), Icterohaemorrhagiae 2 (10.5%), Pyrogenes 2 (10.5%), Djasiman 1 (5.3%), Tarassovi 1 (5.3%). We estimated that the annual incidence of leptospirosis was 11-18 cases per 100,000 population. This was a significantly lower incidence than 2007-08 (p<0.001). CONCLUSIONS: We estimated a much lower incidence of acute leptospirosis than previously, with a notable absence of cases due to the previously predominant serogroup Mini. Our findings indicate a dynamic epidemiology of leptospirosis in this area and highlight the value of multi-year surveillance to understand leptospirosis epidemiology. |
Comparison of the first three waves of avian influenza A(H7N9) virus circulation in the mainland of the People's Republic of China
Xiang N , Iuliano AD , Zhang Y , Ren R , Geng X , Ye B , Tu W , Li CA , Lv Y , Yang M , Zhao J , Wang Y , Yang F , Zhou L , Liu B , Shu Y , Ni D , Feng Z , Li Q . BMC Infect Dis 2016 16 (1) 734 BACKGROUND: H7N9 human cases were first detected in mainland China in March 2013. Circulation of this virus has continued each year shifting to typical winter months. We compared the clinical and epidemiologic characteristics for the first three waves of virus circulation. METHODS: The first wave was defined as reported cases with onset dates between March 31-September 30, 2013, the second wave was defined as October 1, 2013-September 30, 2014 and the third wave was defined as October 1, 2014-September 30, 2015. We used simple descriptive statistics to compare characteristics of the three distinct waves of virus circulation. RESULTS: In mainland China, 134 cases, 306 cases and 219 cases were detected and reported in first three waves, respectively. The median age of cases was statistically significantly older in the first wave (61 years vs. 56 years, 56 years, p < 0.001) compared to the following two waves. Most reported cases were among men in all three waves. There was no statistically significant difference between case fatality proportions (33, 42 and 45%, respectively, p = 0.08). There were no significant statistical differences for time from illness onset to first seeking healthcare, hospitalization, lab confirmation, initiation antiviral treatment and death between the three waves. A similar percentage of cases in all waves reported exposure to poultry or live poultry markets (87%, 88%, 90%, respectively). There was no statistically significant difference in the occurrence of severe disease between the each of the first three waves of virus circulation. Twenty-one clusters were reported during these three waves (4, 11 and 6 clusters, respectively), of which, 14 were considered to be possible human-to-human transmission. CONCLUSION: Though our case investigation for the first three waves found few differences between the epidemiologic and clinical characteristics, there is continued international concern about the pandemic potential of this virus. Since the virus continues to circulate, causes more severe disease, has the ability to mutate and become transmissible from human-to-human, and there is limited natural protection from infection in communities, it is critical that surveillance systems in China and elsewhere are alert to the influenza H7N9 virus. |
Development and implementation of the Ebola Traveler Monitoring Program and clinical outcomes of monitored travelers during October - May 2015, Minnesota
DeVries A , Talley P , Sweet K , Kline S , Stinchfield P , Tosh P , Danila R . PLoS One 2016 11 (12) e0166797 BACKGROUND: In October 2014, the United States began actively monitoring all persons who had traveled from Guinea, Liberia, and Sierra Leone in the previous 21 days. State public health departments were responsible for monitoring all travelers; Minnesota has the largest Liberian population in the United States. The MDH Ebola Clinical Team (ECT) was established to assess travelers with symptoms of concern for Ebola virus disease (EVD), coordinate access to healthcare at appropriate facilities including Ebola Assessment and Treatment Units (EATU), and provide guidance to clinicians. METHODS: Minnesota Department of Health (MDH) began receiving traveler information collected by U.S. Customs and Border Control and Centers for Disease Control and Prevention staff on October 21, 2014 via encrypted electronic communication. All travelers returning from Liberia, Sierra Leone, and Guinea during 10/21/14-5/15/15 were monitored by MDH staff in the manner recommended by CDC based on the traveler's risk categorization as "low (but not zero)", "some" and "high" risk. When a traveler reported symptoms or a temperature ≥100.4 degrees F at any time during their 21-day monitoring period, an ECT member would speak to the traveler and perform a clinical assessment by telephone or via video-chat. Based on the assessment the ECT member would recommend 1) continued clinical monitoring while at home with frequent telephone follow-up by the ECT member, 2) outpatient clinical evaluation at an outpatient site agreed upon by all parties, or 3) inpatient clinical evaluation at one of four Minnesota EATUs. ECT members assessed and approved testing for Ebola virus infection at MDH. Traveler data, calls to the ECT and clinical outcomes were logged on a secure server at MDH. RESULTS: During 10/21/14-5/15/15, a total of 783 travelers were monitored; 729 (93%) traveled from Liberia, 30 (4%) Sierra Leone, and 24 (3%) Guinea. The median number monitored per week was 59 (range 45-143). The median age was 35 years; 136 (17%) were aged <18 years. Thirteen of 256 women of reproductive age (5%) were pregnant. The country of passport issuance was known for 720 of the travelers. The majority of monitored travelers (478 [66%]) used a non-U.S. passport including 442 (61%) Liberian nationals. A total of 772 (99%) travelers were "low (but not zero)" risk; 11 (1%) were "some" risk. Among monitored travelers, 43 (5%) experienced illness symptoms; 29 (67%) had a symptom consistent with EVD. Two were tested for Ebola virus disease and had negative results. Most frequently reported symptoms were fever (20/43, 47%) and abdominal pain (12/43, 28%). During evaluation, 16 (37%) of 43 travelers reported their symptoms began prior to travel; chronic health conditions in 24 travelers including tumors/cancer, pregnancy, and orthopedic conditions were most common. Infectious causes in 19 travelers included upper respiratory infection, malaria, and gastrointestinal infections. DISCUSSION: Prior to 2014, no similar active monitoring program for travelers had been performed in Minnesota; assessment and management of symptomatic travelers was a new activity for MDH. Ensuring safe entrance into healthcare was particularly challenging for children, and pregnant women, as well as those without an established connection to healthcare. Unnecessary inpatient evaluations were successfully avoided by close clinical follow-up by phone. Before similar monitoring programs are considered in the future, careful thought must be given to necessary resources and the impact on affected populations, public health, and the healthcare system. |
Notes from the field: Adverse reaction after vaccinia virus vaccination - New Mexico, 2016
Middaugh N , Petersen B , McCollum AM , Smelser C . MMWR Morb Mortal Wkly Rep 2016 65 (47) 1351-1352 On February 4, 2016, the New Mexico Department of Health (NMDOH) was contacted regarding a patient who had received ACAM2000* smallpox (vaccinia) vaccine 12 days earlier as part of an institutional review board–approved study at a plasma donation center and had numerous lesions surrounding the inoculation site and on the opposite arm, back, and abdomen. ACAM2000 is a live-virus vaccine indicated for active immunization against smallpox. Vaccinia virus is highly effective in preventing smallpox by stimulating an immune response to the closely related Orthopoxvirus. The inoculation site is considered infectious until the scab falls off and intact skin has regrown (2–4 weeks) (1,2). The patient, a man aged 57 years, had no ocular, oral, nasal, or genital lesions. He enrolled in the study on January 22, after meeting inclusion criteria and not having a condition that precluded vaccination (immunosuppression, heart disease, or history or presence of eczema) (1). The vaccination study objective was to induce production of high antivaccinia virus antibody titers for the collection of plasma to be used in manufacturing vaccinia immune globulin intravenous (VIGIV), which is produced by removing and purifying antivaccinia antibodies from plasma of persons with immunity to smallpox. | Adverse reactions to vaccinia vaccination range from mild and self-limited to severe and life-threatening, including inoculation site signs and symptoms, constitutional symptoms, generalized vaccinia, eczema vaccinatum, and progressive vaccinia (1,3). The most frequent complication is inadvertent inoculation at other sites (self and contacts) (2–4) with an estimated occurrence rate of 42.1 cases per 1 million vaccinations (1). Autoinoculation, the unintentional transfer of virus from the vaccination site to elsewhere on the vaccinee’s body, can occur from hands or fomites; the most common nonocular transfer sites are the arm, elbow, and shoulder (2,3). Autoinoculation lesions progress through the same stages as the vaccination site lesion; when autoinoculation occurs >5 days postvaccination, lesions and progression are often attenuated (2,3). |
Expert consensus on metrics to assess the impact of patient-level antimicrobial stewardship interventions in acute care settings
Moehring RW , Anderson DJ , Cochran RL , Hicks LA , Srinivasan A , Dodds Ashley E . Clin Infect Dis 2016 64 (3) 377-383 Antimicrobial stewardship programs (ASPs) positively impact patient care, but metrics to assess ASP impact are poorly defined. We used a modified Delphi approach to select relevant metrics for assessing patient-level interventions in acute care settings for the purposes of internal program decision-making. An expert panel rated 90 candidate metrics on a 9-point Likert scale for association with four criteria: improved antimicrobial prescribing, improved patient care, utility in targeting stewardship efforts, and feasibility in hospitals with electronic health records. Experts further refined, added, or removed metrics during structured teleconferences and re-rated the retained metrics. Six metrics were rated >6 in all criteria: two measures of Clostridium difficile incidence, incidence of drug-resistant pathogens, days of therapy over admissions, days of therapy over patient days, and redundant therapy events. Fourteen metrics rated >6 in all criteria except feasibility were identified as targets for future development. |
Comparative sequence analysis of Cyclospora cayetanensis apicoplast genomes originating from diverse geographical regions.
Cinar HN , Qvarnstrom Y , Wei-Pridgeon Y , Li W , Nascimento FS , Arrowood MJ , Murphy HR , Jang A , Kim E , Kim R , da Silva A , Gopinath GR . Parasit Vectors 2016 9 (1) 611 BACKGROUND: Cyclospora cayetanensis is an emerging coccidian parasite that causes endemic and epidemic diarrheal disease called cyclosporiasis, and this infection is associated with consumption of contaminated produce or water in developed and developing regions. Food-borne outbreaks of cyclosporiasis have occurred almost every year in the USA since the 1990s. Investigations of these outbreaks are currently hampered due to lack of molecular epidemiological tools for trace back analysis. The apicoplast of C. cayetanensis, a relict non-photosynthetic plastid with an independent genome, provides an attractive target to discover sequence polymorphisms useful as genetic markers for detection and trace back analysis of the parasite. Distinct differences in the apicoplast genomes of C. cayetanensis could be useful in designing advanced molecular methods for rapid detection and, subtyping and geographical source attribution, which would aid outbreak investigations and surveillance studies. METHODS: To obtain the genome sequence of the C. cayetanensis apicoplast, we sequenced the C. cayetanensis genomic DNA extracted from clinical stool samples, assembled and annotated a 34,146 bp-long circular sequence, and used this sequence as a reference genome in this study. We compared the genome and the predicted proteome to the data available from other apicomplexan parasites. To initialize the search for genetic markers, we mapped the raw sequence reads from an additional 11 distinct clinical stool samples originating from Nepal, New York, Texas, and Indonesia to the apicoplast reference genome. RESULTS: We identified several high quality single nucleotide polymorphisms (SNPs) and small insertion/deletions spanning the apicoplast genome supported by extensive sequencing reads data, and a 30 bp sequence repeat at the terminal spacer region in a Nepalese sample. The predicted proteome consists of 29 core apicomplexan peptides found in most of the apicomplexans. Cluster analysis of these C. cayetanensis apicoplast genomes revealed a familiar pattern of tight grouping with Eimeria and Toxoplasma, separated from distant species such as Plasmodium and Babesia. CONCLUSIONS: SNPs and sequence repeats identified in this study may be useful as genetic markers for identification and differentiation of C. cayetanensis isolates found and could facilitate outbreak investigations. |
Assessment of traditional and improved stove use on household air pollution and personal exposures in rural western Kenya
Yip F , Christensen B , Sircar K , Naeher L , Bruce N , Pennise D , Lozier M , Pilishvili T , Loo Farrar J , Stanistreet D , Nyagol R , Muoki J , de Beer L , Sage M , Kapil V . Environ Int 2016 99 185-191 BACKGROUND: Over 40% of the world's population relies on solid fuels for heating and cooking. Use of improved biomass cookstoves (ICS) has the potential to reduce household air pollution (HAP). OBJECTIVES: As part of an evaluation to identify ICS for use in Kenya, we collected indoor air and personal air samples to assess differences between traditional cookstoves (TCS) and ICS. METHODS: We conducted a cross-over study in 2012 in two Kenyan villages; up to six different ICS were installed in 45 households during six two-week periods. Forty-eight hour kitchen measurements of fine particulate matter (PM2.5) and carbon monoxide (CO) were collected for the TCS and ICS. Concurrent personal CO measurements were conducted on the mother and one child in each household. We performed descriptive analysis and compared paired measurements between baseline (TCS only) and each ICS. RESULTS: The geometric mean of 48-hour baseline PM2.5 and CO concentrations in the kitchen was 586mug/m3 (95% CI: 460, 747) and 4.9ppm (95% CI: 4.3, 5.5), respectively. For each ICS, the geometric mean kitchen air pollutant concentration was lower than the TCS: median reductions were 38.8% (95% CI: 29.5, 45.2) for PM2.5 and 27.1% (95% CI: 17.4, 40.3) for CO, with statistically significant relationships for four ICS. We also observed a reduction in personal exposures to CO with ICS use. CONCLUSIONS: We observed a reduction in mean 48-hour PM2.5 and CO concentrations compared to the TCS; however, concentrations for both pollutants were still consistently higher than WHO air quality guidelines. Our findings illustrate that ICS tested in real-world settings can reduce exposures to HAP, but implementation of cleaner fuels and related stove technologies may also be necessary to optimize public health benefits. |
Antimicrobial resistance in Salmonella that caused foodborne disease outbreaks: United States, 2003-2012
Brown AC , Grass JE , Richardson LC , Nisler AL , Bicknese AS , Gould LH . Epidemiol Infect 2016 145 (4) 1-9 Although most non-typhoidal Salmonella illnesses are self-limiting, antimicrobial treatment is critical for invasive infections. To describe resistance in Salmonella that caused foodborne outbreaks in the United States, we linked outbreaks submitted to the Foodborne Disease Outbreak Surveillance System to isolate susceptibility data in the National Antimicrobial Resistance Monitoring System. Resistant outbreaks were defined as those linked to one or more isolates with resistance to at least one antimicrobial drug. Multidrug resistant (MDR) outbreaks had at least one isolate resistant to three or more antimicrobial classes. Twenty-one per cent (37/176) of linked outbreaks were resistant. In outbreaks attributed to a single food group, 73% (16/22) of resistant outbreaks and 46% (31/68) of non-resistant outbreaks were attributed to foods from land animals (P < 0.05). MDR Salmonella with clinically important resistance caused 29% (14/48) of outbreaks from land animals and 8% (3/40) of outbreaks from plant products (P < 0.01). In our study, resistant Salmonella infections were more common in outbreaks attributed to foods from land animals than outbreaks from foods from plants or aquatic animals. Antimicrobial susceptibility data on isolates from foodborne Salmonella outbreaks can help determine which foods are associated with resistant infections. |
High-Throughput Next Generation Sequencing of Polioviruses.
Montmayeur AM , Ng TF , Schmidt A , Zhao K , Magana L , Iber J , Castro CJ , Chen Q , Henderson E , Ramos E , Shaw J , Tatusov RL , Dybdahl-Sissoko N , Endegue-Zanga MC , Adeniji JA , Oberste MS , Burns CC . J Clin Microbiol 2016 55 (2) 606-615 Poliovirus (PV) is currently targeted for worldwide eradication and containment. Sanger-based sequencing of the VP1 capsid region is the current standard method for PV surveillance; however, the whole genome sequence is sometimes needed for higher resolution global surveillance. In this study, we optimized whole genome sequencing protocols for poliovirus isolates and FTA cards using NGS, aiming for high sequence coverage, efficiency, and throughput. We found that DNase treatment of poliovirus RNA followed by random RT, amplification, and the Nextera XT DNA Library Preparation Kit produced significantly better results than other preparations. Average viral reads per total reads, a measurement of efficiency, is as high as 84.2% +/- 15.6%; PV genomes covering >99-100% of the reference length were obtained and validated with Sanger sequencing. A total of 52 PV genomes were generated, multiplexing as many as 64 samples in a single Illumina MiSeq run. This high-throughput, sequence-independent NGS approach can facilitate the detection of a diverse range of PV, especially for those in vaccine-derived polioviruses (VDPV), circulating VDPV, or immunodeficiency-related VDPV. In contrast to previous studies on other viruses, our results showed that filtration and nuclease treatment did not produce discernable increases in sequencing efficiency of PV isolates. However, DNase treatment after nucleic acid extraction to remove host DNA significantly improved sequencing results. This NGS method has been successfully implemented to generate PV genomes for molecular epidemiology of the most recent PV isolates. Additionally, the ability to obtain full PV genomes from FTA cards will aid in facilitating global poliovirus surveillance. |
Sexual risk behaviors of African American adolescent females: The role of cognitive and religious factors
George Dalmida S , Aduloju-Ajijola N , Clayton-Jones D , Thomas TL , Erazo Toscano RJ , Lewis R , Fleming T , Taylor S , Lunyong M . J Transcult Nurs 2016 29 (1) 74-83 INTRODUCTION: African American (AA) high school-age girls are more likely to have had sex before age 13 years and have higher rates of all sexually transmitted infections. Cognition and religion/spirituality are associated with adolescent sexuality, therefore, the purpose of this study was to identify cognitive and religious substrates of AA girls' risky sexual behaviors. METHOD: A descriptive study was conducted with 65 AA girls aged 15 to 20 years using computerized questionnaires and cognitive function tasks. RESULTS: Average age was 17.8 +/- 1.9 years and average sexual initiation age was 15.5 +/- 2.6 years. Overall, 57.6% reported a history of vaginal sex. Girls who reported low/moderate religious importance were significantly younger at vaginal sex initiation than girls for whom religion was very/extremely important. Girls who attended church infrequently reported significantly more sexual partners. IMPLICATIONS: Health care providers can use these findings to deliver culturally congruent health care by assessing and addressing these psychosocial factors in this population. |
Social determinants and teen pregnancy prevention: Exploring the role of nontraditional partnerships
Fuller TR , White CP , Chu J , Dean D , Clemmons N , Chaparro C , Thames JL , Henderson AB , King P . Health Promot Pract 2016 19 (1) 23-30 Addressing the social determinants of health (SDOH) that influence teen pregnancy is paramount to eliminating disparities and achieving health equity. Expanding prevention efforts from purely individual behavior change to improving the social, political, economic, and built environments in which people live, learn, work, and play may better equip vulnerable youth to adopt and sustain healthy decisions. In 2010, the Centers for Disease Control and Prevention in partnership with the Office of Adolescent Health funded state- and community-based organizations to develop and implement the Teen Pregnancy Prevention Community-Wide Initiative. This effort approached teen pregnancy from an SDOH perspective, by identifying contextual factors that influence teen pregnancy and other adverse sexual health outcomes among vulnerable youth. Strategies included, but were not limited to, conducting a root cause analysis and establishing nontraditional partnerships to address determinants identified by community members. This article describes the value of an SDOH approach for achieving health equity, explains the integration of such an approach into community-level teen pregnancy prevention activities, and highlights two project partners' efforts to establish and nurture nontraditional partnerships to address specific SDOH. |
Economic analysis of the Nairobi Cancer Registry: Implications for expanding and enhancing cancer registration in Kenya
Korir A , Gakunga R , Subramanian S , Okerosi N , Chesumbai G , Edwards P , Tangka F , Joseph R , Buziba N , Rono V , Parkin DM , Saraiya M . Cancer Epidemiol 2016 45 Suppl 1 S20-S29 INTRODUCTION: Cancer registration is an important activity for informing cancer control activities. Cancer registries in Sub-Saharan Africa have limited resources to effectively operate because of competing priorities. To date, there has not been an assessment of the resources and funding needed to perform all the activities essential for cancer registration in Kenya. Evidence will help registries to quantify and advocate for the funds needed to sustain, enhance, and expand high quality cancer registration in Kenya. METHODS: In this study, we used the Centers for Disease Control and Prevention's (CDC's) International Registry Costing Tool (IntRegCosting Tool) to evaluate the funding, cost, and labor resources used to perform the cancer registry operations in Nairobi County for two annual periods between July 2012 and June 2014. RESULTS: Funding from grants, research studies, and international organizations provided 70% of the registry operations' cost. For both time periods, the most-costly registry activities were related to administration, management, and training, along with data acquisition activities such as data abstraction, entry, and validation. Even among these core registry activities, however, substantial variations existed. CONCLUSIONS: Stable funding for cancer registry operations is necessary to sustain core registry activities in other to deliver high-quality data, which in turn is necessary to foster evidence-based policies to improve cancer outcomes. As stakeholders look into expanding the Nairobi Cancer Registry into a national program, the cost data provided in this study will help justify the funding required for sustaining and expanding registry activities. |
County-level variation in per capita spending for multiple chronic conditions among fee-for-service Medicare beneficiaries, United States, 2014
Matthews KA , Holt J , Gaglioti AH , Lochner KA , Shoff C , McGuire LC , Greenlund KJ . Prev Chronic Dis 2016 13 E162 The prevalence of Medicare beneficiaries aged 65 years or older with 6 or more concurrent chronic conditions (MCC6+) varies geographically (1). Preventing chronic disease costs less than treating it. Chronic diseases that are well managed progress slower than those that are untreated (2). Thus, understanding how Medicare spending is distributed across the United States among older adults with the highest burden of multiple chronic conditions can assist with targeting prevention and disease management efforts. The objective of this analysis was to describe the county-level variation in per capita Medicare spending among MCC6+ beneficiaries. |
Strategies and partnerships toward prevention of healthcare-associated venous thromboembolism
Beckman MG , Abe K , Barnes K , Bartman B , Brady PJ , Hooper WC . J Hosp Med 2016 11 Suppl 2 S5-s7 Venous thromboembolism (VTE), blood clots occurring as deep vein thrombosis, pulmonary embolism, or both, is an important and growing public health issue. The precise number of people affected by VTE is unknown; however, estimates suggest that up to 900,000 events resulting in as many as 100,000 premature deaths occur in the United States yearly with healthcare costs as high as $10 billion.1–3 Although anyone can develop VTE, research has shown that half of VTE events occurring in the outpatient setting are directly linked to a recent hospitalization or surgery.4 In patients with cancer, VTE is a leading cause of death after the cancer itself.5,6 Fortunately, many of these healthcare-associated VTE (HA-VTE) cases can be prevented. Recent analyses have shown that as many as 70% of HA-VTE cases are preventable through appropriate prophylaxis,7–9 yet reports suggest that fewer than half of hospital patients receive VTE prophylaxis in accordance with accepted evidence-based guidelines.10 Appropriate prevention of HA-VTE can result in a significant reduction in overall VTE occurrence, thereby decreasing healthcare burden and unnecessary deaths. | In November 2015, the Centers for Disease Control and Prevention (CDC) released the Healthcare-Associated VTE Prevention Challenge (http://www.cdc.gov/ncbddd/dvt/ha-vte-challenge.html) to identify, highlight, and reward hospitals, managed care organizations, and hospital networks that implemented innovative, effective, and sustainable strategies to prevent HA-VTE. |
Outbreak of Pantoea agglomerans bloodstream infections at an oncology clinic-Illinois, 2012-2013
Yablon BR , Dantes R , Tsai V , Lim R , Moulton-Meissner H , Arduino M , Jensen B , Patel MT , Vernon MO , Grant-Greene Y , Christiansen D , Conover C , Kallen A , Guh AY . Infect Control Hosp Epidemiol 2016 38 (3) 1-6 OBJECTIVE To determine the source of a healthcare-associated outbreak of Pantoea agglomerans bloodstream infections. DESIGN Epidemiologic investigation of the outbreak. SETTING Oncology clinic (clinic A). METHODS Cases were defined as Pantoea isolation from blood or catheter tip cultures of clinic A patients during July 2012-May 2013. Clinic A medical charts and laboratory records were reviewed; infection prevention practices and the facility's water system were evaluated. Environmental samples were collected for culture. Clinical and environmental P. agglomerans isolates were compared using pulsed-field gel electrophoresis. RESULTS Twelve cases were identified; median (range) age was 65 (41-78) years. All patients had malignant tumors and had received infusions at clinic A. Deficiencies in parenteral medication preparation and handling were identified (eg, placing infusates near sinks with potential for splash-back contamination). Facility inspection revealed substantial dead-end water piping and inadequate chlorine residual in tap water from multiple sinks, including the pharmacy clean room sink. P. agglomerans was isolated from composite surface swabs of 7 sinks and an ice machine; the pharmacy clean room sink isolate was indistinguishable by pulsed-field gel electrophoresis from 7 of 9 available patient isolates. CONCLUSIONS Exposure of locally prepared infusates to a contaminated pharmacy sink caused the outbreak. Improvements in parenteral medication preparation, including moving chemotherapy preparation offsite, along with terminal sink cleaning and water system remediation ended the outbreak. Greater awareness of recommended medication preparation and handling practices as well as further efforts to better define the contribution of contaminated sinks and plumbing deficiencies to healthcare-associated infections are needed. Infect Control Hosp Epidemiol 2016;1-6. |
Tetanus immunity gaps in children 5-14 years and men ≥ 15 years of age revealed by integrated disease serosurveillance in Kenya, Tanzania, and Mozambique
Scobie HM , Patel M , Martin D , Mkocha H , Njenga SM , Odiere MR , Pelletreau S , Priest JW , Thompson R , Won KY , Lammie PJ . Am J Trop Med Hyg 2016 96 (2) 415-420 Recent tetanus cases associated with male circumcision in Eastern and Southern Africa (ESA) prompted an examination of tetanus immunity by age and sex using multiplex serologic data from community surveys in three ESA countries during 2012-2013. Tetanus seroprotection was lower among children 5-14 years versus 1-4 years of age in Kenya (66% versus 90%) and Tanzania (66% versus 89%), but not in Mozambique (91% versus 88%), where children receive two booster doses in school. Among males ≥ 15 years of age, tetanus seroprotection was lower than females in Kenya (45% versus 96%), Tanzania (28% versus 94%), and Mozambique (64% versus 90%). Tetanus immunity from infant vaccination doses wanes over time, and only women of reproductive age routinely receive booster doses. To prevent immunity gaps in older children, adolescents, and adult men, a life-course vaccination strategy is needed to provide the three recommended tetanus booster doses. |
Influenza vaccine effectiveness in preventing influenza illness among children during school-based outbreaks in the 2014-2015 season in Beijing, China
Zhang L , Yang P , Thompson MG , Pan Y , Ma C , Wu S , Sun Y , Zhang M , Duan W , Wang Q . Pediatr Infect Dis J 2016 36 (3) e69-e75 BACKGROUND: Little is known about VE against non-medically attended A(H3N2) influenza illness during 2014-2015 when the vaccine component appeared to be a poor match with circulating strains. METHODS: Forty-three eligible school influenza outbreaks in Beijing, China from November 1 to December 31, 2014 were included in this study. The VE of 2014-2015 trivalent inactivated influenza vaccine (IIV3) was assessed in preventing laboratory-confirmed influenza among school-age children through a case-control design, using asymptomatic controls. Influenza vaccination was documented from a vaccination registry. VE was estimated adjusting for age group, sex, rural vs. urban area, body mass index, chronic conditions, onset week and schools through a mixed effects logistic regression model. RESULTS: The average coverage rate of 2014-2015 IIV3 among students across the 43 schools was 47.6%. The fully adjusted VE of 2014-2015 IIV3 against laboratory-confirmed influenza was 38% (95% CI: 12% to 57%). Receipt of previous season's (2013-2014) IIV3 significantly modified VE of the 2014-2015 IIV3; children who received both 2013-2014 and 2014-2015 vaccinations had VE of 29% (95% CI: -8% to 53%) while VE for children who received 2014-2015 IIV3 only was 54% (95% CI: 8% to 77%). CONCLUSIONS: VE for 2014-2015 IIV3 against A (H3N2) illness identified in schools was modest. Children who did not receive the prior season's vaccine with a homologous A (H3N2) component may have enjoyed greater protection than repeated vaccinees. |
Using a domestic and sexual violence prevention advocate to implement a dating violence prevention program with athletes
Jaime MC , Stocking M , Freire K , Perkinson L , Ciaravino S , Miller E . Health Educ Res 2016 31 (6) 679-696 Coaching Boys into Men is an evidence-based dating violence prevention program for coaches to implement with male athletes. A common adaptation of this program is delivery by domestic violence and sexual violence prevention advocates instead of coaches. We explored how this implementer adaptation may influence athlete uptake of program messages and outcomes. Randomly, one school received the program delivered by an advocate while another school received the program delivered by coaches. Athletes completed baseline and follow-up surveys (n = 148), and a subset who received the advocate-led program participated in focus groups (four groups; n = 26). We compared changes in athlete attitudes and behaviors and conducted thematic analyses with qualitative data. We found no significant differences between athletes who received the program from the advocate versus their coaches. Athletes highlighted the advocate's delivery and role as a non-judgmental adult ally as qualities that influenced their uptake of program messages. The acceptability of the advocate-led program may be related to the implementer type along with specific implementer characteristics and delivery methods. Using advocates together with coaches as implementers could increase the reach of this program. Further study of best practices for Coaching Boys into Men adaptation is needed to guide program dissemination and sustainability. |
Development of a multiplex taqMan real-time PCR assay for typing of Mycoplasma pneumoniae based on type-specific indels identified through whole genome sequencing.
Wolff BJ , Benitez AJ , Desai HP , Morrison SS , Diaz MH , Winchell JM . Diagn Microbiol Infect Dis 2016 87 (3) 203-206 We developed a multiplex real-time PCR assay for simultaneously detecting M. pneumoniae and typing into historically-defined P1 types. Typing was achieved based on the presence of short type-specific indels identified through whole genome sequencing. This assay was 100% specific compared to existing methods and may be useful during epidemiologic investigations. |
Laboratory Diagnosis of Chikungunya Virus Infections and Commercial Sources for Diagnostic Assays.
Johnson BW , Russell BJ , Goodman CH . J Infect Dis 2016 214 S471-s474 Detection of chikungunya virus (CHIKV) or viral RNA is the primary laboratory test used to diagnose infection in serum collected <6 days after onset of illness. Two real-time reverse transcription-polymerase chain reaction (RT-PCR) kits are available commercially, but validity data are limited. There are 2 commercial sources of inactivated positive-control CHIKV RNA to be used with purchased primers. The Centers for Disease Control and Prevention provides viral RNA-positive controls and primer and probe nucleotide sequences for real-time RT-PCR testing. Detection of CHIKV-specific immunoglobulin M (IgM) antibody becomes a sensitive test for samples collected approximately >5 days of illness. Commercially available CHIKV IgM-detection assays include lateral flow rapid tests, IgM antibody capture enzyme-linked immunosorbent assays (MAC-ELISAs), and indirect immunofluorescence tests. Nine commercial CHIKV IgM detection assays were evaluated at 3 reference laboratories to provide guidance to public health diagnostic laboratories on their performance parameters. Sensitivity of the rapid tests and 3 MAC-ELISAs was <50%, and thus these assays are not recommended. Three of the MAC-ELISA kits and 1 indirect immunofluorescence kit had comparable performance to the reference assays. In summary, commercial assays with performance comparable to reference assays are available for molecular and serological diagnosis of CHIKV infections. |
Comparison of Babesia microti Real-Time Polymerase Chain Reaction Assays for Confirmatory Diagnosis of Babesiosis.
Souza SS , Bishop HS , Sprinkle P , Qvarnstrom Y . Am J Trop Med Hyg 2016 95 (6) 1413-1416 Babesiosis is an emerging tick-borne disease caused by apicomplexan parasites of the genus Babesia Most human infections in the United States are caused by Babesia microti, but other infection-causing Babesia parasites have been documented as well. Polymerase chain reaction (PCR)-based methods can be used to identify this parasite to the species level. In this study, published real-time PCR assays for the specific detection of B. microti were evaluated against conventional PCR for their analytical performance. All evaluated real-time PCR assays had comparable dynamic range and amplification efficiency, but the sensitivity and specificity varied. The best performing test, a TaqMan assay targeting the 18S ribosomal RNA gene, was further evaluated for diagnostic performance using blood specimens submitted to the Centers for Disease Control and Prevention for parasite detection and was found to have 100% sensitivity and specificity. In conclusion, the 18S TaqMan real-time PCR assay is a sensitive, specific, and rapid method for identification of B. microti among cases of babesiosis in the United States. |
Role of engineered metal oxide nanoparticle agglomeration in reactive oxygen species generation and cathepsin B release in NLRP3 inflammasome activation and pulmonary toxicity
Sager TM , Wolfarth M , Leonard SS , Morris AM , Porter DW , Castranova V , Holian A . Inhal Toxicol 2016 28 (14) 1-12 Incomplete understanding of the contributions of dispersants and engineered nanoparticles/materials (ENM) agglomeration state to biological outcomes presents an obstacle for toxicological studies. Although reactive oxygen species (ROS) production is often regarded as the primary indicator of ENM bioactivity and toxicity, it remains unclear whether ENM produce ROS or whether ROS is an outcome of ENM-induced cell injury. Phagolysosomal disruption and cathepsin B release also promote bioactivity through inflammasome activation. Therefore, specific particle parameters, i.e. preexposure dispersion status and particle surface area, of two ENM (NiO and CeO2) were used to evaluate the role of ROS generation and cathepsin B release during ENM-induced toxicity. Male C57BL/6J mice were exposed to 0, 20, 40, or 80 mug of poorly or well-dispersed NiO-NP or CeO2-NP in four types of dispersion media. At 1- and 7-day postexposure, lung lavage fluid was collected to assess inflammation, cytotoxicity, and inflammasome activation. Results showed that preexposure dispersion status correlated with postexposure pulmonary bioactivity. The differences in bioactivity of NiO-NP and CeO2-NP are likely due to NiO-NP facilitating the release of cathepsin B and in turn inflammasome activation generating proinflammatory cytokines. Further, both metal oxides acted as free radical scavengers. Depending on the pH, CeO2-NP acted as a free radical scavenger in an acidic environment (an environment mimicking the lysosome) while the NiO-NP acted as a scavenger in a physiological pH (an environment that mimics the cytosol of the cell). Therefore, results from this study suggest that ENM-induced ROS is not likely a mechanism of inflammasome activation. |
Severity of respiratory syncytial virus lower respiratory tract infection with viral coinfection in HIV-uninfected children
Mazur NI , Bont L , Cohen AL , Cohen C , von Gottberg A , Groome MJ , Hellferscee O , Klipstein-Grobusch K , Mekgoe OT , Naby F , Moyes J , Tempia S , Treurnicht FK , Venter M , Walaza S , Wolter N , Madhi SA . Clin Infect Dis 2016 64 (4) 443-450 BACKGROUND: Molecular diagnostics enable sensitive detection of respiratory viruses but their clinical significance remains unclear in pediatric lower respiratory tract infections (LRTI). We aimed to determine whether viral coinfections increased life-threatening disease in a large cohort. METHODS: Molecular testing was performed for respiratory viruses in nasopharyngeal aspirates collected from children aged <5 years within 24 hours of hospital admission during sentinel surveillance for Severe Acute Respiratory Illness (SARI) hospitalisation conducted in South Africa during February 2009-December 2013. The primary outcome was life-threatening disease defined as mechanical ventilation, intensive care unit admission or death. RESULTS: Of 2,322 HIV-uninfected children with respiratory syncytial virus (RSV)-associated lower respiratory tract infection (LRTI), 1330 (57.3%) had RSV monoinfection, 38 (1.6%) had life-threatening disease, 575 (24.8%) had rhinovirus (RV), 347 (14.9%) had adenovirus (ADV) and 30 (1.3%) had influenza virus (Infl). RSV and any other viral coinfection was not associated with severe disease (OR: 1.4; 95% 0.7-2.6), ADV coinfection had increased odds of life-threatening disease (aOR: 3.4, 95%CI: 1.6 - 7.2, p=0.001), and Infl coinfection had increased odds of life-threatening disease and prolonged length of stay (aOR: 2.1,95%CI: 1.0-4.5, p=0.05) compared to RSV monoinfection. CONCLUSION: RSV coinfection with any respiratory virus is not associated with more severe disease when compared to RSV alone in this study. However, increased life-threatening disease in RSV-ADV and RSV-Infl coinfection warrants further study. |
Variability in the performance characteristics of IgG anti-HEV assays and its impact on reliability of seroprevalence rates of hepatitis E
Kodani M , Ahmed N , Tejada-Strop A , Poe A , Denniston MM , Drobeniuc J , Kamili S . J Med Virol 2016 89 (6) 1055-1061 Hepatitis E is a major public health problem in developing countries and is increasingly being recognized as a cause of substantial sporadic viral hepatitis infections in industrialized countries. Variable rates of hepatitis E seroprevalence have been reported from the same geographic regions depending on the assay used. In this study, we evaluated the performance characteristics of four assays which included two commercial assays, Wantai HEV-IgG ELISA kit (Wantai, China) and DS-EIA-ANTI-HEV-G kit (DSI, Italy), one NIH-developed immunoassay (NIH-55K, Kuniholm et al. 2009. JID 200:48-56) previously used in several major seroprevalence studies and one in-house western blot assay (CDC-WB). The limit of detection of IgG anti-HEV is 100 mIU/ml for Wantai assay, 200 mIU/ml for CDC-WB assay, 1000 mIU/ml for DSI assay and 40 mIU/ml for NIH-55K assay. Pairwise concordance between the four assays ranged from 56 to 87%. The concordance among all four assays was observed in 52% of the samples, while the concordance among three assays was observed in 37% of the samples. These data show a wide discordance between various IgG anti-HEV assays and warrant a comprehensive evaluation of all the assays using well characterized global serum reference panels. |
Comparing the disk-diffusion and agar dilution tests for Neisseria gonorrhoeae antimicrobial susceptibility testing
Liu H , Taylor TH Jr , Pettus K , Johnson S , Papp JR , Trees D . Antimicrob Resist Infect Control 2016 5 46 BACKGROUND: We assessed the validity of testing for antimicrobial susceptibility of clinical and mutant Neisseria gonorrhoeae (GC) isolates by disk diffusion in comparison to agar dilution, and Etest(R) (bioMerieux, France), respectively, for three third generation extended spectrum cephalosporins (ESC): ceftriaxone (CRO), cefixime (CFX), and cefpodoxime (CPD). METHODS: One hundred and five clinical isolates and ten laboratory-mutants were tested following Clinical Laboratory Standard Institute (CLSI) and manufacturer's standards for each of the three methods. The measured diameters by the disk diffusion method were tested for correlation with the MIC values by agar dilution. In addition, comparisons with the Etest(R) were made. Categorical results for concordance, based on standard CLSI cutoffs, between the disk diffusion and the other two methods, respectively, were tested using the Chi-square statistics. Reproducibility was tested for CFX across a 6-month interval by repeated disk tests. RESULTS: Across all 115 specimens, the disk diffusion tests produced good categorical agreements, exhibiting concordance of 93.1%, 92.1%, and 90.4% with agar dilution and 93.0%, 92.1%, and 90.4% with Etest(R), for CRO, CFX, and CPD, respectively. Pearson correlations between disk-diffusion diameters and agar dilution MIC's were -0.59, -0.67, and -0.81 for CRO, CFX, and CPD, respectively. The correlations between disk diffusion and Etest(R) were -0.58, -0.73, and -0.49. Pearson correlation between the CFX disk readings over a 6-month interval was 91%. CONCLUSIONS: Disk diffusion tests remain to be a useful, reliable and fast screening method for qualitative antimicrobial susceptibility testing for ceftriaxone, cefixime, and cefpodoxime. |
Prenatal and postnatal polybrominated diphenyl ether exposure and visual spatial abilities in children
Vuong AM , Braun JM , Yolton K , Xie C , Webster GM , Sjodin A , Dietrich KN , Lanphear BP , Chen A . Environ Res 2016 153 83-92 Polybrominated diphenyl ethers (PBDEs) are associated with impaired visual spatial abilities in toxicological studies, but no epidemiologic study has investigated PBDEs and visual spatial abilities in children. The Health Outcomes and Measures of the Environment Study, a prospective birth cohort (2003-2006, Cincinnati, OH), was used to examine prenatal and childhood PBDEs and visual spatial abilities in 199 children. PBDEs were measured at 16+/-3 weeks gestation and at 1, 2, 3, 5, and 8 years using gas chromatography/isotope dilution high-resolution mass spectrometry. We used the Virtual Morris Water Maze to measure visual spatial abilities at 8 years. In covariate-adjusted models, 10-fold increases in BDE-47, -99, and -100 at 5 years were associated with shorter completion times by 5.2s (95% Confidence Interval [CI] -9.3, -1.1), 4.5s (95% CI -8.1, -0.9), and 4.7s (95% CI -9.0, -0.3), respectively. However, children with higher BDE-153 at 3 years had longer completion times (beta=5.4s, 95% CI -0.3, 11.1). Prenatal PBDEs were associated with improved visual spatial memory retention, with children spending a higher percentage of their search path in the correct quadrant. Child sex modified some associations between PBDEs and visual spatial learning. Longer path lengths were observed among males with increased BDE-47 at 2 and 3 years, while females had shorter paths. In conclusion, prenatal and postnatal BDE-28, -47, -99, and -100 at 5 and 8 years were associated with improved visual spatial abilities, whereas a pattern of impairments in visual spatial learning was noted with early childhood BDE-153 concentrations. |
Early deterioration of iron status among a cohort of Bolivian infants
Burke RM , Rebolledo PA , Fabiszewski de Aceituno AM , Revollo R , Iniguez V , Klein M , Drews-Botsch C , Leon JS , Suchdev PS . Matern Child Nutr 2016 13 (4) Iron deficiency (ID) and iron deficiency anemia (IDA) are major contributors to infant and maternal morbidity worldwide. There is limited longitudinal data on iron status in young infants and on methods to adjust iron biomarkers for inflammation. We aimed to quantify the prevalence of inflammation-adjusted ID, anemia, and IDA over the first year in a cohort of Bolivian infants and their mothers. Healthy mother-infant dyads were recruited from two peri-urban hospitals. Infants provided three blood draws (2, 6-8, and 12-18 months; N = 160); mothers provided two blood draws (1 and 6-8 months postpartum [plus third anemia measurement at 12-18 months]; N = 250). Blood was analyzed for hemoglobin, ferritin, soluble transferrin receptor, C-reactive protein (CRP), and alpha(1)-acid glycoprotein (AGP). Iron biomarkers were adjusted for inflammation using CRP and AGP; hemoglobin cutoffs were adjusted for altitude. Inflammation (elevated CRP or AGP) was 17% among toddlers 12-18 months of age. ID (inflammation-adjusted ferritin) increased with age (<1%, 56%, and 79% at each blood draw), as did anemia and IDA (anemia: 70%, 76%, and 81%; IDA: <1%, 46%, and 68%). Maternal ID declined from the first to second assessment (39% vs. 27%). Inflammation-adjusted ID prevalence was up to 15 percentage points higher than unadjusted estimates. The high prevalence of ID, anemia, and IDA in this cohort of Bolivian infants beginning at 6-8 months of age suggests that early interventions may be necessary in vulnerable populations. |
Description of 13 infants born during October 2015-January 2016 with congenital zika virus infection without microcephaly at birth - Brazil
van der Linden V , Pessoa A , Dobyns W , Barkovich AJ , Junior HV , Filho EL , Ribeiro EM , Leal MC , Coimbra PP , Aragao MF , Vercosa I , Ventura C , Ramos RC , Cruz DD , Cordeiro MT , Mota VM , Dott M , Hillard C , Moore CA . MMWR Morb Mortal Wkly Rep 2016 65 (47) 1343-1348 Congenital Zika virus infection can cause microcephaly and severe brain abnormalities. Congenital Zika syndrome comprises a spectrum of clinical features; however, as is the case with most newly recognized teratogens, the earliest documented clinical presentation is expected to be the most severe. Initial descriptions of the effects of in utero Zika virus infection centered prominently on the finding of congenital microcephaly. To assess the possibility of clinical presentations that do not include congenital microcephaly, a retrospective assessment of 13 infants from the Brazilian states of Pernambuco and Ceara with normal head size at birth and laboratory evidence of congenital Zika virus infection was conducted. All infants had brain abnormalities on neuroimaging consistent with congenital Zika syndrome, including decreased brain volume, ventriculomegaly, subcortical calcifications, and cortical malformations. The earliest evaluation occurred on the second day of life. Among all infants, head growth was documented to have decelerated as early as 5 months of age, and 11 infants had microcephaly. These findings provide evidence that among infants with prenatal exposure to Zika virus, the absence of microcephaly at birth does not exclude congenital Zika virus infection or the presence of Zika-related brain and other abnormalities. These findings support the recommendation for comprehensive medical and developmental follow-up of infants exposed to Zika virus prenatally. Early neuroimaging might identify brain abnormalities related to congenital Zika infection even among infants with a normal head circumference. |
Detecting biomarkers of secondhand marijuana smoke in young children
Wilson KM , Torok MR , Wei B , Wang L , Robinson M , Sosnoff CS , Blount BC . Pediatr Res 2016 81 (4) 589-592 BACKGROUND: The impact of secondhand marijuana smoke exposure on children is unknown. New methods allow detection of secondhand marijuana smoke in children. METHODS: We studied children ages 1 month to 2 years hospitalized with bronchiolitis in Colorado from 2013-2015. Parents completed a survey, and urine samples were analyzed for cotinine using LC/MS/MS (LOD 0.03 ng/ml) and marijuana metabolites including COOH-THC (LOD 0.015 ng/ml). RESULTS: A total of 43 subjects had urine samples available for analysis. Most (77%) of the subjects were male, and 52% were less than 1 year of age. COOH-THC was detectable in 16% of the samples analyzed (THC+); the range in COOH-THC concentration was .04-1.5 ng/ml. 2 subjects had levels >1 ng/ml. Exposure did not differ by gender or age. Non-white children had more exposure than white children (44% vs. 9%; p<.05). 56% of children with cotinine >2.0 ng/ml were THC+, compared with 7% of those with lower cotinine (p<.01). CONCLUSIONS: Metabolites of marijuana smoke can be detected in children; in this cohort, 16% were exposed. Detectable COOH-THC is more common in children with tobacco smoke exposure. More research is needed to assess the health impacts of marijuana smoke exposure on children and inform public health policy. |
Risks associated with lentiviral vector exposures and prevention strategies
Schlimgen R , Howard J , Wooley D , Thompson M , Baden LR , Yang OO , Christiani DC , Mostoslavsky G , Diamond DV , Duane EG , Byers K , Winters T , Gelfand JA , Fujimoto G , Hudson TW , Vyas JM . J Occup Environ Med 2016 58 (12) 1159-1166 Lentiviral vectors (LVVs) are powerful genetic tools that are being used with greater frequency in biomedical laboratories and clinical trials. Adverse events reported from initial clinical studies provide a basis for risk assessment of occupational exposures, yet many questions remain about the potential harm that LVVs may cause. We review those risks and provide a framework for principal investigators, Institutional Biosafety Committees, and occupational health professionals to assess and communicate the risks of exposure to staff. We also provide recommendations to federal research and regulatory agencies for tracking LVV exposures to evaluate long-term outcomes. U.S. Food and Drug Administration approved antiviral drugs for HIV have theoretical benefits in LVV exposures, although evidence to support their use is currently limited. If treatment is appropriate, we recommend a 7-day treatment with an integrase inhibitor with or without a reverse transcriptase inhibitor within 72 hours of exposure. |
Examining temporal effects on cancer risk in the International Nuclear Workers' Study (INWORKS)
Daniels RD , Bertke SJ , Richardson DB , Cardis E , Gillies M , O'Hagan JA , Haylock R , Laurier D , Leuraud K , Moissonnier M , Thierry-Chef I , Kesminiene A , Schubauer-Berigan MK . Int J Cancer 2016 140 (6) 1260-1269 The paper continues the series of publications from the International Nuclear Workers Study cohort (INWORKS) that comprises 308,297 workers from France, the United Kingdom and the United States, providing 8.2 million person-years of observation from a combined follow-up period (at earliest 1944 to at latest 2005). These workers' external radiation exposures were primarily to photons, resulting in an estimated average career absorbed dose to the colon of 17.4 milligray. The association between cumulative ionizing radiation dose and cancer mortality was evaluated in general relative risk models that describe modification of the excess relative risk (ERR) per gray (Gy) by time since exposure and age at exposure. Methods analogous to a nested-case control study using conditional logistic regression of sampled risks sets were used. Outcomes included: all solid cancers, lung cancer, leukemias excluding chronic lymphocytic, acute myeloid leukemia, chronic myeloid leukemia, multiple myeloma, Hodgkin lymphoma, and non-Hodgkin lymphoma. Significant risk heterogeneity was evident in chronic myeloid leukemia with time since exposure, where we observed increased ERR per Gy estimates shortly after exposure (2-10 year) and again later (20-30 years). We observed delayed effects for acute myeloid leukemia although estimates were not statistically significant. Solid cancer excess risk was restricted to exposure at age 35+ years and also diminished for exposure 30 years prior to attained age. Persistent or late effects suggest additional follow-up may inform on lifetime risks. However, cautious interpretation of results is needed due to analytical limitations and a lack of confirmatory results from other studies. This article is protected by copyright. All rights reserved. |
Asthma among employed adults, by industry and occupation - 21 States, 2013
Dodd KE , Mazurek JM . MMWR Morb Mortal Wkly Rep 2016 65 (47) 1325-1331 Workers in various industries and occupations are at risk for work-related asthma* (1). Data from the 2006-2007 adult Behavioral Risk Factor Surveillance System (BRFSS) Asthma Call-back Survey (ACBS), an in-depth asthma survey conducted with respondents who report an asthma diagnosis, from 33 states indicated that up to 48% of adult current asthma might be related to work and could therefore potentially be prevented (2). Identification of the industries and occupations with increased prevalence of asthma might inform work-related asthma intervention and prevention efforts. To assess the industry-specific and occupation-specific proportions of adults with current asthma by state, CDC analyzed data from the 2013 BRFSS industry and occupation module, collected from 21 states for participants aged ≥18 years who, at the time of the survey interview, were employed or had been out of work for <12 months. Among these respondents, 7.7% had current asthma; based on the Asthma Call-back Survey results, this finding means as many as 2.7 million U.S. workers might have asthma caused by or exacerbated by workplace conditions. State-specific variations in the prevalence of current asthma by industry and occupation were observed. By state, current asthma prevalence was highest among workers in the information industry (18.0%) in Massachusetts and in health care support occupations (21.5%) in Michigan. Analysis of BRFSS industry and occupation and optional asthma modules can be used to identify industries and occupations to assess for asthma among workers, identify workplace exposures, and guide the design and evaluation of effective work-related asthma prevention and education programs (1). |
Commutability assessment of external quality assessment materials with the difference in bias approach: Are acceptance criteria based on medical requirements too strict?
Delatour V , Liu Q , Vesper HW . Clin Chem 2016 62 (12) 1670-1671 Commutability of External Quality Assessment (EQA)1 materials is a key requirement for their use in accuracy-based EQA surveys (1–3). In a recent paper, Korzun et al. (4) evaluated commutability of 4 frozen pools for measurements of direct HDL cholesterol (HDLC) and LDL cholesterol (LDLC). These pools were used in the CDC’s Lipid Standardization Program to assess accuracy of direct HDLC measurements only (4). | Among the results presented using the medical requirement acceptance criteria for bias (4% for LDLC and 5% for HDLC), the authors found that 1 of the 4 frozen pools was commutable for most of the HDLC methods, whereas none were commutable for LDLC methods. The authors concluded that frozen pools prepared according to the CLSI C37 protocol may not always be commutable and especially for direct LDLC assays. | In 2013, Laboratoire national de métrologie et d’essais (LNE) organized a similar study to assess commutability of 5 freshly prepared frozen serum pools prepared according to the CLSI C37-A protocol for HDLC and LDLC. The pools were shipped frozen and analyzed along with 20–25 fresh clinical specimens by 31 medical laboratories operating HDLC and LDLC routine methods on the most popular clinical chemistry analyzers: Roche Cobas, Siemens Vista, Abbott Architect, Ortho CD Vitros, Beckman DxC, Beckman AU, Roche Modular, and Thermo Konelab. |
The effect of vibration exposure during haul truck operation on grip strength, touch sensation, and balance
Pollard J , Porter W , Mayton A , Xu X , Weston E . Int J Ind Ergon 2017 57 23-31 Falls from mobile equipment are reported at surface mine quarry operations each year in considerable numbers. Research shows that a preponderance of falls occur while getting on/off mobile equipment. Contributing factors to the risk of falls include the usage of ladders, exiting onto a slippery surface, and foot or hand slippage. Balance issues may also contribute to fall risks for mobile equipment operators who are exposed to whole-body vibration (WBV). For this reason, the National Institute for Occupational Safety and Health, Office of Mine Safety and Health Research conducted a study at four participating mine sites with seven haul truck operators. The purpose was to ascertain whether WBV and hand-arm vibration (HAV) exposures for quarry haul truck operators were linked to short-term decreases in performance in relation to postural stability, touch sensation threshold, and grip strength that are of crucial importance when getting on/off the trucks. WBV measures of frequency-weighted RMS accelerations (wRMS) and vibration dose value (VDV), when compared to the ISO/ANSI standards, were mostly below levels identified for the Health Guidance Caution Zone (HGCZ), although there were instances where the levels were within and above the specified Exposure Action Value. Comparably, all mean HAV levels, when compared to the ISO/ANSI standards, were below the HGCZ. For the existing conditions and equipment, no significant correlation could be identified between the WBV, HAV, postural stability, touch sensation threshold, and grip strength measures taken during this study. |
Evaluation of lymphatic filariasis and onchocerciasis in three Senegalese districts treated for onchocerciasis with ivermectin
Wilson NO , Badara Ly A , Cama VA , Cantey PT , Cohn D , Diawara L , Direny A , Fall M , Feeser KR , Fox LM , Kabore A , Seck AF , Sy N , Ndiaye D , Dubray C . PLoS Negl Trop Dis 2016 10 (12) e0005198 In Africa, onchocerciasis and lymphatic filariasis (LF) are co-endemic in many areas. Current efforts to eliminate both diseases are through ivermectin-based mass drug administration (MDA). Years of ivermectin distribution for onchocerciasis may have interrupted LF transmission in certain areas. The Kedougou region, Senegal, is co-endemic for LF and onchocerciasis. Though MDA for onchocerciasis started in 1988, in 2014 albendazole had not yet been added for LF. The objective of this study was to assess in an integrated manner the LF and onchocerciasis status in the three districts of the Kedougou region after ≥10 years of ivermectin-based MDA. The study employed an African Programme for Onchocerciasis Control (APOC) onchocerciasis-related methodology. In the three districts, 14 villages close to three rivers that have Simulium damnosum breeding sites were surveyed. Convenience sampling of residents ≥5 years old was performed. Assessment for LF antigenemia by immunochromatographic testing (ICT) was added to skin snip microscopy for onchocerciasis. Participants were also tested for antibodies against Wb123 (LF) and Ov16 (onchocerciasis) antigens. In two districts, no participants were ICT or skin snip positive. In the third district, 3.5% were ICT positive and 0.7% were skin snip positive. In all the three districts, Wb123 prevalence was 0.6%. Overall, Ov16 prevalence was 6.9%. Ov16 prevalence among children 5-9 years old in the study was 2.5%. LF antigenemia prevalence was still above treatment threshold in one district despite ≥10 years of ivermectin-based MDA. The presence of Ov16 positive children suggested recent transmission of Onchocerca volvulus. This study showed the feasibility of integrated evaluation of onchocerciasis and LF but development of integrated robust methods for assessing transmission of both LF and onchocerciasis are needed to determine where MDA can be stopped safely in co-endemic areas. |
Association between Taenia solium infection and HIV/AIDS in northern Tanzania: A matched cross sectional-study
Schmidt V , Kositz C , Herbinger KH , Carabin H , Ngowi B , Naman E , Wilkins PP , Noh J , Matuja W , Winkler AS . Infect Dis Poverty 2016 5 (1) 111 BACKGROUND: The frequency of Taenia solium, a zoonotic helminth, is increasing in many countries of sub-Saharan Africa, where the prevalence of the human immunodeficiency virus (HIV) is also high. However, little is known about how these two infections interact. The aim of this study was to compare the proportion of HIV positive (+) and negative (-) individuals who are infected with Taenia solium (TSOL) and who present with clinical and neurological manifestations of cysticercosis (CC). METHODS: In northern Tanzania, 170 HIV+ individuals and 170 HIV- controls matched for gender, age and village of origin were recruited. HIV staging and serological tests for TSOL antibodies (Ab) and antigen (Ag) were performed. Neurocysticercosis (NCC) was determined by computed tomography (CT) using standard diagnostic criteria. Neurological manifestations were confirmed by a standard neurological examination. In addition, demographic, clinical and neuroimaging data were collected. Further, CD4+ cell counts as well as information on highly active antiretroviral treatment (HAART) were noted. RESULTS: No significant differences between HIV+ and HIV- individuals regarding the sero-prevalence of taeniosis-Ab (0.6% vs 1.2%), CC-Ab (2.4% vs 2.4%) and CC-Ag (0.6% vs 0.0%) were detected. A total of six NCC cases (3 HIV+ and 3 HIV-) were detected in the group of matched participants. Two individuals (1 HIV+ and 1 HIV-) presented with headaches as the main symptom for NCC, and four with asymptomatic NCC. Among the HIV+ group, TSOL was not associated with CD4+ cell counts, HAART duration or HIV stage. CONCLUSIONS: This study found lower prevalence of taeniosis, CC and NCC than had been reported in the region to date. This low level of infection may have resulted in an inability to find cross-sectional associations between HIV status and TSOL infection or NCC. Larger sample sizes will be required in future studies conducted in that area to conclude if HIV influences the way NCC manifests itself. |
Seven prevention priorities of USPHS scientist officers
Huang DT , Dee DL , Ko J , Cole JG , Houston K , Sircar KD , Gaines J . Am J Public Health 2017 107 (1) 39-40 The Commissioned Corps of the US Public Health Service (USPHS), one of America’s seven uniformed services, comprises more than 6700 public health professionals whose mission is to protect, promote, and advance the health and safety of the nation. The Scientist Category, one of 11 professional USPHS categories, includes more than 300 doctoral-level scientists stationed at various state and federal agencies. Among USPHS scientists’ varied work duties and responsibilities are activities related to the seven health priorities delineated in the National Prevention Strategy (NPS), a 2011 federal agenda developed by the Surgeon General–led National Prevention Council that aims to guide improvements in health and well-being in the United States. |
Males' ability to report their partner's contraceptive use at last sex in a nationally representative sample: implications for unintended pregnancy prevention evaluations
Garbers S , Scheinmann R , Gold MA , Catallozzi M , House L , Koumans EH , Bell DL . Am J Mens Health 2016 11 (3) 711-718 Addressing and enabling the role of males in contraceptive choices may facilitate efforts to reduce unintended pregnancy rates and disparities in the United States, but little is known about males' ability to report their partners' contraceptive use. Data from the 2011-2013 National Survey of Family Growth from 2,238 males aged 15 to 44 years who had vaginal sex with a noncohabiting or nonmarital partner and were not seeking pregnancy were examined to tabulate the proportion of males able to report whether their partner used a specific contraceptive method use at last sex (PCM) by sociodemographic and sexual history characteristics. Logistic regression was used to assess odds of being unable to report PCM, adjusting for age and sexual history factors. Most (95.0%) were able to report PCM, with no difference by age group (chi-square = 7.27, p = .281) in unadjusted analyses. Males with a new sex partner (14.8% of the sample), compared with those with an established sex partner, had significantly higher odds of being unable to report PCM in bivariate (11.7% vs. 3.7%, chi-square = 39.39, p < .001) and multivariable (adjusted odds ratio [AOR]: 3.17, 95% confidence interval [CI: 1.74, 5.65]) analyses. Those whose last sexual encounter was more than 3 months ago also had higher odds of being unable to report in bivariate (OR: 1.74, 95% CI [1.05, 2.87]) and multivariable analyses (AOR: 2.04, 95% CI [1.04, 4.03]). Most men were able report PCM, but reporting was significantly lower among men with new sex partners. To inform future research and evaluation relying on male report, validation studies comparing male report with partner report, specifically among new couples, are needed. |
Veteran status, sociodemographic characteristics, and healthcare factors associated with visiting a mental health professional
Frenk SM , Sautter JM , Woodring JV , Kramarow EA . Community Ment Health J 2016 53 (5) 515-524 Using data from a nationally representative study of the community-dwelling U.S. population, we estimated the percentage of male veterans who visited a mental health professional in the past year, compared it to an estimate from non-veteran males, and examined factors associated with visiting a mental health professional. We found that 10.5% of male veterans visited a mental health professional in the past year, compared to only 5.6% of male non-veterans. In the regression models, veteran status, sociodemographic factors, and healthcare utilization were independently associated with visiting a mental health professional. These findings demonstrate the importance of using nationally representative data to assess the mental healthcare needs of veterans. |
Vital Signs: Trends in HIV diagnoses, risk behaviors, and prevention among persons who inject drugs - United States
Wejnert C , Hess KL , Hall HI , Van Handel M , Hayes D , Fulton P Jr , An Q , Koenig LJ , Prejean J , Valleroy LA . MMWR Morb Mortal Wkly Rep 2016 65 (47) 1336-1342 BACKGROUND: Persons who inject drugs (PWID) are at increased risk for poor health outcomes and bloodborne infections, including human immunodeficiency virus (HIV), hepatitis C virus and hepatitis B virus infections. Although substantial progress has been made in reducing HIV infections among PWID, recent changes in drug use could challenge this success. METHODS: CDC used National HIV Surveillance System data to analyze trends in HIV diagnoses. Further, National HIV Behavioral Surveillance interviews of PWID in 22 cities were analyzed to describe risk behaviors and use of prevention services among all PWID and among PWID who first injected drugs during the 5 years before their interview (new PWID). RESULTS: During 2008-2014, HIV diagnoses among PWID declined in urban and nonurban areas, but have leveled off in recent years. Among PWID in 22 cities, during 2005-2015, syringe sharing decreased by 34% among blacks/African Americans (blacks) and by 12% among Hispanics/Latinos (Hispanics), but remained unchanged among whites. The racial composition of new PWID changed during 2005-2015: the percentage who were black decreased from 38% to 19%, the percentage who were white increased from 38% to 54%, and the percentage who were Hispanic remained stable. Among new PWID interviewed in 2015, whites engaged in riskier injection behaviors than blacks. CONCLUSIONS: Decreases in HIV diagnoses among PWID indicate success in HIV prevention. However, emerging behavioral and demographic trends could reverse this success. IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Access to comprehensive prevention services is essential for all PWID. Syringe services programs reduce syringe sharing and can help PWID access prevention and treatment services for HIV and other bloodborne diseases, such as hepatitis C and hepatitis B. |
In vitro human epidermal permeation of nicotine from electronic cigarette refill liquids and implications for dermal exposure assessment
Frasch HF , Barbero AM . J Expo Sci Environ Epidemiol 2016 27 (6) 618-624 Nicotine plus flavorings in a propylene glycol (PG) vehicle are the components of electronic cigarette liquids (e-liquids), which are vaporized and inhaled by the user. Dermal exposure to nicotine and e-liquids may occur among workers in mixing and filling of e-cigarettes in the manufacturing process. Inadvertent skin contact among consumers is also a concern. In vitro nicotine permeation studies using heat-separated human epidermis were performed with surrogate and two commercial e-liquids, neat and aqueous nicotine donor formulations. Steady-state fluxes (Jss), and lag times (tlag) were measured for each formulation. In addition, transient (4 h) exposure and finite dose (1-10 mul/cm2) experiments were undertaken using one commercial e-liquid. Average Jss (mug/cm2/h) from formulations were: nicotine in PG (24 mg/ml): 3.97; commercial e-liquid containing menthol (25 mg/ml nicotine): 10.2; commercial e-liquid containing limonene (25 mg/ml nicotine): 23.7; neat nicotine: 175. E-liquid lag times ranged from 5 to 10 h. Absorbed fraction of nicotine from finite doses was approximately 0.3 at 48 h. The data were applied to transient exposure and finite dose dermal exposure assessment models and to a simple pharmacokinetic model. Three illustrative exposure scenarios demonstrate use of the data to predict systemic uptake and plasma concentrations from dermal exposure. The data demonstrate the potential for significant nicotine absorption through skin contact with e-cigarette refill solutions and the neat nicotine used to mix them.Journal of Exposure Science and Environmental Epidemiology advance online publication, 7 December 2016; doi:10.1038/jes.2016.68. |
Cadmium, lead, and depressive symptoms: analysis of National Health and Nutrition Examination Survey 2011-2012
Buser MC , Scinicariello F . J Clin Psychiatry 2016 78 (5) e515-e521 BACKGROUND: Several studies have noted an association between tobacco smoke and depression. Cadmium and lead are neurotoxicant components of tobacco smoke. The objective of the present study is to investigate the potential association between blood cadmium (BCd) and blood lead (BPb) with current depressive symptoms in the US adult population. METHODS: We conducted cross-sectional analyses of adult participants (≥ 20 years) from the National Health and Nutrition Examination Survey 2011-2012 (N = 3,905). Multivariate logistic regressions were used to analyze the association between BCd and BPb with depressive symptoms; analyses were also stratified on sex and age groups (20-47 years and ≥ 48 years). Presence or absence of depressive symptoms was determined using the Patient Health Questionnaire module. RESULTS: Individuals in the highest quartile of BCd had higher odds of having depressive symptoms (odds ratio = 1.68; 95% confidence limits: 1.12, 2.51). This association was found only in male participants and, more specifically, in younger adult male participants (20-47 years). We found that BPb, cigarette smoking, and obesity were associated with depressive symptoms in younger female adults. CONCLUSIONS: In this study, we report associations between BCd and BPb with current depressive symptoms that were modified by age and sex. Reverse causation cannot be ruled out as a possible explanation since depression may lead to behavioral changes that increase exposure to cadmium and lead (ie, tobacco smoke). The continued efforts at reducing cadmium through tobacco smoking cessation programs may decrease the prevalence of current depressive symptoms. |
Combustible tobacco and smokeless tobacco use among working adults-United States, 2012 to 2014
Syamlal G , Jamal A , Mazurek JM . J Occup Environ Med 2016 58 (12) 1185-1189 OBJECTIVE: The aim of this study was to examine tobacco use among working adults at least 18 years of age. METHODS: The 2012 to 2014 National Health Interview Survey (n = 105,779) was used to estimate prevalences for cigarette smoking, other combustible tobacco use, and smokeless tobacco use and prevalence odds ratios (PORs) for any tobacco product use among working adults at least 18 years of age, by industry and occupation. RESULTS: Of the estimated 144 million currently employed adults, 17% were cigarette smokers, 7.0% other noncigarette combustible tobacco users, and 3.4% smokeless tobacco users. Odds of using tobacco varied by sociodemographic characteristics and by industry and occupations. CONCLUSIONS: Disparities in tobacco use exist among working adults. Continued implementation of proven interventions to prevent and reduce all forms of tobacco use among U.S. workers is warranted, particularly among those workers with a higher burden of use. |
How Chikungunya Virus Virology Affects Its Epidemiology and Transmission: Implications for Influencing Public Health.
Powers AM . J Infect Dis 2016 214 S449-s452 Chikungunya virus has been causing a series of ongoing epidemics around the globe for the past 12 years. During that time, estimates indicate that >4 million cases occurred worldwide. Despite the magnitude of these outbreaks and the broad interest in understanding the virus and disease, significant gaps still exist in our knowledge base. An in-depth understanding of the basic virological elements that can affect the epidemiology of the agent is critical for future development of control and treatment products. This work describes how knowledge of various viral genetic and structural elements has begun to advance the development of vaccines and therapeutics and suggests that further knowledge is needed to provide additional options. |
Surveillance for chikungunya and dengue during the first year of chikungunya virus circulation in Puerto Rico
Sharp TM , Ryff KR , Alvarado L , Shieh WJ , Zaki SR , Margolis HS , Rivera-Garcia B . J Infect Dis 2016 214 S475-s481 After chikungunya virus (CHIKV) transmission was detected in Puerto Rico in May 2014, multiple surveillance systems were used to describe epidemiologic trends and CHIKV-associated disease. Of 28 327 cases reported via passive surveillance, 6472 were tested for evidence of CHIKV infection, and results for 4399 (68%) were positive. Of 250 participants in household cluster investigations, 70 (28%) had evidence of recent CHIKV infection. Enhanced surveillance for chikungunya at 2 hospitals identified 1566 patients who tested positive for CHIKV, of whom 10.9% were hospitalized. Enhanced surveillance for fatal cases enabled identification of 31 cases in which CHIKV was detected in blood or tissue specimens. All surveillance systems detected a peak incidence of chikungunya in September 2014 and continued circulation in 2015. Concomitant surveillance for dengue demonstrated low incidence, which had decreased before CHIKV was introduced. Multifaceted chikungunya surveillance in Puerto Rico resolved gaps in traditional passive surveillance and enabled a holistic description of the spectrum of disease associated with CHIKV infection. |
Tracking insecticide resistance in mosquito vectors of arboviruses: the Worldwide Insecticide resistance Network (WIN)
Corbel V , Achee NL , Chandre F , Coulibaly MB , Dusfour I , Fonseca DM , Grieco J , Juntarajumnong W , Lenhart A , Martins AJ , Moyes C , Ng LC , Pinto J , Raghavendra K , Vatandoost H , Vontas J , Weetman D , Fouque F , Velayudhan R , David JP . PLoS Negl Trop Dis 2016 10 (12) e0005054 The transmission of the arboviral agents of dengue, yellow fever, Chikungunya, and Zika by Aedes mosquitoes represents expanding threats to global health. At the 69th World Health Assembly [1], the WHO Director-General Margaret Chan declared that the spread of the Zika virus was "the result of the abandon of mosquito control" by governments since the 1970s and urged Member States to mobilize more efforts and resources to prevent further spread of the diseases. The recent rise of microcephaly cases and other neurological disorders reported in Brazil prompted WHO to declare Zika as a Public Health Emergency of International Concern [2]. After limited early outbreaks in the Pacific in 2007 and 2013, the Zika virus has spread to more than 30 countries in the Americas and the Caribbean, affecting over 1.5 million people [3]. With growing evidence supporting the link between microcephaly and Zika [4, 5] and preliminary evidence confirming Aedes aegypti as the primary vector in the Brazilian outbreak [6], the mandate for control is clear and urgent. | Although progress is being made on vaccine development (for example, Sanofi Pasteur’s recently licensed dengue vaccine Dengvaxia [7]), vector control by removing larval habitats and using biological and chemical insecticides still remain the first line of defence against arboviruses [8]. Unfortunately, decades of efforts failed to consistently control Aedes mosquito populations and/or to curtail the cycle of epidemics. Control of adult mosquitoes using space spray applications of pyrethroids and organophospates in plural is fraught with complications, including high cost, slow operational response, low community buy-in, ineffective timing of application, and rather low efficacy and/or residual effect [9–11]. Furthermore, some countries have a lack of capacity in monitoring the use of public health insecticides for the control of arbovirus vectors [12] that is essential for guiding pesticide management systems on appropriate use and reduction of risks to human health and environment. |
Use of a tick-borne disease manual increases accuracy of tick identification among primary care providers in Lyme disease endemic areas
Butler AD , Carlson ML , Nelson CA . Ticks Tick Borne Dis 2016 8 (2) 262-265 Given the high incidence of tick bites and tick-borne diseases in the United States, it is important for primary care providers to recognize common ticks and the pathogens they may transmit. If a patient has removed and saved an attached tick, identifying the tick helps guide clinical management and determine whether antibiotic prophylaxis for Lyme disease is appropriate. To investigate providers' ability to recognize common ticks and the pathogens they may transmit, we asked 76 primary care providers from Lyme disease endemic areas to identify the common name or genus of preserved ticks found in their area. At baseline, 10.5%, 46.1%, and 57.9% of participants correctly identified an adult female blacklegged tick (engorged), dog tick, and lone star tick, respectively. Less than half of participants identified the three pathogens most frequently transmitted by blacklegged ticks. Use of a reference manual with tick photographs and drawings substantially improved identification of ticks and associated pathogens and therefore should be encouraged in clinical practice. |
Novel clinical and pathologic findings in a Heartland Virus-associated death
Fill MA , Compton ML , McDonald EC , Moncayo AC , Dunn JR , Schaffner W , Bhatnagar J , Zaki SR , Jones TF , Shieh WJ . Clin Infect Dis 2016 64 (4) 510-512 We describe an investigation into a Heartland Virus (HRTV)-associated death in Tennessee with novel clinical and pathologic findings. HRTV can cause rapidly fatal, widely disseminated infection with multisystem organ failure in patients without substantial comorbidities. We identified viral antigen in multiple organ tissues where it was not detected previously. |
Epidemiology of chikungunya in the Americas
Yactayo S , Staples JE , Millot V , Cibrelus L , Ramon-Pardo P . J Infect Dis 2016 214 S441-s445 Chikungunya virus (CHIKV) emerged in the Americas in late 2013 to cause substantial acute and chronic morbidity. About 1.1 million cases of chikungunya were reported within a year, including severe cases and deaths. The burden of chikungunya is unclear owing to inadequate disease surveillance and underdiagnosis. Virus evolution, globalization, and climate change may further CHIKV spread. No approved vaccine or antiviral therapeutics exist. Early detection and appropriate management could reduce the burden of severe atypical and chronic arthritic disease. Improved surveillance and risk assessment are needed to mitigate the impact of chikungunya. |
Identity of Fasciola spp. in sheep in Egypt
Amer S , ElKhatam A , Zidan S , Feng Y , Xiao L . Parasit Vectors 2016 9 (1) 623 BACKGROUND: In Egypt, liver flukes, Fasciola spp. (Digenea: Fasciolidae), have a serious impact on the farming industry and public health. Both Fasciola hepatica and Fasciola gigantica are known to occur in cattle, providing the opportunity for genetic recombination. Little is known on the identity and genetic variability of Fasciola populations in sheep. METHODS: This study was performed to determine the prevalence of liver flukes in sheep in Menofia Province as a representative area of the delta region in Egypt, as measured by postmortem examination of slaughtered animals at three abattoirs. The identity and genetic variability of Fasciola spp. in slaughtered animals were determined by PCR-sequence analysis of the nuclear ribosomal internal transcribed spacer 1 (ITS1) and the mitochondrial NADH dehydrogenase subunit 1 (nad1) genes. RESULTS: Physical inspection of the liver indicated that 302 of 2058 (14.7%) slaughtered sheep were infected with Fasciola spp. Sequence analysis of the ITS1 and nad1 genes of liver flukes from 17 animals revealed that 11 animals were infected with F. hepatica, four with F. gigantica, and two with both species. Seventy eight of 103 flukes genetically characterized from these animals were F. hepatica, 23 were F. gigantica, and two had ITS1 sequences identical to F. hepatica but nad1 sequences identical to F. gigantica. nad1 sequences of Egyptian isolates of F. gigantica showed pronounced differences from those in the GenBank database. Egyptian F. gigantica haplotypes formed haplogroup D, which clustered in a sister clade with haplogroups A, B and C circulating in Asia, indicating the existence of geographic isolation in the species. CONCLUSIONS: Both F. hepatica and F. gigantica are prevalent in sheep in Egypt and an introgressed form of the two occurs as the result of genetic recombination. In addition, a geographically isolated F. gigantica population is present in the country. The importance of these observations in epidemiology of fascioliasis needs to be examined in future studies. |
Baylisascaris procyonis roundworm seroprevalence among wildlife rehabilitators, United States and Canada, 2012-2015
Sapp SG , Rascoe LN , Wilkins PP , Handali S , Gray EB , Eberhard M , Woodhall DM , Montgomery SP , Bailey KL , Lankau EW , Yabsley MJ . Emerg Infect Dis 2016 22 (12) 2128-2131 Baylisascaris procyonis roundworms can cause potentially fatal neural larva migrans in many species, including humans. However, the clinical spectrum of baylisascariasis is not completely understood. We tested 347 asymptomatic adult wildlife rehabilitators for B. procyonis antibodies; 24 were positive, suggesting that subclinical baylisascariasis is occurring among this population. |
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