Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
Records 1-30 (of 51 Records) |
Query Trace: Chorba T[original query] |
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Updates on the treatment of drug-susceptible and drug-resistant tuberculosis an official ATS/CDC/ERS/IDSA clinical practice guideline
Duarte R , Munsiff SS , Nahid P , Saukkonen JJ , Winston CA , Abubakar I , Acuña-Villaorduña C , Barry PM , Bastos ML , Carr W , Chami H , Chen LL , Chorba T , Daley CL , Garcia-Prats AJ , Holland K , Konstantinidis I , Lipman M , Mammen MJ , Migliori GB , Parvez FM , Shapiro AE , Sotgiu G , Starke JR , Starks AM , Thakore S , Wang SH , Wortham JM . Am J Respir Crit Care Med 2025 211 (1) 15-33 Background: On the basis of recent clinical trial data for the treatment of drug-susceptible and drug-resistant tuberculosis (TB), the American Thoracic Society, U.S. Centers for Disease Control and Prevention, European Respiratory Society, and Infectious Diseases Society of America have updated clinical practice guidelines for TB treatment in children and adults in settings in which mycobacterial cultures, molecular and phenotypic drug susceptibility tests, and radiographic studies, among other diagnostic tools, are available on a routine basis. Methods: A Joint Panel representing multiple interdisciplinary perspectives convened with American Thoracic Society methodologists to review evidence and make recommendations using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) and GRADE-ADOLOPMENT (adoption, adaptation, and, as needed, de novo development of recommendations) methodology. Results: New drug-susceptible TB recommendations include the use of a novel 4-month regimen for people with pulmonary TB and a shortened 4-month regimen for children with nonsevere TB. Drug-resistant TB recommendation updates include the use of novel regimens containing bedaquiline, pretomanid, and linezolid with or without moxifloxacin. Conclusions: All-oral, shorter treatment regimens for TB are now recommended for use in eligible individuals. Copyright © 2025 by the American Thoracic Society. |
Using regression tree analysis to examine demographic and geographic characteristics of COVID-19 vaccination trends over time, United States, May 2021-April 2022, National Immunization Survey Adult COVID Module
Earp M , Meng L , Black CL , Carter RJ , Lu PJ , Singleton JA , Chorba T . Vaccine 2024 42 (26) 126372 ![]() Using data from the nationally representative National Immunization Survey (NIS), we applied conditional linear regression tree methodology to examine relationships between demographic and geographic factors and propensity of receiving various doses of COVID-19 vaccine over time; these analyses identified temporal changes in these relationships that heretofore had not been identified using conventional logistical regression methodologies. Three regression tree models were built using an R package, Recursive Partitioning for Modeling Survey (rpms), to examine propensities over time of receiving a (1) first dose of a two-dose COVID-19 mRNA primary vaccination series or single dose of the Janssen vaccine (vaccine initiation), (2) primary series completion, and (3) monovalent booster dose, using a conditional linear effect model. Persons ≥50 years were more likely to complete a primary series and receive a first booster dose; persons reporting having received non-COVID-19 vaccines recently were more likely to initiate vaccination, complete the primary series, and get a first booster dose; persons reporting having work or school requirements were more likely to complete the primary series. Persons not reporting having received non-COVID-19 vaccines in 2 years but reporting having work or school vaccination requirements were more likely to initiate vaccination than those without work/school requirements. Among persons not reporting having received non-COVID-19 vaccines in 2 years and not reporting having work or school vaccination requirements, those aged ≥50 years were more likely to initiate vaccination than were younger adults. Propensity of receiving various doses was correlated with age, having recently received non-COVID 19 vaccines, and having vaccination requirements at work or school. Regression tree methodology enabled modeling of different COVID-19 vaccination dose propensities as a linear effect of time, revealed changes in relationships over time between demographic factors and propensity of receipt of different doses, and identified populations that may benefit from vaccination outreach efforts. |
Strange Case of a Sojourn in Saranac
Chorba T . Emerg Infect Dis 12/28/2021 27 (3) 994-5 Robert Louis Stevenson, the renowned Scottish author and poet, was born in 1850 in Edinburgh, Scotland. From childhood onward, he suffered from frequent chest infections, fevers, and hemoptysis. This master who gave us Treasure Island (1881–83), A Child’s Garden of Verses (1885), Kidnapped (1886), and Strange Case of Dr Jekyll and Mr Hyde (1886) lived his brief 44 years in an era when tuberculosis (then called consumption) was widespread in Europe but laboratory and radiologic diagnostics were not available. | | On March 24, 1882, the date on which World TB Day is based, Robert Koch announced his discovery of the causative organism of tuberculosis, Mycobacterium tuberculosis. Through Koch’s use of alkalinized methylene blue stain and a brown counterstain for contrast, this discovery laid to rest the theory that tuberculosis was congenital, a belief stemming from its extensive occurrence in families. In 1895, Wilhelm Röntgen first described the potential medical application of radiography when he captured the image of the bony and soft-tissue structures of his wife’s hand on a photographic plate. Without bacteriology or radiography, Stevenson’s persistently cachectic body habitus and pulmonary symptoms were thought to be consistent with tuberculosis, although other diagnoses have been proposed. These have included chronic idiopathic bronchiectasis, sarcoidosis, and hereditary hemorrhagic telangiectasia, any of which could potentially have been exacerbated by residual scarring from the bouts of pneumonia he experienced as a child and by his chain-smoking as an adult. |
Social and demographic factors associated with receipt of a COVID-19 vaccine initial booster dose and with interval between primary series completion and initial booster dose uptake among persons aged ≥ 12 years, United States, August 2021-October 2022
Meng L , Harris L , Shaw L , Lymon H , Reses H , Bell J , Lu PJ , Gibbs-Scharf L , Chorba T . Vaccine 2024 ![]() COVID-19 booster dose vaccination has been crucial in ensuring protection against COVID-19 including recently predominant Omicron variants. Because vaccines against newer SARS-CoV- 2 variants are likely to be recommended in future, it will be valuable to understand past booster dose uptake among different demographic groups. Using U.S. vaccination data, this study examined intervals between primary series completion and receipt of first booster dose (monovalent or bivalent) during August 2021 - October 2022 among persons ≥12 years of age who had completed a COVID-19 vaccine primary series by October 2021. Sub-populations who were late booster recipients (received a booster dose ≥12 months after the primary series) or received no booster dose included persons <35 years old, Johnson & Johnson/Janssen vaccine primary dose recipients, persons in certain racial and ethnic groups, and persons living in rural and more socially vulnerable areas, and in the South region of the United States; these groups may benefit the most from public health outreach efforts to achieve timely COVID-19 vaccination completion in future. |
TB-free Ebeye: Results from integrated TB and noncommunicable disease case finding in Ebeye, Marshall Islands
Brostrom RJ , Largen A , Nasa JN , Jeadrik G , Yamada S , Yadav S , Ko E , Warkentin JV , Chorba TL . J Clin Tuberc Other Mycobact Dis 2024 35 100418 BACKGROUND: Tuberculosis (TB) incidence rates in the Republic of the Marshall Islands are among the highest in the world, 480/100,000 in 2017. In response, the Health Ministry completed islandwide screening in Ebeye Island in 2017. METHODS: Participants were interviewed to obtain TB history, exposures, and symptoms. TB assessment included chest radiography with sputum collection for GeneXpert® MTB-RIF if indicated. TB diagnosis was made by consensus of visiting TB experts. Participants were also screened for Hansen's disease (HD) and diabetes mellitus (DM). For persons aged ≥21 years, blood pressure, cholesterol, and blood glucose were assessed. RESULTS: A total of 5,166 persons (90.0 % of target population) completed screening leading to the identification of 39 new cases of TB (755/100,000) and 14 persons with HD (270/100,000). DM was detected in 1,096 persons (27 %), including in 351 persons not previously diagnosed. The rate of hypertension was 61 % and of hypercholesterolemia was 15 %. New or prevalent TB diagnosis was associated with newly diagnosed or history of DM (aOR 4.68, 2.15-10.20). CONCLUSIONS: In Ebeye, an integrated TB screening campaign found TB, HD, DM, and hypertension. TB and DM were strongly associated. |
The concept of the crown and its potential role in the downfall of coronavirus
Chorba T . Emerg Infect Dis 2020 26 (9) 2302-2305 Coronavirus virions are spherical or variable in shape and composed of an outer layer of lipid covered with a crown of club-shaped peplomers or spikes. Within each spike is a helical single-stranded RNA-containing structural protein. Although the term corona was first used in English in the 1500s, it was borrowed directly from the Latin word for “crown.” Corona is derived from the Ancient Greek κορώνη (korōnè), meaning “garland” or “wreath,” coming from a proto-Indo-European root, sker- or ker-, meaning “to turn” or “to bend.” | | In the 1967 initial description of an electron microscopic image of a human common cold virus, June Almeida (née Hart) and David Tyrrell described the surface of coronavirus particles as being “covered with a distinct layer of projections roughly 200Ǻ [20 nm] long….[with] a narrow stalk just in the limit of resolution of the microscope and a ‘head’ roughly 100Ǻ across”. In micrographs, the club-shaped spikes that stud the surface of coronaviruses are glycoproteins that give the appearance of a radiate crown. |
Social distancing and artful pandemic survival
Chorba T . Emerg Infect Dis 2020 26 (11) 2793-2794 Social distancing is a relatively novel term, recently popularized in strategies for disrupting transmission of newly identified airborne pathogens, including influenza virus variants, Ebola virus, and coronaviruses. An American cultural anthropologist, Edward T. Hall, Jr., coined the term “social distance” in 1963 to describe a zone of space customarily adopted in many cultures to minimize visual, olfactory, auditory, and tactile stimulation when meeting strangers or mere acquaintances. A PubMed search by term indicates that social distancing as an infectious disease intervention first appeared in a 2005 article about strategies for containing an emerging influenza pandemic. However, awareness of distancing oneself from others as a prevention tool against infection dates to biblical times; reference to removing persons with leprosy from the community was recorded in the Bible (Lev. 13:46, New Jerusalem Version) during the 6th–4th centuries bce. Later, for both plague and smallpox, avoiding contact between diseased and healthy persons became a method for disrupting disease transmission. Beginning in the 14th century, Italian port cities began isolating ships and travelers suspected of carrying plague for periods of 30 days (trentino) and later for 40 days (quarantino), thus, the English term “quarantine.” |
SARS-CoV-2, Mannerism, Marten, Mink, and Man
Swancutt M , Chorba T . Emerg Infect Dis 2021 27 (7) 2003-2005 Girolamo Francesco Maria Mazzola (1503–1540), known as Parmigianino (the little one from Parma), was a painter and printmaker. He was born into a family of painters in Parma, in what was then the Duchy of Milan, and died in Cremona, in northern Italy. He was among the first and most prominent artists of the Mannerist school of art of the Late Renaissance that came after the High Renaissance. The High Renaissance is known for the works of Raphael and the early works of Michelangelo, and its art is treasured for perfection of elegance and qualities of balance, proportion, and absoluast, in Mannerism, compositions are said to be exaggerated, almost to a fault, as a reaction to the art of the High Renaissance or perhaps as an attempt to improve on it. In general, it is characterized by realist but decorous art in which there is subtle, unsettling elongation of figures with stylized features and poses. | | Among Parmigianino’s more renowned works is a portrait painting from 1531‒1534 of a young woman, Antea, which appears on the cover of this month’s journal. It is unknown if the painting is an image of a specific person or a stylized composition. We behold a beautiful young woman facing forward, with elongated bodily proportions, as is characteristic of Mannerist works. With a small oval head set upon a large torso and with wide shoulders, her arms and hands appear exaggerated in size, as if the parts of her body were proportioned for different paintings. Yet despite these physical disproportions, the viewer has an impression of great beauty, a testimony to the subtlety and success of this Mannerist portrait. Contributing to the incongruousness of the image of this young lady, we also note that she is clad in the garments of an older woman, or a woman of an age with which we more commonly associate wealth; Antea is bejeweled, fingering a gold chain with her left hand, and dressed luxuriously. Among her layers of garments are a gold blouse with a fine white apron, a detailed gold satin dress, leather gloves, and a marten fur stole complete with the animal’s head, on which the nose is pierced with a ring still attached to a chain. |
Of Those We Have Lost and Those Who Have Saved So Many Others
Chorba T . Emerg Infect Dis 2022 28 (7) 1537-9 Modernism is a term ascribed to styles and transformative movements in multiple cultural spheres—philosophy, music, art, architecture, and literature. In its essence, modernism has at its core experimentation, as a term usually applied to efforts and creations of the late 19th or early 20th century, but sometimes later, characterized by intentional departures from traditional forms. | | There are many well-known examples of modernist efforts in their respective spheres and periods. In biology, Charles Darwin questioned the concept of human uniqueness with the theory of evolution. In literature, the term modernist has been applied to European and American writers who created substantive departures from tradition, as was seen in the works of Fyodor Dostoyevsky, Gustave Flaubert, James Joyce, and William Carlos Williams. In music, modernism is a term ascribed to the period 1890–1930, and postmodernism is a term sometimes accorded to phenomena with modernist qualities but occurring after 1930; however, some critics use modernism to describe a movement of rebellion that continues, dependent on the musician’s attitude rather than the musician’s moment in time. Certainly, Ella Fitzgerald, Miles Davis, Bob Dylan, John Lennon, Charles Mingus, the Rolling Stones, and Neil Young created musical forms that featured modernist iconoclasm, stepping well beyond the early 20th century. In art, modernism is used as a broader categorization of several novel stylistic departures including realism, postimpressionism, fauvism, cubism, dadaism, surrealism, abstract expressionism, and minimalism, each with elements of deliberate experimentation and innovation. |
B for Beethoven
Chorba T . Emerg Infect Dis 2023 29 (9) 1948-9 Ludwig van Beethoven (1770‒1827) is one of the most renowned and admired composers in the development of Western Classical music. He was perhaps the greatest contributor to the musical style transition from Classical (roughly 1750‒1820), with linear compositional styles, to Romantic (roughly 1798‒1837), with dramatic expansion of orchestra size and development of lyrical, less formulaic melodic styles. The German composer’s contributions vastly widened the scope and development of the concerto, quartet, sonata, and symphony. In March 1827, after a prolonged illness, Beethoven died at age 56 in his apartment in Vienna. Discussions of Beethoven’s health have been voluminous, fraught with controversy, and limited by an absence of evidence, characteristic of the first half of the 19th century before the availability of radiologic and microbiologic diagnostics. Starting at age 28, the composer suffered hearing deficits that were initially characterized as tinnitus and high-frequency hearing loss. Letters, journals, and other documents of that era indicate that, in his final decade of his life, Beethoven’s health and hearing progressively declined, yet he produced many works that were expansive and departing from the more conservative structure of his earlier works. |
Ars Longa, Vita Brevis
Chorba T . Emerg Infect Dis 2023 29 (3) 674-5 Frédéric François Chopin (born Fryderyk Franciszek Chopin; 1810–1849) was a prolific Poland-born composer and pianist of outstanding technical ability and talent. Although his public career was limited to 30 performances, his contribution as a composer of significant works for piano is unparalleled in its vast array of genres, including ballades, études, impromptus, mazurkas, nocturnes, polonaises, préludes, scherzi, sonatas, and waltzes. All his works included piano and, although he wrote 2 piano concertos and some chamber music, most of his works were written for solo piano. | | Chopin was said to have been a sickly child; his younger sister Emilia died at the age of 14 from a rapidly progressive respiratory disease. Drawn by its identity as a center for the arts, he moved to Paris at age 21 and thrived as a master pianist and composer. Chopin continued in ill health throughout adulthood, suffering from shortness of breath, cervical lymphadenitis, night sweats, a persistent cough with copious sputum, and later hemoptysis. His physicians were reluctant to give a diagnosis of tuberculosis, a stigma-laden but probable diagnosis in the 19th century. |
Reply to Chang and Yew
Sotgiu G , Battista Migliori G , Menzies D , Mase S , Chorba T , Seaworth B , Nahid P . Am J Respir Crit Care Med 2020 202 (5) 778-779 We appreciate the letter by Drs. Chang and Yew commenting on the Official Guidelines of the American Thoracic Society (ATS)/CDC/European Respiratory Society (ERS)/Infectious Disease Society of America (IDSA) on the treatment of multidrug-resistant tuberculosis (MDR-TB) (1). Three issues are raised in the letter: first, the certainty of the evidence on the use of linezolid and bedaquiline in the management of fluoroquinolone-sensitive and -resistant MDR-TB; second, the risk of resistance to these two drugs with generalized use, suggesting focused use of these drugs in selected patients might limit this hazard and minimize acquisition of resistance and serious adverse events; and third, that with broadening availability of rapid drug susceptibility testing (DST), optimized longer and existing standardized shorter-course regimens still have value. |
A Head of State Leading by Example
Chorba T , Esparza J . Emerg Infect Dis 2022 28 (10) 2141-3 Before the introduction of smallpox vaccine, variolation was practiced as a preventive measure (i.e., deliberate infection with smallpox to provide immunity), most commonly by inserting or rubbing material from smallpox lesions into the skin of uninfected persons. Most persons thus infected would get a milder case of smallpox as the virus was generally introduced via the skin rather than via the respiratory route, as is the case of natural exposure. Infection occurring in this manner could still be transmitted by droplets to others who could develop a full-blown case of smallpox. Variolation developed over several centuries in many different sites including China, India, Sudan, Asia Minor, and Britain. Because variolation was reputed to have risk of inducing severe disease, variolation hesitancy existed long before the smallpox vaccine and its associated vaccine hesitancy. Inoculation with materials putatively derived from cowpox lesions (vaccination) or from horsepox lesions (equination) was a welcomed advance because it was safer and did not present the hazard of onward transmission of smallpox to the contacts of recipients. |
When a Touch of Gold Was Used to Heal the King’s Evil
Krugman J , Chorba T . Emerg Infect Dis 2022 28 (3) 765-7 Throughout history, divine approval has been claimed by many rulers in establishing legitimacy of their monarchy and has been integral to governance in the development of many cultures. In ancient and Imperial China, a tradition of a mandate of heaven, as the will of the universe or natural law, was used to justify the position of the ruler. In the Inca Empire, the traditional ruler was considered the progeny of the sun god and in that capacity had to be accorded absolute power over the people, such as the sun itself has. European history is replete with similar traditions of monarchical claims for legitimacy. In Britain and in France, the evolution of the concept of “the divine right of kings” and the resultant philosophic traditions favoring or opposing such a concept shaped much of the history of the past millennium. Both monarchies claimed to rule by divine will, and to this day, the British Coronation service includes a sacred anointing of the new king or queen. | | Many religious traditions have had thaumaturgic (relating to supernatural powers) touch as a tradition. In Britain, reference to the monarch as having divine power in “the royal touch” dates to the 11th century, when it was believed that Edward the Confessor, last of the Anglo-Saxon kings, possessed powers to heal the sick through some form of laying on of hands. In official ceremonies in his and subsequent reigns, subjects could approach the monarch to seek the imperial touch, hoping to cure their ailments or diseases. For centuries, the disease that most readily lent itself to the occasional appearance of success in this regard was scrofula (i.e., lymphadenitis—most commonly tuberculous cervical lymphadenitis), which would manifest itself with painful and visible sores that could go into remission and even go into resolution, giving the impression of a royally induced cure. Scrofula is a term that has fallen into disuse like many other medical terms in English (e.g., catarrh, ague, quinsy, dropsy, and grippe), principally because of diagnostic advances and more precise disease characterization. However, because of the association of its spontaneous remission with the royal touch, tuberculous lymphadenitis was also called “the king's evil,” and throughout most of the past millennium, its presence in European populations was very common. |
Using a Cloud-Based Machine Learning Classification Tree Analysis to Understand the Demographic Characteristics Associated With COVID-19 Booster Vaccination Among Adults in the United States.
Meng L , Fast HE , Saelee R , Zell E , Murthy BP , Murthy NC , Lu PJ , Shaw L , Harris L , Gibbs-Scharf L , Chorba T . Open Forum Infect Dis 2022 9 (9) ofac446 ![]() ![]() A tree model identified adults age ≤34 years, Johnson & Johnson primary series recipients, people from racial/ethnic minority groups, residents of nonlarge metro areas, and those living in socially vulnerable communities in the South as less likely to be boosted. These findings can guide clinical/public health outreach toward specific subpopulations. |
COVID-19 Vaccine Initiation and Dose Completion During the SARS-CoV-2 Delta Variant Surge in the United States, December 2020-October 2021.
Murthy N , Saelee R , PatelMurthy B , Meng L , Shaw L , Gibbs-Scharf L , Harris L , Chorba T , Zell E . Public Health Rep 2022 138 (1) 333549221123584 ![]() OBJECTIVES: In summer 2021, the number of COVID-19-associated hospitalizations in the United States increased with the surge of the SARS-CoV-2 Delta variant. We assessed how COVID-19 vaccine initiation and dose completion changed during the Delta variant surge, based on jurisdictional vaccination coverage before the surge. METHODS: We analyzed COVID-19 vaccination data reported to the Centers for Disease Control and Prevention. We classified jurisdictions (50 states and the District of Columbia) into quartiles ranging from high to low first-dose vaccination coverage among people aged 12 years as of June 30, 2021. We calculated first-dose vaccination coverage as of June 30 and October 31, 2021, and stratified coverage by quartile, age (12-17, 18-64, 65 years), and sex. We assessed dose completion among those who initiated a 2-dose vaccine series. RESULTS: Of 51 jurisdictions, 15 reached at least 70% vaccination coverage before the Delta variant surge (ie, as of June 30, 2021), while 35 reached that goal as of October 31, 2021. Jurisdictions in the lowest quartile of vaccination coverage (44.9%-54.9%) had the greatest absolute (9.7%-17.9%) and relative (18.1%-39.8%) percentage increase in vaccination coverage during July 1-October 31, 2021. Of those who received the first dose during this period across all jurisdictions, nearly 1 in 5 missed the second dose. CONCLUSIONS: Although COVID-19 vaccination initiation increased during July 1-October 31, 2021, in jurisdictions in the lowest quartile of vaccination coverage, coverage remained below that of jurisdictions in the highest quartile of vaccination coverage before the Delta variant surge. Efforts are needed to improve access to and increase confidence in COVID-19 vaccines, especially in low-coverage areas. |
Factors Associated with Delayed or Missed Second-Dose mRNA COVID-19 Vaccination among Persons >12 Years of Age, United States.
Meng L , Murthy NC , Murthy BP , Zell E , Saelee R , Irving M , Fast HE , Roman PC , Schiller A , Shaw L , Black CL , Gibbs-Scharf L , Harris L , Chorba T . Emerg Infect Dis 2022 28 (8) 1633-1641 To identify demographic factors associated with delaying or not receiving a second dose of the 2-dose primary mRNA COVID-19 vaccine series, we matched 323 million single Pfizer-BioNTech (https://www.pfizer.com) and Moderna (https://www.modernatx.com) COVID-19 vaccine administration records from 2021 and determined whether second doses were delayed or missed. We used 2 sets of logistic regression models to examine associated factors. Overall, 87.3% of recipients received a timely second dose (≤42 days between first and second dose), 3.4% received a delayed second dose (>42 days between first and second dose), and 9.4% missed the second dose. Persons more likely to have delayed or missed the second dose belonged to several racial/ethnic minority groups, were 18-39 years of age, lived in more socially vulnerable areas, and lived in regions other than the northeastern United States. Logistic regression models identified specific subgroups for providing outreach and encouragement to receive subsequent doses on time. |
Disparities in First Dose COVID-19 Vaccination Coverage among Children 5-11 Years of Age, United States.
Murthy NC , Zell E , Fast HE , Murthy BP , Meng L , Saelee R , Vogt T , Chatham-Stephens K , Ottis C , Shaw L , Gibbs-Scharf L , Harris L , Chorba T . Emerg Infect Dis 2022 28 (5) 986-989 We analyzed first-dose coronavirus disease vaccination coverage among US children 5-11 years of age during November-December 2021. Pediatric vaccination coverage varied widely by jurisdiction, age group, and race/ethnicity, and lagged behind vaccination coverage for adolescents aged 12-15 years during the first 2 months of vaccine rollout. |
Disparities in COVID-19 Vaccination Coverage Between Urban and Rural Counties - United States, December 14, 2020-January 31, 2022.
Saelee R , Zell E , Murthy BP , Castro-Roman P , Fast H , Meng L , Shaw L , Gibbs-Scharf L , Chorba T , Harris LQ , Murthy N . MMWR Morb Mortal Wkly Rep 2022 71 (9) 335-340 Higher COVID-19 incidence and mortality rates in rural than in urban areas are well documented (1). These disparities persisted during the B.1.617.2 (Delta) and B.1.1.529 (Omicron) variant surges during late 2021 and early 2022 (1,2). Rural populations tend to be older (aged 65 years) and uninsured and are more likely to have underlying medical conditions and live farther from facilities that provide tertiary medical care, placing them at higher risk for adverse COVID-19 outcomes (2). To better understand COVID-19 vaccination disparities between urban and rural populations, CDC analyzed county-level vaccine administration data among persons aged 5 years who received their first dose of either the BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna) COVID-19 vaccine or a single dose of the Ad.26.COV2.S (Janssen [Johnson & Johnson]) COVID-19 vaccine during December 14, 2020-January 31, 2022, in 50 states and the District of Columbia (DC). COVID-19 vaccination coverage with 1 doses in rural areas (58.5%) was lower than that in urban counties (75.4%) overall, with similar patterns across age groups and sex. Coverage with 1 doses varied among states: 46 states had higher coverage in urban than in rural counties, one had higher coverage in rural than in urban counties. Three states and DC had no rural counties; thus, urban-rural differences could not be assessed. COVID-19 vaccine primary series completion was higher in urban than in rural counties. However, receipt of booster or additional doses among primary series recipients was similarly low between urban and rural counties. Compared with estimates from a previous study of vaccine coverage among adults aged 18 years during December 14, 2020-April 10, 2021, these urban-rural disparities among those now eligible for vaccination (aged 5 years) have increased more than twofold through January 2022, despite increased availability and access to COVID-19 vaccines. Addressing barriers to vaccination in rural areas is critical to achieving vaccine equity, reducing disparities, and decreasing COVID-19-related illness and death in the United States (2). |
Association of tumor necrosis factor inhibitor use with diagnostic features and mortality of tuberculosis in the United States, 2010-2017
Katrak SS , Li R , Reynolds S , Marks SM , Probst JR , Chorba T , Winthrop K , Castro KG , Goswami ND . Open Forum Infect Dis 2022 9 (2) ofab641 BACKGROUND: An elevated risk of tuberculosis (TB) disease in persons who have received tumor necrosis factor alpha inhibitor medications (TNF- inhibitors) has been reported for nearly two decades, but clinical diagnostic features and outcomes of TB in this population remain poorly described. METHODS: We analyzed national surveillance data for TB cases among persons aged 15 years and older reported in the United States during 2010-2017 and associated mortality data reported through 2019 to describe the clinical characteristics of those receiving TNF- inhibitors. RESULTS: Of 70129 TB cases analyzed, 504 (0.7%) of the patients had TNF- inhibitor use reported at TB diagnosis. Patients with TNF- inhibitor use at TB diagnosis were more likely than TB patients not receiving TNF- inhibitors to have TB diagnosed in extrapulmonary sites in conjunction with pulmonary sites (28.8% vs 10.0%, P<.001). Patients receiving TNF- inhibitors were less likely to have acid-fast bacilli noted on sputum smear microscopy (25.6% vs 39.1%, P=.04), and more likely to have drug-resistant disease (13.5% vs 10.0%, P<.001). TB-attributed deaths did not significantly differ between patients receiving and not receiving TNF- inhibitors (adjusted odds ratio, 1.46 [95% confidence interval, .95-2.26]). CONCLUSIONS: Clinicians evaluating TNF- inhibitor-treated patients should have a high index of suspicion for TB and be aware that extrapulmonary or sputum smear-negative TB disease is more common in these patients. No significantly diminished survival of TB patients treated with TNF- inhibitor therapy before TB diagnosis was noted. |
Booster and Additional Primary Dose COVID-19 Vaccinations Among Adults Aged ≥65 Years - United States, August 13, 2021-November 19, 2021.
Fast HE , Zell E , Murthy BP , Murthy N , Meng L , Scharf LG , Black CL , Shaw L , Chorba T , Harris LQ . MMWR Morb Mortal Wkly Rep 2021 70 (50) 1735-1739 Vaccination against SARS-CoV-2 (the virus that causes COVID-19) is highly effective at preventing hospitalization due to SARS-CoV-2 infection and booster and additional primary dose COVID-19 vaccinations increase protection (1-3). During August-November 2021, a series of Emergency Use Authorizations and recommendations, including those for an additional primary dose for immunocompromised persons and a booster dose for persons aged ≥18 years, were approved because of reduced immunogenicity in immunocompromised persons, waning vaccine effectiveness over time, and the introduction of the highly transmissible B.1.617.2 (Delta) variant (4,5). Adults aged ≥65 years are at increased risk for COVID-19-associated hospitalization and death and were one of the populations first recommended a booster dose in the U.S. (5,6). Data on COVID-19 vaccinations reported to CDC from 50 states, the District of Columbia (DC), and eight territories and freely associated states were analyzed to ascertain coverage with booster or additional primary doses among adults aged ≥65 years. During August 13-November 19, 2021, 18.7 million persons aged ≥65 years received a booster or additional primary dose of COVID-19 vaccine, constituting 44.1% of 42.5 million eligible* persons in this age group who previously completed a primary vaccination series.(†) Coverage was similar by sex and age group, but varied by primary series vaccine product and race and ethnicity, ranging from 30.3% among non-Hispanic American Indian or Alaska Native persons to 50.5% among non-Hispanic multiple/other race persons. Strategic efforts are needed to encourage eligible persons aged ≥18 years, especially those aged ≥65 years and those who are immunocompromised, to receive a booster and/or additional primary dose to ensure maximal protection against COVID-19. |
Confusion in the Genesis of Art and Disease: Charles Laval, Paul Gauguin, and Tuberculosis
Chorba T , Jereb J . Emerg Infect Dis 2020 26 (3) 634-5 Charles Laval (1861–1894) was a Parisian painter whose brief life ended in an untimely death from underlying tuberculosis. He was a colleague and contemporary of two other post-Impressionists: Vincent van Gogh (1853–1890) and Paul Gauguin (1848–1903). In part because of misattribution, Laval’s work has receded into a historical footnote to the career of Gauguin, whose output far exceeded that of Laval. Gauguin, among the most renowned of the late 19th century European artists, was a pioneer of the Synthetist school of painting. This post-Impressionist movement encouraged artists to depict their emotions about the subject, beyond its outward appearance, with bold displays of color, relaxation of exactitude, and portrayal of form based on memory. | | Laval studied under realist painter Léon Bonnat at the École des Beaux-Arts in Paris. In the summer of 1886, he became acquainted with van Gogh and Gauguin at Pont-Aven, a growing artist colony in Brittany. In April 1887, Laval and Gauguin set sail for Panama, an adventure that was ostensibly pursued for employment at the invitation of Gauguin’s brother-in-law, a Chilean with business interests in Panama. In June 1887, after several misadventures, Laval and Gauguin left Panama for Martinique, where they painted together before returning to France in November of the same year. |
Essential components of a public health tuberculosis prevention, control, and elimination program: Recommendations of the Advisory Council for the Elimination of Tuberculosis and the National Tuberculosis Controllers Association
Cole B , Nilsen DM , Will L , Etkind SC , Burgos M , Chorba T . MMWR Recomm Rep 2020 69 (7) 1-27 This report provides an introduction and reference tool for tuberculosis (TB) controllers regarding the essential components of a public health program to prevent, control, and eliminate TB. The Advisory Council for the Elimination of Tuberculosis and the National Tuberculosis Controllers Association recommendations in this report update those previously published (Advisory Council for the Elimination of Tuberculosis. Essential components of a tuberculosis prevention and control program. Recommendations of the Advisory Council for the Elimination of Tuberculosis. MMWR Recomm Rep 1995;44[No. RR-11]). The report has been written collaboratively on the basis of experience and expert opinion on approaches to organizing programs engaged in diagnosis, treatment, prevention, and surveillance for TB at state and local levels.This report reemphasizes the importance of well-established priority strategies for TB prevention and control: identification of and completion of treatment for persons with active TB disease; finding and screening persons who have had contact with TB patients; and screening, testing, and treatment of other selected persons and populations at high risk for latent TB infection (LTBI) and subsequent active TB disease.Health departments are responsible for public safety and population health. To meet their responsibilities, TB control programs should institute or ensure completion of numerous responsibilities and activities described in this report: preparing and maintaining an overall plan and policy for TB control; maintaining a surveillance system; collecting and analyzing data; participating in program evaluation and research; prioritizing TB control efforts; ensuring access to recommended laboratory and radiology tests; identifying, managing, and treating contacts and other persons at high risk for Mycobacterium tuberculosis infection; managing persons who have TB disease or who are being evaluated for TB disease; providing TB training and education; and collaborating in the coordination of patient care and other TB control activities. Descriptions of CDC-funded resources, tests for evaluation of persons with TB or LTBI, and treatment regimens for LTBI are provided (Supplementary Appendices; https://stacks.cdc.gov/view/cdc/90289). |
Treatment of drug-resistant tuberculosis. An official ATS/CDC/ERS/IDSA Clinical Practice Guideline
Nahid P , Mase SR , Migliori GB , Sotgiu G , Bothamley GH , Brozek JL , Cattamanchi A , Cegielski JP , Chen L , Daley CL , Dalton TL , Duarte R , Fregonese F , Horsburgh CR Jr , Ahmad Khan F , Kheir F , Lan Z , Lardizabal A , Lauzardo M , Mangan JM , Marks SM , McKenna L , Menzies D , Mitnick CD , Nilsen DM , Parvez F , Peloquin CA , Raftery A , Schaaf HS , Shah NS , Starke JR , Wilson JW , Wortham JM , Chorba T , Seaworth B . Am J Respir Crit Care Med 2019 200 (10) e93-e142 Background: The American Thoracic Society, U.S. Centers for Disease Control and Prevention, European Respiratory Society, and Infectious Diseases Society of America jointly sponsored this new practice guideline on the treatment of drug-resistant tuberculosis (DR-TB). The document includes recommendations on the treatment of multidrug-resistant TB (MDR-TB) as well as isoniazid-resistant but rifampin-susceptible TB.Methods: Published systematic reviews, meta-analyses, and a new individual patient data meta-analysis from 12,030 patients, in 50 studies, across 25 countries with confirmed pulmonary rifampin-resistant TB were used for this guideline. Meta-analytic approaches included propensity score matching to reduce confounding. Each recommendation was discussed by an expert committee, screened for conflicts of interest, according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology.Results: Twenty-one Population, Intervention, Comparator, and Outcomes questions were addressed, generating 25 GRADE-based recommendations. Certainty in the evidence was judged to be very low, because the data came from observational studies with significant loss to follow-up and imbalance in background regimens between comparator groups. Good practices in the management of MDR-TB are described. On the basis of the evidence review, a clinical strategy tool for building a treatment regimen for MDR-TB is also provided.Conclusions: New recommendations are made for the choice and number of drugs in a regimen, the duration of intensive and continuation phases, and the role of injectable drugs for MDR-TB. On the basis of these recommendations, an effective all-oral regimen for MDR-TB can be assembled. Recommendations are also provided on the role of surgery in treatment of MDR-TB and for treatment of contacts exposed to MDR-TB and treatment of isoniazid-resistant TB. |
Romanticism, Mycobacterium, and the Myth of the Muse
Mahoney D , Chorba T . Emerg Infect Dis 2019 25 (3) 617-8 At the transition of the 18th into the 19th century, large numbers of deaths in Europe, especially those in urban areas, were associated with tuberculosis. During those two centuries, many celebrated artists, musicians, and literary giants were lost to the disease. Romanticism—Europe’s dominant artistic, musical, and intellectual movement that began in the late 18th century and waned after 1850—emphasized individualism and emotion. Characteristic themes included the goodness of people, from which urban life detracted, and the simplicities of childhood and all things natural. A popular myth arose that this movement was favored by tuberculosis, which putatively augmented one’s creative faculties. Classicists viewed this belief as consistent with what ancient Greek physicians had called the spes phthisica—an earnest hope of recovery from tuberculosis that drove heightened sensitivity and great creativity despite overwhelming illness. Portrayals of this view appear in Alexander Dumas's La Dame aux Camélias, Victor Hugo's Les Misérables, Giuseppe Verdi's La traviata, and Giacomo Puccini's La bohème. | | Among German writers of the Romantic era who had tuberculosis were Johann Wolfgang von Goethe (1749–1832; best known to English speakers for his poetic drama Faust), Friedrich Schiller (1759–1805; trained as a physician and author of “An die Freude”—the Ode to Joy in the final movement of Beethoven’s Ninth Symphony), and Georg Philipp Friedrich von Hardenberg (1772–1801; principal poet-theoretician of Early German Romanticism). Goethe received his tuberculosis diagnosis when in his early 20s and recovered fully after several years of convalescence. In contrast, Schiller died of pulmonary tuberculosis at age 46 after a period of increasing lethargy. |
Treatment of drug-resistant tuberculosis
Mase SR , Chorba T . Clin Chest Med 2019 40 (4) 775-795 The treatment of drug-resistant tuberculosis (TB) is complicated and has evolved significantly in the past decade with the advent of rapid molecular tests and updated evidence-based guidelines of the World Health Organization and other organizations. The latest recommendations incorporate the use of new drugs and regimens that maximize efficacy and minimize toxicity to improve treatment outcomes for the patients. This article provides an overview of the latest published strategies for clinical and programmatic management of drug-resistant TB. |
Bedaquiline for the treatment of multidrug-resistant tuberculosis in the United States
Mase S , Chorba T , Parks S , Belanger A , Dworkin F , Seaworth B , Warkentin J , Barry P , Shah N . Clin Infect Dis 2019 71 (4) 1010-1016 BACKGROUND: In 2012, the Food and Drug Administration approved the use of bedaquiline fumarate as part of combination therapy for treatment of multidrug-resistant tuberculosis (MDR TB). We describe the treatment outcomes, safety, and tolerability of bedaquiline in our case series. METHODS: Data on patients started on bedaquiline for MDR TB between September 2012 and August 2016 were collected retrospectively through four TB programs using a standardized abstraction tool. Data were analyzed using univariate methods. Adverse events were graded using the Common Terminology Criteria for Adverse Events. RESULTS: Of 14 patients in this case series, 7/14 (50%) had MDR, 4/14 (29%) had pre-extensively-drug-resistant (XDR), and 3/14 (21%) had XDR. All had pulmonary TB, 5/14 (36%) had pulmonary and extrapulmonary TB, and 9/13 (69%) were smear-positive. One patient (7%) had HIV co-infection, 5/14 (36%) had diabetes mellitus, and 5 (36%) had been previously treated for TB. All patients were non-U.S.-born and 5 (36%) had private insurance. All patients achieved sputum culture conversion within a mean of 71 days (26-116); 6/14 after starting bedaquiline. Twelve (86%) completed treatment and 1/14 (7%) moved out of the country. One patient (7%) had QTc prolongation >500 milliseconds and died 20 months after discontinuing bedaquiline of a cause not attributable to the drug. The most common adverse events were peripheral neuropathy (50%), not customarily associated with bedaquiline use, and QTc prolongation (43%). CONCLUSIONS: Of 14 patients, one had an adverse event necessitating bedaquiline discontinuation. Safety, culture conversion, and treatment completion in this series support use of bedaquiline for the treatment of MDR/XDR TB. |
Rifampin-resistant tuberculosis in the United States, 1998-2014
Sharling L , Marks SM , Goodman M , Chorba T , Mase S . Clin Infect Dis 2019 70 (8) 1596-1605 BACKGROUND: Monoresistance to rifamycins necessitates longer and more toxic regimens for tuberculosis (TB). We examined characteristics and mortality associated with rifampin-monoresistant (RMR) TB in the United States. METHODS: We analyzed Mycobacterium tuberculosis culture-positive cases reported to the National TB Surveillance System (excluding California because HIV infection was not reported to CDC during 2005-2010) between 1998 and 2014. We defined: (1) RMR TB found on initial drug susceptibility testing (DST), and (2) possible acquired rifampin-resistant (ARR) TB. We assessed temporal trends in RMR TB. For both classifications of rifampin resistance, we calculated adjusted risk ratios (adjRR) and 95% confidence intervals (CI) for social and clinical characteristics associated with mortality when compared to drug-susceptible TB in multivariable models using backwards selection. RESULTS: Of 180,329 TB cases, 126,431 (70%) cases were eligible for analysis, with 359 (0.28%) of eligible cases reported as RMR. The percentage of RMR TB cases with HIV declined 4% annually during 1998-2014. Persons with HIV and prior TB were more likely to have RMR TB (adjRR=25.9, CI=17.6-38.1), as were persons with HIV and no prior TB (adjRR=3.1, CI=2.4-4.1), versus those without either characteristic, controlling for other statistically significant variables. RMR cases had greater mortality (adjRR=1.4, CI=1.04-1.8), controlling for HIV and other variables. Persons with HIV had greater risk of ARR than persons without HIV (adjRR=9.6, CI=6.9-13.3) and ARR was also associated with increased mortality, controlling for HIV and other variables. CONCLUSIONS: All forms of rifampin resistance were positively associated with HIV infection and increased mortality. |
Tuberculosis surveillance and control, Puerto Rico, 1898-2015
Dirlikov E , Thomas D , Yost D , Tejada-Vera B , Bermudez M , Joglar O , Chorba T . Emerg Infect Dis 2019 25 (3) 538-546 The World Health Organization recognizes Puerto Rico as an area of low tuberculosis (TB) incidence, where TB elimination is possible by 2035. To describe the current low incidence of reported cases, provide key lessons learned, and detect areas that may affect progress, we systematically reviewed the literature about the history of TB surveillance and control in Puerto Rico and supplemented this information with additional references and epidemiologic data. We reviewed 3 periods: 1898-1946 (public health efforts before the advent of TB chemotherapy); 1947-1992 (control and surveillance after the introduction of TB chemotherapy); and 1993-2015 (expanded TB control and surveillance). Although sustained surveillance, continued care, and use of newly developed strategies occurred concomitantly with decreased incidence of reported TB cases and mortality rates, factors that may affect progress remain poorly understood and include potential delayed diagnosis and underreporting, the effects of government debt and Hurricane Maria, and poverty. |
Peace, Liberty, Mycobacteria, and Tuberculosis Mortality
Chorba T . Emerg Infect Dis 2018 24 (3) 611-2 In 1935, Gerhard Domagk and Josef Klarer, working with dyes at the Bayer Institute of Pathology and Bacteriology, published the results of several clinical investigations of sulfamidochrysoidine. This antibacterial drug was the first of the sulfonamide-containing or related products that transformed approaches to treatment of infection and heralded the antibiotic era. Before that, the only antimicrobials available were the arsenicals (arsphenamine and neosalvarsan), which were used to treat syphilis. Sulfamidochrysoidine, produced under the trademark name of Prontosil, was demonstrated to be effective for treating streptococcal and staphylococcal infections. In 1939, Domagk was recognized with the Nobel Prize in Physiology or Medicine; although the Third Reich forced him to decline the award, he subsequently received it in 1947. | | The year 1935 also was the final one in which a US dollar made predominantly of silver (silver dollar) was minted for general circulation. The coin was first issued in 1921. Its design earned it the name “Peace Dollar”; its reverse side portrays an American bald eagle with an olive branch in its talons, intended to celebrate the long-lasting peace that was to have followed the Great War, World War I. The bird is at rest, its wings folded, perched on a craggy rock above the word “Peace,” facing the dawn’s rays rising beyond distant hills. |
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