Last data update: Apr 22, 2024. (Total: 46599 publications since 2009)
Records 1-28 (of 28 Records) |
Query Trace: Ahuja R [original query] |
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Pfizer-BioNTech COVID-19 vaccine effectiveness against SARS-CoV-2 infection among long-term care facility staff with and without prior infection in New York City, January-June 2021.
Peebles K , Arciuolo RJ , Romano AS , Sell J , Greene SK , Lim S , Mulready-Ward C , Ternier A , Badenhop B , Blaney K , Real JE , Spencer M , McPherson TD , Ahuja SD , Sullivan Meissner J , Zucker JR , Rosen JB . J Infect Dis 2023 227 (4) 533-542 BACKGROUND: Evidence is accumulating of coronavirus disease 2019 (COVID-19) vaccine effectiveness among persons with prior severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS: We evaluated the effect against incident SARS-CoV-2 infection of (1) prior infection without vaccination, (2) vaccination (2 doses of Pfizer-BioNTech COVID-19 vaccine) without prior infection, and (3) vaccination after prior infection, all compared with unvaccinated persons without prior infection. We included long-term care facility staff in New York City aged <65 years with weekly SARS-CoV-2 testing from 21 January to 5 June 2021. Test results were obtained from state-mandated laboratory reporting. Vaccination status was obtained from the Citywide Immunization Registry. Cox proportional hazards models adjusted for confounding with inverse probability of treatment weights. RESULTS: Compared with unvaccinated persons without prior infection, incident SARS-CoV-2 infection risk was lower in all groups: 54.6% (95% confidence interval, 38.0%-66.8%) lower among unvaccinated, previously infected persons; 80.0% (67.6%-87.7%) lower among fully vaccinated persons without prior infection; and 82.4% (70.8%-89.3%) lower among persons fully vaccinated after prior infection. CONCLUSIONS: Two doses of Pfizer-BioNTech COVID-19 vaccine reduced SARS-CoV-2 infection risk by ≥80% and, for those with prior infection, increased protection from prior infection alone. These findings support recommendations that all eligible persons, regardless of prior infection, be vaccinated against COVID-19. |
Perspective: Human milk composition and related data for national health and nutrition monitoring and related research
Ahuja JKC , Casavale KO , Li Y , Hopperton KE , Chakrabarti S , Hines EP , Brooks SPJ , Bondy GS , MacFarlane AJ , Weiler HA , Wu X , Borghese MM , Ahluwalia N , Cheung W , Vargas AJ , Arteaga S , Lombo T , Fisher MM , Hayward D , Pehrsson PR . Adv Nutr 2022 13 (6) 2098-2114 National health and nutrition monitoring is an important federal effort in the United States and Canada, and the basis for many of their nutrition and health policies. Understanding of child exposures through human milk (HM) remains out of reach due to lack of current and representative data on HM's composition and intake volume. This article provides an overview of the current national health and nutrition monitoring activities for HM-fed children, HM composition (HMC) and volume data used for exposure assessment, categories of potential measures in HM, and associated variability factors. In this Perspective, we advocate for a framework for collection and reporting of HMC data for national health and nutrition monitoring and programmatic needs, including a shared vision for a publicly available Human Milk Composition Data Repository (HMCD-R) to include essential metadata associated with HMC. HMCD-R can provide a central, integrated platform for researchers and public health officials for compiling, evaluating, and sharing HMC data. The compiled compositional and metadata in HMCD-R would provide pertinent measures of central tendency and variability and allow use of modeling techniques to approximate compositional profiles for subgroups, providing more accurate exposure assessments for purposes of monitoring and surveillance. HMC and related metadata could facilitate understanding the complexity and variability of HM composition, provide crucial data for assessment of infant and maternal nutritional needs, and inform public health policies, food and nutrition programs, and clinical practice guidelines. |
Comparative hospitalization risk for SARS-CoV-2 Omicron and Delta variant infections, by variant predominance periods and patient-level sequencing results, New York City, August 2021-January 2022.
Greene SK , Levin-Rector A , Kyaw NTT , Luoma E , Amin H , McGibbon E , Mathes RW , Ahuja SD . Influenza Other Respir Viruses 2022 17 (1) e13062 BACKGROUND: Comparing disease severity between SARS-CoV-2 variants among populations with varied vaccination and infection histories can help characterize emerging variants and support healthcare system preparedness. METHODS: We compared COVID-19 hospitalization risk among New York City residents with positive laboratory-based SARS-CoV-2 tests when 98% of sequencing results were Delta (August-November 2021) or Omicron (BA.1 and sublineages, January 2022). A secondary analysis defined variant exposure using patient-level sequencing results during July 2021-January 2022, comprising 1-18% of weekly confirmed cases. RESULTS: Hospitalization risk was lower among patients testing positive when Omicron (16,025/488,053, 3.3%) than when Delta predominated (8268/158,799, 5.2%). In multivariable analysis adjusting for demographic characteristics and prior diagnosis and vaccination status, patients testing positive when Omicron predominated, compared with Delta, had 0.72 (95% CI: 0.63, 0.82) times the hospitalization risk. In a secondary analysis of patients with sequencing results, hospitalization risk was similar among patients infected with Omicron (2042/29,866, 6.8%), compared with Delta (1780/25,272, 7.0%), and higher among the subset who received two mRNA vaccine doses (adjusted relative risk 1.64; 95% CI: 1.44, 1.87). CONCLUSIONS: Hospitalization risk was lower among patients testing positive when Omicron predominated, compared with Delta. This finding persisted after adjusting for prior diagnosis and vaccination status, suggesting intrinsic virologic properties, not population-based immunity, explained the lower severity. Secondary analyses demonstrated collider bias from the sequencing sampling frame changing over time in ways associated with disease severity. Representative data collection is necessary to avoid bias when comparing disease severity between previously dominant and newly emerging variants. |
Top food category contributors to sodium and potassium intake - United States, 2015-2016
Woodruff RC , Zhao L , Ahuja JKC , Gillespie C , Goldman J , Harris DM , Jackson SL , Moshfegh A , Rhodes D , Sebastian RS , Terry A , Cogswell ME . MMWR Morb Mortal Wkly Rep 2020 69 (32) 1064-1069 Most U.S. adults consume too much sodium and not enough potassium (1,2). For apparently healthy U.S. adults aged ≥19 years, guidelines recommend reducing sodium intake that exceeds 2,300 mg/day and consuming at least 3,400 mg/day of potassium for males and at least 2,600 mg/day for females* (1). Reducing population-level sodium intake can reduce blood pressure and prevent cardiovascular diseases, the leading causes of death in the United States (1,3). Adequate potassium intake might offset the hypertensive effects of excessive sodium intake (1). Data from the 2015-2016 What We Eat in America (WWEIA) dietary interview component of the National Health and Nutrition Examination Survey (NHANES)(†) were analyzed to identify top food categories contributing to sodium and potassium intake for U.S. residents aged ≥1 year. During 2015-2016, 40% of sodium consumed came from the top 10 food categories, which included prepared foods with sodium added (e.g., deli meat sandwiches and pizza). Approximately 43% of potassium consumed was from 10 food categories, which included foods naturally low in sodium (e.g., unflavored milk, fruit, vegetables) and prepared foods. These results can inform efforts to encourage consumption of foods naturally low in sodium, which might have the dual benefit of reducing sodium intake and increasing potassium intake, contributing to cardiovascular disease prevention. |
Assessing changes in sodium content of selected popular commercially processed and restaurant foods: Results from the USDA: CDC Sentinel Foods Surveillance Program
Ahuja JKC , Li Y , Haytowitz DB , Bahadur R , Pehrsson PR , Cogswell ME . Nutrients 2019 11 (8) This report provides an update from the U.S. Department of Agriculture - Centers for Disease Control and Prevention Sentinel Foods Surveillance Program, exploring changes in sodium and related nutrients (energy, potassium, total and saturated fat, and total sugar) in popular, sodium-contributing, commercially processed and restaurant foods with added sodium. In 2010-2013, we obtained 3432 samples nationwide and chemically analyzed 1654 composites plus label information for 125 foods, to determine baseline laboratory and label sodium concentrations, respectively. In 2014-2017, we re-sampled and chemically analyzed 43 of the Sentinel Foods (1181 samples), tested for significant changes of at least +/-10% (p < 0.05), in addition to tracking changes in labels for 108 Sentinel Foods. Our results show that the label sodium levels of a majority of the Sentinel Foods had not changed since baseline (~1/3rd of the products reported changes, with twice as many reductions as increases). Laboratory analyses of the 43 Sentinel Foods show that eight foods had significant changes (p < 0.05); sodium content continues to be high and variable, and there was no consistent pattern of changes in related nutrients. Comparisons of changes in labels and laboratory sodium shows consistency for 60% of the products, i.e., similar changes (or no changes) in laboratory and label sodium content. The data from this monitoring program may help public health officials to develop strategies to reduce and monitor sodium trends in the food supply. |
NIH workshop on human milk composition: summary and visions
Casavale KO , Ahuja JKC , Wu X , Li Y , Quam J , Olson R , Pehrsson P , Allen L , Balentine D , Hanspal M , Hayward D , Hines EP , McClung JP , Perrine CG , Belfort MB , Dallas D , German B , Kim J , McGuire M , McGuire M , Morrow AL , Neville M , Nommsen-Rivers L , Rasmussen KM , Zempleni J , Lynch CJ . Am J Clin Nutr 2019 110 (3) 769-779 Nationally representative data from mother-child dyads that capture human milk composition (HMC) and associated health outcomes are important for advancing the evidence to inform federal nutrition and related health programs, policies, and consumer information across the governments in the United States and Canada as well as in nongovernment sectors. In response to identified gaps in knowledge, the National Institute of Diabetes and Digestive and Kidney Diseases of the NIH sponsored the "Workshop on Human Milk Composition-Biological, Environmental, Nutritional, and Methodological Considerations" held 16-17 November 2017 in Bethesda, Maryland. Through presentations and discussions, the workshop aimed to 1) share knowledge on the scientific need for data on HMC; 2) explore the current understanding of factors affecting HMC; 3) identify methodological challenges in human milk (HM) collection, storage, and analysis; and 4) develop a vision for a research program to develop an HMC data repository and database. The 4 workshop sessions included 1) perspectives from both federal agencies and nonfederal academic experts, articulating scientific needs for data on HMC that could lead to new research findings and programmatic advances to support public health; 2) information about the factors that influence lactation and/or HMC; 3) considerations for data quality, including addressing sampling strategies and the complexities in standardizing collection, storage, and analyses of HM; and 4) insights on how existing research programs and databases can inform potential visions for HMC initiatives. The general consensus from the workshop is that the limited scope of HM research initiatives has led to a lack of robust estimates of the composition and volume of HM consumed and, consequently, missed opportunities to improve maternal and infant health. |
Treatment correlates of successful outcomes in pulmonary multidrug-resistant tuberculosis: an individual patient data meta-analysis
Ahmad N , Ahuja SD , Akkerman OW , Alffenaar JC , Anderson LF , Baghaei P , Bang D , Barry PM , Bastos ML , Behera D , Benedetti A , Bisson GP , Boeree MJ , Bonnet M , Brode SK , Brust JCM , Cai Y , Caumes E , Cegielski JP , Centis R , Chan PC , Chan ED , Chang KC , Charles M , Cirule A , Dalcolmo MP , D'Ambrosio L , de Vries G , Dheda K , Esmail A , Flood J , Fox GJ , Frechet-Jachym M , Fregona G , Gayoso R , Gegia M , Gler MT , Gu S , Guglielmetti L , Holtz TH , Hughes J , Isaakidis P , Jarlsberg L , Kempker RR , Keshavjee S , Khan FA , Kipiani M , Koenig SP , Koh WJ , Kritski A , Kuksa L , Kvasnovsky CL , Kwak N , Lan Z , Lange C , Laniado-Laborin R , Lee M , Leimane V , Leung CC , Leung EC , Li PZ , Lowenthal P , Maciel EL , Marks SM , Mase S , Mbuagbaw L , Migliori GB , Milanov V , Miller AC , Mitnick CD , Modongo C , Mohr E , Monedero I , Nahid P , Ndjeka N , O'Donnell MR , Padayatchi N , Palmero D , Pape JW , Podewils LJ , Reynolds I , Riekstina V , Robert J , Rodriguez M , Seaworth B , Seung KJ , Schnippel K , Shim TS , Singla R , Smith SE , Sotgiu G , Sukhbaatar G , Tabarsi P , Tiberi S , Trajman A , Trieu L , Udwadia ZF , van der Werf TS , Veziris N , Viiklepp P , Vilbrun SC , Walsh K , Westenhouse J , Yew WW , Yim JJ , Zetola NM , Zignol M , Menzies D . Lancet 2018 392 (10150) 821-834 BACKGROUND: Treatment outcomes for multidrug-resistant tuberculosis remain poor. We aimed to estimate the association of treatment success and death with the use of individual drugs, and the optimal number and duration of treatment with those drugs in patients with multidrug-resistant tuberculosis. METHODS: In this individual patient data meta-analysis, we searched MEDLINE, Embase, and the Cochrane Library to identify potentially eligible observational and experimental studies published between Jan 1, 2009, and April 30, 2016. We also searched reference lists from all systematic reviews of treatment of multidrug-resistant tuberculosis published since 2009. To be eligible, studies had to report original results, with end of treatment outcomes (treatment completion [success], failure, or relapse) in cohorts of at least 25 adults (aged >18 years). We used anonymised individual patient data from eligible studies, provided by study investigators, regarding clinical characteristics, treatment, and outcomes. Using propensity score-matched generalised mixed effects logistic, or linear regression, we calculated adjusted odds ratios and adjusted risk differences for success or death during treatment, for specific drugs currently used to treat multidrug-resistant tuberculosis, as well as the number of drugs used and treatment duration. FINDINGS: Of 12 030 patients from 25 countries in 50 studies, 7346 (61%) had treatment success, 1017 (8%) had failure or relapse, and 1729 (14%) died. Compared with failure or relapse, treatment success was positively associated with the use of linezolid (adjusted risk difference 0.15, 95% CI 0.11 to 0.18), levofloxacin (0.15, 0.13 to 0.18), carbapenems (0.14, 0.06 to 0.21), moxifloxacin (0.11, 0.08 to 0.14), bedaquiline (0.10, 0.05 to 0.14), and clofazimine (0.06, 0.01 to 0.10). There was a significant association between reduced mortality and use of linezolid (-0.20, -0.23 to -0.16), levofloxacin (-0.06, -0.09 to -0.04), moxifloxacin (-0.07, -0.10 to -0.04), or bedaquiline (-0.14, -0.19 to -0.10). Compared with regimens without any injectable drug, amikacin provided modest benefits, but kanamycin and capreomycin were associated with worse outcomes. The remaining drugs were associated with slight or no improvements in outcomes. Treatment outcomes were significantly worse for most drugs if they were used despite in-vitro resistance. The optimal number of effective drugs seemed to be five in the initial phase, and four in the continuation phase. In these adjusted analyses, heterogeneity, based on a simulated I(2) method, was high for approximately half the estimates for specific drugs, although relatively low for number of drugs and durations analyses. INTERPRETATION: Although inferences are limited by the observational nature of these data, treatment outcomes were significantly better with use of linezolid, later generation fluoroquinolones, bedaquiline, clofazimine, and carbapenems for treatment of multidrug-resistant tuberculosis. These findings emphasise the need for trials to ascertain the optimal combination and duration of these drugs for treatment of this condition. FUNDING: American Thoracic Society, Canadian Institutes of Health Research, US Centers for Disease Control and Prevention, European Respiratory Society, Infectious Diseases Society of America. |
Using reports of latent tuberculosis infection among young children to identify tuberculosis transmission in New York City, 2006-2012
Slutsker JS , Trieu L , Crossa A , Ahuja SD . Am J Epidemiol 2018 187 (6) 1303-1310 The presence of latent tuberculosis infection (LTBI) in young children indicates recent tuberculosis (TB) transmission. We reviewed surveillance reports of children with LTBI to assess whether more follow-up is needed to prevent TB in this high-risk population. Data on all children under 5 years of age who were reported by health-care providers or laboratories to the New York City Department of Health during 2006-2012 were abstracted from the TB surveillance and case management system, and those with LTBI were identified. Potential source cases, defined as any infectious TB case diagnosed in the 2 years before a child was reported and whose residence was within 0.5 miles (0.8 km) of the child's residence, were identified. Neighborhood risk factors for TB transmission were examined. Among 3,511 reports of children under age 5 years, 1,722 (49%) had LTBI. The children were aged 2.9 years, on average, and most (64%) had been born in the United States. A potential source case was identified for 92% of the children; 27 children lived in the same building as a TB patient. Children with potential source cases were more likely to reside in neighborhoods with high TB incidence, poverty, and population density. The high proportion of children born in the United States and the young average age of the cases imply that undetected TB transmission occurred. Monitoring reports could be used to identify places where transmission occurred, and additional investigation is needed to prevent TB disease. |
Public awareness of health-related risks from uncontrolled hypertension
Ahuja R , Ayala C , Tong X , Wall HK , Fang J . Prev Chronic Dis 2018 15 E40 Uncontrolled hypertension, a common disorder, is associated with increased long-term risk of several serious conditions. Awareness of the health risks of uncontrolled hypertension is not well understood. We used data from a nationwide panel survey to assess the awareness of risk associated with uncontrolled hypertension, stratified by cardiovascular disease risk factors. Awareness of increased risk from uncontrolled hypertension was high for some outcomes (heart attack, heart failure, stroke), and low for others (kidney disease, dementia). Several disparities in awareness were found. Complementary clinical and public health interventions could be instituted to increase awareness and target people who are high risk. |
Comparison of different treatments for isoniazid-resistant tuberculosis: an individual patient data meta-analysis
Fregonese F , Ahuja SD , Akkerman OW , Arakaki-Sanchez D , Ayakaka I , Baghaei P , Bang D , Bastos M , Benedetti A , Bonnet M , Cattamanchi A , Cegielski P , Chien JY , Cox H , Dedicoat M , Erkens C , Escalante P , Falzon D , Garcia-Prats AJ , Gegia M , Gillespie SH , Glynn JR , Goldberg S , Griffith D , Jacobson KR , Johnston JC , Jones-Lopez EC , Khan A , Koh WJ , Kritsk A , Lan ZY , Lee JH , Li PZ , Maciel EL , Galliez RM , Merle CSC , Munang M , Narendran G , Nguyen VN , Nunn A , Ohkado A , Park JS , Phillips PPJ , Ponnuraja C , Reves R , Romanowski K , Seung K , Schaaf HS , Skrahina A , van Soolingen D , Tabarsi P , Trajman A , Trieu L , Velayutham V Banurekha VV , Viiklepp P , Wang JY , Yoshiyama T , Menzies D . Lancet Respir Med 2018 6 (4) 265-275 BACKGROUND: Isoniazid-resistant, rifampicin-susceptible (INH-R) tuberculosis is the most common form of drug resistance, and is associated with failure, relapse, and acquired rifampicin resistance if treated with first-line anti-tuberculosis drugs. The aim of the study was to compare success, mortality, and acquired rifampicin resistance in patients with INH-R pulmonary tuberculosis given different durations of rifampicin, ethambutol, and pyrazinamide (REZ); a fluoroquinolone plus 6 months or more of REZ; and streptomycin plus a core regimen of REZ. METHODS: Studies with regimens and outcomes known for individual patients with INH-R tuberculosis were eligible, irrespective of the number of patients if randomised trials, or with at least 20 participants if a cohort study. Studies were identified from two relevant systematic reviews, an updated search of one of the systematic reviews (for papers published between April 1, 2015, and Feb 10, 2016), and personal communications. Individual patient data were obtained from authors of eligible studies. The individual patient data meta-analysis was performed with propensity score matched logistic regression to estimate adjusted odds ratios (aOR) and risk differences of treatment success (cure or treatment completion), death during treatment, and acquired rifampicin resistance. Outcomes were measured across different treatment regimens to assess the effects of: different durations of REZ (</=6 months vs >6 months); addition of a fluoroquinolone to REZ (fluoroquinolone plus 6 months or more of REZ vs 6 months or more of REZ); and addition of streptomycin to REZ (streptomycin plus 6 months of rifampicin and ethambutol and 1-3 months of pyrazinamide vs 6 months or more of REZ). The overall quality of the evidence was assessed using GRADE methodology. FINDINGS: Individual patient data were requested for 57 cohort studies and 17 randomised trials including 8089 patients with INH-R tuberculosis. We received 33 datasets with 6424 patients, of which 3923 patients in 23 studies received regimens related to the study objectives. Compared with a daily regimen of 6 months of (H)REZ (REZ with or without isoniazid), extending the duration to 8-9 months had similar outcomes; as such, 6 months or more of (H)REZ was used for subsequent comparisons. Addition of a fluoroquinolone to 6 months or more of (H)REZ was associated with significantly greater treatment success (aOR 2.8, 95% CI 1.1-7.3), but no significant effect on mortality (aOR 0.7, 0.4-1.1) or acquired rifampicin resistance (aOR 0.1, 0.0-1.2). Compared with 6 months or more of (H)REZ, the standardised retreatment regimen (2 months of streptomycin, 3 months of pyrazinamide, and 8 months of isoniazid, rifampicin, and ethambutol) was associated with significantly worse treatment success (aOR 0.4, 0.2-0.7). The quality of the evidence was very low for all outcomes and treatment regimens assessed, owing to the observational nature of most of the data, the diverse settings, and the imprecision of estimates. INTERPRETATION: In patients with INH-R tuberculosis, compared with treatment with at least 6 months of daily REZ, addition of a fluoroquinolone was associated with better treatment success, whereas addition of streptomycin was associated with less treatment success; however, the quality of the evidence was very low. These results support the conduct of randomised trials to identify the optimum regimen for this important and common form of drug-resistant tuberculosis. FUNDING: World Health Organization and Canadian Institutes of Health Research. |
Modeled changes in US sodium intake from reducing sodium concentrations of commercially processed and prepared foods to meet voluntary standards established in North America: NHANES
Cogswell ME , Patel SM , Yuan K , Gillespie C , Juan W , Curtis CJ , Vigneault M , Clapp J , Roach P , Moshfegh A , Ahuja J , Pehrsson P , Brookmire L , Merritt R . Am J Clin Nutr 2017 106 (2) 530-540 Background: Approximately 2 in 3 US adults have prehypertension or hypertension that increases their risk of cardiovascular disease. Reducing sodium intake can decrease blood pressure and prevent hypertension. Approximately 9 in 10 Americans consume excess sodium (≥2300 mg/d). Voluntary sodium standards for commercially processed and prepared foods were established in North America, but their impact on sodium intake is unclear.Objective: We modelled the potential impact on US sodium intake of applying voluntary sodium standards for foods.Design: We used NHANES 2007-2010 data for 17,933 participants aged ≥1 y to model predicted US daily mean sodium intake and the prevalence of excess sodium intake with the use of the standards of the New York City's National Salt Reduction Initiative (NSRI) and Health Canada for commercially processed and prepared foods. The Food and Nutrient Database for Dietary Studies food codes corresponding to foods reported by NHANES participants were matched to NSRI and Health Canada food categories, and the published sales-weighted mean percent reductions were applied.Results: The US population aged ≥1 y could have reduced their usual daily mean sodium intake of 3417 mg by 698 mg (95% CI: 683, 714 mg) by applying NSRI 2014 targets and by 615 mg (95% CI: 597, 634 mg) by applying Health Canada's 2016 benchmarks. Significant reductions could have occurred, regardless of age, sex, race/ethnicity, income, education, or hypertension status, up to a mean reduction in sodium intake of 850 mg/d in men aged ≥19 y by applying NSRI targets. The proportion of adults aged ≥19 y who consume ≥2300 mg/d would decline from 88% (95% CI: 86%, 91%) to 71% (95% CI: 68%, 73%) by applying NSRI targets and to 74% (95% CI: 71%, 76%) by applying Health Canada benchmarks.Conclusion: If established sodium standards are applied to commercially processed and prepared foods, a significant reduction of US sodium intake could occur. |
Epidemiology of pediatric multidrug-resistant tuberculosis in the United States, 1993-2014
Smith SE , Pratt R , Trieu L , Barry PM , Thai DT , Ahuja SD , Shah S . Clin Infect Dis 2017 65 (9) 1437-1443 Background: Multidrug-resistant tuberculosis (MDR TB) is an important global public health threat, but accurate estimates of MDR TB burden among children are lacking. Methods: We analyzed demographic, clinical and laboratory data for newly-diagnosed pediatric (<15 years) TB cases reported to the US National TB Surveillance System (NTSS) during 1993-2014. MDR TB was defined as culture-confirmed TB disease with resistance to at least isoniazid and rifampicin. To ascertain potential under-estimation of pediatric MDR TB, we surveyed high burden states for clinically-diagnosed cases treated for MDR TB. Results: Of 20,789 pediatric TB cases, 5,162 (24.8%) had bacteriologically-confirmed TB. Among 4,862 (94.2%) with drug-susceptibility testing, 82 (1.7%) had MDR TB. Most pediatric MDR TB cases were female (n=51, 62%), median age was 5 years (IQR 1-12), one-third were Hispanic (n=28, 34%), and two-thirds (n=55, 67%) were born in the US. Most cases had additional resistance to ≥1 other first-line drug (n=66; 80.5%) and one-third had resistance to ≥1 second-line drug (24/73 tested). Of 77 who started treatment prior to 2013, 66 (86%) completed treatment and 4 (5%) died. Among the four high TB burden states/jurisdictions surveyed, there was 42-55% under-estimation of pediatric MDR TB cases when using only culture-confirmed case definitions. Conclusions: Only one-quarter of pediatric TB cases had culture-confirmed TB, likely resulting in underestimation of true pediatric MDR TB burden in the US using strictly bacteriologic criteria. Better estimates of pediatric MDR TB burden in the US are needed and should include clinical diagnoses based on epidemiologic criteria. |
A comparison of concentrations of sodium and related nutrients (potassium, total dietary fiber, total and saturated fat, and total sugar) in private-label and national brands of popular, sodium-contributing, commercially packaged foods in the United States
Ahuja JK , Pehrsson PR , Cogswell M . J Acad Nutr Diet 2017 117 (5) 770-777 e17 BACKGROUND: Private-label brands account for about one in four foods sold in US supermarkets. They provide value to consumers due to their low cost. We know of no US studies comparing the nutrition content of private-label products with corresponding national brand products. OBJECTIVE: The objective was to compare concentrations of sodium and related nutrients (potassium, total dietary fiber, total and saturated fat, and total sugar) in popular sodium-contributing, commercially packaged foods by brand type (national or private-label brand). DESIGN: During 2010 to 2014, the Nutrient Data Laboratory of the US Department of Agriculture obtained 1,706 samples of private-label and national brand products from up to 12 locations nationwide and chemically analyzed 937 composites for sodium and related nutrients. The samples came from 61 sodium-contributing, commercially packaged food products for which both private-label and national brands were among the top 75% to 80% of brands for US unit sales. In this post hoc comparative analysis, the authors assigned a variable brand type (national or private label) to each composite and determined mean nutrient contents by brand type overall and by food product and type. STATISTICAL ANALYSES PERFORMED: The authors tested for significant differences (P<0.05) by brand type using independent sample t tests or Mann-Whitney U tests when appropriate. RESULTS: Overall for all foods sampled, differences between brand types were not statistically significant for any of the nutrients studied. However, differences in both directions exist for a few individual food products and food categories. CONCLUSIONS: Concentrations of sodium and related nutrients (potassium, total dietary fiber, total and saturated fat, and total sugar) do not differ systematically between private-label and national brands, suggesting that brand type is not a consideration for nutritional quality of foods in the United States. The study data provide public health officials with baseline nutrient content by brand type to help focus US sodium-reduction efforts. |
Sodium intake among US school-aged children: National Health and Nutrition Examination Survey, 2011-2012
Quader ZS , Gillespie C , Sliwa SA , Ahuja JK , Burdg JP , Moshfegh A , Pehrsson PR , Gunn JP , Mugavero K , Cogswell ME . J Acad Nutr Diet 2017 117 (1) 39-47.e5 BACKGROUND: Identifying current major dietary sources of sodium can enhance strategies to reduce excess sodium intake, which occurs among 90% of US school-aged children. OBJECTIVE: To describe major food sources, places obtained, and eating occasions contributing to sodium intake among US school-aged children. DESIGN: Cross-sectional analysis of data from the 2011-2012 National Health and Nutrition Examination Survey. PARTICIPANTS/SETTING: A nationally representative sample of 2,142 US children aged 6 to 18 years who completed a 24-hour dietary recall. MAIN OUTCOME MEASURES: Population proportions of sodium intake from major food categories, places, and eating occasions. STATISTICAL ANALYSES PERFORMED: Statistical analyses accounted for the complex survey design and sampling. Wald F tests and t tests were used to examine differences between subgroups. RESULTS: Average daily sodium intake was highest among adolescents aged 14 to 18 years (3,565+/-120 mg), lowest among girls (2,919+/-74 mg). Little variation was seen in average intakes or the top five sodium contributors by sociodemographic characteristics or weight status. Ten food categories contributed to almost half (48%) of US school-aged children's sodium intake, and included pizza, Mexican-mixed dishes, sandwiches, breads, cold cuts, soups, savory snacks, cheese, plain milk, and poultry. More than 80 food categories contributed to the other half of children's sodium intake. Foods obtained from stores contributed 58% of sodium intake, fast-food/pizza restaurants contributed 16%, and school cafeterias contributed 10%. Thirty-nine percent of sodium intake was consumed at dinner, 31% at lunch, 16% from snacks, and 14% at breakfast. CONCLUSIONS: With the exception of plain milk, which naturally contains sodium, the top 10 food categories contributing to US schoolchildren's sodium intake during 2011-2012 comprised foods in which sodium is added during processing or preparation. Sodium is consumed throughout the day from multiple foods and locations, highlighting the importance of sodium reduction across the US food supply. |
Sodium content of popular commercially processed and restaurant foods in the United States
Ahuja JKC , Wasswa-Kintu S , Haytowitz DB , Daniel M , Thomas R , Showell B , Nickle M , Roseland JM , Gunn J , Cogswell M , Pehrsson PR . Prev Med Rep 2015 2 962-967 PURPOSE: The purpose of this study was to provide baseline estimates of sodium levels in 125 popular, sodium-contributing, commercially processed and restaurant foods in the U.S., to assess future changes as manufacturers reformulate foods. METHODS: In 2010-2013, we obtained ~ 5200 sample units from up to 12 locations and analyzed 1654 composites for sodium and related nutrients (potassium, total dietary fiber, total and saturated fat, and total sugar), as part of the U.S. Department of Agriculture-led sodium-monitoring program. We determined sodium content as mg/100 g, mg/serving, and mg/kcal and compared them against U.S. Food and Drug Administration's (FDA) sodium limits for "low" and "healthy" claims and to the optimal sodium level of < 1.1 mg/kcal, extrapolating from the Healthy Eating Index-2010. RESULTS: Results from this study represent the baseline nutrient values to use in assessing future changes as foods are reformulated for sodium reduction. Sodium levels in over half (69 of 125) of the foods, including all main dishes and most Sentinel Foods from fast-food outlets or restaurants (29 of 33 foods), exceeded the FDA sodium limit for using the claim "healthy". Only 13 of 125 foods had sodium values below 1.1 mg/kcal. We observed a wide range of sodium content among similar food types and brands. CONCLUSIONS: Current sodium levels in commercially processed and restaurant foods in the U.S. are high and variable. Targeted benchmarks and increased awareness of high sodium content and variability in foods would support reduction of sodium intakes in the U.S. |
Sodium content of foods contributing to sodium intake: comparison between selected foods from the CDC Packaged Food Database and the USDA National Nutrient Database for Standard Reference
Maalouf J , Cogswell ME , Yuan K , Martin C , Gillespie C , Ahuja JK , Pehrsson P , Merritt R . Procedia Food Sci 2015 4 114-124 The sodium concentration (mg/100g) for 23 of 125 Sentinel Foods (e.g. white bread) were identified in the 2009 CDC Packaged Food Database (PFD) and compared with data in the USDA's 2013 National Nutrient Database for Standard Reference(SR 26). Sentinel Foods are foods identified by USDA to be monitored as primary indicators to assess the changes in the sodium content of commercially processed foods from stores and restaurants. Overall, 937 products were evaluated in the CDC PFD, and between 3 (one brand of ready-to-eat cereal) and 126 products (white bread) were evaluated per selected food. The mean sodium concentrations of 17 of the 23 (74%) selected foods in the CDC PFD were 90%-110% of the mean sodium concentrations in SR 26 and differences in sodium concentration were statistically significant for 6 Sentinel Foods. The sodium concentration of most of the Sentinel Foods, as selected in the PFD, appeared to represent the sodium concentrations of the corresponding food category. The results of our study help improve the understanding of how nutrition information compares between national analytic values and the label and whether the selected Sentinel Foods represent their corresponding food category as indicators for assessment of change of the sodium content in the food supply. |
Are birth certificate and hospital discharge linkages performed in 52 jurisdictions in the United States?
Kim SY , Ahuja S , Stampfel C , Williamson D . Matern Child Health J 2015 19 (12) 2615-20 OBJECTIVES: The purpose of this study was to determine the number and characteristics of US State Registrars of Vital Statistics (Vital Registrars) and State Systems Development Initiative (SSDI) Coordinators that link birth certificate and hospital discharge data as well as using linkage processes. METHODS: Vital Registrars and SSDI Coordinators in all 52 vital records jurisdictions (50 states, District of Columbia, and New York City) were asked to complete a 41-question survey. We examined frequency distributions among completed surveys using SAS 9.3. RESULTS: The response rate was 100 % (N = 52) for Vital Registrars and 96 % (N = 50) for SSDI Coordinators. Nearly half of Vital Registrars (n = 22) and SSDI Coordinators (n = 23) reported that their jurisdiction linked birth certificate and hospital discharge records at least once in the last 4 years. Among those who link, the majority of Vital Registrars (77.3 %) and SSDI Coordinators (82.6 %) link both maternal and infant hospital discharge records to the birth certificate. Of those who do not link, 43 % of the Vital Registrars and 55 % of SSDI Coordinators reported an interest in linking birth certificate and hospital discharge data. Reasons for not linking included lack of staff time, inability to access raw data, high cost, and unavailability of personal identifiers to link the two sources. CONCLUSIONS: Results of our analysis provide a national perspective on data linkage practices in the US. Our findings can be used to promote further data linkages, facilitate sharing of data and linkage methodologies, and identify uses of the resulting linked data. |
Increasing the efficiency and yield of a tuberculosis contact investigation through electronic data systems matching
Sanderson JM , Proops DC , Trieu L , Santos E , Polsky B , Ahuja SD . J Am Med Inform Assoc 2015 22 (5) 1089-93 BACKGROUND: Electronic health data may improve the timeliness and accuracy of resource-intense contact investigations (CIs) in healthcare settings. METHODS: In September 2013, we initiated a CI around a healthcare worker (HCW) with infectious tuberculosis (TB) who worked in a maternity ward. Two sources of electronic health data were employed: hospital-based electronic medical records (EMRs), to identify patients exposed to the HCW, and an electronic immunization registry, to obtain contact information for exposed infants and their providers at two points during follow-up. RESULTS: Among 954 patients cared for in the maternity ward during the HCW's infectious period, the review of EMRs identified 285 patients (30%) who interacted with the HCW and were, thus, exposed to TB. Matching infants to the immunization registry offered new provider information for 52% and 30% of the infants in the first and second matches. Providers reported evaluation results for the majority of patients (66%). CONCLUSION: Data matching improved the efficiency and yield of this CI, thereby demonstrating the usefulness of enhancing CIs with electronic health data. |
Sodium monitoring in commercially processed and restaurant foods
Ahuja JK , Pehrsson PR , Haytowitz DB , Wasswa-Kintu S , Nickle M , Showell B , Thomas R , Roseland J , Williams J , Khan M , Nguyen Q , Hoy K , Martin C , Rhodes D , Moshfegh A , Gillespie C , Gunn J , Merritt R , Cogswell M . Am J Clin Nutr 2015 101 (3) 622-31 BACKGROUND: Most sodium in the US diet comes from commercially processed and restaurant foods. Sodium reduction in these foods is key to several recent public health efforts. OBJECTIVE: The objective was to provide an overview of a program led by the USDA, in partnership with other government agencies, to monitor sodium contents in commercially processed and restaurant foods in the United States. We also present comparisons of nutrients generated under the program to older data. DESIGN: We track approximately 125 commercially processed and restaurant food items ("sentinel foods") annually using information from food manufacturers and periodically by nationwide sampling and laboratory analyses. In addition, we monitor >1100 other commercially processed and restaurant food items, termed "priority-2 foods" (P2Fs) biennially by using information from food manufacturers. These foods serve as indicators for assessing changes in the sodium content of commercially processed and restaurant foods in the United States. We sampled all sentinel foods nationwide and reviewed all P2Fs in 2010-2013 to determine baseline sodium concentrations. RESULTS: We updated sodium values for 73 sentinel foods and 551 P2Fs in the USDA's National Nutrient Database for Standard Reference (releases 23-26). Sodium values changed by at least 10% for 43 of the sentinel foods, which, for 31 foods, including commonly consumed foods such as bread, tomato catsup, and potato chips, the newer sodium values were lower. Changes in the concentrations of related nutrients (total and saturated fat, total sugar, potassium, or dietary fiber) that were recommended by the 2010 Dietary Guidelines for Americans for reduced or increased consumption accompanied sodium reduction. The results of sodium reduction efforts, based on resampling of the sentinel foods or re-review of P2Fs, will become available beginning in 2015. CONCLUSION: This monitoring program tracks sodium reduction efforts, improves food composition databases, and strengthens national nutrition monitoring. |
The Global Nutrition Report 2014: actions and accountability to accelerate the world's progress on nutrition
Haddad L , Achadi E , Ag Bendech M , Ahuja A , Bhatia K , Bhutta Z , Blossner M , Borghi E , Colecraft E , de Onis M , Eriksen K , Fanzo J , Flores-Ayala R , Fracassi P , Kimani-Murage E , Nago Koukoubou E , Krasevec J , Newby H , Nugent R , Oenema S , Martin-Prevel Y , Randel J , Requejo J , Shyam T , Udomkesmalee E , Reddy KS . J Nutr 2015 145 (4) 663-71 In 2013, the Nutrition for Growth Summit called for a Global Nutrition Report (GNR) to strengthen accountability in nutrition so that progress in reducing malnutrition could be accelerated. This article summarizes the results of the first GNR. By focusing on undernutrition and overweight, the GNR puts malnutrition in a new light. Nearly every country in the world is affected by malnutrition, and multiple malnutrition burdens are the "new normal." Unfortunately, the world is off track to meet the 2025 World Health Assembly (WHA) targets for nutrition. Many countries are, however, making good progress on WHA indicators, providing inspiration and guidance for others. Beyond the WHA goals, nutrition needs to be more strongly represented in the Sustainable Development Goal (SDG) framework. At present, it is only explicitly mentioned in 1 of 169 SDG targets despite the many contributions improved nutritional status will make to their attainment. To achieve improvements in nutrition status, it is vital to scale up nutrition programs. We identify bottlenecks in the scale-up of nutrition-specific and nutrition-sensitive approaches and highlight actions to accelerate coverage and reach. Holding stakeholders to account for delivery on nutrition actions requires a well-functioning accountability infrastructure, which is lacking in nutrition. New accountability mechanisms need piloting and evaluation, financial resource flows to nutrition need to be made explicit, nutrition spending targets should be established, and some key data gaps need to be filled. For example, many UN member states cannot report on their WHA progress and those that can often rely on data >5 y old. The world can accelerate malnutrition reduction substantially, but this will require stronger accountability mechanisms to hold all stakeholders to account. |
Sodium content in major brands of US packaged foods, 2009
Gillespie C , Maalouf J , Yuan K , Cogswell ME , Gunn JP , Levings J , Moshfegh A , Ahuja JK , Merritt R . Am J Clin Nutr 2015 101 (2) 344-53 BACKGROUND: Most Americans consume more sodium than is recommended, the vast majority of which comes from commercially packaged and restaurant foods. In 2010 the Institute of Medicine recommended that manufacturers reduce the amount of sodium in their products. OBJECTIVE: The aim was to assess the sodium content in commercially packaged food products sold in US grocery stores in 2009. DESIGN: With the use of sales and nutrition data from commercial sources, we created a database with nearly 8000 packaged food products sold in major US grocery stores in 2009. We estimated the sales-weighted mean and distribution of sodium content (mg/serving, mg/100 g, and mg/kcal) of foods within food groups that contribute the most dietary sodium to the US diet. We estimated the proportion of products within each category that exceed 1) the Food and Drug Administration's (FDA's) limits for sodium in foods that use a "healthy" label claim and 2) 1150 mg/serving or 50% of the maximum daily intake recommended in the 2010 Dietary Guidelines for Americans. RESULTS: Products in the meat mixed dishes category had the highest mean and median sodium contents per serving (966 and 970 mg, respectively). Products in the salad dressing and vegetable oils category had the highest mean and median concentrations per 100 g (1072 and 1067 mg, respectively). Sodium density was highest in the soup category (18.4 mg/kcal). More than half of the products sold in 11 of the 20 food categories analyzed exceeded the FDA limits for products with a "healthy" label claim. In 4 categories, >10% of the products sold exceeded 1150 mg/serving. CONCLUSIONS: The sodium content in packaged foods sold in major US grocery stores varied widely, and a large proportion of top-selling products exceeded limits, indicating the potential for reduction. Ongoing monitoring is necessary to evaluate the progress in sodium reduction. |
Risk for tuberculosis disease among contacts with prior positive tuberculin skin test: a retrospective cohort study, New York City
Gounder PP , Harris TG , Anger H , Trieu L , Meissner JS , Cadwell BL , Shashkina E , Ahuja SD . J Gen Intern Med 2015 30 (6) 742-8 BACKGROUND: Patients with prior positive tuberculin skin test (TST) results may benefit from prophylaxis after repeat exposure to infectious tuberculosis (TB). OBJECTIVE: To evaluate factors associated with active TB disease among persons with prior positive TST results named as contacts of persons with infectious TB. DESIGN: Population-based retrospective cohort study. PARTICIPANTS: A total of 2,933 contacts with prior positive TST results recently exposed to infectious TB identified in New York City's TB registry during the period from January 1, 1997 through December 31, 2003. MAIN MEASUREMENTS: Contacts developing active TB disease ≤ 4 years after exposure were identified and compared with those who did not, using Poisson regression analysis. Genotyping was performed on selected Mycobacterium tuberculosis-positive isolates. KEY RESULTS: Among contacts with prior positive TST results, 39 (1.3 %) developed active TB disease ≤ 4 years after exposure (≤2 years: 34). Risk factors for contacts that were independently associated with TB were age < 5 years (adjusted prevalence ratio [aPR] = 19.48; 95 % confidence interval [CI] = 7.15-53.09), household exposure (aPR = 2.60;CI = 1.30-5.21), exposure to infectious patients (i.e., cavities on chest radiograph, acid-fast bacilli on sputum smear; aPR = 1.9 3;CI = 1.01-3.71), and exposure to a U.S.-born index patient (aPR = 4.04; CI = 1.95-8.38). Receipt of more than1 month of treatment for latent TB infection following the current contact investigation was found to be protective (aPR = 0.27; CI = 0.08-0.93). Genotype results were concordant with the index patients among 14 of 15 contacts who developed active TB disease and had genotyping results available. CONCLUSIONS: Concordant genotype results and a high proportion of contacts developing active TB disease within 2 years of exposure indicate that those with prior positive TST results likely developed active TB disease from recent rather than remote infection. Healthcare providers should consider prophylaxis for contacts with prior TB infection, especially young children and close contacts of TB patients (e.g., those with household exposure). |
Vital Signs: sodium intake among U.S. school-aged children - 2009-2010
Cogswell ME , Yuan K , Gunn JP , Gillespie C , Sliwa S , Galuska DA , Barrett J , Hirschman J , Moshfegh AJ , Rhodes D , Ahuja J , Pehrsson P , Merritt R , Bowman BA . MMWR Morb Mortal Wkly Rep 2014 63 (36) 789-97 BACKGROUND: A national health objective is to reduce average U.S. sodium intake to 2,300 mg daily to help prevent high blood pressure, a major cause of heart disease and stroke. Identifying common contributors to sodium intake among children can help reduction efforts. METHODS: Average sodium intake, sodium consumed per calorie, and proportions of sodium from food categories, place obtained, and eating occasion were estimated among 2,266 school-aged (6–18 years) participants in What We Eat in America, the dietary intake component of the National Health and Nutrition Examination Survey, 2009–2010. RESULTS: U.S. school-aged children consumed an estimated 3,279 mg of sodium daily with the highest total intake (3,672 mg/d) and intake per 1,000 kcal (1,681 mg) among high school–aged children. Forty-three percent of sodium came from 10 food categories: pizza, bread and rolls, cold cuts/cured meats, savory snacks, sandwiches, cheese, chicken patties/nuggets/tenders, pasta mixed dishes, Mexican mixed dishes, and soups. Sixty-five percent of sodium intake came from store foods, 13% from fast food/pizza restaurants, 5% from other restaurants, and 9% from school cafeteria foods. Among children aged 14–18 years, 16% of total sodium intake came from fast food/pizza restaurants versus 11% among those aged 6–10 years or 11–13 years (p<0.05). Among children who consumed a school meal on the day assessed, 26% of sodium intake came from school cafeteria foods. Thirty-nine percent of sodium was consumed at dinner, followed by lunch (29%), snacks (16%), and breakfast (15%). IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Sodium intake among school-aged children is much higher than recommended. Multiple food categories, venues, meals, and snacks contribute to sodium intake among school-aged children supporting the importance of populationwide strategies to reduce sodium intake. New national nutrition standards are projected to reduce the sodium content of school meals by approximately 25%–50% by 2022. Based on this analysis, if there is no replacement from other sources, sodium intake among U.S. school-aged children will be reduced by an average of about 75–150 mg per day and about 220–440 mg on days children consume school meals. |
Re: "Estimated rate of reactivation of latent tuberculosis infection in the United States, overall and by population subgroup"
Sanderson JM , Meissner JS , Ahuja SD . Am J Epidemiol 2014 180 (5) 556-7 In an investigation using national data sources, Shea et al. (1) estimated the rate of reactivation tuberculosis (TB) to be 0.084 cases per 100 person-years among persons with latent TB infection (LTBI) in the United States. The authors present these findings as the overall rate of reactivation TB in the United States, and they state that the groups identified as having higher rates of reactivation TB “have increased rates of progression and will receive even greater benefit from testing and treatment” (1, p. 223) for LTBI. While this study represents an important attempt to quantify the contribution of reactivation TB to the overall TB burden in the United States, this extrapolation has significant implications for TB control programs, and we urge caution in the interpretation and application of these results. | Shea et al. (1) differentiated reactivation TB cases from primary TB cases on the basis of cluster status, with cases that clustered being considered cases of primary TB. A cluster was defined as “at least 2 cases with indistinguishable TB genotypes reported within statistically significant geospatial zones” (1, p. 217). While using genotyping to distinguish primary TB from reactivation TB is a common molecular epidemiologic technique, limitations with this method, such as sampling bias (2), unknown strain variation (3), and genotyping methods with limited discriminatory power (4), have been documented. |
Transmission of multidrug-resistant tuberculosis in the USA: a cross-sectional study
Moonan PK , Teeter LD , Salcedo K , Ghosh S , Ahuja SD , Flood J , Graviss EA . Lancet Infect Dis 2013 13 (9) 777-84 BACKGROUND: Multidrug-resistant (MDR) tuberculosis is a potential threat to tuberculosis elimination, but the extent of MDR tuberculosis disease in the USA that is attributable to transmission within the country is unknown. We assessed transmission of MDR tuberculosis and potential contributing factors in the USA. METHODS: In a cross-sectional study, clinical, demographic, epidemiological, and Mycobacterium tuberculosis genotype data were obtained during routine surveillance of all verified cases of MDR tuberculosis reported from eight states in the USA (California from Jan 1, 2007, to Dec 31, 2009; Texas from Jan 1, 2007, to March 31, 2009; and the states of Colorado, Maryland, Massachusetts, New York, Tennessee, and Washington from Jan 1, 2007 to Dec 31, 2008). In-depth interviews and health-record abstraction were done for all who consented to ascertain potential interpersonal connections. FINDINGS: 168 cases of MDR tuberculosis were reported in the eight states during our study period. 92 individuals (55%) consented to in-depth interview. 20 (22%) of these individuals developed MDR tuberculosis as a result of transmission in the USA; a source case was identified for eight of them (9%). 20 individuals (22%) had imported active tuberculosis (ie, culture-confirmed disease within 3 months of entry into the USA). 38 (41%) were deemed to have reactivation of disease, of whom 14 (15%) had a known previous episode of tuberculosis outside the USA. Five individuals (5%) had documented treatment of a previous episode in the USA, and so were deemed to have relapsed. For nine cases (10%), insufficient evidence was available to definitively classify reason for presentation. INTERPRETATION: About a fifth of cases of MDR tuberculosis in the USA can be linked to transmission within the country. Many individuals acquire MDR tuberculosis before entry into the USA. MDR tuberculosis needs to be diagnosed rapidly to reduce potential infectious periods, and clinicians should consider latent tuberculosis infection treatment-tailored to the results of drug susceptibility testing of the putative source case-for exposed individuals. FUNDING: Centers for Disease Control and Prevention. |
Multidrug resistant pulmonary tuberculosis treatment regimens and patient outcomes: an individual patient data meta-analysis of 9,153 patients
Ahuja SD , Ashkin D , Avendano M , Banerjee R , Bauer M , Bayona JN , Becerra MC , Benedetti A , Burgos M , Centis R , Chan ED , Chiang CY , Cox H , D'Ambrosio L , Deriemer K , Dung NH , Enarson D , Falzon D , Flanagan K , Flood J , Garcia-Garcia ML , Gandhi N , Granich RM , Hollm-Delgado MG , Holtz TH , Iseman MD , Jarlsberg LG , Keshavjee S , Kim HR , Koh WJ , Lancaster J , Lange C , de Lange WC , Leimane V , Leung CC , Li J , Menzies D , Migliori GB , Mishustin SP , Mitnick CD , Narita M , O'Riordan P , Pai M , Palmero D , Park SK , Pasvol G , Pena J , Perez-Guzman C , Quelapio MI , Ponce-de-Leon A , Riekstina V , Robert J , Royce S , Schaaf HS , Seung KJ , Shah L , Shim TS , Shin SS , Shiraishi Y , Sifuentes-Osornio J , Sotgiu G , Strand MJ , Tabarsi P , Tupasi TE , van Altena R , Van der Walt M , Van der Werf TS , Vargas MH , Viiklepp P , Westenhouse J , Yew WW , Yim JJ . PLoS Med 2012 9 (8) e1001300 BACKGROUND: Treatment of multidrug resistant tuberculosis (MDR-TB) is lengthy, toxic, expensive, and has generally poor outcomes. We undertook an individual patient data meta-analysis to assess the impact on outcomes of the type, number, and duration of drugs used to treat MDR-TB. METHODS AND FINDINGS: Three recent systematic reviews were used to identify studies reporting treatment outcomes of microbiologically confirmed MDR-TB. Study authors were contacted to solicit individual patient data including clinical characteristics, treatment given, and outcomes. Random effects multivariable logistic meta-regression was used to estimate adjusted odds of treatment success. Adequate treatment and outcome data were provided for 9,153 patients with MDR-TB from 32 observational studies. Treatment success, compared to failure/relapse, was associated with use of: later generation quinolones, (adjusted odds ratio [aOR]: 2.5 [95% CI 1.1-6.0]), ofloxacin (aOR: 2.5 [1.6-3.9]), ethionamide or prothionamide (aOR: 1.7 [1.3-2.3]), use of four or more likely effective drugs in the initial intensive phase (aOR: 2.3 [1.3-3.9]), and three or more likely effective drugs in the continuation phase (aOR: 2.7 [1.7-4.1]). Similar results were seen for the association of treatment success compared to failure/relapse or death: later generation quinolones, (aOR: 2.7 [1.7-4.3]), ofloxacin (aOR: 2.3 [1.3-3.8]), ethionamide or prothionamide (aOR: 1.7 [1.4-2.1]), use of four or more likely effective drugs in the initial intensive phase (aOR: 2.7 [1.9-3.9]), and three or more likely effective drugs in the continuation phase (aOR: 4.5 [3.4-6.0]). CONCLUSIONS: In this individual patient data meta-analysis of observational data, improved MDR-TB treatment success and survival were associated with use of certain fluoroquinolones, ethionamide, or prothionamide, and greater total number of effective drugs. However, randomized trials are urgently needed to optimize MDR-TB treatment. (Please see later in the article for the Editors' Summary.) |
Distinct clinical and epidemiological features of tuberculosis in New York City caused by the RD(Rio)Mycobacterium tuberculosis sublineage
Weisenberg SA , Gibson AL , Huard RC , Kurepina N , Bang H , Lazzarini LC , Chiu Y , Li J , Ahuja S , Driscoll J , Kreiswirth BN , Ho JL . Infect Genet Evol 2012 12 (4) 664-70 BACKGROUND: Genetic tracking of Mycobacterium tuberculosis is a cornerstone of tuberculosis (TB) control programs. The RD(Rio)M. tuberculosis sublineage was previously associated with TB in Brazil. We investigated 3847 M. tuberculosis isolates and registry data from New York City (NYC) (2001-2005) to: (1) affirm the position of RD(Rio) strains within the M. tuberculosis phylogenetic structure, (2) determine its prevalence, and (3) define transmission, demographic, and clinical characteristics associated with RD(Rio) TB. METHODS: Isolates classified as RD(Rio) or non-RD(Rio)M. tuberculosis by multiplex PCR were further classified as clustered (2 isolates) or unique based primarily upon IS6110-RFLP patterns and lineage-specific cluster proportions were calculated. The secondary case rate of RD(Rio) was compared with other prevalent M. tuberculosis lineages. Genotype data were merged with the data from the NYC TB Registry to assess demographic and clinical characteristics. RESULTS: RD(Rio) strains were found to: (1) be restricted to the Latin American-Mediterranean family, (2) cause approximately 8% of TB cases in NYC, and (3) be associated with heightened transmission as shown by: (i) a higher cluster proportion compared to other prevalent lineages, (ii) a higher secondary case rate, and (iii) cases in children. Furthermore, RD(Rio) strains were significantly associated with US-born Black or Hispanic race, birth in Latin American and Caribbean countries, and isoniazid resistance. CONCLUSIONS: The RD(Rio) genotype is a single M. tuberculosis strain population that is emerging in NYC. The findings suggest that expanded RD(Rio) case and exposure identification could be of benefit due to its association with heightened transmission. |
Mycobacterium tuberculosis cluster with developing drug resistance, New York, New York, USA, 2003-2009
Perri BR , Proops D , Moonan PK , Munsiff SS , Kreiswirth BN , Goranson C , Ahuja SD . Emerg Infect Dis 2011 17 (3) 372-8 In 2004, identification of patients infected with the same Mycobacterium tuberculosis strain in New York, New York, USA, resulted in an outbreak investigation. The investigation involved data collection and analysis, establishing links between patients, and forming transmission hypotheses. Fifty-four geographically clustered cases were identified during 2003-2009. Initially, the M. tuberculosis strain was drug susceptible. However, in 2006, isoniazid resistance emerged, resulting in isoniazid-resistant M. tuberculosis among 17 (31%) patients. Compared with patients with drug-susceptible M. tuberculosis, a greater proportion of patients with isoniazid-resistant M. tuberculosis were US born and had a history of illegal drug use. No patients named one another as contacts. We used patient photographs to identify links between patients. Three links were associated with drug use among patients infected with isoniazid-resistant M. tuberculosis. The photographic method would have been more successful if used earlier in the investigation. Name-based contact investigation might not identify all contacts, particularly when illegal drug use is involved. |
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