Last data update: Jun 11, 2024. (Total: 46992 publications since 2009)
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Query Trace: Bonner K [original query] |
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Behavioral and social drivers of COVID-19 vaccination initiation in the US: a longitudinal study March─ October 2021
Abad N , Bonner KE , Huang Q , Baack B , Petrin R , Das D , Hendrich MA , Gosz MS , Lewis Z , Lintern DJ , Fisun H , Brewer NT . J Behav Med 2024 Many studies have examined behavioral and social drivers of COVID-19 vaccination initiation, but few have examined these drivers longitudinally. We sought to identify the drivers of COVID-19 vaccination initiation using the Behavioral and Social Drivers of Vaccination (BeSD) Framework. Participants were a nationally-representative sample of 1,563 US adults who had not received a COVID-19 vaccine by baseline. Participants took surveys online at baseline (spring 2021) and follow-up (fall 2021). The surveys assessed variables from BeSD Framework domains (i.e., thinking and feeling, social processes, and practical issues), COVID-19 vaccination initiation, and demographics at baseline and follow-up. Between baseline and follow-up, 65% of respondents reported initiating COVID-19 vaccination. Vaccination intent increased from baseline to follow-up (p < .01). Higher vaccine confidence, more positive social norms towards vaccination, and receiving vaccine recommendations at baseline predicted subsequent COVID-19 vaccine initiation (all p < .01). Among factors assessed at follow-up, social responsibility and vaccine requirements had the greatest associations with vaccine initiation (all p < .01). Baseline vaccine confidence, social norms, and vaccination recommendations were associated with subsequent vaccine initiation, all of which could be useful targets for behavioral interventions. Furthermore, interventions that highlight social responsibility to vaccinate or promote vaccination requirements could also be beneficial. |
Strengthening COVID-19 vaccine confidence & demand during the US COVID-19 emergency response
Abad N , Bonner KE , Kolis J , Brookmeyer KA , Voegeli C , Lee JT , Singleton JA , Quartarone R , Black C , Yee D , Ramakrishnan A , Rodriguez L , Clay K , Hummer S , Holmes K , Manns BJ , Donovan J , Humbert-Rico T , Flores SA , Griswold S , Meyer S , Cohn A . Vaccine 2024 In October 2020, the CDC's Vaccinate with Confidence strategy specific to COVID-19 vaccines rollout was published. Adapted from an existing vaccine confidence framework for childhood immunization, the Vaccinate with Confidence strategy for COVID-19 aimed to improve vaccine confidence, demand, and uptake of COVID-19 vaccines in the US. The objectives for COVID-19 were to 1. build trust, 2. empower healthcare personnel, and 3. engage communities and individuals. This strategy was implemented through a dedicated unit, the Vaccine Confidence and Demand (VCD) team, which collected behavioral insights; developed and disseminated toolkits and best practices in collaboration with partners; and collaborated with health departments and community-based organizations to engage communities and individuals in behavioral interventions to strengthen vaccine demand and increase COVID-19 vaccine uptake. The VCD team collected and used social and behavioral data through establishing the Insights Unit, implementing rapid community assessments, and conducting national surveys. To strengthen capacity at state and local levels, the VCD utilized "Bootcamps," a rapid training of trainers on vaccine confidence and demand, "Confidence Consults", where local leaders could request tailored advice to address local vaccine confidence challenges from subject matter experts, and utilized surge staffing to embed "Vaccine Demand Strategists" in state and local public health agencies. In addition, collaborations with Prevention Research Centers, the Institute of Museum and Library Services, and the American Psychological Association furthered work in behavioral science, community engagement, and health equity. The VCD team operationalized CDC's COVID-19 Vaccine with Confidence strategy through behavioral insights, capacity building opportunities, and collaborations to improve COVID-19 vaccine confidence, demand, and uptake in the US. The inclusion of applied behavioral science approaches were a critical component of the COVID-19 vaccination program and provides lessons learned for how behavioral science can be integrated in future emergency responses. |
Employer Requirements and COVID-19 Vaccination and Attitudes among Healthcare Personnel in the U.S.: Findings from National Immunization Survey Adult COVID Module, August - September 2021 (preprint)
Lee JT , Hu SS , Zhou T , Bonner K , Kriss JL , Wilhelm E , Carter RJ , Holmes C , de Perio MA , Lu PJ , Nguyen KH , Brewer NT , Singleton JA . medRxiv 2022 15 Introduction Employer vaccination requirements have been used to increase vaccination uptake among healthcare personnel (HCP). In summer 2021, HCP were the group most likely to have employer requirements for COVID-19 vaccinations as healthcare facilities led the implementation of such requirements. This study examined the association between employer requirements and HCP's COVID-19 vaccination status and attitudes about the vaccine. Methods Participants were a national representative sample of United States (US) adults who completed the National Immunization Survey Adult COVID Module (NIS-ACM) during August-September 2021. Respondents were asked about COVID-19 vaccination and intent, requirements for vaccination, place of work, attitudes surrounding vaccinations, and sociodemographic variables. This analysis focused on HCP respondents. We first calculated the weighted proportion reporting COVID-19 vaccination for HCP by sociodemographic variables. Then we computed unadjusted and adjusted prevalence ratios for vaccination coverage and key indicators on vaccine attitudes, comparing HCP based on individual self-report of vaccination requirements. Results Of 12,875 HCP respondents, 41.5% reported COVID-19 vaccination employer requirements. Among HCP with vaccination requirements, 90.5% had been vaccinated against COVID-19, as compared to 73.3% of HCP without vaccination requirements-a pattern consistent across sociodemographic groups. Notably, the greatest differences in uptake between HCP with and without employee requirements were seen in sociodemographic subgroups with the lowest vaccination uptake, e.g., HCP aged 18-29 years, HCP with high school or less education, HCP living below poverty, and uninsured HCP. In every sociodemographic subgroup examined, vaccine uptake was more equitable among HCP with vaccination requirements than in HCP without. Finally, HCP with vaccination requirements were also more likely to express confidence in the vaccine's safety (68.3% vs. 60.1%) and importance (89.6% vs 79.6%). Conclusion In a large national US sample, employer requirements were associated with higher and more equitable HCP vaccination uptake across all sociodemographic groups examined. Our findings suggest that employer requirements can contribute to improving COVID-19 vaccination coverage, similar to patterns seen for other vaccines. Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. This article is a US Government work. It is not subject to copyright under 17 USC 105 and is also made available for use under a CC0 license. |
Travel history among persons infected with SARS-CoV-2 variants of concern in the United States, December 2020-February 2021.
Dunajcik A , Haire K , Thomas JD , Moriarty LF , Springer Y , Villanueva JM , MacNeil A , Silk B , Nemhauser JB , Byrkit R , Taylor M , Queen K , Tong S , Lee J , Batra D , Paden C , Henderson T , Kunkes A , Ojo M , Firestone M , Martin Webb L , Freeland M , Brown CM , Williams T , Allen K , Kauerauf J , Wilson E , Jain S , McDonald E , Silver E , Stous S , Wadford D , Radcliffe R , Marriott C , Owes JP , Bart SM , Sosa LE , Oakeson K , Wodniak N , Shaffner J , Brown Q , Westergaard R , Salinas A , Hallyburton S , Ogale Y , Offutt-Powell T , Bonner K , Tubach S , Van Houten C , Hughes V , Reeb V , Galeazzi C , Khuntia S , McGee S , Hicks JT , Dinesh Patel D , Krueger A , Hughes S , Jeanty F , Wang JC , Lee EH , Assanah-Deane T , Tompkins M , Dougherty K , Naqvi O , Donahue M , Frederick J , Abdalhamid B , Powers AM , Anderson M . PLOS Glob Public Health 2023 3 (3) e0001252 The first three SARS-CoV-2 phylogenetic lineages classified as variants of concern (VOCs) in the United States (U.S.) from December 15, 2020 to February 28, 2021, Alpha (B.1.1.7), Beta (B.1.351), and Gamma (P.1) lineages, were initially detected internationally. This investigation examined available travel history of coronavirus disease 2019 (COVID-19) cases reported in the U.S. in whom laboratory testing showed one of these initial VOCs. Travel history, demographics, and health outcomes for a convenience sample of persons infected with a SARS-CoV-2 VOC from December 15, 2020 through February 28, 2021 were provided by 35 state and city health departments, and proportion reporting travel was calculated. Of 1,761 confirmed VOC cases analyzed, 1,368 had available data on travel history. Of those with data on travel history, 1,168 (85%) reported no travel preceding laboratory confirmation of SARS-CoV-2 and only 105 (8%) reported international travel during the 30 days preceding a positive SARS-CoV-2 test or symptom onset. International travel was reported by 92/1,304 (7%) of persons infected with the Alpha variant, 7/55 (22%) with Beta, and 5/9 (56%) with Gamma. Of the first three SARS-CoV-2 lineages designated as VOCs in the U.S., international travel was common only among the few Gamma cases. Most persons infected with Alpha and Beta variant reported no travel history, therefore, community transmission of these VOCs was likely common in the U.S. by March 2021. These findings underscore the importance of global surveillance using whole genome sequencing to detect and inform mitigation strategies for emerging SARS-CoV-2 VOCs. |
A qualitative study of behavioral and social drivers of COVID-19 vaccine confidence and uptake among unvaccinated Americans in the US April-May 2021
Abad N , Messinger SD , Huang Q , Hendrich MA , Johanson N , Fisun H , Lewis Z , Wilhelm E , Baack B , Bonner KE , Kobau R , Brewer NT . PLoS One 2023 18 (2) e0281497 INTRODUCTION: Around one-third of Americans reported they were unwilling to get a COVID-19 vaccine in April 2021. This focus group study aimed to provide insights on the factors contributing to unvaccinated adults' hesitancy or refusal to get vaccinated with COVID-19 vaccines. METHOD: Ipsos recruited 59 unvaccinated US adults who were vaccine hesitant (i.e., conflicted about or opposed to receiving a COVID-19 vaccination) using the Ipsos KnowledgePanel. Trained facilitators led a total of 10 focus groups via video-conference in March and April 2021. Two coders manually coded the data from each group using a coding frame based on the focus group discussion guide. The coding team collaborated in analyzing the data for key themes. RESULTS: Data analysis of transcripts from the focus groups illuminated four main themes associated with COVID-19 vaccine hesitancy: lack of trust in experts and institutions; concern about the safety of COVID-19 vaccines; resistance towards prescriptive guidance and restrictions; and, despite personal reluctance or unwillingness to get vaccinated, acceptance of others getting vaccinated. DISCUSSION: Vaccine confidence communication strategies should address individual concerns, describe the benefits of COVID-19 vaccination, and highlight evolving science using factural and neutral presentations of information to foster trust. |
Behavioral and social drivers of COVID-19 vaccination in the United States, August-November 2021
Bonner KE , Vashist K , Abad NS , Kriss JL , Meng L , Lee JT , Wilhelm E , Lu PJ , Carter RJ , Boone K , Baack B , Masters NB , Weiss D , Black C , Huang Q , Vangala S , Albertin C , Szilagyi PG , Brewer NT , Singleton JA . Am J Prev Med 2023 INTRODUCTION: COVID-19 vaccines are safe, effective, and widely available, but many adults in the U.S. have not been vaccinated for COVID-19. This study examined the associations between behavioral and social drivers of vaccination with COVID-19 vaccine uptake in the U.S. adults and their prevalence by region. METHODS: A nationally representative sample of U.S. adults participated in a cross-sectional telephone survey in August-November 2021; the analysis was conducted in January 2022. Survey questions assessed self-reported COVID-19 vaccine initiation, demographics, and behavioral and social drivers of vaccination. RESULTS: Among the 255,763 respondents, 76% received their first dose of COVID-19 vaccine. Vaccine uptake was higher among respondents aged ≥75 years (94%), females (78%), and Asian non-Hispanic people (94%). The drivers of vaccination most strongly associated with uptake included higher anticipated regret from nonvaccination, risk perception, and confidence in vaccine safety and importance, followed by work- or school-related vaccination requirements, social norms, and provider recommendation (all p<0.05). The direction of association with uptake varied by reported level of difficulty in accessing vaccines. The prevalence of all of these behavioral and social drivers of vaccination was highest in the Northeast region and lowest in the Midwest and South. CONCLUSIONS: This nationally representative survey found that COVID-19 vaccine uptake was most strongly associated with greater anticipated regret, risk perception, and confidence in vaccine safety and importance, followed by vaccination requirements and social norms. Interventions that leverage these social and behavioral drivers of vaccination have the potential to increase COVID-19 vaccine uptake and could be considered for other vaccine introductions. |
Case report: Persistent shedding of a live vaccine-derived rubella virus in a young man with severe combined immunodeficiency and cutaneous granuloma.
Bonner KE , Sukerman E , Liko J , Lanzieri TM , Sutton M , DeBess E , Leesman C , Icenogle J , Hao L , Chen MH , Faisthalab R , Leman RF , Cieslak PR , DeRavin SS , Perelygina L . Front Immunol 2022 13 1075351 A young man with X-linked severe combined immunodeficiency developed a persistent vaccine-derived rubella virus (VDRV) infection, with the emergence of cutaneous granulomas more than fifteen years after receipt of two doses of measles-mumps-rubella (MMR) vaccine. Following nasopharyngeal swab (NP) collection, VDRV was detected by real-time polymerase chain reaction (RT-qPCR) and sequencing, and live, replication-competent VDRV was isolated in cell culture. To assess duration and intensity of viral shedding, sequential respiratory samples, one cerebrospinal fluid sample, and two urine samples were collected over 15 months, and VDRV RNA was detected in all samples by RT-qPCR. Live VDRV was cultured from nine of the eleven respiratory specimens and from one urine specimen. To our knowledge, this was the first reported instance of VDRV cultured from respiratory specimens or from urine. To assess potential transmission to close contacts, NP specimens and sera were collected from all household contacts, all of whom were immunocompetent and previously vaccinated with MMR. VDRV RNA was not detected in any NP swabs from the contacts, nor did serologic investigations suggest VDRV transmission to any contacts. This report highlights the need to understand the prevalence and duration of VDRV shedding in granuloma patients and to estimate the risk of VDRV transmission to immune and non-immune contacts. |
Silicone passive sampling used to identify novel dermal chemical exposures of firefighters and assess PPE innovations
Bonner EM , Horn GP , Smith DL , Kerber S , Fent KW , Tidwell LG , Scott RP , Adams KT , Anderson KA . Int J Hyg Environ Health 2022 248 114095 A plethora of chemicals are released into the air during combustion events, including a class of compounds called polycyclic aromatic hydrocarbons (PAHs). PAHs have been implicated in increased risk of cancer and cardiovascular disease, both of which are disease endpoints of concern in structural firefighters. Current commercially available personal protective equipment (PPE) typically worn by structural firefighters during fire responses have gaps in interfaces between the ensemble elements (e.g., hood and jacket) that allow for ingress of contaminants and dermal exposure. This pilot study aims to use silicone passive sampling to assess improvements in dermal protection afforded by a novel configuration of PPE, which incorporates a one-piece liner to eliminate gaps in two critical interfaces between pieces of gear. The study compared protection against parent and alkylated PAHs between the one-piece liner PPE and the standard configuration of PPE with traditional firefighting jacket and pants. Mannequins (n = 16) dressed in the PPE ensembles were placed in a Fireground Exposure Simulator for 10 min, and exposed to smoke from a combusting couch. Silicone passive samplers were placed underneath PPE at vulnerable locations near interfaces in standard PPE, and in the chamber air, to measure PAHs and calculate the dermal protection provided by both types of PPE. Silicone passive sampling methodology and analyses using gas chromatography with mass-spectrometry proved to be well-suited for this intervention study, allowing for the calculation and comparison of worker protection factors for 51 detected PAHs. Paired comparisons of the two PPE configurations found greater sum 2-3 ring PAH exposure underneath the standard PPE than the intervention PPE at the neck and chest, and at the chest for 4-7 ring PAHs (respective p-values: 0.00113, 0.0145, and 0.0196). Mean worker protection factors of the intervention PPE were also greater than the standard PPE for 98% of PAHs at the neck and chest. Notably, the intervention PPE showed more than 30 times the protection compared to the standard PPE against two highly carcinogenic PAHs, dibenzo[a,l]pyrene and benzo[c]fluorene. Nine of the detected PAHs in this study have not been previously reported in fireground exposure studies, and 26 other chemicals (not PAHs) were detected using a large chemical screening method on a subset of the silicone samplers. Silicone passive sampling appears to be an effective means for measuring dermal exposure reduction to fireground smoke, providing evidence in this study that reducing gaps in PPE interfaces could be further pursued as an intervention to reduce dermal exposure to PAHs, among other chemicals. |
Explaining demographic differences in COVID-19 vaccination stage in the United States - April-May 2021.
Huang Q , Abad N , Bonner KE , Baack B , Petrin R , Hendrich MA , Lewis Z , Brewer NT . Prev Med 2022 166 107341 COVID-19 vaccine coverage in the US has marked demographic and geographical disparities, but few explanations exist for them. Our paper aimed to identify behavioral and social drivers that explain these vaccination disparities. Participants were a national sample of 3562 American adults, recruited from the Ipsos KnowledgePanel. Participants completed an online survey in spring 2021, when COVD-19 vaccination was available for higher-risk groups but not yet available to all US adults. The survey assessed COVID-19 vaccination stage (intentions and vaccine uptake), constructs from the Increasing Vaccination Model (IVM) domains (thinking and feeling, social processes, and direct behavior change), self-reported exposure to COVID-19 vaccine information, and demographic characteristics. Analyses used multiple imputation to address item nonresponse and linear regressions to conduct mediation analyses. Higher COVID-19 vaccination stage was strongly associated with older age, liberal political ideology, and higher income in adjusted analyses (all p < .001). Vaccination stage was more modestly associated with urbanicity, white race, and Hispanic ethnicity (all p < .05). Some key mediators that explained more than one-third of demographic differences in vaccination stage were perceived vaccine effectiveness, social norms, and recommendations from family and friends across most demographic characteristics (all p < .05). Other mediators included safety concerns, trust, altruism, provider recommendation, and information seeking. Access to vaccination, barriers to vaccination, and self-efficacy explained few demographic differences. One of the most reliable explanations for demographic differences in COVID-19 vaccination stage is social processes, including social norms, recommendations, and altruism. Interventions to promote COVID-19 vaccination should address social processes and other domains in the IVM. |
Employer requirements and COVID-19 vaccination and attitudes among healthcare personnel in the U.S.: Findings from National Immunization Survey Adult COVID Module, August - September 2021.
Lee JT , Sean Hu S , Zhou T , Bonner KE , Kriss JL , Wilhelm E , Carter RJ , Holmes C , de Perio MA , Lu PJ , Nguyen KH , Brewer NT , Singleton JA . Vaccine 2022 40 (51) 7476-7482 INTRODUCTION: Employer vaccination requirements have been used to increase vaccination uptake among healthcare personnel (HCP). In summer 2021, HCP were the group most likely to have employer requirements for COVID-19 vaccinations as healthcare facilities led the implementation of such requirements. This study examined the association between employer requirements and HCP's COVID-19 vaccination status and attitudes about the vaccine. METHODS: Participants were a national representative sample of United States (US) adults who completed the National Immunization Survey Adult COVID Module (NIS-ACM) during August-September 2021. Respondents were asked about COVID-19 vaccination and intent, requirements for vaccination, place of work, attitudes surrounding vaccinations, and sociodemographic variables. This analysis focused on HCP respondents. We first calculated the weighted proportion reporting COVID-19 vaccination for HCP by sociodemographic variables. Then we computed unadjusted and adjusted prevalence ratios for vaccination coverage and key indicators on vaccine attitudes, comparing HCP based on individual self-report of vaccination requirements. RESULTS: Of 12,875 HCP respondents, 41.5% reported COVID-19 vaccination employer requirements. Among HCP with vaccination requirements, 90.5% had been vaccinated against COVID-19, as compared to 73.3% of HCP without vaccination requirements-a pattern consistent across sociodemographic groups. Notably, the greatest differences in uptake between HCP with and without employee requirements were seen in sociodemographic subgroups with the lowest vaccination uptake, e.g., HCP aged 18-29 years, HCP with high school or less education, HCP living below poverty, and uninsured HCP. In every sociodemographic subgroup examined, vaccine uptake was more equitable among HCP with vaccination requirements than in HCP without. Finally, HCP with vaccination requirements were also more likely to express confidence in the vaccine's safety (68.3% vs. 60.1%) and importance (89.6% vs 79.6%). CONCLUSION: In a large national US sample, employer requirements were associated with higher and more equitable HCP vaccination uptake across all sociodemographic groups examined. Our findings suggest that employer requirements can contribute to improving COVID-19 vaccination coverage, similar to patterns seen for other vaccines. |
COVID-19 vaccination coverage and intent among women aged 18-49 years by pregnancy status, United States, April-November 2021.
Razzaghi H , Yankey D , Vashist K , Lu PJ , Kriss JL , Nguyen KH , Lee J , Ellington S , Polen K , Bonner K , Jatlaoui TC , Wilhelm E , Meaney-Delman D , Singleton JA . Vaccine 2022 40 (32) 4554-4563 BACKGROUND: Pregnant and postpartum women are at increased risk for severe illness from COVID-19. We assessed COVID-19 vaccination coverage, intent, and attitudes among women of reproductive age overall and by pregnancy status in the United States. METHODS: Data from the National Immunization Survey Adult COVID Module collected during April 22-November 27, 2021, were analyzed to assess COVID-19 vaccination (receipt of 1 dose), intent for vaccination, and attitudes towards vaccination among women aged 18-49years overall and by pregnancy status (trying to get pregnant, currently pregnant, breastfeeding, and not trying to get pregnant or currently pregnant or breastfeeding). Logistic regression and predictive marginals were used to generate unadjusted and adjusted prevalence ratios (PRs and aPRs). Trend analyses were conducted to assess monthly changes in vaccination and intent. RESULTS: Our analyses included 110,925 women aged 18-49years. COVID-19 vaccination coverage (1 dose) was 63.2% overall (range from 53.3% in HHS Region 4 to 76.5% in HHS Region 1). Vaccination coverage was lowest among pregnant women (45.1%), followed by women who were trying to get pregnant (49.5%), women who were breastfeeding (51.5%), and all other women (64.9%). Non-Hispanic (NH) Black women who were pregnant or breastfeeding had significantly lower vaccination coverage (aPR: 0.74 and 0.66, respectively) than NH White women. DISCUSSION: Our findings are consistent with other studies showing lower vaccination coverage among pregnant individuals, with substantially lower vaccination coverage among NH Black women who are pregnant or breastfeeding. Given the overlapping and disproportionate risks of COVID-19 and maternal mortality among Black women, it is critical that COVID-19 vaccination be strongly recommended for these populations and all women of reproductive age. Healthcare and public health providers may take advantage of every opportunity to encourage vaccination and enlist the assistance of community leaders, particularly in communities with low vaccination coverage. |
Notes from the field: Enteropathogenic escherichia coli outbreak at a child care center - Oregon, August 2021
Bonner KE , Carter M , Zielinski C , Morey K , McLitus L , DeBess E , Hatch J , Leman R . MMWR Morb Mortal Wkly Rep 2022 71 (14) 527 On August 16, 2021, the Oregon Health Authority Public Health Division (OPHD) was notified of two pediatric cases of Shiga toxigenic Escherichia coli among members of the same household. Each of the patients received a positive polymerase chain reaction test result for Shiga toxin in a stool specimen. E. coli O157:H7 was subsequently isolated from stool culture from both patients. During routine case investigation, the local health department determined that one patient, aged 2 years, had attended an in-home child care center. OPHD visited the child care center on August 18 to conduct case ascertainment among staff members and children, share recommendations for rapid isolation and exclusion of those ill, observe infection prevention practices during diaper changing, and educate staff members on infection prevention measures for toys and high-touch surfaces. The investigation team requested parental consent and attempted to collect clinical information on gastrointestinal symptoms during July 30–August 18 and stool specimens from all staff members and children on the day of the visit. A child care center staff member followed up with other staff members and children who were not present on the day of the visit to obtain clinical information and provide them with specimen collection kits and instructions. Stool specimens were placed in Cary-Blair transport medium, transported to OPHD, and tested for 22 enteric pathogens using the BioFire FilmArray Gastrointestinal Panel (BioFire Diagnostics, LLC). |
COVID-19 Vaccination Coverage and Vaccine Confidence by Sexual Orientation and Gender Identity - United States, August 29-October 30, 2021.
McNaghten AD , Brewer NT , Hung MC , Lu PJ , Daskalakis D , Abad N , Kriss J , Black C , Wilhelm E , Lee JT , Gundlapalli A , Cleveland J , Elam-Evans L , Bonner K , Singleton J . MMWR Morb Mortal Wkly Rep 2022 71 (5) 171-176 Lesbian, gay, bisexual, and transgender (LGBT) populations have higher prevalences of health conditions associated with severe COVID-19 illness compared with non-LGBT populations (1). The potential for low vaccine confidence and coverage among LGBT populations is of concern because these persons historically experience challenges accessing, trusting, and receiving health care services (2). Data on COVID-19 vaccination among LGBT persons are limited, in part because of the lack of routine data collection on sexual orientation and gender identity at the national and state levels. During August 29-October 30, 2021, data from the National Immunization Survey Adult COVID Module (NIS-ACM) were analyzed to assess COVID-19 vaccination coverage and confidence in COVID-19 vaccines among LGBT adults aged 18 years. By sexual orientation, gay or lesbian adults reported higher vaccination coverage overall (85.4%) than did heterosexual adults (76.3%). By race/ethnicity, adult gay or lesbian non-Hispanic White men (94.1%) and women (88.5%), and Hispanic men (82.5%) reported higher vaccination coverage than that reported by non-Hispanic White heterosexual men (74.2%) and women (78. 6%). Among non-Hispanic Black adults, vaccination coverage was lower among gay or lesbian women (57.9%) and bisexual women (62.1%) than among heterosexual women (75.6%). Vaccination coverage was lowest among non-Hispanic Black LGBT persons across all categories of sexual orientation and gender identity. Among gay or lesbian adults and bisexual adults, vaccination coverage was lower among women (80.5% and 74.2%, respectively) than among men (88.9% and 81.7%, respectively). By gender identity, similar percentages of adults who identified as transgender or nonbinary and those who did not identify as transgender or nonbinary were vaccinated. Gay or lesbian adults and bisexual adults were more confident than were heterosexual adults in COVID-19 vaccine safety and protection; transgender or nonbinary adults were more confident in COVID-19 vaccine protection, but not safety, than were adults who did not identify as transgender or nonbinary. To prevent serious illness and death, it is important that all persons in the United States, including those in the LGBT community, stay up to date with recommended COVID-19 vaccinations. |
COVID-19 Case Investigation and Contact Tracing in the US, 2020.
Lash RR , Moonan PK , Byers BL , Bonacci RA , Bonner KE , Donahue M , Donovan CV , Grome HN , Janssen JM , Magleby R , McLaughlin HP , Miller JS , Pratt CQ , Steinberg J , Varela K , Anschuetz GL , Cieslak PR , Fialkowski V , Fleischauer AT , Goddard C , Johnson SJ , Morris M , Moses J , Newman A , Prinzing L , Sulka AC , Va P , Willis M , Oeltmann JE . JAMA Netw Open 2021 4 (6) e2115850 IMPORTANCE: Contact tracing is a multistep process to limit SARS-CoV-2 transmission. Gaps in the process result in missed opportunities to prevent COVID-19. OBJECTIVE: To quantify proportions of cases and their contacts reached by public health authorities and the amount of time needed to reach them and to compare the risk of a positive COVID-19 test result between contacts and the general public during 4-week assessment periods. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study took place at 13 health departments and 1 Indian Health Service Unit in 11 states and 1 tribal nation. Participants included all individuals with laboratory-confirmed COVID-19 and their named contacts. Local COVID-19 surveillance data were used to determine the numbers of persons reported to have laboratory-confirmed COVID-19 who were interviewed and named contacts between June and October 2020. MAIN OUTCOMES AND MEASURES: For contacts, the numbers who were identified, notified of their exposure, and agreed to monitoring were calculated. The median time from index case specimen collection to contact notification was calculated, as were numbers of named contacts subsequently notified of their exposure and monitored. The prevalence of a positive SARS-CoV-2 test among named and tested contacts was compared with that jurisdiction's general population during the same 4 weeks. RESULTS: The total number of cases reported was 74 185. Of these, 43 931 (59%) were interviewed, and 24 705 (33%) named any contacts. Among the 74 839 named contacts, 53 314 (71%) were notified of their exposure, and 34 345 (46%) agreed to monitoring. A mean of 0.7 contacts were reached by telephone by public health authorities, and only 0.5 contacts per case were monitored. In general, health departments reporting large case counts during the assessment (≥5000) conducted smaller proportions of case interviews and contact notifications. In 9 locations, the median time from specimen collection to contact notification was 6 days or less. In 6 of 8 locations with population comparison data, positive test prevalence was higher among named contacts than the general population. CONCLUSIONS AND RELEVANCE: In this cross-sectional study of US local COVID-19 surveillance data, testing named contacts was a high-yield activity for case finding. However, this assessment suggests that contact tracing had suboptimal impact on SARS-CoV-2 transmission, largely because 2 of 3 cases were either not reached for interview or named no contacts when interviewed. These findings are relevant to decisions regarding the allocation of public health resources among the various prevention strategies and for the prioritization of case investigations and contact tracing efforts. |
Measurement and analysis of the neutron energy spectrum and associated occupational exposure from a shielded241 Am-Be source
Stringer JS , Spitz H , Glover S . Radiat Prot Dosimetry 2020 190 (2) 125-131 A set of five Bonner spheres was used to measure the ambient neutron H*(10) dose around an orphan 241Am-Be neutron source shielded with different arrangements and types of neutron-absorbing materials. These results were compared to measurements obtained using a portable radiation dosemeter. The Bonner sphere measurement results identified the presence of a large thermal and intermediate neutron component from the shielded 241Am-Be source that was not revealed using the portable instrument. |
Burden of Candidemia in the United States, 2017
Tsay SV , Mu Y , Williams S , Epson E , Nadle J , Bamberg WM , Barter DM , Johnston HL , Farley MM , Harb S , Thomas S , Bonner LA , Harrison LH , Hollick R , Marceaux K , Mody RK , Pattee B , Shrum Davis S , Phipps EC , Tesini BL , Gellert AB , Zhang AY , Schaffner W , Hillis S , Ndi D , Graber CR , Jackson BR , Chiller T , Magill S , Vallabhaneni S . Clin Infect Dis 2020 71 (9) e449-e453 BACKGROUND: Candidemia is a common healthcare-associated bloodstream infection with high morbidity and mortality. There are no current estimates of candidemia burden in the United States. METHODS: In 2017, the Centers for Disease Control and Prevention (CDC) conducted active population-based surveillance for candidemia through the Emerging Infections Program (EIP) in 45 counties in nine states encompassing ~17 million persons (5% of the national population). Laboratories serving the catchment area population reported all blood cultures with Candida, and a standard case definition was applied to identify cases that occurred in surveillance area residents. Burden of cases and mortality was estimated by extrapolating surveillance area cases to national numbers using 2017 national census data. RESULTS: We identified 1,226 candidemia cases across nine surveillance sites in 2017. Based on this, we estimated 22,660 (95% confidence interval [CI]: 20,210-25,110) cases of candidemia occurred in the United States in 2017. Overall estimated incidence was 7.0 cases per 100,000 persons, with highest rates in adults >/=65 years (20.1/100,000), males (7.9/100,000), and those of black race (12.3/100,000). An estimated 3,380 (95% CI: 1,318-5,442) deaths occurred within seven days of a positive Candida blood culture and 5,628 (95% CI: 2,465-8,791) deaths occurred during the hospitalization with candidemia. CONCLUSIONS: Our analysis highlights the substantial burden of candidemia in the U.S. Because candidemia is only one form of invasive candidiasis, the true burden of invasive infections due to Candida is higher. Ongoing surveillance can support future burden estimates and help assess the impact of prevention interventions. |
The changing epidemiology of candidemia in the United States: Injection drug use as an increasingly common risk factor - active surveillance in selected sites, United States, 2014-17
Zhang AY , Shrum S , Williams S , Petnic S , Nadle J , Johnston H , Barter D , VonBank B , Bonner L , Hollick R , Marceaux K , Harrison L , Schaffner W , Tesini BL , Farley MM , Pierce RA , Phipps E , Mody RK , Chiller TM , Jackson BR , Vallabhaneni S . Clin Infect Dis 2019 71 (7) 1732-1737 BACKGROUND: Injection drug use (IDU) is a known, but infrequent risk factor on candidemia, however, the opioid epidemic and increases in IDU may be changing the epidemiology of candidemia. METHODS: Active population-based surveillance for candidemia was conducted in selected US counties. Cases of candidemia were categorized as IDU cases if IDU was indicated in the medical records in the 12 months prior to the date of initial culture. RESULTS: During 2017, 1191 candidemia cases were identified in patients over the age of 12 years (incidence: 6.9 per 100,000 population); 128 (10.7%) had IDU history and this proportion was especially high (34.6%) in patients with candidemia aged 19-44 years. Candidemia patients with IDU history were younger than those without (median age: 35 vs 63 years, p<0.001). Candidemia cases involving recent IDU were less likely to have typical risk factors including malignancy (7.0% vs 29.4%, Relative Risk (RR): 0.2; 95% Confidence Interval (CI): 0.1-0.5), abdominal surgery (3.9% vs 17.5%, RR: 0.2, CI: 0.09-0.5), and total parenteral nutrition (3.9% vs 22.5%, RR: 0.2, CI: 0.07-0.4). Candidemia cases with IDU occurred more commonly in smokers (68.8% vs 18.5%, RR: 3.7, CI: 3.1-4.4), those with hepatitis C (54.7% vs 6.4%, RR: 8.5, CI: 6.5-11.3), and in people who were homeless (13.3% vs 0.8%, RR: 15.7; CI: 7.1-34.5). CONCLUSION: Clinicians should consider screening for candidemia in people who inject drugs and IDU in patients with candidemia who lack typical candidemia risk factors, especially in those with who are 19-44 years, and have community-associated candidemia. |
Population-based active surveillance for culture-confirmed candidemia - four sites, United States, 2012-2016
Toda M , Williams SR , Berkow EL , Farley MM , Harrison LH , Bonner L , Marceaux KM , Hollick R , Zhang AY , Schaffner W , Lockhart SR , Jackson BR , Vallabhaneni S . MMWR Surveill Summ 2019 68 (8) 1-15 PROBLEM/CONDITION: Candidemia is a bloodstream infection (BSI) caused by yeasts in the genus Candida. Candidemia is one of the most common health care-associated BSIs in the United States, with all-cause in-hospital mortality of up to 30%. PERIOD COVERED: 2012-2016. DESCRIPTION OF SYSTEM: CDC's Emerging Infections Program (EIP), a collaboration among CDC, state health departments, and academic partners that was established in 1995, was used to conduct active, population-based laboratory surveillance for candidemia in 22 counties in four states (Georgia, Maryland, Oregon, and Tennessee) with a combined population of approximately 8 million persons. Laboratories serving the catchment areas were recruited to report candidemia cases to the local EIP program staff. A case was defined as a blood culture that was positive for a Candida species collected from a surveillance area resident during 2012-2016. Isolates were sent to CDC for species confirmation and antifungal susceptibility testing. Any subsequent blood cultures with Candida within 30 days of the initial positive culture in the same patient were considered part of the same case. Trained surveillance officers collected clinical information from the medical chart for all cases, and isolates were sent to CDC for species confirmation and antifungal susceptibility testing. RESULTS: Across all sites and surveillance years (2012-2016), 3,492 cases of candidemia were identified. The crude candidemia incidence averaged across sites and years during 2012-2016 was 8.7 per 100,000 population; important differences in incidence were found by site, age group, sex, and race. The crude annual incidence was the highest in Maryland (14.1 per 100,000 population) and lowest in Oregon (4.0 per 100,000 population). The crude annual incidence of candidemia was highest among adults aged >/=65 years (25.5 per 100,000 population) followed by infants aged <1 year (15.8). The crude annual incidence was higher among males (9.4) than among females (8.0) and was approximately 2 times greater among blacks than among nonblacks (13.7 versus 5.8). Ninety-six percent of cases occurred in patients who were hospitalized at the time of or during the week after having a positive culture. One third of cases occurred in patients who had undergone a surgical procedure in the 90 days before the candidemia diagnosis, 77% occurred in patients who had received systemic antibiotics in the 14 days before the diagnosis, and 73% occurred in patients who had had a central venous catheter (CVC) in place within 2 days before the diagnosis. Ten percent were in patients who had used injection drugs in the past 12 months. The median time from admission to candidemia diagnosis was 5 days (interquartile range [IQR]: 0-16 days). Among 2,662 cases that were treated in adults aged >18 years, 34% were treated with fluconazole alone, 30% with echinocandins alone, and 34% with both. The all-cause, in-hospital case-fatality ratio was 25% for any time after admission; the all-cause in-hospital case-fatality ratio was 8% for <48 hours after a positive culture for Candida species. Candida albicans accounted for 39% of cases, followed by Candida glabrata (28%) and Candida parapsilosis (15%). Overall, 7% of isolates were resistant to fluconazole and 1.6% were resistant to echinocandins, with no clear trends in resistance over the 5-year surveillance period. INTERPRETATION: Approximately nine out of 100,000 persons developed culture-positive candidemia annually in four U.S. sites. The youngest and oldest persons, men, and blacks had the highest incidences of candidemia. Patients with candidemia identified in the surveillance program had many of the typical risk factors for candidemia, including recent surgery, exposure to broad-spectrum antibiotics, and presence of a CVC. However, an unexpectedly high proportion of candidemia cases (10%) occurred in patients with a history of injection drug use (IDU), suggesting that IDU has become a common risk factor for candidemia. Deaths associated with candidemia remain high, with one in four cases resulting in death during hospitalization. PUBLIC HEALTH ACTION: Active surveillance for candidemia yielded important information about the disease incidence and death rate and persons at greatest risk. The surveillance was expanded to nine sites in 2017, which will improve understanding of the geographic variability in candidemia incidence and associated clinical and demographic features. This surveillance will help monitor incidence trends, track emergence of resistance and species distribution, monitor changes in underlying conditions and predisposing factors, assess trends in antifungal treatment and outcomes, and be helpful for those developing prevention efforts. IDU has emerged as an important risk factor for candidemia, and interventions to prevent invasive fungal infections in this population are needed. Surveillance data documenting that approximately two thirds of candidemia cases were caused by species other than C. albicans, which are generally associated with greater antifungal resistance than C. albicans, and the presence of substantial fluconazole resistance supports 2016 clinical guidelines recommending a switch from fluconazole to echinocandins as the initial treatment for candidemia in most patients. |
Urinary phthalate biomarker concentrations and postmenopausal breast cancer risk
Reeves KW , Santana MD , Manson JE , Hankinson SE , Zoeller RT , Bigelow C , Sturgeon SR , Spiegelman D , Tinker L , Luo J , Chen B , Meliker J , Bonner MR , Cote ML , Cheng TD , Calafat AM . J Natl Cancer Inst 2019 111 (10) 1059-1067 Background: Growing laboratory and animal model evidence supports the potentially carcinogenic effects of some phthalates, chemicals used as plasticizers in a wide variety of consumer products, including cosmetics, medications, and vinyl flooring. However, prospective data on whether phthalates are associated with human breast cancer risk are lacking. Methods: We conducted a nested case-control study within the Women's Health Initiative (WHI) prospective cohort (N = 419 invasive cases and 838 controls). Controls were matched 2:1 to cases on age, enrollment date, follow-up time, and WHI study group. We quantified thirteen phthalate metabolites and creatinine in two or three urine samples per participant over one to three years. Multivariable conditional logistic regression analysis was used to estimate odds ratios and 95% confidence intervals (OR, 95% CI) for breast cancer risk associated with each phthalate biomarker over up to 19 years of follow-up. Results: Overall, we did not observe statistically significant positive associations between phthalate biomarkers and breast cancer risk in multivariable analyses (e.g. 4th vs 1st quartile of diethylhexyl phthalate OR 1.03, 95% CI 0.91 - 1.17). Results were generally similar in analyses restricted to disease subtypes, to non-users of postmenopausal hormone therapy, stratified by body mass index, or to cases diagnosed within three, five, or ten years. Conclusions: In the first prospective analysis of phthalates and postmenopausal breast cancer, phthalate biomarker concentrations did not result in an increased risk of developing invasive breast cancer. |
Comprehensive cancer control: promoting survivor health and wellness
Rohan EA , Miller N , Bonner F3rd , Fultz-Butts K , Pratt-Chapman ML , Alfano CM , Santiago KC , Bergman K , Tai E . Cancer Causes Control 2018 29 (12) 1277-1285 PURPOSE: As of 2016, an estimated 15.5 million cancer survivors were living in the United States and the number of cancer survivors is expected to increase to 20.3 million by 2026. Numerous clinical studies have shown that comorbidities, such as obesity and diabetes, and unhealthy lifestyle choices, such as physical inactivity and heavy smoking, negatively influence overall quality of life and long-term survival of cancer survivors. Accordingly, survivorship programs seek to focus on overall wellness, including symptom management, monitoring for late effects of treatment, monitoring for recurrence, helping patients adapt healthy behaviors, and quality of life. This paper provides a broad overview of public health efforts to address the needs of cancer survivors. METHODS: To describe a range of examples of survivorship initiatives in comprehensive cancer control, we analyzed documents from comprehensive cancer control programs and coalitions and solicited detailed examples from several national partners. RESULTS: Comprehensive cancer control programs, coalitions, and partners are undertaking myriad initiatives to address cancer survivorship and building upon evidence-based interventions to promote healthy behaviors for cancer survivors across the country. CONCLUSION: A coordinated public health approach to caring for the growing population of cancer survivors can help address the long-term physical, psychosocial, and economic effects of cancer treatment on cancer survivors and their families. |
Role of p53 in the chronic pulmonary immune response to tangled or rod-like multi-walled carbon nanotubes
Duke KS , Thompson EA , Ihrie MD , Taylor-Just AJ , Ash EA , Shipkowski KA , Hall JR , Tokarz DA , Cesta MF , Hubbs AF , Porter DW , Sargent LM , Bonner JC . Nanotoxicology 2018 12 (9) 1-17 The fiber-like shape of multi-walled carbon nanotubes (MWCNTs) is reminiscent of asbestos, suggesting they pose similar health hazards when inhaled, including pulmonary fibrosis and mesothelioma. Mice deficient in the tumor suppressor p53 are susceptible to carcinogenesis. However, the chronic pathologic effect of MWCNTs delivered to the lungs of p53 heterozygous (p53(+/-)) mice has not been investigated. We hypothesized that p53(+/-) mice would be susceptible to lung tumor development after exposure to either tangled (t-) or rod-like (r-) MWCNTs. Wild-type (p53(+/+)) or p53(+/-) mice were exposed to MWCNTs (1 mg/kg) via oropharyngeal aspiration weekly over four consecutive weeks and evaluated for cellular and pathologic outcomes 11-months post-initial exposure. No lung or pleural tumors were observed in p53(+/+) or p53(+/-) mice exposed to either t- or rMWCNTs. In comparison to tMWCNTs, the rMWCNTs induced the formation of larger granulomas, a greater number of lymphoid aggregates and greater epithelial cell hyperplasia in terminal bronchioles in both p53(+/-) and p53(+/+) mice. A constitutively larger area of CD45R(+)/CD3(+) lymphoid tissue was observed in p53(+/-) mice compared to p53(+/+) mice. Importantly, p53(+/-) mice had larger granulomas induced by rMWCNTs as compared to p53(+/+) mice. These findings indicate that a combination of p53 deficiency and physicochemical characteristics including nanotube geometry are factors in susceptibility to MWCNT-induced lymphoid infiltration and granuloma formation. |
Neonatal and pediatric candidemia: Results from population-based active laboratory surveillance in four US locations, 2009-2015
Benedict K , Roy M , Kabbani S , Anderson EJ , Farley MM , Harb S , Harrison LH , Bonner L , Wadu VL , Marceaux K , Hollick R , Beldavs ZG , Zhang AY , Schaffner W , Graber CR , Derado G , Chiller TM , Lockhart SR , Vallabhaneni S . J Pediatric Infect Dis Soc 2018 7 (3) e78-e85 Introduction: Candida is a leading cause of healthcare-associated bloodstream infections in the United States. Infants and children have unique risk factors for candidemia, and the Candida species distribution in this group is different that among adults; however, candidemia epidemiology in this population has not been described recently. Methods: We conducted active population-based candidemia surveillance in 4 US metropolitan areas between 2009 and 2015. We calculated incidences among neonates (0-30 days old), infants (0-364 days old), and noninfant children (1-19 years old), documented their clinical features and antifungal drug resistance. Results: We identified 307 pediatric candidemia cases. Incidence trends varied according to site, but overall, the incidence in neonates decreased from 31.5 cases/100000 births in 2009 to 10.7 to 11.8 cases/100000 births between 2012 and 2015, the incidence in infants decreased from 52.1 cases/100000 in 2009 to 15.7 to 17.5 between 2012 and 2015, and the incidence in noninfant children decreased steadily from 1.8 cases/100000 in 2009 to 0.8 in 2014. Common underlying conditions were prematurity in neonates (78%), surgery in nonneonate infants (38%), and malignancy in noninfant children (28%). Most neonate cases were caused by C albicans (67%), whereas non-C. albicans species accounted for 60% of cases in nonneonate infants and noninfant children. Fluconazole and echinocandin resistance rates were low overall. Thirty-day crude mortality was 13%. Conclusions: The incidence of candidemia among neonates and infants declined after 2009 but remained stable from 2012 to 2015. Antifungal drug resistance is uncommon. Reasons for the lack of recent declines in neonatal and infant candidemia deserve further exploration. In this article, we describe the epidemiology of candidemia in children in the United States and on the basis of data collected as part of US Centers for Disease Control and Prevention active population-based surveillance. Trends in incidence, clinical characteristics, species distribution, and resistance rates are presented. |
Implementing key drivers for diabetes self-management education and support programs: Early outcomes, activities, facilitators, and barriers
Morgan JM , Mensa-Wilmot Y , Bowen SA , Murphy M , Bonner T , Rutledge S , Rutledge G . Prev Chronic Dis 2018 15 E15 Diabetes, a serious and costly condition, is characterized by illness and death from long-term microvascular and macrovascular complications (1). Additionally, numerous and well-known comorbidities can accompany diabetes, including cardiovascular disease, retinopathy, amputations, and nephropathy (1). Often these complications and comorbidities interfere with a person’s ability to self-manage their diabetes (2). The Centers for Disease Control and Prevention (CDC) projects that as many as 1 in 3 adults could have diabetes by 2050 (3). In 2012, the United States spent an estimated $245 billion on diabetes care, including $176 billion in direct medical costs and $69 billion in indirect costs from lost workdays, restricted activity, disability, and early death (4). Many costly complications among people with diabetes can be prevented or delayed with appropriate preventive care and self-management (5). |
Early results of states' efforts to support, scale, and sustain the National Diabetes Prevention Program
Mensa-Wilmot Y , Bowen SA , Rutledge S , Morgan JM , Bonner T , Farris K , Blacher R , Rutledge G . Prev Chronic Dis 2017 14 E130 The Centers for Disease Control and Prevention (CDC) developed a cooperative agreement with health departments in all 50 states and the District of Columbia to strengthen chronic disease prevention and management efforts through the implementation of evidence-based strategies, such as CDC's National Diabetes Prevention Program. The National Diabetes Prevention Program supports organizations to deliver the year-long lifestyle change program that has been proven to prevent or delay the onset of type 2 diabetes among those at high risk. This article describes activities, barriers, and facilitators reported by funded states during the first 3 years (2013-2015) of a 5-year funding cycle. |
Serum polychlorinated biphenyls and leukocyte telomere length in a highly-exposed population: The Anniston Community Health Survey.
Callahan CL , Pavuk M , Birnbaum LS , Ren X , Olson JR , Bonner MR . Environ Int 2017 108 212-220 BACKGROUND: Serum polychlorinated biphenyls (PCBs) have previously been associated with longer leukocyte telomere length (LTL) in most, but not all, of the few previous studies. PCBs were produced in Anniston, Alabama from 1929 to 1971 and participants of the Anniston Community Health Survey (ACHS) were highly exposed. OBJECTIVES: We evaluated serum levels of 35 PCBs and relative telomere length in 559 ACHS participants. METHODS: Relative LTL was measured in DNA extracted from blood clots. We assessed PCBs individually, grouped by chlorination, and summed PCBs. We used linear regression to assess the association between each PCB metric while adjusting for pertinent covariates. RESULTS: Serum PCBs were associated with longer LTL among white participants and the oldest age group of black participants. Among white participants, compared with those in the first quartile of sum PCBs those in the third quartile of sum PCBs had 8.09% longer relative LTL (95% CI: 1.99; 14.55) and those in the fourth had 7.58% longer relative LTL (95%CI: -0.01; 15.76) (p-quadratic=0.05). Among African American participants, serum PCBs were associated with longer relative LTL among those over age 64 only. Tests for interaction were not statistically significant. CONCLUSIONS: We observed a non-linear positive association between serum PCBs and LTL among white participants. Serum PCBs were associated with longer LTL in the oldest age group of African Americans. This association may provide insight into the cancers previously associated with exposure to PCBs, melanoma and non-Hodgkin lymphoma, which have been associated with long LTL in previous studies. |
Occupational exposure to pesticides and the incidence of lung cancer in the Agricultural Health Study
Bonner MR , Beane Freeman LE , Hoppin JA , Koutros S , Sandler DP , Lynch CF , Hines CJ , Thomas K , Blair A , Alavanja MC . Environ Health Perspect 2016 125 (4) 544-551 BACKGROUND: Occupational pesticide use is associated with lung cancer in some, but not all, epidemiologic studies. In the Agricultural Health Study (AHS), we previously reported positive associations between several pesticides and lung cancer incidence. OBJECTIVE: We evaluated use of 43 pesticides and 654 lung cancer cases after ten years of additional follow-up in the AHS, a prospective cohort study comprised of 57,310 pesticide applicators from Iowa and North Carolina. METHODS: Information about lifetime pesticide use and other factors was ascertained at enrollment (1993-1997) and updated with a follow-up questionnaire (1999-2005). Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI), adjusting for smoking (smoking status and pack-years), gender, and lifetime days of use of any pesticides. RESULTS: Hazard ratios were elevated in the highest exposure category of lifetime days of use for pendimethalin (1.50; 95% CI = 0.98-2.31), dieldrin (1.93; 95% CI = 0.70-5.30), and chlorimuron-ethyl (1.74; 95% CI = 1.02-2.96), although monotonic exposure-response gradients were not evident. The HRs for intensity-weighted lifetime days of use of these pesticides were similar. For parathion, the trend was statistically significant for intensity-weighted lifetime days (p=0.049) and borderline for lifetime days (p=0.073). None of the remaining pesticides evaluated were associated with lung cancer incidence. CONCLUSIONS: These analyses provide additional evidence for an association between pendimethalin, dieldrin, and parathion use and lung cancer risk. We found an association between chlorimuron-ethyl, a herbicide introduced in 1986, and lung cancer that has not been previously reported. Continued follow-up is warranted. |
Sustainable HIV treatment in Africa through viral-load-informed differentiated care
Phillips A , Shroufi A , Vojnov L , Cohn J , Roberts T , Ellman T , Bonner K , Rousseau C , Garnett G , Cambiano V , Nakagawa F , Ford D , Bansi-Matharu L , Miners A , Lundgren JD , Eaton JW , Parkes-Ratanshi R , Katz Z , Maman D , Ford N , Vitoria M , Doherty M , Dowdy D , Nichols B , Murtagh M , Wareham M , Palamountain KM , Chakanyuka Musanhu C , Stevens W , Katzenstein D , Ciaranello A , Barnabas R , Braithwaite RS , Bendavid E , Nathoo KJ , van de Vijver D , Wilson DP , Holmes C , Bershteyn A , Walker S , Raizes E , Jani I , Nelson LJ , Peeling R , Terris-Prestholt F , Murungu J , Mutasa-Apollo T , Hallett TB , Revill P . Nature 2015 528 (7580) S68-76 There are inefficiencies in current approaches to monitoring patients on antiretroviral therapy in sub-Saharan Africa. Patients typically attend clinics every 1 to 3 months for clinical assessment. The clinic costs are comparable with the costs of the drugs themselves and CD4 counts are measured every 6 months, but patients are rarely switched to second-line therapies. To ensure sustainability of treatment programmes, a transition to more cost-effective delivery of antiretroviral therapy is needed. In contrast to the CD4 count, measurement of the level of HIV RNA in plasma (the viral load) provides a direct measure of the current treatment effect. Viral-load-informed differentiated care is a means of tailoring care so that those with suppressed viral load visit the clinic less frequently and attention is focussed on those with unsuppressed viral load to promote adherence and timely switching to a second-line regimen. The most feasible approach to measuring viral load in many countries is to collect dried blood spot samples for testing in regional laboratories; however, there have been concerns over the sensitivity and specificity of this approach to define treatment failure and the delay in returning results to the clinic. We use modelling to synthesize evidence and evaluate the cost-effectiveness of viral-load-informed differentiated care, accounting for limitations of dried blood sample testing. We find that viral-load-informed differentiated care using dried blood sample testing is cost-effective and is a recommended strategy for patient monitoring, although further empirical evidence as the approach is rolled out would be of value. We also explore the potential benefits of point-of-care viral load tests that may become available in the future. |
News from the CDC: chronic fatigue syndrome (CFS) and standardized patient videos - a novel approach to educating medical students about CFS
Brimmer DJ , Campbell C , Bonner K , Lin JM . Transl Behav Med 2013 3 (4) 338-339 The Centers for Disease Control and Prevention (CDC), Division of High-Consequence Pathogens and Pathology, Chronic Viral Diseases Branch houses CDC's chronic fatigue syndrome (CFS) research and education program. The program's provider education and outreach initiative has conducted research and implemented activities to educate healthcare professionals about CFS diagnosis and management, including evaluating knowledge, attitudes, and beliefs among US providers [1], assessing best methods for CFS continuing medical education (CME) [2], and developing a train-the-trainer program [3]. In 2012, meetings with stakeholders and evaluations of existing outreach efforts informed the program's decision to target medical students and residents as a way to influence CFS education at the beginning of the medical education process. This report describes the background and process for developing a CFS education curriculum using standardized patients and plans to disseminate the curriculum using MedEd Portal. | CFS is a complex illness characterized by disabling fatigue and accompanying symptoms of prolonged post-exertional malaise, unrefreshing sleep, impaired concentration and short-term memory, muscle and joint pain, headache, sore throat, and tender lymph nodes [4]. Patients with CFS report barriers to healthcare utilization, which may delay diagnosis and treatment [5]. In part, delayed diagnosis and treatment reflects a lack of knowledge by providers who may recognize CFS but have difficulty with patient management. |
A multi-stakeholder perspective on the use of alternative test strategies for nanomaterial safety assessment
Nel AE , Nasser E , Godwin H , Avery D , Bahadori T , Bergeson L , Beryt E , Bonner JC , Boverhof D , Carter J , Castranova V , Deshazo JR , Hussain SM , Kane AB , Klaessig F , Kuempel E , Lafranconi M , Landsiedel R , Malloy T , Miller MB , Morris J , Moss K , Oberdorster G , Pinkerton K , Pleus RC , Shatkin JA , Thomas R , Tolaymat T , Wang A , Wong J . ACS Nano 2013 7 (8) 6422-33 There has been a conceptual shift in toxicological studies from describing what happens to explaining how the adverse outcome occurs, thereby enabling a deeper and improved understanding of how biomolecular and mechanistic profiling can inform hazard identification and improve risk assessment. Compared to traditional toxicology methods, which have a heavy reliance on animals, new approaches to generate toxicological data are becoming available for the safety assessment of chemicals, including high-throughput and high-content screening (HTS, HCS). With the emergence of nanotechnology, the exponential increase in the total number of engineered nanomaterials (ENMs) in research, development, and commercialization requires a robust scientific approach to screen ENM safety in humans and the environment rapidly and efficiently. Spurred by the developments in chemical testing, a promising new toxicological paradigm for ENMs is to use alternative test strategies (ATS), which reduce reliance on animal testing through the use of in vitro and in silico methods such as HTS, HCS, and computational modeling. Furthermore, this allows for the comparative analysis of large numbers of ENMs simultaneously and for hazard assessment at various stages of the product development process and overall life cycle. Using carbon nanotubes as a case study, a workshop bringing together national and international leaders from government, industry, and academia was convened at the University of California, Los Angeles, to discuss the utility of ATS for decision-making analyses of ENMs. After lively discussions, a short list of generally shared viewpoints on this topic was generated, including a general view that ATS approaches for ENMs can significantly benefit chemical safety analysis. |
Interlaboratory evaluation of rodent pulmonary responses to engineered nanomaterials: the NIEHS Nano Go Consortium
Bonner JC , Silva RM , Taylor AJ , Brown JM , Hilderbrand SC , Castranova V , Porter D , Elder A , Oberdorster G , Harkema JR , Bramble LA , Kavanagh TJ , Botta D , Nel A , Pinkerton KE . Environ Health Perspect 2013 121 (6) 676-82 BACKGROUND: Engineered nanomaterials (ENMs) have potential benefits, but also present safety concerns for human health. Inter-laboratory studies in rodents using standardized protocols are needed for ENM toxicity assessment. METHODS: Four labs evaluated lung responses in C57BL/6 mice to ENMs delivered by oropharyngeal aspiration (OPA). Three labs evaluated Sprague-Dawley (SD) or Fisher (F)344 rats following intratracheal instillation (IT). ENMs tested were three forms of titanium dioxide (TiO2); anatase/rutile spheres (TiO2-P25), anatase spheres (TiO2-A), anatase nanobelts (TiO2-NB), and three forms of multiwalled carbon nanotubes (MWCNT); original (O), purified (P), and carboxylic acid "functionalized" (F). Bronchoalveolar lavage fluid was collected after 1 day for differential cell counts, lactate dehydrogenase (LDH), and protein. Lungs were fixed for histopathology. Responses were also examined at 7 days (TiO2) and 21 days (MWCNTs). RESULTS: TiO2-A, TiO2-P25, and TiO2-NB caused significant neutrophilia in mice at 1 day in 3 out of 4 labs, respectively. TiO2-NB caused neutrophilia in rats at 1 day in 2 out of 3 labs, while TiO2-P25 or TiO2-A had no significant effect in any of the labs. Inflammation induced by TiO2 in mice and rats resolved by day 7. All MWCNT types caused neutrophilia at 1 day in 3 out of 4 mouse labs and all rat labs. Three out of 4 labs observed similar histopathology to O-MWCNT or TiO2-NB in mice. CONCLUSIONS: ENMs produced similar patterns of neutrophilia and pathology in rats and mice. Although inter-laboratory variability was found in the degree of neutrophilia caused by the three types of TiO2 nanoparticles, similar findings of relative potency for the three types of MWCNTs were found across all laboratories, thus providing greater confidence in these inter-laboratory comparisons. |
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