Last data update: Apr 22, 2024. (Total: 46599 publications since 2009)
Records 1-18 (of 18 Records) |
Query Trace: Collier MG [original query] |
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Outbreak of hepatitis B and hepatitis C virus infections associated with a cardiology clinic, West Virginia, 2012-2014.
Tressler SR , Del Rosario MC , Kirby MD , Simmons AN , Scott MA , Ibrahim S , Forbi JC , Thai H , Xia GL , Lyman M , Collier MG , Patel PR , Bixler D . Infect Control Hosp Epidemiol 2021 42 (12) 1-6 OBJECTIVE: To stop transmission of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in association with myocardial perfusion imaging (MPI) at a cardiology clinic. DESIGN: Outbreak investigation and quasispecies analysis of HCV hypervariable region 1 genome. SETTING: Outpatient cardiology clinic. PATIENTS: Patients undergoing MPI. METHODS: Case patients met definitions for HBV or HCV infection. Cases were identified through surveillance registry cross-matching against clinic records and serological screening. Observations of clinic practices were performed. RESULTS: During 2012-2014, 7 cases of HCV and 4 cases of HBV occurred in 4 distinct clusters among patients at a cardiology clinic. Among 3 case patients with HCV infection who had MPI on June 25, 2014, 2 had 98.48% genetic identity of HCV RNA. Among 4 case patients with HCV infection who had MPI on March 13, 2014, 3 had 96.96%-99.24% molecular identity of HCV RNA. Also, 2 clusters of 2 patients each with HBV infection had MPI on March 7, 2012, and December 4, 2014. Clinic staff reused saline vials for >1 patient. No infection control breaches were identified at the compounding pharmacy that supplied the clinic. Patients seen in clinic through March 27, 2015, were encouraged to seek testing for HBV, HCV, and human immunodeficiency virus. The clinic switched to all single-dose medications and single-use intravenous flushes on March 27, 2015, and no further cases were identified. CONCLUSIONS: This prolonged healthcare-associated outbreak of HBV and HCV was most likely related to breaches in injection safety. Providers should follow injection safety guidelines in all practice settings. |
Hepatitis B and C virus infections transmitted through organ transplantation investigated by CDC, United States, 2014-2017
Bixler D , Annambholta P , Abara WE , Collier MG , Jones J , Mixson-Hayden T , Basavaraju SV , Ramachandran S , Kamili S , Moorman A . Am J Transplant 2019 19 (9) 2570-2582 We evaluated clinical outcomes among organ recipients with donor-derived hepatitis B virus (HBV) or hepatitis C virus (HCV) infections investigated by CDC from 2014-2017 in the United States. We characterized new HBV infections in organ recipients if donors tested negative for total anti-HBc, HBsAg and HBV DNA, and new recipient HCV infections if donors tested negative for anti-HCV and HCV RNA. Donor risk behaviors were abstracted from next-of-kin interviews and medical records. During 2014-2017, seven new recipient HBV infections associated with seven donors were identified; six (86%) recipients survived. At last follow-up, all survivors had functioning grafts and five (83%) had started antiviral therapy. Twenty new recipient HCV infections associated with nine donors were identified; 19 (95%) recipients survived. At last follow-up, 18 (95%) survivors had functioning grafts and 14 (74%) had started antiviral treatment. Combining donor next-of kin interviews and medical records, 11/16 (69%) donors had evidence of injection drug use and all met Public Health Service increased risk donor (IRD) criteria. IRD designation led to early diagnosis of recipient infection, and prompt implementation of therapy, likely reducing the risk of graft failure, liver disease and death. This article is protected by copyright. All rights reserved. |
Characteristics of deceased solid organ donors and screening results for hepatitis B, C, and human immunodeficiency viruses - United States, 2010-2017
Abara WE , Collier MG , Moorman A , Bixler D , Jones J , Annambhotla P , Bowman J , Levi ME , Brooks JT , Basavaraju SV . MMWR Morb Mortal Wkly Rep 2019 68 (3) 61-66 The ongoing U.S. opioid crisis has resulted in an increase in drug overdose deaths and acute hepatitis C virus (HCV) infections, with young persons (who might be eligible organ donors) most affected. In 2013, the Public Health Service released a revised guideline to reduce the risk for unintended organ transplantation-associated hepatitis B virus (HBV), HCV, and human immunodeficiency virus (HIV) transmission (1). The guideline describes criteria to categorize donors at increased risk (increased risk donors [IRDs]) for transmitting these viruses to recipients (1). It also recommends universal donor testing for HBV, HCV, and HIV. CDC analyzed deceased donor data for the period 2010-2017 reported to the Organ Procurement and Transplantation Network for IRDs and standard risk donors (SRDs) (i.e., donors who do not meet any of the criteria for increased risk designation). During this period, the proportion of IRDs increased approximately 200%, from 8.9% to 26.3%; the percentage with drug intoxication reported as the mechanism of death also increased approximately 200%, from 4.3% to 13.4%; and the proportion of these donors with reported injection drug use (IDU) increased approximately 500%, from 1.3% to 8.0%. Compared with SRDs, IRDs were significantly more likely to have positive HBV and HCV screening results. These findings demonstrate the continuing need for identifying viral bloodborne pathogen infection risk factors among deceased donors to reduce the risk for transmission, monitor posttransplant infection in recipients, and offer treatment if infection occurs. |
The predictive value of International Classification of Disease codes for chronic hepatitis C virus infection surveillance: The utility and limitations of electronic health records
Abara WE , Moorman AC , Zhong Y , Collier MG , Rupp LB , Gordon SC , Boscarino JA , Schmidt MA , Trinacty CM , Holmberg SD . Popul Health Manag 2018 21 (2) 110-115 Surveillance of chronic hepatitis C virus (HCV) cases faces limitations that result in delays and underreporting. With increasing use of electronic health records (EHRs), the authors evaluated the predictive value of using International Classification of Diseases, Ninth Revision (ICD-9) codes to identify chronic HCV cases from EHR data. Longitudinal EHR data from 4 health care systems during 2006-2012 were evaluated. Using chart abstraction and review to confirm chronic HCV cases ("gold standard" definition), the authors calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 2 case definitions: (1) >/=2 ICD-9 codes separated by >/= 6 months and (2) >/=1 positive HCV RNA (ribonucleic acid) test. Among 2,718,995 patients, 20,779 (0.8%) with ICD-9 codes indicating a likely diagnosis of chronic HCV infection were identified; 13,595 (65.4%) of these were randomly selected for review. Case definition 1 (>/= 2 ICD-9 codes separated by >/= 6 months) had 70.3% sensitivity, 91.9% PPV, 99.9% specificity, and 99.9% NPV while case definition 2 (>/= 1 positive HCV RNA test) had 74.1% sensitivity, 97.4% PPV, 99.9% specificity, and 99.9% NPV. The predictive values of these alternate EHR-derived ICD-9 code-based case definitions suggest that these measures may be useful in capturing the burden of diagnosed chronic HCV infections. Their use can augment current chronic HCV case surveillance efforts; however, their accuracy may vary by length of observation and completeness of EHR data. |
Using population based hospitalization data to monitor increases in conditions causing morbidity among persons who inject drugs
Collier MG , Doshani M , Asher A . J Community Health 2018 43 (3) 598-603 Epidemics of opioid use and injection drug use (IDU) are associated with an increase in HIV and viral hepatitis infections and overdose deaths in the United States. Persons who inject drugs (PWID) are also at risk for serious infections caused by skin organisms introduced via IDU. We examined National Inpatient Sample hospital discharge data to determine trends in three serious infectious disease-associated conditions that primarily affect PWID in addition to HIV and viral hepatitis: infective endocarditis (IE), central nervous system (CNS) abscesses, and osteomyelitis. We found an increase in the number of primary hospitalization discharge diagnoses for IE among persons aged </=39 years from 2009 to 2013. Hospitalization rates for these diagnoses also increased over this study period for person with secondary diagnoses of hepatitis B, C, or D viruses and substance-related disorders for IE, CNS abscess and osteomyelitis. Policies that improve access to sterile injection equipment, improve education regarding IDU, and treatment for substance use disorder may help to reduce the impact of serious and often fatal infectious diseases among PWID. |
The financial burden of public health responses to hepatitis A cases among food handlers, 2012-2014
Morey RJ , Collier MG , Nelson NP . Public Health Rep 2017 132 (4) 33354917710947 When food handlers become ill with hepatitis A virus (HAV) infection, state and local health departments must assess the risk of HAV transmission through prepared food and recommend or provide postexposure prophylaxis (PEP) for those at risk for HAV infection. Providing PEP (eg, hepatitis A [HepA] vaccine or immunoglobulin), however, is costly. To describe the burden of these responses on state and local health departments, we determined the number of public health responses to HAV infections among food handlers by reviewing public internet sources of media articles. We then contacted each health department to collect data on whether PEP was recommended to food handlers or restaurant patrons, the number of PEP doses given, the number of HepA vaccine or immunoglobulin doses given as PEP, and the mean number of health department person-hours required for the response. Of 32 public health responses identified from Twitter, HealthMap, and Google alerts from January 1, 2012, to December 31, 2014, a total of 27 (84%) recommended PEP for other food handlers or restaurant patrons or both. Per public health response, the mean cost per dose of the HepA vaccine or immunoglobulin was $34 139; the mean personnel cost per response was $7329; and the total mean cost of each response was $41 468. PEP is expensive. Less aggressive approaches to PEP, such as limiting PEP to fellow food handlers in nonoutbreak situations, should be considered in the postvaccination era. HepA vaccine for PEP provides long-term immunity and can be used when immunoglobulin is unavailable or cannot be administered within 14 days of exposure to HAV. |
Comparison of three popular methods for recruiting young persons who inject drugs for interventional studies
Collier MG , Garfein RS , Cuevas-Mota J , Teshale EH . J Urban Health 2017 94 (4) 587-591 Persons who inject drugs (PWID) are at risk for adverse health outcomes as a result of their drug use, and the resulting social stigma makes this a difficult population to reach for interventions aimed at reducing morbidity and mortality. During our study of adult PWID aged ≤40 years living in San Diego during 2009 and 2010, we compared three different sampling methods: respondent-driven sampling (RDS), venue-based sampling at one syringe exchange program (SEP), and street-based outreach. We compared demographic, socioeconomic, health, and behavioral factors and tested participants for HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) and compared across the three methods. Overall, 561 (74.8%) of the targeted 750 PWID were enrolled. Venue-based convenience sampling enrolled 96% (242/250) of the targeted participants, followed closely by street-based outreach with 92% (232/250) recruited. While RDS yielded the fewest recruits, producing only 35% (87/250) of the expected participants, those recruited through RDS were more likely to be female, more racially diverse, and younger. |
Detection, reporting, and treatment of hepatitis C infections among hemodialysis patients
Collier MG , Nguyen DB , Patel PR , Moorman AC . Infect Control Hosp Epidemiol 2017 38 (4) 493-494 Hepatitis C virus (HCV) is transmitted primarily through contact with the blood of an infected person, and healthcare-associated HCV infection outbreaks are well documented. 1 The prevalence of HCV infection among patients with end-stage renal disease (ESRD) who receive hemodialysis (HD) is high (7.8%–14%).Reference Goodkin, Bieber, Gillespie, Robinson and Jadoul 2 HCV infection is an independent risk factor for death in HD patients and increases the chance of graft failure and death after renal transplantation.Reference Kalantar-Zadeh, Kilpatrick and McAllister 3 Although interferon injection therapies are poorly tolerated in HCV-infected HD patients, those who completed the therapies demonstrated improved survival.Reference Kalantar-Zadeh, Kilpatrick and McAllister 3 In 2014, all-oral curative HCV therapies became available specifically for patients with ESRD.Reference Roth, Nelson and Bruchfeld 4 | Testing is essential to detect HCV infection in high-risk populations. The Centers for Disease Control and Prevention (CDC) recommends routine screening of chronic HD patients for HCV antibody (anti-HCV) upon facility admission and every 6 months to identify possible dialysis-related transmission.Reference Alter, Lyerla and Tokars 5 Patients who test positive for anti-HCV should undergo confirmatory HCV nucleic acid testing (NAT) to detect HCV RNA.Reference Getchell, Wroblewski and DeMaria 6 HCV-infected patients should be evaluated for recommended care and treatment.Reference Alter, Lyerla and Tokars 5 | Testing has frequently identified HCV transmission and outbreaks in dialysis units that may otherwise be difficult to detect because of the typically asymptomatic nature of acute infection. Basic infection-control lapses are often identified in dialysis centers with HCV outbreaks.Reference Alter, Lyerla and Tokars 5 As a result, any case of new HCV infection in a patient undergoing HD should be reported to public health authorities to facilitate investigation and rapid correction of breaches. Rigorous adherence to recommended infection control practices is needed to protect patients and prevent outbreaks in this population. We analyzed data from outbreaks of HCV in dialysis facilities reported to the CDC for opportunities to reduce HCV prevalence in this population. |
Impact of universal infant hepatitis B vaccination in the US-affiliated Pacific Islands, 1985-2015
Abara WE , Collier MG , Teshale EH . Vaccine 2017 35 (7) 997-1000 The US-affiliated Pacific Island countries (USAPI) is an endemic region for hepatitis B virus (HBV) infection. Universal infant hepatitis B vaccination was introduced in the USAPI in the mid-1980s to mitigate the HBV burden. We assessed the impact of universal infant vaccination on the HBV infection prevalence over time among children born in the 1980s, 1990s, and 2000s in the USAPI. Demographic and serologic data from serial sero-surveys conducted between 1985 and 2015 were obtained. Descriptive statistics and analysis of variance were performed. From data obtained from 4827 children (2-11years), HBV prevalence decreased markedly: 8.4% in the 1980s; 2.5% in the 1990s; and 0.2% in the 2000s (P<0.0001) as vaccination coverage increased: 76.4% in the 1980s; 87.3% in the 1990s; and 97.5% in the 2000s (P<0.0001). These findings underscore the protective effect of universal infant hepatitis B vaccination over time on the HBV burden in an HBV endemic region. |
Hepatitis C virus transmission in a skilled nursing facility, North Dakota, 2013
Calles DL , Collier MG , Khudyakov Y , Mixson-Hayden T , VanderBusch L , Weninger S , Miller TK . Am J Infect Control 2016 45 (2) 126-132 BACKGROUND: From March-May 2013, 3 cases of acute hepatitis C virus (HCV) infection were diagnosed among elderly patients residing at the same skilled nursing facility (facility A) and who received health care at hospital X during their likely exposure period. METHODS: We performed HCV testing of at-risk populations; quasispecies analysis was performed to determine relatedness of HCV in persons with current infection. Infection control practice assessments were conducted at facility A and hospital X. Persons residing in facility A on September 9, 2013, were enrolled in a case-control study to identify risk factors for HCV infection. RESULTS: Forty-five outbreak-associated infections were identified. Thirty cases and 62 controls were enrolled in the case-control study. Only podiatry (odds ratio, 11.6; 95% confidence interval, 2.4-57.2) and international normalized ratio monitoring by phlebotomy (odds ratio, 6.7; 95% confidence interval, 1.7-26.6) at facility A were significantly associated with case status. Infection control lapses during podiatry and point-of-care testing procedures at facility A were identified. CONCLUSIONS: HCV transmission was confirmed among residents of facility A. The exact mode of transmission was not able to be identified, but infection control lapses were likely responsible. This outbreak highlights the importance of prompt reporting and investigation of incident HCV infection and the need for adherence to basic infection control procedures by health care personnel. |
Hepatitis a infections among food handlers in the United States, 1993–2011
Sharapov UM , Kentenyants K , Groeger J , Roberts H , Holmberg SD , Collier MG . Public Health Rep 2016 131 (1) 26-29 We reviewed news reports of hepatitis A virus (HAV)-infected food handlers in the United States from 1993 to 2011 using the LexisNexis® search engine. Using U.S. news reports, we identified 192 HAV-infected food handlers who worked while infectious; of these HAV-infected individuals, 34 (18%) transmitted HAV to restaurant patrons. News reports of HAV-infected food handlers declined from 1993 to 2011. This analysis suggests that universal childhood vaccination contributed to the decrease in reports of HAV-infected food handlers, but mandatory vaccination of this group is unlikely to be cost-effective. |
Incident hepatitis among repeat blood donors: a sentinel event signaling possible health care-associated infection and need for reporting to public health authorities
Moorman AC , Stramer SL , Schaefer MK , Collier MG , Suryaprasad A , Kuehnert MJ , Moore Z , Rowan E , Habicht K , Bradley K , Fucci MC , Hopkins C , Xu F . Transfusion 2015 55 (10) 2531-3 Identification of a recently acquired viral hepatitis infection among repeat blood donors can be a sentinel event signaling a possible healthcare-associated infection (HAI) in the donor, especially in individuals who did not disclose self-reported behavioral risk factors and were test-negative at prior successful donations. With the 2012 update to the Council of State and Territorial Epidemiologists (CSTE) acute hepatitis B and hepatitis C surveillance case definitions, asymptomatic individuals who meet the laboratory criteria for these case definitions should be included among the cases reportable to public health authorities (1,2). This report serves as a reminder of the importance of recognizing incident hepatitis infections in blood donors as a possible sentinel event to uncover previous healthcare-associated transmission clusters, and that identification of a hepatitis B virus (HBV) or hepatitis C virus (HCV) nucleic acid test (NAT) confirmed positive result within six months of a NAT negative result (as may be identified in a repeat blood donor) is reportable to public health authorities. Recent data suggest consideration that this six month period be extended to within one year. |
Hepatitis A and B among young persons who inject drugs - vaccination, past, and present infection
Collier MG , Drobeniuc J , Cuevas-Mota J , Garfein RS , Kamili S , Teshale EH . Vaccine 2015 33 (24) 2808-12 BACKGROUND: Our study aims were to assess hepatitis A virus (HAV) and hepatitis B virus (HBV) susceptibility and infection among young persons who inject drugs (PWID) who may have been vaccinated as children and to evaluate self-report of HAV and HBV vaccination. METHODS: We recruited PWID aged 18-40 years-old in San Diego during 2009 and 2010 and collected demographic, socioeconomic, health, and behavioral factors. Participants were asked if they had been vaccinated against HAV and HBV, and serum samples were collected for HAV and HBV serologic testing. RESULTS: Of 519 participants, 365 (72%) were male, 252 (49%) were white non-Hispanic, 38 (7%) were Black non-Hispanic, 138 (27%) were White Hispanic, and 22 (4%) were born outside the U. S. Of the total participants, 245 (47%) had surface hepatitis B antibody (anti-HBs) titers <10mIU/ml (i.e., HBV susceptible) and 325 (63%) had no detectable HAV antibodies (HAV susceptible). Hepatitis B surface antigen was detected in 7 (1%) of total participants; and 135 (26%) were anti-HCV-antibody positive. Compared to serologic findings, self-report of HBV and HAV vaccination was 71% and 41% sensitive, and 58% and 73% specific, respectively. CONCLUSION: HAV and HBV antibodies in half or more of this young PWID population did not have levels indicative of protection, and about a quarter had HCV infection, putting them at risk for complications resulting from co-infection with HAV or HBV. Programs serving this population should vaccinate PWIDs against HAV and HBV and not rely on self-report of vaccination. |
Awareness of HCV infection among persons who inject drugs in San Diego, California
Collier MG , Bhaurla SK , Cuevas-Mota J , Armenta RF , Teshale EH , Garfein RS . Am J Public Health 2014 105 (2) e1-e2 We asked persons who inject drugs questions about HCV, including past testing and diagnosis followed by HCV testing. Of 540 participants, 145 (27%) were anti-HCV positive, but of those who were positive, only 46 (32%) knew about their infection. Asking about previous HCV testing results yielded better results than did asking about prior HCV diagnosis. Factors associated with knowing about HCV infection included older age, HIV testing, and drug treatment. Comprehensive approaches to educating and screening this population for HCV need implementation. |
Hepatitis A hospitalizations in the United States, 2002-2011
Collier MG , Tong X , Xu F . Hepatology 2014 61 (2) 481-5 BACKGROUND: Hepatitis A illness severity increases with age. One indicator of hepatitis A illness severity is whether persons hospitalized. We describe changes in primary hepatitis A hospitalization rates in the United States from 2002-2011, including changes in demographics, secondary discharge diagnoses, and factors affecting hospitalization duration. METHODS: We describe changes from 2002-2011 among U. S. residents hospitalized with a principal hepatitis A diagnosis and accompanying secondary diagnoses using ICD-9 codes from the National Inpatient Survey discharge data. We calculated rates of hospitalizations with hepatitis A as the principal discharge diagnosis and rates of secondary discharge diagnoses. Using multiple regression, we assessed the effect of secondary diagnoses on hospitalization length of stay for five time intervals: 2002-2003, 2004-2005, 2006-2007, 2008-2009 and 2010-2011. RESULTS: Rates of hospitalization for hepatitis A as a principal diagnosis decreased from 0.72/100,000 to 0.29/100,000 (p <0.0001) and mean age of those hospitalized increased from 37.6 years to 45.5 years (p <0.0001) during 2002-2011. The percentage of hepatitis A hospitalizations covered by Medicare increased from 12.4% to 22.7% (p <0.0001). Secondary comorbid discharge diagnoses increased, including liver disease, hypertension, ischemic heart disease, disorders of lipid metabolism, and chronic kidney disease. No changes in length-of-stay or in-hospital deaths from hepatitis A overtime were found, but persons with liver disease were hospitalized longer. DISCUSSION: Hospitalization rates for hepatitis A illness have declined significantly from 2002-2011, but the characteristics of the hospitalized population also changed. Persons hospitalized for hepatitis A in recent years are older and more likely to have liver diseases and other comorbid medical conditions. Hepatitis A disease and resulting hospitalizations could be prevented through adult vaccination. |
Outbreak of hepatitis A in the USA associated with frozen pomegranate arils imported from Turkey: an epidemiological case study.
Collier MG , Khudyakov YE , Selvage D , Adams-Cameron M , Epson E , Cronquist A , Jervis RH , Lamba K , Kimura AC , Sowadsky R , Hassan R , Park SY , Garza E , Elliott AJ , Rotstein DS , Beal J , Kuntz T , Lance SE , Dreisch R , Wise ME , Nelson NP , Suryaprasad A , Drobeniuc J , Holmberg SD , Xu F . Lancet Infect Dis 2014 14 (10) 976-81 BACKGROUND: In May, 2013, an outbreak of symptomatic hepatitis A virus infections occurred in the USA. Federal, state, and local public health officials investigated the cause of the outbreak and instituted actions to control its spread. We investigated the source of the outbreak and assessed the public health measures used. METHODS: We interviewed patients, obtained their shopping information, and did genetic analysis of hepatitis A virus recovered from patients' serum and stool samples. We tested products for the virus and traced supply chains. FINDINGS: Of 165 patients identified from ten states, 69 (42%) were admitted to hospital, two developed fulminant hepatitis, and one needed a liver transplant; none died. Illness onset occurred from March 31 to Aug 12, 2013. The median age of patients was 47 years (IQR 35-58) and 91 (55%) were women. 153 patients (93%) reported consuming product B from retailer A. 40 patients (24%) had product B in their freezers, and 113 (68%) bought it according to data from retailer A. Hepatitis A virus genotype IB, uncommon in the Americas, was recovered from specimens from 117 people with hepatitis A virus illness. Pomegranate arils that were imported from Turkey-where genotype IB is common-were identified in product B. No hepatitis A virus was detected in product B. INTERPRETATION: Imported frozen pomegranate arils were identified as the vehicle early in the investigation by combining epidemiology-with data from several sources-genetic analysis of patient samples, and product tracing. Product B was removed from store shelves, the public were warned not to eat product B, product recalls took place, and postexposure prophylaxis with both hepatitis A virus vaccine and immunoglobulin was provided. Our findings show that modern public health actions can help rapidly detect and control hepatitis A virus illness caused by imported food. Our findings show that postexposure prophylaxis can successfully prevent hepatitis A illness when a specific product is identified. Imported food products combined with waning immunity in some adult populations might make this type of intervention necessary in the future. |
Assessing compliance with a county board order for third trimester syphilis screening in Maricopa County, Arizona
Collier MG , Taylor MM , Winscott MM , Mickey T , England B . Sex Reprod Healthc 2011 2 (3) 125-8 OBJECTIVES: Due to high rates of congenital syphilis, a Maricopa County board order was issued in 2003 to increase prenatal syphilis screening. The provisions of this order included prenatal syphilis screening during the first prenatal visit, to be repeated during the third trimester, and again at delivery. The purpose of the study was to evaluate syphilis screening practices and barriers to screening among obstetric providers. METHODS: Maricopa County medical providers who delivered at least 21 infants (97.2% of all deliveries) in 2008 according to live birth records were surveyed by telephone. RESULTS: A total of 146 surveys were completed representing 76% (319/421) of the delivering providers and 83% of delivered infants for 2008. All of the represented prenatal care providers reported testing their patients for syphilis at the first trimester, and 284 (89%) reported screening again during the third trimester. CONCLUSIONS: All of the surveyed providers reported screening at least once for syphilis during pregnancy and most reported re-screening during the third trimester as recommended by the Maricopa County board order. Similar public health screening guidance should be considered in areas where congenital syphilis rates are high and/or where syphilis is prevalent among women of childbearing age. A local health order of this type is a simple intervention that can provide practice guidance on emerging health issues. |
Reticence to prescribe: utilization of expedited partner therapy among obstetrics providers in Arizona
Taylor MM , Collier MG , Winscott MM , Mickey T , England B . Int J STD AIDS 2011 22 (8) 449-52 Expedited partner therapy (EPT) is the practice of providing an extra dose or prescription of antibiotic to patients diagnosed with chlamydia or gonorrhoea to deliver to their sexual partner(s). Obstetrical providers who delivered more than 20 infants in Maricopa County, Arizona, USA, during the year 2008 were surveyed by telephone regarding their use of EPT. A total of 142 eligible respondents completed the survey, representing 34% (142/421) of the delivering providers, 67 (47%) of whom reported the use of EPT in their clinics. Having received information about EPT was significantly associated with its use (67% versus 41%) (P = 0.008). The most common reasons for not using EPT included the inability to obtain allergy history in partners (24%) and concern for liability (11%). Additional education regarding the use of EPT may increase the use of this personal and public health tool among some obstetrics providers in Maricopa County; however, concerns for liability may limit broad utilization. |
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