The role of school health services in addressing the needs of students with chronic health conditions: a systematic review
Leroy ZC , Wallin R , Lee S . J Sch Nurs 2016 33 (1) 64-72 Children and adolescents in the United States spend many hours in school. Students with chronic health conditions (CHCs) may face lower academic achievement, increased disability, fewer job opportunities, and limited community interactions as they enter adulthood. School health services provide safe and effective management of CHCs, often for students with limited access to health care. A systematic review to assess the role of school health services in addressing CHCs among students in Grades K-12 was completed using primary, peer-reviewed literature published from 2000 to 2015, on selected conditions: asthma, food allergies, diabetes, seizure disorders, and poor oral health. Thirty-nine articles met the inclusion criteria and results were synthesized; however, 38 were on asthma. Direct access to school nursing and other health services, as well as disease-specific education, improved health and academic outcomes among students with CHCs. Future research needs to include standardized definitions and data collection methods for students with CHCs. |
Unhealthy weight management practices and non-medical use of prescription drugs
Clayton HB , Demissie Z , Lowry R , Lundeen EA , Sharma AJ , Bohm MK . Am J Prev Med 2016 52 (2) 215-219 INTRODUCTION: Non-medical use of prescription drugs (NMUPD) has reached epidemic proportions in the U.S. With approximately one in five high school students engaging in NMUPD, it is important to understand behavioral correlates. METHODS: Data were combined from the 2011 and 2013 cycles of the Youth Risk Behavior Survey, a nationally representative, cross-sectional survey. After restricting the analytic sample to students who reported a weight loss goal of either staying the same weight or losing weight, logistic regression models were used to estimate adjusted prevalence ratios and 95% CIs for associations between unhealthy weight management practices (UWMPs) and lifetime NMUPD. Individual UWMPs-fasting; taking diet pills, powders, or liquids without a doctor's advice; and vomiting or taking laxatives-and total number of UWMPs were examined. Data were analyzed in 2016. RESULTS: UWMPs were more prevalent among female students (21.1% vs 10.7% for fasting; 7.5% vs 5.2% for taking diet pills, powders, or liquids; and 7.6% vs 3.2% for vomiting or taking laxatives). Significant associations between individual UWMPs and NMUPD and between the number of UWMPs and NMUPD were observed. DISCUSSION: UWMPs were associated with NMUPD. Health educators in the school setting, as well as other health professionals who provide services to an adolescent population, can focus on healthy weight management strategies, and other substance-specific messages. CONCLUSIONS: The association between UWMPs and NMUPD may reflect a constellation of problem behaviors exhibited among some adolescents. |
Improving breast cancer outcomes through patient navigation
Richardson LC . J Womens Health (Larchmt) 2016 25 (12) 1193-1194 Breast cancer deaths have been decreasing for several decades with half of the improvement attributed to mammographic screening.1 Cancer screening is not just a screening test but also involves a complex sequence of events at which women can be lost because of individual, provider, health system, and societal factors.2 If diagnostic follow-up and treatment are needed, navigation has a role beyond the initial screening tests. Helping women navigate the health-care system to get to and through treatment is critical for optimal outcomes. Studies using the National Cancer Institute’s CISNET models have found that appropriate treatment will provide the best outcomes and likely decrease mortality, especially in underserved women.3,4 Patient navigation is a novel intervention that has been implemented widely and the purpose of which is to help patients traverse the complex healthcare system.5 The objective of patient navigation is that women who participate, especially those from underserved populations, breast cancer outcomes will improve by decreasing the amount of time it takes for women to receive follow-up services and avoiding loss to follow-up. If diagnostic follow-up and treatment are not obtained, the full benefit of screening is not realized. | The article by Oppong et al. in this issue describes the patient navigation program implemented in the Capital Breast Care Center (CBCC) in Washington, DC. The article examined the interval to diagnosis after an abnormal mammogram for women receiving patient navigation services through CBCC.6 Oppong et al. found that from 2010 to 2012, just less than 10% of women who received screening mammograms through CBCC were recommended to have additional follow-up; 80% of those who were recommended for follow-up returned for diagnostic imaging within a median of 39 days. Of the 162 women recommended for biopsy, 81.5% received the biopsy within a median of 21 days. The authors indicate that these intervals are within performance standards for CDC’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP), which recommend that women complete a diagnostic workup within 60 days of an abnormal screening mammogram.7 |
Increasing cardiac rehabilitation participation from 20% to 70%: A road map from the Million Hearts Cardiac Rehabilitation Collaborative
Ades PA , Keteyian SJ , Wright JS , Hamm LF , Lui K , Newlin K , Shepard DS , Thomas RJ . Mayo Clin Proc 2016 92 (2) 234-242 The primary aim of the Million Hearts initiative is to prevent 1 million cardiovascular events over 5 years. Concordant with the Million Hearts' focus on achieving more than 70% performance in the "ABCS" of aspirin for those at risk, blood pressure control, cholesterol management, and smoking cessation, we outline the cardiovascular events that would be prevented and a road map to achieve more than 70% participation in cardiac rehabilitation (CR)/secondary prevention programs by the year 2022. Cardiac rehabilitation is a class Ia recommendation of the American Heart Association and the American College of Cardiology after myocardial infarction or coronary revascularization, promotes the ABCS along with lifestyle counseling and exercise, and is associated with decreased total mortality, cardiac mortality, and rehospitalizations. However, current participation rates for CR in the United States generally range from only 20% to 30%. This road map focuses on interventions, such as electronic medical record-based prompts and staffing liaisons that increase referrals of appropriate patients to CR, increase enrollment of appropriate individuals into CR, and increase adherence to longer-term CR. We also calculate that increasing CR participation from 20% to 70% would save 25,000 lives and prevent 180,000 hospitalizations annually in the United States. |
Risk behaviors and testing history of African American MSM: implications for prevention
McCree DH , Johnson W , Baytop C , Royal S . J Natl Med Assoc 2016 108 (4) 220-224 Objectives: Knowledge of HIV status is an important step in prevention efforts especially for at risk populations like MSM. CDC recommends that MSM be tested at least annually. There is a limited information on the demographics and risk behaviors of MSM who never tested or test infrequently. This study examined the demographic characteristics, risk behaviors, and HIV status of African American MSM who reported never previously testing for HIV, testing > 12 months prior, or testing within the last 12 months from a testing evaluation study in Washington, D.C. Methods: Eligibility requirements were: 18-64 years old; Black/African American; biologically male; and self-reported oral and/or anal sex with a man in the past six months. Descriptive statistics and logistic regression analyses were used. Results: Men who never tested had greater odds of being 25-34 years old, identifying as bisexual or heterosexual and reporting condomless sex with female and male partners. In the multivariate model, men who never tested or tested > 12 months prior to the study had a greater likelihood of having a BS degree, and being age 35 or over. Being newly identified as HIV-positive was associated with never testing and testing > 12 months prior, but was significant in the multivariate model only for never testing. Conclusion: Results suggest prevention strategies should target risk behaviors rather than orientation and engage older men. Future studies should identify factors associated with risky sexual behaviors for men who never test or test infrequently in order to inform prevention interventions. © 2016. |
School-based HIV/STD testing behaviors and motivations among black and Hispanic teen MSM: Results from a formative evaluation
Morris E , Topete P , Rasberry CN , Lesesne CA , Kroupa E , Carver L . J Sch Health 2016 86 (12) 888-897 BACKGROUND: This evaluation explores experiences with, and motivations for, human immunodeficiency virus (HIV) and sexually transmitted disease (STD) testing among black and Hispanic school-aged young men who have sex with men (YMSM). METHODS: Participants were recruited at community-based organizations that serve YMSM in New York City, Philadelphia, and San Francisco. Eligible participants were 13- to 19-year-old black or Hispanic males who reported attraction to or sexual behavior with other males and/or identified as gay or bisexual, and attended at least 90 days of school in the previous 18 months. Participants (N = 415) completed web-based questionnaires and/or in-depth interviews (N = 32). RESULTS: In the past year, 72.0% of questionnaire participants had been tested for HIV, 13.5% of them at school or school clinic. Participants reported that they would be more likely to get an HIV test if they could be tested close to or at school (34.4%), and 64.4% would use HIV testing if offered in schools. Most interview participants reported willingness to use school-based services if they were offered nonjudgmentally, privately, and confidentially by providers with experience serving YMSM. CONCLUSION: Schools can provide opportunities to make HIV and STD testing accessible to school-aged YMSM, but the services must be provided in ways that are comfortable to them. |
Swaziland HIV Incidence Measurement Survey (SHIMS): a prospective national cohort study
Justman J , Reed JB , Bicego G , Donnell D , Li K , Bock N , Koler A , Philip NM , Mlambo CK , Parekh BS , Duong YT , Ellenberger DL , El-Sadr WM , Nkambule R . Lancet HIV 2016 4 (2) e83-e92 BACKGROUND: Swaziland has the highest national HIV prevalence worldwide. The Swaziland HIV Incidence Measurement Survey (SHIMS) provides the first national HIV incidence estimate based on prospectively observed HIV seroconversions. METHODS: A two-stage survey sampling design was used to select a nationally representative sample of men and women aged 18-49 years from 14 891 households in 575 enumeration areas in Swaziland, who underwent household-based counselling and rapid HIV testing during 2011. All individuals aged 18-49 years who resided or had slept in the household the night before and were willing to undergo home-based HIV testing, answer demographic and behavioural questions in English or siSwati, and provide written informed consent were eligible for the study. We performed rapid HIV testing and assessed sociodemographic and behavioural characteristics with use of a questionnaire at baseline and, for HIV-seronegative individuals, 6 months later. We calculated HIV incidence with Poisson regression modelling as events per person-years x 100, and we assessed covariables as predictors with Cox proportional hazards modelling. Survey weighting was applied and all models used survey sampling methods. FINDINGS: Between Dec 10, 2010, and June 25, 2011, 11 897 HIV-seronegative adults were enrolled in SHIMS and 11 232 (94%) were re-tested. Of these, 145 HIV seroconversions were observed, resulting in a weighted HIV incidence of 2.4% (95% CI 2.1-2.8). Incidence was nearly twice as high in women (3.1%; 95% CI 2.6-3.7) as in men (1.7%; 1.3-2.1, p<0.0001). Among men, partner's HIV-positive status (adjusted hazard ratio [aHR] 2.67, 1.06-6.82, p=0.040) or unknown serostatus (aHR 4.64, 2.32-9.27, p<0.0001) in the past 6 months predicted HIV seroconversion. Among women, significant predictors included not being married (aHR 2.90, 1.44-5.84, p=0.0030), having a spouse who lives elsewhere (aHR 2.66, 1.29-5.45, p=0.0078), and having a partner in the past 6 months with unknown HIV status (aHR 2.87, 1.44-5.84, p=0.0030). INTERPRETATION: Swaziland has the highest national HIV incidence in the world. In high-prevalence countries, population-based incidence measures and programmes that further expand HIV testing and support disclosure of HIV status are needed. FUNDING: President's Emergency Plan for AIDS Relief (PEPFAR) by the Centers for Disease Control and Prevention. |
Menstrual cups and sanitary pads to reduce school attrition, and sexually transmitted and reproductive tract infections: A cluster randomised controlled feasibility study in rural Western Kenya
Phillips-Howard PA , Nyothach E , Ter Kuile FO , Omoto J , Wang D , Zeh C , Onyango C , Mason L , Alexander KT , Odhiambo FO , Eleveld A , Mohammed A , van Eijk AM , Edwards RT , Vulule J , Faragher B , Laserson KF . BMJ Open 2016 6 (11) e013229 OBJECTIVES: Conduct a feasibility study on the effect of menstrual hygiene on schoolgirls' school and health (reproductive/sexual) outcomes. DESIGN: 3-arm single-site open cluster randomised controlled pilot study. SETTING: 30 primary schools in rural western Kenya, within a Health and Demographic Surveillance System. PARTICIPANTS: Primary schoolgirls 14-16 years, experienced 3 menses, no precluding disability, and resident in the study area. INTERVENTIONS: 1 insertable menstrual cup, or monthly sanitary pads, against 'usual practice' control. All participants received puberty education preintervention, and hand wash soap during intervention. Schools received hand wash soap. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary: school attrition (drop-out, absence); secondary: sexually transmitted infection (STI) (Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoea), reproductive tract infection (RTI) (bacterial vaginosis, Candida albicans); safety: toxic shock syndrome, vaginal Staphylococcus aureus. RESULTS: Of 751 girls enrolled 644 were followed-up for a median of 10.9 months. Cups or pads did not reduce school dropout risk (control=8.0%, cups=11.2%, pads=10.2%). Self-reported absence was rarely reported and not assessable. Prevalence of STIs in the end-of-study survey among controls was 7.7% versus 4.2% in the cups arm (adjusted prevalence ratio (aPR) 0.48, 0.24 to 0.96, p=0.039), 4.5% with pads (aPR=0.62; 0.37 to 1.03, p=0.063), and 4.3% with cups and pads pooled (aPR=0.54, 0.34 to 0.87, p=0.012). RTI prevalence was 21.5%, 28.5% and 26.9% among cup, pad and control arms, 71% of which were bacterial vaginosis, with a prevalence of 14.6%, 19.8% and 20.5%, per arm, respectively. Bacterial vaginosis was less prevalent in the cups (12.9%) compared with pads (20.3%, aPR=0.65, 0.44 to 0.97, p=0.034) and control (19.2%, aPR=0.67, 0.43 to 1.04, p=0.075) arm girls enrolled for 9 months or longer. No adverse events were identified. CONCLUSIONS: Provision of menstrual cups and sanitary pads for approximately 1 school-year was associated with a lower STI risk, and cups with a lower bacterial vaginosis risk, but there was no association with school dropout. A large-scale trial on menstrual cups is warranted. TRIAL REGISTRATION: ISRCTN17486946; Results. |
Middle East respiratory syndrome coronavirus and children: What pediatric health care professionals need to know
Bartenfeld M , Griese S , Uyeki T , Gerber SI , Peacock G . Clin Pediatr (Phila) 2016 56 (2) 187-189 As of December 31, 2015, 1621 laboratory-confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) had been reported to the World Health Organization (WHO), with 584 deaths in 26 countries (http://www.who.int/emergencies/mers-cov/en/). Two imported MERS-CoV cases were identified in the United States in May 2014.1 WHO has not declared this disease to constitute a Public Health Emergency of International Concern. However, sporadic MERS-CoV cases could continue to be imported into the United States. This article provides background information on MERS-CoV and MERS-CoV infections in children for pediatric health care providers in the United States. MERS-CoV infections among children have been reported, and severe respiratory illnesses have been documented in children with underlying conditions. United States health care providers should be vigilant in assessing children with severe respiratory illnesses and history of recent travel in or near the Arabian Peninsula for MERS-CoV infections. |
Notes from the field: Clostridium perfringens gastroenteritis outbreak associated with a catered lunch - North Carolina, November 2015
Rinsky JL , Berl E , Greene V , Morrow J , Didomenico A , MacFarquhar J , Gomez GA , Luquez C , Williams C . MMWR Morb Mortal Wkly Rep 2016 65 (46) 1300-1301 During November 2015, the North Carolina Division of Public Health was notified by the Pitt County Health Department (PCHD) that approximately 40 persons who attended a catered company Thanksgiving lunch the previous day were ill with diarrhea and abdominal pain. The North Carolina Division of Public Health and PCHD worked together to investigate the source of illness and implement control measures. Within hours of notification, investigators developed and distributed an online survey to all lunch attendees regarding symptoms and foods consumed and initiated a cohort study. A case of illness was defined as abdominal pain or diarrhea in a lunch attendee with illness onset <24 hours after the event. Risk ratios (RRs) and 95% confidence intervals (CIs) were estimated for all menu items. Among 80 attendees, 58 (73%) completed the survey, including 44 respondents (76%) who reported illnesses meeting the case definition; among these, 41 (93%) reported diarrhea, and 40 (91%) reported abdominal pain. There were no hospitalizations. Symptom onset began a median of 13 hours after lunch (range = 1-22 hours). Risk for illness among persons who ate turkey or stuffing (38 of 44; 86%), which were plated and served together, was significantly higher than risk for illness among those who did not eat turkey or stuffing (six of 14; 43%) (RR = 2.02; 95% CI = 1.09-3.73). |
Progress toward poliomyelitis eradication - Pakistan, January 2015-September 2016
Hsu CH , Mahamud A , Safdar RM , Ahmed J , Jorba J , Sharif S , Farag N , Martinez M , Tangermann RH , Ehrhardt D . MMWR Morb Mortal Wkly Rep 2016 65 (46) 1295-1299 Pakistan, Afghanistan, and Nigeria remain the only countries where endemic wild poliovirus type 1 (WPV1) transmission continues. This report describes the activities, challenges, and progress toward polio eradication in Pakistan during January 2015-September 2016 and updates previous reports. In 2015, a total of 54 WPV1 cases were reported in Pakistan, an 82% decrease from 2014. In 2016, 15 WPV1 cases had been reported as of November 1, representing a 61% decrease compared with the 38 cases reported during the same period in 2015. Among the 15 WPV1 cases reported in 2016, children aged <36 months accounted for 13 cases; four of those children had received only a single dose of oral poliovirus vaccine (OPV). Seven of the 15 WPV1 cases occurred in the province of Khyber Pakhtunkhwa (KP), five in Sindh, two in the Federally Administered Tribal Areas (FATA), and one in Balochistan. During January-September 2016, WPV1 was detected in 9% (36 of 384) of environmental samples collected, compared with 19% (69 of 354) of samples collected during the same period in 2015. Rigorous implementation of the 2015-2016 National Emergency Action Plan (NEAP), coordinated by the National Emergency Operations Center (EOC), has resulted in a substantial decrease in overall WPV1 circulation compared with the previous year. However, detection of WPV1 cases in high-risk areas and the detection of WPV1 in environmental samples from geographic areas where no polio cases are identified highlight the need to continue to improve the quality of supplemental immunization activities (SIAs), immunization campaigns focused on vaccinating children with OPV outside of routine immunization services, and surveillance for acute flaccid paralysis (AFP). Continuation and refinement of successful program strategies, as outlined in the new 2016-2017 NEAP, with particular focus on identifying children missed by vaccination, community-based vaccination, and rapid response to virus identification are needed to stop WPV transmission. |
Early diagnosis of HIV infection in infants - one Caribbean and six sub-Saharan African countries, 2011-2015
Diallo K , Kim AA , Lecher S , Ellenberger D , Beard RS , Dale H , Hurlston M , Rivadeneira M , Fonjungo PN , Broyles LN , Zhang G , Sleeman K , Nguyen S , Jadczak S , Abiola N , Ewetola R , Muwonga J , Fwamba F , Mwangi C , Naluguza M , Kiyaga C , Ssewanyana I , Varough D , Wysler D , Lowrance D , Louis FJ , Desinor O , Buteau J , Kesner F , Rouzier V , Segaren N , Lewis T , Sarr A , Chipungu G , Gupta S , Singer D , Mwenda R , Kapoteza H , Chipeta Z , Knight N , Carmona S , MacLeod W , Sherman G , Pillay Y , Ndongmo CB , Mugisa B , Mwila A , McAuley J , Chipimo PJ , Kaonga W , Nsofwa D , Nsama D , Mwamba FZ , Moyo C , Phiri C , Borget MY , Ya-Kouadio L , Kouame A , Adje-Toure CA , Nkengasong J . MMWR Morb Mortal Wkly Rep 2016 65 (46) 1285-1290 Pediatric human immunodeficiency virus (HIV) infection remains an important public health issue in resource-limited settings. In 2015, 1.4 million children aged <15 years were estimated to be living with HIV (including 170,000 infants born in 2015), with the vast majority living in sub-Saharan Africa. In 2014, 150,000 children died from HIV-related causes worldwide. Access to timely HIV diagnosis and treatment for HIV-infected infants reduces HIV-associated mortality, which is approximately 50% by age 2 years without treatment. Since 2011, the annual number of HIV-infected children has declined by 50%. Despite this gain, in 2014, only 42% of HIV-exposed infants received a diagnostic test for HIV, and in 2015, only 51% of children living with HIV received antiretroviral therapy (1). Access to services for early infant diagnosis of HIV (which includes access to testing for HIV-exposed infants and clinical diagnosis of HIV-infected infants) is critical for reducing HIV-associated mortality in children aged <15 years. Using data collected from seven countries supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), progress in the provision of HIV testing services for early infant diagnosis was assessed. During 2011-2015, the total number of HIV diagnostic tests performed among HIV-exposed infants within 6 weeks after birth (tests for early infant diagnosis of HIV), as recommended by the World Health Organization (WHO) increased in all seven countries (Cote d'Ivoire, the Democratic Republic of the Congo, Haiti, Malawi, South Africa, Uganda, and Zambia); however, in 2015, the rate of testing for early infant diagnosis among HIV-exposed infants was <50% in five countries. HIV positivity among those tested declined in all seven countries, with three countries (Cote d'Ivoire, the Democratic Republic of the Congo, and Uganda) reporting >50% decline. The most common challenges for access to testing for early infant diagnosis included difficulties in specimen transport, long turnaround time between specimen collection and receipt of results, and limitations in supply chain management. Further reductions in HIV mortality in children can be achieved through continued expansion and improvement of services for early infant diagnosis in PEPFAR-supported countries, including initiatives targeted to reach HIV-exposed infants, ensure access to programs for early infant diagnosis of HIV, and facilitate prompt linkage to treatment for children diagnosed with HIV infection. |
HIV care and treatment of American Indians/Alaska Natives with diagnosed HIV infection - 27 states and the District of Columbia, 2012
Mitsch A , Surendera Babu A , Seneca D , Whiteside YO , Warne D . Int J STD AIDS 2016 28 (10) 953-961 The objective of this study was to measure linkage to care, retention in care, and suppressed viral load (VL) among American Indians/Alaska Natives (AIs/ANs) aged ≥13 years with diagnosed HIV infection. We used national HIV case surveillance data to measure linkage to care, defined as ≥1 CD4 or VL test ≤1 month after HIV diagnosis during 2013; retention in care, defined as ≥2 CD4 or VL tests ≥3 months apart during 2012; and suppressed VL, defined as <200 copies/mL at the most recent VL test during 2012. In 2013, 74.1% of AIs/ANs were linked to care. At year-end 2012, 46.9% of AIs/ANs were retained in care and 45.1% were virally suppressed. A lower percentage of females (41.3%), compared with males (46.5), were virally suppressed. By age group, the lowest percentage of virally suppressed AIs/ANs (37.5%) were aged 13-34 years. To improve individual health and to prevent HIV among AIs/ANs, outcomes must improve - particularly for female AIs/ANs and for AIs/ANs aged 13-34 years. Screening for HIV infection in accordance with Centers for Disease Control and Prevention's testing recommendations can lead to improvements along the continuum of HIV care. |
Household transmission of Neisseria meningitidis in the meningitis belt
Meyer SA , Kristiansen PA . Lancet Glob Health 2016 4 (12) e885-e886 The epidemiology of Neisseria meningitidis is dynamic, with risk of meningococcal disease varying widely by region and depending on a confluence of host, organism, and environmental factors. Because transmission of N meningitidis results mainly in asymptomatic carriage, evaluation of oropharyngeal carriage can be helpful to understand the epidemiology and transmission of N meningitidis and, in turn, develop strategies for the prevention and control of meningococcal disease. The bacterium is transmitted through respiratory droplets and close contact, with transmission increasing in crowded settings such as military camps, universities, and schools.1 Household contacts of patients with meningococcal disease have been shown to be at increased risk of meningococcal carriage and disease in developed countries, where incidence of meningococcal disease is low and outbreaks infrequent. However, less is known about household transmission dynamics of N meningitidis in the unique epidemiological context of the meningitis belt of sub-Saharan Africa, which is characterised by high rates of endemic disease, annual outbreaks, and periodic large-scale epidemics, historically due to serogroup A meningococci.2 | In The Lancet Global Health, Caroline Trotter and colleagues3 describe the importance of household transmission of N meningitidis in the meningitis belt using data from a series of cross-sectional meningococcal carriage surveys held across seven countries to describe meningococcal carriage and impact of a novel meningococcal serogroup A conjugate vaccine (MenAfriVac; Serum Institute of India PVT, Pune, India). Within the study the investigators recruited a subset of 184 households containing putative N meningitidis carriers due to any serogroup for longitudinal household carriage surveys carried out over 6 months. 133 households with confirmed index carriers were compared with 51 control households in which N meningitidis in the putative index carrier was ruled out by reference testing. 21% (152 of 739) of individuals within index carrier households subsequently acquired N meninigitidis compared with 9% (35 of 371) of individuals in control households. Due to a paucity of serogroup A carriers, the impact of MenAfriVac vaccination on carriage acquisition or loss within households could not be determined. Although the overall carriage acquisition rate was 2·4% per month (95% CI 1·6–4·0), rates among all age groups were four-to-five-times higher in households with an index carrier. Overall, the mean duration of carriage was 3·4 months (2·7–4·4). Index carriers were most likely to be adolescents, with a median age of 12 years, and children younger than 5 years were most likely to acquire carriage. In index carrier households, most individuals that subsequently developed carriage acquired the same or a similar strain as the index carrier, providing evidence for within-household transmission, although external acquisition was also noted. Further analysis of the strains with next-generation sequencing will be useful to further differentiate transmission within households versus external acquisition. |
Identifying and addressing the daily needs of contacts of an Ebola patient during investigation, monitoring, and movement restriction, Ohio
McCarty CL , Karwowski MP , Basler C , Erme M , Kippes C , Quinn K , de Fijter S , DiOrio C , Braden C , Knust B , Santibañez S . Public Health Rep 2016 131 (5) 661-665 An essential element of Ebola control involves monitoring and movement restrictions for people who come into contact with an Ebola patient while the patient is infectious. Although procedures can vary by local regulations, monitoring and movement restrictions for Ebola contacts normally last for 21 days after the last exposure to the infectious patient. Contact monitoring and movement restrictions allow for early identification of disease to prevent further transmission.1 However, movement restrictions also limit a contact’s ability to meet some of his or her own daily living needs. Ensuring that measures and processes are in place to provide for these needs is an important component of implementing movement restrictions. Stigmatization of contacts because of community fears creates an additional need for supports.2 A previous report of a related Ebola investigation in Texas described the needs of Ebola contacts, including basic needs for food, financial assistance, and education. In that investigation, health officials found that meeting the needs of Ebola contacts was essential to successful contact monitoring.3 | Providing for the daily needs of people whose movement is restricted during an outbreak response is not new to public health. This need was noted during the typhus and cholera epidemics in New York City in 18924 and during the severe acute respiratory syndrome epidemic in Taiwan and Canada in 2013, where affected individuals experienced uncomfortable surroundings, discrimination, uncertainty, and a need for family support.5,6 We discuss the importance of preparing for such daily needs and how the Ebola experience in Ohio adds to the Texas report to inform future situations in which movement restrictions are needed. |
Incidence and etiology of hospitalized acute respiratory infections in the Egyptian Delta
Rowlinson E , Dueger E , Mansour A , Azzazy N , Mansour H , Peters L , Rosenstock S , Hamid S , Said MM , Geneidy M , Abd Allah M , Kandeel A . Influenza Other Respir Viruses 2016 11 (1) 23-32 INTRODUCTION: Acute Respiratory Infections (ARI) are responsible for nearly two million childhood deaths worldwide. A limited number of studies have been published on the epidemiology of viral respiratory pathogens in Egypt. METHODS: A total of 6113 hospitalized patients >1 month of age with suspected ARI were enrolled between June 23, 2009 and December 31, 2013. Naso- and oropharyngeal specimens were collected and tested for influenza A and B, respiratory syncytial virus, human metapneumovirus, adenovirus, and parainfluenza viruses 1-3. Blood specimens from children 1-11 months were cultured and bacterial growth was identified by polymerase chain reaction. Results from a healthcare utilization survey on the proportion of persons seeking care for ARI was used to calculate adjusted ARI incidence rates in the surveillance population. RESULTS: The proportion of patients with a viral pathogen detected decreased with age from 67% in patients age 1-11 months to 19% in patients ≥65 years of age. Influenza was the dominant viral pathogen detected in patients ≥1 year of age (13.9%). The highest incidence rates for hospitalized ARI were observed in children 1-11 months (1757.9-5537.5/100 000 population) and RSV was the most commonly detected pathogen in this age group. CONCLUSION: In this study population, influenza is the largest viral contributor to hospitalized ARIs and children 1-11 months of age experience a high rate of ARI hospitalizations. This study highlights a need for surveillance of additional viral pathogens and alternative detection methods for bacterial pathogens, which may reveal a substantial proportion of as yet unidentified etiologies in adults. |
Knowledge and awareness of cervical cancer among HIV-infected women in Ethiopia
Shiferaw N , Brooks MI , Salvador-Davila G , Lonsako S , Kassahun K , Ansel J , Osakwe C , Weldegebreal T , Ahmed I , Asnake M , Blumenthal PD . Obstet Gynecol Int 2016 2016 1274734 Introduction. Cervical cancer is one of the leading causes of cancer death among Ethiopian women. Low awareness of cervical cancer, in combination with low health care seeking behavior, is a key challenge for cervical cancer prevention. This study assessed the knowledge of cervical cancer among HIV-infected women in Ethiopia. Methods. A facility-based cross-sectional survey was conducted from August to September 2012 among HIV-infected women between 21 and 49 years of age. Basic descriptive statistics were performed using SPSS. Results. A total of 432 HIV-infected women participated in this study. About 71% of participants had ever heard of cervical cancer. Among women who had ever heard of cervical cancer, 49% did not know the cause while 74% were able to identify at least one risk factor for cervical cancer. Only 33% of women were able to correctly address when women should seek care and 33% identified at least one treatment option for cervical cancer. Conclusion. This study revealed that knowledge about cervical cancer was generally low, in particular for health care seeking behavior and treatment of cervical cancer. Health awareness programs should be strengthened at both community and health facility levels with emphasis highlighting the causes, risk factors, care seeking behaviors, and treatment options for cervical cancer. |
Characteristics of pregnant women with hepatitis B virus infection in 5 US public health jurisdictions, 2008-2012
Walker TY , Smith EA , Fenlon N , Lazaroff JE , Dusek C , Fineis P , Crowley SA , Benson R , Veselsky SL , Murphy TV . Public Health Rep 2016 131 (5) 685-694 Objective. We estimated the prevalence of hepatitis B surface antigen (HBsAg), a serologic marker of active hepatitis B virus (HBV) infection, among pregnant women, and estimated the proportion HBsAg-positive pregnant women who had received additional recommended testing. Methods. From 2008 through 2012, Perinatal Hepatitis B Prevention Programs (PHBPPs) in Florida, Michigan, Minnesota, New York City, and Texas prospectively collected data on demographic characteristics of HBsAg-positive pregnant women. We estimated the prevalence of HBsAg positivity among pregnant women by demographic characteristics using natality data. PHBPPs (excluding Texas) collected additional recommended testing (for hepatitis B e antigen [HBeAg] and/or HBV deoxyribonucleic acid [DNA]) among HBsAg-positive pregnant women to measure levels of viremia. Results. During the study period, 15,205 HBsAg-positive women were case-managed. The median age of HBsAg-positive women was 29 years; prenatal HBsAg screening was at a median of 27 weeks pre-delivery. Of 15,205 HBsAg-positive women, 11,293 (74.3%) were foreign-born. In four PHBPPs with 14,098 pregnancies among 12,214 HBsAg-positive women, HBeAg and/or HBV DNA testing was documented for 2,794 (19.8%) pregnancies. The estimated prevalence of HBsAg positivity among pregnant women was 0.38% (17,023 of 4,468,773). HBsAg prevalence was highest among foreign-born women from most regions in Asia (2.0% to 8.7%; with the exception of South Asia, 0.4%) and Africa (3.4%). Conclusion. One-fifth of HBsAg-positive pregnant women had documentation for HBeAg and/or HBV DNA, and about onethird reported receiving care for HBV infection during a case-managed pregnancy. Greater emphasis is needed on prenatal evaluation for HBV liver disease care and treatment among pregnant women with HBV infection. |
An international comparison of the instigation and design of health registers in the epidemiological response to major environmental health incidents
Behbod B , Leonardi G , Motreff Y , Beck CR , Yzermans J , Lebret E , Muravov OI , Bayleyegn T , Wolkin AF , Lauriola P , Close R , Crabbe H , Pirard P . J Public Health Manag Pract 2017 23 (1) 20-28 CONTEXT: Epidemiological preparedness is vital in providing relevant, transparent, and timely intelligence for the management, mitigation, and prevention of public health impacts following major environmental health incidents. A register is a set of records containing systematically collected, standardized data about individual people. Planning for a register of people affected by or exposed to an incident is one of the evolving tools in the public health preparedness and response arsenal. OBJECTIVE: We compared and contrasted the instigation and design of health registers in the epidemiological response to major environmental health incidents in England, France, Italy, the Netherlands, and the United States. DESIGN: Consultation with experts from the 5 nations, supplemented with a review of gray and peer-reviewed scientific literature to identify examples where registers have been used. SETTING: Populations affected by or at risk from major environmental health incidents in England, France, Italy, the Netherlands, and the United States. METHODS: Nations were compared with respect to the (1) types of major incidents in their remit for considering a register; (2) arrangements for triggering a register; (3) approaches to design of register; (4) arrangements for register implementation; (5) uses of registers; and (6) examples of follow-up studies. RESULTS: Health registers have played a key role in the effective public health response to major environmental incidents, including sudden chemical, biological, radiological, or nuclear, as well as natural, more prolonged incidents. Value has been demonstrated in the early and rapid deployment of health registers, enabling the capture of a representative population. CONCLUSION: The decision to establish a health register must ideally be confirmed immediately or soon after the incident using a set of agreed criteria. The establishment of protocols for the instigation, design, and implementation of health registers is recommended as part of preparedness activities. Key stakeholders must be aware of the importance of, and protocols for, establishing a register.Agencies will find value in preparing and implementing registers as part of an effective public health response to major environmental incidents, including sudden chemical, biological, radiological, or nuclear incidents, as well as natural, more prolonged incidents. |
Reconstructing historical VOC concentrations in drinking water for epidemiological studies at a U.S. military base: Summary of results
Maslia Morris L , Aral Mustafa M , Ruckart Perri Z , Bove Frank J . Water (Basel) 2016 8 (10) 449 A U.S. government health agency conducted epidemiological studies to evaluate whether exposures to drinking water contaminated with volatile organic compounds (VOC) at U.S. Marine Corps Base Camp Lejeune, North Carolina, were associated with increased health risks to children and adults. These health studies required knowledge of contaminant concentrations in drinking water-at monthly intervals-delivered to family housing, barracks, and other facilities within the study area. Because concentration data were limited or unavailable during much of the period of contamination (1950s-1985), the historical reconstruction process was used to quantify estimates of monthly mean contaminant-specific concentrations. This paper integrates many efforts, reports, and papers into a synthesis of the overall approach to, and results from, a drinking-water historical reconstruction study. Results show that at the Tarawa Terrace water treatment plant (WTP) reconstructed (simulated) tetrachloroethylene (PCE) concentrations reached a maximum monthly average value of 183 micrograms per liter (g/L) compared to a one-time maximum measured value of 215 g/L and exceeded the U.S. Environmental Protection Agency's current maximum contaminant level (MCL) of 5 g/L during the period November 1957-February 1987. At the Hadnot Point WTP, reconstructed trichloroethylene (TCE) concentrations reached a maximum monthly average value of 783 g/L compared to a one-time maximum measured value of 1400 g/L during the period August 1953-December 1984. The Hadnot Point WTP also provided contaminated drinking water to the Holcomb Boulevard housing area continuously prior to June 1972, when the Holcomb Boulevard WTP came on line (maximum reconstructed TCE concentration of 32 g/L) and intermittently during the period June 1972-February 1985 (maximum reconstructed TCE concentration of 66 g/L). Applying the historical reconstruction process to quantify contaminant-specific monthly drinking-water concentrations is advantageous for epidemiological studies when compared to using the classical exposed versus unexposed approach. |
Legionnaires' outbreaks preventable with water management programs
Lucas CE , Cooley LA , Kunz JM , Garrison LE . ASHRAE J 2016 58 (11) 84-86 The first documented outbreak of Legionnaires' disease was investigated by the Centers for Disease Control and Prevention (CDC) in 1976. Researchers of the time identified a novel bacterial agent responsible for causing the severe pneumonia that sickened or killed several of the American Legionnaires who attended a convention in Pennsylvania. In the ensuing years, scientists characterized the newly discovered bacterium, called Legionella in tribute to the first known victims. Since then we have discovered where the bacteria live, how they cause disease, and the ways they can be transmitted to humans. Most importantly, we learned that most of the disease caused by Legionella is preventable. |
An observational study to evaluate associations between low-level gestational exposure to organophosphate pesticides and cognition during early childhood
Donauer S , Altaye M , Xu Y , Sucharew H , Succop P , Calafat AM , Khoury JC , Lanphear B , Yolton K . Am J Epidemiol 2016 184 (5) 410-8 Prenatal exposure to organophosphate pesticides, which is ubiquitous, may be detrimental to neurological development. We examined 327 mother/infant pairs in Cincinnati, Ohio, between 2003 and 2006 to determine associations between prenatal exposure to organophosphate pesticides and neurodevelopment. Twice during pregnancy urinary concentrations of 6 common dialkylphosphates, nonspecific metabolites of organophosphate pesticides, were measured. Aggregate concentrations of diethylphosphates, dimethylphosphates, and total dialkylphosphates were calculated. Bayley Scales of Infant Development, Second Edition-Mental and Psychomotor Developmental indices were administered at ages 1, 2, and 3 years, the Clinical Evaluation of Language Fundamentals-Preschool, Second Edition, at age 4, and the Wechsler Preschool and Primary Scale of Intelligence, Third Edition, at age 5. Mothers with higher urinary total dialkylphosphate concentrations reported higher levels of socioeconomic status and increased fresh fruit and vegetable intake. We found no associations between prenatal exposure to organophosphate pesticides and cognition at 1-5 years of age. In our cohort, exposure to organophosphate pesticides during pregnancy was not associated with cognition during early childhood. It is possible that a higher socioeconomic status and healthier diet may protect the fetus from potential adverse associations with gestational organophosphate pesticide exposure, or that dietary exposure to the metabolites is innocuous and not an ideal measure of exposure to the parent compound. |
In utero and childhood DDT, DDE, PBDE and PCBs exposure and sex hormones in adolescent boys: The CHAMACOS study
Eskenazi B , Rauch SA , Tenerelli R , Huen K , Holland NT , Lustig RH , Kogut K , Bradman A , Sjodin A , Harley KG . Int J Hyg Environ Health 2016 220 364-372 Dichlorodiphenyltrichloroethane (DDT), polybrominated diphenyl ether (PBDE) flame retardants, and polychlorinated biphenyls (PCBs) are believed to be endocrine-disrupting chemicals (EDCs) in humans and animals. The purpose of this study is to examine the relationship of in utero and childhood exposure to these purported EDCs and reproductive hormones in adolescent boys who participated in CHAMACOS, an ongoing birth cohort in California's Salinas Valley. We measured o,p'- and p,p'-DDT, p,p'- DDE, PBDEs and PCBs in serum collected from mothers during pregnancy or at delivery and from their sons at 9 years. We measured concentrations of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and total testosterone (T) from 234 of their sons at 12 years. In adjusted models, we found that a 10-fold increase in maternal prenatal serum concentrations of BDE-153 was associated with a 22.2% increase (95% CI: 1.0, 47.9) in FSH, a 96.6% increase (95% CI: 35.7, 184.7) in LH, and a 92.4% increase (95% CI: 20.9, 206.2) increase in T. Similarly, BDE-100 concentrations were associated with increases in boys' LH levels. A 10-fold increase in total prenatal SigmaPCBs was associated with a 64.5% increase (95% CI: 8.6, 149.0) in FSH, primarily driven by non- dioxin-like congeners. Boys' hormone levels were only marginally associated with prenatal DDT or DDE in primary models, but when boys' Tanner stage at age 12 was added to models, prenatal maternal DDT levels were associated with decreases in LH (adjusted percent change per 10-fold increase=-18.5%, 95% CI: -29.8, -5.4) and T (percent change=-18.2%, 95% CI: -30.2, -4.2) and DDE with LH (percent change=-18.3%, 95% CI: -32.9, -0.6). Exposures measured in the children's serum at 9 years also showed associations between BDE-153 and SigmaPCBs. However, there is evidence that these associations appear to be mediated by child BMI. This study suggests associations on male hormones of 12 year old boys related to exposure to certain EDC exposure prenatally. The implications on future reproductive function in puberty and adulthood should be determined. |
Development and evaluation of a short adverse childhood experiences measure
Wade R Jr , Becker BD , Bevans KB , Ford DC , Forrest CB . Am J Prev Med 2016 52 (2) 163-172 INTRODUCTION: Clinicians require tools to rapidly identify individuals with significant childhood adversity as part of routine primary care. The goal of this study was to shorten the 11-item Behavioral Risk Factor Surveillance System Adverse Childhood Experiences (ACEs) measure and evaluate the feasibility and validity of this shortened measure as a screener to identify adults who have experienced significant childhood adversity. METHODS: Statistical analysis was conducted in 2015. ACE item responses obtained from 2011-2012 Behavioral Risk Factor Surveillance System data were combined to form a sample of 71,413 adults aged ≥18 years. The 11-item Behavioral Risk Factor Surveillance System ACE measure was subsequently reduced to a two-item screener by maintaining the two dimensions of abuse and household stressors and selecting the most prevalent item within each dimension. RESULTS: The screener included household alcohol and childhood emotional abuse items. Overall, 42% of respondents and at least 75% of the individuals with four or more ACEs endorsed one or both of these experiences. Using the 11-item ACE measure as the standard, a cut off of one or more ACEs yielded a sensitivity of 99%, but specificity was low (66%). Specificity improved to 94% when using a cut off of two ACEs, but sensitivity diminished (70%). There was no substantive difference between the 11-and two-item ACE measures in their strength of association with an array of health outcomes. CONCLUSIONS: A two-item ACE screener appropriate for rapid identification of adults who have experienced significant childhood adversity was developed. |
Ceftriaxone-resistant nontyphoidal salmonella from humans, retail meats, and food animals in the United States, 1996-2013
Iwamoto M , Reynolds J , Karp BE , Tate H , Fedorka-Cray PJ , Plumblee JR , Hoekstra RM , Whichard JM , Mahon BE . Foodborne Pathog Dis 2016 14 (2) 74-83 BACKGROUND: Ceftriaxone resistance in Salmonella is a serious public health threat. Ceftriaxone is commonly used to treat severe Salmonella infections, especially in children. Identifying the sources and drivers of ceftriaxone resistance among nontyphoidal Salmonella is crucial. MATERIALS AND METHODS: The National Antimicrobial Resistance Monitoring System (NARMS) tracks antimicrobial resistance in foodborne and other enteric bacteria from humans, retail meats, and food animals. We examined NARMS data reported during 1996-2013 to characterize ceftriaxone-resistant Salmonella infections in humans. We used Spearman rank correlation to examine the relationships between the annual percentage of ceftriaxone resistance among Salmonella isolates from humans with isolates from retail meats and food animals. RESULTS: A total of 978 (2.9%) of 34,100 nontyphoidal Salmonella isolates from humans were resistant to ceftriaxone. Many (40%) ceftriaxone-resistant isolates were from children younger than 18 years. Most ceftriaxone-resistant isolates were one of three serotypes: Newport (40%), Typhimurium (26%), or Heidelberg (12%). All were resistant to other antimicrobials, and resistance varied by serotype. We found statistically significant correlations in ceftriaxone resistance between human and ground beef Newport isolates (r = 0.83), between human and cattle Typhimurium isolates (r = 0.57), between human and chicken Heidelberg isolates (r = 0.65), and between human and turkey Heidelberg isolates (r = 0.67). CONCLUSIONS: Ceftriaxone resistance among Salmonella Newport, Typhimurium, and Heidelberg isolates from humans strongly correlates with ceftriaxone resistance in isolates from ground beef, cattle, and poultry, respectively. These findings support other lines of evidence that food animals are important reservoirs of ceftriaxone-resistant Salmonella that cause human illness in the United States. |
Complete Genome Sequences for Three Chromosomes of the Burkholderia stabilis Type Strain (ATCC BAA-67).
Bugrysheva JV , Cherney B , Sue D , Conley AB , Rowe LA , Knipe KM , Frace MA , Loparev VN , Avila JR , Anderson K , Hodge DR , Pillai SP , Weigel LM . Genome Announc 2016 4 (6) We report here the complete annotated genome sequence of the Burkholderia stabilis type strain ATCC BAA-67. There were three circular chromosomes with a combined size of 8,527,947 bp and G+C composition of 66.4%. These characteristics closely resemble the genomes of other sequenced members of the Burkholderia cepacia complex. |
Metagenomics of two severe foodborne outbreaks provides diagnostic signatures and signs of co-infection not attainable by traditional methods.
Huang AD , Luo C , Pena-Gonzalez A , Weigand MR , Tarr C , Konstantinidis KT . Appl Environ Microbiol 2016 83 (3) Diagnostic testing for foodborne pathogens relies on culture-based techniques that are not rapid enough for real-time disease surveillance and do not give a quantitative picture of pathogen abundance or the response of the natural microbiome. Powerful sequence-based, culture-independent approaches such as shotgun metagenomics could sidestep these limitations, and potentially reveal a pathogen-specific signature on the microbiome that would have implications not only for diagnostics but also for better understanding disease progression and pathogen ecology. However, metagenomics have not yet been validated for foodborne pathogen detection. Toward closing these gaps, we applied shotgun metagenomics to stool samples collected from two geographically isolated (Alabama and Colorado) foodborne outbreaks, where the etiologic agents were identified as distinct strains of Salmonella enterica serovar Heidelberg by culture-dependent methods. Metagenomic investigations were consistent with the culture-based findings and revealed, in addition, the in-situ abundance and level of intra-population diversity of the pathogen, the possibility for co-infections with Staphylococcus aureus, and significant shifts in the gut microbiome during infection relative to reference healthy samples. Additionally, we designed our bioinformatics pipeline to deal with several challenges associated with analysis of clinical samples such as the high frequency of co-eluting human DNA sequences and assessment of the virulence potential of pathogens. Comparisons of these results to those of other studies revealed that in several cases of diarrheal outbreaks -but not all- the disease and healthy states of the gut microbial community might be distinguishable, opening new possibilities for diagnostics. IMPORTANCE STATEMENT: Diagnostic testing for enteric pathogens has relied for decades on culture-based techniques but a total of 38.4 million cases of foodborne illness per year cannot be attributed to specific causes. This study describes new culture-independent metagenomic approaches and the associated bioinformatics approaches to detect and type the causative agents of microbial disease with unprecedented accuracy, opening new possibilities for future development of health technologies and diagnostics. Our tools and approaches should be applicable to other microbial diseases in addition to foodborne diarrhea. |
Whole genome relationships among Francisella bacteria of diverse origin define new species and provide specific regions for detection.
Challacombe JF , Petersen JM , Gallegos-Graves V , Hodge D , Pillai S , Kuske CR . Appl Environ Microbiol 2016 83 (3) Francisella tularensis (Ft) is a highly virulent zoonotic pathogen that causes tularemia, and because of weaponization efforts in past world wars, is considered a Tier 1 biothreat agent. Detection and surveillance of Ft may be confounded by the presence of uncharacterized, closely related organisms. Through DNA-based diagnostics and environmental surveys, novel clinical and environmental Francisella isolates have been obtained in recent years. Here we present 17 new Francisella genomes and a comparison of their characteristics to each other and to 14 publicly available genomes as well as a comparative analysis of 16S rRNA and sdhA genes from over 90 Francisella strains. Delineation of new species in bacteria is challenging, especially when isolates having very close genomic characteristics exhibit different physiological features - for example, when some are virulent pathogens in humans and animals, while others are non-pathogenic or are opportunistic pathogens. Species resolution within Francisella varies with analyses of single genes, multiple gene or protein sets, or whole genome comparisons of nucleic acid and amino acid sequences. Analyses focusing on single genes (16S rRNA, sdhA), multiple gene sets (virulence genes, LPS biosynthesis, pathogenicity island) and whole genome comparisons (nucleotide and protein) gave congruent results, but with different discrimination confidence. We designate four new species within the genus; Francisella opportunistica sp. nov. (MA06-7296), Francisella salina sp. nov. (TX07-7308), Francisella uliginis sp. nov. (TX07-7310), and Francisella frigiditurris sp. nov. (CA97-1460). This study provides a robust comparative framework to discern species and virulence features of newly detected Francisellas IMPORTANCE: DNA-based detection and sequencing methods have identified thousands of new bacteria in the human body and the environment. In most cases, there are no cultured isolates that correspond to these sequences. While DNA-based approaches are highly sensitive, accurately assigning species is difficult without known near-relatives for comparison. This ambiguity poses challenges for clinical cases, disease epidemics and environmental surveillance, where response times must be short. Many new Francisella isolates have been identified globally. However, their species designations and potential for causing human disease remain ambiguous. Through detailed genome comparisons, we identified features that differentiate F. tularensis from clinical and environmental Francisella isolates and provide a knowledge base for future comparison of Francisellas identified in clinical samples or environmental surveys. |
CDC Grand Rounds: Family History and Genomics as Tools for Cancer Prevention and Control.
Rodriguez JL , Thomas CC , Massetti GM , Duquette D , Avner L , Iskander J , Khoury MJ , Richardson LC . MMWR Morb Mortal Wkly Rep 2016 65 (46) 1291-1294 Although many efforts in cancer prevention and control have routinely focused on behavioral risk factors, such as tobacco use, or on the early detection of cancer, such as colorectal cancer screening, advances in genetic testing have created new opportunities for cancer prevention through evaluation of family history and identification of cancer-causing inherited mutations. Through the collection and evaluation of a family cancer history by a trained health care provider, patients and families at increased risk for a hereditary cancer syndrome can be identified, referred for genetic counseling and testing, and make informed decisions about options for cancer risk reduction (1). Although hereditary cancers make up a small proportion of all cancers, the number of affected persons can be large, and the level of risk among affected persons is high. Two hereditary cancer syndromes for which public health professionals have worked to reduce the burden of morbidity and mortality are hereditary breast and ovarian cancer syndrome (HBOC) and Lynch syndrome. |
Adjusting health expenditures for inflation: A review of measures for health services research in the United States
Dunn A , Grosse SD , Zuvekas SH . Health Serv Res 2016 53 (1) 175-196 OBJECTIVE: To provide guidance on selecting the most appropriate price index for adjusting health expenditures or costs for inflation. DATA SOURCES: Major price index series produced by federal statistical agencies. STUDY DESIGN: We compare the key characteristics of each index and develop suggestions on specific indexes to use in many common situations and general guidance in others. DATA COLLECTION/EXTRACTION METHODS: Price series and methodological documentation were downloaded from federal websites and supplemented with literature scans. PRINCIPAL FINDINGS: The gross domestic product implicit price deflator or the overall Personal Consumption Expenditures (PCE) index is preferable to the Consumer Price Index (CPI-U) to adjust for general inflation, in most cases. The Personal Health Care (PHC) index or the PCE health-by-function index is generally preferred to adjust total medical expenditures for inflation. The CPI medical care index is preferred for the adjustment of consumer out-of-pocket expenditures for inflation. A new, experimental disease-specific Medical Care Expenditure Index is now available to adjust payments for disease treatment episodes. CONCLUSIONS: There is no single gold standard for adjusting health expenditures for inflation. Our discussion of best practices can help researchers select the index best suited to their study. |
Large-scale implementation of disease control programmes: a cost-effectiveness analysis of long-lasting insecticide-treated bed net distribution channels in a malaria-endemic area of western Kenya-a study protocol
Gama E , Were V , Ouma P , Desai M , Niessen L , Buff AM , Kariuki S . BMJ Open 2016 6 (11) e012776 INTRODUCTION: Historically, Kenya has used various distribution models for long-lasting insecticide-treated bed nets (LLINs) with variable results in population coverage. The models presently vary widely in scale, target population and strategy. There is limited information to determine the best combination of distribution models, which will lead to sustained high coverage and are operationally efficient and cost-effective. Standardised cost information is needed in combination with programme effectiveness estimates to judge the efficiency of LLIN distribution models and options for improvement in implementing malaria control programmes. The study aims to address the information gap, estimating distribution cost and the effectiveness of different LLIN distribution models, and comparing them in an economic evaluation. METHODS AND ANALYSIS: Evaluation of cost and coverage will be determined for 5 different distribution models in Busia County, an area of perennial malaria transmission in western Kenya. Cost data will be collected retrospectively from health facilities, the Ministry of Health, donors and distributors. Programme-effectiveness data, defined as the number of people with access to an LLIN per 1000 population, will be collected through triangulation of data from a nationally representative, cross-sectional malaria survey, a cross-sectional survey administered to a subsample of beneficiaries in Busia County and LLIN distributors' records. Descriptive statistics and regression analysis will be used for the evaluation. A cost-effectiveness analysis will be performed from a health-systems perspective, and cost-effectiveness ratios will be calculated using bootstrapping techniques. ETHICS AND DISSEMINATION: The study has been evaluated and approved by Kenya Medical Research Institute, Scientific and Ethical Review Unit (SERU number 2997). All participants will provide written informed consent. The findings of this economic evaluation will be disseminated through peer-reviewed publications. |
Economic assessment of integrated cancer and cardiovascular registries: The Barbados experience
Martelly TN , Rose AM , Subramanian S , Edwards P , Tangka FK , Saraiya M . Cancer Epidemiol 2016 45 Suppl 1 S37-S42 BACKGROUND: This report describes the resources required to support the integrated approach of the Barbados National Registry for Chronic Non-communicable Diseases (BNR) to non-communicable disease (NCD) case registration, and to identify differences in cost for collecting and maintaining information on cancer and cardiovascular disease (CVD) case registration. METHODS: We used the modified Centers for Disease Control and Prevention's International Registry Costing Tool to collect data from the CVD and cancer registries. We used cancer and CVD cost data for the annual period April 2014 through March 2015 to estimate the total cost and cost per case. We used prospectively collected average annual CVD cases, and for cancer cases we assumed 2 or 3 years are needed for retrospective data collection. RESULTS: The Ministry of Health provided 56% of the resources for the registries. Labor accounted for over 70% of both registries' budgets, while management and administration, along with data collection and analysis, incurred the highest costs per case. Total variable cost activities related to data collection and analysis were higher for the CVD component (US$131,297) than the cancer component (US$58,917). The CVD cost per case (US$489) was in between the cancer 2-year (US$382) and the cancer 3-year (US$573) cost-per-case estimates. CONCLUSION: These findings indicate that there are substantial fixed costs related to management and administration of NCD registries. All registries need management and administration support. When registries are combined, management and administration costs can be shared. We project that registries that can share fixed-cost infrastructure are likely to incur a lower total cost per case. |
Evaluation of school-based dental sealant programs: An updated Community Guide Systematic Economic Review
Griffin SO , Naavaal S , Scherrer C , Patel M , Chattopadhyay S . Am J Prev Med 2016 52 (3) 407-415 CONTEXT: A recently updated Community Guide systematic review of the effectiveness of school sealant programs (SSPs) still found strong evidence that SSPs reduced dental caries among schoolchildren. This follow-up systematic review updates SSP cost and benefit information from the original 2002 review. EVIDENCE ACQUISITION: Using Community Guide economic review methods, the authors searched the literature from January 2000 to November 20, 2014. The final body of evidence included 14 studies-ten from the current search and four with cost information from the 2002 review. Nine studies had information on SSP costs; six on sealant benefit (averted treatment costs and productivity losses); four on SSP net cost (cost minus benefit); and three on net cost to Medicaid of clinically delivered sealants. The authors imputed productivity losses and discounted costs/outcomes when this information was missing. The analysis, conducted in 2015, reported all values in 2014 U.S. dollars. EVIDENCE SYNTHESIS: The median one-time SSP cost per tooth sealed was $11.64. Labor accounted for two thirds of costs, and time to provide sealants was a major cost driver. The median annual economic benefit was $6.29, suggesting that over 4 years the SSP benefit ($23.37 at a 3% discount rate) would exceed costs by $11.73 per sealed tooth. In addition, two of four economic models and all three analyses of Medicaid claims data found that SSP benefit to society exceeded SSP cost. CONCLUSIONS: Recent evidence indicates the benefits of SSPs exceed their costs when SSPs target schools attended by a large number of high-risk children. |
Impact of removing mucosal barrier injury laboratory-confirmed bloodstream infections from central line-associated bloodstream infection rates in the National Healthcare Safety Network, 2014
See I , Soe MM , Epstein L , Edwards JR , Magill SS , Thompson ND . Am J Infect Control 2016 45 (3) 321-323 Central line-associated bloodstream infection (CLABSI) event data reported to the National Healthcare Safety Network from 2014, the first year of required use of the mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI) definition, were analyzed to assess the impact of removing MBI-LCBI events from CLABSI rates. CLABSI rates decreased significantly in some location types after removing MBI-LCBI events, and MBI-LCBI events will be removed from publicly reported CLABSI rates. |
Estimating enhanced prevaccination measles transmission hotspots in the context of cross-scale dynamics
Becker AD , Birger RB , Teillant A , Gastanaduy PA , Wallace GS , Grenfell BT . Proc Natl Acad Sci U S A 2016 113 (51) 14595-14600 A key question in clarifying human-environment interactions is how dynamic complexity develops across integrative scales from molecular to population and global levels. Apart from its public health importance, measles is an excellent test bed for such an analysis. Simple mechanistic models have successfully illuminated measles dynamics at the city and country levels, revealing seasonal forcing of transmission as a major driver of long-term epidemic behavior. Seasonal forcing ties closely to patterns of school aggregation at the individual and community levels, but there are few explicit estimates of school transmission due to the relative lack of epidemic data at this scale. Here, we use data from a 1904 measles outbreak in schools in Woolwich, London, coupled with a stochastic Susceptible-Infected-Recovered model to analyze measles incidence data. Our results indicate that transmission within schools and age classes is higher than previous population-level serological data would suggest. This analysis sheds quantitative light on the role of school-aged children in measles cross-scale dynamics, as we illustrate with references to the contemporary vaccination landscape. |
Estimating the burden of rubella virus infection and congenital rubella syndrome through a rubella immunity assessment among pregnant women in the Democratic Republic of the Congo: Potential impact on vaccination policy
Alleman MM , Wannemuehler KA , Hao L , Perelygina L , Icenogle JP , Vynnycky E , Fwamba F , Edidi S , Mulumba A , Sidibe K , Reef SE . Vaccine 2016 34 (51) 6502-6511 BACKGROUND: Rubella-containing vaccines (RCV) are not yet part of the Democratic Republic of the Congo's (DRC) vaccination program; however RCV introduction is planned before 2020. Because documentation of DRC's historical burden of rubella virus infection and congenital rubella syndrome (CRS) has been minimal, estimates of the burden of rubella virus infection and of CRS would help inform the country's strategy for RCV introduction. METHODS: A rubella antibody seroprevalence assessment was conducted using serum collected during 2008-2009 from 1605 pregnant women aged 15-46years attending 7 antenatal care sites in 3 of DRC's provinces. Estimates of age- and site-specific rubella antibody seroprevalence, population, and fertility rates were used in catalytic models to estimate the incidence of CRS per 100,000 live births and the number of CRS cases born in 2013 in DRC. RESULTS: Overall 84% (95% CI 82, 86) of the women tested were estimated to be rubella antibody seropositive. The association between age and estimated antibody seroprevalence, adjusting for study site, was not significant (p=0.10). Differences in overall estimated seroprevalence by study site were observed indicating variation by geographical area (p0.03 for all). Estimated seroprevalence was similar for women declaring residence in urban (84%) versus rural (83%) settings (p=0.67). In 2013 for DRC nationally, the estimated incidence of CRS was 69/100,000 live births (95% CI 0, 186), corresponding to 2886 infants (95% CI 342, 6395) born with CRS. CONCLUSIONS: In the 3 provinces, rubella virus transmission is endemic, and most viral exposure and seroconversion occurs before age 15years. However, approximately 10-20% of the women were susceptible to rubella virus infection and thus at risk for having an infant with CRS. This analysis can guide plans for introduction of RCV in DRC. Per World Health Organization recommendations, introduction of RCV should be accompanied by a campaign targeting all children 9months to 14years of age as well as vaccination of women of child bearing age through routine services. |
Estimating vaccine effectiveness in preventing laboratory-confirmed influenza in outpatient settings in South Africa, 2015
McAnerney JM , Walaza S , Tempia S , Blumberg L , Treurnicht FK , Madhi SA , Valley-Omar Z , Cohen C . Influenza Other Respir Viruses 2016 11 (2) 177-181 Trivalent seasonal influenza vaccine effectiveness during the 2015 season in South Africa was assessed using a test-negative case control study design. Influenza A(H1N1)pdm09 was the dominant circulating strain. Overall influenza vaccine coverage was 3.2% (29/899). The vaccine effectiveness estimate, against any influenza virus infection, adjusted for age, underlying conditions and timing within season was 46.2% (95% CI: -23.5% to 76.5%), and 53.6% (95% CI: -62.6% to 80.3%) against influenza A(H1N1)pdm09. This article is protected by copyright. All rights reserved. |
Factors associated with the uptake of and adherence to HIV pre-exposure prophylaxis in people who have injected drugs: an observational, open-label extension of the Bangkok Tenofovir Study
Martin M , Vanichseni S , Suntharasamai P , Sangkum U , Mock PA , Chaipung B , Worrajittanon D , Leethochawalit M , Chiamwongpaet S , Kittimunkong S , Gvetadze RJ , McNicholl JM , Paxton LA , Curlin ME , Holtz TH , Samandari T , Choopanya K . Lancet HIV 2016 4 (2) e59-e66 BACKGROUND: Results of the randomised, double-blind, placebo-controlled Bangkok Tenofovir Study (BTS) showed that taking tenofovir daily as pre-exposure prophylaxis (PrEP) can reduce the risk of HIV infection by 49% in people who inject drugs. In an extension to the trial, participants were offered 1 year of open-label tenofovir. We aimed to examine the demographic characteristics, drug use, and risk behaviours associated with participants' uptake of and adherence to PrEP. METHODS: In this observational, open-label extension of the BTS (NCT00119106), non-pregnant, non-breastfeeding, HIV-negative BTS participants, all of whom were current or previous injecting drug users at the time of enrolment in the BTS, were offered daily oral tenofovir (300 mg) for 1 year at 17 Bangkok Metropolitan Administration drug-treatment clinics. Participant demographics, drug use, and risk behaviours were assessed at baseline and every 3 months using an audio computer-assisted self-interview. HIV testing was done monthly and serum creatinine was assessed every 3 months. We used logistic regression to examine factors associated with the decision to take daily tenofovir as PrEP, the decision to return for at least one PrEP follow-up visit, and greater than 90% adherence to PrEP. FINDINGS: Between Aug 1, 2013, and Aug 31, 2014, 1348 (58%) of the 2306 surviving BTS participants returned to the clinics, 33 of whom were excluded because they had HIV (n=27) or grade 2-4 creatinine results (n=6). 798 (61%) of the 1315 eligible participants chose to start open-label PrEP and were followed up for a median of 335 days (IQR 0-364). 339 (42%) participants completed 12 months of follow-up; 220 (28%) did not return for any follow-up visits. Participants who were 30 years or older (odds ratio [OR] 1.8, 95% CI 1.4-2.2; p<0.0001), injected heroin (OR 1.5, 1.1-2.1; p=0.007), or had been in prison (OR 1.7, 1.3-2.1; p<0.0001) during the randomised trial were more likely to choose PrEP than were those without these characteristics. Participants who reported injecting heroin or being in prison during the 3 months before open-label enrolment were more likely to return for at least one open-label follow-up visit than those who did not report injecting heroin (OR 3.0, 95 % CI 1.3-7.3; p=0.01) or being in prison (OR 2.3, 1.4-3.7; p=0.0007). Participants who injected midazolam or were in prison during open-label follow-up were more likely to be greater than 90% adherent than were those who did not inject midazolam (OR 2.2, 95% CI 1.2-4.3; p=0.02) or were not in prison (OR 4.7, 3.1-7.2; p<0.0001). One participant tested positive for HIV, yielding an HIV incidence of 2.1 (95% CI 0.05-11.7) per 1000 person-years. No serious adverse events related to tenofovir use were reported. INTERPRETATION: More than 60% of returning, eligible BTS participants started PrEP, which indicates that a substantial proportion of PWID who are knowledgeable about PrEP might be interested in taking it. Participants who had injected heroin or been in prison were more likely to choose to take PrEP, suggesting that participants based their decision to take PrEP, at least in part, on their perceived risk of incident HIV infection. FUNDING: US Centers for Disease Control and Prevention and the Bangkok Metropolitan Administration. |
Influenza vaccination of healthcare personnel by work setting and occupation-U.S., 2014
Lu PJ , O'Halloran AC , Ding H , Williams WW , Black CL . Am J Prev Med 2016 51 (6) 1015-1026 INTRODUCTION: Routine influenza vaccination of healthcare personnel (HCP) can reduce influenza-related illness and its potentially serious consequences among HCP and their patients. Influenza vaccination has been routinely recommended for HCP since 1984. METHODS: Data from the 2013 and 2014 National Health Interview Survey were analyzed in 2015. Kaplan-Meier survival estimated the cumulative proportion of HCP reporting 2013-2014 season influenza vaccination. Vaccination coverage by work setting and occupation were assessed. Multivariable logistic regression and predictive marginal analyses identified factors independently associated with vaccination among HCP. RESULTS: Influenza vaccination coverage was 64.9% among HCP aged ≥18 years (95% CI=60.5%, 69.3%), which was significantly higher compared with non-HCP among the same age group (41.0%, 95% CI=39.8%, 42.1%) (p<0.05). Vaccination coverage was higher among physicians (82.3%) and nurses (77.5%) than other types of HCP (range, 50.2%-65.6%). Coverage was higher among HCP working in hospitals (76.9%) versus other settings (range, 53.9%-60.2%). Characteristics independently associated with an increased likelihood of vaccination among HCP were older age, higher education, having more physician contacts, and having health insurance. Having never been married was independently associated with decreased likelihood of vaccination among HCP. CONCLUSIONS: Influenza vaccination coverage was higher among HCP than non-HCP, but still below the national target of 90%. Vaccination coverage varied widely by occupation type, work settings, and demographic characteristics. Evidence-based interventions, such as making vaccine available at no cost in the workplace and active promotion of vaccination, are needed to increase influenza vaccination among HCP in all healthcare settings. |
The role of pharmacists in preventing falls among America's older adults
Karani MV , Haddad Y , Lee R . Front Public Health 2016 4 250 Falls are the leading cause of both fatal and non-fatal injuries in people aged 65 years and older and can lead to significant costs, injuries, functional decline, and reduced quality of life. While certain medications are known to increase fall risk, medication use is a modifiable risk factor. Pharmacists have specialized training in medication management and can play an important role in fall prevention. Working in a patient-centered team-based approach, pharmacists can collaborate with the primary care providers to reduce fall risk. They can screen for fall risk, review and optimize medication therapy, recommend vitamin D, and educate patients and caregivers about ways to prevent falls. To help health-care providers implement fall prevention, the Centers for Disease Control and Prevention developed the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative. Based on the established clinical guidelines, STEADI provides members of the health-care team, including pharmacists, with the tools and resources they need to manage their older patients' fall risk. These tools are being adapted to specifically advance the roles of pharmacists in reviewing medications, identifying those that increase fall risk, and communicating those risks with patients' primary care providers. Through a multidisciplinary approach, pharmacists along with other members of the health-care team can better meet the needs of America's growing older adult population and reduce falls. |
Computational fluid dynamic modeling of a medium-sized surface mine blasthole drill shroud
Zheng Y , Reed WR , Zhou L , Rider JP . Min Eng 2016 68 (11) 43-49 The Pittsburgh Mining Research Division of the U.S. National Institute for Occupational Safety and Health (NIOSH) recently developed a series of models using computational fluid dynamics (CFD) to study airflows and respirable dust distribution associated with a mediumsized surface blasthole drill shroud with a dry dust collector system. Previously run experiments conducted in NIOSH's full-scale drill shroud laboratory were used to validate the models. The setup values in the CFD models were calculated from experimental data obtained from the drill shroud laboratory and measurements of test material particle size. Subsequent simulation results were compared with the experimental data for several test scenarios, including 0.14 m3/s (300 cfm) and 0.24 m3/s (500 cfm) bailing airflow with 2:1, 3:1 and 4:1 dust collector-tobailing airflow ratios. For the 2:1 and 3:1 ratios, the calculated dust concentrations from the CFD models were within the 95 percent confidence intervals of the experimental data. This paper describes the methodology used to develop the CFD models, to calculate the model input and to validate the models based on the experimental data. Problem regions were identified and revealed by the study. The simulation results could be used for future development of dust control methods for a surface mine blasthole drill shroud. |
Cross-reactivity of the 31 kDa antigen of Angiostrongylus cantonensis - dealing with the immunodiagnosis of meningoencephalitis
Morassutti AL , Rascoe LN , Handali S , DASilva AJ , Wilkins PP , Graeff-Teixeira C . Parasitology 2016 144 (4) 1-5 The primary causative agent of eosinophilic meningoencephalitis (EoM) in endemic regions is the nematode Angiostrongylus cantonensis. The occurrence of EoM was previously restricted to countries in Southeast Asia and the Pacific Islands; however, more recently, it has been reported from other regions, including Brazil. The commonly used diagnosis is detection of specific antibody reactivity to the 31 kDa antigen, which is derived from female worm somatic extracts. Here we report the occurrence of cross-reactivity to this antigen in sera from other parasitic infections, especially those that may cause EoM, such as gnathostomiasis, toxocariasis, hydatidosis and strongyloidiasis. We also demonstrated that the cross-reactivity, in part, is dependent of the concentration of antigen used in Western blot assays. We discuss the importance of these findings on the interpretation of this test. |
Detection of methicillin-resistant Staphylococcus aureus using phage amplification combined with matrix-assisted laser desorption/ionization mass spectrometry
Rees JC , Barr JR . Anal Bioanal Chem 2016 409 (5) 1379-1386 Antibiotic resistance continues to contribute significantly to morbidity and mortality across the world. Developing new tests for antibiotic-resistant bacteria is a core action to combat resistant infections. We describe a method that uses phage amplification detection (PAD) combined with matrix-assisted laser desorption/ionization mass spectrometry (MALDI-MS) to rapidly identify Staphylococcus aureus and determine phenotypic susceptibility to cefoxitin. Samples tested for S. aureus are incubated together with bacteriophage in the presence and absence of cefoxitin and subjected to rapid trypsin digestion followed by MALDI-MS analysis. Tryptic peptides derived from amplified phage proteins can be detected by MALDI-MS, as validated by time-of-flight (TOF)/TOF analysis of each peptide combined with database searching. Methicillin-resistant S. aureus show significant phage amplification in the presence of cefoxitin, while methicillin-sensitive S. aureus show no phage amplification relative to a no-antibiotic control. We also show that PAD methodology can be implemented on an FDA-approved commercial MALDI-MS bacterial identification system to identify S. aureus and determine antibiotic susceptibility. The novelty of this assay includes the use of phage-derived tryptic peptides as detected by MALDI-MS to monitor the results of PAD on an instrument common to many modern microbiology laboratories. |
Does incorporating change in APRI or FIB-4 indices over time improve the accuracy of a single index for identifying liver fibrosis in persons with chronic hepatitis C virus infection?
Gounder PP , Haering C , Bruden DJ , Townshend-Bulson L , Simons BC , Spradling PR , McMahon BJ . J Clin Gastroenterol 2016 52 (1) 60-66 BACKGROUND: The aspartate aminotransferase-to-platelet ratio index (APRI) and a fibrosis index calculated using platelets (FIB-4) have been proposed as noninvasive markers of liver fibrosis. GOALS: To determine APRI/FIB-4 accuracy for predicting histologic liver fibrosis and evaluate whether incorporating change in index improves test accuracy in hepatitis C virus (HCV)-infected Alaska Native persons. STUDY: Using liver histology as the gold standard, we determined the test characteristics of APRI to predict Metavir ≥F2 fibrosis and FIB-4 to predict Metavir ≥F3 fibrosis. Index discrimination was measured as the area under the receiver operator characteristic curve. We fit a logistic regression model to determine whether incorporating change in APRI/FIB-4 over time improved index discrimination. RESULTS: Among 283 participants, 46% were female, 48% had a body mass index >30, 11% had diabetes mellitus, 8% reported current heavy alcohol use. Participants were infected with HCV genotypes 1 (68%), 2 (17%), or 3 (15%). On liver histology, 30% of study participants had ≥F2 fibrosis and 15% had ≥F3 fibrosis. The positive predictive value of an APRI>1.5/FIB-4>3.25 for identifying fibrosis was 77%/78%. The negative predictive value of an APRI<0.5/FIB-4<1.45 was 91%/87%. The area under the receiver operator characteristic curve of an APRI/FIB-4 for identifying fibrosis was 0.82/0.84. Incorporating change in APRI/FIB-4 did not improve index discrimination. CONCLUSIONS: The accuracy of APRI/FIB-4 for identifying liver fibrosis in HCV-infected Alaska Native persons is similar to that reported in other populations and could help prioritize patients for treatment living in areas without access to liver biopsy. Change in APRI/FIB-4 was not predictive of degree of fibrosis. |
The role of technology in the neonatal screening laboratory
De Jesus VR . J Inborn Errors Metab Screen 2016 4 1-2 In 1961, Dr. Robert Guthrie initiated the collection of blood as dried spots on filter paper for testing newborns for the detection of phenylketonuria (PKU) (1, 2). He analyzed these dried blood spot (DBS) specimens with a bacterial inhibition test that he developed to measure phenylalanine (2). This combination of easily transportable specimens and an inexpensive, simple test made large-scale testing for PKU possible. As a result of Guthrie’s efforts, the successful introduction of DBS as a source for PKU screening eventually led to population-based screening for over 32 disorders for all newborns in the United States from only a few blood drops collected from a heel stick and absorbed into special filter paper. | Today, newborn screening (NBS) is the largest population-based genetic screening effort in the U.S. and is performed worldwide (3). The detection of treatable, inherited congenital disorders is a major public health responsibility. The U.S. Centers for Disease Control and Prevention has recognized newborn screening as one of the ten great public health achievements in the United States in the first decade on the 21st century (4). Newborn screening programs are designed to detect asymptomatic newborns that are at higher risk for certain diseases from those who may not, using DBS specimens collected 24–72 hours after birth. Babies that are screen-positive are rapidly followed-up with a diagnostic confirmation and appropriate treatment that helps to prevent mental retardation, premature death and other deleterious clinical outcomes. Improvements in technology and the expansion of the recommended uniform newborn screening panel of diseases have led to earlier life-saving treatment and intervention for at least 12,000 additional newborns each year in the United States with selected genetic, hearing and endocrine disorders (5). |
Placental massive perivillous fibrinoid deposition associated with coxsackievirus A16-report of a case, and review of the literature
Heller DS , Tellier R , Pabbaraju K , Wong S , Faye-Petersen OM , Muehlenbachs A , Goldsmith C , Denison A , Zaki SR . Pediatr Dev Pathol 2016 19 (5) 421-423 Massive placental perivillous fibrinoid deposition in the placenta is thought to be an immune-related condition associated with poor perinatal outcomes, including growth restriction and intrauterine fetal demise, with a high risk of recurrence. Rare cases have been associated with Coxsackievirus infection. We present such a case and review the literature. |
Willingness to know the cause of death and hypothetical acceptability of the minimally invasive autopsy in six diverse African and Asian settings: A mixed methods socio-behavioural study
Maixenchs M , Anselmo R , Zielinski-Gutierrez E , Odhiambo FO , Akello C , Ondire M , Zaidi SS , Soofi SB , Bhutta ZA , Diarra K , Djiteye M , Dembele R , Sow S , Minsoko PC , Agnandji ST , Lell B , Ismail MR , Carrilho C , Ordi J , Menendez C , Bassat Q , Munguambe K . PLoS Med 2016 13 (11) e1002172 BACKGROUND: The minimally invasive autopsy (MIA) is being investigated as an alternative to complete diagnostic autopsies for cause of death (CoD) investigation. Before potential implementation of the MIA in settings where post-mortem procedures are unusual, a thorough assessment of its feasibility and acceptability is essential. METHODS AND FINDINGS: We conducted a socio-behavioural study at the community level to understand local attitudes and perceptions related to death and the hypothetical feasibility and acceptability of conducting MIAs in six distinct settings in Gabon, Kenya, Mali, Mozambique, and Pakistan. A total of 504 interviews (135 key informants, 175 health providers [including formal health professionals and traditional or informal health providers], and 194 relatives of deceased people) were conducted. The constructs "willingness to know the CoD" and "hypothetical acceptability of MIAs" were quantified and analysed using the framework analysis approach to compare the occurrence of themes related to acceptability across participants. Overall, 75% (379/504) of the participants would be willing to know the CoD of a relative. The overall hypothetical acceptability of MIA on a relative was 73% (366/504). The idea of the MIA was acceptable because of its perceived simplicity and rapidity and particularly for not "mutilating" the body. Further, MIAs were believed to help prevent infectious diseases, address hereditary diseases, clarify the CoD, and avoid witchcraft accusations and conflicts within families. The main concerns regarding the procedure included the potential breach of confidentiality on the CoD, the misperception of organ removal, and the incompatibility with some religious beliefs. Formal health professionals were concerned about possible contradictions between the MIA findings and the clinical pre-mortem diagnoses. Acceptability of the MIA was equally high among Christian and Islamic communities. However, in the two predominantly Muslim countries, MIA acceptability was higher in Mali than in Pakistan. While the results of the study are encouraging for the potential use of the MIA for CoD investigation in low-income settings, they remain hypothetical, with a need for confirmation with real-life MIA implementation and in populations beyond Health and Demographic Surveillance System areas. CONCLUSIONS: This study showed a high level of interest in knowing the CoD of a relative and a high hypothetical acceptability of MIAs as a tool for CoD investigation across six distinct settings. These findings anticipate potential barriers and facilitators, both at the health facility and community level, essential for local tailoring of recommendations for future MIA implementation. |
Nutritional situation among Syrian refugees hosted in Iraq, Jordan, and Lebanon: cross sectional surveys
Hossain SM , Leidman E , Kingori J , Al Harun A , Bilukha OO . Confl Health 2016 10 26 BACKGROUND: Ongoing armed conflict in Syria has caused large scale displacement. Approximately half of the population of Syria have been displaced including the millions living as refugees in neighboring countries. We sought to assess the health and nutrition of Syrian refugees affected by the conflict. METHODS: Representative cross-sectional surveys of Syrian refugees were conducted between October 2 and November 30, 2013 in Lebanon, April 12 and May 1, 2014 in Jordan, and May 20 and 31, 2013 in Iraq. Surveys in Lebanon were organized in four geographical regions (North, South, Beirut/Mount Lebanon and Bekaa). In Jordan, independent surveys assessed refugees residing in Za'atri refugee camp and refugees residing among host community nationwide. In Iraq, refugees residing in Domiz refugee camp in the Kurdistan region were assessed. Data collected on children aged 6 to 59 months included anthropometric indicators, morbidity and feeding practices. In Jordan and Lebanon, data collection also included hemoglobin concentration for children and non-pregnant women aged 15 to 49 years, anthropometric indicators for both pregnant and non-pregnant women, and household level indicators such as access to safe water and sanitation. RESULTS: The prevalence of global acute malnutrition among children 6 to 59 months of age was less than 5 % in all samples (range 0.3-4.4 %). Prevalence of acute malnutrition among women 15 to 49 years of age, defined as mid-upper arm circumference less than 23.0 cm, was also relatively low in all surveys (range 3.5-6.5 %). For both children and non-pregnant women, anemia prevalence was highest in Za'atri camp in Jordan (48.4 % and 44.8 %, respectively). Most anemia was mild or moderate; prevalence of severe anemia was less than or equal to 1.1 % in all samples of children and women. CONCLUSIONS: Despite the ongoing conflict, results from all surveys indicate that global acute malnutrition is relatively low in the assessed Syrian refugee populations. However, prevalence of anemia suggests a serious public health problem among women and children, especially in Za'atri camp. Based on these findings, nutrition partners in the region have reprioritized response interventions, focusing on activities to address micronutrient deficiencies such as food fortification. |
The new ANSI nail gun standard: A lost opportunity for safety
Howard J , Branche CM , Earnest GS . Am J Ind Med 2016 60 (2) 147-151 Pneumatic nail guns have been shown in published studies to cause injury and death to both workers and consumers, but those equipped with sequential trigger mechanisms provide much greater safety protection against unintentional discharge than those equipped with contact triggers. In 2015 the American National Standards Institute (ANSI) approved a revision to its 2002 nail gun standard, but failed to require sequential triggers. Substantive and procedural deficiencies in the ANSI standard's development process resulted in a scientifically unsound nail gun safety standard, detracting from its use as the basis for a mandatory national safety standard and ultimately from its ability to protect worker and consumer users. |
Determinants of disinfectant use among nurses in U.S. healthcare facilities
Dumas O , Wiley AS , Henneberger PK , Speizer FE , Zock JP , Varraso R , Le Moual N , Boggs KM , Camargo CA Jr . Am J Ind Med 2016 60 (1) 131-140 BACKGROUND: Disinfectant use among healthcare workers has been associated with respiratory disorders, especially asthma. We aimed to describe disinfectants used by U.S. nurses, and to investigate qualitative and quantitative differences according to workplace characteristics and region. METHODS: Disinfectant use was assessed by questionnaire in 8,851 nurses. Hospital characteristics were obtained from the American Hospital Association database. RESULTS: Working in a hospital was associated with higher disinfectant use (OR: 2.06 [95%CI: 1.89-2.24]), but lower spray use (0.74 [0.66-0.82]). Nurses working in smaller hospitals (<50 beds vs. ≥200 beds) were more likely to use disinfectants (1.69 [1.23-2.32]) and sprays (1.69 [1.20-2.38]). Spray use was lower in the West than in the Northeast (0.75 [0.58-0.97]). CONCLUSION: Disinfectant use was more common among nurses working in smaller hospitals, possibly because they perform more diverse tasks. Variations in spray use by hospital size and region suggest additional targets for future efforts to prevent occupational asthma. |
Defining hazard from the mine worker's perspective
Eiter BM , Kosmoski CL , Connor BP . Min Eng 2016 68 (11) 50-54 In the recent past, the mining industry has witnessed a substantial increase in the numbers of fatalities occurring at metal and nonmetal mine sites, but it is unclear why this is occurring. One possible explanation is that workers struggle with identifying worksite hazards and accurately assessing the associated risk. The purpose of this research was to explore this possibility within the mining industry and to more fully understand stone, sand and gravel (SSG) mine workers' thoughts, understandings and perceptions of worksite hazards and risks. Eight mine workers were interviewed and asked to identify common hazards they come across when doing their jobs and to then discuss their perceptions of the risks associated with those identified hazards. The results of this exploratory study indicate the importance of workers' jobrelated experience as it applies to hazard identification and risk perception, particularly their knowledge of or familiarity with a task, whether or not they had personal control over that task, and the frequency with which they perform that task. |
Efficacy and Safety of High-Dose Ivermectin for Reducing Malaria Transmission (IVERMAL): Protocol for a Double-Blind, Randomized, Placebo-Controlled, Dose-Finding Trial in Western Kenya.
Smit MR , Ochomo E , Aljayyoussi G , Kwambai T , Abong'o B , Bayoh N , Gimnig J , Samuels A , Desai M , Phillips-Howard PA , Kariuki S , Wang D , Ward S , Ter Kuile FO . JMIR Res Protoc 2016 5 (4) e213 BACKGROUND: Innovative approaches are needed to complement existing tools for malaria elimination. Ivermectin is a broad spectrum antiparasitic endectocide clinically used for onchocerciasis and lymphatic filariasis control at single doses of 150 to 200 mcg/kg. It also shortens the lifespan of mosquitoes that feed on individuals recently treated with ivermectin. However, the effect after a 150 to 200 mcg/kg oral dose is short-lived (6 to 11 days). Modeling suggests higher doses, which prolong the mosquitocidal effects, are needed to make a significant contribution to malaria elimination. Ivermectin has a wide therapeutic index and previous studies have shown doses up to 2000 mcg/kg (ie, 10 times the US Food and Drug Administration approved dose) are well tolerated and safe; the highest dose used for onchocerciasis is a single dose of 800 mcg/kg. OBJECTIVE: The aim of this study is to determine the safety, tolerability, and efficacy of ivermectin doses of 0, 300, and 600 mcg/kg/day for 3 days, when provided with a standard 3-day course of the antimalarial dihydroartemisinin-piperaquine (DP), on mosquito survival. METHODS: This is a double-blind, randomized, placebo-controlled, parallel-group, 3-arm, dose-finding trial in adults with uncomplicated malaria. Monte Carlo simulations based on pharmacokinetic modeling were performed to determine the optimum dosing regimens to be tested. Modeling showed that a 3-day regimen of 600 mcg/kg/day achieved similar median (5 to 95 percentiles) maximum drug concentrations (Cmax) of ivermectin to a single of dose of 800 mcg/kg, while increasing the median time above the lethal concentration 50% (LC50, 16 ng/mL) from 1.9 days (1.0 to 5.7) to 6.8 (3.8 to 13.4) days. The 300 mcg/kg/day dose was chosen at 50% of the higher dose to allow evaluation of the dose response. Mosquito survival will be assessed daily up to 28 days in laboratory-reared Anopheles gambiae s.s. populations fed on patients' blood taken at days 0, 2 (Cmax), 7 (primary outcome), 10, 14, 21, and 28 after the start of treatment. Safety outcomes include QT-prolongation and mydriasis. The trial will be conducted in 6 health facilities in western Kenya and requires a sample size of 141 participants (47 per arm). Sub-studies include (1) rich pharmacokinetics and (2) direct skin versus membrane feeding assays. RESULTS: Recruitment started July 20, 2015. Data collection was completed July 2, 2016. Unblinding and analysis will commence once the database has been completed, cleaned, and locked. CONCLUSIONS: High-dose ivermectin, if found to be safe and well tolerated, might offer a promising new tool for malaria elimination. |
Safety, tolerability, and efficacy of repeated doses of dihydroartemisinin-piperaquine for prevention and treatment of malaria: a systematic review and meta-analysis
Gutman J , Kovacs S , Dorsey G , Stergachis A , Ter Kuile FO . Lancet Infect Dis 2016 17 (2) 184-193 BACKGROUND: Intermittent preventive treatment (IPT) for malaria is used in infants, children, adults, and pregnant women. Dihydroartemisinin-piperaquine (DP) is an effective, well tolerated artemisinin-based combination therapy. The long half-life of piperaquine makes it attractive for IPT. We conducted a systematic review and meta-analysis to establish the efficacy and safety of repeated treatment with DP. METHODS: Following PRISMA guidelines, we searched multiple databases on Sept 1, 2016, with the terms: "human" AND "dihydroartemisinin-piperaquine" OR "DHA-PPQ". Studies were eligible if they were randomised controlled trials (RCTs) or prospective cohort studies involving repeat exposures to standard 3-day courses of DP for either seasonal malaria chemoprevention, mass drug administration, or treatment of clinical malaria, conducted at any time and in any geographic location. Random-effects meta-analysis was used to generate pooled incidence rate ratios and relative risks, or risk differences. FINDINGS: 11 studies were included: two repeat treatment studies (one in children younger than 5 years and one in pregnant women), and nine IPT trials (five in children younger than 5 years, one in schoolchildren, one in adults, two in pregnant women). Comparator interventions included placebo, artemether-lumefantrine, sulfadoxine-pyrimethamine (SP), SP+amodiaquine, SP+piperaquine, SP+chloroquine, and co-trimoxazole. Of 14 628 participants, 3935 received multiple DP courses (2-18). Monthly IPT-DP was associated with an 84% reduction in the incidence of malaria parasitaemia measured by microscopy compared with placebo. Monthly IPT-DP was associated with fewer serious adverse events than placebo, daily co-trimoxazole, or monthly SP. Among 56 IPT-DP recipients (26 children, 30 pregnant women) with cardiac parameters, all QTc intervals were within normal limits, with no significant increase in QTc prolongation with increasing courses of DP. INTERPRETATION: Monthly DP appears well tolerated and effective for IPT. Additional data are needed in pregnancy and to further explore the cardiac safety with monthly dosing. FUNDING: Bill & Melinda Gates Foundation and NIH. |
Photo quiz: A 4-year-old boy vomits on his sister
Westblade LF , Mathison BA , Singer MS , Jerris RC , Caltharp SA . J Clin Microbiol 2016 54 (12) 2845 A 4-year-old boy with a 2-month history of cough presented to a pediatric urgent care center following an acute coughing episode where he vomited on his sister's shirt and a live worm-like organism admixed with vomitus and mucus was discovered. His chronic cough was characterized by an undulating course, increased nocturnal severity, and frequent posttussive emesis. The patient had no significant previous medical or travel history. On physical examination, the boy was afebrile and breathing at a normal rate and rhythm. A chest radiograph showed no abnormal findings. He exhibited no abdominal distention, tenderness, or guarding. On presentation, a complete blood count was notable for mild eosinophilia (430 eosinophils/μl [normal, <350 eosinophils/μl]) (See reference 1 in the answer to the photo quiz [doi:10.1128/JCM.03116-14]), and the worm-like organism was submitted to the pathology department for identification (Fig. 1). |
Increasing insecticide resistance in Anopheles funestus and Anopheles arabiensis in Malawi, 2011-2015
Mzilahowa T , Chiumia M , Mbewe RB , Uzalili VT , Luka-Banda M , Kutengule A , Mathanga DP , Ali D , Chiphwanya J , Zoya J , Mulenga S , Dodoli W , Bergeson-Lockwood J , Troell P , Oyugi J , Lindblade K , Gimnig JE . Malar J 2016 15 (1) 563 BACKGROUND: Susceptibility of principal Anopheles malaria vectors to common insecticides was monitored over a 5-year period across Malawi to inform and guide the national malaria control programme. METHODS: Adult blood-fed Anopheles spp. and larvae were collected from multiple sites in sixteen districts across the country between 2011 and 2015. First generation (F1) progeny aged 2-5 days old were tested for susceptibility, using standard WHO procedures, against pyrethroids (permethrin and deltamethrin), carbamates (bendiocarb and propoxur), organophosphates (malathion and pirimiphos-methyl) and an organochlorine (DDT). RESULTS: Mortality of Anopheles funestus to deltamethrin, permethrin, bendiocarb and propoxur declined significantly over the 5-year (2011-2015) monitoring period. There was wide variation in susceptibility to DDT but it was not associated with time. In contrast, An. funestus exhibited 100% mortality to the organophosphates (malathion and pirimiphos-methyl) at all sites tested. There was reduced mortality of Anopheles arabiensis to deltamethrin over time though this was not statistically significant. However, mortality of An. arabiensis exposed to permethrin declined significantly over time. Anopheles arabiensis exposed to DDT were more likely to be killed if there was high ITN coverage in the mosquito collection area the previous year. There were no other associations between mosquito mortality in a bioassay and ITN coverage or IRS implementation. Mortality of An. funestus from four sites exposed to deltamethrin alone ranged from 2 to 31% and from 41 to 94% when pre-exposed to the synergist piperonyl butoxide followed by deltamethrin. For permethrin alone, mortality ranged from 2 to 13% while mortality ranged from 63 to 100% when pre-exposed to PBO. CONCLUSION: Pyrethroid resistance was detected in An. funestus and An. arabiensis populations across Malawi and has worsened over the last 5 years. New insecticides and control strategies are urgently needed to reduce the burden of malaria in Malawi. |
Answer to December 2016 photo quiz
Westblade LF , Mathison BA , Singer MS , Jerris RC , Caltharp SA . J Clin Microbiol 2016 54 (12) 3076 A noctuid caterpillar. Due to the presence of the worm-like organism in the vomitus, the child's mother was concerned about a parasitic helminth infection; however, the organism was subsequently identified as a noctuid caterpillar (larva) (2). The overall morphology and size, together with the presence of prolegs, a defined head capsule, and segmentation, distinguished the organism from a helminth of medical importance. Closer examination of the midlateral portion of the caterpillar revealed a green and black raised “nodular” structure that was suggestive of parasitosis by a member of the family Tachinidae, a family of parasitic flies (3). | Based on the history, it was unclear if the boy had attempted to ingest the caterpillar and subsequently vomited or if the caterpillar was already present on his sibling's shirt. It was also uncertain if the child's mother thought the caterpillar was related to his 2-month history of cough. Despite the ambiguity surrounding the patient's history, the boy's mother was concerned about the identity of the organism and potential for parasitic infection and ultimately sought medical counsel to address these concerns. An ova and parasite examination of a single, incidental stool specimen collected at the time of the child's presentation demonstrated the presence of Entamoeba coli cysts, but no helminth ova were observed. |
Assessment of state perinatal hepatitis B prevention laws
Culp LA , Caucci L , Fenlon NE , Lindley MC , Nelson NP , Murphy TV . Am J Prev Med 2016 51 (6) e179-e185 INTRODUCTION: Identifying pregnant women with hepatitis B virus (HBV) infection for post-exposure prophylaxis of their infants is critical to preventing mother-to-child transmission of HBV infection. HBV infection in infancy results in premature death from chronic liver disease or cancer in 25% of affected infants. Universal screening of pregnant women for HBV infection is the standard of care, and in many states is supported by laws for screening and reporting these infections to public health. No recent assessment of state screening and reporting laws for HBV infection has been published. METHODS: In 2014, the authors analyzed laws current through December 31, 2013 from U.S. jurisdictions (50 states and the District of Columbia) related to HBV infection and hepatitis B surface antigen screening and reporting requirements generally and for pregnant women specifically. RESULTS: All states require reporting of cases of HBV infection. Twenty-six states require pregnant women to be screened. Thirty-three states require public health reporting of HBV infections in pregnant women, but only 12 states require reporting pregnancy status of women with HBV infection. CONCLUSIONS: This assessment revealed significant variability in laws related to screening and reporting of HBV infection among pregnant women in the U.S. Implementing comprehensive HBV infection screening and reporting laws for pregnant women may facilitate identifying HBV-infected pregnant women and preventing HBV infection in their infants. |
Improving the public health infrastructure capacity in the U.S. Pacific territories
Dopson SA . J Health Care Poor Underserved 2016 27 (4) 1632-1637 The public health emergency of 2009 pandemic influenza A (H1N1) virus resulted in supplemental funding provided by Congress to the 62 states and territories. The CDC's response included deployment of personnel to the U.S. Pacific territories, who provided technical assistance on laboratory capacity, information technology, surveillance, planning, and continuity of operations. |
Communication between infectious disease physicians and US state and local public health agencies: Strengths, challenges, and opportunities
Santibanez S , Polgreen PM , Beekmann SE , Cairns C , Filice GA , Layton M , Hughes JM . Public Health Rep 2016 131 (5) 666-670 Strong working relationships between infectious disease (ID) physicians and public health have resulted in the early detection of emerging infectious threats. From May 6 through June 5, 2015, we surveyed ID physicians in the Infectious Diseases Society of America's Emerging Infections Network about communications with public health. A total of 688 of 1491 (46%) members completed the survey, 624 (91%) of whom knew how to reach their health department directly for an urgent issue. Only 38 (6%) described communications with their health department as poor. Interest in newer technologies (eg, mobile smartphone applications) showed mixed results. Interest in a smartphone application differed significantly by years of ID experience,with 81 of 146 (55%) respondents with <5 years of ID experience, 172 of 359 (48%) respondents with 5 to 24 years of ID experience, and 61 of 183 (33%) respondents with >25 years of ID experience in favor of a smartphone application (P < .001). As more physicians adopt newer communication technologies, health departments should be prepared to incorporate these tools to communicate with ID physicians. |
Lifetime abortion of female sex workers in Iran: findings of a National Bio-Behavioural Survey In 2010
Karamouzian M , Mirzazadeh A , Shokoohi M , Khajehkazemi R , Sedaghat A , Haghdoost AA , Sharifi H . PLoS One 2016 11 (11) e0166042 INTRODUCTION: Unintended pregnancies and abortion may be considered as occupational hazards for female sex workers (FSWs). As our understanding of contraceptive and abortion practices of Iranian FSWs is very limited, this study tries to assess the dynamics of contraception and abortion among this sub-population. METHODS: This survey was conducted in 2010, by recruiting 872 FSWs through facility-based sampling from 21 sites in 14 cities in Iran. Data were collected through face-to-face interviews using a pilot-tested standardized risk assessment questionnaire. We applied the logistic regression model to investigate the correlates of induced abortion among FSWs. RESULTS: Of the 863 participants with valid responses to the abortion variable, 35.3% (95% CI: 32.1-38.6) acknowledged ever induced abortion and the annual rate of abortion was estimated at 20.7 per 1000 women. Around 31.2% of FSWs reported no usual contraceptive use, 32.6% barrier method, 23.6% non-barrier modern contraception methods, and 12.5% dual protection. In our multivariable model, older age (Adjusted Odds Ratio (AOR) = 1.74, 95% Confidence Interval (CI): 1.02, 2.96), group sex (AOR = 1.92, 95% CI: 1.10, 3.35), history of travel for sex work (AOR = 1.55, 95% CI: 1.09, 2.20), sexual violence (AOR = 1.77, 95% CI: 1.25, 2.50), STIs in last year (AOR = 1.53, 95% CI: 1.09, 2.14), and accessing family planning services (AOR = 1.76, 95% CI: 1.24, 2.49) were significant predictors of lifetime abortion. CONCLUSIONS: The reproductive health needs of Iranian FSWs are unmet and around one-third of FSWs reported induced abortion. Scaling-up comprehensive family planning services and empowering FSWs to have safer sex practices may help them to prevent unintended pregnancies and further risk of HIV transmission. |
Abortion surveillance - United States, 2013
Jatlaoui TC , Ewing A , Mandel MG , Simmons KB , Suchdev DB , Jamieson DJ , Pazol K . MMWR Surveill Summ 2016 65 (12) 1-44 PROBLEM/CONDITION: Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States. PERIOD COVERED: 2013. DESCRIPTION OF SYSTEM: Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, the District of Columbia, and New York City). The reporting areas provide this information voluntarily. For 2013, data were received from 49 reporting areas. For trend analysis, abortion data were evaluated from 47 areas that reported data every year during 2004-2013. Census and natality data, respectively, were used to calculate abortion rates (number of abortions per 1,000 women) and ratios (number of abortions per 1,000 live births). RESULTS: A total of 664,435 abortions were reported to CDC for 2013. Of these abortions, 98.2% were from the 47 reporting areas that provided data every year during 2004-2013. Among these 47 reporting areas, the abortion rate for 2013 was 12.5 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 200 abortions per 1,000 live births. From 2012 to 2013, the total number, rate, and ratio of reported abortions decreased 5%. From 2004 to 2013, the total number, rate, and ratio of reported abortions decreased 20%, 21%, and 17%, respectively. In 2013, all three measures reached their lowest level for the entire period of analysis (2004-2013). In 2013 and throughout the period of analysis, women in their 20s accounted for the majority of abortions and had the highest abortion rates; women in their 30s and older accounted for a much smaller percentage of abortions and had lower abortion rates. In 2013, women aged 20-24 and 25-29 years accounted for 32.7% and 25.9% of all abortions, respectively, and had abortion rates of 21.8 and 18.2 abortions per 1,000 women aged 20-24 and 25-29 years, respectively. In contrast, women aged 30-34, 35-39, and ≥40 years accounted for 16.8%, 9.2%, and 3.6% of all abortions, respectively, and had abortion rates of 11.8, 7.0, and 2.5 abortions per 1,000 women aged 30-34 years, 35-39 years, and ≥40 years, respectively. During 2004-2013, the decrease in abortion rates among adult women aged 20-39 years ranged from 8% to 27% across these age groups, whereas the abortion rate was stable for women aged ≥40 years. In 2013, adolescents aged <15 and 15-19 years accounted for 0.3% and 11.4% of all abortions, respectively, and had abortion rates of 0.6 and 8.2 abortions per 1,000 adolescents aged <15 and 15-19 years, respectively. From 2004 to 2013, the percentage of abortions accounted for by adolescents aged 15-19 years decreased 31% and their abortion rate decreased 46%. These decreases were greater than the decreases for women in any older age group. In contrast to the percentage distribution of abortions and abortion rates by age, abortion ratios in 2013 and throughout the entire period of analysis were highest among adolescents and lowest among women aged 30-39 years. Abortion ratios decreased from 2004 to 2013 for women in all age groups, except for adolescents aged <15 years. In 2013, the majority (66.0%) of abortions were performed by ≤8 weeks' gestation, and nearly all (91.6%) were performed by ≤13 weeks' gestation. Few abortions were performed between 14 and 20 weeks' gestation (7.1%) or at ≥21 weeks' gestation (1.3%). From 2004 to 2013, the percentage of all abortions performed at ≤13 weeks' gestation remained consistently high (≥91.5%) and among those performed at ≤13 weeks' gestation, the percentage performed at ≤6 weeks' gestation increased 16%. In 2013, among the 43 reporting areas that included medical (nonsurgical) abortion on their reporting form, a total of 67.9% of abortions were performed by curettage at ≤13 weeks' gestation, 22.2% were performed by early medical abortion (a nonsurgical abortion at ≤8 weeks' gestation), and 8.6% were performed by curettage at >13 weeks' gestation; all other methods were uncommon. Among abortions performed at ≤8 weeks' gestation that were eligible for early medical abortion on the basis of gestational age, 32.8% were completed by this method. From 2012 to 2013, the percentage of abortions reported as early medical abortions increased 5%. Deaths of women associated with complications from abortion for 2013 are being investigated as part of CDC's Pregnancy Mortality Surveillance System. In 2012, the most recent year for which data were available, four women were identified to have died as a result of complications from known legal induced abortion. No reported deaths were associated with known illegal induced abortion. INTERPRETATION: Among the 47 areas that reported data every year during 2004-2013, the decreases in the total number, rate, and ratio of reported abortions that occurred during 2009-2012 continued from 2012 to 2013, resulting in historic lows for all three measures of abortion. PUBLIC HEALTH ACTION: The data in this report can help program planners and policymakers identify groups of women with highest rates of abortion. Unintended pregnancy is the major contributor to abortion. Increasing access to and use of contraception, including the most effective methods, can reduce unintended pregnancies and further reduce the number of abortions performed in the United States. |
Flavoured tobacco products in the USA: Synthesis of recent multidiscipline studies with implications for advancing tobacco regulatory science
Stanton CA , Villanti AC , Watson C , Delnevo CD . Tob Control 2016 25 ii1-ii3 Almost all tobacco products include flavour additives. As of 2014, over 1300 flavouring ingredients had been identified in cigarettes, smokeless and roll-your-own tobacco products.1 The 2009 Family Smoking Prevention and Tobacco Control Act—which gave the US Food and Drug Administration (FDA) authority to regulate tobacco products in the USA—banned the inclusion of characterising flavours (eg, candy, fruit) other than tobacco and menthol in cigarettes, but not other tobacco products.2 Additionally the FDA’s Center for Tobacco Products (CTP) has conducted reviews3–5 and requested information on the impact of menthol cigarettes on population health through the Federal Register and meetings of the Tobacco Product Scientific Advisory Committee. | While the US FDA has not yet asserted its authority to regulate flavours in non-cigarette tobacco products (eg, smokeless tobacco, cigars, hookah) or e-cigarettes to date, the FDA signalled in materials accompanying the May 2016 deeming regulations its intent to issue a product standard that would ban characterising flavours in cigars, cigarillos and little cigars.6 Meanwhile, other countries are enacting more robust regulations regarding flavoured tobacco products, with bans on menthol flavoured products proposed and being passed in countries such as Brazil, Turkey, Germany and Ethiopia.7 |
Notes from the field: Community-based prevention of Rocky Mountain spotted fever - Sonora, Mexico, 2016
Straily A , Drexler N , Cruz-Loustaunau D , Paddock CD , Alvarez-Hernandez G . MMWR Morb Mortal Wkly Rep 2016 65 (46) 1302-1303 Rocky Mountain spotted fever (RMSF), a life-threatening tickborne zoonosis caused by Rickettsia rickettsii, is a reemerging disease in Mexico. R. rickettsii is an intracellular bacterium that infects vascular endothelium and can cause multisystem organ failure and death in the absence of timely administration of a tetracycline-class antibiotic, typically doxycycline. Epidemic RMSF, as described in parts of Arizona and Mexico, is associated with massive local infestations of the brown dog tick (Rhiphicephalus sanguineus sensu lato) on domestic dogs and in peridomestic settings that result in high rates of human exposure; for example, during 2003-2012, in Arizona the incidence of RMSF in the three most highly affected communities was 150 times the U.S. national average. In 2015, the Mexico Ministry of Health (MOH) declared an epidemiologic emergency because of high and sustained rates of RMSF in several states in northern Mexico, including the state of Sonora. During 2004-2015, a total of 1,129 cases and 188 RMSF deaths were reported from Sonora (Sonora MOH, unpublished data, 2016). During 2009-2015, one impoverished community (community A) in Sonora reported 56 cases of RMSF involving children and adolescents, with a case-fatality rate of 40% (Sonora MOH, unpublished data, 2016). Poverty and lack of timely access to health services are risk factors for severe RMSF. Children are especially vulnerable to infection, because they might have increased contact with dogs and spend more time playing around spaces where ticks survive. In Sonora, case fatality rates for children aged <10 years can be as high as 30%, which is almost four times the aggregate case-fatality rate reported for the general population of the state (8%), and 10-13 times higher than the case-fatality rate described for this age group in the United States (2.4%). |
Housing improvement: a novel paradigm for urban vector-borne disease control?
Vazquez-Prokopec GM , Lenhart A , Manrique-Saide P . Trans R Soc Trop Med Hyg 2016 110 (10) 567-569 As the world's population crosses the 7.4 billion mark and urban areas become humanity's dominant landscape, there is a pressing need for strategically planning for future population growth in light of current trends in social inequality, accelerated climate change, extreme poverty and (re)emerging infectious diseases. On 25 September 2015, world leaders meeting at the United Nations Sustainable Development Summit adopted the 2030 Agenda for Sustainable Development:1 a blueprint for humanity's future rooted in a set of 17 Sustainable Development Goals (SDGs). This Agenda, which extends the original eight Millennium Development Goals through the 21st century, now includes SDGs addressing human rights, climate change, overexploitation of natural resources and sustainable urban growth.1 In including urbanization as a major SDG, world leaders have officially recognized the relevance of cities as catalyzers for current and future development. By 2050, it is estimated that more than 6.5 billion people (two-thirds of the human population) will live in urban areas.2 Thus, improving human health, reducing poverty and promoting sustainable development will be strongly tied to transforming the way urban spaces are built and how countries mitigate the impacts of climate change and address issues of poverty and infectious disease propagation. |
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