Last data update: May 13, 2024. (Total: 46773 publications since 2009)
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Use of the Pfizer pentavalent meningococcal vaccine among persons aged ≥10 years: Recommendations of the Advisory Committee on Immunization Practices - United States, 2023
Collins JP , Crowe SJ , Ortega-Sanchez IR , Bahta L , Campos-Outcalt D , Loehr J , Morgan RL , Poehling KA , McNamara LA . MMWR Morb Mortal Wkly Rep 2024 73 (15) 345-350 Meningococcal disease is a life-threatening invasive infection caused by Neisseria meningitidis. Two quadrivalent (serogroups A, C, W, and Y) meningococcal conjugate vaccines (MenACWY) (MenACWY-CRM [Menveo, GSK] and MenACWY-TT [MenQuadfi, Sanofi Pasteur]) and two serogroup B meningococcal vaccines (MenB) (MenB-4C [Bexsero, GSK] and MenB-FHbp [Trumenba, Pfizer Inc.]), are licensed and available in the United States and have been recommended by CDC's Advisory Committee on Immunization Practices (ACIP). On October 20, 2023, the Food and Drug Administration approved the use of a pentavalent meningococcal vaccine (MenACWY-TT/MenB-FHbp [Penbraya, Pfizer Inc.]) for prevention of invasive disease caused by N. meningitidis serogroups A, B, C, W, and Y among persons aged 10-25 years. On October 25, 2023, ACIP recommended that MenACWY-TT/MenB-FHbp may be used when both MenACWY and MenB are indicated at the same visit for the following groups: 1) healthy persons aged 16-23 years (routine schedule) when shared clinical decision-making favors administration of MenB vaccine, and 2) persons aged ≥10 years who are at increased risk for meningococcal disease (e.g., because of persistent complement deficiencies, complement inhibitor use, or functional or anatomic asplenia). Different manufacturers' serogroup B-containing vaccines are not interchangeable; therefore, when MenACWY-TT/MenB-FHbp is used, subsequent doses of MenB should be from the same manufacturer (Pfizer Inc.). This report summarizes evidence considered for these recommendations and provides clinical guidance for the use of MenACWY-TT/MenB-FHbp. |
Selection of antibiotics as prophylaxis for close contacts of patients with meningococcal disease in areas with ciprofloxacin resistance - United States, 2024
Berry I , Rubis AB , Howie RL , Sharma S , Marasini D , Marjuki H , Crowe S , McNamara LA . MMWR Morb Mortal Wkly Rep 2024 73 (5) 99-103 Meningococcal disease, caused by the bacterium Neisseria meningitidis, is a rare but life-threatening illness that requires prompt antibiotic treatment for patients and antibiotic prophylaxis for their close contacts. Historically, N. meningitidis isolates in the United States have been largely susceptible to the antibiotics recommended for prophylaxis, including ciprofloxacin. Since 2019, however, the number of meningococcal disease cases caused by ciprofloxacin-resistant strains has increased. Antibiotic prophylaxis with ciprofloxacin in areas with ciprofloxacin resistance might result in prophylaxis failure. Health departments should preferentially consider using antibiotics other than ciprofloxacin as prophylaxis for close contacts when both of the following criteria have been met in a local catchment area during a rolling 12-month period: 1) the reporting of two or more invasive meningococcal disease cases caused by ciprofloxacin-resistant strains, and 2) ≥20% of all reported invasive meningococcal disease cases are caused by ciprofloxacin-resistant strains. Other than ciprofloxacin, alternative recommended antibiotic options include rifampin, ceftriaxone, or azithromycin. Ongoing monitoring for antibiotic resistance of meningococcal isolates through surveillance and health care providers' reporting of prophylaxis failures will guide future updates to prophylaxis considerations and recommendations. |
Risk factors for serogroup B meningococcal disease among college students
Weil LM , Crowe SJ , Rubis AB , Soeters HM , Meyer SA , Hariri S , McNamara LA . Open Forum Infect Dis 2023 10 (12) ofad607 BACKGROUND: College students are at increased risk for invasive meningococcal disease, but which students are most at risk is unclear. METHODS: US meningococcal disease cases in persons aged 18-24 years during 2014-2017 were included. Patients were classified as undergraduate students or other persons. Incidence in different student and non-student populations was compared. RESULTS: During 2014-2017, 229 meningococcal disease cases were reported in persons aged 18-24 years; 120 were in undergraduate students. Serogroup B accounted for 74% of cases in students. Serogroup B disease incidence was 4-fold higher in undergraduate students, 11.8-fold higher among first-year undergraduate students, and 8.6-fold higher among residence hall residents versus non-undergraduates. During outbreaks, students affiliated with Greek life had a 9.8-fold higher risk of disease compared to other students. A significantly higher party school ranking was observed for schools with sporadic or outbreak cases when compared to schools with no cases. CONCLUSIONS: The findings of increased disease risk among first-year students and those living on campus or affiliated with Greek life can inform shared clinical decision-making for serogroup B vaccines to prevent this rare but serious disease. These data also can inform school serogroup B vaccination policies and outbreak response measures. |
Differences in meningococcal disease incidence by health insurance type and among persons experiencing homelessness-United States, 2016-2019
Isenhour CJ , Crowe SJ , McNamara LA . PLoS One 2023 18 (10) e0293070 Meningococcal disease is a serious but rare disease in the United States. Prior publications suggest incidence differs among privately vs publicly-insured persons, and that incidence is higher among persons experiencing homelessness (PEH) than persons not known to be experiencing homelessness (non-PEH). Using insurance claims data for persons aged <1 to 64 years, we calculated meningococcal disease incidence among a population with employer-sponsored commercial insurance and persons enrolled in state Medicaid programs nationwide. We also examined meningococcal disease incidence by PEH status in Medicaid data. From 2016 through 2019, persons who met our study inclusion criteria contributed a total of 84,460,548 person-years (PYs) to our analysis of commercial insurance data and 253,496,622 PYs to our analysis of Medicaid data. Incidence was higher among persons enrolled in Medicaid (0.12 cases per 100,000 PYs) than persons with commercial insurance (0.06 cases per 100,000 PYs). Incidence was 3.17 cases per 100,000 PYs among PEH in Medicaid, 27 times higher than among non-PEH in Medicaid. Understanding the underlying drivers of the higher meningococcal disease incidence among PEH and persons enrolled in Medicaid may inform prevention strategies for populations experiencing a higher burden of disease. |
Developing a prototype pathogen plan and research priorities for the alphaviruses
Powers AM , Williamson LE , Carnahan RH , Crowe JE Jr , Hyde JL , Jonsson CB , Nasar F , Weaver SC . J Infect Dis 2023 228 S414-s426 The Togaviridae family, genus, Alphavirus, includes several mosquito-borne human pathogens with the potential to spread to near pandemic proportions. Most of these are zoonotic, with spillover infections of humans and domestic animals, but a few such as chikungunya virus (CHIKV) have the ability to use humans as amplification hosts for transmission in urban settings and explosive outbreaks. Most alphaviruses cause nonspecific acute febrile illness, with pathogenesis sometimes leading to either encephalitis or arthralgic manifestations with severe and chronic morbidity and occasional mortality. The development of countermeasures, especially against CHIKV and Venezuelan equine encephalitis virus that are major threats, has included vaccines and antibody-based therapeutics that are likely to also be successful for rapid responses with other members of the family. However, further work with these prototypes and other alphavirus pathogens should target better understanding of human tropism and pathogenesis, more comprehensive identification of cellular receptors and entry, and better understanding of structural mechanisms of neutralization. |
Vaccination coverage among adolescents aged 13-17 years - National Immunization Survey-Teen, United States, 2022
Pingali C , Yankey D , Elam-Evans LD , Markowitz LE , Valier MR , Fredua B , Crowe SJ , DeSisto CL , Stokley S , Singleton JA . MMWR Morb Mortal Wkly Rep 2023 72 (34) 912-919 Three vaccines are routinely recommended for adolescents to prevent pertussis, meningococcal disease, and cancers caused by human papillomavirus (HPV). CDC analyzed data from the 2022 National Immunization Survey-Teen for 16,043 adolescents aged 13-17 years to assess vaccination coverage. Birth cohort analyses were conducted to assess trends in vaccination coverage by age 13 years (i.e., before the 13th birthday) and by age 14 years (i.e., before the 14th birthday) among adolescents who were due for routine vaccination before and during the COVID-19 pandemic. Cross-sectional analysis was used to assess coverage estimates among adolescents aged 13-17 years. In 2022, vaccination coverage by age 14 years among adolescents born in 2008 continued to lag that of earlier birth cohorts and varied by sociodemographic factors and access to health care compared with coverage among earlier birth cohorts. Vaccination coverage by age 13 years among adolescents born in 2009 was similar to coverage estimates obtained before the COVID-19 pandemic. Among all adolescents aged 13-17 years, 2022 vaccination coverage levels did not differ from 2021 levels; however, initiation of the HPV vaccination series decreased among those who were insured by Medicaid. Coverage with ≥1 dose of tetanus, diphtheria, and acellular pertussis vaccine and ≥1 dose meningococcal conjugate vaccine was high and stable (around 90%). Providers should review adolescent vaccination records, especially among those born in 2008 and those in populations eligible for the Vaccines for Children program, to ensure adolescents are up to date with all recommended vaccines. |
Retirement and cognitive aging in a racially diverse sample of older Americans
Andel R , Veal BM , Howard VJ , MacDonald LA , Judd SE , Crowe M . J Am Geriatr Soc 2023 71 (9) 2769-2778 BACKGROUND: Retirement represents a crucial transitional period for many adults with possible consequences for cognitive aging. We examined trajectories of cognitive change before and after retirement in Black and White adults. METHODS: Longitudinal examination of up to 10 years (mean = 7.1 ± 2.2 years) using data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study-a national, longitudinal study of Black and White adults ≥45 years of age. Data were from 2226 members of the REGARDS study who retired around the time when an occupational ancillary survey was administered. Cognitive function was an average of z-scores for tests of verbal fluency, memory, and global function. RESULTS: Cognitive functioning was stable before retirement (Estimate = 0.05, p = 0.322), followed by a significant decline after retirement (Estimate = -0.15, p < 0.001). The decline was particularly pronounced in White (Estimate = -0.19, p < 0.001) compared with Black (Estimate = -0.07, p = 0.077) participants, twice as large in men (Estimate = -0.20, p < 0.001) compared with women (Estimate = -0.11, p < 0.001), highest among White men (Estimate = -0.22, p < 0.001) and lowest in Black women (Estimate = -0.04, p = 0.457). Greater post-retirement cognitive decline was also observed among participants who attended college (Estimate = -0.14, p = 0.016). While greater work complexity (Estimate = 0.92, p < 0.05) and higher income (Estimate = 1.03, p < 0.05) were related to better cognitive function at retirement, neither was significantly related to cognitive change after retirement. CONCLUSION: Cognitive functioning may decline at an accelerated rate immediately post-retirement, more so in White adults and men than Black adults and women. Lifelong structural inequalities including occupational segregation and other social determinants of cognitive health may obscure the role of retirement in cognitive aging. |
Potently neutralizing human monoclonal antibodies against the zoonotic pararubulavirus Sosuga virus (preprint)
Parrington HM , Kose N , Armstrong E , Handal L , Diaz S , Reidy J , Dong J , Stewart-Jones GBE , Shrivastava-Ranjan P , Jain S , Albarino CG , Carnahan RH , Crowe JE . bioRxiv 2022 17 Sosuga virus (SOSV) is a recently discovered paramyxovirus with a single known human case of disease. There has been little laboratory research on SOSV pathogenesis or immunity, and no approved therapeutics or vaccines are available. Here, we report the discovery of human monoclonal antibodies (mAbs) from the circulating memory B cells of the only known human case and survivor of SOSV infection. We isolated six mAbs recognizing the functional attachment protein (HN) and 18 mAbs against the fusion (F) protein. The anti-HN mAbs all target the globular head of the HN protein and can be organized into 4 competition-binding groups that exhibit epitope diversity. The anti-F mAbs can be divided into pre- or post-fusion conformation-specific categories and further into 8 competition-binding groups. Generally, pre-fusion conformation-specific anti-F mAbs showed higher potency in neutralization assays than did mAbs only recognizing the post-fusion conformation of F protein. Most of the anti-HN mAbs were more potently neutralizing than the anti-F mAbs, with mAbs in one of the HN competition-binding groups possessing ultra-potent (<1 ng/mL) half maximal inhibitory (IC50) virus neutralization values. These findings provide insight into the molecular basis for human antibody recognition of paramyxovirus surface proteins and the mechanisms of SOSV neutralization. Copyright The copyright holder for this preprint is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission. |
Potently neutralizing human monoclonal antibodies against the zoonotic pararubulavirus Sosuga virus
Parrington HM , Kose N , Armstrong E , Handal LS , Diaz S , Reidy J , Dong J , Stewart-Jones GB , Shrivastava-Ranjan P , Jain S , Albariño CG , Carnahan RH , Crowe JE . JCI Insight 2023 8 (8) Sosuga virus (SOSV) is a recently discovered paramyxovirus with a single known human case of disease. There has been little laboratory research on SOSV pathogenesis or immunity, and no approved therapeutics or vaccines are available. Here, we report the discovery of human monoclonal antibodies (mAbs) from the circulating memory B cells of the only known human case and survivor of SOSV infection. We isolated six mAbs recognizing the functional attachment protein hemagglutinin-neuraminidase (HN) and 18 mAbs against the fusion (F) protein. The anti-HN mAbs all target the globular head of the HN protein and can be organized into 4 competition-binding groups that exhibit epitope diversity. The anti-F mAbs can be divided into pre- or postfusion conformation-specific categories and further into 8 competition-binding groups. The only antibody in the panel that did not display neutralization activity was the single, postfusion-specific anti-F mAb. Most of the anti-HN mAbs were more potently neutralizing than the anti-F mAbs, with mAbs in one of the HN competition-binding groups possessing ultra-potent (<1 ng/mL) half maximal inhibitory (IC50) virus neutralization values. These findings provide insight into the molecular basis for human antibody recognition of paramyxovirus surface proteins and the mechanisms of SOSV neutralization. |
Prehospital stroke care part 1: Emergency medical services and the stroke systems of care
Zachrison KS , Nielsen VM , de la Ossa NP , Madsen TE , Cash RE , Crowe RP , Odom EC , Jauch EC , Adeoye OM , Richards CT . Stroke 2022 54 (4) 1138-1147 Acute stroke care begins before hospital arrival, and several prehospital factors are critical in influencing overall patient care and poststroke outcomes. This topical review provides an overview of the state of the science on prehospital components of stroke systems of care and how emergency medical services systems may interact in the system to support acute stroke care. Topics include layperson recognition of stroke, prehospital transport strategies, networked stroke care, systems for data integration and real-time feedback, and inequities that exist within and among systems. |
National vaccination coverage among adolescents aged 13-17 Years - National Immunization Survey-Teen, United States, 2021
Pingali C , Yankey D , Elam-Evans LD , Markowitz LE , Valier MR , Fredua B , Crowe SJ , Stokley S , Singleton JA . MMWR Morb Mortal Wkly Rep 2022 71 (35) 1101-1108 CDC’s Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination of persons aged 11–12 years with tetanus, diphtheria, and acellular pertussis vaccine (Tdap), human papillomavirus (HPV) vaccine, and quadrivalent meningococcal conjugate vaccine (MenACWY). A second (booster) dose of MenACWY is recommended at age 16 years. On the basis of shared clinical decision-making, adolescents aged 16–23 years may receive a serogroup B meningococcal vaccine (MenB) series. Catch-up vaccination is recommended for hepatitis A vaccine (HepA); hepatitis B vaccine (HepB); measles, mumps, and rubella vaccine (MMR); and varicella vaccine (VAR) for adolescents whose childhood vaccinations are not up to date (1). Although COVID-19 vaccination and influenza vaccination coverage estimates are not presented in this report, vaccination with a COVID-19 vaccine and annual influenza vaccination are also recommended by ACIP for adolescents* (2). To estimate vaccination coverage, CDC analyzed data for 18,002 adolescents aged 13–17 years from the 2021 National Immunization Survey-Teen (NIS-Teen).† Coverage with ≥1 dose of Tdap§ (89.6%) and ≥1 dose of MenACWY¶ (89.0%) remained high and stable compared with the previous year. Increases in coverage with the following vaccines occurred from 2020 to 2021: ≥1 dose of HPV** vaccine (from 75.1% to 76.9%); adolescents who were up to date with HPV vaccination (HPV UTD)†† (from 58.6% to 61.7%); and ≥2 MenACWY doses among adolescents aged 17 years (from 54.4% to 60.0%). Coverage with MenACWY, HPV vaccine, and ≥2 HepA doses was lower among adolescents living in nonmetropolitan statistical areas (non-MSAs)§§ than among those living in MSA principal cities. The potential impact of the COVID-19 pandemic was assessed by comparing vaccination coverage by age and birth year before and during the COVID-19 pandemic. Coverage with ≥1 MenACWY dose by age 13 years was 5.1 percentage points lower among adolescents who reached age 13 years during the pandemic (2021) compared with those who reached age 13 in 2019. Coverage with ≥1 Tdap dose by age 12 years was 4.1 percentage points lower among children who reached age 12 years during the pandemic (2020) compared with those who reached age 12 before the pandemic. Coverage with ≥1 HPV vaccine dose by ages 12 and 13 years among children and adolescents who reached age 12 or 13 during the pandemic did not differ from coverage before the pandemic. Many children and adolescents might have missed routine medical care and recommended vaccinations during the COVID-19 pandemic. Review of patient vaccination records is important for providers to ensure that children and adolescents are up to date with all recommended vaccinations. |
Novel outbreak-associated food vehicles, United States
Whitham HK , Sundararaman P , Dewey-Mattia D , Manikonda K , Marshall KE , Griffin PM , Gleason BL , Subramhanya S , Crowe SJ . Emerg Infect Dis 2021 27 (10) 2554-2559 Novel outbreak-associated food vehicles (i.e., foods not implicated in past outbreaks) can emerge as a result of evolving pathogens and changing consumption trends. To identify these foods, we examined data from the Centers for Disease Control and Prevention Foodborne Disease Outbreak Surveillance System and found 14,216 reported outbreaks with information on implicated foods. We compared foods implicated in outbreaks during 2007-2016 with those implicated in outbreaks during 1973-2006. We identified 28 novel food vehicles, of which the most common types were fish, nuts, fruits, and vegetables; one third were imported. Compared with other outbreaks, those associated with novel food vehicles were more likely to involve illnesses in multiple states and food recalls and were larger in terms of cases, hospitalizations, and deaths. Two thirds of novel foods did not require cooking after purchase. Prevention efforts targeting novel foods cannot rely solely on consumer education but require industry preventive measures. |
Food recalls associated with foodborne disease outbreaks, United States, 2006-2016
Qiu Q , Dewey-Mattia D , Subramhanya S , Cui Z , Griffin PM , Lance S , Lanier W , Wise ME , Crowe SJ . Epidemiol Infect 2021 149 1-24 About 800 foodborne disease outbreaks are reported in the United States annually. Few are associated with food recalls. We compared 226 outbreaks associated with food recalls with those not associated with recalls during 2006-2016. Recall-associated outbreaks had, on average, more illnesses per outbreak and higher proportions of hospitalisations and deaths than non-recall-associated outbreaks. The top confirmed aetiology for recall-associated outbreaks was Salmonella. Pasteurised and unpasteurised dairy products, beef and molluscs were the most frequently implicated foods. The most common pathogen-food pairs for outbreaks with recalls were Escherichia coli-beef and norovirus-molluscs; the top pairs for non-recall-associated outbreaks were scombrotoxin-fish and ciguatoxin-fish. For outbreaks with recalls, 48% of the recalls occurred after the outbreak, 27% during the outbreak, 3% before the outbreak, and 22% were inconclusive or had unknown recall timing. Fifty per cent of recall-associated outbreaks were multistate, compared with 2% of non-recall-associated outbreaks. The differences between recall-associated outbreaks and non-recall-associated outbreaks help define the types of outbreaks and food vehicles that are likely to have a recall. Improved outbreak vehicle identification and traceability of rarely recalled foods could lead to more recalls of these products, resulting in fewer illnesses and deaths. |
Partnerships involved in public health testing for Zika virus in Florida, 2016
Heberlein-Larson L , Gillis LD , Morrison A , Scott B , Cook M , Cannons A , Quaye E , White S , Cone M , Mock V , Schiffer J , Lonsway D , Petway M , Otis A , Stanek D , Hamilton J , Crowe S . Public Health Rep 2019 134 43s-52s The emergence of Zika virus in the Americas in 2015 and its association with birth defects and other adverse health outcomes triggered an unprecedented public health response and a demand for testing. In 2016, when Florida exceeded state public health laboratory capacity for diagnostic testing, the state formed partnerships with federal and commercial laboratories. Eighty-two percent of the testing (n = 33 802 of 41 008 specimens) by the laboratory partners, including Florida's Bureau of Public Health Laboratories (BPHL; n = 13 074), a commercial laboratory (n = 19 214), and the Centers for Disease Control and Prevention (CDC; n = 1514), occurred from July through November 2016, encompassing the peak period of local transmission. These partnerships allowed BPHL to maintain acceptable test turnaround times of 1 to 4 days for nucleic acid testing and 3 to 7 days for serologic testing. Lessons learned from this response to inform future outbreaks included the need for early planning to establish outside partnerships, adding specimen triage strategies to surge plans, and integrating state and CDC information systems. |
Multidrug-Resistant Campylobacter jejuni Outbreak Linked to Puppy Exposure - United States, 2016-2018.
Montgomery MP , Robertson S , Koski L , Salehi E , Stevenson LM , Silver R , Sundararaman P , Singh A , Joseph LA , Weisner MB , Brandt E , Prarat M , Bokanyi R , Chen JC , Folster JP , Bennett CT , Francois Watkins LK , Aubert RD , Chu A , Jackson J , Blanton J , Ginn A , Ramadugu K , Stanek D , DeMent J , Cui J , Zhang Y , Basler C , Friedman CR , Geissler AL , Crowe SJ , Dowell N , Dixon S , Whitlock L , Williams I , Jhung MA , Nichols MC , de Fijter S , Laughlin ME . MMWR Morb Mortal Wkly Rep 2018 67 (37) 1032-1035 Campylobacter causes an estimated 1.3 million diarrheal illnesses in the United States annually (1). In August 2017, the Florida Department of Health notified CDC of six Campylobacter jejuni infections linked to company A, a national pet store chain based in Ohio. CDC examined whole-genome sequencing (WGS) data and identified six isolates from company A puppies in Florida that were highly related to an isolate from a company A customer in Ohio. This information prompted a multistate investigation by local and state health and agriculture departments and CDC to identify the outbreak source and prevent additional illness. Health officials from six states visited pet stores to collect puppy fecal samples, antibiotic records, and traceback information. Nationally, 118 persons, including 29 pet store employees, in 18 states were identified with illness onset during January 5, 2016-February 4, 2018. In total, six pet store companies were linked to the outbreak. Outbreak isolates were resistant by antibiotic susceptibility testing to all antibiotics commonly used to treat Campylobacter infections, including macrolides and quinolones. Store record reviews revealed that among 149 investigated puppies, 142 (95%) received one or more courses of antibiotics, raising concern that antibiotic use might have led to development of resistance. Public health authorities issued infection prevention recommendations to affected pet stores and recommendations for testing puppies to veterinarians. This outbreak demonstrates that puppies can be a source of multidrug-resistant Campylobacter infections in humans, warranting a closer look at antimicrobial use in the commercial dog industry. |
Naloxone administration frequency during emergency medical service events - United States, 2012-2016
Cash RE , Kinsman J , Crowe RP , Rivard MK , Faul M , Panchal AR . MMWR Morb Mortal Wkly Rep 2018 67 (31) 850-853 As the opioid epidemic in the United States has continued since the early 2000s (1,2), most descriptions have focused on misuse and deaths. Increased cooperation with state and local partners has enabled more rapid and comprehensive surveillance of nonfatal opioid overdoses (3).* Naloxone administrations obtained from emergency medical services (EMS) patient care records have served as a useful proxy for overdose surveillance in individual communities and might be a previously unused data source to describe the opioid epidemic, including fatal and nonfatal events, on a national level (4-6). Using data from the National Emergency Medical Services Information System (NEMSIS),(dagger) the trend in rate of EMS naloxone administration events from 2012 to 2016 was compared with opioid overdose mortality rates from National Vital Statistics System multiple cause-of-death mortality files. During 2012-2016, the rate of EMS naloxone administration events increased 75.1%, from 573.6 to 1004.4 administrations per 100,000 EMS events, mirroring the 79.7% increase in opioid overdose mortality from 7.4 deaths per 100,000 persons to 13.3. A bimodal age distribution of patients receiving naloxone from EMS parallels a similar age distribution of deaths, with persons aged 25-34 years and 45-54 years most affected. However, an accurate estimate of the complete injury burden of the opioid epidemic requires assessing nonfatal overdoses in addition to deaths. Evaluating and monitoring nonfatal overdose events via the novel approach of using EMS data might assist in the development of timely interventions to address the evolving opioid crisis. |
Surveillance for foodborne disease outbreaks - United States, 2009-2015
Dewey-Mattia D , Manikonda K , Hall AJ , Wise ME , Crowe SJ . MMWR Surveill Summ 2018 67 (10) 1-11 PROBLEM/CONDITION: Known foodborne disease agents are estimated to cause approximately 9.4 million illnesses each year in the United States. Although only a small subset of illnesses are associated with recognized outbreaks, data from outbreak investigations provide insight into the foods and pathogens that cause illnesses and the settings and conditions in which they occur. REPORTING PERIOD: 2009-2015 DESCRIPTION OF SYSTEM: The Foodborne Disease Outbreak Surveillance System (FDOSS) collects data on foodborne disease outbreaks, which are defined as the occurrence of two or more cases of a similar illness resulting from the ingestion of a common food. Since the early 1960s, foodborne outbreaks have been reported voluntarily to CDC by state, local, and territorial health departments using a standard form. Beginning in 2009, FDOSS reporting was made through the National Outbreak Reporting System, a web-based platform launched that year. RESULTS: During 2009-2015, FDOSS received reports of 5,760 outbreaks that resulted in 100,939 illnesses, 5,699 hospitalizations, and 145 deaths. All 50 states, the District of Columbia, Puerto Rico, and CDC reported outbreaks. Among 2,953 outbreaks with a single confirmed etiology, norovirus was the most common cause of outbreaks (1,130 outbreaks [38%]) and outbreak-associated illnesses (27,623 illnesses [41%]), followed by Salmonella with 896 outbreaks (30%) and 23,662 illnesses (35%). Outbreaks caused by Listeria, Salmonella, and Shiga toxin-producing Escherichia coli (STEC) were responsible for 82% of all hospitalizations and 82% of deaths reported. Among 1,281 outbreaks in which the food reported could be classified into a single food category, fish were the most commonly implicated category (222 outbreaks [17%]), followed by dairy (136 [11%]) and chicken (123 [10%]). The food categories responsible for the most outbreak-associated illnesses were chicken (3,114 illnesses [12%]), pork (2,670 [10%]), and seeded vegetables (2,572 [10%]). Multistate outbreaks comprised only 3% of all outbreaks reported but accounted for 11% of illnesses, 34% of hospitalizations, and 54% of deaths. INTERPRETATION: Foodborne disease outbreaks provide information about the pathogens and foods responsible for illness. Norovirus remains the leading cause of foodborne disease outbreaks, highlighting the continued need for food safety improvements targeting worker health and hygiene in food service settings. Outbreaks caused by Listeria, Salmonella, and STEC are important targets for public health intervention efforts, and improving the safety of chicken, pork, and seeded vegetables should be a priority. PUBLIC HEALTH ACTION: The causes of foodborne illness should continue to be tracked and analyzed to inform disease prevention policies and initiatives. Strengthening the capacity of state and local health departments to investigate and report outbreaks will assist with these efforts through identification of the foods, etiologies, and settings linked to these outbreaks. |
Systems, supplies, and staff: a mixed-methods study of health care workers' experiences and health facility preparedness during a large national cholera outbreak, Kenya 2015
Curran KG , Wells E , Crowe SJ , Narra R , Oremo J , Boru W , Githuku J , Obonyo M , De Cock KM , Montgomery JM , Makayotto L , Langat D , Lowther SA , O'Reilly C , Gura Z , Kioko J . BMC Public Health 2018 18 (1) 723 BACKGROUND: From December 2014 to September 2016, a cholera outbreak in Kenya, the largest since 2010, caused 16,840 reported cases and 256 deaths. The outbreak affected 30 of Kenya's 47 counties and occurred shortly after the decentralization of many healthcare services to the county level. This mixed-methods study, conducted June-July 2015, assessed cholera preparedness in Homa Bay, Nairobi, and Mombasa counties and explored clinic- and community-based health care workers' (HCW) experiences during outbreak response. METHODS: Counties were selected based on cumulative cholera burden and geographic characteristics. We conducted 44 health facility cholera preparedness checklists (according to national guidelines) and 8 focus group discussions (FGDs). Frequencies from preparedness checklists were generated. To determine key themes from FGDs, inductive and deductive codes were applied; MAX software for qualitative data analysis (MAXQDA) was used to identify patterns. RESULTS: Some facilities lacked key materials for treating cholera patients, diagnosing cases, and maintaining infection control. Overall, 82% (36/44) of health facilities had oral rehydration salts, 65% (28/43) had IV fluids, 27% (12/44) had rectal swabs, 11% (5/44) had Cary-Blair transport media, and 86% (38/44) had gloves. A considerable number of facilities lacked disease reporting forms (34%, 14/41) and cholera treatment guidelines (37%, 16/43). In FDGs, HCWs described confusion regarding roles and reporting during the outbreak, which highlighted issues in coordination and management structures within the health system. Similar to checklist findings, FGD participants described supply challenges affecting laboratory preparedness and infection prevention and control. Perceived successes included community engagement, health education, strong collaboration between clinic and community HCWs, and HCWs' personal passion to help others. CONCLUSIONS: The confusion over roles, reporting, and management found in this evaluation highlights a need to adapt, implement, and communicate health strategies at the county level, in order to inform and train HCWs during health system transformations. International, national, and county stakeholders could strengthen preparedness and response for cholera and other public health emergencies in Kenya, and thereby strengthen global health security, through further investment in the existing Integrated Disease Surveillance and Response structure and national cholera prevention and control plan, and the adoption of county-specific cholera control plans. |
A tale of two countries: progress towards UNAIDS 90-90-90 targets in Botswana and Australia
Marukutira T , Stoove M , Lockman S , Mills LA , Gaolathe T , Lebelonyane R , Jarvis JN , Kelly SL , Wilson DP , Luchters S , Crowe SM , Hellard M . J Int AIDS Soc 2018 21 (3) UNAIDS 90-90-90 targets and Fast-Track commitments are presented as precursors to ending the AIDS epidemic by 2030, through effecting a 90% reduction in new HIV infections and AIDS-related deaths from 2010 levels (HIV epidemic control). Botswana, a low to middle-income country with the third-highest HIV prevalence, and Australia, a low-prevalence high-income country with an epidemic concentrated among men who have sex with men (MSM), have made significant strides towards achieving the UNAIDS 90-90-90 targets. These two countries provide lessons for different epidemic settings. This paper discusses the lessons that can be drawn from Botswana and Australia with respect to their success in HIV testing, treatment, viral suppression and other HIV prevention strategies for HIV epidemic control. Botswana and Australia are on target to achieving the 90-90-90 targets for HIV epidemic control, made possible by comprehensive HIV testing and treatment programmes in the two countries. As of 2015, 70% of all people assumed to be living with HIV had viral suppression in Botswana and Australia. However, HIV incidence remains above one per cent in the general population in Botswana and in MSM in Australia. The two countries have demonstrated that rapid HIV testing that is accessible and targeted at key and vulnerable populations is required in order to continue identifying new HIV infections. All citizens living with HIV in both countries are eligible for antiretroviral therapy (ART) and viral load monitoring through government-funded programmes. Notwithstanding their success in reducing HIV transmission to date, programmes in both countries must continue to be supported at current levels to maintain epidemic suppression. Scaled HIV testing, linkage to care, universal ART, monitoring patients on treatment over and above strengthened HIV prevention strategies (e.g. male circumcision and pre-exposure prophylaxis) will all continue to require funding. The progress that Botswana and Australia have made towards meeting the 90-90-90 targets is commendable. However, in order to reduce HIV incidence significantly towards 2030, there is a need for sustained HIV testing, linkage to care and high treatment coverage. Botswana and Australia provide useful lessons for developing countries with generalized epidemics and high-income countries with concentrated epidemics. |
Shiga Toxin-Producing E. coli Infections Associated with Flour.
Crowe SJ , Bottichio L , Shade LN , Whitney BM , Corral N , Melius B , Arends KD , Donovan D , Stone J , Allen K , Rosner J , Beal J , Whitlock L , Blackstock A , Wetherington J , Newberry LA , Schroeder MN , Wagner D , Trees E , Viazis S , Wise ME , Neil KP . N Engl J Med 2017 377 (21) 2036-2043 Background In 2016, a multijurisdictional team investigated an outbreak of Shiga toxin-producing Escherichia coli (STEC) serogroup O121 and O26 infections linked to contaminated flour from a large domestic producer. Methods A case was defined as infection with an outbreak strain in which illness onset was between December 21, 2015, and September 5, 2016. To identify exposures associated with the outbreak, outbreak cases were compared with non-STEC enteric illness cases, matched according to age group, sex, and state of residence. Products suspected to be related to the outbreak were collected for STEC testing, and a common point of contamination was sought. Whole-genome sequencing was performed on isolates from clinical and food samples. Results A total of 56 cases were identified in 24 states. Univariable exact conditional logistic-regression models of 22 matched sets showed that infection was significantly associated with the use of one brand of flour (odds ratio, 21.04; 95% confidence interval [CI], 4.69 to 94.37) and with tasting unbaked homemade dough or batter (odds ratio, 36.02; 95% CI, 4.63 to 280.17). Laboratory testing isolated the outbreak strains from flour samples, and whole-genome sequencing revealed that the isolates from clinical and food samples were closely related to one another genetically. Trace-back investigation identified a common flour-production facility. Conclusions This investigation implicated raw flour as the source of an outbreak of STEC infections. Although it is a low-moisture food, raw flour can be a vehicle for foodborne pathogens. |
The role of occupation in explaining cognitive functioning in later life: Education and occupational complexity in a U.S. national sample of black and white men and women
Fujishiro K , MacDonald LA , Crowe M , McClure LA , Howard VJ , Wadley VG . J Gerontol B Psychol Sci Soc Sci 2017 74 (7) 1189-1199 Objective: Positive associations between education and late-life cognition have been widely reported. This study examines whether occupational complexity mediates the relationship between education and late-life cognition, and whether the magnitude of mediation differs by race, gender, or education level. Methods: Data were from a population-based cohort of non-Hispanic Blacks and Whites aged ≥45 years (n = 7,357). Education was categorized as less than high school, high school, some college, and college or higher. Using linear regression, we estimated the direct effect of each successive increase in education on cognitive functioning and indirect effects via substantive complexity of work. Results: Occupational complexity significantly mediated 11%-22% of the cognitive gain associated with higher levels of education. The pattern of mediation varied between White men and all other race-gender groups: among White men, the higher the education, the greater the mediation effect by occupational complexity. Among Black men and women of both races, the higher the education, the smaller the mediation effect. Discussion: Higher levels of education may provide opportunity for intellectually engaging environments throughout adulthood in the form of complex work, which may protect late-life cognition. However, this protective effect of occupational complexity may not occur equally across race-gender subgroups. |
Utility of Combining Whole Genome Sequencing with Traditional Investigational Methods To Solve Foodborne Outbreaks of Salmonella Infections Associated with Chicken: A New Tool for Tackling This Challenging Food Vehicle.
Crowe SJ , Green A , Hernandez K , Peralta V , Bottichio L , Defibaugh-Chavez S , Douris A , Gieraltowski L , Hise K , La-Pham K , Neil KP , Simmons M , Tillman G , Tolar B , Wagner D , Wasilenko J , Holt K , Trees E , Wise ME . J Food Prot 2017 80 (4) 654-660 High consumption rates and a multitude of brands make multistate foodborne outbreaks of Salmonella infections associated with chicken challenging to investigate, but whole genome sequencing is a powerful tool that can be used to assist investigators. Whole genome sequencing of pathogens isolated from clinical, environmental, and food samples is increasingly being used in multistate foodborne outbreak investigations to determine with unprecedented resolution how closely related these isolates are to one another genetically. In 2014, federal and state health officials investigated an outbreak of 146 Salmonella Heidelberg infections in 24 states. A follow-up analysis was conducted after the conclusion of the investigation in which 27 clinical and 24 food isolates from the outbreak underwent whole genome sequencing. These isolates formed seven clades, the largest of which contained clinical isolates from a subcluster of case patients who attended a catered party. One isolate from a chicken processed by a large producer was closely related genetically (zero to three single-nucleotide polymorphism differences) to the clinical isolates from these subcluster case patients. Chicken from this large producer was also present in the kitchen of the caterer on the day before the event, thus providing additional evidence that the chicken from this producer was the outbreak source. This investigation highlights how whole genome sequencing can be used with epidemiologic and traceback evidence to identify chicken sources of foodborne outbreaks. |
Cross-neutralizing and protective human antibody specificities to poxvirus infections
Gilchuk I , Gilchuk P , Sapparapu G , Lampley R , Singh V , Kose N , Blum DL , Hughes LJ , Satheshkumar PS , Townsend MB , Kondas AV , Reed Z , Weiner Z , Olson VA , Hammarlund E , Raue HP , Slifka MK , Slaughter JC , Graham BS , Edwards KM , Eisenberg RJ , Cohen GH , Joyce S , Crowe JE Jr . Cell 2016 167 (3) 684-694.e9 Monkeypox (MPXV) and cowpox (CPXV) are emerging agents that cause severe human infections on an intermittent basis, and variola virus (VARV) has potential for use as an agent of bioterror. Vaccinia immune globulin (VIG) has been used therapeutically to treat severe orthopoxvirus infections but is in short supply. We generated a large panel of orthopoxvirus-specific human monoclonal antibodies (Abs) from immune subjects to investigate the molecular basis of broadly neutralizing antibody responses for diverse orthopoxviruses. Detailed analysis revealed the principal neutralizing antibody specificities that are cross-reactive for VACV, CPXV, MPXV, and VARV and that are determinants of protection in murine challenge models. Optimal protection following respiratory or systemic infection required a mixture of Abs that targeted several membrane proteins, including proteins on enveloped and mature virion forms of virus. This work reveals orthopoxvirus targets for human Abs that mediate cross-protective immunity and identifies new candidate Ab therapeutic mixtures to replace VIG. |
Ebola Virus Disease Diagnostics, Sierra Leone: Analysis of Real-time Reverse Transcription-Polymerase Chain Reaction Values for Clinical Blood and Oral Swab Specimens.
Erickson BR , Sealy TK , Flietstra T , Morgan L , Kargbo B , Matt-Lebby VE , Gibbons A , Chakrabarti AK , Graziano J , Presser L , Flint M , Bird BH , Brown S , Klena JD , Blau DM , Brault AC , Belser JA , Salzer JS , Schuh AJ , Lo M , Zivcec M , Priestley RA , Pyle M , Goodman C , Bearden S , Amman BR , Basile A , Bergeron E , Bowen MD , Dodd KA , Freeman MM , McMullan LK , Paddock CD , Russell BJ , Sanchez AJ , Towner JS , Wang D , Zemtsova GE , Stoddard RA , Turnsek M , Guerrero LW , Emery SL , Stovall J , Kainulainen MH , Perniciaro JL , Mijatovic-Rustempasic S , Shakirova G , Winter J , Sexton C , Liu F , Slater K , Anderson R , Andersen L , Chiang CF , Tzeng WP , Crowe SJ , Maenner MJ , Spiropoulou CF , Nichol ST , Stroher U . J Infect Dis 2016 214 S258-S262 During the Ebola virus outbreak of 2013-2016, the Viral Special Pathogens Branch field laboratory in Sierra Leone tested approximately 26 000 specimens between August 2014 and October 2015. Analysis of the B2M endogenous control Ct values showed its utility in monitoring specimen quality, comparing results with different specimen types, and interpretation of results. For live patients, blood is the most sensitive specimen type and oral swabs have little diagnostic utility. However, swabs are highly sensitive for diagnostic testing of corpses. |
Vibriosis, not cholera: toxigenic Vibrio cholerae non-O1, non-O139 infections in the United States, 1984-2014
Crowe SJ , Newton AE , Gould LH , Parsons MB , Stroika S , Bopp CA , Freeman M , Greene K , Mahon BE . Epidemiol Infect 2016 144 (15) 1-7 Toxigenic strains of Vibrio cholerae serogroups O1 and O139 have caused cholera epidemics, but other serogroups - such as O75 or O141 - can also produce cholera toxin and cause severe watery diarrhoea similar to cholera. We describe 31 years of surveillance for toxigenic non-O1, non-O139 infections in the United States and map these infections to the state where the exposure probably originated. While serogroups O75 and O141 are closely related pathogens, they differ in how and where they infect people. Oysters were the main vehicle for O75 infection. The vehicles for O141 infection include oysters, clams, and freshwater in lakes and rivers. The patients infected with serogroup O75 who had food traceback information available ate raw oysters from Florida. Patients infected with O141 ate oysters from Florida and clams from New Jersey, and those who only reported being exposed to freshwater were exposed in Arizona, Michigan, Missouri, and Texas. Improving the safety of oysters, specifically, should help prevent future illnesses from these toxigenic strains and similar pathogenic Vibrio species. Post-harvest processing of raw oysters, such as individual quick freezing, heat-cool pasteurization, and high hydrostatic pressurization, should be considered. |
Assessment of community event-based surveillance for Ebola virus disease, Sierra Leone, 2015
Ratnayake R , Crowe SJ , Jasperse J , Privette G , Stone E , Miller L , Hertz D , Fu C , Maenner MJ , Jambai A , Morgan O . Emerg Infect Dis 2016 22 (8) 1431-7 In 2015, community event-based surveillance (CEBS) was implemented in Sierra Leone to assist with the detection of Ebola virus disease (EVD) cases. We assessed the sensitivity of CEBS for finding EVD cases during a 7-month period, and in a 6-week subanalysis, we assessed the timeliness of reporting cases with no known epidemiologic links at time of detection. Of the 12,126 CEBS reports, 287 (2%) met the suspected case definition, and 16 were confirmed positive. CEBS detected 30% (16/53) of the EVD cases identified during the study period. During the subanalysis, CEBS staff identified 4 of 6 cases with no epidemiologic links. These CEBS-detected cases were identified more rapidly than those detected by the national surveillance system; however, too few cases were detected to determine system timeliness. Although CEBS detected EVD cases, it largely generated false alerts. Future versions of community-based surveillance could improve case detection through increased staff training and community engagement. |
Prognostic indicators for Ebola patient survival
Crowe SJ , Maenner MJ , Kuah S , Erickson BR , Coffee M , Knust B , Klena J , Foday J , Hertz D , Hermans V , Achar J , Caleo GM , Van Herp M , Albarino CG , Amman B , Basile AJ , Bearden S , Belser JA , Bergeron E , Blau D , Brault AC , Campbell S , Flint M , Gibbons A , Goodman C , McMullan L , Paddock C , Russell B , Salzer JS , Sanchez A , Sealy T , Wang D , Saffa G , Turay A , Nichol ST , Towner JS . Emerg Infect Dis 2016 22 (2) 217-23 To determine whether 2 readily available indicators predicted survival among patients with Ebola virus disease in Sierra Leone, we evaluated information for 216 of the 227 patients in Bo District during a 4-month period. The indicators were time from symptom onset to healthcare facility admission and quantitative real-time reverse transcription PCR cycle threshold (Ct), a surrogate for viral load, in first Ebola virus-positive blood sample tested. Of these patients, 151 were alive when detected and had reported healthcare facility admission dates and Ct values available. Time from symptom onset to healthcare facility admission was not associated with survival, but viral load in the first Ebola virus-positive blood sample was inversely associated with survival: 52 (87%) of 60 patients with a Ct of >24 survived and 20 (22%) of 91 with a Ct of <24 survived. Ct values may be useful for clinicians making treatment decisions or managing patient or family expectations. |
Notes from the field: Ongoing cholera outbreak - Kenya, 2014-2016
George G , Rotich J , Kigen H , Catherine K , Waweru B , Boru W , Galgalo T , Githuku J , Obonyo M , Curran K , Narra R , Crowe SJ , O'Reilly CE , Macharia D , Montgomery J , Neatherlin J , De Cock KM , Lowther S , Gura Z , Langat D , Njeru I , Kioko J , Muraguri N . MMWR Morb Mortal Wkly Rep 2016 65 (3) 68-69 On January 6, 2015, a man aged 40 years was admitted to Kenyatta National Hospital in Nairobi, Kenya, with acute watery diarrhea. The patient was found to be infected with toxigenic Vibrio cholerae serogroup O1, serotype Inaba. A subsequent review of surveillance reports identified four patients in Nairobi County during the preceding month who met either of the Kenya Ministry of Health suspected cholera case definitions: 1) severe dehydration or death from acute watery diarrhea (more than four episodes in 12 hours) in a patient aged ≥5 years, or 2) acute watery diarrhea in a patient aged ≥2 years in an area where there was an outbreak of cholera. An outbreak investigation was immediately initiated. A confirmed cholera case was defined as isolation of V. cholerae O1 or O139 from the stool of a patient with suspected cholera or a suspected cholera case that was epidemiologically linked to a confirmed case. By January 15, 2016, a total of 11,033 suspected or confirmed cases had been reported from 22 of Kenya's 47 counties. The outbreak is ongoing. |
Vital signs: multistate foodborne outbreaks - United States, 2010-2014
Crowe SJ , Mahon BE , Vieira AR , Gould LH . MMWR Morb Mortal Wkly Rep 2015 64 (43) 1221-5 INTRODUCTION: Millions of U.S. residents become ill from foodborne pathogens each year. Most foodborne outbreaks occur among small groups of persons in a localized area. However, because many foods are distributed widely and rapidly, and because detection methods have improved, outbreaks that occur in multiple states and that even span the entire country are being recognized with increasing frequency. METHODS: This report analyzes data from CDC's Foodborne Disease Outbreak Surveillance System to describe multistate foodborne outbreaks that occurred in the United States during 2010-2014. RESULTS: During this 5-year period, 120 multistate foodborne disease outbreaks (with identified pathogen and food or common setting) were reported to CDC. These multistate outbreaks accounted for 3% (120 of 4,163) of all reported foodborne outbreaks, but were responsible for 11% (7,929 of 71,747) of illnesses, 34% (1,460 of 4,247) of hospitalizations, and 56% (66 of 118) of deaths associated with foodborne outbreaks. Salmonella (63 outbreaks), Shiga toxin-producing E. coli (34), and Listeria monocytogenes (12) were the leading pathogens. Fruits (17), vegetable row crops (15), beef (13), sprouts (10), and seeded vegetables (nine) were the most commonly implicated foods. Traceback investigations to identify the food origin were conducted for 87 outbreaks, of which 55 led to a product recall. Imported foods were linked to 18 multistate outbreaks. CONCLUSIONS: Multistate foodborne disease outbreaks account for a disproportionate number of outbreak-associated illnesses, hospitalizations, and deaths relative to their occurrence. Working together, food industries and public health departments and agencies can develop and implement more effective ways to identify and to trace contaminated foods linked to multistate outbreaks. Lessons learned during outbreak investigations can help improve food safety practices and regulations, and might prevent future outbreaks. |
Selecting quality service dogs (part 1): morphological and health considerations
Parenti L , Wilson M , Foreman AM , Wirth O , Meade BJ . APDT Chron Dog 2015 2015 71-77 Service dogs include dogs for mobility, vision, hearing, developmental disabilities, diabetic alert, seizure alert, and psychiatric support. They are trained to "provide work or perform tasks related to an individual's disability." When accompanied by a service dog, the individual with a disability is afforded some public access protections (Parenti, Foreman, Meade, and Wirth, 2013). Current demand for service dogs outweighs supply (M. Winkle, Crowe, and Hendrix, 2012), and average wait times of up to three years for a well-trained dog are not uncommon. Service dogs are generally trained for a minimum of 18 months, and training can cost anywhere from $10,000 to $20,000 (Allen and Blascovich, 1996. According to some estimates, only 50% of dogs entering training progress to the level of service dog (Batt, Batt, Baguley, and McGreevy, 2008), increasing the cost of training and limiting the number of available dogs. Hereditary diseases and behavioral problems are the most common reasons for a dog to be released from a training program (Wahl, Herbst, Tsai, and Murphy, 2008). Targeted selection and breeding of physically and behaviorally healthy dogs would allow organizations to allocate their resources more efficiently, reduce training costs, and increase the supply of service dogs to those in need. Service dog training programs nationwide can benefit from selecting and breeding dogs based on characteristics relevant to their service dog specialty. This is the first of three articles on the selection and breeding of dogs for service work. The current article addresses morphological and health considerations; the remaining articles will focus on behavior and temperament characteristics and research in the field of service dog training. |
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