Trivalent inactivated influenza vaccine is not associated with sickle cell crises in children
Hambidge SJ , Ross C , Glanz J , McClure D , Daley MF , Xu S , Shoup JA , Narwaney K , Baggs J , Weintraub E . Pediatrics 2011 129 (1) e54-9 BACKGROUND AND OBJECTIVES: Children with sickle cell disease are considered at high risk for complications from influenza infection and are recommended to receive annual influenza vaccination. However, data on the safety of influenza vaccination in children with sickle cell anemia are sparse. METHODS: Using a retrospective cohort of children aged 6 months to 17 years in 8 managed care organizations that comprise the Vaccine Safety Datalink and who had a diagnosis of sickle cell anemia from 1999 to 2006, we conducted matched case-control and self-controlled case series studies to examine the association of trivalent inactivated influenza vaccination with hospitalization for sickle cell crisis in the 2 weeks after vaccination. RESULTS: From an original pool of 1085 pediatric subjects with a diagnosis of sickle cell anemia, we identified 179 children with at least 1 sickle cell crisis during any influenza season (October 1-March 31). In the matched case-control study (matching on age category, gender, Vaccine Safety Datalink site, and season), the odds ratio of hospitalization for a crisis in vaccinated compared with unvaccinated children was not significant: 1.3 (95% confidence interval 0.8-2.2). In the self-controlled case series study of hospitalized cases, the incident rate ratio for hospitalization with sickle cell crisis in the 2 weeks after trivalent inactivated influenza vaccination was also not significant: 1.2 (95% confidence interval 0.75-1.95). CONCLUSION: This large cohort study did not find an association of influenza vaccination and hospitalization for sickle cell crises in children with sickle cell anemia. |
Differences in multijoint radiographic osteoarthritis phenotypes among African Americans and Caucasians: the Johnston County Osteoarthritis project
Nelson AE , Renner JB , Schwartz TA , Kraus VB , Helmick CG , Jordan JM . Arthritis Rheum 2011 63 (12) 3843-52 OBJECTIVE: To define and contrast multiple joint radiographic osteoarthritis (OA) phenotypes describing hand and whole-body radiographic OA among African Americans and Caucasians. METHODS: We conducted a cross-sectional analysis in the Johnston County Osteoarthritis Project, using radiographic data for the hands, tibiofemoral (TF) joints, patellofemoral joints, hips, and lumbosacral (LS) spine. Radiographs were read for OA by a single radiologist using standard atlases. Fisher's exact test, with correction for multiple comparisons, was used to compare phenotype frequencies by race and sex. Logistic regression was used to provide odds ratios, which were adjusted for sex, age, and body mass index (BMI). RESULTS: Sixteen mutually exclusive hand (n = 2,083) and 32 whole-body (n = 1,419) radiographic OA phenotypes were identified. We found that in comparison to Caucasians, African Americans had significantly less frequent radiographic OA of the distal interphalangeal joints, both in isolation and in combination with other hand joint sites, but had comparable frequencies of radiographic OA for other hand joint sites. Moreover, African Americans had less frequent radiographic OA of the hand, both in isolation and in combination with other joint sites, as compared to Caucasians. In contrast, African Americans had more than twice the odds of isolated OA of the TF joint and 77% higher odds of radiographic OA of the TF joint and LS spine together as compared to Caucasians. CONCLUSION: Even after adjustment for sex, age, and BMI, African Americans were less likely than Caucasians to have hand radiographic OA phenotypes, but more likely to have knee radiographic OA phenotypes involving the TF joint. African Americans may have a higher burden of multiple large-joint OA involvement not captured by most definitions of "generalized OA." |
Host factors that influence mother-to-child transmission of HIV-1: genetics, coinfections, behavior and nutrition.
Ellington SR , King CC , Kourtis AP . Future Virol 2011 6 (12) 1451-1469 Mother-to-child transmission (MTCT) is the most important mode of HIV-1 acquisition among infants and children and it can occur in utero, intrapartum and postnatally through breastfeeding. Great progress has been made in preventing MTCT through use of antiretroviral regimens during gestation, labor/delivery and breastfeeding. The mechanisms of MTCT, however, are multifactorial and remain incompletely understood. This review focuses on select host factors affecting MTCT, in particular genetic factors, coexisting infections, behavioral factors and nutrition. Whereas much emphasis has been placed on decreasing maternal HIV-1 viral load, an important determinant of MTCT, through use of antiretroviral agents, complementary focus on overall maternal health is often neglected. By addressing coinfections in mothers and infants, improving the mother's nutritional status and modifying risky behaviors and practices, not only is maternal and child health improved, but a direct benefit in reducing MTCT can be derived. The study of genetic variations in susceptibility to HIV-1 infection is rapidly evolving, and the future is likely to bring revolutionary changes in HIV-1 prevention by enhancing natural resistance to infection and by individually tailoring pharmacologic regimens. (2011 Future Medicine Ltd.) |
Role of donor genital tract HIV-1 diversity in the transmission bottleneck
Boeras DI , Hraber PT , Hurlston M , Evans-Strickfaden T , Bhattacharya T , Giorgi EE , Mulenga J , Karita E , Korber BT , Allen S , Hart CE , Derdeyn CA , Hunter E . Proc Natl Acad Sci U S A 2011 108 (46) E1156-63 The predominant mode of HIV-1 infection is heterosexual transmission, where a genetic bottleneck is imposed on the virus quasispecies. To probe whether limited genetic diversity in the genital tract (GT) of the transmitting partner drives this bottleneck, viral envelope sequences from the blood and genital fluids of eight transmission pairs from Rwanda and Zambia were analyzed. The chronically infected transmitting partner's virus population was heterogeneous with distinct genital subpopulations, and the virus populations within the GT of two of four women sampled longitudinally exhibited evidence of stability over time intervals on the order of weeks to months. Surprisingly, the transmitted founder variant was not derived from the predominant GT subpopulations. Rather, in each case, the transmitting variant was phylogenetically distinct from the sampled locally replicating population. Although the exact distribution of the virus population present in the GT at the time of transmission cannot be unambiguously defined in these human studies, it is unlikely, based on these data, that the transmission bottleneck is driven in every case by limited viral diversity in the donor GT or that HIV transmission is solely a stochastic event. |
Update on diagnosis and treatment within the four clinical phases of chronic hepatitis B infection
McMahon BJ , Simons BC , Livingston SE . Curr Hepat Rep 2011 10 (4) 229-234 Four phases of chronic hepatitis B virus [1] infection have been identified: immune tolerant, immune active, inactive, and hepatitis B surface antigen (HBsAg) clearance. These phases are defined by using a combination of hepatitis B "e" antigen (HBeAg) status, alanine aminotransferase (ALT) level, and HBV DNA level. To determine the extent of liver inflammation and fibrosis needed to decide whether antiviral therapy is necessary often requires a liver biopsy. Recent studies have found that levels of HBsAg can also be used to determine the phase of HBV and can even predict persons who may remain in the inactive phase over time. Non invasive markers including transient elastography can detect a proportion of those with a high probability of severe fibrosis and mild disease but are not yet helpful to determine the status of most chronically infected persons. (2011 Springer Science+Business Media, LLC.) |
The final phase of polio eradication: new vaccines and complex choices
Cochi SL , Linkins RW . J Infect Dis 2011 205 (2) 169-71 The Global Polio Eradication Initiative (GPEI) made rapid progress after its launch by the World Health Assembly in 1988, reducing polio cases by more than 99% from an estimated 350 000 in 1988 to 719 cases in 2000. However, further progress toward eradicating polio stalled after 2000 in a handful of tropical endemic countries, and the international spread of the virus from these endemic areas led to recurrent outbreaks in previously polio-free countries. One factor related to the stalled progress was the well-documented lower immunogenicity and effectiveness in tropical developing countries of oral poliovirus vaccine (OPV) [1, 2], so attention focused on developing and licensing monovalent type 1 and type 3 vaccines to improve the effectiveness of vaccination by avoiding cross-interference between the 3 serotypes that occurs following vaccination with the traditional trivalent OPV (tOPV). This issue of the Journal contains the most recent in a series of 3 clinical trials in 2 African (Egypt, South Africa) countries and 1 Asian (India) country, demonstrating the superior type-specific immunogenicity in developing countries of monovalent oral poliovirus vaccines (mOPVs), as compared with tOPV [3–6]. In particular, the 3 trials demonstrate the superior immune responses of monovalent OPV type 1 (mOPV1) and type 3 (mOPV3) compared with tOPV, either following 1 dose of vaccine given to newborn infants (in Egypt and South Africa), or 2 doses given at birth and 1 month of age (in India). |
Infection control in the multidrug-resistant era: tending the human microbiome
Tosh PK , McDonald LC . Clin Infect Dis 2011 54 (5) 707-13 Increasing understanding of the normal commensal microorganisms in humans suggests that restoring and maintaining the microbiome may provide a key to preventing colonization and infection with multidrug-resistant organisms (MDROs). Intact communities of commensals can prevent colonization with MDROs through both competition for space and resources and the complex immunologic and biochemical interactions that have developed between commensal and host over millennia. Current antimicrobials, however, exert tremendous collateral damage to the human microbiome through overuse and broadening spectrum, which has likely been the driving force behind the introduction and proliferation of MDROs. The future direction of infection control and anti-infective therapy will likely capitalize on an expanding understanding of the protective role of the microbiome by (1) developing and using more microbiome-sparing antimicrobial therapy, (2) developing techniques to maintain and restore indigenous microbiota, and (3) discovering and exploiting host protective mechanisms normally afforded by an intact microbiome. |
Association between use of statins and mortality among patients hospitalized with laboratory-confirmed influenza virus infections: a multistate study
Vandermeer ML , Thomas AR , Kamimoto L , Reingold A , Gershman K , Meek J , Farley MM , Ryan P , Lynfield R , Baumbach J , Schaffner W , Bennett N , Zansky S . J Infect Dis 2011 205 (1) 13-9 BACKGROUND: Statins may have anti-inflammatory and immunomodulatory effects that could reduce the risk of mortality from influenza virus infections. METHODS: The Centers for Disease Control and Prevention's Emerging Infections Program conducts active surveillance for persons hospitalized with laboratory-confirmed influenza in 59 counties in 10 states. We analyzed data for hospitalized adults during the 2007-2008 influenza season to evaluate the association between receiving statins and influenza-related death. RESULTS: We identified 3043 patients hospitalized with laboratory-confirmed influenza, of whom 1013 (33.3%) received statins and 151 (5.0%) died within 30 days of their influenza test. Patients who received statins were more likely to be older, male, and white; to suffer from cardiovascular, metabolic, renal, and chronic lung disease; and to have been vaccinated against influenza that season. In a multivariable logistic regression model, administration of statins prior to or during hospitalization was associated with a protective odds of death (adjusted odds ratio, 0.59 [95% confidence interval, .38-.92]) when adjusting for age; race; cardiovascular, lung, and renal disease; influenza vaccination; and antiviral administration. CONCLUSIONS: Statin use may be associated with reduced mortality in patients hospitalized with influenza. |
Restricted enzooticity of hepatitis E virus genotypes 1 to 4 in the United States.
Dong C , Meng J , Dai X , Liang JH , Feagins AR , Meng XJ , Belfiore NM , Bradford C , Corn JL , Cray C , Glass GE , Gordon ML , Hesse RA , Montgomery DL , Nicholson WL , Pilny AA , Ramamoorthy S , Shaver DD , Drobeniuc J , Purdy MA , Fields HA , Kamili S , Teo CG . J Clin Microbiol 2011 49 (12) 4164-72 Hepatitis E is recognized as a zoonosis, and swine are known reservoirs, but how broadly enzootic its causative agent, hepatitis E virus (HEV), is remains controversial. To determine the prevalence of HEV infection in animals, a serological assay with capability to detect anti-HEV-antibody across a wide variety of animal species was devised. Recombinant antigens comprising truncated capsid proteins generated from HEV-subgenomic constructs that represent all four viral genotypes were used to capture anti-HEV in the test sample and as an analyte reporter. To facilitate development and validation of the assay, serum samples were assembled from blood donors (n = 372), acute hepatitis E patients (n = 94), five laboratory animals (rhesus monkey, pig, New Zealand rabbit, Wistar rat, and BALB/c mouse) immunized with HEV antigens, and four pigs experimentally infected with HEV. The assay was then applied to 4,936 sera collected from 35 genera of animals that were wild, feral, domesticated, or otherwise held captive in the United States. Test positivity was determined in 457 samples (9.3%). These originated from: bison (3/65, 4.6%), cattle (174/1,156, 15%), dogs (2/212, 0.9%), Norway rats (2/318, 0.6%), farmed swine (267/648, 41.2%), and feral swine (9/306, 2.9%). Only the porcine samples yielded the highest reactivities. HEV RNA was amplified from one farmed pig and two feral pigs and characterized by nucleotide sequencing to belong to genotype 3. HEV infected farmed swine primarily, and the role of other animals as reservoirs of its zoonotic spread appears to be limited. |
Plasmodium knowlesi: a malaria parasite of monkeys and humans
Collins WE . Annu Rev Entomol 2012 57 107-21 Plasmodium knowlesi is a malaria parasite of monkeys of southeast Asia that is transmitted by mosquitoes of the Anopheles leucosphyrus group. Humans are frequently infected with this parasite and misdiagnosed as being infected with Plasmodium malariae. The parasite was a major monkey animal model for developing antimalarial vaccines and investigations of the biology of parasite invasion. P. knowlesi is the first monkey malaria parasite genome to be sequenced and annotated. |
Evaluating a persistent nuisance odor in an office building
Ceballos DM , Burr GA . J Occup Environ Hyg 2012 9 (1) D1-6 The National Institute for Occupational Safety and Health (NIOSH) received a technical assistance request for a health hazard evaluation from a federal government property manager. The request concerned nausea; headache; and eye, nose, throat, and respiratory irritation among employees at an office leased by the property manager. Employees believed that a persistent chemical odor in the office might be responsible for these symptoms. We met with employer and employee representatives, observed the office layout and workplace conditions, and spoke with employees. We measured temperature, relative humidity (RH), carbon dioxide (CO2), and carbon monoxide (CO) in the office. For comparison, we also took general area air samples for hydrogen sulfide (H2S), formaldehyde, and volatile organic compounds (VOCs) in the office and in two nearby businesses in the same building. We collected two bulk samples of carpet from the office and analyzed them for VOC emissions. We also sent each office employee a survey asking if he or she smelled an odor while at work and if he or she had health concerns associated with this odor. |
Blood mercury levels among fish consumers residing in areas with high environmental burden
Wolkin A , Hunt D , Martin C , Caldwell KL , McGeehin MA . Chemosphere 2011 86 (9) 967-71 Mercury is a ubiquitous, persistent toxicant found in the environment. In water, mercury bioaccumulates up the food chain and leads to high concentrations in fish. Consumption of contaminated fish is the major source of exposure to mercury in the US. The objective of this study was to enroll persons living in areas selected by the Environmental Protection Agency (EPA) to have high mercury concentrations and who consume at least 6oz of locally caught fish per week to determine the feasibility of monitoring future trends among a population identified as highly exposed. Blood samples were collected at time of interview and analyzed for mercury. Participants (n=287) were enrolled from North Carolina, Maryland, and South Dakota. Participants reported eating an average of five servings of fish per week. The overall geometric mean for total mercury was 0.75mcgL(-1), with North Carolina having the highest mean level (2.02mcgL(-1)). Overall, 42% of the study population had levels greater than the US geometric mean 0.83mcgL(-1). The number of servings of fish consumed was not found to be associated with blood mercury levels. We were able to identify some persons with elevated mercury concentrations living in areas identified by EPA; however, identifying and monitoring a highly exposed population over time would be challenging. |
Accuracy of self-reported family history is strongly influenced by the accuracy of self-reported personal health status of relatives.
Janssens AC , Henneman L , Detmar SB , Khoury MJ , Steyerberg EW , Eijkemans MJ , Mushkudiani N , Oostra BA , van Duijn CM , Mackenbach JP . J Clin Epidemiol 2012 65 (1) 82-9 OBJECTIVE: We investigated the accuracy of self-reported family history for diabetes, hypertension, and overweight against two reference standards: family history based on physician-assessed health status of relatives and on self-reported personal health status of relatives. STUDY DESIGN AND SETTING: Subjects were participants from the Erasmus Rucphen Family study, an extended family study among descendants of 20 couples who lived between 1850 and 1900 in a southwest region of the Netherlands and their relatives (n=1,713). Sensitivity and specificity of self-reported family history were calculated. RESULTS: Sensitivity of self-reported family history was 89.2% for diabetes, 92.2% for hypertension, and 78.4% for overweight when family history based on relatives' self-reported personal health status was used as reference and 70.8% for diabetes, 67.4% for hypertension, and 77.3% for overweight when physician-assessed health status of relatives was used. Sensitivity and specificity of self-reported personal health status were 76.8% and 98.8% for diabetes, 38.9% and 98.0% for hypertension, and 80.9% and 75.7% for overweight, respectively. CONCLUSION: The accuracy of self-reported family history of diabetes and hypertension is strongly influenced by the accuracy of self-reported personal health status of relatives. Raising awareness of personal health status is crucial to ensure the utility of family history for the assessment of risk and disease prevention. |
The pelvic examination as a screening tool: practices of US physicians
Stormo AR , Hawkins NA , Cooper CP , Saraiya M . Arch Intern Med 2011 171 (22) 2053-4 According to the Centers for Disease Control and Prevention (CDC), approximately 63.4 million pelvic examinations were performed in US physicians' offices and US clinics in 2008.1 Traditionally, this procedure has been performed in conjunction with annual Papanicolaou tests but since the American College of Obstetricians and Gynecologists extended its recommended cervical cancer screening interval to no more than every 3 years with human papillomavirus co-testing,2 there are questions about whether an annual pelvic examination is needed. | Pelvic examinations have been performed on asymptomatic women to screen for sexually transmitted infections, to screen for ovarian and other gynecologic cancers, and to determine whether women should receive hormonal contraceptives. However, use of pelvic examinations for these purposes is not supported by scientific evidence and is not recommended by any US organization.3-6 | Little is known about physicians' pelvic examination practices. In a recent Australian study, reasons general practitioners gave for performing pelvic examinations of asymptomatic women ranged from detecting pathologic conditions to simply performing this procedure “out of habit.”7 In this study, we sought to determine the purposes for which US physicians conduct pelvic examinations. |
A novel vehicle for transmission of Escherichia coli O157:H7 to humans: multistate outbreak of E. coli O157:H7 infections associated with consumption of ready-to-bake commercial prepackaged cookie dough--United States, 2009
Neil KP , Biggerstaff G , Macdonald JK , Trees E , Medus C , Musser KA , Stroika SG , Zink D , Sotir MJ . Clin Infect Dis 2011 54 (4) 511-8 BACKGROUND: Escherichia coli O157:H7 is a Shiga toxin-producing E. coli (STEC) associated with numerous foodborne outbreaks in the United States and is an important cause of bacterial gastrointestinal illness. In May 2009, we investigated a multistate outbreak of E. coli O157:H7 infections. METHODS: Outbreak-associated cases were identified using serotyping and molecular subtyping procedures. Traceback investigation and product testing were performed. A matched case-control study was conducted to identify exposures associated with illness using age-, sex-, and state-matched controls. RESULTS: Seventy-seven patients with illnesses during the period 16 March-8 July 2009 were identified from 30 states; 35 were hospitalized, 10 developed hemolytic-uremic syndrome, and none died. Sixty-six percent of patients were <19 years; 71% were female. In the case-control study, 33 of 35 case patients (94%) consumed ready-to-bake commercial prepackaged cookie dough, compared with 4 of 36 controls (11%) (matched odds ratio = 41.3; P < .001); no other reported exposures were significantly associated with illness. Among case patients consuming cookie dough, 94% reported brand A. Three nonoutbreak STEC strains were isolated from brand A cookie dough. The investigation led to a recall of 3.6 million packages of brand A cookie dough and a product reformulation. CONCLUSIONS: This is the first reported STEC outbreak associated with consuming ready-to-bake commercial prepackaged cookie dough. Despite instructions to bake brand A cookie dough before eating, case patients consumed the product uncooked. Manufacturers should consider formulating ready-to-bake commercial prepackaged cookie dough to be as safe as a ready-to-eat product. More effective consumer education about the risks of eating unbaked cookie dough is needed. |
Canned soup consumption and urinary bisphenol A: a randomized crossover trial
Carwile JL , Ye X , Zhou X , Calafat AM , Michels KB . JAMA 2011 306 (20) 2218-20 Human exposure to bisphenol A (BPA) is widespread.1 In adults, urinary BPA concentrations are positively associated with cardiovascular disease and diabetes.2 Exposure occurs primarily through the diet.3 Bisphenol A has been quantified in many canned goods,4,5 where it is present as a by-product of interior epoxy coatings used to prevent corrosion. We hypothesized that canned soup consumption would increase urinary BPA concentrations relative to fresh soup consumption. |
Genetic associations with metabolic syndrome and its quantitative traits by race/ethnicity in the United States.
Vassy JL , Shrader P , Yang Q , Liu T , Yesupriya A , Chang MH , Dowling NF , Ned RM , Dupuis J , Florez JC , Khoury MJ , Meigs JB . Metab Syndr Relat Disord 2011 9 (6) 475-82 BACKGROUND: Elevated insulin resistance (IR), triglycerides (TG), body mass index (BMI), and waist circumference (WC) are features of the metabolic syndrome. Although several single-nucleotide polymorphisms (SNPs) associated with these traits have been reported, no study has reported their risk allele frequencies and effect sizes among the major U.S. race/ethnic groups in a nationally representative sample. METHODS: We compared the risk allele frequencies of eight SNPs previously associated with IR, TG, BMI, or WC by race/ethnicity (non-Hispanic white, non-Hispanic black, Mexican American) in 3,030 participants of the National Health and Nutrition Examination Study III (NHANES III). In regression models predicting IR, TG, BMI, WC, and metabolic syndrome, we tested whether the SNP effect sizes on these traits varied by race/ethnicity. RESULTS: Risk allele frequencies varied by race/ethnicity for all eight loci (P<0.0001). The directionality of effects of the variants on IR, TG, WC, and BMI was generally consistent with previous observations and did not differ by race/ethnicity (P>0.001), although our study had low power for this test. No SNP predicted metabolic syndrome in any of the three groups (P>0.05). CONCLUSIONS: The significance of racial/ethnic differences in risk allele frequencies merits consideration if genetic discoveries are to have clinical and public health applicability. |
STD and HIV testing behaviors among black and Puerto Rican young adults
Carter MW , Kraft JM , Hatfield-Timajchy K , Hock-Long L , Hogben M . Perspect Sex Reprod Health 2011 43 (4) 238-46 CONTEXT: Given the high rates of infection among urban young adults, STD and HIV testing promotion is a public health priority. To inform future testing efforts, lifetime and recent testing behaviors of this population within casual and serious relationships should be better understood. METHODS: Data from a 2007-2008 study conducted in select neighborhoods in Hartford and Philadelphia were used to examine self-reported STD and HIV testing behaviors and attitudes among 483 sexually active black and Puerto Rican young adults aged 18-25. Multivariate ordered logit regression analyses were conducted to assess characteristics associated with lifetime number of STD tests. RESULTS: More than eight in 10 participants reported having been tested for STDs, and a similar proportion for HIV, most of them multiple times. Nineteen percent had ever had an STD diagnosis. A majority-86%-perceived their risk of STD infection in the next year as "not at all likely." Sixty-one percent of those in serious relationships reported that both partners had been tested, compared with 25% of those in casual relationships. Characteristics associated with higher lifetime number of STD tests were being female (odds ratio, 2.2), being from Philadelphia (2.5), being black (1.5), having lived with two or more serious partners (1.7) and having ever received an STD diagnosis (2.3). DISCUSSION: Despite their risks, participants did not perceive themselves to be at risk of STDs. However, they did report testing repeatedly. Testing was highly acceptable, particularly within serious relationships. Questions about the timing of testing initiation and repeat testing merit attention for the benefits of widespread testing to be fully realized. |
The third described case of transfusion-transmitted Babesia duncani
Bloch EM , Herwaldt BL , Leiby DA , Shaieb A , Herron RM , Chervenak M , Reed W , Hunter R , Ryals R , Hagar W , Xayavong MV , Slemenda SB , Pieniazek NJ , Wilkins PP , Kjemtrup AM . Transfusion 2011 52 (7) 1517-22 BACKGROUND: Almost all of the reported US tick-borne and transfusion-associated Babesia cases have been caused by Babesia microti, which is endemic in the Northeast and upper Midwest. We investigated a case caused by B. duncani (formerly, the WA1-type parasite), in a 59-year-old California resident with sickle cell disease (HbSS) whose only risk factor for infection was receipt of red blood cell transfusions. CASE REPORT: The patient's case was diagnosed in September 2008: intraerythrocytic parasites were noted on a blood smear, after a several-month history of increasing transfusion requirements. Molecular and indirect fluorescent antibody (IFA) analyses were negative for B. microti but were positive for B. duncani (IFA titer, 1:1024). The complete 18S ribosomal RNA gene of the parasite was amplified from a blood specimen; the DNA sequence was identical to the sequence for the index WA1 parasite isolated in 1991. The patient's case prompted a transfusion investigation: 34 of 38 pertinent blood donors were evaluated, none of whom tested positive by B. microti IFA. The implicated donor-a 67-year-old California resident-had a B. duncani titer of 1:4096; B. duncani also was isolated by inoculating jirds (Mongolian gerbils) with a blood specimen from March 2009, more than 10 months after his index donation in April 2008. The patient's case was diagnosed more than 4 months after the implicated transfusion in May 2008. CONCLUSIONS: This patient had the third documented transfusion case caused by B. duncani. His case underscores the fact that babesiosis can be caused by agents not detected by molecular or serologic analyses for B. microti. |
Rural parents' vaccination-related attitudes and intention to vaccinate middle and high school children against influenza following educational influenza vaccination intervention
Sales JM , Painter JE , Pazol K , Gargano LM , Orenstein W , Hughes JM , Diclemente RJ . Hum Vaccin 2011 7 (11) 1146-52 OBJECTIVE: This study examined changes in parental influenza vaccination attitudes and intentions after participating in school-based educational influenza vaccination intervention. METHODS: Participants were drawn from three counties participating in a school-based influenza vaccination intervention in rural Georgia (baseline N=324; follow-up N=327). Data were collected pre- and post-intervention from phone surveys with parents' with children attending middle- and high-school. Attitudes, beliefs, vaccination history, and intention to vaccinate were assessed. RESULTS: Parents who participated in the intervention conditions reported significantly higher influenza vaccination rates in their adolescents, relative to a control group, as well as increased vaccination rates post-intervention participation relative to their baseline rates. Intervention participants reported greater intention to have their adolescent vaccinated in the coming year compared to control parents. Significant differences were observed post intervention in perceived barriers and benefits of vaccination. CONCLUSIONS: These findings suggest that a school-delivered educational influenza vaccination intervention targeting parents and teens may influence influenza vaccination in rural communities. Future influenza vaccination efforts geared toward the parents of rural middle- and high-school students may benefit from addressing barriers and benefits of influenza vaccination. |
Safety, tolerability, and immunogenicity of inactivated trivalent seasonal influenza vaccine administered with a needle-free disposable-syringe jet injector
Simon JK , Carter M , Pasetti MF , Sztein MB , Kotloff KL , Weniger BG , Campbell JD , Levine MM . Vaccine 2011 29 (51) 9544-50 BACKGROUND: Jet injectors (JIs) avoid safety drawbacks of needle-syringe (N-S) while generating similar immune responses. A new generation of disposable-syringe jet injectors (DSJIs) overcomes the cross-contamination risk of multi-use-nozzle devices used in 20th-century campaigns. In the first study in humans, the newly-US-licensed LectraJet(R) model M3 RA DSJI was compared to N-S. METHODS: Sixty healthy adults received one 0.5mL intramuscular dose of the 2009-2010 seasonal, trivalent, inactivated influenza vaccine (TIV) in randomized, double-masked fashion by either DSJI (n=30) or N-S (n=30). Adverse reactions were monitored for 90 days after injection, and serologic responses assayed by hemagglutination inhibition (HI) at days 28 and 90. RESULTS: There were no related serious adverse events (SAEs), nor differing rates of unsolicited AEs between DSJI and N-S. Solicited erythema and induration occurred more often after DSJI, but were transient and well-tolerated; a trend was noted for fewer systemic reactions by DSJI. Pre-vaccination HI geometric mean titers (GMT) increased by 28 days for H1N1, H3N2, and B antigens by 13-, 14-, and 8-fold via DSJI, and by 7-, 10-, and 7-fold for N-S, respectively. No trending differences in GMT, seroconversion, or seroprotection were noted; sample sizes precluded non-inferiority assessment. CONCLUSIONS: DSJI delivery of TIV is well-tolerated and immunogenic. |
Validity of parental report of influenza vaccination in young children seeking medical care
Brown C , Clayton-Boswell H , Chaves SS , Prill MM , Iwane MK , Szilagyi PG , Edwards KM , Staat MA , Weinberg GA , Fairbrother G , Hall CB , Zhu Y , Bridges CB . Vaccine 2011 29 (51) 9488-9492 BACKGROUND: Despite frequent use of self-reported information to determine pediatric influenza vaccination coverage, little data are available on the validity of parental reporting of their child's influenza vaccination status and on factors affecting its accuracy. METHODS: We compared parent reported influenza vaccination of children to documented reports of vaccination collected from medical records (the criterion standard) among children aged 6-59 months who presented to selected hospitals, emergency departments, and clinics in three U.S. counties with acute respiratory illness during three influenza seasons (November through May of 2004-2007). Demographic and epidemiologic data were collected from chart reviews and parental surveys. RESULTS: Among 3072 children aged 6-59 months, 47.5% were reported by the parent to have received influenza vaccine and 39.5% of children had medical record verification of influenza vaccination. Sensitivity and specificity of parental reporting was 92.1% and 82.3%, respectively, when compared to the immunization record. However, 17.7% of children whose parents reported vaccination had no influenza vaccination documented in their medical records, and this proportion was even higher at 28.6%, among children with an underlying high-risk medical condition. Greater reporting accuracy was associated with younger age of child (6-23 months vs. 24-59 months), white non-Hispanic race/ethnicity, having health insurance, and having a mother with a college education. CONCLUSIONS: Our findings indicate that although parental report of influenza vaccination is fairly reliable ( approximately 76-96%), over reporting by parents often occurs and immunization record review remains the preferable method for determining vaccination status in children. |
Prevention of antibiotic-nonsusceptible Streptococcus pneumoniae with conjugate vaccines
Hampton LM , Farley MM , Schaffner W , Thomas A , Reingold A , Harrison LH , Lynfield R , Bennett NM , Petit S , Gershman K , Baumbach J , Beall B , Jorgensen J , Glennen A , Zell ER , Moore M . J Infect Dis 2011 205 (3) 401-11 BACKGROUND: Streptococcus pneumoniae (pneumococcus) caused approximately 44,000 US invasive pneumococcal disease (IPD) cases in 2008. Antibiotic nonsusceptibility complicates IPD treatment. Using penicillin susceptibility breakpoints adopted in 2008, we evaluated antibiotic-nonsusceptible IPD trends in light of the introductions of a 7-valent pneumococcal conjugate vaccine (PCV7) in 2000 and a 13-valent pneumococcal conjugate vaccine (PCV13) in 2010. METHODS: IPD cases were defined by isolation of pneumococcus from a normally sterile site in individuals residing in Active Bacterial Core surveillance (ABCs) areas during 1998-2008. Pneumococci were serotyped and tested for antibiotic susceptibility using broth microdilution. RESULTS: During 1998-2008, ABCs identified 43,198 IPD cases. Penicillin-nonsusceptible strains caused 6%-14% of IPD cases, depending on age. Between 1998-1999 and 2008, penicillin-nonsusceptible IPD rates declined 64% for children aged <5 years (12.1-4.4 cases per 100,000), and 45% for adults aged ≥65 (4.8-2.6 cases per 100,000). Rates of IPD nonsusceptible to multiple antibiotics mirrored these trends. During 2007-2008, serotypes in PCV13 but not PCV7 caused 78%-97% of penicillin-nonsusceptible IPD, depending on age. CONCLUSIONS: Antibiotic-nonsusceptible IPD rates remain below pre-PCV7 rates for children <5 and adults ≥65 years old. PCV13 vaccines hold promise for further nonsusceptibility reductions. |
Expanding and improving urban outreach immunization in Patna, India
Pradhan N , Ryman TK , Varkey S , Ranjan A , Gupta SK , Krishna G , Swetanki RP , Young R . Trop Med Int Health 2011 17 (3) 292-9 OBJECTIVES: We conducted a case study of an urban immunization outreach strategy to determine the feasibility of the intervention and to measure administrative immunization coverage outcomes. METHODS: A multipronged strategy for improving immunization coverage in Urban Patna, India, was implemented for 1 year (2009/2010). The strategy was designed to increase immunization sites, shift human resources, plan logistics, improve community mobilization, provide supervision, strengthen data flow and implement special vaccination drives. RESULTS: Over 1 year, the coverage of all primary vaccines of the Universal Immunization Program improved by over 100%. CONCLUSION: Coverage can be rapidly improved through outreach immunization in low socioeconomic areas if existing opportunities are carefully utilized. |
Clinical validation of multiplex real-time PCR assays for detection of bacterial meningitis pathogens.
Wang X , Theodore MJ , Mair R , Trujillo-Lopez E , du Plessis M , Wolter N , Baughman AL , Hatcher C , Vuong J , Lott L , von Gottberg A , Sacchi C , McDonald JM , Messonnier NE , Mayer LW . J Clin Microbiol 2011 50 (3) 702-8 Neisseria meningitidis (Nm), Haemophilus influenzae (Hi), and Streptococcus pneumoniae (Sp) are important causes of meningitis and other infections, and rapid, sensitive, and specific laboratory assays are critical for effective public health interventions. Singleplex real-time PCR assays have been developed to detect Nm ctrA, Hi hpd and Sp lytA, and serogroup-specific genes in the cap locus for Nm serogroups A, B, C, W135, X and Y. However, the assay sensitivity for serogroups B, W135 and Y is low. We aimed to improve assay sensitivity and develop multiplex assays to reduce time and cost. New singleplex real-time PCR assays B-synD, W-synG, and Y-synF showed 100% specificity for detecting Nm species, with high sensitivity [B-synD, 99%(75/76); W-synG, 97%(38/39); and Y-synF, 100%(66/66)]. The lower limit of detection (LLD) was 9, 43 and 10 copies/reaction for B-synD, W-synG, and Y-synF assays, respectively, a significant improvement compared to the previous singleplex assays. We developed three multiplex real-time PCR assays for detection of: (i) Nm ctrA, Hi hpd and Sp lytA (NHS); (ii) Nm serogroups A, W135 and X (AWX), and (iii) Nm serogroups B, C and Y (BCY). Each multiplex assay was 100% specific for detecting its target organisms or serogroups, and the LLD was similar to that for singleplex. Pairwise comparison of real-time PCR between multiplex and singleplex showed that cycle threshold values of the multiplex were similar to those for singleplex. There were no substantial differences in the sensitivity and specificity between these multiplex and singleplex real-time PCR assays. |
Development of monoclonal antibodies to recombinant terrelysin and characterization of expression in Aspergillus terreus.
Nayak AP , Green BJ , Friend S , Beezhold DH . J Med Microbiol 2011 61 489-499 Aspergillus terreus is an emerging pathogen that mostly affects immunocompromised patients with infections that are often difficult to manage therapeutically. Current diagnostic strategies are limited to the detection of fungal growth using radiological methods or biopsy that often does not enable species-specific identification. As a result, there is a critical need for diagnostic techniques to enable early and specific identification of the causative agent. In this study, we describe monoclonal antibodies (mAbs) developed to a previously described recombinant terrelysin. Sixteen hybridomas of various IgG isotypes were generated to the recombinant protein, of which seven demonstrated reactivity to the native protein in hyphal extracts. Cross-reactivity analysis using hyphal extracts from 29 fungal species, including 12 Aspergillus species and 5 different strains of A. terreus showed that 3 mAbs (13G10, 15B5 and 10G4) were A. terreus-specific. Epitope analysis demonstrated mAbs 13G10 and 10G4 recognize the same epitope 'PSNEFE', while mAb 15B5 recognized the epitope 'LYEGQFHS'. Time course studies showed that terrelysin expression was highest during early hyphal growth and dramatically reduced after mycelial expansion. Immunolocalization studies demonstrated that terrelysin is localized not only within the cytoplasm of hyphae but appeared to be more abundant at the hyphal tip. These findings were confirmed in cultures grown at room temperature as well as at 37 degrees C. Additionally, terrelysin was detected in the supernatant of A. terreus cultures. These observations suggest terrelysin may be a candidate biomarker for A. terreus infection. |
Evaluation of screening tests for detecting Chlamydia trachomatis: bias associated with the patient-infected-status algorithm
Hadgu A , Dendukuri N , Wang L . Epidemiology 2012 23 (1) 72-82 In recent years, the evaluation of nucleic acid amplification tests (NAATs) for detecting Chlamydia trachomatis and Neisseria gonorrhea is based on a methodology called the patient-infected-status algorithm (PISA). In the simplest version of PISA, 4 test-specimen combinations (comparator tests) are used to define the gold standard. If a person shows a positive result by any 2 or more of these 4 comparator tests, the person is classified as infected; otherwise, the person is considered to be uninfected. A new test is then compared with this diagnostic algorithm. PISA-based sensitivity and specificity estimates of nucleic acid amplification tests have been published in the medical and microbiologic literature and have been included in FDA-approved package inserts of NAATs for detecting C. trachomatis. Using simulations, we compare 2 versions of the patient-infected-status algorithm with latent-class models and an imperfect gold standard. We show that the PISA can produce highly biased test-performance parameter estimates. In a series of simulated scenarios, none of the 95% confidence intervals for PISA-based estimates of sensitivity and prevalence contained the true values. In addition, the PISA-based estimates of sensitivity and specificity change markedly as the true prevalence changes. We recommend that PISA should not be used for estimating the sensitivity and specificity of tests. |
Utility of the tourniquet test and the white blood cell count to differentiate dengue among acute febrile illnesses in the emergency room
Gregory CJ , Lorenzi OD , Colon L , Sepulveda Garcia A , Santiago LM , Cruz Rivera R , Cuyar Bermudez LJ , Ortiz Baez F , Vazquez Aponte D , Tomashek KM , Gutierrez J , Alvarado L . PLoS Negl Trop Dis 2011 5 (12) e1400 Dengue often presents with non-specific clinical signs, and given the current paucity of accurate, rapid diagnostic laboratory tests, identifying easily obtainable bedside markers of dengue remains a priority. Previous studies in febrile Asian children have suggested that the combination of a positive tourniquet test (TT) and leucopenia can distinguish dengue from other febrile illnesses, but little data exists on the usefulness of these tests in adults or in the Americas. We evaluated the diagnostic accuracy of the TT and leucopenia (white blood cell count <5000/mm(3)) in identifying dengue as part of an acute febrile illness (AFI) surveillance study conducted in the Emergency Department of Saint Luke's Hospital in Ponce, Puerto Rico. From September to December 2009, 284 patients presenting to the ED with fever for 2-7 days and no identified source were enrolled. Participants were tested for influenza, dengue, leptospirosis and enteroviruses. Thirty-three (12%) patients were confirmed as having dengue; 2 had dengue co-infection with influenza and leptospirosis, respectively. An infectious etiology was determined for 141 others (136 influenza, 3 enterovirus, 2 urinary tract infections), and 110 patients had no infectious etiology identified. Fifty-two percent of laboratory-positive dengue cases had a positive TT versus 18% of patients without dengue (P<0.001), 87% of dengue cases compared to 28% of non-dengue cases had leucopenia (P<0.001). The presence of either a positive TT or leucopenia correctly identified 94% of dengue patients. The specificity and positive predictive values of these tests was significantly higher in the subset of patients without pandemic influenza A H1N1, suggesting improved discriminatory performance of these tests in the absence of concurrent dengue and influenza outbreaks. However, even during simultaneous AFI outbreaks, the absence of leucopenia combined with a negative tourniquet test may be useful to rule out dengue. |
Local innate immune responses and influenza virus transmission and virulence in ferrets
Maines TR , Belser JA , Gustin KM , van Hoeven N , Zeng H , Svitek N , von Messling V , Katz JM , Tumpey TM . J Infect Dis 2011 205 (3) 474-85 Host innate immunity is the first line of defense against invading pathogens, including influenza viruses. Ferrets are well recognized as the best model of influenza virus pathogenesis and transmission, but little is known about the innate immune response of ferrets after infection with this virus. The goal of this study was to investigate the contribution of localized host responses to influenza virus pathogenicity and transmissibility in this model by measuring the level of messenger RNA expression of 12 cytokines and chemokines in the upper and lower respiratory tracts of ferrets infected with H5N1, H1N1, or H3N2 influenza viruses that exhibit diverse virulence and transmissibility in ferrets. We found a strong temporal correlation between inflammatory mediators and the kinetics and frequency of transmission, clinical signs associated with transmission, peak virus shedding, and virulence. Our findings point to a link between localized innate immunity and influenza virus transmission and disease progression. |
Oseltamivir inhibits H7 influenza virus replication in mice inoculated by the ocular route
Belser JA , Sleeman K , Pearce MB , Katz JM , Gubareva LV , Tumpey TM . Antimicrob Agents Chemother 2011 56 (3) 1616-8 The majority of human infections associated with H7 influenza viruses have resulted in ocular and not respiratory disease. While oseltamivir has been prescribed to individuals presenting with conjunctivitis following H7 virus exposure, it is unknown if oseltamivir inhibits virus replication in ocular tissue. We demonstrate that H7 viruses possess sensitivity to neuraminidase inhibitors, and that administration of oseltamivir before ocular virus challenge in mice inhibits H7N7 and H7N3 virus replication in ocular and respiratory tissues. |
Engineered combined positive control template for real-time reverse-transcription PCR reactions in multiple-pathogen detection assays
Kodani M , Winchell JM . J Clin Microbiol 2011 50 (3) 1057-60 Recently, we evaluated a custom TaqMan Array Card (TAC) detection system, formerly known as TaqMan(R) Low Density Array (TLDA) card, for simultaneous real-time PCR identification of 21 pathogens and three control targets in duplicate from respiratory specimens (Kodani, M., et al. 2011. J Clin Microbiol 49:2175-2182). We engineered an adaptable and expandable system of in-vitro RNA transcripts to serve as a combined positive control for both DNA and RNA targets in multiple pathogen detection technologies based on real-time reverse-transcription PCR. |
Extraction and inhibition of enzymatic activity of Botulinum neurotoxins/B1, /B2, /B3, /B4, and /B5 by a panel of monoclonal anti-BoNT/B antibodies
Kalb SR , Santana WI , Geren IN , Garcia-Rodriguez C , Lou J , Smith TJ , Marks JD , Smith LA , Pirkle JL , Barr JR . BMC Biochem 2011 12 (1) 58 BACKGROUND: Botulism is caused by botulinum neurotoxins (BoNTs), extremely toxic proteins which can induce respiratory failure leading to long-term intensive care or death. Treatment for botulism includes administration of antitoxins, which must be administered early in the course of the intoxication; therefore, rapid determination of human exposure to BoNT is an important public health goal. In previous work, our laboratory reported on Endopep-MS, a mass spectrometry-based activity method for detecting and differentiating BoNT/A, /B, /E, and /F in clinical samples. We also demonstrated that antibody-capture is effective for purification and concentration of BoNTs from complex matrices such as clinical samples. However, some antibodies inhibit or neutralize the enzymatic activity of BoNT, so the choice of antibody for toxin extraction is critical. RESULTS: In this work, we evaluated 24 anti-BoNT/B monoclonal antibodies (mAbs) for their ability to inhibit the in vitro activity of BoNT/B1, /B2, /B3, /B4, and /B5 and to extract those toxins. Among the mAbs, there were significant differences in ability to extract BoNT/B subtypes and inhibitory effect on BoNT catalytic activity. Some of the mAbs tested enhanced the in vitro light chain activity of BoNT/B, suggesting that BoNT/B may undergo conformational change upon binding some mAbs. CONCLUSIONS: In addition to determining in vitro inhibition abilities of a panel of mAbs against BoNT/B1-/B5, this work has determined B12.2 and 2B18.2 to be the best mAbs for sample preparation prior to Endopep-MS. These mAb characterizations also have the potential to assist with mechanistic studies of BoNT/B protection and treatment, which is important for studying alternative therapeutics for botulism. |
Clonal relatedness of enterotoxigenic Escherichia coli (ETEC) strains expressing LT and CS17 isolated from children with diarrhoea in La Paz, Bolivia
Rodas C , Klena JD , Nicklasson M , Iniguez V , Sjoling A . PLoS One 2011 6 (11) e18313 BACKGROUND: Enterotoxigenic Escherichia coli (ETEC) is a major cause of traveller's and infantile diarrhoea in the developing world. ETEC produces two toxins, a heat-stable toxin (known as ST) and a heat-labile toxin (LT) and colonization factors that help the bacteria to attach to epithelial cells. METHODOLOGY/PRINCIPAL FINDINGS: In this study, we characterized a subset of ETEC clinical isolates recovered from Bolivian children under 5 years of age using a combination of multilocus sequence typing (MLST) analysis, virulence typing, serotyping and antimicrobial resistance test patterns in order to determine the genetic background of ETEC strains circulating in Bolivia. We found that strains expressing the heat-labile (LT) enterotoxin and colonization factor CS17 were common and belonged to several MLST sequence types but mainly to sequence type-423 and sequence type-443 (Achtman scheme). To further study the LT/CS17 strains we analysed the nucleotide sequence of the CS17 operon and compared the structure to LT/CS17 ETEC isolates from Bangladesh. Sequence analysis confirmed that all sequence type-423 strains from Bolivia had a single nucleotide polymorphism; SNP(bol) in the CS17 operon that was also found in some other MLST sequence types from Bolivia but not in strains recovered from Bangladeshi children. The dominant ETEC clone in Bolivia (sequence type-423/SNP(bol)) was found to persist over multiple years and was associated with severe diarrhoea but these strains were variable with respect to antimicrobial resistance patterns. CONCLUSION/SIGNIFICANCE: The results showed that although the LT/CS17 phenotype is common among ETEC strains in Bolivia, multiple clones, as determined by unique MLST sequence types, populate this phenotype. Our data also appear to suggest that acquisition and loss of antimicrobial resistance in LT-expressing CS17 ETEC clones is more dynamic than acquisition or loss of virulence factors. |
"Complexities in hindcasting models - when should we say enough is enough,"
Maslia ML , Aral MM , Faye RE , Grayman WM , Suarez-Soto RJ , Sautner JB , Anderson BA , Bove FJ , Ruckart PZ , Moore SM . Ground Water 2011 50 (1) 10-6; discussion 16-8 In a recent article, TP Clement (2010, hereafter referred to as TPC) discusses the complexities and limitations of "hindcasting" models and criticizes the use of complex models when undertaking investigations of subsurface reactive transport processes. TPC implies that complex numerical models that stimulate reactive transport processes in groundwater are likely if not always an inappropriate tool to apply to "hindcasting" investiagtions and that scientists and engineers who implement these investiagtions using such models are somehow not aware of teh technical and scientific complexities and limitations of such methods and approaches. To illustrate his point of view, TPC uses a case study of an ongoing health study of exposure to volatile organic compounds (VOCs) in drinking water at US Marine Corps Base Camp Lejeune, North Carolina (hereafter referred to as the case-control health study at Camp Lejeune). The article presents some thought-provoking points-of-view. However, we believe there is a lack of detail on several key issues that require specificity and clarification, particularly with respect to modleing approaches and methods, the physics of containment occurrence and reactive transport in teh subsurface, and agency policies for the review and dissemination of data and reports. |
Clinical indications and determinants of the rise of cesarean section in three hospitals in rural China
Qin C , Zhou M , Callaghan WM , Posner SF , Zhang J , Berg CJ , Zhao G . Matern Child Health J 2011 16 (7) 1484-90 This study investigated changes in cesarean delivery rate and cesarean indications in 3 county-level hospitals in rural China. Hospital delivery records in 1997 and 2003 were used to examine the reasons behind the changes. In Chengde County Hospital, the cesarean delivery rate increased from 28% in 1997 to 54% in 2003. The rate increased from 43% in 1997 to 65% in 2003 in Anxian County Hospital and Anxian Maternal and Child Health Hospital. The dramatic increase in cesarean delivery in the study hospitals was associated with a shift from more severe to mild or no clinical indications. The ratio of mild to moderate to severe hypertension increased substantially. More than half of the cephalopelvic disproportion cases were diagnosed prior to labor. The majority of nuchal cord cases were diagnosed without fetal distress. Maternal/family request was the number one cesarean indication in Anxian County Hospital and Anxian MCH Hospital in 2003. Ultrasound evidence of nuchal cord moved from the ninth ranked indication in 1997 to the second in 2003 in Chengde County Hospital. |
Progression of occupational risk management with advances in nanomaterials
Murashov V , Schulte P , Howard J . J Occup Environ Hyg 2012 9 (1) D12-22 Nanotechnology has been touted as a transformative technology that would encompass a broad range of products and application areas and improve many aspects of human life. As nanotechnology matures, the complexity of its main product, nanomaterials, increases. Four generations of nanomaterials have been defined by a World Technology Evaluation Center (WTEC) Report,( Citation1 ) namely, passive nanomaterials, active nanomaterials, integrated nanosystems, and molecular nanosystems. According to the Woodrow Wilson Nanotechnology Consumer Product Inventory,( Citation2 ) there are over 1000 self-identified nano-enabled consumer products on the market. Most of these products are based on first-generation “passive nanomaterials.” Limited understanding of passive nanomaterial hazards has challenged traditional occupational health risk assessment and management approaches. New approaches including suggestions for the development and adoption of proactive approaches to nanotechnology risk assessment and control have been proposed.( Citation3 ) Unlike reactive approaches, where risk control measures are applied to well characterized hazards, proactive or anticipatory approaches aim at minimizing risks of hazards before they are fully characterized. |
The role of force and repetition in musculoskeletal disorder risk
Gallagher S . Proc Hum Factors Ergon Soc Annu Meet 2011 55 (1) 1042-1046 While many epidemiological papers have examined the effects of force and repetition on musculoskeletal disorder (MSD) risk, relatively few have examined the effects of these factors in combination. Many papers that have examined both factors in combination provide evidence of an interaction between force and repetition in the development of MSDs. When biological tissues are tested to failure using varied levels of force and repetition, a similar interaction is observed. Taken together, these findings suggest that force and repetition should not be treated as independent risk factors for MSDs, but as factors dependent on one another. This paper further posits that fatigue failure models provide a useful framework that helps to explain the observed force-repetition relationship. A model is presented that summarizes the hypothesized role of force and repetition on tissue injury and repair. |
A multifaceted public health approach to statewide aviation safety
Mode NA , O'Connor MB , Conway GA , Hill RD . Am J Ind Med 2011 55 (2) 176-86 BACKGROUND: During the 1990s, Alaskan pilots had one of the most hazardous occupations in the US. In 2000, a multifaceted public health initiative was launched, focusing on Alaskan air taxi/commuter (AT) operations, including risk factor identification, improved weather information, and the formation of an industry-led safety organization. METHODS: Effectiveness was assessed by comparing rates of crashes using Poisson regression, comparing trends in annual numbers of crashes, and assessing changes in the number and type of controlled flight into terrain (CFIT) events. RESULTS: The greatest improvements were seen in Alaska fatal AT crashes with a 57% decrease in rates between time periods. While the number of AT crashes in the rest of the US steadily declined during 1990-2009, Alaska only showed significant declines after 2000. CFIT crashes declined but remained more deadly than other crashes. CONCLUSIONS: This coordinated effort was successful in reducing crashes in the Alaskan AT industry. (Am. J. Ind. Med. (c) 2011 Wiley Periodicals, Inc.) |
Occupation and the prevalence of respiratory health symptoms and conditions: the Atherosclerosis Risk in Communities study
Mirabelli MC , London SJ , Charles LE , Pompeii LA , Wagenknecht LE . J Occup Environ Med 2011 54 (2) 157-65 OBJECTIVES: To examine associations between occupation and respiratory health in a large, population-based cohort of adults in the United States. METHODS: Data from 15,273 participants, aged 45 to 64 years, in the Atherosclerosis Risk in Communities study were used to examine associations of current or most recent job held with the prevalence of self-reported chronic cough, chronic bronchitis, wheezing, asthma, and measures of lung function collected by spirometry. RESULTS: Eleven percent of participants reported wheezing and 9% were classified as having airway obstruction. Compared with individuals in managerial and administrative jobs, increased prevalences of respiratory outcomes were observed among participants in selected occupations, including construction and extractive trades (wheezing, prevalence ratio = 1.92, 95% confidence interval = 1.35, 2.73; airway obstruction, prevalence ratio = 1.31, 95% confidence interval = 1.05, 1.65). CONCLUSIONS: Specific occupations are associated with adverse respiratory health. |
Prospective study on neurotoxic effects in manganese-exposed bridge construction welders
Bowler RM , Gocheva V , Harris M , Ngo L , Abdelouahab N , Wilkinson J , Doty RL , Park R , Roels HA . Neurotoxicology 2011 32 (5) 596-605 BACKGROUND: In a group of 43 confined space welders dose-effect relationships had been identified for adverse neurological/neuropsychological functional effects in relation to manganese (Mn) in blood or air (cumulative exposure index). The welders' exposure to Mn was unprotected and with poor ventilation, lasting on average 16.5 months. A follow-up examination 3.5 years later, after cessation of confined space welding, was carried out to re-assess the status of mood, movement/neuromotor and cognitive functions, and olfaction. METHODS: In 2008, 26 welders (70% response rate) were retested using a similar methodology as at baseline (Bowler et al., 2007). A general linear model was used to estimate individual-specific endpoint differences over time. Mean age was 47 years, mean years of education 12.4, and mean total years of welding 16.9 years. Thirteen participants no longer welded. RESULTS: At follow-up, mean blood Mn concentration had decreased from 10.0 to 8.4 mcg/L (p=0.002). Those still welding had higher blood Mn than those no longer welding (9.9 mcg/L vs. 6.8 mcg/L, p=0.002). Several domains of cognitive functioning improved substantially as shown by large effect sizes. Emotional disturbance improved only slightly clinically, but complaints of depression and anxiety persisted. Motor dexterity/tactile function and graphomotor tremor improved significantly, while psychomotor speed remained unchanged. The findings of the neurological examination (UPDRS) did not change compared to baseline, whereas rigidity, dominant postural hand tremor and body sway worsened. Olfactory test scores remained depressed. CONCLUSION: After 3.5 years of cessation of confined space welding, only cognitive function improved significantly, while olfactory, extrapyramidal, and mood disturbances remained constant or were exacerbated. This suggests differential intrinsic vulnerabilities of the brain loci involved with Mn exposure. As the Mn exposure of the Bay Bridge welders frequently exceeded the Cal-OSHA TLV of 0.2 mg Mn/m(3) at baseline, a more stringent preventive measure is recommended for confined space welding. |
Harmonization of measurement strategies for exposure to manufactured nano-objects; report of a workshop
Brouwer D , Berges M , Virji MA , Fransman W , Bello D , Hodson L , Gabriel S , Tielemans E . Ann Occup Hyg 2011 56 (1) 1-9 The present paper summarizes the outcome of the discussions at the First International Scientific Workshop on Harmonization of Strategies to Measure and Analyze Exposure to (Manufactured) Nano-objects in Workplace Air that was organized and hosted by the Netherlands Organization for Applied Scientific Research (TNO) and the Institute for Occupational Safety and Health of the German Social Accident Insurance (IFA) (Zeist, The Netherlands, December 2010). It reflects the discussions by 25 international participants in the area of occupational (nano) exposure assessment from Europe, USA, Japan, and Korea on nano-specific issues related to the three identified topics: (i) measurement strategies; (ii) analyzing, evaluating, and reporting of exposure data; and (iii) core information for (exposure) data storage. Preliminary recommendations were achieved with respect to (i) a multimetric approach to exposure assessment, a minimal set of data to be collected, and basic data analysis and reporting as well as (ii) a minimum set of contextual information to be collected and reported. Other issues that have been identified and are of great interest include (i) the need for guidance on statistical approaches to analyze time-series data and on electron microscopy analysis and its reporting and (ii) the need for and possible structure of a (joint) database to store and merge data. To make progress in the process of harmonization, it was concluded that achieving agreement among researchers on the preliminary recommendations of the workshop is urgent. |
Three cases of hairy cell leukemia in coal miners
Aristeguieta C , de Perio MA . Leuk Lymphoma 2011 52 (12) 2391-2 We identified three cases of hairy cell leukemia (HCL) in a small group of coal miners in Alabama, USA. All three cases of HCL were male, aged between 43 and 63 years old at diagnosis and had worked as miners between 6 and 14 years. All had long-term exposure to coal dust and diesel exhaust, which have been speculated as risk factors for HCL [Citation1,Citation2]. We are highlighting the cluster to alert physicians about possible occupational causes of HCL. | The miners’ union contacted the Mine Safety and Health Administration (MSHA) because of concerns of high exposures to diesel fuel and exhaust. MSHA's Safety and Health Technology Center assessed the mine in July 2008 and found no elevated exhaust gas components (diesel particulate matter, carbon monoxide, nitric oxide and nitrogen dioxide) [Citation3]. These findings likely do not reflect typical worker exposures because the mine was not producing at capacity at the time of the assessment. Nevertheless, MSHA recommended improved procedures for replacing diesel engine filters and maintaining filter housings. |
A CART technique to adjust production from longwall coal operations under ventilation constraints
Karacan CO , Goodman GVR . Saf Sci 2011 50 (3) 510-522 Methane emissions in longwall coal mines can arise from a variety of geologic and production factors, where ventilation and degasification are primary control measures to prevent excessive methane levels. However, poor ventilation practices or inadequate ventilation may result in accumulation of dangerous methane-air mixtures. The need exists for a set of rules and a model to be used as guidelines to adjust coal production according to expected methane emissions and current ventilation conditions. In this paper, hierarchical classification and regression tree (CART) analyses are performed as nonparametric modeling efforts to predict methane emissions that can arise during extraction of a longwall panel. These emissions are predicted for a range of coal productivities while considering specific operational, panel design and geologic parameters such as gas content, proximate composition of coal, seam height, panel width, cut height, cut depth, and panel size. Analyses are conducted for longwall mines with and without degasification of the longwall panel. These models define a range of coal productivities that can be achieved without exceeding specified emissions rates under given operating and geological conditions. Finally, the technique was applied to longwall mines that operate with and without degasification system to demonstrate its use and predictive capability. The predicted results proved to be close to the actual measurements to estimate ventilation requirements. Thus, the CART-based model that is given in this paper can be used to predict methane emission rates and to adjust operation parameters under ventilation constrains in longwall mining. |
State of malaria diagnostic testing at clinical laboratories in the United States, 2010: a nationwide survey
Abanyie FA , Arguin PM , Gutman J . Malar J 2011 10 340 BACKGROUND: The diagnosis of malaria can be difficult in non-endemic areas, such as the United States, and delays in diagnosis and errors in treatment occur too often. METHODS: A nationwide survey of laboratories in the United States and its nine dependent territories was conducted in 2010 to determine factors that may contribute to shortcomings in the diagnosis of malaria. This survey explored the availability of malaria diagnostic tests, techniques used, and reporting practices. RESULTS: The survey was completed by 201 participants. Ninety percent reported that their laboratories had at least one type of malaria diagnostic test available on-site. Nearly all of the respondents' laboratories performed thick and thin smears on-site; approximately 50% had access to molecular testing; and only 17% had access to rapid diagnostic tests on-site. Seventy-three percent reported fewer than five confirmed cases of malaria in their laboratory during the 12-month period preceding the survey. Twenty-eight percent stated that results of species identification took more than 24 hours to report. Only five of 149 respondents that performed testing 24 hours a day, 7 days a week complied with all of the Clinical and Laboratory Standards Institute (CLSI) guidelines for analysis and reporting of results. CONCLUSION: Although malaria diagnostic testing services were available to a majority of U.S. laboratories surveyed, very few were in complete compliance with all of the CLSI guidelines for analysis and reporting of results, and most respondents reported very few cases of malaria annually. Laboratories' difficulty in adhering to the rigorous CLSI guidelines and their personnel's lack of practice and proficiency may account for delays and errors in diagnosis. It is recommended that laboratories that infrequently process samples for malaria seek opportunities for practice and proficiency training annually and take advantage of available resources to assist in species identification. |
Effects of malaria and its treatment in early pregnancy
Desai M , Dellicour S . Lancet Infect Dis 2011 12 (5) 359-60 Malaria can have devastating consequences for pregnant women and their developing fetuses. The lack of information on the effect of malaria in the first trimester has been previously identified as an important knowledge gap in estimating the burden of malaria in pregnancy.1 Similarly, few data are available on the safety in early pregnancy of the artemisinin class of compounds, alone or as combination therapies,2 the most effective antimalarials to date. Although extrapolation of animal reprotoxicology data to human beings is ambiguous, it suggests that artemisinin derivatives could cause birth defects or pregnancy loss when used in the early first trimester of pregnancy.3 Policy makers and health practitioners need reliable data to determine the best treatment for malaria in the first trimester of pregnancy.4 | In The Lancet Infectious Diseases, R McGready and colleagues5 report results of the largest retrospective analysis to date of the effect of malaria infection and treatment in early pregnancy. The investigators analysed 25 years of data from the Shoklo Malaria Research Unit (SMRU) clinics on the Thai–Burmese border, including over 48 000 pregnancies.5 Their findings showed that the main risk factors for miscarriage were malaria infection (symptomatic and asymptomatic), smoking, and increasing maternal age. McGready and colleagues concluded that there was no evidence of increased miscarriage with first-trimester exposure to artemisinin derivatives when controlling for malaria infection and parasitaemia based on 64 exposures compared with women treated with chloroquine (354), or quinine (355), and women who had no malaria during pregnancy (16 668). |
Trends in sex hormone concentrations in US males: 1988-1991 to 1999-2004
Nyante SJ , Graubard BI , Li Y , McQuillan GM , Platz EA , Rohrmann S , Bradwin G , McGlynn KA . Int J Androl 2011 35 (3) 456-66 Previous studies suggest that male testosterone concentrations have declined over time. To explore this in a large US population, we examined testosterone and free testosterone concentrations in National Health and Nutrition Examination Surveys (NHANES) from 1988-1991 and 1999-2004. We also examined sex hormone-binding globulin (SHBG), estradiol, and androstanediol glucuronide (3alpha-diol-G) over the same period. Non-Hispanic white, non-Hispanic black, and Mexican-American men from 1988-1991 and 1999-2004 NHANES surveys who were ≥20 years old and had serum from morning blood draws were included in this analysis (1988-1991: N = 1,413; 1999-2004: N = 902). Testosterone, estradiol and SHBG were measured by competitive electrochemiluminescence immunoassays and 3alpha-diol-G was measured by enzyme immunoassay. Free testosterone was calculated using testosterone and SHBG values. Adjusted mean hormone concentrations were estimated using linear regression, accounting for NHANES sampling weights and design, age, race/ethnicity, body mass index, waist circumference, alcohol use and smoking. Differences in adjusted mean concentrations (Delta) and two-sided p-values were calculated; p < 0.05 was statistically significant. Overall, 3alpha-diol-G and estradiol declined between 1988-1991 and 1999-2004, but there was little change in testosterone, free testosterone, or SHBG (Delta: 3alpha-diol-G = -1.83 ng/mL, p < 0.01; estradiol = -6.07 pg/mL, p < 0.01; testosterone = -0.03 ng/mL, p = 0.75; free testosterone = -0.001 ng/mL, p = 0.67; SHBG = -1.17 nmol/L, p = 0.19). Stratification by age and race revealed that SHBG and 3alpha-diol-G declined among whites 20-44 years old (Delta: SHBG = -5.14 nmol/L, p < 0.01; 3alpha-diol-G = -2.89 ng/mL, p < 0.01) and free testosterone increased among blacks 20-44 years old (Delta: 0.014 ng/mL, p = 0.03). Estradiol declined among all ages of whites and Mexican-Americans. In conclusion, there was no evidence for testosterone decline between 1988-1991 and 1999-2004 in the US general population. Subgroup analyses suggest that SHBG and 3alpha-diol-G declined in young white men, estradiol declined in white and Mexican-American men, and free testosterone increased in young black men. These changes may be related to the increasing prevalence of reproductive disorders in young men. |
A comparative study of interventions for delaying the initiation of sexual intercourse among Latino and black youth
Guilamo-Ramos V , Jaccard J , Dittus P , Bouris A , Gonzalez B , Casillas E , Banspach S . Perspect Sex Reprod Health 2011 43 (4) 247-254 CONTEXT: Latino and black adolescents are disproportionately affected by STDs, including HIV, and unintended pregnancies. Few parent-based interventions have targeted these youth, focused on early adolescence and had high participation rates. METHODS: Between 2003 and 2009, a randomized clinical trial was conducted with 2,016 Latino and black mother-adolescent dyads in New York City. Adolescents were eligible if they were in grade 6 or 7. Dyads were assigned to one of three conditions: a parent-based intervention, Families Talking Together (FTT); an adolescent-only intervention, Making a Difference! (MAD); or a combined FTT+MAD intervention. Respondents completed questionnaires at baseline and 12 months later. Single-degree-of-freedom contrasts and logistic regression analysis were used to evaluate differences in outcomes by intervention. RESULTS: The proportion of youth who reported ever having engaged in vaginal intercourse increased over the study period by eight percentage points among those in the MAD group, five points in the FTT group and three points in the combined group; the differences among these increases were not statistically significant. Adolescents in the two FTT groups were significantly more likely than those in the MAD group to indicate that their mother had talked to them about not having intercourse (79% vs. 68%). They also scored higher than youth in the MAD group on measures of communication and perceived maternal attributes, and lower on activities that might lead to risky behaviors. CONCLUSIONS: The proportions of adolescents who initiated intercourse during the study period were not significantly different across groups, implying that the interventions were comparable. Findings suggest that FTT may have led to improved parenting behaviors. |
Exploring the connections between HIV serostatus and individual, household, and community socioeconomic resources: evidence from two population-based surveys in Kenya
Ishida K , Arnold M , Stupp P , Kizito P , Ichwara J . Soc Sci Med 2011 74 (2) 185-95 The positive association between health and socioeconomic status (SES) is well documented. However, available empirical evidence on the SES gradients of HIV serostatus is mixed, and few studies have explored the effects of community SES indicators on individual's HIV risk. Using nationally representative data of women and men from the 2003 Demographic and Health Survey and the 2007 AIDS Indicator Survey from Kenya, we assessed the associations between HIV serostatus and SES as measured by educational attainment and household wealth at the individual/household and community levels. Additionally, we explored changes in these associations between 2003 and 2007. Results from bivariate and cohort analyses showed that during this period, HIV burden shifted from higher to lower SES subgroups at both the individual/household and community levels, particularly among women aged 15-24 years. Results from multi-level logistic regression models showed that this shift was generally significant among women. In addition, communities' collective educational attainment, measured as the percentage of residents with some secondary schooling or higher, was a more significant predictor and protective factor for HIV risk than individual/household-level SES indicators for women in 2007 and men in both years. Our findings highlight the relevance of community-level SES to HIV dynamics in Kenya between 2003 and 2007. |
Spatio-temporal modeling of sparse geostatistical malaria sporozoite rate data using a zero inflated binomial model
Amek N , Bayoh N , Hamel M , Lindblade KA , Gimnig J , Laserson KF , Slutsker L , Smith T , Vounatsou P . Spat Spatiotemporal Epidemiol 2011 2 (4) 283-290 The proportion of malaria vectors harboring the infectious stage of the parasite (the sporozoite rates) is an important component of measures of malaria transmission. Variation in time and/or space in sporozoite rates contribute substantially to spatio-temporal variation in transmission. However, because most vectors test negative for sporozoites, sporozoite rate data are sparse with large number of observed zeros across locations or over time in the case of longitudinal data. Rarely are appropriate methods and models used in analyzing such data. In this study, Bayesian zero inflated binomial (ZIB) geostatistical models were developed and compared with standard binomial analogues to analyze sporozoite data obtained from the KEMRI/CDC health and demographic surveillance system (HDSS) site in rural Western Kenya during 2002-2004. ZIB models showed a better predictive ability, identified more significant covariates and obtained narrower credible intervals for all parameters compared to standard geostatistical binomial model. (2011 Elsevier Ltd.) |
Exposure to tobacco smoke among adults in Bangladesh
Palipudi KM , Sinha DN , Choudhury S , Mustafa Z , Andes L , Asma S . Indian J Public Health 2011 55 (3) 210-9 OBJECTIVE: To examine exposure to second-hand smoke (SHS) at home, in workplace, and in various public places in Bangladesh. MATERIALS AND METHODS: Data from 2009 Global Adult Tobacco Survey (GATS) conducted in Bangladesh was analyzed. The data consists of 9,629 respondents from a nationally representative multi-stage probability sample of adults aged 15 years and above. Exposure to second-hand smoke was defined as respondents who reported being exposed to tobacco smoke in the following locations: Indoor workplaces, homes, government building or office, health care facilities, public transportation, schools, universities, restaurants, and cafes, coffee shops or tea houses. Exposure to tobacco smoke in these places was examined by gender across various socioeconomic and demographic sub-groups that include age, residence, education and wealth index using SPSS 17.0 for complex samples. RESULTS: The study shows high prevalence of SHS exposure at home and in workplace and in public places. Exposure to SHS among adults was reported high at home (54.9%) (male-58.2% and female-51.7%), in workplace (63%) (male-67.8% and female-30.4%), and in any public place (57.8%) (male-90.4% and female-25.1%) 30 days preceding the survey. Among the public places examined exposure was low in the educational institutions (schools-4.3%) and health care facilities (5.8%); however, exposure was high in public transportation (26.3%), and restaurants (27.6%). SHS exposure levels at home, in workplace and public places were varied widely across various socioeconomic and demographic sub-groups. CONCLUSIONS: Exposure was reported high in settings having partial ban as compared to settings having a complete ban. Following the WHO FCTC and MPOWER measures, strengthening smoke-free legislation may further the efforts in Bangladesh towards creating and enforcing 100% smoke-free areas and educating the public about the dangers of SHS. Combining these efforts can have a complementary effect on protecting the people from hazardous effect of SHS as well as reducing the social acceptance of smoking both at home and in public and workplaces. Ongoing surveillance in Bangladesh is necessary to measure progress towards monitoring SHS exposure. |
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