Global responses to prevent, manage, and control cardiovascular diseases
Coronado F , Melvin SC , Bell RA , Zhao G . Prev Chronic Dis 2022 19 E84 Cardiovascular disease (CVD), a group of disorders of the heart and blood vessels that includes coronary heart disease, stroke, congestive heart failure, and other conditions, is the leading cause of death worldwide and a major contributor to disability. In 2020, an estimated 523 million people had some form of CVD, and approximately 19 million deaths were attributable to CVD; this represents approximately 32% of all global deaths and is an absolute increase of 18.7% from 2010 (1,2). Global trends for disability-adjusted life years for CVD and the CVD burden attributable to modifiable risk factors have also continued to increase steadily since 1990 (3). In the US, nearly half of adults (approximately 127 million) had 1 or more CVD condition (2). Provisional mortality data for 2021 indicate that even during the COVID-19 pandemic, heart disease and stroke remained the first and the fifth leading causes of death in the US, respectively (4). Despite advancements in the management of CVD and other health outcomes worldwide, minority, disadvantaged, and underserved populations continue to experience significant health disparities, with these disparities exacerbated during the COVID-19 pandemic (5,6). This special collection of Preventing Chronic Disease (PCD) highlights public health research, evaluation, and programmatic implementation that incorporate the lens of health equity to address CVD and improve the cardiovascular health of diverse populations. |
The association of trauma with self-reported flares and disease activity in systemic lupus erythematosus (SLE)
Katz P , Patterson SL , DeQuattro K , Lanata CM , Barbour KE , Greenlund KJ , Gordon C , Criswell LA , Dall'Era M , Yazdany J . Rheumatology (Oxford) 2022 OBJECTIVES: Trauma has been linked to incident SLE, but its relationship with SLE disease activity is unknown. This analysis examines associations between trauma exposures and patient-reported SLE disease activity and flares. METHODS: Data were from the California Lupus Epidemiology Study (CLUES). Flares were self-reported as any flare and, of those, flares accompanied by medical care (hospitalization or physician contact). The Systemic Lupus Activity Questionnaire (SLAQ) assessed disease activity. The Brief Trauma Questionnaire (BTQ) assessed all historical trauma exposures. The Adverse Childhood Experiences (ACEs) questionnaire was available for a subset. Multivariable regression analyses (n=252) examined whether trauma exposure was associated with flares or SLAQ controlling for age, sex, poverty, race/ethnicity, comorbidities, perceived stress, disease duration, and self-reported disease damage. RESULTS: Excluding exposure to serious illness, 63.4% reported 1 trauma exposure. Any traumatic event, excluding illness, doubled the odds of a flare (OR 2.27 [95% CI 1.24, 4.17]) and was associated with significantly higher SLAQ scores ( 2.31 [0.86, 3.76]). Adjusted odds of any flare and flare with medical care were significantly elevated for those with both BTQ and ACE exposures (5.91 [2.21, 15.82] and 4.69 [1.56, 14.07], respectively). SLAQ scores were also higher for those with both exposures ( 5.22 [3.00, 7.44]). CONCLUSION: In this cohort, those with a history of trauma reported more flares and greater disease activity. Identifying mechanisms of associations between trauma and disease activity and flares, as well as interventions to mitigate the effects of trauma exposures is critical, given the high rates of trauma exposures. |
Estimated SARS-CoV-2 antibody seroprevalence trends and relationship to reported case prevalence from a repeated, cross-sectional study in the 50 states and the District of Columbia, United States-October 25, 2020-February 26, 2022.
Wiegand RE , Deng Y , Deng X , Lee A , Meyer WA3rd , Letovsky S , Charles MD , Gundlapalli AV , MacNeil A , Hall AJ , Thornburg NJ , Jones J , Iachan R , Clarke KEN . Lancet Reg Health Am 2023 18 100403 BACKGROUND: Sero-surveillance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can reveal trends and differences in subgroups and capture undetected or unreported infections that are not included in case-based surveillance systems. METHODS: Cross-sectional, convenience samples of remnant sera from clinical laboratories from 51 U.S. jurisdictions were assayed for infection-induced SARS-CoV-2 antibodies biweekly from October 25, 2020, to July 11, 2021, and monthly from September 6, 2021, to February 26, 2022. Test results were analyzed for trends in infection-induced, nucleocapsid-protein seroprevalence using mixed effects models that adjusted for demographic variables and assay type. FINDINGS: Analyses of 1,469,792 serum specimens revealed U.S. infection-induced SARS-CoV-2 seroprevalence increased from 8.0% (95% confidence interval (CI): 7.9%-8.1%) in November 2020 to 58.2% (CI: 57.4%-58.9%) in February 2022. The U.S. ratio of the change in estimated seroprevalence to the change in reported case prevalence was 2.8 (CI: 2.8-2.9) during winter 2020-2021, 2.3 (CI: 2.0-2.5) during summer 2021, and 3.1 (CI: 3.0-3.3) during winter 2021-2022. Change in seroprevalence to change in case prevalence ratios ranged from 2.6 (CI: 2.3-2.8) to 3.5 (CI: 3.3-3.7) by region in winter 2021-2022. INTERPRETATION: Ratios of the change in seroprevalence to the change in case prevalence suggest a high proportion of infections were not detected by case-based surveillance during periods of increased transmission. The largest increases in the seroprevalence to case prevalence ratios coincided with the spread of the B.1.1.529 (Omicron) variant and with increased accessibility of home testing. Ratios varied by region and season with the highest ratios in the midwestern and southern United States during winter 2021-2022. Our results demonstrate that reported case counts did not fully capture differing underlying infection rates and demonstrate the value of sero-surveillance in understanding the full burden of infection. Levels of infection-induced antibody seroprevalence, particularly spikes during periods of increased transmission, are important to contextualize vaccine effectiveness data as the susceptibility to infection of the U.S. population changes. FUNDING: This work was supported by the Centers for Disease Control and Prevention, Atlanta, Georgia. |
Epidemiology of human parainfluenza virus type 3 (HPIV-3) and respiratory syncytial virus (RSV) infections in the time of COVID-19: findings from a household cohort in Maryland
Hetrich MK , Oliva J , Wanionek K , Knoll MD , Lamore M , Esteban I , Veguilla V , Dawood FS , Karron RA . Clin Infect Dis 2023 76 (8) 1349-1357 BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, human parainfluenza type 3 (HPIV-3) and respiratory syncytial virus (RSV) circulation increased as nonpharmaceutical interventions were relaxed. Using data from 175 households (n = 690 members) followed between November 2020 and October 2021, we characterized HPIV-3 and RSV epidemiology in children aged 0-4 years and their households. METHODS: Households with ≥1 child aged 0-4 years were enrolled; members collected weekly nasal swabs (NS) and additional NS with respiratory illnesses (RI). We tested NS from RI episodes in children aged 0-4 years for HPIV-3, RSV, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using reverse-transcriptase polymerase chain reaction (RT-PCR). Among children with HPIV-3 or RSV infection, we tested contemporaneous NS from household members. We compared incidence rates (IRs) of RI with each virus during epidemic periods and identified household primary cases (the earliest detected household infection), and associated community exposures. RESULTS: 41 of 175 (23.4%) households had individuals with HPIV-3 (n = 45) or RSV (n = 46) infections. Among children aged 0-4 years, RI IRs /1000 person-weeks were 8.7 [6.0, 12.2] for HPIV-3, 7.6 [4.8, 11.4] for RSV, and 1.9 [1.0, 3.5] for SARS-CoV-2. Children aged 0-4 years accounted for 35 of 36 primary HPIV-3 or RSV cases. Children attending childcare or preschool had higher odds of primary infection (odds ratio, 10.81; 95% confidence interval, 3.14-37.23). CONCLUSIONS: Among children aged 0-4 years, RI IRs for HPIV-3 and RSV infection were 4-fold higher than for SARS-CoV-2 during epidemic periods. HPIV-3 and RSV were almost exclusively introduced into households by young children. |
Impact of COVID-19-related care disruptions on blood pressure management and control in community health centers.
Meador M , Coronado F , Roy D , Bay RC , Lewis JH , Chen J , Cheung R , Utman C , Hannan JA . BMC Public Health 2022 22 (1) 2295 BACKGROUND: Uncontrolled hypertension is a leading risk factor for cardiovascular disease. To ensure continuity of care, community health centers (CHCs) nationwide implemented virtual care (telehealth) during the pandemic. CHCs use the Centers for Medicare & Medicaid Services (CMS) 165v8 Controlling High Blood Pressure measure to report blood pressure (BP) control performance. CMS 165v8 specifications state that if no BP is documented during the measurement period, the patient's BP is assumed uncontrolled. METHODS: To examine trends in BP documentation and control rates in CHCs as telehealth use increased during the pandemic compared with pre-pandemic period, we assessed documentation of BP measurement and BP control rates from December 2019 - October 2021 among persons ages 18-85 with a diagnosis of hypertension who had an in-person or telehealth encounter in 11 CHCs. Rates were compared between CHCs that did and did not implement self-measured BP monitoring (SMBP). RESULTS: The percent of patients with hypertension with no documented BP measurement was 0.5% in December 2019 and increased to 15.2% (overall), 25.6% (non-SMBP CHCs), and 11.2% (SMBP CHCs) by October 2021. BP control using CMS 165v8 was 63.5% in December 2019 and decreased to 54.9% (overall), 49.1% (non-SMBP), and 57.2% (SMBP) by October 2021. When assessing BP control only in patients with documented BP measurements, CHCs largely maintained BP control rates (63.8% in December 2019; 64.8% (overall), 66.0% (non-SMBP), and 64.4% (SMBP) by October 2021). CONCLUSIONS: The transition away from in-person to telehealth visits during the pandemic likely increased the number of patients with hypertension lacking a documented BP measurement, subsequently negatively impacting BP control using CMS 165v8. There is an urgent need to enhance the flexibility of virtual care, improve EHR data capture capabilities for patient-generated data, and implement expanded policy and systems-level changes for SMBP, an evidence-based strategy that can build patient trust, increase healthcare engagement, and improve hypertension outcomes. |
A Community Guide systematic review: School dietary and physical activity interventions
Buchanan LR , Wethington HR , Finnie RKC , Mercer SL , Merlo C , Michael S , Sliwa S , Pratt CA , Ochiai E . Am J Prev Med 2022 64 (3) 441-451 CONTEXT: Schools can play an important role in supporting a healthy lifestyle by offering nutritious foods and beverages and providing opportunities for physical activity. A healthy diet and regular physical activity may reduce the risk of obesity. This manuscript reports on a Community Guide systematic review examining the effectiveness of interventions in schools combining school meal or fruit and vegetable snack programs and physical activity. EVIDENCE ACQUISITION: Studies meeting the intervention definition were identified from a literature search (search period: January 1990-November 2019). Community Guide systematic review methods were used to assess effectiveness as measured by dietary behavior, physical activity, and weight changes; analyses were conducted in 2020. EVIDENCE SYNTHESIS: Interventions (n=24 studies) were considered effective for increasing physical activity (median increase=21.8 minutes/day; interquartile interval= -0.8 to 27.4 minutes/day), modestly increasing fruit and vegetable intake (median relative increase=12.1%; interquartile interval= -4.6%, 73.4%), and decreasing the prevalence of overweight and obesity (median decrease=2.5 percentage points; interquartile interval= -8.1, -1.6 percentage points) among elementary school students through sixth grade. There were not enough studies to determine the effectiveness of interventions for middle- and high-school students. CONCLUSIONS: School meal or fruit and vegetable snack interventions combined with physical activity were effective in increasing physical activity, with modest effects for improving fruit and vegetable consumption and reducing the prevalence of overweight and obesity among elementary students. These results may inform researchers and school administrators about healthy eating and physical activity interventions. |
Implementation and evaluation of a collaborative, pharmacy-based hepatitis C and HIV screening program
Klepser DG , Klepser ME , Peters PJ , Hoover KW , Weidle PJ . Prev Chronic Dis 2022 19 E83 INTRODUCTION: Pharmacy-based HIV and hepatitis C virus (HCV) screening services developed in conjunction with state and local health departments can improve public health through increased access to testing and a linkage-to-care strategy. The objective of this study was to evaluate the impact of implementing HIV and HCV screening in community pharmacies. METHODS: This prospective, multicenter implementation project was conducted from July 2015 through August 2018. Sixty-one pharmacies participated in 3 US regions. We assessed the effectiveness of point-of-care testing, counseling, and disease education for populations at increased risk for HIV and HCV infection through screening programs offered in community pharmacies. Pharmacy customers were offered screening with point-of-care HIV and/or HCV tests. Reactive test results were reported to state or local health departments for disease surveillance. RESULTS: A total of 1,164 patients were screened for HIV, HCV, or both at the 61 participating pharmacies; the average number of patients screened per pharmacy was 19. Pharmacists conducted 1,479 HIV or HCV tests among the 1,164 patients. Five of 612 (0.8%) HIV tests yielded a reactive result, and 181 of 867 (20.9%) of HCV tests yielded a reactive result. CONCLUSION: Patients at increased risk of HIV or HCV can benefit from screening for infection at community pharmacies. Ease of accessibility to testing coupled with a strategy for linkage to care designed for the local community can improve patient care and improve the course of treatment for HIV and HCV. |
Screening eaves of houses reduces indoor mosquito density in rural, western Kenya
Abong'o B , Gimnig JE , Omoke D , Ochomo E , Walker ED . Malar J 2022 21 (1) 377 BACKGROUND: Despite the scale-up of insecticide-treated nets and indoor residual spraying, the bulk of malaria transmission in western Kenya still occurs indoors, late at night. House improvement is a potential long-term solution to further reduce malaria transmission in the region. METHODS: The impact of eave screening on mosquito densities was evaluated in two rural villages in western Kenya. One-hundred-and-twenty pairs of structurally similar, neighbouring houses were used in the study. In each pair, one house was randomly selected to receive eave screening at the beginning of the study while the other remained unscreened until the end of the sampling period. Mosquito sampling was performed monthly by motorized aspiration method for 4 months. The collected mosquitoes were analysed for species identification. RESULTS: Compared to unscreened houses, significantly fewer female Anopheles funestus (RR = 0.40, 95% CI 0.29-0.55), Anopheles gambiae Complex (RR = 0.46, 95% CI 0.34-0.62) and Culex species (RR = 0.53, 95% CI 0.45-0.61) were collected in screened houses. No significant differences in the densities of the mosquitoes were detected in outdoor collections. Significantly fewer Anopheles funestus were collected indoors from houses with painted walls (RR = 0.05, 95% CI 0.01-0.38) while cooking in the house was associated with significantly lower numbers of Anopheles gambiae Complex indoors (RR = 0.60, 95% CI 0.45-0.79). Nearly all house owners (99.6%) wanted their houses permanently screened, including 97.7% that indicated a willingness to use their own resources. However, 99.2% required training on house screening. The cost of screening a single house was estimated at KES6,162.38 (US$61.62). CONCLUSION: Simple house modification by eave screening has the potential to reduce the indoor occurrence of both Anopheles and Culex mosquito species. Community acceptance was very high although education and mobilization may be needed for community uptake of house modification for vector control. Intersectoral collaboration and favourable government policies on housing are important links towards the adoption of house improvements for malaria control. |
Prevalence of elevated blood lead levels and risk factors among children living in Patna, Bihar, India 2020
Brown MJ , Patel P , Nash E , Dikid T , Blanton C , Forsyth JE , Fontaine R , Sharma P , Keith J , Babu B , Vaisakh TP , Azarudeen MJ , Riram B , Shrivastava A . PLoS Glob Public Health 2022 2 (10) e0000743 Childhood lead exposure remains a key health concern for officials worldwide, contributing some 600,000 new cases of intellectually disabled children annually. Most children affected by high exposure to lead live in low- and middle-income countries. The leaded gasoline phase out in India was completed in 2000. Yet, in 2020, an estimated 275 million children aged 0 to 9 years had blood lead levels (BLLs) 5 g/dL known to adversely affect intelligence and behavior. Lead sources reported in India include spices, cookware, paint, traditional medicines and cosmetics, and lead-acid battery recycling and repair. However, their relative contribution has not been characterized. More than 200 lead pollution sites related to battery recycling and repair activities were identified in Bihar and Jharkhand, India. Ninety percent of the recycling sites had soil lead concentrations exceeding the US Environmental Protection Agency's standards. We compared blood and environmental lead levels in two groups of children in Patna, Bihar. Households in proximity to battery recycling operations (Proximal n = 67) versus households distal to these operations (Distal n = 68). The average age of children was 40 months; 46% were female. Overall, the geometric mean (GM) BLL was 11.6 g/dL. GM BLLs of children in Proximal and Distal households were not significantly different (10.2 g/dL vs. 13.1 g/dL respectively; p0.07). About 87% children, 56 Proximal and 62 Distal had BLLs 5 g/dl. Lead concentrations in environmental samples were significantly higher in Proximal households (soil mean 9.8 vs. 1.6 g/ft2; dust mean 52.9 vs. 29.9 g/ft2 p<0.001; Proximal vs. Distal respectively) whereas concentrations in all spices were higher in Distal households (mean 46.8 vs 134.5 ppm p<0.001; Proximal vs. Distal respectively), and turmeric (mean 59.4 vs. 216.9 ppm Proximal vs. Distal respectively). In multivariate analyses for all children lead in spices and turmeric and number of rooms in the house were significant while for the Proximal group only lead in spices remained in the model. The predictive value of these models was poor. For the Distal group, a model with lead concentration in spices, turmeric and soil and number of rooms in the house was a much better fit. Of the 34 water samples collected, 7 were above the Indian standard of 10 ppb for lead in drinking water (2 in the Proximal area, 5 in the Distal area). Children in Patna, Bihar, India are exposed to multiple sources of lead, with lead levels in house dust and loose, locally sourced spices the most likely to increase blood lead levels. A holistic approach to blood lead testing and source identification and remediation are necessary to prevent lead exposure. |
Nearly Complete Genome Sequences of Type 2 Sabin-Like Polioviruses from Northern Nigerian Poliovirus Surveillance, 2016 to 2018.
Zhao K , Schmidt A , Tang K , Castro CJ , Liu H , Pang H , Chen Q , Baba M , Soji OB , Bukbuk D , Akinola M , Adeniji JA , Marine RL , Ng TFF , Jorba J , Burns CC . Microbiol Resour Announc 2022 12 (1) e0073522 We sequenced 109 type 2 Sabin-like poliovirus isolates that had been collected from acute flaccid paralysis patients or healthy children in Nigeria. Understanding the genetic makeup of these viruses may contribute to polio eradication efforts. |
Systematic sequencing of imported cases leads to detection of SARS-CoV-2 B.1.1.529 (Omicron) variant in central Viet Nam.
Do Thai Hung , Nguyen Bao Trieu , Do Thi Thu Thuy , Olmsted A , Trinh Hoang Long , Nguyen Duc Duy , Huynh Kim Mai , Bui Thi Thu Hien , Nguyen van Van , Tran van Kiem , Vo Thi Thuy Trang , Nguyen Truong Duy , Ton That Thanh , Huynh van Dong , Gould PL , Moore MR . Western Pac Surveill Response J 2022 13 (4) 1-4 As authorities braced for the arrival of the Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), infrastructure investments and government directives prompted action in central Viet Nam to establish capacity for genomic surveillance sequencing. From 17 November 2021 to 7 January 2022, the Pasteur Institute in Nha Trang sequenced 162 specimens from 98 150 confirmed SARS-CoV-2 cases in the region collected from 8 November to 31 December 2021. Of these, all 127 domestic cases were identified as the B.1.617.2 (Delta) variant, whereas 92% (32/35) of imported cases were identified as the B.1.1.529 (Omicron) variant, all among international flight passengers. Patients were successfully isolated, enabling health-care workers to prepare for additional cases. Most (78%) of the 32 Omicron cases were fully vaccinated, suggesting continued importance of public health and social measures to control the spread of new variants. |
One health zoonotic disease prioritization and systems mapping: An integration of two One Health tools
Varela K , Goryoka G , Suwandono A , Mahero M , Valeri L , Pelican K , Salyer SJ . Zoonoses Public Health 2022 70 (2) 146-159 One Health is a collaborative approach that requires synergies between human, animal and environmental health sectors, other key sectors, and partners supporting these capacity-building efforts. Multiple One Health capacity-building tools are available that can be used independently or together. Two tools that have been used in sequence to inform each other include the US Centers for Disease Control and Prevention's One Health Zoonotic Disease Prioritization (OHZDP) Process and University of Minnesota/US Department of Agriculture's One Health Systems Mapping and Analysis Resource Toolkit™ (OH-SMART). In August 2017, a workshop was held in Islamabad, Pakistan, that integrated these two tools for the first time. In this integrated workshop, we used the OHZDP to develop a list of priority zoonotic diseases for Pakistan and OH-SMART™ to conduct a partner assessment and disease-specific gap analysis. Both tools were used to identify areas for One Health collaboration for the priority zoonotic diseases. Additionally, we trained 11 in-country facilitators representing the human and animal health sectors on both tools. This manuscript describes the integration of these two tools-using the Pakistan workshop as a process case study-to inform future efforts to implement One Health tools synergistically. Implementation of the technical and logistical aspects of the integrated workshop was detailed: (1) workshop preparation, (2) facilitator training, (3) workshop implementation and (4) workshop outcomes. Sixteen months after the workshop, we conducted an in-country facilitator survey to follow-up on the utility of both tools and the training for facilitators. We evaluated facilitator survey results using a qualitative analysis software Atlas.ti. Using the OHZDP Process and OH-SMART™ together achieved continuity between the two processes and provided a professional development opportunity for in-country facilitators. Based on the success of this integrated workshop, partners developing and implementing One Health tools should recognize the importance of collaboration to maximize outcomes. |
Clinical progression and outcomes of patients hospitalized with COVID-19 in humanitarian settings: a prospective cohort study in South Sudan and Eastern Democratic Republic of the Congo
Doocy S , Bollemeijer I , Leidman E , Sebushishe A , Mbong EN , Page K . PLoS Glob Public Health 2022 2 (10) e0000924 Little information is available on COVID-19 in Africa and virtually none is from humanitarian and more resource-constrained settings. This study characterizes hospitalized patients in the African humanitarian contexts of Juba, South Sudan and North and South Kivu in Eastern Democratic Republic of the Congo. This observational cohort was conducted between December 2020 and June 2021. Patients presenting for care at five facilities or referred from home-based care by mobile medical teams were eligible for enrollment and followed until death or recovery. Disease progression was characterized for hospitalized patients using survival analysis and mixed effects regression model to estimate survival odds for patient characteristics and treatments received. 144 COVID-19 cases enrolled as hospitalized patients were followed to recovery/death. The observed mortality proportion among hospitalized patients was 16.7% (CI: 11.2-23.3%); mortality was three times higher in South Sudan, where patients presented later after symptom onset and in worse conditions. Age and diabetes history were the only patient characteristics associated with decreased survival; clinical status indicators associated with decreased survival included fever, low oxygen level, elevated respiratory and pulse rates. The only therapy associated with survival was non-invasive oxygen; invasive oxygen therapies and other specialized treatments were rarely received. Improving availability of oxygen monitoring and proven COVID-19 therapies in humanitarian and resource-poor settings is critical for health equity. Customizing training to reflect availability of specific medications, therapies and operational constraints is particularly important given the range of challenges faced by providers in these settings. |
Characterizing acceptable and appropriate implementation strategies of a biobehavioral survey among men who have sex with men and others assigned male who have sex with men in Zimbabwe
Parmley LE , Miller SS , Harris TG , Mugurungi O , Rogers JH , Hakim A , Musuka G , Chingombe I , Mapingure M . PLoS Glob Public Health 2022 2 (10) e0001097 Key populations including men who have sex with men (MSM), female sex workers, people who inject drugs, transgender persons, and prisoners account for nearly 50% of new HIV infections globally. To inform the HIV response and monitor trends in HIV prevalence and incidence among key populations, countries have increased efforts to implement biobehavioral surveys (BBS) with these groups as part of routine surveillance. Yet the marginalized nature of populations participating in a BBS requires contextually acceptable and appropriate strategies for effective implementation. We conducted a formative assessment to inform the first BBS conducted with MSM and others assigned male who have sex with men (OAMSM) in Zimbabwe, where same-sex sexual behaviors are illegal and highly stigmatized and describe applications of our findings. Qualitative data were collected through four focus groups with 32 MSM/OAMSM and 25 in-depth interviews (15 MSM/OAMSM, 10 service providers/gatekeepers) from December 2018 to January 2019. Rapid assessment techniques were employed including rapid identification of themes from audio recordings and review of detailed field notes and memos to identify key themes. Findings from this assessment included contextually relevant considerations including behaviors and terminology to avoid when working with MSM/OAMSM in Zimbabwe, appropriate compensation amounts for survey participation, proposed data collection sites, and differences in sexual openness, marital status, and networks among younger and older MSM/OAMSM. Participants also reported strong network ties suggesting respondent-driven sampling-a peer chain referral approach-to be an appropriate recruitment method in this context. Taken together, these findings highlighted key considerations and strategies for implementation to ensure the subsequent BBS in Zimbabwe was both acceptable and appropriate. These results and applications of these results are important for informing surveillance efforts and broader HIV-related engagement efforts among MSM/OAMSM in Zimbabwe as well as in other contextually similar countries in Southern Africa. |
HIV pre-exposure prophylaxis services for black and hispanic or latino gay, bisexual, and other men who have sex with men and transgender women in THRIVE, 2015-2020
Tanner MR , Zhu W , Iqbal K , Dominguez KL , Yu L , Hayes T , Wiener J , Koenig LJ , Batey S , Burgess S , Elamin F , Fox A , Price A , Wood L , Hoover KW . J Acquir Immune Defic Syndr 2022 92 (4) 286-292 BACKGROUND: AND SETTING: From 2015-2020 the THRIVE project supported seven U.S. health departments to improve HIV prevention services for Black or African American (Black) and Hispanic or Latino gay, bisexual, and other men who have sex with men (GBM) and transgender women (TGW). METHODS: We described services provided in the THRIVE PrEP continuum. Using Poisson regression models we estimated associations between race or ethnicity and age and PrEP screening, linkage, and prescription. We examined associations between co-location of services and PrEP linkage and prescription for two sites. RESULTS: THRIVE served 12,972 GBM without HIV; 37% of PrEP-eligible GBM were prescribed PrEP. THRIVE served 1,185 TGW without HIV; 45% of PrEP-eligible TGW were prescribed PrEP. Black and Hispanic or Latino GBM were 29% (RR=0.71, 95% CI 0.66-0.77) and 19% (RR=0.81, 95% CI 0.75-0.87) less likely, respectively, to be prescribed PrEP than White GBM. GBM 18-24 years and ≥55 years were 19% (RR=0.81, 95% CI 0.75-0.87) and 22% (RR=0.78, 95% CI 0.67-0.9) less likely, respectively, to be prescribed PrEP compared to those 35-44 years. Co-located services were associated with a 54% (RR = 1.54, 95% CI 1.44-1.64) and a 31% (RR = 1.31, 95% CI: 1.19-1.43) greater likelihood of PrEP linkage and prescription respectively compared to services at different locations. CONCLUSIONS: THRIVE provided PrEP to higher proportions of PrEP-eligible persons than current national estimates, however PrEP use disparities persist. Co-location of services may be a useful component of jurisdictional strategies to increase PrEP coverage. |
Making a C-DIFFerence: Implementation of a prevention collaborative to reduce hospital-onset Clostridioides difficile infection rates
White KA , Barnes LEA , Snyder RL , Fike LV , Kuhar DT , Cochran RL . Antimicrob Steward Healthc Epidemiol 2022 2 (1) e87 OBJECTIVE: To assist hospitals in reducing Clostridioides difficile infections (CDI), the Centers for Disease Control and Prevention (CDC) implemented a collaborative using the CDC CDI prevention strategies and the Targeted Assessment for Prevention (TAP) Strategy as foundational frameworks. SETTING: Acute-care hospitals. METHODS: We invited 400 hospitals with the highest cumulative attributable differences (CADs) to the 12-month collaborative, with monthly webinars, coaching calls, and deployment of the CDC CDI TAP facility assessments. Infection prevention barriers, gaps identified, and interventions implemented were qualitatively coded by categorizing them to respective CDI prevention strategies. Standardized infection ratios (SIRs) were reviewed to measure outcomes. RESULTS: Overall, 76 hospitals participated, most often reporting CDI testing as their greatest barrier to achieving reduction (61%). In total, 5,673 TAP assessments were collected across 46 (61%) hospitals. Most hospitals (98%) identified at least 1 gap related to testing and at least 1 gap related to infrastructure to support prevention. Among 14 follow-up hospitals, 64% implemented interventions related to infrastructure to support prevention (eg, establishing champions, reviewing individual CDIs) and 86% implemented testing interventions (eg, 2-step testing, testing algorithms). The SIR decrease between the pre-collaborative and post-collaborative periods was significant among participants (16.7%; P < .001) but less than that among nonparticipants (25.1%; P < .001). CONCLUSIONS: This article describes gaps identified and interventions implemented during a comprehensive CDI prevention collaborative in targeted hospitals, highlighting potential future areas of focus for CDI prevention efforts as well as reported challenges and barriers to prevention of one of the most common healthcare-associated infections affecting hospitals and patients nationwide. |
Tree-based data mining for safety assessment of first COVID-19 booster doses in the Vaccine Safety Datalink.
Katherine Yih W , Daley MF , Duffy J , Fireman B , McClure D , Nelson J , Qian L , Smith N , Vazquez-Benitez G , Weintraub E , Williams JTB , Xu S , Maro JC . Vaccine 2022 41 (2) 460-466 BACKGROUND: The Centers for Disease Control and Prevention's Vaccine Safety Datalink (VSD) has been performing safety surveillance for COVID-19 vaccines since their earliest authorization in the United States. Complementing its real-time surveillance for pre-specified health outcomes using pre-specified risk intervals, the VSD conducts tree-based data-mining to look for clustering of a broad range of health outcomes after COVID-19 vaccination. This study's objective was to use this untargeted, hypothesis-generating approach to assess the safety of first booster doses of Pfizer-BioNTech (BNT162b2), Moderna (mRNA-1273), and Janssen (Ad26.COV2.S) COVID-19 vaccines. METHODS: VSD enrollees receiving a first booster of COVID-19 vaccine through April 2, 2022 were followed for 56 days. Incident diagnoses in inpatient or emergency department settings were analyzed for clustering within both the hierarchical ICD-10-CM code structure and the follow-up period. The self-controlled tree-temporal scan statistic was used, conditioning on the total number of cases for each diagnosis. P-values were estimated by Monte Carlo simulation; p = 0.01 was pre-specified as the cut-off for statistical significance of clusters. RESULTS: More than 2.4 and 1.8 million subjects received Pfizer-BioNTech and Moderna boosters after an mRNA primary series, respectively. Clusters of urticaria/allergy/rash were found during Days 10-15 after the Moderna booster (p = 0.0001). Other outcomes that clustered after mRNA boosters, mostly with p = 0.0001, included unspecified adverse effects, common vaccine-associated reactions like fever and myalgia, and COVID-19. COVID-19 clusters were in Days 1-10 after booster receipt, before boosters would have become effective. There were no noteworthy clusters after boosters following primary Janssen vaccination. CONCLUSIONS: In this untargeted data-mining study of COVID-19 booster vaccination, a cluster of delayed-onset urticaria/allergy/rash was detected after the Moderna booster, as has been reported after Moderna vaccination previously. Other clusters after mRNA boosters were of unspecified or common adverse effects and COVID-19, the latter evidently reflecting immunity to COVID-19 after 10 days. |
Impact of the COVID-19 Vaccination Program on case incidence, emergency department visits, and hospital admissions among children aged 5-17 Years during the Delta and Omicron Periods-United States, December 2020 to April 2022.
Topf KG , Sheppard M , Marx GE , Wiegand RE , Link-Gelles R , Binder AM , Cool AJ , Lyons BC , Park S , Fast HE , Presnetsov A , Azondekon GR , Soetebier KA , Adjemian J , Barbour KE . PLoS One 2022 17 (12) e0276409 BACKGROUND: In the United States, national ecological studies suggest a positive impact of COVID-19 vaccination coverage on outcomes in adults. However, the national impact of the vaccination program on COVID-19 in children remains unknown. To determine the association of COVID-19 vaccination with U.S. case incidence, emergency department visits, and hospital admissions for pediatric populations during the Delta and Omicron periods. METHODS: We conducted an ecological analysis among children aged 5-17 and compared incidence rate ratios (RRs) of COVID-19 cases, emergency department visits, and hospital admissions by pediatric vaccine coverage, with jurisdictions in the highest vaccine coverage quartile as the reference. RESULTS: RRs comparing states with lowest pediatric vaccination coverage to the highest pediatric vaccination coverage were 2.00 and 0.64 for cases, 2.96 and 1.11 for emergency department visits, and 2.76 and 1.01 for hospital admissions among all children during the Delta and Omicron periods, respectively. During the 3-week peak period of the Omicron wave, only children aged 12-15 and 16-17 years in the states with the lowest versus highest coverage, had a significantly higher rate of emergency department visits (RR = 1.39 and RR = 1.34, respectively). CONCLUSIONS: COVID-19 vaccines were associated with lower case incidence, emergency department visits and hospital admissions among children during the Delta period but the association was weaker during the Omicron period. Pediatric COVID-19 vaccination should be promoted as part of a program to decrease COVID-19 impact among children; however, vaccine effectiveness may be limited when available vaccines do not match circulating viral variants. |
Influenza Vaccine Effectiveness Against Influenza A(H3N2)-Related Illness in the United States During the 2021-2022 Influenza Season.
Price AM , Flannery B , Talbot HK , Grijalva CG , Wernli KJ , Phillips CH , Monto AS , Martin ET , Belongia EA , McLean HQ , Gaglani M , Mutnal M , Geffel KM , Nowalk MP , Tartof SY , Florea A , McLean C , Kim SS , Patel MM , Chung JR . Clin Infect Dis 2022 76 (8) 1358-1363 BACKGROUND: In the United States, influenza activity during the 2021-2022 season was modest and sufficient enough to estimate influenza vaccine effectiveness for the first time since the beginning of the COVID-19 pandemic. We estimated influenza vaccine effectiveness against lab-confirmed outpatient acute illness caused by predominant A(H3N2) viruses. METHODS: Between October 2021 and April 2022, research staff across 7 sites enrolled patients aged ≥6 months seeking outpatient care for acute respiratory illness with cough. Using a test-negative design, we assessed VE against influenza A(H3N2). Due to strong correlation between influenza and SARS-CoV-2 vaccination, participants who tested positive for SARS-CoV-2 were excluded from vaccine effectiveness estimations. Estimates were adjusted for site, age, month of illness, race/ethnicity and general health status. RESULTS: Among 6,260 participants, 468 (7%) tested positive for influenza only, including 440 (94%) for A(H3N2). All 206 sequenced A(H3N2) viruses were characterized as belonging to genetic group 3C.2a1b subclade 2a.2, which has antigenic differences from the 2021-2022 season A(H3N2) vaccine component that belongs to clade 3C.2a1b subclade 2a.1. After excluding 1,948 SARS-CoV-2 positive patients, 4,312 patients were included in analyses of influenza VE; 2,463 (57%) were vaccinated against influenza. Effectiveness against A(H3N2) for all ages was 36% (95%CI, 20-49%) overall. CONCLUSION: Influenza vaccination in 2021-2022 provided protection against influenza A(H3N2)-related outpatient visits among young persons. |
Evaluation of the safety, immunogenicity, and faecal shedding of novel oral polio vaccine type 2 in healthy newborn infants in Bangladesh: a randomised, controlled, phase 2 clinical trial.
Zaman K , Bandyopadhyay AS , Hoque M , Gast C , Yunus M , Jamil KM , Mainou BA , Konopka-Anstadt JL , Hendley WS , Vincent A , Clemens R , Clemens SAC , Ross AG , Clemens JD , Tritama E . Lancet 2022 401 (10371) 131-139 BACKGROUND: Type 2 circulating vaccine-derived polioviruses (cVDPV2) from Sabin oral poliovirus vaccines (OPVs) are the leading cause of poliomyelitis. A novel type 2 OPV (nOPV2) has been developed to be more genetically stable with similar tolerability and immunogenicity to that of Sabin type 2 vaccines to mitigate the risk of cVDPV2. We aimed to assess these aspects of nOPV2 in poliovirus vaccine-naive newborn infants. METHODS: In this randomised, double-blind, controlled, phase 2 trial we enrolled newborn infants at the Matlab Health Research Centre, Chandpur, Bangladesh. We included infants who were healthy and were a single birth after at least 37 weeks' gestation. Infants were randomly assigned (2:1) to receive either two doses of nOPV2 or placebo, administered at age 0-3 days and at 4 weeks. Exclusion criteria included receipt of rotavirus or any other poliovirus vaccine, any infection or illness at the time of enrolment (vomiting, diarrhoea, or intolerance to liquids), diagnosis or suspicion of any immunodeficiency disorder in the infant or a close family member, or any contraindication for venipuncture. The primary safety outcome was safety and tolerability after one and two doses of nOPV2, given 4 weeks apart in poliovirus vaccine-naive newborn infants and the primary immunogenicity outcome was the seroconversion rate for neutralising antibodies against type 2 poliovirus, measured 28 days after the first and second vaccinations with nOPV2. Study staff recorded solicited and unsolicited adverse events after each dose during daily home visits for 7 days. Poliovirus neutralising antibody responses were measured in sera drawn at birth and at age 4 weeks and 8 weeks. This study is registered on ClinicalTrials.gov, NCT04693286. FINDINGS: Between Sept 21, 2020, and Aug 16, 2021, we screened 334 newborn infants, of whom three (<1%) were found to be ineligible and one (<1%) was withdrawn by the parents; the remaining 330 (99%) infants were assigned to receive nOPV2 (n=220 [67%]) or placebo (n=110 [33%]). nOPV2 was well tolerated; 154 (70%) of 220 newborn infants in the nOPV2 group and 78 (71%) of 110 in the placebo group had solicited adverse events, which were all mild or moderate in severity. Severe unsolicited adverse events in 11 (5%) vaccine recipients and five (5%) placebo recipients were considered unrelated to vaccination. 306 (93%) of 330 infants had seroprotective maternal antibodies against type 2 poliovirus at birth, decreasing to 58 (56%) of 104 in the placebo group at 8 weeks. In the nOPV2 group 196 (90%) of 217 infants seroconverted by week 8 after two doses, when 214 (99%) had seroprotective antibodies. INTERPRETATION: nOPV2 was well tolerated and immunogenic in newborn infants, with two doses, at birth and 4 weeks, resulting in almost 99% of infants having protective neutralising antibodies. FUNDING: Bill & Melinda Gates Foundation. |
Associations Between Routine Adolescent Vaccination Status and Parental Intent to Get a COVID-19 Vaccine for Their Adolescent.
Pingali C , Zhang F , Santibanez TA , Elam-Evans LD , Hill HA , Valier MR , Singleton JA . JAMA Pediatr 2022 177 (2) 208-210 This cross-sectional study investigates whether US adolescents routine vaccination status is associated with their parents self-reported intent or hesitancy to have them vaccinated for COVID-19. | eng |
Safety monitoring of JYNNEOS Vaccine during the 2022 Mpox outbreak - United States, May 22-October 21, 2022
Duffy J , Marquez P , Moro P , Weintraub E , Yu Y , Boersma P , Donahue JG , Glanz JM , Goddard K , Hambidge SJ , Lewin B , Lewis N , Rouse D , Shimabukuro T . MMWR Morb Mortal Wkly Rep 2022 71 (49) 1555-1559 JYNNEOS (Modified Vaccinia Ankara vaccine, Bavarian Nordic) is recommended in the United States for persons exposed to or at high risk for exposure to Monkeypox virus during the 2022 monkeypox (mpox) outbreak (1). JYNNEOS is a live, nonreplicating viral vaccine licensed for the prevention of smallpox and mpox in adults aged ≥18 years, administered as a 0.5-mL 2-dose series given 28 days apart by subcutaneous injection (2). On August 9, 2022, the Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for administration of 0.1 mL doses by intradermal injection for adults aged ≥18 years as a strategy to increase vaccine supply, and administration of 0.5 mL doses subcutaneously for persons aged <18 years (3). During May 22-October 21, 2022, a total of 987,294 JYNNEOS vaccine doses were administered in the United States. CDC has monitored JYNNEOS vaccine safety using the Vaccine Adverse Event Reporting System (VAERS) and the Vaccine Safety Datalink (VSD) for vaccine recipients of all ages, and through single-patient emergency Investigational New Drug (EIND) procedures for persons aged <18 years vaccinated before August 9, 2022. The most common adverse health events reported to VAERS for adults were nonserious and included injection site reactions, which was consistent with the prelicensure studies. Adverse health events were reported at similar rates for doses received by intradermal and subcutaneous administration. Serious adverse events were rare in adults, and no serious adverse events have been identified among persons aged <18 years. Overall, postlicensure and postauthorization surveillance to date support JYNNEOS vaccine safety. |
Evaluation of immune response to single dose of quadrivalent HPV vaccine at 10-year post-vaccination
Joshi S , Anantharaman D , Muwonge R , Bhatla N , Panicker G , Butt J , Rani Reddy Poli U , Malvi SG , Esmy PO , Lucas E , Verma Y , Shah A , Zomawia E , Pimple S , Jayant K , Hingmire S , Chiwate A , Divate U , Vashist S , Mishra G , Jadhav R , Siddiqi M , Sankaran S , Pillai Rameshwari Ammal Kannan T , Kartha P , Shastri SS , Sauvaget C , Radhakrishna Pillai M , Waterboer T , Müller M , Sehr P , Unger ER , Sankaranarayanan R , Basu P . Vaccine 2022 41 (1) 236-245 BACKGROUND: The recent World Health Organization recommendation supporting single-dose of HPV vaccine will significantly reduce programmatic cost, mitigate the supply shortage, and simplify logistics, thus allowing more low- and middle-income countries to introduce the vaccine. From a programmatic perspective the durability of protection offered by a single-dose will be a key consideration. The primary objectives of the present study were to determine whether recipients of a single-dose of quadrivalent HPV vaccine had sustained immune response against targeted HPV types (HPV 6,11,16,18) at 10 years post-vaccination and whether this response was superior to the natural antibody titres observed in unvaccinated women. METHODS: Participants received at age 10-18 years either one, two or three doses of the quadrivalent HPV vaccine. Serology samples were obtained at different timepoints up to 10 years after vaccination from a convenience sample of vaccinated participants and from age-matched unvaccinated women at one timepoint. The evolution of the binding and neutralizing antibody response was presented by dose received. 10-year durability of immune responses induced by a single-dose was compared to that after three doses of the vaccine and in unvaccinated married women. RESULTS: The dynamics of antibody response among the single-dose recipients observed over 120 months show stabilized levels 18 months after vaccination for all four HPV types. Although the HPV type-specific (binding or neutralizing) antibody titres after a single-dose were significantly inferior to those after three doses of the vaccine (lower bounds of GMT ratios < 0.5), they were all significantly higher than those observed in unvaccinated women following natural infections (GMT ratios: 2.05 to 4.04-fold higher). The results correlate well with the high vaccine efficacy of single-dose against persistent HPV 16/18 infections reported by us earlier at 10-years post-vaccination. CONCLUSION: Our study demonstrates the high and durable immune response in single-dose recipients of HPV vaccine at 10-years post vaccination. |
Progress toward poliomyelitis eradication - Afghanistan, January 2021-September 2022
Mohamed A , Akbar IE , Chaudhury S , Wadood MZ , Ather F , Jorba J , Martinez M . MMWR Morb Mortal Wkly Rep 2022 71 (49) 1541-1546 Afghanistan and Pakistan are the two remaining countries with endemic wild poliovirus type 1 (WPV1) transmission (1). During 2019-2020, these countries reported their highest numbers of WPV1 cases since 2014 and experienced outbreaks of type 2 circulating vaccine-derived poliovirus (cVDPV2) (2-4).* In Afghanistan, the number of WPV1 cases nearly doubled, from 29 in 2019 to 56 in 2020; 308 cVDPV2 cases were reported during 2020. After years of active conflict, the Afghanistan government was fully replaced by the Taliban de facto government on August 15, 2021. This report describes activities and progress toward polio eradication in Afghanistan during January 2021-September 2022 and updates previous reports (3,4). During January-December 2021, four WPV1 and 43 cVDPV2 cases were detected, representing decreases of 93% from 56 cases and 86% from 308 cases, respectively, during 2020. During January-September 2022 (reported as of October 20), two WPV1 cases and zero cVDPV2 cases were detected. Although no supplementary immunization activities (SIAs)(†) occurred during July-October 2021, SIAs resumed during November 2021 in all districts after the political transition, and 3.5-4.5 million previously unreachable persons have been vaccinated since. However, restrictions on how SIAs are conducted are still in place in the critical South Region provinces of Kandahar, Helmand, and Uruzgan. If efforts to vaccinate all children are enhanced and expanded, Afghanistan has an opportunity to interrupt WPV1 transmission during 2023. |
Reduced risk for Mpox after receipt of 1 or 2 doses of JYNNEOS vaccine compared with risk among unvaccinated persons - 43 U.S. Jurisdictions, July 31-October 1, 2022
Payne AB , Ray LC , Cole MM , Canning M , Houck K , Shah HJ , Farrar JL , Lewis NM , Fothergill A , White EB , Feldstein LR , Roper LE , Lee F , Kriss JL , Sims E , Spicknall IH , Nakazawa Y , Gundlapalli AV , Shimabukuro T , Cohen AL , Honein MA , Mermin J , Payne DC . MMWR Morb Mortal Wkly Rep 2022 71 (49) 1560-1564 As of October 28, 2022, a total of 28,244* monkeypox (mpox) cases have been reported in the United States during an outbreak that has disproportionately affected gay, bisexual, and other men who have sex with men (MSM) (1). JYNNEOS vaccine (Modified Vaccinia Ankara vaccine, Bavarian Nordic), administered subcutaneously as a 2-dose (0.5 mL per dose) series (with doses administered 4 weeks apart), was approved by the Food and Drug Administration (FDA) in 2019 to prevent smallpox and mpox disease (2); an FDA Emergency Use Authorization issued on August 9, 2022, authorized intradermal administration of 0.1 mL per dose, increasing the number of persons who could be vaccinated with the available vaccine supply(†) (3). A previous comparison of mpox incidence during July 31-September 3, 2022, among unvaccinated, but vaccine-eligible men aged 18-49 years and those who had received ≥1 JYNNEOS vaccine dose in 32 U.S. jurisdictions, found that incidence among unvaccinated persons was 14 times that among vaccinated persons (95% CI = 5.0-41.0) (4). During September 4-October 1, 2022, a total of 205,504 persons received JYNNEOS vaccine dose 2 in the United States.(§) To further examine mpox incidence among persons who were unvaccinated and those who had received either 1 or 2 JYNNEOS doses, investigators analyzed data on 9,544 reported mpox cases among men(¶) aged 18-49 years during July 31-October 1, 2022, from 43 U.S. jurisdictions,** by vaccination status. During this study period, mpox incidence (cases per 100,000 population at risk) among unvaccinated persons was 7.4 (95% CI = 6.0-9.1) times that among persons who received only 1 dose of JYNNEOS vaccine ≥14 days earlier and 9.6 (95% CI = 6.9-13.2) times that among persons who received dose 2 ≥14 days earlier. The observed distribution of subcutaneous and intradermal routes of administration of dose 1 among vaccinated persons with mpox was not different from the expected distribution. This report provides additional data suggesting JYNNEOS vaccine provides protection against mpox, irrespective of whether the vaccine is administered intradermally or subcutaneously. The degree and durability of such protection remains unclear. Persons eligible for mpox vaccination should receive the complete 2-dose series to optimize strength of protection(††) (5). |
Leaving no one behind: Defining and implementing an integrated life course approach to vaccination across the next decade as part of the Immunization Agenda 2030
Wallace AS , Ryman TK , Privor-Dumm L , Morgan C , Fields R , Garcia C , Sodha SV , Lindstrand A , Nic Lochlainn LM . Vaccine 2022 Strategic Priority 4 (SP4) of the Immunization Agenda 2030 aims to ensure that all people benefit from recommended immunizations throughout the life-course, integrated with essential health services. Therefore, it is necessary for immunization programs to have coordination and collaboration across all health programs. Although there has been progress, immunization platforms in the second year of life and beyond need continued strengthening, including booster doses and catch-up vaccination, for all ages, and recommended vaccines for older age groups. We note gaps in current vaccination programs policies and achieved coverage, in the second year of life and beyond. In 2021, the second dose of measles-containing vaccine (MCV2), given in the second year of life, achieved 71% global coverage vs 81% for MCV1. For adolescents, 60% of all countries have adopted human papillomavirus vaccines in their vaccination schedule with a global coverage rate of only 12 percent in 2021. Approximately 65% of the countries recommend influenza vaccines for older adults, high-risk adults and pregnant women, and only 25% recommended pneumococcal vaccines for older adults. To achieve an integrated life course approach to vaccination, we reviewed the evidence, gaps, and strategies in four focus areas: generating evidence for disease burden and potential vaccine impact in older age groups; building awareness and shifting policy beyond early childhood; building integrated delivery approaches throughout the life course; and identifying missed opportunities for vaccination, implementing catch-up strategies, and monitoring vaccination throughout the life course. We identified needs, such as tailoring strategies to the local context, conducting research and advocacy to mobilize resources and build political will. Mustering sufficient financial support and demand for an integrated life course approach to vaccination, particularly in times of COVID-19, is both a challenge and an opportunity. |
Reproductive coercion and intimate partner violence victimization among a racially and ethnically diverse young adult sample
Muñoz EA , Le VD , Lu Y , Shorey RC , Temple JR . J Interpers Violence 2023 38 Np1261-np1278 Reproductive coercion is an understudied form of intimate partner violence (IPV) that occurs when a person attempts to control the autonomous reproductive decision making of their intimate partner. Previous research has demonstrated that individuals who experience reproductive coercion are more likely to experience other forms of IPV (e.g., physical and sexual). Research has also shown that Black/African American and Latinx/Hispanic individuals are at an increased risk of experiencing reproductive coercion compared to their White/Non-Hispanic peers. However, most of the research on reproductive coercion has been conducted in family-planning clinics where IPV is reported at a higher rate than in community samples. Thus, using a diverse community sample of female-identifying young adults (N = 370) who were recruited as part of an ongoing longitudinal study on dating violence, we examined the prevalence of lifetime reproductive coercion and its relationship with other forms of IPV, as well as the differences in prevalence among racial and ethnic groups. Lifetime prevalence of being victimized by any form of reproductive coercion was 11.4%. Results indicated that individuals who experienced reproductive coercion were more likely to experience physical and sexual IPV relative to those who did not experience reproductive coercion. With respect to race/ethnicity, 5.6% of White participants, 10.5% of Black/African American participants, and 14.8% of Hispanic/Latinx participants reported experiencing reproductive coercion. Chi-square analyses showed Hispanic/Latinx participants had a significantly higher prevalence of reproductive coercion when compared to White/Non-Hispanic participants. These findings suggest a need for additional research on culturally-specific risk and protective factors related to reproductive coercion among Hispanic/Latinx individuals to identify potential intervention and prevention strategies. |
NFKB2 haploinsufficiency identified via screening for IFNα2 autoantibodies in children and adolescents hospitalized with SARS-CoV-2-related complications.
Bodansky A , Vazquez SE , Chou J , Novak T , Al-Musa A , Young C , Newhams M , Kucukak S , Zambrano LD , Mitchell A , Wang CY , Moffitt K , Halasa NB , Loftis LL , Schwartz SP , Walker TC , Mack EH , Fitzgerald JC , Gertz SJ , Rowan CM , Irby K , Sanders RC Jr , Kong M , Schuster JE , Staat MA , Zinter MS , Cvijanovich NZ , Tarquinio KM , Coates BM , Flori HR , Dahmer MK , Crandall H , Cullimore ML , Levy ER , Chatani B , Nofziger R , Geha RS , DeRisi J , Campbell AP , Anderson M , Randolph AG . J Allergy Clin Immunol 2023 151 (4) 926-930.e2 BACKGROUND: Autoantibodies against type I IFNs occur in approximately 10% of adults with life-threatening coronavirus disease 2019 (COVID-19). The frequency of anti-IFN autoantibodies in children with severe sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is unknown. OBJECTIVE: We quantified anti-type I IFN autoantibodies in a multicenter cohort of children with severe COVID-19, multisystem inflammatory syndrome in children (MIS-C), and mild SARS-CoV-2 infections. METHODS: Circulating anti-IFN-α2 antibodies were measured by a radioligand binding assay. Whole-exome sequencing, RNA sequencing, and functional studies of peripheral blood mononuclear cells were used to study any patients with levels of anti-IFN-α2 autoantibodies exceeding the assay's positive control. RESULTS: Among 168 patients with severe COVID-19, 199 with MIS-C, and 45 with mild SARS-CoV-2 infections, only 1 had high levels of anti-IFN-α2 antibodies. Anti-IFN-α2 autoantibodies were not detected in patients treated with intravenous immunoglobulin before sample collection. Whole-exome sequencing identified a missense variant in the ankyrin domain of NFKB2, encoding the p100 subunit of nuclear factor kappa-light-chain enhancer of activated B cells, aka NF-κB, essential for noncanonical NF-κB signaling. The patient's peripheral blood mononuclear cells exhibited impaired cleavage of p100 characteristic of NFKB2 haploinsufficiency, an inborn error of immunity with a high prevalence of autoimmunity. CONCLUSIONS: High levels of anti-IFN-α2 autoantibodies in children and adolescents with MIS-C, severe COVID-19, and mild SARS-CoV-2 infections are rare but can occur in patients with inborn errors of immunity. |
Severe acute respiratory disease in American mink experimentally infected with SARS-CoV-2.
Adney DR , Lovaglio J , Schulz JE , Yinda CK , Avanzato VA , Haddock E , Port JR , Holbrook MG , Hanley PW , Saturday G , Scott D , Shaia C , Nelson AM , Spengler JR , Tansey C , Cossaboom CM , Wendling NM , Martens C , Easley J , Yap SW , Seifert SN , Munster VJ . JCI Insight 2022 7 (22) An animal model that fully recapitulates severe COVID-19 presentation in humans has been a top priority since the discovery of SARS-CoV-2 in 2019. Although multiple animal models are available for mild to moderate clinical disease, models that develop severe disease are still needed. Mink experimentally infected with SARS-CoV-2 developed severe acute respiratory disease, as evident by clinical respiratory disease, radiological, and histological changes. Virus was detected in nasal, oral, rectal, and fur swabs. Deep sequencing of SARS-CoV-2 from oral swabs and lung tissue samples showed repeated enrichment for a mutation in the gene encoding nonstructural protein 6 in open reading frame 1ab. Together, these data indicate that American mink develop clinical features characteristic of severe COVID-19 and, as such, are uniquely suited to test viral countermeasures. |
Development of an improved standard reference material for folate vitamers in human serum
Camara JE , Pritchett JS , Daniels YC , Bedner M , Nelson MA , Lowenthal MS , Fazili Z , Pfeiffer CM , Phinney KW , Sharpless KE , Sander LC , Lippa KA , Yen JH , Kuszak AJ , Wise SA . Anal Bioanal Chem 2022 415 (5) 809-821 The US National Institute of Standards and Technology (NIST) developed a Standard Reference Material (SRM) 3949 Folate Vitamers in Frozen Human Serum to replace SRM 1955 Homocysteine and Folate in Human Serum. The presence of increased endogenous levels of folic acid and 5-methyltetrahydrofolate (5mTHF) in SRM 3949, enhanced folate stability via addition of ascorbic acid, and inclusion of values for additional minor folates are improvements over SRM 1955 that should better serve the clinical folate measurement community. The new SRM contains folates at three levels. To produce SRM 3949, pilot sera were collected from 15 individual donors, 5 of whom were given a 400-g folic acid supplement 1h prior to blood draw to increase serum levels of 5mTHF and folic acid for the high-level material. To stabilize the folates, 0.5% (mass concentration) ascorbic acid was added as soon as possible after preparation of serum. These pilot sera were screened for five folates plus the pyrazino-s-triazine derivative of 4--hydroxy-5-methyltetrahydrofolate (MeFox) at the US Centers for Disease Control and Prevention (CDC) by isotope dilution liquid chromatography-tandem mass spectrometry (ID-LC-MS/MS). Based on these results, a blending protocol was specified to obtain the three desired folate concentrations for SRM 3949. ID-LC-MS/MS analysis at the CDC and NIST was utilized to assign values for folic acid and 5mTHF, as well as several minor folates. |
Factors associated with large-for-gestational-age infants born after frozen embryo transfer cycles
Roshong AJ , DeSantis CE , Yartel AK , Heitmann RJ , Kissin DM , Pier BD . F S Rep 2022 3 (4) 332-341 Objective: To examine trends of frozen embryo transfer (FET) proportions and large-for-gestational-age (LGA) incidence and determine risk factors for LGA infants after FET. Design: Retrospective cohort study. Setting: Not applicable. Patient(s): Frozen embryo transfer cycles. Intervention(s): None. Main Outcome Measure(s): Singleton LGA infant. Result(s): The percentage of FETs increased from 20%–74% of transfers, whereas the rate of LGA among FET singleton births decreased from 18%–12% during 2004–2018. In a subanalysis of 127,525 FET-associated singleton live births during 2016–2018, patient factors associated with LGA were higher-than-normal maternal body mass index (body mass index [BMI], 25.0–29.9 kg/m2; adjusted relative risk [aRR], 1.31; 95% confidence interval [CI], 1.26–1.36; BMI, 30.0–34.9 kg/m2; aRR, 1.48; 95% CI, 1.41–1.55; and BMI, >35 Kg/m2; aRR, 1.68; 95% CI, 1.59–1.77) and ≥1 prior birth vs. none. Low maternal BMI (<18.5 vs. 18.5–24.9 kg/m2) and cycles involving patients who were non-Hispanic (NH) Asian/Native Hawaiian/Pacific Islander, NH Black, or Hispanic (compared with NH White) were at lower risk of LGA infants. Cycle factors associated with LGA included gestational carrier use (aRR, 1.25; 95% CI, 1.16–1.34) and donor sperm (aRR, 1.17; 95% CI, 1.10–1.25). Conclusion(s): Although the number and proportion of FET cycles increased from 2004–2018, the rate of LGA after FET decreased. Maternal BMI, parity, and race/ethnicity were the strongest risk factors for LGA infants after FET. © 2022 |
Approaches to quantify the contribution of multiple anemia risk factors in children and women from cross-sectional national surveys
Ko YiAn , Williams AM , Peerson JM , Luo HanQi , Flores-Ayala R , Wirth JP , Engle-Stone R , Young MF , Suchdev PS . PLoS Glob Public Health 2022 2 (10) e0001071 Background: Attributable fractions (AF) of anemia are often used to understand the multifactorial etiologies of anemia, despite challenges interpreting them in cross-sectional studies. We aimed to compare different statistical approaches for estimating AF for anemia due to inflammation, malaria, and micronutrient deficiencies including iron, vitamin A, vitamin B12, and folate. |
COVID-19 Outbreaks Linked to Workplaces, 23 US Jurisdictions, August-October 2021.
Luckhaupt SE , Horter L , Groenewold MR , dePerio MA , Robbins CL , Sweeney MH , Thomas I , Valencia D , Ingram A , Heinzerling A , Nguyen A , Townsend EB , Weber RC , Reichbind D , Dishman H , Kerins JL , Lendacki FR , Austin C , Dixon L , Spillman B , Simonson S , Tonzel J , Krueger A , Duwell M , Bachaus B , Rust B , Barrett C , Morrison B , OwersBonner KA , Karlsson ND , Angelon-Gaetz K , McClure ES , Kline KE , Dangar D , Reed C , Karpowicz J , Anderson SM , Cantor S , Chaudhary I , Ellis EM , Taylor ML , Sedon A , Kocharian A , Morris C , Samson ME , Mangla AT . Public Health Rep 2022 138 (2) 333549221138294 OBJECTIVES: Early in the COVID-19 pandemic, several outbreaks were linked with facilities employing essential workers, such as long-term care facilities and meat and poultry processing facilities. However, timely national data on which workplace settings were experiencing COVID-19 outbreaks were unavailable through routine surveillance systems. We estimated the number of US workplace outbreaks of COVID-19 and identified the types of workplace settings in which they occurred during August-October 2021. METHODS: The Centers for Disease Control and Prevention collected data from health departments on workplace COVID-19 outbreaks from August through October 2021: the number of workplace outbreaks, by workplace setting, and the total number of cases among workers linked to these outbreaks. Health departments also reported the number of workplaces they assisted for outbreak response, COVID-19 testing, vaccine distribution, or consultation on mitigation strategies. RESULTS: Twenty-three health departments reported a total of 12 660 workplace COVID-19 outbreaks. Among the 12 470 workplace types that were documented, 35.9% (n = 4474) of outbreaks occurred in health care settings, 33.4% (n = 4170) in educational settings, and 30.7% (n = 3826) in other work settings, including non-food manufacturing, correctional facilities, social services, retail trade, and food and beverage stores. Eleven health departments that reported 3859 workplace outbreaks provided information about workplace assistance: 3090 (80.1%) instances of assistance involved consultation on COVID-19 mitigation strategies, 1912 (49.5%) involved outbreak response, 436 (11.3%) involved COVID-19 testing, and 185 (4.8%) involved COVID-19 vaccine distribution. CONCLUSIONS: These findings underscore the continued impact of COVID-19 among workers, the potential for work-related transmission, and the need to apply layered prevention strategies recommended by public health officials. |
Silicone passive sampling used to identify novel dermal chemical exposures of firefighters and assess PPE innovations
Bonner EM , Horn GP , Smith DL , Kerber S , Fent KW , Tidwell LG , Scott RP , Adams KT , Anderson KA . Int J Hyg Environ Health 2022 248 114095 A plethora of chemicals are released into the air during combustion events, including a class of compounds called polycyclic aromatic hydrocarbons (PAHs). PAHs have been implicated in increased risk of cancer and cardiovascular disease, both of which are disease endpoints of concern in structural firefighters. Current commercially available personal protective equipment (PPE) typically worn by structural firefighters during fire responses have gaps in interfaces between the ensemble elements (e.g., hood and jacket) that allow for ingress of contaminants and dermal exposure. This pilot study aims to use silicone passive sampling to assess improvements in dermal protection afforded by a novel configuration of PPE, which incorporates a one-piece liner to eliminate gaps in two critical interfaces between pieces of gear. The study compared protection against parent and alkylated PAHs between the one-piece liner PPE and the standard configuration of PPE with traditional firefighting jacket and pants. Mannequins (n = 16) dressed in the PPE ensembles were placed in a Fireground Exposure Simulator for 10 min, and exposed to smoke from a combusting couch. Silicone passive samplers were placed underneath PPE at vulnerable locations near interfaces in standard PPE, and in the chamber air, to measure PAHs and calculate the dermal protection provided by both types of PPE. Silicone passive sampling methodology and analyses using gas chromatography with mass-spectrometry proved to be well-suited for this intervention study, allowing for the calculation and comparison of worker protection factors for 51 detected PAHs. Paired comparisons of the two PPE configurations found greater sum 2-3 ring PAH exposure underneath the standard PPE than the intervention PPE at the neck and chest, and at the chest for 4-7 ring PAHs (respective p-values: 0.00113, 0.0145, and 0.0196). Mean worker protection factors of the intervention PPE were also greater than the standard PPE for 98% of PAHs at the neck and chest. Notably, the intervention PPE showed more than 30 times the protection compared to the standard PPE against two highly carcinogenic PAHs, dibenzo[a,l]pyrene and benzo[c]fluorene. Nine of the detected PAHs in this study have not been previously reported in fireground exposure studies, and 26 other chemicals (not PAHs) were detected using a large chemical screening method on a subset of the silicone samplers. Silicone passive sampling appears to be an effective means for measuring dermal exposure reduction to fireground smoke, providing evidence in this study that reducing gaps in PPE interfaces could be further pursued as an intervention to reduce dermal exposure to PAHs, among other chemicals. |
Evaluation of methodology for real-time monitoring of diesel particulate matter in underground mines
Habibi A , Bugarski AD , Loring D , Cable A , Ingalls L , Rutter C . Min Metall Explor 2022 40 (1) 453-461 The results of diesel particulate matter (DPM) monitoring were used by the underground mining industry to mitigate adverse effects of exposure to DPM. NIOSH Method 5040, currently used for ambient and personal exposure monitoring, does not provide needed real-time information. The objective of this study is to develop a methodology for continuous monitoring of DPM concentrations in an underground environment, founded on the application of the Dekati electrical particle sensor (DePS). The DePS, which measures concentrations of submicron aerosol in real time using a diffusion-charging sensor, was evaluated by comparing the results of the concurrent measurements with reference methods at several locations downstream of the diesel-powered equipment. The DePS results were found to correlate well to those obtained by reference methods. However, it was found that dependence of the response on the physical and chemical properties of aerosols necessitates site-specific correlation factors for the targeted matrices. The site-specific factors for number and mass of diesel aerosols were derived using the results of concurrent measurements with TSI NanoScan, FLIR Airtec, and carbon analyses performed on the concurrently collected filter samples. The results showed that methodology based on compensated DePS measurements would be suitable for continuous monitoring of DPM in underground mining operations. © 2022, Society for Mining, Metallurgy & Exploration Inc. |
Assessment of challenges in patrol vehicles and with equipment among law enforcement officers
Hsiao H . Appl Ergon 2022 108 103946 Understanding the challenges Law Enforcement Officers (LEOs) have encountered with their vehicle and equipment and the correlation between equipment configuration and LEO body dimensions is critical for improving vehicle/equipment specifications to better accommodate today's LEOs. 974 LEOs participated in a study on their vehicle, equipment, and body measurements at 12 sites across the U.S. 88% participants reported discomfort/pain at the end of a shift. The most affected body areas were the lower back and hips. Handguns, radios, and handcuffs on duty belt and seat adjustment were associated with the discomfort/pain. 41% LEOs identified inadequate seat adjustment. Stature, buttock-popliteal length, eye height (sitting), knee height (sitting), shoulder-grip length, popliteal height, sitting height, hip breadth, and body weight were key parameters associated with seat adjustment needs. A third of officers experienced neck pain associated with the use of in-vehicle mobile data terminals and more fore/aft adjustment was needed. |
Chronic obstructive pulmonary disease mortality by industry and occupation - United States, 2020
Syamlal G , Kurth LM , Dodd KE , Blackley DJ , Hall NB , Mazurek JM . MMWR Morb Mortal Wkly Rep 2022 71 (49) 1550-1554 Chronic obstructive pulmonary disease (COPD), a progressive lung disease, is characterized by long-term respiratory symptoms and airflow limitation (1). COPD accounts for most of the deaths from chronic lower respiratory diseases, the sixth leading cause of death in the United States in 2020.* Workplace exposures and tobacco smoking are risk factors for COPD; however, one in four workers with COPD have never smoked (2-4). To describe COPD mortality among U.S. residents aged 15 years categorized as ever-employed (i.e., with information on their usual industry and occupation), CDC analyzed the most recent 2020 multiple cause-of-death data() from 46 states and New York City.() Among 3,077,127 decedents, 316,023 (10.3%) had COPD() listed on the death certificate. The highest age-adjusted** COPD death rates per 100,000 ever-employed persons were for females (101.3), White persons (116.9), and non-Hispanic or Latino (non-Hispanic) persons (115.8). The highest proportionate mortality ratios (PMRs)() were for workers employed in the mining industry (1.3) and in food preparation and serving related occupations (1.3). Elevated COPD mortality among workers in certain industries and occupations underscores the importance of targeted interventions (e.g., reduction or elimination of COPD-associated risk factors, engineering controls, and workplace smoke-free policies) to prevent COPD from developing and to intervene before illness becomes symptomatic or severe. |
A pilot comparison of fixatives for hookworm real-time polymerase chain reaction
Bradbury R , Inagaki K , Singh G , Agana U , Patterson K , Malloch L , Rodriguez E , Qvarnstrom Y , Hobbs CV . Am J Trop Med Hyg 2022 108 (2) 335-339 Polymerase chain reaction (PCR) is increasingly used in the diagnosis of soil-transmitted helminth infections. Despite this, few studies have evaluated the impact of different fecal fixatives on the outcome of fecal helminth qPCR analysis, and none have evaluated the effect of commercial parasitology fixatives commonly used in diagnostic laboratories. We fixed dog feces containing Ancylostoma spp. hookworm eggs in zinc polyvinyl alcohol (Zn-PVA) and Total-Fix, and with 70% ethanol (EtOH) as a control. DNA was extracted at timepoints 11, 33, 64, and 94 days and subjected to Ancylostoma spp. quantitative PCR (qPCR). A linear regression model was created to assess the effect of preservative types on the temporal change of qPCR quantification cycle number (Cq) values, accounting for variances among individual animals. Fixation in 70% EtOH least affected Cq values over 94 days. Total-Fix preservation yielded a higher Cq overall, but there was no significant difference compared with 70% EtOH fixation. Fixation in Zn-PVA resulted in significantly (P < 0.001) higher Cq values than 70% EtOH after only 33 days and loss of amplification at 64 days. Consistent with other helminth fixation studies, 70% EtOH performed well in preserving hookworm DNA over 94 days. Total-Fix provided a comparable alternative for qPCR analysis for hookworm. Fixation in Zn-PVA resulted in loss of detectable hookworm DNA at 64 days, as determined by qPCR. |
Which trap is best Alternatives to outdoor human landing catches for malaria vector surveillance: a meta-analysis
Eckert J , Oladipupo S , Wang Y , Jiang S , Patil V , McKenzie BA , Lobo NF , Zohdy S . Malar J 2022 21 (1) 378 BACKGROUND: Human landing catches (HLC) are an entomological collection technique in which humans are used as attractants to capture medically relevant host-seeking mosquitoes. The use of this method has been a topic of extensive debate for decades mainly due to ethical concerns. Many alternatives to HLC have been proposed; however, no quantitative review and meta-analysis comparing HLC to outdoor alternative trapping methods has been conducted. METHODS: A total of 58 comparisons across 12 countries were identified. We conducted a meta-analysis comparing the standardized mean difference of Anopheles captured by HLC and alternative traps. To explain heterogeneity, three moderators were chosen for analysis: trap type, location of study, and species captured. A meta-regression was fit to understand how the linear combination of moderators helped in explaining heterogeneity. The possibility of biased results due to publication bias was also explored. RESULTS: Random-effects meta-analysis showed no statistically significant difference in the mean difference of Anopheles collected. Moderator analysis was conducted to determine the effects of trap type, geographical location of study, and the species of Anopheles captured. On average, tent-based traps captured significantly more Anopheles than outdoor HLC (95% CI: [- .9065, - 0.0544]), alternative traps in Africa captured on average more mosquitoes than outdoor HLC (95% CI: [- 2.8750, - 0.0294]), and alternative traps overall captured significantly more Anopheles gambiae s.l. than outdoor HLC (95% CI: [- 4.4613, - 0.2473]) on average. Meta-regression showed that up to 55.77% of the total heterogeneity found can be explained by a linear combination of the three moderators and the interaction between trap type and species. Subset analysis on An. gambiae s.l. showed that light traps specifically captured on average more of this species than HLC (95% CI: [- 18.3751, - 1.0629]). Publication bias likely exists. With 59.65% of studies reporting p-values less than 0.025, we believe there is an over representation in the literature of results indicating that alternative traps are superior to outdoor HLC. CONCLUSIONS: Currently, there is no consensus on a single "magic bullet" alternative to outdoor HLC. The diversity of many alternative trap comparisons restricts potential metrics for comparisons to outdoor HLC. Further standardization and specific question-driven trap evaluations that consider target vector species and the vector control landscape are needed to allow for robust meta-analyses with less heterogeneity and to develop data-driven decision-making tools for malaria vector surveillance and control. |
Building on Capacity Established through US Centers for Disease Control and Prevention Global Health Programs to Respond to COVID-19, Cameroon.
Dokubo EK , Shang JD , N'Dir A , Ndongmo CB , Okpu G , Fadil YM , Takang LE , Angumua C , Lyonga E , Mayer M , Ayukotabe T , Nkwoh TK , Hedje J , Etoundi GA , Njock RL . Emerg Infect Dis 2022 28 (13) S181-s190 The COVID-19 pandemic has highlighted the need for resilient health systems with the capacity to effectively detect and respond to disease outbreaks and ensure continuity of health service delivery. The pandemic has disproportionately affected resource-limited settings with inadequate health capacity, resulting in disruptions in health service delivery and worsened outcomes for key health indicators. As part of the US government's goal of ensuring health security, the US Centers for Disease Control and Prevention has used its scientific and technical expertise to build health capacity and address health threats globally. We describe how capacity developed through global health programs of the US Centers for Disease Control and Prevention in Cameroon was leveraged to respond to coronavirus disease and maintain health service delivery. The health system strengthening efforts in Cameroon can be applied in similar settings to ensure preparedness for future global public health threats and improve health outcomes. |
Adapting Longstanding Public Health Collaborations between Government of Kenya and CDC Kenya in Response to the COVID-19 Pandemic, 2020-2021.
Herman-Roloff A , Aman R , Samandari T , Kasera K , Emukule GO , Amoth P , Chen TH , Kisivuli J , Weyenga H , Hunsperger E , Onyango C , Juma B , Munyua P , Wako D , Akelo V , Kimanga D , Ndegwa L , Mohamed AA , Okello P , Kariuki S , DeCock KM , Bulterys M . Emerg Infect Dis 2022 28 (13) S159-s167 Kenya's Ministry of Health (MOH) and the US Centers for Disease Control and Prevention in Kenya (CDC Kenya) have maintained a 40-year partnership during which measures were implemented to prevent, detect, and respond to disease threats. During the COVID-19 pandemic, the MOH and CDC Kenya rapidly responded to mitigate disease impact on Kenya's 52 million residents. We describe activities undertaken jointly by the MOH and CDC Kenya that lessened the effects of COVID-19 during 5 epidemic waves from March through December 2021. Activities included establishing national and county-level emergency operations centers and implementing workforce development and deployment, infection prevention and control training, laboratory diagnostic advancement, enhanced surveillance, and information management. The COVID-19 pandemic provided fresh impetus for the government of Kenya to establish a national public health institute, launched in January 2022, to consolidate its public health activities and counter COVID-19 and future infectious, vaccine-preventable, and emerging zoonotic diseases. |
Building noncommunicable disease workforce capacity through field epidemiology training programs: Experience from India, 2018-2021
Ramalingam A , Raju M , Ganeshkumar P , Yadav R , Tanwar S , Sakthivel M , Mukhtar Q , Kaur P . Prev Chronic Dis 2022 19 E82 By 2003, India had started to shift from a high burden of communicable diseases to noncommunicable diseases (NCDs). By 2019, NCDs accounted for two-thirds of all deaths in India (1,2). However, the epidemiologic transition of growth of NCD burden was not uniform among all states. Thus, state-specific policy decisions and program strategies are required to address the growing NCD burden. | | In response to rising NCD prevalence, India launched the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS) in 2010 to cover all districts in India (3). The program focused on prevention, screening, diagnosis, and management of hypertension, diabetes, cardiovascular disease, and cancer. Program implementation in the states has faced challenges because of a poorly designed monitoring system, interruptions in drug supply, unreliable access to diagnostics, and poor financial planning. A skilled public health workforce at the state and district levels is required to monitor, analyze, and interpret program data to identify key challenges and implement evidence-based strategies to address the challenges (4). |
VMMC programmatic successes and challenges: Western Kenya case study
Agot K , Onyango J , Ochillo M , Odoyo-June E . Curr HIV/AIDS Rep 2022 19 (6) 491-500 PURPOSE OF REVIEW: The Nyanza region of western Kenya is lauded for impressive coverage of voluntary medical male circumcision (VMMC) and remains the bedrock of the VMMC program in Kenya. We conducted literature review on programmatic successes and challenges of implementing VMMC program in the region. RECENT FINDINGS: Responsive stakeholders' engagement, robust policy environment, effective technical working groups, prompt capacity building of health facilities, government support, flexible implementation strategies, and sustained donor funding contributed to the successes of the program that saw circumcision prevalence in Nyanza reach between 75.6 and 85.3% among 15-29-year-olds by 2019. However, the lack of support for early infant circumcision, inadequate domestic financing, and slow pace of service integration into government health facilities continue to undermine the progress towards sustainability. While local ownership of the VMMC program has been demonstrated through its inclusion in county annual health workplans and progressive integration into routine health care, continued dependence on declining external funding threatens its sustainability. Furthermore, Kenya is experiencing a youth bulge with a projected high demand for VMMC which calls for increased resource inputs into the program. Strategies are therefore needed to increase domestic resource inflows into VMMC. |
Rapid Evaluations of Telehealth Strategies to Address Hypertension: A Mixed-Methods Exploration at Two US Health Systems During the COVID-19 Pandemic.
Sreedhara M , Suvada K , Bostic M , Scott A , Blum E , Jordan J , Beasley KL . Prev Chronic Dis 2022 19 E81 Telehealth is a promising intervention for hypertension management and control and was rapidly adopted by health systems to ensure continuity of care during the COVID-19 pandemic. Rapid evaluations of telehealth strategies at 2 US health systems explored how telehealth affected health care access and blood pressure outcomes among populations disproportionately affected by hypertension. Both health systems implemented telehealth strategies to maintain continuity of health care services during the COVID-19 pandemic. The evaluations used a mixed-method approach; qualitative interviews were conducted with key staff, and quantitative analyses were performed on patient electronic health record data. Both health systems exhibited similar trends in telehealth use, which allowed for continued access to health care for some patients but hindered other patients who had limited access to the internet or the equipment needed. Telehealth provides opportunities for blood pressure control and management. Further evaluation is needed to understand the role of broadband internet access as a social determinant of health and its impact on equitable patient access to health care. |
Human rabies - Texas, 2021
Blackburn D , Minhaj FS , Al Hammoud R , Orciari L , Miller J , Maness T , Stewart J , Singletary B , Ledezma E , Ellsworth M , Carlo-Angleró A , Niezgoda M , Gigante CM , Rao AK , Satheshkumar PS , Heresi GP , Kieffer A , Wallace RM . MMWR Morb Mortal Wkly Rep 2022 71 (49) 1547-1549 In late August 2021, a boy aged 7 years was bitten by a bat while he was playing outside his apartment home in Medina County, Texas. He informed his parents; however, no rabies postexposure prophylaxis (PEP) was sought because there were no visible bite marks, and the family was unaware that contact with a bat, including in the absence of visible bite marks, might cause rabies. Approximately 2 months later, the child was hospitalized for altered mental status, seizures, and hypersalivation and ultimately received a diagnosis of rabies. Experimental therapies were attempted; however, the child died 22 days after symptom onset. Fifty-seven persons who met criteria for suspected or known exposure to infectious secretions in this case were advised to consult with a medical provider about the need for rabies PEP in accordance with Advisory Committee on Immunization Practices (ACIP) guidelines (1). Rabies, an acute, progressive neuroencephalitis, is nearly always fatal. Although dogs are the most common source of human rabies deaths worldwide and account for an estimated 59,000 annual cases of human rabies globally (2), bats are the most common source of domestically acquired rabies in the United States and have been implicated in 31 (81.6%) of 38 human infections since 2000 (3). Attempts to prevent death or poor neurologic outcomes once rabies symptoms develop have been largely unsuccessful (4). Administration of rabies PEP, comprising rabies immunoglobulin and a series of doses of rabies vaccine, is critical to preventing rabies after an exposure; enhanced public education about the risk posed by bats, and the availability of PEP to prevent rabies, is needed. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Community Health Services
- Disease Reservoirs and Vectors
- Environmental Health
- Genetics and Genomics
- Global Health
- Health Behavior and Risk
- Health Equity and Health Disparities
- Healthcare Associated Infections
- Immunity and Immunization
- Injury and Violence
- Laboratory Sciences
- Maternal and Child Health
- Occupational Safety and Health
- Parasitic Diseases
- Public Health Leadership and Management
- Reproductive Health
- Telehealth and Telemedicine
- Zoonotic and Vectorborne Diseases
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