Last data update: Nov 04, 2024. (Total: 48056 publications since 2009)
Records 1-4 (of 4 Records) |
Query Trace: Cowger T[original query] |
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Epidemiology of tuberculosis among children and adolescents in the USA, 2007-17: an analysis of national surveillance data
Cowger TL , Wortham JM , Burton DC . Lancet Public Health 2019 4 (10) e506-e516 BACKGROUND: Understanding tuberculosis epidemiology among children and adolescents informs treatment and prevention efforts, and efforts to eliminate disparities in tuberculosis incidence and mortality. We sought to describe the epidemiology of children and adolescents with tuberculosis disease in the USA, including tuberculosis incidence rates by parental country of birth and for US territories and freely associated states, which have not been previously described. METHODS: We analysed data for children aged younger than 15 years and adolescents aged 15-17 years with tuberculosis disease reported to the National Tuberculosis Surveillance System during 2007-17, and calculated tuberculosis incidence rates using population estimates from the US Census Bureau. FINDINGS: During 2010-17, 6072 tuberculosis cases occurred among children and adolescents; of these, 5175 (85%) of 6072 occurred in the 50 US states or the District of Columbia and 897 (15%) of 6072 in US-affiliated islands. In US states, 3520 (68%) of 5175 cases occurred among US-born people overall, including 2977 (76%) of 3896 children and 543 (42%) of 1279 adolescents. The incidence rate among children and adolescents was 1.0 per 100 000 person-years during 2007-17 and declined 47.8% (95% CI -51.4 to -44.1) during this period. We observed disproportionately high tuberculosis rates among children and adolescents of all non-white racial or ethnic groups, people living in US-affiliated islands, and children born in or with parents from tuberculosis-endemic countries. INTERPRETATION: Overall, tuberculosis incidence among children and adolescents in the USA is low and steadily declining, but additional efforts are needed to eliminate disparities in incidence and mortality. FUNDING: US Centers for Disease Control and Prevention. |
Programmatic evaluation of an algorithm for intensified TB case finding and isoniazid preventive therapy for people living with HIV in Thailand and Vietnam
Cowger T , Thai LH , Duong BD , Danyuttapolchai J , Kittimunkong S , Nhung NV , Nhan DT , Monkongdee P , Thoa CK , Khanh VT , Nateniyom S , Ntb Y , Ngoc DV , Thinh T , Whitehead S , Pevzner ES . J Acquir Immune Defic Syndr 2017 76 (5) 512-521 BACKGROUND: Tuberculosis (TB) screening affords clinicians opportunities to diagnose or exclude TB disease and initiate Isoniazid Preventive Therapy (IPT) for people living with HIV (PLHIV). METHODS: We implemented an algorithm to diagnose or rule out TB among PLHIV in eleven HIV clinics in Thailand and Vietnam. We assessed algorithm yield and uptake of IPT and factors associated with TB disease among PLHIV. RESULTS: A total of 1,448 PLHIV not yet on antiretroviral therapy (ART) were enrolled and screened for TB. Overall, 634 (44%) screened positive and 119 (8%) were diagnosed with TB; of these, 40% (48/119) were diagnosed by a positive culture following a negative sputum smear microscopy. In total, 55% of those eligible (263/477) started on IPT and of those, 75% (196/263) completed therapy. The prevalence of TB disease we observed in this study was 8.2% (8,218 per 100,000 persons): 46 and 25 times the prevalence of TB in the general population in Thailand and Vietnam, respectively. Several factors were independently associated with TB disease including being underweight (aOR [95% CI]: 2.3 [1.2, 2.6]) and using injection drugs (aOR [95% CI]: 2.9 [1.3, 6.3]). CONCLUSIONS: The high yield of TB disease diagnosed among PLHIV screened with the algorithm, and higher burden among PLHIV who inject drugs, underscores the need for innovative, tailored approaches to TB screening and prevention. As countries adopt Test-and-Start for ART, TB screening, sensitive TB diagnostics, and IPT should be included in differentiated-care models for HIV to improve diagnosis and prevention of TB among PLHIV. |
The role of supplementary environmental surveillance to complement acute flaccid paralysis surveillance for wild poliovirus in Pakistan - 2011-2013.
Cowger TL , Burns CC , Sharif S , Gary HE Jr , Iber J , Henderson E , Malik F , Zahoor Zaidi SS , Shaukat S , Rehman L , Pallansch MA , Orenstein WA . PLoS One 2017 12 (7) e0180608 BACKGROUND: More than 99% of poliovirus infections are non-paralytic and therefore, not detected by acute flaccid paralysis (AFP) surveillance. Environmental surveillance (ES) can detect circulating polioviruses from sewage without relying on clinical presentation. With extensive ES and continued circulation of polioviruses, Pakistan presents a unique opportunity to quantify the impact of ES as a supplement to AFP surveillance on overall completeness and timeliness of poliovirus detection. METHODS: Genetic, geographic and temporal data were obtained for all wild poliovirus (WPV) isolates detected in Pakistan from January 2011 through December 2013. We used viral genetics to assess gaps in AFP surveillance and ES as measured by detection of 'orphan viruses' (≥1.5% different in VP1 capsid nucleotide sequence). We compared preceding detection of closely related circulating isolates (≥99% identity) detected by AFP surveillance or ES to determine which surveillance system first detected circulation before the presentation of each polio case. FINDINGS: A total of 1,127 WPV isolates were detected by AFP surveillance and ES in Pakistan from 2011-2013. AFP surveillance and ES combined exhibited fewer gaps (i.e., % orphan viruses) in detection than AFP surveillance alone (3.3% vs. 7.7%, respectively). ES detected circulation before AFP surveillance in nearly 60% of polio cases (200 of 346). For polio cases reported from provinces conducting ES, ES detected circulation nearly four months sooner on average (117.6 days) than did AFP surveillance. INTERPRETATION: Our findings suggest ES in Pakistan is providing earlier, more sensitive detection of wild polioviruses than AFP surveillance alone. Overall, targeted ES through strategic selection of sites has important implications in the eradication endgame strategy. |
Screening practices and attitudes of obstetricians-gynecologists toward new and emerging tobacco products
England L , Anderson B , Tong V , Mahoney J , Coleman-Cowger V , Melstrom P , Schulkin J . Am J Obstet Gynecol 2014 211 (6) 695 e1-7 OBJECTIVE(S): We examined screening practices and attitudes of obstetricians-gynecologists toward the use of non-combusted tobacco products (chewing tobacco, snuff/snus, electronic cigarettes, and dissolvables) during pregnancy. STUDY DESIGN: The authors mailed a survey in 2012 to 1,024 members of the American College of Obstetricians and Gynecologists, including Collaborative Ambulatory Research Network (CARN)- and non-CARN members. Stratified random selection was used to generate CARN and non-CARN samples. RESULTS: Response rates were 52% and 31% for CARN and non-CARN members, respectively. Of 252 total eligible respondents (those currently providing obstetrical care) 53% reported screening pregnant women at intake for non-combusted tobacco product use all or some of the time, and 40% none of the time. Those reporting that non-combusted products have adverse health effects during pregnancy but are safer than cigarettes ranged from 20% (dissolvables) to 28% (electronic cigarettes), and that the health effects are the same as those of cigarettes from 13% (electronic cigarettes) to 52% (chewing tobacco). Approximately 14% reported that electronic cigarettes have no adverse health effects, while < 1% reported no health effects for the remaining products. Two-thirds wanted to know more about the potential health effects of non-combusted tobacco products; only 5% felt fully informed. CONCLUSIONS: A large proportion of obstetrician-gynecologists reported never or inconsistently screening their pregnant patients for use of non-combusted tobacco products. Responses regarding the harms of these products relative to cigarettes were mixed and most respondents wanted more information. Development and dissemination of guidance for providers is needed improve decision making regarding non-combusted tobacco products. |
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