Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-5 (of 5 Records) |
Query Trace: Augustine RJ[original query] |
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Diagnosis, treatment, and prevention of tuberculosis among people experiencing homelessness in the United States: Current recommendations
Marks SM , Self JL , Venkatappa T , Wolff MB , Hopkins PB , Augustine RJ , Khan A , Schwartz NG , Schmit KM , Morris SB . Public Health Rep 2023 138 (6) 333549221148173 OBJECTIVE: Tuberculosis (TB) is a public health problem, especially among people experiencing homelessness (PEH). The Advisory Council for the Elimination of Tuberculosis issued recommendations in 1992 for TB prevention and control among PEH. Our goal was to provide current guidelines and information in one place to inform medical and public health providers and TB programs on TB incidence, diagnosis, and treatment among PEH. METHODS: We reviewed and synthesized diagnostic and treatment recommendations for TB disease and latent TB infection (LTBI) as of 2022 and information after 1992 on the magnitude of homelessness in the United States, the incidence of TB among PEH, the role of public health departments in TB case management among PEH, and recently published evidence. RESULTS: In 2018, there were 1.45 million estimated PEH in the United States. During the past 2 decades, the incidence of TB was >10 times higher and the prevalence of LTBI was 7 to 20 times higher among PEH than among people not experiencing homelessness. TB outbreaks were common in overnight shelters. Permanent housing for PEH and the use of rapid TB diagnostic tests, along with isolation and treatment, reduced TB exposure among PEH. The use of direct observation enhanced treatment adherence among PEH, as did involvement of social workers to help secure shelter, food, safety, and treatment for comorbidities, especially HIV and substance use disorders. Testing and treatment for LTBI prevented progression to TB disease, and shorter LTBI regimens helped improve adherence. Federal agencies and the National Health Care for the Homeless Council have helpful resources. CONCLUSION: Improvements in TB diagnosis, treatment, and prevention among PEH are possible by following existing recommendations and using client-centered approaches. |
Prevalence and types of drugs used among hepatitis A patients during outbreaks associated with person-to-person transmission, Kentucky, Michigan, and West Virginia, 2016-2019
Hofmeister MG , Asher A , Jones CM , Augustine RJ , Burkholder C , Collins J , Foster MA , McBee S , Thoroughman D , Thomasson ED , Weng MK , Spradling PR . J Appalach Health 2022 4 (1) 51-60 BACKGROUND: People who use drugs are at increased risk for hepatitis A virus infection. Since 1996, the Advisory Committee on Immunization Practices has recommended hepatitis A vaccination for people who use drugs. Since 2016, the U.S. has experienced widespread hepatitis A outbreaks associated with person-to-person transmission. PURPOSE: To describe the prevalence of drug use, route of use, and drugs used among hepatitis A outbreak-associated patients. METHODS: State outbreak and medical records were reviewed to describe the prevalence, type, and route of drug use among a random sample of 812 adult outbreak-associated hepatitis A patients from Kentucky, Michigan, and West Virginia during 2016-2019. Differences in drug-use status were analyzed by demographic and risk-factor characteristics using the X (2) test. RESULTS: Among all patients, residents of Kentucky (55.6%), Michigan (51.1%), and West Virginia (60.1%) reported any drug use, respectively. Among patients that reported any drug use, methamphetamine was the most frequently reported drug used in Kentucky (42.3%) and West Virginia (42.1%); however, opioids were the most frequently reported drug used in Michigan (46.8%). Hepatitis A patients with documented drug use were more likely (p<0.05) to be experiencing homelessness/unstable housing, have been currently or recently incarcerated, and be aged 18-39 years compared to those patients without documented drug use. IMPLICATIONS: Drug use was prevalent among person-to-person hepatitis A outbreak-associated patients, and more likely among younger patients and patients experiencing homelessness or incarceration. Increased hepatitis A vaccination coverage is critical to prevent similar outbreaks in the future. |
Prevalence of indications for adult hepatitis A vaccination among hepatitis A outbreak-associated cases, three US states, 2016-2019
Hofmeister MG , Weng MK , Thoroughman D , Thomasson ED , McBee S , Foster MA , Collins J , Burkholder C , Augustine RJ , Spradling PR . Vaccine 2021 39 (44) 6460-6463 BACKGROUND: Safe and effective hepatitis A vaccines have been recommended in the United States for at-risk adults since 1996; however, adult vaccination coverage is low. METHODS: Among a random sample of adult outbreak-associated hepatitis A cases from three states that were heavily affected by person-to-person hepatitis A outbreaks, we assessed the presence of documented Advisory Committee on Immunization Practices (ACIP) indications for hepatitis A vaccination, hepatitis A vaccination status, and whether cases that were epidemiologically linked to an outbreak-associated hepatitis A case had received postexposure prophylaxis (PEP). RESULTS: Overall, 74.1% of cases had a documented ACIP indication for hepatitis A vaccination. Fewer than 20% of epidemiologically linked cases received PEP. CONCLUSIONS: Efforts are needed to increase provider awareness of and adherence to ACIP childhood and adult hepatitis A vaccination and PEP recommendations in order to stop the current person-to-person hepatitis A outbreaks and prevent similar outbreaks in the future. |
Factors associated with hepatitis A mortality during person-to-person outbreaks: A matched case-control study-United States, 2016-2019
Hofmeister MG , Xing J , Foster MA , Augustine RJ , Burkholder C , Collins J , McBee S , Thomasson ED , Thoroughman D , Weng MK , Spradling PR . Hepatology 2020 74 (1) 28-40 BACKGROUND & AIMS: During 2016-2020, the United States experienced person-to-person hepatitis A outbreaks that are unprecedented in the vaccine era, during which case-fatality ratios reported by some jurisdictions exceeded those historically associated with hepatitis A. APPROACH & RESULTS: To identify factors associated with hepatitis A-related mortality, we performed a matched case-control study (matched on age [±5 years] and county of residence in a 1:4 ratio) using data collected from health department and hospital medical records of outbreak-associated patients in Kentucky, Michigan, and West Virginia. Controls were hepatitis A outbreak-associated patients who did not die. There were 110 cases (mean age 53.6 years) and 414 matched controls (mean age 51.9 years); most cases (68.2%) and controls (63.8%) were male. Significantly (p<0.05) higher odds of mortality were associated with pre-existing non-viral liver disease (adjusted odds ratio [aOR] 5.2), history of hepatitis B (aOR 2.4), diabetes (aOR 2.2), and cardiovascular disease (aOR 2.2), as well as initial MELD score ≥30 (aOR 10.0), AST/ALT ratio >2 (aOR 10.3), and platelet count <150,000/uL (aOR 3.7) among hepatitis A outbreak-associated patients in the independent multivariable conditional logistic regression analyses (each model adjusted for sex). CONCLUSIONS: Pre-existing liver disease, diabetes, cardiovascular disease, and initial MELD score ≥30, AST/ALT ratio ≥1, or platelet count <150,000/uL among hepatitis A patients were independently associated with higher odds of mortality. Providers should be vigilant for such features and have a low threshold to escalate care and consider consultation for liver transplantation. Our findings support the Advisory Committee on Immunization Practices recommendation to vaccinate persons with chronic liver disease, though future recommendations to include adults with diabetes and cardiovascular disease should be considered. |
Hepatitis A person-to-person outbreaks: Epidemiology, morbidity burden, and factors associated with hospitalization - multiple states, 2016-2019
Hofmeister MG , Xing J , Foster MA , Augustine RJ , Burkholder C , Collins J , McBee S , Thomasson ED , Thoroughman D , Weng MK , Spradling PR . J Infect Dis 2020 223 (3) 426-434 BACKGROUND: Since 2016, the US has experienced person-to-person hepatitis A outbreaks unprecedented in the vaccine era. The proportion of cases hospitalized in these outbreaks exceeds historical national surveillance data. METHODS: We described the epidemiology, characterized the reported increased morbidity, and identified factors associated with hospitalization during the outbreaks by reviewing a 10% random sample of outbreak-associated hepatitis A cases in Kentucky, Michigan, and West Virginia-three heavily affected states. We calculated descriptive statistics and conducted age-adjusted log-binomial regression analyses to identify factors associated with hospitalization. RESULTS: Participants in the random sample (n=817) were primarily male (62.5%) with mean age of 39.0 years; 51.8% were hospitalized. Among those with available information, 73.2% reported drug use, 14.0% were experiencing homelessness, 29.7% were currently or recently incarcerated, and 61.6% were epidemiologically linked to a known outbreak-associated case. Residence in Michigan (adjusted risk ratio [aRR] 1.8), being a man who has sex with men (aRR 1.5), non-injection drug use (aRR 1.3), and homelessness (aRR 1.3) were significantly (p<0.05) associated with hepatitis A-related hospitalization. CONCLUSIONS: Our findings support current Advisory Committee on Immunization Practices recommendations to vaccinate all persons who use drugs, men who have sex with men, and persons experiencing homelessness against hepatitis A. |
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