Last data update: Oct 28, 2024. (Total: 48004 publications since 2009)
Records 1-30 (of 34 Records) |
Query Trace: Arnold KE[original query] |
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COVID-19 vaccine reactogenicity and vaccine attitudes among children and parents/guardians after multisystem inflammatory syndrome in children or COVID-19 hospitalization: September 2021-May 2022
Yousaf AR , Kunkel A , Abrams JY , Shah AB , Hammett TA , Arnold KE , Beltran YL , Laham FR , Kao CM , Hunstad DA , Hussaini L , Baida N , Salazar L , Perez MA , Rostad CA , Godfred-Cato S , Campbell AP , Belay ED . Pediatr Infect Dis J 2023 42 (3) 252-259 BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) is a multiorgan hyperinflammatory condition following SARS-CoV-2 infection. Data on COVID-19 vaccine adverse events and vaccine attitudes in children with prior MIS-C are limited. We described characteristics associated with COVID-19 vaccination, vaccine adverse events and vaccine attitudes in children with a history of MIS-C or COVID-19 and their parents/guardians. METHODS: We enrolled children previously hospitalized for MIS-C or COVID-19 from 3 academic institutions. We abstracted charts and interviewed children and parents/guardians regarding vaccine adverse events and acceptability. RESULTS: Of 163 vaccine-eligible children enrolled with a history of MIS-C and 70 with history of COVID-19, 51 (31%) and 34 (49%), respectively, received mRNA COVID-19 vaccine a median of 10 (Interquartile Range 6-13) months after hospital discharge. Among 20 children with MIS-C and parents/guardians who provided interviews, local injection site reaction of brief duration (mean 1.8 days) was most commonly reported; no children required medical care within 2 weeks postvaccination. Vaccine survey results of interviewed, vaccinated children and their parents/guardians: of 20 children with MIS-C and 15 children with COVID-19, 17 (85%) and 13 (87%), respectively, listed doctors in the top 3 most trusted sources for vaccine information; 13 (65%) and 9 (60%) discussed vaccination with their doctor. CONCLUSIONS: COVID-19 vaccination was well tolerated in children with prior MIS-C or COVID-19 participating in our investigation. Parents/guardians regarded their children's doctors as a trusted source of information for COVID-19 vaccines, and most vaccinated children's parents/guardians had discussed COVID-19 vaccination for their child with their doctor. |
Multisystem inflammatory syndrome in adults (MIS-A): case finding through systematic review of electronic medical records.
Melgar M , Haston J , DeCuir J , Cheng Q , Arnold KE , Meng L , Murphy DJ , Overton E , Hollberg J , Tobin-D'Angelo M , Patel P , Campbell AP , Godfred-Cato Do S , Belay ED . Clin Infect Dis 2022 75 (11) 1903-1911 BACKGROUND: Multisystem inflammatory syndrome in adults (MIS-A) is a severe condition temporally associated with SARS-CoV-2 infection. METHODS: In this retrospective cohort study, we applied the U.S. Centers for Disease Control and Prevention (CDC) case definition to identify diagnosed and undiagnosed MIS-A cases among adults discharged April 2020-January 2021 from four Atlanta, Georgia hospitals affiliated with a single medical center. Non-MIS-A COVID-19 hospitalizations were identified using International Classification of Diseases, Tenth Revision encounter code U07.1. We calculated the ratio of MIS-A to COVID-19 hospitalizations, compared demographic characteristics of the two cohorts, and described clinical characteristics of MIS-A patients. RESULTS: We identified 11 MIS-A cases, none of which were diagnosed by the treatment team, and 5,755 COVID-19 hospitalizations (ratio 1: 523). Compared with patients with COVID-19, patients with MIS-A were more likely to be younger than 50 years (72.7% vs. 26.1%, p < 0.01) and to be non-Hispanic Black persons (81.8% vs. 50.0%, p = 0.04). Ten patients with MIS-A (90.9%) had at least one underlying medical condition. Two MIS-A patients (18.2%) had a previous episode of laboratory-confirmed COVID-19, occurring 37 and 55 days prior to admission. All MIS-A patients developed left ventricular systolic dysfunction. None had documented mucocutaneous involvement. All required intensive care, all received systemic corticosteroids, eight (72.7%) required mechanical ventilation, two (18.2%) required mechanical cardiovascular circulatory support, and none received intravenous immunoglobulin. Two (18.2%) died or were discharged to hospice. CONCLUSIONS: MIS-A is severe but likely underrecognized complication of SARS-CoV-2 infection. Improved recognition of MIS-A is needed to quantify its burden and identify populations at highest risk. |
Characteristics of Women with Urinary Tract Infection in Pregnancy
Johnson CY , Rocheleau CM , Howley MM , Chiu SK , Arnold KE , Ailes EC . J Womens Health (Larchmt) 2021 30 (11) 1556-1564 Background: Urinary tract infection (UTI) is the most common bacterial infection in pregnancy. Known risk factors for UTI in pregnancy include diabetes and certain urologic conditions. Other maternal characteristics might also be associated with risk and could provide clues to the etiology of UTI in pregnancy. Our objective was to identify maternal characteristics associated with UTI in pregnancy. Materials and Methods: We used data from pregnant women participating in the National Birth Defects Prevention Study, a population-based study of risk factors for major structural birth defects in 10 U.S. sites, from 1997 to 2011. In cross-sectional analyses, we used multivariable log-binomial regression to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for associations between self-reported maternal characteristics and UTI in pregnancy. Results: In our sample of 41,869 women, the overall prevalence of reported UTI in pregnancy was 18%, but ranged from 11% to 26% between study sites. In adjusted models, diabetes was moderately associated with higher UTI prevalence (PR 1.39, 95% CI: 1.24-1.57). Higher UTI prevalence was associated even more strongly with low educational attainment (PR 2.06, 95% CI: 1.77-2.40 for some high school vs. graduate school), low household income (PR 1.64, 95% CI: 1.46-1.84 for <$10,000 vs. ≥$50,000), and race/ethnicity (PR 1.45, 95% CI: 1.13-1.80 for American Indian or Alaska Native vs. White women). Conclusions: About one in six women reported UTI in pregnancy but the prevalence varied markedly by geography and maternal characteristics. This variability could provide clues to the causes of UTI in pregnancy. |
Update: COVID-19 Among Workers in Meat and Poultry Processing Facilities - United States, April-May 2020.
Waltenburg MA , Victoroff T , Rose CE , Butterfield M , Jervis RH , Fedak KM , Gabel JA , Feldpausch A , Dunne EM , Austin C , Ahmed FS , Tubach S , Rhea C , Krueger A , Crum DA , Vostok J , Moore MJ , Turabelidze G , Stover D , Donahue M , Edge K , Gutierrez B , Kline KE , Martz N , Rajotte JC , Julian E , Diedhiou A , Radcliffe R , Clayton JL , Ortbahn D , Cummins J , Barbeau B , Murphy J , Darby B , Graff NR , Dostal TKH , Pray IW , Tillman C , Dittrich MM , Burns-Grant G , Lee S , Spieckerman A , Iqbal K , Griffing SM , Lawson A , Mainzer HM , Bealle AE , Edding E , Arnold KE , Rodriguez T , Merkle S , Pettrone K , Schlanger K , LaBar K , Hendricks K , Lasry A , Krishnasamy V , Walke HT , Rose DA , Honein MA . MMWR Morb Mortal Wkly Rep 2020 69 (27) 887-892 Meat and poultry processing facilities face distinctive challenges in the control of infectious diseases, including coronavirus disease 2019 (COVID-19) (1). COVID-19 outbreaks among meat and poultry processing facility workers can rapidly affect large numbers of persons. Assessment of COVID-19 cases among workers in 115 meat and poultry processing facilities through April 27, 2020, documented 4,913 cases and 20 deaths reported by 19 states (1). This report provides updated aggregate data from states regarding the number of meat and poultry processing facilities affected by COVID-19, the number and demographic characteristics of affected workers, and the number of COVID-19-associated deaths among workers, as well as descriptions of interventions and prevention efforts at these facilities. Aggregate data on confirmed COVID-19 cases and deaths among workers identified and reported through May 31, 2020, were obtained from 239 affected facilities (those with a laboratory-confirmed COVID-19 case in one or more workers) in 23 states.* COVID-19 was confirmed in 16,233 workers, including 86 COVID-19-related deaths. Among 14 states reporting the total number of workers in affected meat and poultry processing facilities (112,616), COVID-19 was diagnosed in 9.1% of workers. Among 9,919 (61%) cases in 21 states with reported race/ethnicity, 87% occurred among racial and ethnic minority workers. Commonly reported interventions and prevention efforts at facilities included implementing worker temperature or symptom screening and COVID-19 education, mandating face coverings, adding hand hygiene stations, and adding physical barriers between workers. Targeted workplace interventions and prevention efforts that are appropriately tailored to the groups most affected by COVID-19 are critical to reducing both COVID-19-associated occupational risk and health disparities among vulnerable populations. Implementation of these interventions and prevention efforts(dagger) across meat and poultry processing facilities nationally could help protect workers in this critical infrastructure industry. |
Maternal occupational exposure to solvents and gastroschisis in offspring - National Birth Defects Prevention Study 1997-2011
Spinder N , Almli LM , Desrosiers TA , Arnold KE , Bergman JEH , Kromhout H , Boezen HM , de Walle HEK , Rocheleau C , Reefhuis J . Occup Environ Med 2020 77 (3) 172-178 OBJECTIVES: The aim of this study was to assess the association between maternal occupational exposure to solvents and gastroschisis in offspring. METHODS: We used data from the National Birth Defects Prevention Study, a large population-based case-control study of major birth defects conducted in 10 US states from 1997 to 2011. Infants with gastroschisis were ascertained by active birth defects surveillance systems. Control infants without major birth defects were selected from vital records or birth hospital records. Self-reported maternal occupational histories were collected by telephone interview. Industrial hygienists reviewed this information to estimate exposure to aromatic, chlorinated and petroleum-based solvents from 1 month before conception through the first trimester of pregnancy. Cumulative exposure to solvents was estimated for the same period accounting for estimated exposure intensity and frequency, job duration and hours worked per week. ORs and 95% CIs were estimated to assess the association between exposure to any solvents or solvent classes, and gastroschisis risk. RESULTS: Among 879 cases and 7817 controls, the overall prevalence of periconceptional solvent exposure was 7.3% and 7.4%, respectively. Exposure to any solvent versus no exposure to solvents was not associated with gastroschisis after adjusting for maternal age (OR 1.00, 95% CI 0.75 to 1.32), nor was an association noted for solvent classes. There was no exposure-response relationship between estimated cumulative solvent exposure and gastroschisis after adjusting for maternal age. CONCLUSION: Our study found no association between maternal occupational solvent exposure and gastroschisis in offspring. Further research is needed to understand risk factors for gastroschisis. |
Risk of gastroschisis with maternal genitourinary infections: the US National Birth Defects Prevention Study 1997-2011
Feldkamp ML , Arnold KE , Krikov S , Reefhuis J , Almli LM , Moore CA , Botto LD . BMJ Open 2019 9 (3) e026297 OBJECTIVE: To assess the association between occurrence and timing of maternal self-reported genitourinary tract infection (urinary tract infections [UTIs] and/or sexually transmitted infection [STI]) and risk for gastroschisis in the offspring. DESIGN: Population-based case-control study. SETTING: National Birth Defects Prevention Study, a multisite study in the USA. PARTICIPANTS: Mothers of 1366 gastroschisis cases and 11 238 healthy controls. MAIN OUTCOME MEASURES: Crude and adjusted ORs (aORs) with 95% CIs. RESULTS: Genitourinary infections were frequent in case (19.3%) and control women (9.9%) during the periconceptional period (defined as 3 months prior to 3 months after conception). UTI and/or STI in the periconceptional period were associated with similarly increased risks for gastroschisis (aOR 1.5, 95% CI 1.3 to 1.8; aOR 1.6, 95% CI 1.2 to 2.3, respectively). The risk was increased with a UTI before (aOR 2.5; 95% CI 1.4 to 4.5) or after (aOR 1.7; 95% CI 1.1 to 2.6) conception only among women >/=25 years of age. The risk was highest among women <20 years of age with an STI before conception (aOR 3.6; 95% CI 1.5 to 8.4) and in women >/=25 years of age, the risk was similar for before (aOR 2.9; 95% CI 1.0 to 8.5) and after (aOR 2.8; 95% CI 1.3 to 6.1) conception. A specific STI pathogen was reported in 89.3% (50/56) of cases and 84.3% (162/191) of controls with Chlamydia trachomatis the most common (25/50 cases, 50%; 58/162 controls, 36%) and highest among women <20 years of age (16/25 cases, 64%; 22/33 controls, 67%). CONCLUSIONS: UTI and/or STI were associated with an increased risk for gastroschisis, with the strength of the association varying by maternal age and timing of infection. |
Maternal genitourinary infections and risk of birth defects in the National Birth Defects Prevention Study
Howley MM , Feldkamp ML , Papadopoulos EA , Fisher SC , Arnold KE , Browne ML . Birth Defects Res 2018 110 (19) 1443-1454 BACKGROUND: Genitourinary infections (GUIs) are common among sexually active women. Yet, little is known about the risk of birth defects associated with GUIs. METHODS: Using data from the National Birth Defects Prevention Study, a multisite, population-based, case-control study, we assessed self-reported maternal GUIs in the month before through the third month of pregnancy (periconception) from 29,316 birth defect cases and 11,545 unaffected controls. We calculated odds ratios (ORs) and 95% confidence intervals to estimate the risk of 52 major structural birth defects associated with GUIs. We also calculated risk of birth defects associated with each type of GUI: urinary tract infection (UTI) and sexually transmitted infection (STI). RESULTS: In our analysis, 10% (n = 2,972) of case and 9% (n = 1,014) of control mothers reported a periconceptional GUI. A GUI was significantly associated with 11 of the 52 birth defects examined (ORs ranging from 1.19 to 2.26): encephalocele, cataracts, cleft lip, esophageal atresia, duodenal atresia/stenosis, small intestinal atresia/stenosis, colonic atresia/stenosis, transverse limb deficiency, conoventricular septal defect, atrioventricular septal defect, and secundum atrial septal defect. A periconceptional UTI was significantly associated with nine birth defects (ORs from 1.21 to 2.48), and periconceptional STI was significantly associated with four birth defects (ORs ranging from 1.63 to 3.72). CONCLUSIONS: While misclassification of GUIs in our analysis is likely, our findings suggest GUIs during the periconceptional period may increase the risk for specific birth defects. |
Antibiotics dispensed to privately insured pregnant women with urinary tract infections - United States, 2014
Ailes EC , Summers AD , Tran EL , Gilboa SM , Arnold KE , Meaney-Delman D , Reefhuis J . MMWR Morb Mortal Wkly Rep 2018 67 (1) 18-22 Urinary tract infections (UTIs) occur in about 8% of pregnant women, and untreated UTIs can have serious consequences, including pyelonephritis, preterm labor, low birth weight, and sepsis (1). Pregnant women are typically screened for UTIs during early pregnancy, and those with bacteriuria are treated with antibiotics (1,2). Antibiotic stewardship is critical to improving patient safety and to combating antibiotic resistance. Because of the potential risk for birth defects, including anencephaly, heart defects, and orofacial clefts, associated with use of sulfonamides and nitrofurantoin during pregnancy (3), a 2011 committee opinion from the American College of Obstetricians and Gynecologists (ACOG) recommended that sulfonamides and nitrofurantoin may be prescribed in the first trimester of pregnancy only when other antimicrobial therapies are deemed clinically inappropriate (4). To assess the effects of these recommendations, CDC analyzed the Truven Health MarketScan Commercial Database* to examine antibiotic prescriptions filled by pregnant women with UTIs. Among 482,917 pregnancies in 2014, 7.2% of women had an outpatient UTI diagnosis during the 90 days before the date of last menstrual period (LMP) or during pregnancy. Among pregnant women with UTIs, the most frequently prescribed antibiotics during the first trimester were nitrofurantoin, ciprofloxacin, cephalexin, and trimethoprim-sulfamethoxazole. Given the potential risks associated with use of some of these antibiotics in early pregnancy and the potential for unrecognized pregnancy, women's health care providers should be familiar with the ACOG recommendations and consider the possibility of early pregnancy when treating women of reproductive age. |
Update: interim guidance for health care providers caring for pregnant women with possible Zika virus exposure - United States, July 2016
Oduyebo T , Igbinosa I , Petersen EE , Polen KN , Pillai SK , Ailes EC , Villanueva JM , Newsome K , Fischer M , Gupta PM , Powers AM , Lampe M , Hills S , Arnold KE , Rose LE , Shapiro-Mendoza CK , Beard CB , Munoz JL , Rao CY , Meaney-Delman D , Jamieson DJ , Honein MA . MMWR Morb Mortal Wkly Rep 2016 65 (29) 739-44 CDC has updated its interim guidance for U.S. health care providers caring for pregnant women with possible Zika virus exposure, to include the emerging data indicating that Zika virus RNA can be detected for prolonged periods in some pregnant women. To increase the proportion of pregnant women with Zika virus infection who receive a definitive diagnosis, CDC recommends expanding real-time reverse transcription-polymerase chain reaction (rRT-PCR) testing. Possible exposures to Zika virus include travel to or residence in an area with active Zika virus transmission, or sex* with a partner who has traveled to or resides in an area with active Zika virus transmission without using condoms or other barrier methods to prevent infection.(dagger) Testing recommendations for pregnant women with possible Zika virus exposure who report clinical illness consistent with Zika virus disease( section sign) (symptomatic pregnant women) are the same, regardless of their level of exposure (i.e., women with ongoing risk for possible exposure, including residence in or frequent travel to an area with active Zika virus transmission, as well as women living in areas without Zika virus transmission who travel to an area with active Zika virus transmission, or have unprotected sex with a partner who traveled to or resides in an area with active Zika virus transmission). Symptomatic pregnant women who are evaluated <2 weeks after symptom onset should receive serum and urine Zika virus rRT-PCR testing. Symptomatic pregnant women who are evaluated 2-12 weeks after symptom onset should first receive a Zika virus immunoglobulin (IgM) antibody test; if the IgM antibody test result is positive or equivocal, serum and urine rRT-PCR testing should be performed. Testing recommendations for pregnant women with possible Zika virus exposure who do not report clinical illness consistent with Zika virus disease (asymptomatic pregnant women) differ based on the circumstances of possible exposure. For asymptomatic pregnant women who live in areas without active Zika virus transmission and who are evaluated <2 weeks after last possible exposure, rRT-PCR testing should be performed. If the rRT-PCR result is negative, a Zika virus IgM antibody test should be performed 2-12 weeks after the exposure. Asymptomatic pregnant women who do not live in an area with active Zika virus transmission, who are first evaluated 2-12 weeks after their last possible exposure should first receive a Zika virus IgM antibody test; if the IgM antibody test result is positive or equivocal, serum and urine rRT-PCR should be performed. Asymptomatic pregnant women with ongoing risk for exposure to Zika virus should receive Zika virus IgM antibody testing as part of routine obstetric care during the first and second trimesters; immediate rRT-PCR testing should be performed when IgM antibody test results are positive or equivocal. This guidance also provides updated recommendations for the clinical management of pregnant women with confirmed or possible Zika virus infection. These recommendations will be updated when additional data become available. |
Possible Zika virus infection among pregnant women - United States and Territories, May 2016
Simeone RM , Shapiro-Mendoza CK , Meaney-Delman D , Petersen EE , Galang RR , Oduyebo T , Rivera-Garcia B , Valencia-Prado M , Newsome KB , Perez-Padilla J , Williams TR , Biggerstaff M , Jamieson DJ , Honein MA , Ahmed F , Anesi S , Arnold KE , Barradas D , Barter D , Bertolli J , Bingham AM , Bollock J , Bosse T , Bradley KK , Brady D , Brown CM , Bryan K , Buchanan V , Bullard PD , Carrigan A , Clouse M , Cook S , Cooper M , Davidson S , DeBarr A , Dobbs T , Dunams T , Eason J , Eckert A , Eggers P , Ellington SR , Feldpausch A , Fredette CR , Gabel J , Glover M , Gosciminski M , Gay M , Haddock R , Hand S , Hardy J , Hartel ME , Hennenfent AK , Hills SL , House J , Igbinosa I , Im L , Jeff H , Khan S , Kightlinger L , Ko JY , Koirala S , Korhonen L , Krishnasamy V , Kurkjian K , Lampe M , Larson S , Lee EH , Lind L , Lindquist S , Long J , Macdonald J , MacFarquhar J , Mackie DP , Mark-Carew M , Martin B , Martinez-Quinones A , Matthews-Greer J , McGee SA , McLaughlin J , Mock V , Muna E , Oltean H , O'Mallan J , Pagano HP , Park SY , Peterson D , Polen KN , Porse CC , Rao CY , Ropri A , Rinsky J , Robinson S , Rosinger AY , Ruberto I , Schiffman E , Scott-Waldron C , Semple S , Sharp T , Short K , Signs K , Slavinski SA , Stevens T , Sweatlock J , Talbot EA , Tonzel J , Traxler R , Tubach S , Van Houten C , VinHatton E , Viray M , Virginie D , Warren MD , Waters C , White P , Williams T , Winters AI , Wood S , Zaganjor I . MMWR Morb Mortal Wkly Rep 2016 65 (20) 514-9 Zika virus is a cause of microcephaly and brain abnormalities (1), and it is the first known mosquito-borne infection to cause congenital anomalies in humans. The establishment of a comprehensive surveillance system to monitor pregnant women with Zika virus infection will provide data to further elucidate the full range of potential outcomes for fetuses and infants of mothers with asymptomatic and symptomatic Zika virus infection during pregnancy. In February 2016, Zika virus disease and congenital Zika virus infections became nationally notifiable conditions in the United States (2). Cases in pregnant women with laboratory evidence of Zika virus infection who have either 1) symptomatic infection or 2) asymptomatic infection with diagnosed complications of pregnancy can be reported as cases of Zika virus disease to ArboNET* (2), CDC's national arboviral diseases surveillance system. Under existing interim guidelines from the Council for State and Territorial Epidemiologists (CSTE), asymptomatic Zika virus infections in pregnant women who do not have known pregnancy complications are not reportable. ArboNET does not currently include pregnancy surveillance information (e.g., gestational age or pregnancy exposures) or pregnancy outcomes. To understand the full impact of infection on the fetus and neonate, other systems are needed for reporting and active monitoring of pregnant women with laboratory evidence of possible Zika virus infection during pregnancy. Thus, in collaboration with state, local, tribal, and territorial health departments, CDC established two surveillance systems to monitor pregnancies and congenital outcomes among women with laboratory evidence of Zika virus infection(dagger) in the United States and territories: 1) the U.S. Zika Pregnancy Registry (USZPR),( section sign) which monitors pregnant women residing in U.S. states and all U.S. territories except Puerto Rico, and 2) the Zika Active Pregnancy Surveillance System (ZAPSS), which monitors pregnant women residing in Puerto Rico. As of May 12, 2016, the surveillance systems were monitoring 157 and 122 pregnant women with laboratory evidence of possible Zika virus infection from participating U.S. states and territories, respectively. Tracking and monitoring clinical presentation of Zika virus infection, all prenatal testing, and adverse consequences of Zika virus infection during pregnancy are critical to better characterize the risk for congenital infection, the performance of prenatal diagnostic testing, and the spectrum of adverse congenital outcomes. These data will improve clinical guidance, inform counseling messages for pregnant women, and facilitate planning for clinical and public health services for affected families. |
Increasing prevalence of gastroschisis - 14 States, 1995-2012
Jones AM , Isenburg J , Salemi JL , Arnold KE , Mai CT , Aggarwal D , Arias W , Carrino GE , Ferrell E , Folorunso O , Ibe B , Kirby RS , Krapfl HR , Marengo LK , Mosley BS , Nance AE , Romitti PA , Spadafino J , Stock J , Honein MA . MMWR Morb Mortal Wkly Rep 2016 65 (2) 23-6 Gastroschisis is a serious congenital defect in which the intestines protrude through an opening in the abdominal wall. Gastroschisis requires surgical repair soon after birth and is associated with an increased risk for medical complications and mortality during infancy. Reports from multiple surveillance systems worldwide have documented increasing prevalence of gastroschisis since the 1980s, particularly among younger mothers; however, since publication of a multistate U.S. report that included data through 2005 (1), it is not known whether prevalence has continued to increase. Data on gastroschisis from 14 population-based state surveillance programs were pooled and analyzed to assess the average annual percent change (AAPC) in prevalence and to compare the prevalence during 2006-2012 with that during 1995-2005, stratified by maternal age and race/ethnicity. The pooled data included approximately 29% of U.S. births for the period 1995-2012. During 1995-2012, gastroschisis prevalence increased in every category of maternal age and race/ethnicity, and the AAPC ranged from 3.1% in non-Hispanic white (white) mothers aged <20 years to 7.9% in non-Hispanic black (black) mothers aged <20 years. These corresponded to overall percentage increases during 1995-2012 that ranged from 68% in white mothers aged <20 years to 263% in black mothers aged <20 years. Gastroschisis prevalence increased 30% between the two periods, from 3.6 per 10,000 births during 1995-2005 to 4.9 per 10,000 births during 2006-2012 (prevalence ratio = 1.3, 95% confidence interval [CI]: 1.3-1.4), with the largest increase among black mothers aged <20 years (prevalence ratio = 2.0, 95% CI: 1.6-2.5). Public health research is urgently needed to identify factors contributing to this increase. |
Ebola virus disease - Sierra Leone and Guinea, August 2015
Hersey S , Martel LD , Jambai A , Keita S , Yoti Z , Meyer E , Seeman S , Bennett S , Ratto J , Morgan O , Akyeampong MA , Sainvil S , Worrell MC , Fitter D , Arnold KE . MMWR Morb Mortal Wkly Rep 2015 64 (35) 981-4 The Ebola virus disease (Ebola) outbreak in West Africa began in late 2013 in Guinea (1) and spread unchecked during early 2014. By mid-2014, it had become the first Ebola epidemic ever documented. Transmission was occurring in multiple districts of Guinea, Liberia, and Sierra Leone, and for the first time, in capital cities (2). On August 8, 2014, the World Health Organization (WHO) declared the outbreak to be a Public Health Emergency of International Concern (3). Ministries of Health, with assistance from multinational collaborators, have reduced Ebola transmission, and the number of cases is now declining. While Liberia has not reported a case since July 12, 2015, transmission has continued in Guinea and Sierra Leone, although the numbers of cases reported are at the lowest point in a year. In August 2015, Guinea and Sierra Leone reported 10 and four confirmed cases, respectively, compared with a peak of 526 (Guinea) and 1,997 (Sierra Leone) in November 2014. This report details the current situation in Guinea and Sierra Leone, outlines strategies to interrupt transmission, and highlights the need to maintain public health response capacity and vigilance for new cases at this critical time to end the outbreak. |
Pneumonia among adults hospitalized with laboratory-confirmed seasonal influenza virus infection - United States, 2005-2008
Garg S , Jain S , Dawood FS , Jhung M , Perez A , D'Mello T , Reingold A , Gershman K , Meek J , Arnold KE , Farley MM , Ryan P , Lynfield R , Morin C , Baumbach J , Hancock EB , Zansky S , Bennett N , Thomas A , Schaffner W , Finelli L . BMC Infect Dis 2015 15 369 BACKGROUND: Influenza and pneumonia combined are the leading causes of death due to infectious diseases in the United States. We describe factors associated with pneumonia among adults hospitalized with influenza. METHODS: Through the Emerging Infections Program, we identified adults ≥ 18 years, who were hospitalized with laboratory-confirmed influenza during October 2005 through April 2008, and had a chest radiograph (CXR) performed. Pneumonia was defined as the presence of a CXR infiltrate and either an ICD-9-CM code or discharge summary diagnosis of pneumonia. RESULTS: Among 4,765 adults hospitalized with influenza, 1392 (29 %) had pneumonia. In multivariable analysis, factors associated with pneumonia included: age ≥ 75 years, adjusted odds ratio (AOR) 1.27 (95 % confidence interval 1.10-1.46), white race AOR 1.24 (1.03-1.49), nursing home residence AOR 1.37 (1.14-1.66), chronic lung disease AOR 1.37 (1.18-1.59), immunosuppression AOR 1.45 (1.19-1.78), and asthma AOR 0.76 (0.62-0.92). Patients with pneumonia were significantly more likely to require intensive care unit (ICU) admission (27 % vs. 10 %), mechanical ventilation (18 % vs. 5 %), and to die (9 % vs. 2 %). CONCLUSIONS: Pneumonia was present in nearly one-third of adults hospitalized with influenza and was associated with ICU admission and death. Among patients hospitalized with influenza, older patients and those with certain underlying conditions are more likely to have pneumonia. Pneumonia is common among adults hospitalized with influenza and should be evaluated and treated promptly. |
Meningococcal carriage among Georgia and Maryland high school students
Harrison LH , Shutt KA , Arnold KE , Stern EJ , Pondo T , Kiehlbauch JA , Myers RA , Hollick RA , Schmink S , Vello M , Stephens DS , Messonnier NE , Mayer L , Clark TA . J Infect Dis 2014 211 (11) 1761-8 BACKGROUND: Meningococcal disease incidence in the U.S. is at an all-time low. In a previous study of Georgia high school students, meningococcal carriage prevalence was 7%. The purpose of this study was to measure the impact of a meningococcal conjugate vaccine on serogroup Y meningococcal carriage and to define the dynamics of carriage in high school students. METHODS: This was a prospective cohort study at 8 high schools, 4 each in Maryland and Georgia during a school year. In each state, 2 high schools were randomized for participating students to receive MCV4-DT at the beginning of the study and 2 at the end. Oropharyngeal swab cultures for meningococcal carriage were performed three times during the school year. RESULTS: Among 3,311 students, prevalence of meningococcal carriage was 3.21%- 4.01%. Phenotypically non-groupable strains accounted for 88% of carriage isolates. There were only 5 observed acquisitions of serogroup Y strains during the study; therefore, the impact of MCV4-DT on meningococcal carriage could not be determined. CONCLUSIONS: Meningococcal carriage rates in U.S. high school students were lower than expected and the vast majority of strains did not express capsule. These findings may help explain the historically low incidence of meningococcal disease in the U.S. |
Child, household, and caregiver characteristics associated with hospitalization for influenza among children 6-59 months of age: an Emerging Infections Program study
Dharan NJ , Sokolow LZ , Cheng PY , Gargiullo P , Gershman K , Lynfield R , Morin C , Thomas A , Meek J , Farley MM , Arnold KE , Reingold A , Craig AS , Schaffner W , Bennett NM , Zansky S , Baumbach J , Lathrop S , Kamimoto L , Shay DK . Pediatr Infect Dis J 2014 33 (6) e141-50 BACKGROUND: Young children are at increased risk of severe outcomes from influenza illness, including hospitalization. We conducted a case-control study to identify risk factors for influenza-associated hospitalizations among children in U.S. Emerging Infections Program sites. METHODS: Cases were children 6-59 months of age hospitalized for laboratory-confirmed influenza infections during 2005-08. Age- and zip-code-matched controls were enrolled. Data on child, caregiver, and household characteristics were collected from parents and medical records. Conditional logistic regression was used to identify independent risk factors for hospitalization. RESULTS: We enrolled 290 (64%) of 454 eligible cases and 1,089 (49%) of 2,204 eligible controls. Risk for influenza hospitalization increased with maternal age <26 years (odds ratio [OR] 1.8, 95% confidence interval [CI] 1.1-2.9); household income below the poverty threshold (OR 2.2, CI 1.4-3.6); smoking by >50% of household members (OR 2.9, CI 1.4-6.6); lack of household influenza vaccination (OR 1.8, CI 1.2-2.5); and presence of chronic illnesses, including hematologic/oncologic (OR 11.8, CI 4.5-31.0), pulmonary (OR 2.9, CI 1.9-4.4), and neurologic (OR 3.8, CI 1.6-9.2) conditions. Full influenza immunization decreased the risk among children aged 6-23 months (OR 0.5, CI 0.3-0.9) but not among those 24-59 months of age (OR 1.5, CI 0.8-3.0; p-value for difference = 0.01). CONCLUSIONS: Chronic illnesses, young maternal age, poverty, household smoking, and lack of household influenza vaccination increased the risk of influenza hospitalization. These characteristics may help providers to identify young children who are at greatest risk for severe outcomes from influenza illness. |
Increase in rates of hospitalization due to laboratory-confirmed influenza among children and adults during the 2009-10 influenza pandemic
Cox CM , D'Mello T , Perez A , Reingold A , Gershman K , Yousey-Hindes K , Arnold KE , Farley MM , Ryan P , Lynfield R , Morin C , Baumbach J , Hancock EB , Zansky S , Bennett NM , Thomas A , Schaffner W , Finelli L . J Infect Dis 2012 206 (9) 1350-8 BACKGROUND: The Emerging Infections Programs (EIP) network has conducted population-based surveillance for hospitalizations due to laboratory-confirmed influenza among children since 2003, with the network expanding in 2005 to include adults. METHODS: From 15 April 2009 through 30 April 2010, the EIP conducted surveillance among 22.1 million people residing in 10 states. Incidence rates per 100,000 population were calculated using US Census Bureau data. Mean historic rates were calculated on the basis of previously published and unpublished EIP data. RESULTS: During the 2009 pandemic of influenza A virus subtype H1N1 infection, rates of hospitalizations due to laboratory-confirmed influenza were 202, 88, 49, 31, 27, 36, 28, and 27 episodes per 100,000 among persons aged <6 months, 6-23 months, 2-4 years, 5-17 years, 18-49 years, 50-64 years, 65-74 years, and ≥75 years, respectively. Comparative mean rates from previous influenza seasons during which EIP conducted surveillance were 153, 53, 20, 6, 4, 8, 20, and 56 episodes per 100,000 among persons aged <6 months, 6-23 months, 2-4 years, 5-17 years, 18-49 years, 50-64 years, 65-74 years, and ≥75 years, respectively. CONCLUSIONS: During the pandemic, rates of hospitalization due to laboratory-confirmed influenza among individuals aged 5-17 years and 18-49 years increased 5-fold and 6-fold, respectively, compared with mean rates from previous influenza seasons. Hospitalization rates for other pediatric and adult age groups increased, compared with mean rates from previous influenza seasons, whereas the rate among individuals aged ≥75 years decreased. |
Reduced influenza antiviral treatment among children and adults hospitalized with laboratory-confirmed influenza infection in the year following the 2009 pandemic
Garg S , Chaves SS , Perez A , D'Mello T , Gershman K , Meek J , Yousey-Hindes K , Arnold KE , Farley MM , Tengelsen L , Ryan P , Sharangpani R , Lynfield R , Morin C , Baumbach J , Hancock EB , Zansky S , Bennett NM , Fowler B , Bradley K , Thomas A , Cooper T , Schaffner W , Boulton R , Finelli L , Fry A . Clin Infect Dis 2012 55 (3) e18-21 Influenza antiviral treatment is recommended for all persons hospitalized with influenza virus infection. During the 2010-2011 influenza season, antiviral treatment of children and adults hospitalized with laboratory-confirmed influenza declined significantly compared to treatment during the 2009 pandemic (children: 56% versus 77%, p <0.01; adults 77% versus 82%, p<0.01). |
Building data quality and confidence in data reported to the national healthcare safety network
Arnold KE , Thompson ND . Infect Control Hosp Epidemiol 2012 33 (5) 446-8 Since 2009, the Centers for Disease Control and Prevention | (CDC) has provided funding to 51 states and territories to | develop healthcare-associated infection (HAI) prevention | programs and, in some states, funds for systematic validation | of data reported by hospitals to the National Healthcare Safety | Network (NHSN). As of 2011, at least 11 state health departments (SHDs) have completed validation projects for | central line-associated bloodstream infections (CLABSIs), | and in several states validation is ongoing. Differences in | resource availability and the numbers of hospitals reporting | to NHSN within states have resulted in a variety of methods | used to validate HAI data. To enable efficient use of resources, | SHDs often employ a targeted approach to selecting the | healthcare facilities, units, and medical charts for validation;1 | therefore, direct comparison of the results may be limited. | Nevertheless, common themes include an opportunity for | hospital staff to receive additional education and training on | NHSN methods, and impartial feedback regarding the quality | and completeness of their HAI reporting efforts. Both activities build confidence in the data available to SHDs, group | users, and the CDC to inform policy and HAI prevention | efforts. |
Influenza-associated hospitalizations by industry, 2009-10 influenza season, United States
Luckhaupt SE , Sweeney MH , Funk R , Calvert GM , Nowell M , D'Mello T , Reingold A , Meek J , Yousey-Hindes K , Arnold KE , Ryan P , Lynfield R , Morin C , Baumbach J , Zansky S , Bennett NM , Thomas A , Schaffner W , Jones T . Emerg Infect Dis 2012 18 (4) 556-562 In response to pandemic (H1N1) 2009, data were collected on work status and industry of employment of 3,365 adults hospitalized with laboratory-confirmed influenza during the 2009-10 influenza season in the United States. The proportion of workers hospitalized for influenza was lower than their proportion in the general population, reflecting underlying protective characteristics of workers compared with nonworkers. The most commonly represented sectors were transportation and warehousing; administrative and support and waste management and remediation services; health care; and accommodation and food service. |
Network approach for prevention of healthcare-associated infections
Horan TC , Arnold KE , Rebmann CA , Fridkin SK . Infect Control Hosp Epidemiol 2011 32 (11) 1143-4 We applaud the successful reduction of healthcare-associated infection (HAI) rates achieved by hospitals | that participated for 5 years or more in the Duke Infection | Control Outreach Network (DICON), as described by Anderson and colleagues in their recent report.1 | DICON provides a successful example of HAI reduction, using validated, | risk-adjusted local data to drive prevention activities, and it | adds to existing evidence supporting this HAI prevention | strategy.2 | " | 4 | To help ensure an accurate understanding of the | current landscape of HAI-reporting infrastructures that can | contribute to such reductions, we would like to clarify that | the National Healthcare Safety Network (NHSN) can, and in | some states does, also function much as DICON does to | provide complete, validated, risk-adjusted data for local action, with the distinction that funding for NHSN and, particularly, validation requires public support, whereas DICON | is funded directly by the facilities it serves. We disagree with | the authors' statement that NHSN data are "obtained from | convenience samples (ie, are not complete), are not validated, | and are not fed back to individual hospitals in a timely fashion," for the following reasons. While it is true that not all | US hospitals report HAIs to NHSN and participation in | NHSN is still voluntary in some states, increasingly it is being | used as a platform for state mandatory reporting of HAIs (23 | states and the District of Columbia as of July 2011). Also, | beginning in January 2011, NHSN became the reporting tool | for central line-associated bloodstream infections in hospitals | with intensive care units that participate in the Hospital Inpatient Quality Reporting Program of the Centers for Medicare and Medicaid Services (CMS).5 | The result is that now | more than 4,200 of the 5,800 hospitals in the United States | belong to NHSN and are reporting data continuously on a | variety of HAIs, with central line-associated bloodstream infections and surgical site infections being the most common | focus of surveillance and reporting. Therefore, we believe that | as currently constituted, NHSN has become representative of | US hospitals for certain HAI types, and future expansion is | likely |
A cluster of mucormycosis infections in hematology patients: challenges in investigation and control of invasive mold infections in high-risk patient populations
Llata E , Blossom DB , Khoury HJ , Rao CY , Wannemuehler KA , Noble-Wang J , Langston AA , Ribner BS , Lyon GM , Arnold KE , Jackson DR , Brandt ME , Chiller TM , Balajee SA , Srinivasan A , Magill SS . Diagn Microbiol Infect Dis 2011 71 (1) 72-80 Mucormycosis has been reported to be occurring more frequently in hematopoietic stem cell transplant (HSCT) recipients in recent years. We investigated a hospital cluster of mucormycosis cases among patients with hematologic disorders. Case-patients were identified through hospital microbiology and pathology database searches and compared to randomly selected controls matched on underlying disease and hospital discharge date using conditional logistic regression. Environmental assessments, including collection of samples for fungal cultures, were performed. Of 11 case-patients, 6 (55%) had acute myelogenous leukemia and 3 (27%) were allogeneic HSCT recipients. Five case-patients (45%) died. In univariate analysis, case-patients were more likely than controls to have refractory hematologic disease (odds ratio [OR], 13.75; 95% confidence interval [CI], 1.31-689); neutropenia >14 days (OR, 11.50; 95% CI, 1.27-558) or to have received voriconazole prophylaxis (OR, 11.26; 95% CI, 1.11-infinity). A point source was not identified. Factors such as underlying disease state and antifungal prophylaxis type may identify hematology patients at highest risk for mucormycosis. Our investigation highlighted critical knowledge gaps, including strain typing methods, the role of the hospital environment in mucormycosis outbreaks, and hospital environmental infection control measures most likely to reduce exposure of immunosuppressed persons to mucormycetes. |
Diversity of factor H-binding protein in Neisseria meningitidis carriage isolates
Marsh JW , Shutt KA , Pajon R , Tulenko MM , Liu S , Hollick RA , Kiehlbauch JA , Clark TA , Stephens DS , Arnold KE , Myers RA , Mayer LW , Harrison LH . Vaccine 2011 29 (35) 6049-58 Several meningococcal vaccines under development for prevention of serogroup B disease target the factor H-binding protein (FHbp), an immunogenic lipoprotein expressed on the surface of Neisseria meningitidis. Based upon sequence and phylogenetic analyses, FHbp can be classified into 3 protein variants (1, 2 or 3) or 2 subfamilies (A or B). The potential effect of FHbp-containing vaccines on meningococcal carriage is not known. We determined the diversity of FHbp among a population of carriage isolates obtained from Georgia and Maryland high school students in 1998 and 2006-2007. Analysis of the fHbp gene sequence from 408 carriage isolates identified 30 different FHbp protein sequences. The majority of carriage isolates harbored FHbp proteins belonging to variant 2/subfamily A. Association between FHbp proteins and genetic lineage was observed among the carriage isolates. However, split decomposition analysis, together with tests of linkage disequilibrium and pairwise homoplasy suggest recombination at fHbp contribute to allelic diversity. Of note, the FHbp proteins in serogroup B vaccines under development are either absent or not well represented in this carriage population. The FHbp genetic repertoire observed in carriage isolate populations will be useful in understanding the potential impact of FHbp-containing vaccines on meningococcal carriage. |
Children with asthma hospitalized with seasonal or pandemic influenza, 2003-2009
Dawood FS , Kamimoto L , D'Mello TA , Reingold A , Gershman K , Meek J , Arnold KE , Farley M , Ryan P , Lynfield R , Morin C , Baumbach J , Zansky S , Bennett N , Thomas A , Schaffner W , Kirschke D , Finelli L . Pediatrics 2011 128 (1) e27-32 OBJECTIVE: To describe the characteristics and clinical courses of asthmatic children hospitalized with seasonal or 2009 pandemic H1N1 influenza and compare complications by influenza type. METHODS: During the 2003-2009 influenza seasons and the 2009 pandemic, we conducted surveillance of 5.3 million children aged 17 years or younger for hospitalization with laboratory-confirmed influenza and identified those with asthma (defined as those aged 2-17 years with a history of asthma in their medical record or a discharge code for acute asthma exacerbation or status asthmaticus). We collected data from medical records on medical history and clinical course; data on asthma severity and control were not routinely collected. RESULTS: During the 2003-2009 influenza seasons, 701 (32%) of 2165 children hospitalized with influenza had asthma; during the 2009 pandemic, 733 (44%) of 1660 children had asthma. The median age of the asthmatic children was 7 years, and 73% had no additional medical conditions. Compared with asthmatic children with seasonal influenza, a higher proportion with 2009 pandemic H1N1 influenza required intensive care (16% vs 22%; P = .01) and were diagnosed with pneumonia (40% vs 46%; P = .04), whereas equal proportions had respiratory failure (5% vs 5%; P = .8) and died (1% vs 1%; P = .4). More asthmatic children with influenza A (seasonal or pandemic) had diagnoses of asthma exacerbations compared with those with influenza B (51% vs 29%; P < .01). CONCLUSIONS: The majority of asthmatic children hospitalized with influenza have no additional medical conditions. Complications such as pneumonia and need for intensive care occur in a substantial proportion, highlighting the importance of influenza prevention through vaccination among asthmatic children. |
sodC-based real-time PCR for detection of Neisseria meningitidis.
Dolan Thomas J , Hatcher CP , Satterfield DA , Theodore MJ , Bach MC , Linscott KB , Zhao X , Wang X , Mair R , Schmink S , Arnold KE , Stephens DS , Harrison LH , Hollick RA , Andrade AL , Lamaro-Cardoso J , de Lemos AP , Gritzfeld J , Gordon S , Soysal A , Bakir M , Sharma D , Jain S , Satola SW , Messonnier NE , Mayer LW . PLoS One 2011 6 (5) e19361 Real-time PCR (rt-PCR) is a widely used molecular method for detection of Neisseria meningitidis (Nm). Several rt-PCR assays for Nm target the capsule transport gene, ctrA. However, over 16% of meningococcal carriage isolates lack ctrA, rendering this target gene ineffective at identification of this sub-population of meningococcal isolates. The Cu-Zn superoxide dismutase gene, sodC, is found in Nm but not in other Neisseria species. To better identify Nm, regardless of capsule genotype or expression status, a sodC-based TaqMan rt-PCR assay was developed and validated. Standard curves revealed an average lower limit of detection of 73 genomes per reaction at cycle threshold (C(t)) value of 35, with 100% average reaction efficiency and an average R(2) of 0.9925. 99.7% (624/626) of Nm isolates tested were sodC-positive, with a range of average C(t) values from 13.0 to 29.5. The mean sodC C(t) value of these Nm isolates was 17.6+/-2.2 (+/-SD). Of the 626 Nm tested, 178 were nongroupable (NG) ctrA-negative Nm isolates, and 98.9% (176/178) of these were detected by sodC rt-PCR. The assay was 100% specific, with all 244 non-Nm isolates testing negative. Of 157 clinical specimens tested, sodC detected 25/157 Nm or 4 additional specimens compared to ctrA and 24 more than culture. Among 582 carriage specimens, sodC detected Nm in 1 more than ctrA and in 4 more than culture. This sodC rt-PCR assay is a highly sensitive and specific method for detection of Nm, especially in carriage studies where many meningococcal isolates lack capsule genes. |
Seasonal and 2009 pandemic influenza A (H1N1) virus infection during pregnancy: a population-based study of hospitalized cases
Creanga AA , Kamimoto L , Newsome K , D'Mello T , Jamieson DJ , Zotti ME , Arnold KE , Baumbach J , Bennett NM , Farley MM , Gershman K , Kirschke D , Lynfield R , Meek J , Morin C , Reingold A , Ryan P , Schaffner W , Thomas A , Zansky S , Finelli L , Honein MA . Am J Obstet Gynecol 2011 204 S38-45 We sought to describe characteristics of hospitalized reproductive-aged (15-44 years) women with seasonal (2005/2006 through 2008/2009) and 2009 pandemic influenza A (H1N1) virus infection. We used population-based data from the Emerging Infections Program in 10 US states, and compared characteristics of pregnant (n = 150) and nonpregnant (n = 489) seasonal, and pregnant (n = 489) and nonpregnant (n = 1088) pandemic influenza cases using chi(2) and Fisher's exact tests. Pregnant women represented 23.5% and 31.0% of all reproductive-aged women hospitalized for seasonal and pandemic influenza, respectively. Significantly more nonpregnant than pregnant women with seasonal (71.2% vs 36.0%) and pandemic (69.7% vs 31.9%) influenza had an underlying medical condition other than pregnancy. Antiviral treatment was significantly more common with pandemic than seasonal influenza for both pregnant (86.5% vs 24.0%) and nonpregnant (82.0% vs 55.2%) women. Pregnant women comprised a significant proportion of influenza-hospitalized reproductive-aged women, underscoring the importance of influenza vaccination during pregnancy. |
Adult hospitalizations for laboratory-positive influenza during the 2005-2006 through 2007-2008 seasons in the United States
Dao CN , Kamimoto L , Nowell M , Reingold A , Gershman K , Meek J , Arnold KE , Farley M , Ryan P , Lynfield R , Morin C , Baumbach J , Hancock E , Zansky S , Bennett NM , Thomas A , Vandermeer M , Kirschke DL , Schaffner W , Finelli L . J Infect Dis 2010 202 (6) 881-8 BACKGROUND: Rates of influenza-associated hospitalizations in the United States have been estimated using modeling techniques with data from pneumonia and influenza hospitalization discharge diagnoses, but they have not been directly estimated from laboratory-positive cases. METHODS: We calculated overall, age-specific, and site-specific rates of laboratory-positive, influenza-associated hospitalization among adults and compared demographic and clinical characteristics and outcomes of hospitalized cases by season with use of data collected by the Emerging Infections Program Network during the 2005-2006 through 2007-2008 influenza seasons. RESULTS: Overall rates of adult influenza-associated hospitalization per 100,000 persons were 9.9 during the 2005-2006 season, 4.8 during the 2006-2007 season, and 18.7 during the 2007-2008 season. Rates of hospitalization varied by Emerging Infections Program site and increased with increasing age. Higher overall and age-specific rates of hospitalization were observed during influenza A (H3) predominant seasons and during periods of increased circulation of influenza B. More than 80% of hospitalized persons each season had 1 underlying medical condition, including chronic cardiovascular and metabolic diseases. CONCLUSIONS: Rates varied by season, age, geographic location, and type/subtype of circulating influenza viruses. Influenza-associated hospitalization surveillance is essential for assessing the relative severity of influenza seasons over time and the burden of influenza-associated complications. |
Burden of seasonal influenza hospitalization in children, United States, 2003 to 2008
Dawood FS , Fiore A , Kamimoto L , Bramley A , Reingold A , Gershman K , Meek J , Hadler J , Arnold KE , Ryan P , Lynfield R , Morin C , Mueller M , Baumbach J , Zansky S , Bennett NM , Thomas A , Schaffner W , Kirschke D , Finelli L . J Pediatr 2010 157 (5) 808-14 OBJECTIVES: To estimate the rates of hospitalization with seasonal influenza in children aged <18 years from a large, diverse surveillance area during 2003 to 2008. STUDY DESIGN: Through the Emerging Infections Program Network, population-based surveillance for laboratory-confirmed influenza was conducted in 10 states, including 5.3 million children. Hospitalized children were identified retrospectively; clinicians made influenza testing decisions. Data collected from the hospital record included demographics, medical history, and clinical course. Incidence rates were calculated with census data. RESULTS: The highest hospitalization rates occurred in children aged <6 months (seasonal range, 9-30/10 000 children), and the lowest rates occurred in children aged 5 to 17 years (0.3-0.8/10 000). Overall, 4015 children were hospitalized, 58% of whom were identified with rapid diagnostic tests alone. Forty percent of the children who were hospitalized had underlying medical conditions; asthma (18%), prematurity (15% of children aged <2 years), and developmental delay (7%) were the most common. Severe outcomes included intensive care unit admission (12%), respiratory failure (5%), bacterial coinfection (2%), and death (0.5%). CONCLUSIONS: Influenza-associated hospitalization rates varied by season and age and likely underestimate true rates because many hospitalized children are not tested for influenza. The proportion of children with severe outcomes was substantial across seasons. Quantifying incidence of influenza hospitalization and severe outcomes is critical to defining disease burden. |
Influenza-associated pneumonia in children hospitalized with laboratory-confirmed influenza, 2003-2008
Dawood FS , Fiore A , Kamimoto L , Nowell M , Reingold A , Gershman K , Meek J , Hadler J , Arnold KE , Ryan P , Lynfield R , Morin C , Baumbach J , Zansky S , Bennett NM , Thomas A , Schaffner W , Kirschke D , Finelli L . Pediatr Infect Dis J 2010 29 (7) 585-90 BACKGROUND: Pneumonia is one of the most common complications in children hospitalized with influenza. We describe hospitalized children with influenza-associated pneumonia and associated risk indicators. METHODS: Through Emerging Infections Program Network population based surveillance, children aged <18 years hospitalized with laboratory confirmed influenza with a chest radiograph during hospitalization were identified during the 2003-2008 influenza seasons. A case with radiologically confirmed influenza-associated pneumonia was defined as a child from the surveillance area hospitalized with: (1) laboratory-confirmed influenza and (2) evidence of new pneumonia on chest radiograph during hospitalization. Hospitalized children with pneumonia were compared with those without pneumonia by univariate and multivariate analysis. RESULTS: Overall, 2992 hospitalized children with influenza with a chest radiograph were identified; 1072 (36%) had influenza-associated pneumonia.When compared with children hospitalized with influenza without pneumonia, hospitalized children with influenza-associated pneumonia were more likely to require intensive care unit admission (21% vs. 11%, P < 0.01), develop respiratory failure (11% versus 3%, P < 0.01), and die(0.9% vs. 0.3% P 0.01). In multivariate analysis, age 6 to 23 months(adjusted OR: 2.1, CI: 1.6 -2.8), age 2 to 4 years (adjusted OR: 1.7, CI:1.3-2.2), and asthma (adjusted OR: 1.4, CI: 1.1-1.8) were significantly associated with influenza-associated pneumonia. CONCLUSIONS: Hospitalized children with influenza-associated pneumonia were more likely to have a severe clinical course than other hospitalized children with influenza, and children aged 6 months to 4 years and those with asthma were more likely to have influenza-associated pneumonia. Identifying children at greater risk for influenza-associated pneumonia will inform prevention and treatment strategies targeting children at risk for influenza complications. |
Staphylococcus aureus community-onset pneumonia in patients admitted to children's hospitals during autumn and winter of 2006-2007
Kallen AJ , Reed C , Patton M , Arnold KE , Finelli L , Hageman J . Epidemiol Infect 2010 138 (5) 666-72 Staphylococcus aureus is a relatively uncommon cause of community-onset pneumonia (COP) that may complicate influenza infection. We reviewed admissions to children's hospitals to describe more systematically this entity. Records of patients hospitalized at three children's hospitals between 1 October 2006 and 30 April 2007 who had a positive S. aureus culture from a sterile site or respiratory specimen were reviewed and data were abstracted for episodes of primary S. aureus COP. Overall, 30 episodes met criteria for primary S. aureus COP; 12 (41%) involved methicillin-resistant S. aureus. Patients in 11 (37%) episodes were seen by a healthcare provider for their symptoms prior to hospital admission; three received an antimicrobial, none of which had activity against the S. aureus isolated. Mechanical ventilation was required in 21 (70%) episodes; five (17%) patients died. When evaluating patients with severe COP, providers should be aware of the potential for S. aureus, including methicillin-resistant strains. |
Catheter-related polymicrobial bloodstream infections among pediatric bone marrow transplant outpatients-Atlanta, Georgia, 2007
Wiersma P , Schillie S , Keyserling H , Watson JR , De A , Banerjee SN , Drenzek CL , Arnold KE , Shivers C , Kendrick L , Ryan LG , Jensen B , Noble-Wang J , Srinivasan A . Infect Control Hosp Epidemiol 2010 31 (5) 522-7 OBJECTIVE: To identify risk factors for polymicrobial bloodstream infections (BSIs) in pediatric bone marrow transplant (BMT) outpatients attending a newly constructed clinic affiliated with a children's hospital. METHODS: All 30 outpatients treated at a new BMT clinic during September 10-21, 2007, were enrolled in a cohort study. The investigation included interviews, medical records review, observations, and bacterial culture and molecular typing of patient and environmental isolates. Data were analyzed using exact conditional logistic regression. RESULTS: Thirteen patients experienced BSIs caused by 16 different, predominantly gram-negative organisms. Presence of a tunneled catheter (odds ratio [OR], 19.9 [95% confidence interval {CI}, 2.4-infinity), catheter access (OR, 13.7 [95% CI, 1.8-infinity]), and flushing of a catheter with predrawn saline (OR, 12.9 [95% CI, 1.0-766.0]) were independently associated with BSI. The odds of experiencing a BSI increased by a factor of 16.8 with each additional injection of predrawn saline (95% CI, 1.8-827.0). Although no environmental source of pathogens was identified, interviews revealed breaches in recommended infection prevention practice and medication handling. Saline flush solutions were predrawn, and multiple doses were obtained from single-dose preservative-free vials to avoid delays in patient care. CONCLUSION: We speculate that infection prevention challenges in the new clinic, combined with successive needle punctures of vials, facilitated extrinsic contamination and transmission of healthcare-associated pathogens. We recommend that preservative-free single-use vials not be punctured more than once. Use of single-use prefilled saline syringes might prevent multiuse of single-use saline vials. Storage of saline outside a medication supply system might be advisable. Before opening new clinic facilities, hospitals should consider conducting a mock patient flow exercise to identify infection control challenges. |
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