Last data update: Apr 22, 2024. (Total: 46599 publications since 2009)
Records 1-30 (of 80 Records) |
Query Trace: Bruce MG[original query] |
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Immunogenicity of quadrivalent human papillomavirus vaccine among Alaska Native children aged 9-14 years at 5 years after vaccination
Davis BM , Blake I , Panicker G , Meites E , Thompson G , Geis J , Bruden D , Fischer M , Singleton R , Unger ER , Markowitz LE , Bruce MG . Vaccine 2024 BACKGROUND: Persistent human papillomavirus (HPV) infection can cause anogenital and oropharyngeal cancers. Many HPV infections and HPV-associated cancers are vaccine-preventable. Studies suggest long-term persistence of vaccine-induced antibodies. However, data are limited among Alaska Native people. METHODS: During 2011-2014, we enrolled Alaska Native children aged 9-14 years who received a 3-dose series of quadrivalent HPV vaccine (4vHPV). We collected sera at 1 month and 1, 2, 3, and 5 years post-vaccination to evaluate trends in type-specific immunoglobulin G antibody concentrations for the 4vHPV types (HPV 6/11/16/18). RESULTS: All participants (N = 469) had detectable antibodies against all 4vHPV types at all timepoints post-vaccination. For all 4vHPV types, antibody levels peaked by 1 month post-vaccination and gradually declined in subsequent years. At 5 years post-vaccination, antibody levels were higher among children who received 4vHPV at a younger age. CONCLUSIONS: Alaska Native children maintained antibodies against all 4vHPV types at 5 years post-vaccination. |
COVID-19 infection and incident diabetes in American Indian and Alaska Native people: a retrospective cohort study
Keck JW , Lacy ME , Bressler S , Blake I , Chukwuma U , Bruce MG . Lancet Reg Health Am 2024 33 100727 BACKGROUND: Evidence suggests an increased risk of new-onset diabetes following COVID-19 infection. American Indian/Alaska Native (AI/AN) people were disparately impacted by the COVID-19 pandemic and historically have had higher diabetes incidence than other racial/ethnic groups in the US. We measured the association between COVID-19 infection and incident diabetes in AI/AN people. METHODS: We conducted a retrospective cohort study using de-identified patient data from the Indian Health Service's (IHS) National Patient Information Reporting System. We estimated age-adjusted diabetes incidence rates, incidence rate ratios, and adjusted hazard ratios among three cohorts spanning pre-pandemic (1/1/2018-2/28/2020) and pandemic (3/1/2020-12/31/2021) timeframes: 1) pre-pandemic cohort (1,503,085 individuals); 2) no-COVID-19 pandemic cohort (1,344,339 individuals); and 3) COVID-19 cohort (176,483 individuals). FINDINGS: The COVID-19 cohort had an increased hazard of diabetes compared to the no-COVID-19 group (adjusted hazard ratio (aHR) = 1.56; 95% CI: 1.50-1.62) and the pre-pandemic group (aHR = 1.27; 95% CI: 1.22-1.32). The association between COVID-19 infection and new-onset diabetes was stronger in those with severe COVID-19 illness. A sensitivity analysis comparing the COVID-19 cohort to members of other cohorts that had acute upper respiratory infections showed an attenuated but higher risk of new-onset diabetes in those with COVID-19. INTERPRETATION: AI/AN people diagnosed with COVID-19 had an elevated risk of a new diabetes diagnosis when compared to the no-COVID-19 group and the pre-pandemic group. The increased diabetes risk in the COVID-19 group remained in a sensitivity analysis that limited the comparator groups to individuals with an AURI diagnosis. FUNDING: US National Institute of Diabetes and Digestive and Kidney Diseases. |
Rate and durability of clearance of hepatitis B surface antigen in Alaska Native persons with long-term hepatitis B virus infection: 1982-2019
Bruden D , McMahon BJ , Snowball M , Towshend-Bulson L , Homan C , Johnston JM , Simons BC , Bruce MG , Cooley L , Spradling PR , Harris AM . Hepatology 2023 BACKROUND AIMS: A functional cure and therapeutic endpoint of chronic hepatitis B virus (HBV) infection is defined as clearance of hepatitis B surface antigen (HBsAg) from serum. Little is known about the long-term durability of HBsAg loss in the Alaskan Native population. APPROACH RESULTS: We performed a retrospective cohort study of Alaskan Native patients with chronic HBV-monoinfection from January, 1982 through December 2019. The original group in this cohort were identified during a 1982 to 1987 population-based screening for three HBV serologic markers in 53,000 Alaska Native persons. With close to 32,000 years of follow-up, we assessed the frequency and duration of HBsAg seroclearance (HBsAg negative for >6 mo). We examined factors associated with HBsAg clearance and followed persons for a median of 13.1 years afterwards to assess durability of HBsAg clearance. Among 1,079 persons with an average length of follow-up of 33 years, 260 (24%) cleared HBsAg at a constant rate of 0.82% per person/per year. Of 260 persons who cleared, 249 (96%) remained HBsAg negative while 11 persons had≥ 2 transient HBsAg positive results in subsequent follow-up. CONCLUSIONS: Of patients with chronic HBV monoinfection, 0.82% of people per year achieved a functional cure. HBsAg seroclearance was durable for treated and non-treated patients and lasted on average over 13 years without seroreversion. The findings and conclusions in this report are those of the authors and do not necessarily represent the official positions of the Centers for Disease Control and Prevention. |
Invasive pneumococcal disease and potential impact of pneumococcal conjugate vaccines among adults, including persons experiencing homelessness - Alaska, 2011-2020
Steinberg J , Bressler SS , Orell L , Thompson GC , Kretz A , Reasonover AL , Bruden D , Bruce MG , Fischer M . Clin Infect Dis 2023 BACKGROUND: Adults aged ≥65 years, adults with certain underlying medical conditions, and persons experiencing homelessness are at increased risk for invasive pneumococcal disease (IPD). Two new pneumococcal conjugate vaccines, 15-valent pneumococcal conjugate vaccine (PCV15) and 20-valent pneumococcal conjugate vaccine (PCV20), were recently approved for use in U.S. adults. We described the epidemiology of IPD among Alaska adults and estimated the proportion of IPD cases potentially preventable by new vaccines. METHODS: We used statewide, laboratory-based surveillance data to calculate and compare IPD incidence rates and 95% confidence intervals (CI) among Alaska adults aged ≥18 years during 2011-2020 and estimate the proportion of IPD cases that were caused by serotypes in PCV15 and PCV20. RESULTS: During 2011-2020, 1,164 IPD cases were reported among Alaska adults for an average annual incidence of 21.3 cases per 100,000 adults per year (95% CI: 20.1-22.5). Incidence increased significantly during the study period (p<0.01). IPD incidence among Alaska Native adults was 4.7 times higher than among non-Alaska Native adults (95% CI: 4.2-5.2). Among adults experiencing homelessness in Anchorage, IPD incidence was 72 times higher than the general adult population (95% CI: 59-89). Overall, 1,032 (89%) Alaska adults with IPD had an indication for pneumococcal vaccine according to updated vaccination guidelines; 456 (39%) and 700 (60%) cases were caused by serotypes in PCV15 and PCV20, respectively. CONCLUSIONS: Use of PCV15 and PCV20 could substantially reduce IPD among adults in Alaska, including Alaska Native adults and adults experiencing homelessness. |
Effectiveness of the COVID-19 vaccines on preventing symptomatic SARS-CoV-2 infections and hospitalizations in Southwestern Alaska, January-December 2021
Lefferts B , Bruden D , Plumb ID , Hodges E , Bates E , January G , Bruce MG . Vaccine 2023 The population in rural southwest Alaska has been disproportionately affected by COVID-19. To assess the benefit of COVID-19 vaccines, we analyzed data from the regional health system. We estimated vaccine effectiveness (VE) during January 16-December 3, 2021, against symptomatic SARS-CoV-2 infection after a primary series or booster dose, and overall VE against hospitalization. VE of a primary series against symptomatic infection among adult residents was 91.3% (95% CI: 85.7, 95.2) during January 16-May 7, 2021, 50.3% (95% CI, 41.1%-58.8%) during July 17-September 24, and 37.0% (95% CI, 27.8-45.0) during September 25-December 3, 2021; VE of a booster dose during September 25-December 3, 2021, was 92.1% (95% CI: 87.2-95.2). During the overall study period, VE against hospitalization was 91.9% (95% CI: 85.4-95.5). COVID-19 vaccination offered strong protection against hospitalization and a booster dose restored protection against symptomatic infection. |
Response to Editorial
Bruce MG , Miernyk K , Sacco F , Thomas T , McMahon B , Hennessy T . Helicobacter 2019 24 (2) e12558 We read with interest the editorial by Lee et al1 | that highlighted | the challenge of elevated rates of H pylori‐associated gastric can‐ | cer among Alaska Native people and recognized our ongoing work | in Alaska to document and address this health disparity. As health | practitioners in Alaska, we share their concerns about the elevated | gastric cancer rates and would welcome increased efforts to reduce | the health threats associated with H pylori infection; however, some | of their points require a response. The authors posit that H pylori | eradication programs and pilot studies used in Japan and Taiwan | should be applied to Alaska. While such studies offer an intriguing | approach, early results have not completely answered the question | of how to prevent gastric cancer. The absence of evidence‐based | guidelines and the lack of national or professional society recom‐ | mendations supporting population‐level H pylori eradication are a | strong indication that this approach is not yet proven. There are im‐ | portant unanswered questions about the risks and benefits of such | an eradication program. These risks include, but are not limited to, | the potential to develop worsening antimicrobial resistance among | H pylori and antimicrobial resistance among non‐targeted commen‐ | sal or pathogenic organisms, and the risk of causing harm by giving | antibiotics to healthy persons who may not be at risk for gastric can‐ | cer (eg, allergic responses, drug‐drug interactions, Clostridium diffi‐ | cile infections). Additional unanswered questions relevant for Alaska | include the effectiveness and feasibility of a population‐level H pylori | eradication program in a remote population with high rates of H py‐ | lori reinfection, a high proportion of H pylori isolates demonstrating | antimicrobial resistance, and documented high rates of treatment | failure. Even if the health benefit of a population‐based eradication | effort were to be established, concerns about funding, logistical op‐ | erations, and the relative value of such a program compared with | other high priority health concerns would need to be considered. In | Alaska, such concerns are magnified, where our ~200 rural commu‐ | nities are dispersed over a mostly roadless area larger than Texas, | Taiwan, and Japan combined |
Epidemiology of invasive Haemophilus influenzae serotype a disease in the North American Arctic, 2006-2017
Zulz T , Huang G , Rudolph K , DeByle C , Tsang R , Desai S , Massey S , Bruce MG . Int J Circumpolar Health 2022 81 (1) 2150382 Invasive Haemophilus influenzae type a (iHia) disease was detected in Alaska and Northern Canada in 2002 and 2000, respectively. From 2006 to 2017, 164 iHia cases (Alaska=53, Northern Canada=111) were reported. Rates of iHia disease per 100,000 persons were higher in Northern Canada compared to Alaska and were significantly higher in Indigenous (Alaska 2.8, Northern Canada 9.5) compared to non-Indigenous populations (Alaska 0.1, Northern Canada=0.4). Disease rates were highest in Indigenous children <2 years of age (Alaska 56.2, Northern Canada=144.1) and significantly higher than in non-Indigenous children <2 (Alaska 0.1, Northern Canada 0.4). The most common clinical presentation in children <5 years was meningitis of age and pneumonia in persons ≥5 years old. Most patients were hospitalised (Alaska=87%, Northern Canada=89%) and fatality was similar (Alaska=11%, Northern Canada=10%). MLST testing showed sequence types ST23 and ST576 in Northern Canada and ST576, ST23 and ST56 in Alaska. Alaska and Northern Canada have high rates of iHia disease. A vaccine is needed in these regions to protect young children. |
Invasive group A streptococcal disease in pregnant women and young children: a systematic review and meta-analysis
Sherwood E , Vergnano S , Kakuchi I , Bruce MG , Chaurasia S , David S , Dramowski A , Georges S , Guy R , Lamagni T , Levy-Bruhl D , Lyytikäinen O , Naus M , Okaro JO , Oppegaard O , Vestrheim DF , Zulz T , Steer AC , Van Beneden CA , Seale AC . Lancet Infect Dis 2022 22 (7) 1076-1088 BACKGROUND: The incidence of invasive disease caused by group A streptococcus (GAS) has increased in multiple countries in the past 15 years. However, despite these reports, to the best of our knowledge, no systematic reviews and combined estimates of the incidence of invasive GAS have been done in key high-risk groups. To address this, we estimated the incidence of invasive GAS disease, including death and disability outcomes, among two high-risk groups-namely, pregnant women and children younger than 5 years. METHODS: We did a systematic review and meta-analyses on invasive GAS outcomes, including incidence, case fatality risks, and neurodevelopmental impairment risk, among pregnant women, neonates (younger than 28 days), infants (younger than 1 year), and children (younger than 5 years) worldwide and by income region. We searched several databases for articles published from Jan 1, 2000, to June 3, 2020, for publications that reported invasive GAS outcomes, and we sought unpublished data from an investigator group of collaborators. We included studies with data on invasive GAS cases, defined as laboratory isolation of Streptococcus pyogenes from any normally sterile site, or isolation of S pyogenes from a non-sterile site in a patient with necrotising fasciitis or streptococcal toxic shock syndrome. For inclusion in pooled incidence estimates, studies had to report a population denominator, and for inclusion in pooled estimates of case fatality risk, studies had to report aggregate data on the outcome of interest and the total number of cases included as a denominator. We excluded studies focusing on groups at very high risk (eg, only preterm infants). We assessed heterogeneity with I(2). FINDINGS: Of the 950 published articles and 29 unpublished datasets identified, 20 studies (seven unpublished; 3829 cases of invasive GAS) from 12 countries provided sufficient data to be included in pooled estimates of outcomes. We did not identify studies reporting invasive GAS incidence among pregnant women in low-income and middle-income countries (LMICs) nor any reporting neurodevelopmental impairment after invasive GAS in LMICs. In nine studies from high-income countries (HICs) that reported invasive GAS in pregnancy and the post-partum period, invasive GAS incidence was 0·12 per 1000 livebirths (95% CI 0·11 to 0·14; I(2)=100%). Invasive GAS incidence was 0·04 per 1000 livebirths (0·03 to 0·05; I(2)=100%; 11 studies) for neonates, 0·13 per 1000 livebirths (0·10 to 0·16; I(2)=100%; ten studies) for infants, and 0·09 per 1000 person-years (95% CI 0·07 to 0·10; I(2)=100%; nine studies) for children worldwide; 0·12 per 1000 livebirths (95% CI 0·00 to 0·24; I(2)=100%; three studies) in neonates, 0·33 per 1000 livebirths (-0·22 to 0·88; I(2)=100%; two studies) in infants, and 0·22 per 1000 person-years (0·13 to 0·31; I(2)=100%; two studies) in children in LMICs; and 0·02 per 1000 livebirths (0·00 to 0·03; I(2)=100%; eight studies) in neonates, 0·08 per 1000 livebirths (0·05 to 0·11; I(2)=100%; eight studies) in infants, and 0·05 per 1000 person-years (0·03 to 0·06; I(2)=100%; seven studies) in children for HICs. Case fatality risks were high, particularly among neonates in LMICs (61% [95% CI 33 to 89]; I(2)=54%; two studies). INTERPRETATION: We found a substantial burden of invasive GAS among young children. In LMICs, little data were available for neonates and children and no data were available for pregnant women. Incidences of invasive GAS are likely to be underestimates, particularly in LMICs, due to low GAS surveillance. It is essential to improve available data to inform development of prevention and management strategies for invasive GAS. FUNDING: Wellcome Trust. |
Protection and antibody levels 35 years after primary series with hepatitis B vaccine and response to a booster dose
Bruce MG , Bruden D , Hurlburt D , Morris J , Bressler S , Thompson G , Lecy D , Rudolph K , Bulkow L , Hennessy T , Simons BC , Weng MK , Nelson N , McMahon BJ . Hepatology 2022 76 (4) 1180-1189 BACKGROUND: The duration of protection from hepatitis B vaccination in children and adults is not known. In 1981, we used three doses of plasma-derived hepatitis B vaccine to immunize a cohort of 1578 Alaska Native adults and children from 15 Alaska communities who were 6 months or older. METHODS: We tested persons for anti-HBs levels 35 years after receiving the primary series. Those with levels <10 mIU/ml received 1 booster dose of recombinant hepatitis B vaccine 2-4 weeks later and were then evaluated on the basis of anti-HBs measurements 30 days post-booster. RESULTS: Among the 320 recruited, 112 persons had not participated in the 22 nor 30-year follow-up study (Group 1) and 208 persons had participated but were not given an HBV booster dose (Group 2). Among the 112 persons in Group 1 who responded to the original primary series, 53 (47.3%) had an anti-HBs level ≥10 mIU/ml. Among group 1, 73.7% (28/38) of persons available for a booster dose responded to it with an anti-HBs level ≥10 mIU/ml at 30 days. Initial anti-HBs level after the primary series was correlated with higher anti-HBs levels at 35 years. Among 8 persons who tested positive for anti-HBc, none tested positive for HBsAg nor HBV DNA. CONCLUSIONS: Based on anti-HBs level ≥10 mIU/ml at 35 years and a 73.7% booster dose response, we estimate 86% of participants had evidence of protection 35 years later. Booster doses are not needed in the general population at this time. |
Antigen Test Positivity After COVID-19 Isolation - Yukon-Kuskokwim Delta Region, Alaska, January-February 2022.
Lefferts B , Blake I , Bruden D , Hagen MB , Hodges E , Kirking HL , Bates E , Hoeldt A , Lamont B , Saydah S , MacNeil A , Bruce MG , Plumb ID . MMWR Morb Mortal Wkly Rep 2022 71 (8) 293-298 Isolation is recommended during acute infection with SARS-CoV-2, the virus that causes COVID-19, but the duration of infectiousness varies among individual persons. Rapid antigen test results have been correlated with detection of viable virus (1-3) and might inform isolation guidance, but data are limited for the recently emerged SARS-CoV-2 B.1.1.529 (Omicron) variant. On January 5, 2022, the Yukon-Kuskokwim Health Corporation (YKHC) recommended that persons with SARS-CoV-2 infection isolate for 10 days after symptom onset (or, for asymptomatic persons, 10 days after a positive nucleic acid amplification or antigen test result). However, isolation could end after 5-9 days if symptoms were resolving or absent, fever was absent for 24 hours without fever-reducing medications, and an Abbott BinaxNOW COVID-19 Ag (BinaxNOW) rapid antigen test result was negative. Antigen test results and associated individual characteristics were analyzed among 3,502 infections reported to YKHC during January 1-February 9, 2022. After 5-9 days, 396 of 729 persons evaluated (54.3%) had a positive antigen test result, with a declining percentage positive over time. In a multivariable model, a positive antigen test result was more likely after 5 days compared with 9 days (adjusted odds ratio [aOR]=6.39) or after symptomatic infection (aOR=9.63), and less likely after previous infection (aOR=0.30), receipt of a primary COVID-19 vaccination series (aOR=0.60), or after both previous infection and receipt of a primary COVID-19 vaccination series (aOR=0.17). Antigen tests might be a useful tool to guide recommendations for isolation after SARS-CoV-2 infection. During the 10 days after infection, persons might be infectious to others and are recommended to wear a well-fitting mask when around others, even if ending isolation after 5 days. |
Mortality among Alaska Native adults with confirmed hepatitis C virus infection compared with the general population in Alaska, 1995-2016
Bressler SS , Bruden D , Nolen LD , Bruce MG , Towshend-Bulson L , Spradling P , McMahon BJ . Can J Gastroenterol Hepatol 2022 2022 2573545 BACKGROUND: Hepatitis C virus (HCV) infection incidence rates in the United States have increased since 2010 as a byproduct of the opioid crisis despite the introduction of direct-acting antiviral agents in 2013. HCV infection is associated with higher rates of liver-related and nonhepatic causes of death. METHODS: This study compared demographic characteristics and age-adjusted death rates from 1995 to 2016 among Alaska Native (AN) adults infected with HCV (AK-HepC) to rates among the AN and non-AN adult populations living in Alaska. Liver-related disease (LRD) and other disease-specific age-adjusted death rates were compared between the populations. RESULTS: The all-cause death rate among the AK-HepC cohort was 2.2- and 3.4-fold higher than AN and non-AN adults, respectively, and remained stable over time in all populations. The LRD death rate among the AK-HepC cohort was 18- and 11-fold higher than the non-AN and AN, respectively. The liver cancer rate among the AK-HepC cohort was 26-fold higher compared to the Alaska statewide population. The AK-HepC cohort had elevated rates of death associated with nonhepatic diseases with circulatory disease having the highest rate in all populations. Among liver cancer deaths in the AK-HepC cohort, 32% had HCV listed as a contributing cause of death on the death certificate. CONCLUSIONS: Death rates in the AK-HepC cohort remained stable since 1995 and higher compared to the general population. People with HCV infection had an elevated risk for all-cause, liver-related, and nonhepatic causes of death. Hepatitis C infection may be underrepresented as a cause of mortality in the United States. |
Lower respiratory tract infection hospitalizations among American Indian/Alaska Native adults, Indian Health Service and Alaska Region, 1998-2014
Bruce MG , Bressler SS , Apostolou A , Singleton RJ . Int J Infect Dis 2021 111 130-137 OBJECTIVES: In this study, we describe changes in LRTI rates from 1998-2014 among hospitalized AI/AN adults residing in Alaska and other Indian Health Service (IHS) regions. METHODS: We calculated age-adjusted hospital discharge rates and rate ratios from the IHS Direct and Contract Health Services Inpatient Dataset, IHS National Patient Information Reporting System for AI/AN adults ≥18 years, hospitalized at an IHS-operated, tribally operated or contract hospital with an LRTI-associated diagnosis during 1998-2014. RESULTS: Overall, there were 13,733 LRTI-associated hospitalizations in Alaska (1998-2014) with an age-adjusted rate of 13.7/1,000 adults. Among non-AK AI/AN, there were a total of 79,170 hospitalizations with a rate of 8.6/1,000 adults. In the pre-PCV7 and pre-PCV13 periods, LRTI rates were higher in AK AI/AN (12.4 and 14.1) compared to non-AK AI/AN (10.1 and 9.1, p<0.0001), respectively. In post-PCV7 and post-PCV13 periods, LRTI rates were also higher in AK (13.5 and 15.0) compared to non-AK (9.2 and 7.3, p<0.0001). CONCLUSIONS: Over the study period, we observed a 26% increase in rates of LRTI among adult AI/AN residing in Alaska compared with a 38% decrease in rates among AI/AN residing in non-AK. This disparity is likely due to a variety of factors such as tobacco use, crowding etc. Strategies to reduce LRTI in AI/AN adults are needed. |
Acceptability of household practices to prevent boils in rural Alaska
Plumb ID , Dobson J , Seeman S , Bruce MG , Reasonover A , Lefferts B , Rudolph KM , Klejka J , Hennessy TW . J Environ Health 2021 84 (1) 26-34 Boils are a major health problem affecting rural Alaska Native communities. Boils result from transmission of Staphylococcus aureus from steam bath surfaces, infected skin, and household environments. To assess the acceptability of practices to prevent boils within one community, we surveyed 57 households before and after distribution of supplies and educational materials. Before distribution, 64% of households cleaned steam baths with bleach (23/36), 72% used steam bath seat barriers (41/57), 74% did not share scrubbers (42/57), 35% added recommended bleach to laundry (20/57), and 30% used hand sanitizer (17/57). After distribution, 75% households used new scrubbers (43/57), 88% used new seat barriers (50/57), and 25% used new antiseptic skin cleanser (14/57). Additionally, after the intervention, more households used seat barriers in steam baths (from 72% to 86%, p = .046) and hand sanitizer (from 30% to 60%, p < .001). This study supports development of a household-based intervention as a potential strategy to prevent boils in Alaska Native communities. |
Global Landscape Review of Serotype-Specific Invasive Pneumococcal Disease Surveillance among Countries Using PCV10/13: The Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) Project
Deloria Knoll M , Bennett JC , Garcia Quesada M , Kagucia EW , Peterson ME , Feikin DR , Cohen AL , Hetrich MK , Yang Y , Sinkevitch JN , Ampofo K , Aukes L , Bacci S , Bigogo G , Brandileone MC , Bruce MG , Camilli R , Castilla J , Chan G , Chanto Chacón G , Ciruela P , Cook H , Corcoran M , Dagan R , Danis K , de Miguel S , De Wals P , Desmet S , Galloway Y , Georgakopoulou T , Hammitt LL , Hilty M , Ho PL , Jayasinghe S , Kellner JD , Kleynhans J , Knol MJ , Kozakova J , Kristinsson KG , Ladhani SN , Lara CS , León ME , Lepp T , Mackenzie GA , Mad'arová L , McGeer A , Mungun T , Mwenda JM , Nuorti JP , Nzoyikorera N , Oishi K , De Oliveira LH , Paragi M , Pilishvili T , Puentes R , Rafai E , Saha SK , Savrasova L , Savulescu C , Scott JA , Scott KJ , Serhan F , Setchanova LP , Sinkovec Zorko N , Skoczyńska A , Swarthout TD , Valentiner-Branth P , van der Linden M , Vestrheim DF , von Gottberg A , Yildirim I , Hayford K , Pserenade Team . Microorganisms 2021 9 (4) Serotype-specific surveillance for invasive pneumococcal disease (IPD) is essential for assessing the impact of 10- and 13-valent pneumococcal conjugate vaccines (PCV10/13). The Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) project aimed to evaluate the global evidence to estimate the impact of PCV10/13 by age, product, schedule, and syndrome. Here we systematically characterize and summarize the global landscape of routine serotype-specific IPD surveillance in PCV10/13-using countries and describe the subset that are included in PSERENADE. Of 138 countries using PCV10/13 as of 2018, we identified 109 with IPD surveillance systems, 76 of which met PSERENADE data collection eligibility criteria. PSERENADE received data from most (n = 63, 82.9%), yielding 240,639 post-PCV10/13 introduction IPD cases. Pediatric and adult surveillance was represented from all geographic regions but was limited from lower income and high-burden countries. In PSERENADE, 18 sites evaluated PCV10, 42 PCV13, and 17 both; 17 sites used a 3 + 0 schedule, 38 used 2 + 1, 13 used 3 + 1, and 9 used mixed schedules. With such a sizeable and generally representative dataset, PSERENADE will be able to conduct robust analyses to estimate PCV impact and inform policy at national and global levels regarding adult immunization, schedule, and product choice, including for higher valency PCVs on the horizon. |
Serotype distribution of remaining pneumococcal meningitis in the mature PCV10/13 period: Findings from the PSERENADE Project
Garcia Quesada M , Yang Y , Bennett JC , Hayford K , Zeger SL , Feikin DR , Peterson ME , Cohen AL , Almeida SCG , Ampofo K , Ang M , Bar-Zeev N , Bruce MG , Camilli R , Chacón GC , Ciruela P , Cohen C , Corcoran M , Dagan R , De Wals P , Desmet S , Diawara I , Gierke R , Guevara M , Hammitt LL , Hilty M , Ho PL , Jayasinghe S , Kleynhans J , Kristinsson KG , Ladhani SN , McGeer A , Mwenda JM , Pekka Nuorti J , Oishi K , Ricketson LJ , Sanz JC , Savrasova L , Setchanova LP , Smith A , Valentiner-Branth P , Valenzuela MT , van der Linden M , van Sorge NM , Varon E , Winje BA , Yildirim I , Zintgraff J , Knoll MD . Microorganisms 2021 9 (4) Pneumococcal conjugate vaccine (PCV) introduction has reduced pneumococcal meningitis incidence. The Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) project described the serotype distribution of remaining pneumococcal meningitis in countries using PCV10/13 for least 5-7 years with primary series uptake above 70%. The distribution was estimated using a multinomial Dirichlet regression model, stratified by PCV product and age. In PCV10-using sites (N = 8; cases = 1141), PCV10 types caused 5% of cases <5 years of age and 15% among ≥5 years; the top serotypes were 19A, 6C, and 3, together causing 42% of cases <5 years and 37% ≥5 years. In PCV13-using sites (N = 32; cases = 4503), PCV13 types caused 14% in <5 and 26% in ≥5 years; 4% and 13%, respectively, were serotype 3. Among the top serotypes are five (15BC, 8, 12F, 10A, and 22F) included in higher-valency PCVs under evaluation. Other top serotypes (24F, 23B, and 23A) are not in any known investigational product. In countries with mature vaccination programs, the proportion of pneumococcal meningitis caused by vaccine-in-use serotypes is lower (≤26% across all ages) than pre-PCV (≥70% in children). Higher-valency PCVs under evaluation target over half of remaining pneumococcal meningitis cases, but questions remain regarding generalizability to the African meningitis belt where additional data are needed. |
Stomach cancer incidence and mortality trends among circumpolar nations
Simkin J , Nash SH , Barchuk A , O'Brien DK , Erickson AC , Hanley B , Hannah H , Corriveau A , Larsen IK , Skovlund CW , Larønningen S , Dummer TJ , Bruce MG , Ogilvie G . Cancer Epidemiol Biomarkers Prev 2021 30 (5) 845-856 BACKGROUND: Stomach cancer incidence and mortality rates are declining across circumpolar nations, but the burden may not be distributed equally across sub-populations, including Indigenous peoples. Our objective was to examine stomach cancer incidence and mortality trends across circumpolar populations. METHODS: Cancer incidence and mortality data from 1999-2016 were obtained from the Canadian Cancer Registry, Canadian Vital Statistics, CDC WONDER, NORDCAN, Northwestern Russian cancer registries and National Cancer Reports. The direct method was used to calculate ten-year rolling age-standardized incidence and mortality rates to the World (WHO 2000-2025) and 2011 Canadian standard populations. Standardized incidence rate ratios (SRRs) were calculated. Data were stratified by sex, year and region. US data were broken down by race (White; American Indian/Alaska Native (AIAN)). Race data were not available from non-US cancer registries. RESULTS: Most populations showed declining incidence and mortality rates over time. Incidence rates among Greenland males and females, Alaska AIAN males and females, and Northern Canadian both sexes were elevated compared to regional counterparts and remained stable. The largest male SRR was observed among Alaska AIAN versus Alaska Whites (SRR=3.82, 95% CI=2.71-5.37). The largest female SRR was observed among Alaska AIAN versus Alaska Whites (SRR=4.10, 95% CI=2.62-6.43). CONCLUSIONS: Despite stomach cancer incidence and mortality rates declining overall, some northern and Indigenous populations experience elevated and stable incidence and mortality rates. IMPACT: There is a need to address disparities observed among circumpolar sub-populations. Given similarities in incidence, mortality and risk factor prevalence across circumpolar regions, addressing disparities could benefit from coordinated international action. |
Proceedings of a workshop to discuss the epidemiology of invasive Haemophilus influenzae disease with emphasis on serotype a and b in the Americas, 2019
Cox AD , Kuo Lee R , Ulanova M , Bruce MG , Tsang RSW . Vaccine 2020 39 (4) 627-632 On March 9, 2019, a one-day workshop titled "The current epidemiology of invasive Haemophilus influenzae disease in the Americas", jointly organized by the Public Health Agency of Canada (PHAC), the Canadian Institute of Health Research (CIHR), and the National Research Council Canada (NRC), brought together experts in the epidemiology and surveillance of invasive Haemophilus influenzae (Hi) disease from the Pan American Health Organization (PAHO) and its five regional reference laboratories in South America, USA, and Canada in Ottawa, Ontario, Canada. This workshop built upon recommendations of previous related workshops and incorporated updated data. |
A high-risk subpopulation in the U.S. disproportionately affected by high rates of gastric cancer: The Alaska Native people
Vindigni SM , Nolen LD , Bruce MG . Clin Gastroenterol Hepatol 2020 19 (3) 620-621 With great interest, we read the article by Thrift and El-Serag1 providing an overview of the epidemiology, risk factors, prevention, and surveillance approaches to gastric cancer. The article highlights one of the most prevalent and under-recognized malignances throughout the world, and we appreciate the authors’ discussion of this topic. Although they nicely describe varying incidence rates by geography and race/ethnicity in the United States, they failed to describe the population with the highest incidence rate in the United States, Alaska Native (AN) people. |
Vaccination status of Alaska Native persons with hepatitis a virus infection - Alaska, 1996-2018
Plumb ID , Gounder PP , Nolen LD , Massay SC , Castrodale L , McLaughlin J , Snowball M , Homan C , Nelson NP , Singleton R , Bruce MG , McMahon BJ . Clin Infect Dis 2020 72 (12) 2212-2214 Following increases in reported cases of hepatitis A, we assessed the impact of hepatitis A vaccine in Alaska Native persons. During 1996-2018, only 6 cases of hepatitis A were identified, all in unvaccinated adults. Populations can be protected against hepatitis A by achieving sufficient vaccination coverage over time. |
A prospective cohort study of immunogenicity of quadrivalent human papillomavirus vaccination among Alaska Native Children, Alaska, United States
Bruce MG , Meites E , Bulkow L , Panicker G , Hurlburt D , Lecy D , Thompson G , Rudolph K , Unger ER , Hennessy T , Markowitz LE . Vaccine 2020 38 (42) 6585-6591 OBJECTIVE: In the United States, HPV vaccination is routinely recommended at age 11 or 12 years; the series can be started at age 9. We conducted a cohort study to assess long-term immunogenicity of quadrivalent HPV vaccine (4vHPV) in an American Indian/Alaska Native (AI/AN) Indigenous population. METHODS: During 2011-2014, we enrolled AI/AN girls and boys aged 9-14 years, who were vaccinated with a 3-dose series of 4vHPV. Serum specimens were collected at five time points: immediately prior to doses 2 and 3, and at one month, one year, and two years after series completion. Antibody testing was performed using a multiplex virus-like-particle-IgG ELISA for 4vHPV types (HPV 6/11/16/18). RESULTS: Among 477 children (405 girls/72 boys) completing the 3-dose series, median age at enrollment was 11.2 years. Of the 477, 72 (15%) were tested before dose 2 and 70 (15%) before dose 3. Following series completion, 435 (91%) were tested at one month, 382 (80%) at one year, and 351 (74%) at two years. All tested participants had detectable antibody to 4vHPV types at all time points measured. Geometric mean concentrations (GMCs) for 4vHPV types at one month and two years post-series completion were 269.9 and 32.7 AU/ml for HPV6, 349.3 and 42.9 AU/ml for HPV11, 1240.2 and 168.3 IU/ml HPV16, and 493.2 and 52.2 IU/ml for HPV18. Among children tested after each dose, GMCs after doses 1 and 2 were 3.9 and 32.2 AU/ml for HPV6, 5.3 and 45.6 AU/ml for HPV11, 20.8 and 187.9 IU/ml for HPV16; and 6.6 and 49.7 IU/ml for HPV18. No serious adverse events were reported. CONCLUSION: All AI/AN children developed antibodies to all 4vHPV types after vaccination. GMCs rose after each dose, then decreased to a plateau over the subsequent two years. This cohort will continue to be followed to determine duration of antibody response. |
Gastric cancer among American Indian and Alaska Native populations in the United States, 2005-2016
Melkonian SC , Pete D , Jim MA , Haverkamp D , Wiggins CL , Bruce MG , White MC . Am J Gastroenterol 2020 115 (12) 1989-1997 INTRODUCTION: American Indian and Alaska Native (AI/AN) populations have higher gastric cancer rates than the general US population. This study provides a comprehensive overview of incidence rates among AI/AN persons during 2005-2016 compared with non-Hispanic whites (whites). METHODS: Population-based cancer registry data for 2005-2016 were linked with the Indian Health Service patient registration databases to address racial misclassification. Age-adjusted gastric cancer incidence rates were expressed per 100,000 per year. Incidence and trend analyses were restricted to purchased/referred care delivery area counties in 6 geographic regions, comparing gastric cancer incidence rates for AI/AN vs white populations in the United States. RESULTS: Gastric cancer rates were higher in the AI/AN compared with white populations in nearly every US region. Incidence rates for central/distal portions of the stomach were higher in AI/AN individuals compared with whites. Rates of later stage gastric cancer were higher in AI/AN populations overall and in every region except the Pacific Coast and East. Incidence rates decreased significantly over time in both populations. Declining rates in the AI/AN populations were driven by changes in the Pacific Coast and Northern Plains regions. DISCUSSION: AI/AN populations have a disproportionately high incidence of gastric cancer, especially in Alaska. High incidence in the central/distal portions of the stomach among AI/AN populations likely reflects a high prevalence of Helicobacter pylori infection in these populations. These data can be used to develop interventions to reduce risk factors and improve access to health services among AI/AN people at high risk for gastric cancer. |
Presence of antibodies against Haemophilus influenzae serotype a in Alaska prior to and after the emergence of invasive infections
McClure M , Miernyk K , Bruden D , Rudolph K , Hennessy TW , Bruce MG , Nolen LD . J Infect Dis 2020 223 (2) 326-332 BACKGROUND: Haemophilus influenzae bacteria can cause asymptomatic carriage and invasive disease. H. influenzae serotype a (Hia) is an emerging cause of invasive disease in Alaska, with greatest burden occurring among rural Alaska Native (AN) children. The first case of invasive Hia (iHia) in Alaska was reported in 2002; however, it is unclear how long the pathogen has been in Alaska. METHODS: We quantified IgG antibodies against Hia (anti-Hia) in 839 banked serum samples from Alaska residents, comparing antibody concentrations in samples drawn in the decades prior to (1980s and 1990s) and after (2000s) the emergence of iHia. We also assessed serum antibody concentration by age group, region of residence, and race. RESULTS: Anti-Hia was >0.1 microg/mL in 88.1% (348/395) and 91.0% (404/444) of samples from the decades prior and after the emergence of Hia, respectively (p=0.17). No significant differences in antibody levels were detected between people from rural and urban regions (1.55 microg/mL vs. 2.08 microg/mL, p=0.91 for age >/=5) or between AN and non-AN people (2.50 microg/mL vs 2.60 microg/mL, p=0.26). CONCLUSIONS: Our results are consistent with widespread Hia exposure in Alaska predating the first iHia case. No difference in Hia antibody prevalence was detected between populations with differing levels of invasive disease. |
Epidemiology of invasive Haemophilus influenzae serotype a disease - United States, 2008-2017
Soeters HM , Oliver SE , Plumb ID , Blain AE , Zulz T , Simons BC , Barnes M , Farley MM , Harrison LH , Lynfield R , Massay S , McLaughlin J , Muse AG , Petit S , Schaffner W , Thomas A , Torres S , Watt J , Pondo T , Whaley MJ , Hu F , Wang X , Briere EC , Bruce MG . Clin Infect Dis 2020 73 (2) e371-e379 BACKGROUND: Haemophilus influenzae serotype a (Hia) can cause invasive disease similar to serotype b; no Hia vaccine is available. We describe the epidemiology of invasive Hia disease in the United States overall and specifically in Alaska during 2008-2017. METHODS: Active population- and laboratory-based surveillance for invasive Hia disease was conducted through Active Bacterial Core surveillance sites and from Alaska statewide invasive bacterial disease surveillance. Sterile-site isolates were serotyped via slide agglutination or real-time polymerase chain reaction. Incidences in cases per 100,000 were calculated. RESULTS: From 2008-2017, an estimated average of 306 invasive Hia disease cases occurred annually in the United States (estimated annual incidence: 0.10); incidence increased by an average of 11.1% annually. Overall, 42.7% of cases were in children aged <5 years (incidence: 0.64), with highest incidence among children aged <1 year (1.60). Case fatality was 7.8% overall and was highest among adults aged >/=65 years (15.1%). Among children aged <5 years, incidence was 17 times higher among American Indians and Alaska Native (AI/AN) children (8.29) than among children of all other races combined (0.49). In Alaska, incidences among all ages (0.68) and among children aged <1 year (24.73) were nearly 6 and 14 times higher, respectively, than corresponding U.S. incidences. Case fatality in Alaska was 10.2%, and the vast majority (93.9%) of cases occurred among AI/AN. CONCLUSIONS: Incidence of invasive Hia disease has increased since 2008, with the highest burden among AI/AN children. These data can inform prevention strategies, including Hia vaccine development. |
Haemophilus influenzae serotype a (Hia) carriage in a small Alaska community after a cluster of invasive Hia disease, 2018
Nolen LD , Tiffany A , DeByle C , Bruden D , Thompson G , Reasonover A , Hurlburt D , Mosites E , Simons BC , Klejka J , Castrodale L , McLaughlin J , Bruce MG . Clin Infect Dis 2020 73 (2) e280-e286 BACKGROUND: Between May and July 2018, four invasive Haemophilus influenzae serotype a (iHia) infections occurred in a remote Alaska community. We performed a public health response to prevent further illness and understand Hia carriage in the community. METHODS: We collected oropharyngeal (OP) samples community-wide from untreated individuals to evaluate baseline carriage. Risk factor data was collected by interview. To prevent additional illness, we offered prophylactic rifampin to individuals in contact with iHia patients (contacts) and to all children aged <10 years. OP samples were collected again eight weeks post-rifampin distribution. Samples were tested using real-time PCR and culture. RESULTS: At baseline, Hia was carried by 4/27 (14.8%) contacts and 7/364 (1.9%) non-contacts (p<0.01). Contacts aged <10 years were more likely to carry Hia at any timepoint (11/18, 61%) than contacts aged >/=10 years (3/34, 8.8%) or non-contacts aged <10 years (2/139, 1.4%) and >/=10 years (6/276, 2.2%)(p<0.001 for all). Hia carriers were clustered in nine households (7% of total households). At the household level, carriage was associated with households with >/=1 contact (PR=5.6, CI:1.3-21.6), crowding (PR=7.7, CI:1.1-199.5) and >/=3 tobacco users (PR=5.0, CI:1.2-19.6). Sixty-six percent (40/61) of contacts and 90% (111/124) of non-contacts aged <10 years received rifampin. Elevated carriage prevalence persisted in contacts when retested eight weeks after rifampin distribution (contacts 6/25 (24%), non-contacts 2/114 (1.8%), p<0.001). CONCLUSIONS: Hia carriage prevalence was significantly higher among people who had contact with iHia patients than the general community. Rifampin prophylaxis did not result in a reduction of Hia carriage prevalence in this community. |
Increasing non-susceptibility to antibiotics within carried pneumococcal serotypes - Alaska, 2008-2015
Plumb ID , Gounder PP , Bruden DJT , Bulkow LR , Rudolph KM , Singleton RJ , Hennessy TW , Bruce MG . Vaccine 2020 38 (27) 4273-4280 BACKGROUND: In Alaska, while introduction of 13-valent pneumococcal conjugate vaccine led to declines in invasive pneumococcal disease, carriage prevalence remained stable because of replacement with non-vaccine serotypes. We assessed antibiotic non-susceptibility of carried pneumococci during serotype redistribution, determined the contributions of within-serotype shifts, and assessed factors that could explain changes in non-susceptibility. METHODS: Each year from 2008 to 2015, at multiple sites in Alaska, we collected nasopharyngeal swabs and completed surveys for a convenience sample of participants. Pneumococcal serotyping and antimicrobial susceptibility testing for penicillin and erythromycin were performed. We described changes in non-susceptibility of isolates from 2008-2011 to 2012-2015, and assessed the contributions of serotype redistribution and within-serotype changes in non-susceptibility by comparing observed data to modeled data removing either factor. We used weighted logistic regression to assess whether reported risk factors could explain changes over time in non-susceptibility within serotypes. RESULTS: From 2008-2011 to 2012-2015, the overall proportion of isolates non-susceptible to penicillin or erythromycin increased by 3%, from 23% (n = 1,183) to 26% (n = 1,589; P < 0.05). However, a decrease of 3% would be expected if serotype redistribution occurred without within-serotype changes in non-susceptibility. Standardization by either factor produced hypothetical data significantly different to observed data. Within serotypes, the average annual increase in odds of non-susceptibility to penicillin or erythromycin was 1.08 (95% CI 1.05-1.11). Recent antibiotic exposure, urban residence and increased household size of participants predicted isolate non-susceptibility but did not explain the increase over time. DISCUSSION: An overall increase in non-susceptibility of carried pneumococcal isolates to penicillin or erythromycin resulted from increases in non-susceptibility within serotypes, which outweighed a protective effect of serotype redistribution. Characterization of emerging resistant clones within carried non-vaccine serotypes, including risk factors for colonization and disease, would support disease prevention efforts and inform vaccine strategies. |
Presence of cagPAI genes and characterization of vacA s, i and m regions in Helicobacter pylori isolated from Alaskans and their association with clinical pathologies.
Miernyk KM , Bruden D , Rudolph KM , Hurlburt DA , Sacco F , McMahon BJ , Bruce MG . J Med Microbiol 2020 69 (2) 218-227 Introduction. Gastric cancer is a health disparity in the Alaska Native people. The incidence of Helicobacter pylori infection, a risk factor for non-cardia gastric adenocarcinoma, is also high. Gastric cancer is partially associated with the virulence of the infecting strain.Aim. To genotype the vacA s, m and i and cag pathogenicity island (cagPAI) genes in H. pylori from Alaskans and investigate associations with gastropathy.Methodology. We enrolled patients with gastritis, peptic ulcer disease (PUD) and intestinal metaplasia (IM) in 1998-2005 and patients with gastric cancer in 2011-2013. Gastric biopsies were collected and cultured and PCR was performed to detect the presence of the right and left ends of the cagPAI, the cagA, cagE, cagT and virD4 genes and to genotype the vacA s, m and i regions.Results. We recruited 263 people; 22 (8 %) had no/mild gastritis, 121 (46 %) had moderate gastritis, 40 (15%) had severe gastritis, 38 (14 %) had PUD, 30 (11 %) had IM and 12 (5 %) had gastric cancer. H. pylori isolates from 150 (57%) people had an intact cagPAI; those were associated with a more severe gastropathy (P</=0.02 for all comparisons). H. pylori isolates from 77 % of people had either the vacA s1/i1/m1 (40 %; 94/234) or s2/i2/m2 (37 %; 86/234) genotype. vacA s1/i1/m1 was associated with a more severe gastropathy (P</=0.03 for all comparisons).Conclusions. In this population with high rates of gastric cancer, we found that just over half of the H. pylori contained an intact cagPAI and 40 % had the vacA s1/i1/m1 genotype. Infection with these strains was associated with a more severe gastropathy. |
Combating gastric cancer in Alaska Native people: An expert and community symposium: Alaska Native Gastric Cancer Symposium
Nolen LD , Vindigni SM , Parsonnet J , Bruce MG , Martinson HA , Thomas TK , Sacco F , Nash S , Olnes MJ , Miernyk K , Bruden D , Ramaswamy M , McMahon B , Goodman KJ , Bass AJ , Hur C , Inoue M , Camargo MC , Cho SJ , Parnell K , Allen E , Woods T , Melkonian S . Gastroenterology 2019 158 (5) 1197-1201 Alaska Native (AN) people experience higher incidence of, and mortality from, gastric cancer compared to other U.S. populations(1, 2). Compared to the general U.S. population, gastric cancer in AN people occurs at a younger age, is diagnosed at later stages, is more evenly distributed between the sexes, and is more frequently signet-ring or diffuse histology(3). It is known that the prevalence of Helicobacter pylori (Hp) infection, a risk factor for gastric cancer, is high in AN people(4); however, high antimicrobial resistance combined with high reinfection rates in Alaska make treatment at the population level complex(5). In addition, health issues in AN people are uniquely challenging due to the extremely remote locations of many residents. A multiagency workgroup hosted a symposium in Anchorage that brought internationally-recognized experts and local leaders together to evaluate issues around gastric cancer in the AN population. The overall goal of this symposium was to identify the best strategies to combat gastric cancer in the AN population through prevention and early diagnosis. |
Risk for invasive streptococcal infections among adults experiencing homelessness, Anchorage, Alaska, USA, 2002-2015
Mosites E , Zulz T , Bruden D , Nolen L , Frick A , Castrodale L , McLaughlin J , Van Beneden C , Hennessy TW , Bruce MG . Emerg Infect Dis 2019 25 (10) 1911-8 The risk for invasive streptococcal infection has not been clearly quantified among persons experiencing homelessness (PEH). We compared the incidence of detected cases of invasive group A Streptococcus infection, group B Streptococcus infection, and Streptococcus pneumoniae (pneumococcal) infection among PEH with that among the general population in Anchorage, Alaska, USA, during 2002-2015. We used data from the Centers for Disease Control and Prevention's Arctic Investigations Program surveillance system, the US Census, and the Anchorage Point-in-Time count (a yearly census of PEH). We detected a disproportionately high incidence of invasive streptococcal disease in Anchorage among PEH. Compared with the general population, PEH were 53.3 times as likely to have invasive group A Streptococcus infection, 6.9 times as likely to have invasive group B Streptococcus infection, and 36.3 times as likely to have invasive pneumococcal infection. Infection control in shelters, pneumococcal vaccination, and infection monitoring could help protect the health of this vulnerable group. |
Lack of in-home piped water and reported consumption of sugar-sweetened beverages among adults in rural Alaska
Mosites E , Seeman S , Fenaughty A , Fink K , Eichelberger L , Holck P , Thomas TK , Bruce MG , Hennessy TW . Public Health Nutr 2019 23 (5) 1-8 OBJECTIVE: To assess whether a community water service is associated with the frequency of sugar-sweetened beverages (SSB) consumption, obesity, or perceived health status in rural Alaska. DESIGN: We examined the cross-sectional associations between community water access and frequency of SSB consumption, body mass index categories, and perceived health status using data from the 2013 and 2015 Alaska Behavioral Risk Factor Surveillance System (BRFSS). Participants were categorized by zip code to 'in-home piped water service' or 'no in-home piped water service' based on water utility data. We evaluated the univariable and multivariable (adjusting for age, household income and education) associations between water service and outcomes using log-linear survey-weighted generalized linear models. SETTING: Rural Alaska, USA. SUBJECTS: Eight hundred and eighty-seven adults, aged 25 years and older. RESULTS: In unadjusted models, participants without in-home water reported consuming SSB more often than participants with in-home water (1.46, 95 % CI: 1.06, 2.00). After adjustment for potential confounders, the effect decreased but remained borderline significant (1.29, 95 % CI: 1.00, 1.67). Obesity was not significantly associated with water service but self-reported poor health was higher in those communities without in-home water (1.63, 95 % CI: 1.05, 2.54). CONCLUSIONS: Not having access to in-home piped water could affect behaviours surrounding SSB consumption and general perception of health in rural Alaska. |
The relationship between previous antimicrobial use, antimicrobial resistance and treatment outcome among Alaskans treated for Helicobacter pylori infection
Bruce MG , Bruden D , Newbrough D , Hurlburt DA , Hennessy TW , Morris JM , Reasonover AL , Sacco F , McMahon BJ . GastroHep 2019 1 (4) 172-179 Background: Helicobacter pylori isolates from Alaska have demonstrated a high prevalence of antimicrobial resistance. Objective(s): To determine treatment failure in three groups, and analyse the relationship between treatment failure and antimicrobial resistance. Method(s): Antimicrobial susceptibility was determined using agar dilution and Etest. Treatment success was determined using the urea breath test 2 months after antimicrobial therapy. Result(s): Among 303 treated adult patients, 103 (34%) failed initial treatment despite a 91% compliance with medication. About 222 (73%) patients were treated with a clarithromycin-based regimen, 55 (18%) with a metronidazole-based regimen, 15 (5%) with a regimen that contained clarithromycin and metronidazole and 11 (4%) with other antimicrobials. Among 260 culture-positive patients, 156 (60%) were infected with metronidazole-resistant isolates, 74 (28%) clarithromycin-resistant, 52 (20%) clarithromycin/metronidazole-resistant, 40 (15%) levofloxacin-resistant, 11 (4%) clarithromycin/metronidazole/levofloxacin-resistant and nine (3%) amoxicillin-resistant. Overall, 34% of patients were treated with at least one antibiotic to which their infecting organism was resistant. Among patients treated with clarithromycin-based regimens, treatment failed in 72% of patients carrying clarithromycin-resistant H pylori vs 20% with clarithromycin-sensitive strains (RR = 3.7, P < 0.001). Among patients treated with metronidazole-based regimens, treatment failed in 19% of patients carrying metronidazole-resistant H pylori vs 24% with metronidazole-sensitive strains (P = 0.72). Conclusion(s): A high proportion of H pylori isolates demonstrate resistance to clarithromycin, metronidazole or levofloxacin. Over one third of H pylori-infected patients were treated with an antibiotic to which their infecting organism demonstrated resistance. Clarithromycin resistance is associated with a greater risk for failure with clarithromycin-based multidrug regimens compared to clarithromycin-sensitive; resistance to metronidazole did not affect treatment failure. |
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