Last data update: May 13, 2024. (Total: 46773 publications since 2009)
Records 1-30 (of 41 Records) |
Query Trace: Del Rio C[original query] |
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The testing imperative: Why the US ending the human immunodeficiency virus (HIV) epidemic program needs to renew efforts to expand HIV testing in clinical and community-based settings
Nosyk B , Fojo AT , Kasaie P , Enns B , Trigg L , Piske M , Hutchinson AB , DiNenno EA , Zang X , Del Rio C . Clin Infect Dis 2023 76 (12) 2206-2208 Data from several modeling studies demonstrate that large-scale increases in human immunodeficiency virus (HIV) testing across settings with a high burden of HIV may produce the largest incidence reductions to support the US Ending the HIV Epidemic (EHE) initiative's goal of reducing new HIV infections 90% by 2030. Despite US Centers for Disease Control and Prevention's recommendations for routine HIV screening within clinical settings and at least yearly screening for individuals most at risk of acquiring HIV, fewer than half of US adults report ever receiving an HIV test. Furthermore, total domestic funding for HIV prevention has remained unchanged between 2013 and 2019. The authors describe the evidence supporting the value of expanded HIV testing, identify challenges in implementation, and present recommendations to address these barriers through approaches at local and federal levels to reach EHE targets. |
Cost-effectiveness analysis of integrated bite case management and sustained dog vaccination for rabies control
Taylor E , Prada JM , Del Rio Vilas V , Undurraga EA , Wallace R , Horton DL . Am J Trop Med Hyg 2023 109 (1) 205-213 The successful prevention, control, and elimination of dog-mediated rabies is challenging due to insufficient resource availability and inadequate placement. An integrated dog bite case management (IBCM) system plus dog vaccination can help address these challenges. Based on data from the IBCM system in Haiti, we conducted a cost-effectiveness evaluation of a newly established IBCM system plus sustained vaccination and compared it with 1) a no bite-case management (NBCM) and 2) a non-risk-based (NRB) program, where bite victims presenting at a health clinic would receive post-exposure prophylaxis regardless of risk assessment. We also provide cost-effectiveness guidance for an ongoing IBCM system and for sub-optimal dog vaccination coverages, considering that not all cost-effective interventions are affordable. Cost-effectiveness outcomes included average cost per human death averted (USD/death averted) and per life-year gained (LYG). The analysis used a governmental perspective. Considering a sustained 5-year implementation with 70% dog vaccination coverage, IBCM had a lower average cost per death averted (IBCM: $7,528, NBCM: $7,797, NRB: $15,244) and cost per LYG (IBCM: $152, NBCM: $158, NRB: $308) than NBCM and NRB programs. As sensitivity analysis, we estimated cost-effectiveness for alternative scenarios with lower dog-vaccination coverages (30%, 55%) and lower implementation costs. Our results suggest that better health and cost-effectiveness outcomes are achieved with the continued implementation of an IBCM program ($118 per life-year saved) compared with a newly established IBCM program ($152 per life-year saved). Our results suggest that IBCM is more cost-effective than non-integrated programs to eliminate dog-mediated human rabies. |
Cabotegravir for HIV prevention in cisgender men and transgender women
Landovitz RJ , Donnell D , Clement ME , Hanscom B , Cottle L , Coelho L , Cabello R , Chariyalertsak S , Dunne EF , Frank I , Gallardo-Cartagena JA , Gaur AH , Gonzales P , Tran HV , Hinojosa JC , Kallas EG , Kelley CF , Losso MH , Madruga JV , Middelkoop K , Phanuphak N , Santos B , Sued O , Valencia Huamaní J , Overton ET , Swaminathan S , Del Rio C , Gulick RM , Richardson P , Sullivan P , Piwowar-Manning E , Marzinke M , Hendrix C , Li M , Wang Z , Marrazzo J , Daar E , Asmelash A , Brown TT , Anderson P , Eshleman SH , Bryan M , Blanchette C , Lucas J , Psaros C , Safren S , Sugarman J , Scott H , Eron JJ , Fields SD , Sista ND , Gomez-Feliciano K , Jennings A , Kofron RM , Holtz TH , Shin K , Rooney JF , Smith KY , Spreen W , Margolis D , Rinehart A , Adeyeye A , Cohen MS , McCauley M , Grinsztejn B . N Engl J Med 2021 385 (7) 595-608 BACKGROUND: Safe and effective long-acting injectable agents for preexposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) infection are needed to increase the options for preventing HIV infection. METHODS: We conducted a randomized, double-blind, double-dummy, noninferiority trial to compare long-acting injectable cabotegravir (CAB-LA, an integrase strand-transfer inhibitor [INSTI]) at a dose of 600 mg, given intramuscularly every 8 weeks, with daily oral tenofovir disoproxil fumarate-emtricitabine (TDF-FTC) for the prevention of HIV infection in at-risk cisgender men who have sex with men (MSM) and in at-risk transgender women who have sex with men. Participants were randomly assigned (1:1) to receive one of the two regimens and were followed for 153 weeks. HIV testing and safety evaluations were performed. The primary end point was incident HIV infection. RESULTS: The intention-to-treat population included 4566 participants who underwent randomization; 570 (12.5%) identified as transgender women, and the median age was 26 years (interquartile range, 22 to 32). The trial was stopped early for efficacy on review of the results of the first preplanned interim end-point analysis. Among 1698 participants from the United States, 845 (49.8%) identified as Black. Incident HIV infection occurred in 52 participants: 13 in the cabotegravir group (incidence, 0.41 per 100 person-years) and 39 in the TDF-FTC group (incidence, 1.22 per 100 person-years) (hazard ratio, 0.34; 95% confidence interval, 0.18 to 0.62). The effect was consistent across prespecified subgroups. Injection-site reactions were reported in 81.4% of the participants in the cabotegravir group and in 31.3% of those in the TDF-FTC group. In the participants in whom HIV infection was diagnosed after exposure to CAB-LA, INSTI resistance and delays in the detection of HIV infection were noted. No safety concerns were identified. CONCLUSIONS: CAB-LA was superior to daily oral TDF-FTC in preventing HIV infection among MSM and transgender women. Strategies are needed to prevent INSTI resistance in cases of CAB-LA PrEP failure. (Funded by the National Institute of Allergy and Infectious Diseases and others; HPTN 083 ClinicalTrials.gov number, NCT02720094.). |
Antimicrobial resistance control efforts in Africa: a survey of the role of Civil Society Organisations
Fraser JL , Alimi YH , Varma JK , Muraya T , Kujinga T , Carter VK , Schultsz C , Del Rio Vilas VJ . Glob Health Action 2021 14 (1) 1868055 Background: Antimicrobial resistance (AMR) is a growing public health threat in Africa. AMR prevention and control requires coordination across multiple sectors of government and civil society partners. Objectives: To assess the current role, needs, and capacities of CSOs working in AMR in Africa. Methods: We conducted an online survey of 35 CSOs working in 37 countries across Africa. The survey asked about priorities for AMR, current AMR-specific activities, monitoring practices, training needs, and preferences for sharing information on AMR. Further data were gathered on the main roles of the organisations, the length of time engaged in and budget spent on AMR-related activities, and their involvement in the development and implementation of National Action Plans (NAPs). Results were assessed against The Africa Centres for Disease Control and Prevention (Africa CDC) Framework for Antimicrobial Resistance (2018-2023). Results: CSOs with AMR-related activities are working in all four areas of Africa CDC's Framework: improving surveillance, delaying emergence, limiting transmission, and mitigating harm from infections caused by AMR microorganisms. Engagement with the four objectives is mainly through advocacy, followed by accountability and service delivery. There were limited monitoring activities reported by CSOs, with only seven (20%) providing an example metric used to monitor their activities related to AMR, and 27 (80%) CSOs reporting having no AMR-related strategy. Half the CSOs reported engaging with the development and implementation of NAPs; however, only three CSOs are aligning their work with these national strategies. Conclusion: CSOs across Africa are supporting AMR prevention and control, however, there is potential for more engagement. Africa CDC and other government agencies should support the training of CSOs in strategies to control AMR. Tailored training programmes can build knowledge of AMR, capacity for monitoring processes, and facilitate further identification of CSOs' contribution to the AMR Framework and alignment with NAPs and regional strategies. |
The potential epidemiological impact of COVID-19 on the HIV/AIDS epidemic and the cost-effectiveness of linked, opt-out HIV testing: A modeling study in six US cities.
Zang X , Krebs E , Chen S , Piske M , Armstrong WS , Behrends CN , Del Rio C , Feaster DJ , Marshall BDL , Mehta SH , Mermin J , Metsch LR , Schackman BR , Strathdee SA , Nosyk B . Clin Infect Dis 2020 72 (11) e828-e834 BACKGROUND: Widespread viral and serological testing for SARS-CoV-2 may present a unique opportunity to also test for HIV infection. We estimated the potential impact of adding linked, opt-out HIV testing alongside SARS-CoV-2 testing on HIV incidence and the cost-effectiveness of this strategy in six US cities. METHODS: Using a previously-calibrated dynamic HIV transmission model, we constructed three sets of scenarios for each city: (1) sustained current levels of HIV-related treatment and prevention services (status quo); (2) temporary disruptions in health services and changes in sexual and injection risk behaviours at discrete levels between 0%-50%; and (3) linked HIV and SARS-CoV-2 testing offered to 10%-90% of the adult population in addition to scenario (2). We estimated cumulative HIV infections between 2020-2025 and incremental cost-effectiveness ratios of linked HIV testing over 20 years. RESULTS: In the absence of linked, opt-out HIV testing, we estimated a total of 16.5% decrease in HIV infections between 2020-2025 in the best-case scenario (50% reduction in risk behaviours and no service disruptions), and 9.0% increase in the worst-case scenario (no behavioural change and 50% reduction in service access). We estimated that HIV testing (offered at 10%-90% levels) could avert a total of 576-7,225 (1.6%-17.2%) new infections. The intervention would require an initial investment of $20.6M-$220.7M across cities; however, the intervention would ultimately result in savings in health care costs in each city. CONCLUSIONS: A campaign in which HIV testing is linked with SARS-CoV-2 testing could substantially reduce HIV incidence and reduce direct and indirect health care costs attributable to HIV. |
Precision Public Health as a Key Tool in the COVID-19 Response.
Rasmussen SA , Khoury MJ , Del Rio C . JAMA 2020 324 (10) 933-934 With more than 20 million cases of coronavirus disease 2019 (COVID-19) globally and now exceeding 5 million cases in the United States, the COVID-19 pandemic represents one of the greatest public health challenges in more than a century. To succeed against COVID-19, multiple public health tools and interventions will be needed to minimize morbidity and mortality related to COVID-19. Although extreme public health interventions, for example, lockdowns and stay-at-home mandates, were initially critical to flattening the curve, many fundamental questions remain, such as when can employees deemed nonessential return to work, how can children safely return to school, and who should be first to receive a vaccine once it becomes available. Information about who is at highest risk of hospitalization, intensive care unit admission, and death based on age, sex, race/ethnicity, and underlying conditions is now becoming available.1 In addition, the relationship between neighborhood factors (eg, increased neighborhood household crowding rate) and risks for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and COVID-19 disease outcomes are now recognized.2 |
Towards rabies elimination in the Asia-Pacific region: From theory to practice
Rupprecht CE , Abela-Ridder B , Abila R , Amparo AC , Banyard A , Blanton J , Chanachai K , Dallmeier K , de Balogh K , Del Rio Vilas V , Ertl H , Freuling C , Hill R , Houillon G , Jakava-Viljanen M , Kasemsuwan S , Lechenet J , Nel L , Panichabhongse P , Rahman SA , Tantawichien T , Vandeputte J , Viriyabancha W , Vos A , Wallace R , Yale G , Yurachai O , Mueller T . Biologicals 2020 64 83-95 Rabies is a major neglected zoonotic disease and causes a substantial burden in the Asian region. Currently, Pacific Oceania is free of rabies but enzootic areas throughout southeast Asia represent a major risk of disease introduction to this region. On September 25-26, 2019, researchers, government officials and related stakeholders met at an IABS conference in Bangkok, Thailand to engage on the topic of human rabies mediated by dogs. The objective of the meeting was focused upon snowballing efforts towards achieving substantial progress in rabies prevention, control and elimination within Asia by 2030, and thereby to safeguard the Pacific region. Individual sessions focused upon domestic animal, wildlife and human vaccination; the production and evaluation of quality, safety and efficacy of existing rabies biologics; and the future development of new products. Participants reviewed the progress to date in eliminating canine rabies by mass vaccination, described supportive methods to parenteral administration by oral vaccine application, considered updated global and local approaches at human prophylaxis and discussed the considerable challenges ahead. Such opportunities provide continuous engagement on disease management among professionals at a trans-disciplinary level and promote new applied research collaborations in a modern One Health context. |
Impact of abstinence and of reducing illicit drug use without abstinence on HIV viral load
Nance RM , Trejo MEP , Whitney BM , Delaney JAC , Altice F , Beckwith CG , Chander G , Chandler R , Christopoulous K , Cunningham C , Cunningham WE , Del Rio C , Donovan D , Eron JJ , Fredericksen RJ , Kahana S , Kitahata MM , Kronmal R , Kuo I , Kurth A , Mathews WC , Mayer KH , Moore RD , Mugavero MJ , Ouellet LJ , Quan VM , Saag MS , Simoni JM , Springer S , Strand L , Taxman F , Young JD , Crane HM . Clin Infect Dis 2019 70 (5) 867-874 BACKGROUND: Substance use is common among people living with HIV (PLWH) and a barrier to achieving viral suppression. OBJECTIVE: Among PLWH who report illicit drug use, we evaluated associations between HIV viral load (VL) and reduced use of illicit opioids, methamphetamine/crystal, cocaine/crack, and marijuana, regardless of whether or not abstinence was achieved. DESIGN: Longitudinal cohort studySetting/participantsPLWH in clinical care at 8 HIV clinics or 5 clinical studies. MEASUREMENTS: We used joint longitudinal and survival models to examine the impact of decreasing drug use and of abstinence for each drug on viral suppression. We repeated analyses using linear mixed models to examine associations between change in frequency of drug use and VL. RESULTS: The number of PLWH who were using each drug at baseline ranged from n=568 (illicit opioids) to n=4272 (marijuana). Abstinence was associated with higher odds of viral suppression (OR 1.4-2.2) and lower relative VL (ranging from 21-42% by drug) for all four drug categories. Reducing frequency of illicit opioid or methamphetamine/crystal use without abstinence was associated with VL suppression (OR 2.2, 1.6 respectively). Reducing frequency of illicit opioid or methamphetamine/crystal use without abstinence was associated with lower relative VL (47%, 38% respectively). LIMITATIONS: Observational data have limitations with causal inference. CONCLUSIONS: Abstinence was associated with viral suppression. In addition, reducing use of illicit opioids or methamphetamine/crystal, even without abstinence, was also associated with viral suppression. Findings highlight the impact of reducing substance use even when abstinence is not achieved and the potential benefits of medications, behavioral interventions, and harm-reduction interventions. |
Antimicrobial drug prescription and Neisseria gonorrhoeae susceptibility, United States, 2005-2013
Kirkcaldy RD , Bartoces MG , Soge OO , Riedel S , Kubin G , Del Rio C , Papp JR , Hook EW 3rd , Hicks LA . Emerg Infect Dis 2017 23 (10) 1657-1663 We investigated whether outpatient antimicrobial drug prescribing is associated with Neisseria gonorrhoeae antimicrobial drug susceptibility in the United States. Using susceptibility data from the Gonococcal Isolate Surveillance Project during 2005-2013 and QuintilesIMS data on outpatient cephalosporin, macrolide, and fluoroquinolone prescribing, we constructed multivariable linear mixed models for each antimicrobial agent with 1-year lagged annual prescribing per 1,000 persons as the exposure and geometric mean MIC as the outcome of interest. Multivariable models did not demonstrate associations between antimicrobial drug prescribing and N. gonorrhoeae susceptibility for any of the studied antimicrobial drugs during 2005-2013. Elucidation of epidemiologic factors contributing to resistance, including further investigation of the potential role of antimicrobial drug use, is needed. |
Large Cluster of Neisseria Meningitidis Urethritis in Columbus, Ohio, 2015.
Bazan JA , Turner AN , Kirkcaldy RD , Retchless AC , Kretz CB , Briere E , Tzeng YL , Stephens DS , Maierhofer C , Del Rio C , Abrams AJ , Trees DL , Ervin M , Licon DB , Fields KS , Roberts MW , Dennison A , Wang X . Clin Infect Dis 2017 65 (1) 92-99 Background.: Neisseria meningitidis (Nm) is a Gram-negative diplococcus that normally colonizes the nasopharynx and rarely infects the urogenital tract. On Gram stain of urethral exudates, Nm can be misidentified as the more common sexually transmitted pathogen Neisseria gonorrhoeae. Methods.: In response to a large increase in cases of Nm urethritis identified among men presenting for screening at a sexually transmitted disease clinic in Columbus, Ohio, we investigated the epidemiologic characteristics of men with Nm urethritis and the molecular and phylogenetic characteristics of their Nm isolates. The study was conducted between 1 January and 18 November 2015. Results.: Seventy-five Nm urethritis cases were confirmed by biochemical and polymerase chain reaction testing. Men with Nm urethritis were a median age of 31 years (interquartile range [IQR] = 24-38) and had a median of 2 sex partners in the last 3 months (IQR = 1-3). Nm cases were predominantly black (81%) and heterosexual (99%). Most had urethral discharge (91%), reported oral sex with a female in the last 12 months (96%), and were treated with a ceftriaxone-based regimen (95%). A minority (15%) also had urethral chlamydia coinfection. All urethral Nm isolates were nongroupable, ST-11 clonal complex (cc11), ET-15, and clustered together phylogenetically. Urethral Nm isolates were similar by fine typing (PorA P1.5-1,10-8, PorB 2-2, FetA F3-6), except 1, which had a different PorB type (2-78). Conclusions.: Between January and November 2015, 75 urethritis cases due to a distinct Nm clade occurred among primarily black, heterosexual men in Columbus, Ohio. Future urogenital Nm infection studies should focus on pathogenesis and modes of sexual transmission. |
Emergence of a new Neisseria meningitidis clonal complex 11 lineage 11.2 clade as an effective urogenital pathogen.
Tzeng YL , Bazan JA , Turner AN , Wang X , Retchless AC , Read TD , Toh E , Nelson DE , Del Rio C , Stephens DS . Proc Natl Acad Sci U S A 2017 114 (16) 4237-4242 Neisseria meningitidis (Nm) clonal complex 11 (cc11) lineage is a hypervirulent pathogen responsible for outbreaks of invasive meningococcal disease, including among men who have sex with men, and is increasingly associated with urogenital infections. Recently, clusters of Nm urethritis have emerged primarily among heterosexual males in the United States. We determined that nonencapsulated meningococcal isolates from an ongoing Nm urethritis outbreak among epidemiologically unrelated men in Columbus, Ohio, are linked to increased Nm urethritis cases in multiple US cities, including Atlanta and Indianapolis, and that they form a unique clade (the US Nm urethritis clade, US_NmUC). The isolates belonged to the cc11 lineage 11.2/ET-15 with fine type of PorA P1.5-1, 10-8; FetA F3-6; PorB 2-2 and express a unique FHbp allele. A common molecular fingerprint of US_NmUC isolates was an IS1301 element in the intergenic region separating the capsule ctr-css operons and adjacent deletion of cssA/B/C and a part of csc, encoding the serogroup C capsule polymerase. This resulted in the loss of encapsulation and intrinsic lipooligosaccharide sialylation that may promote adherence to mucosal surfaces. Furthermore, we detected an IS1301-mediated inversion of an approximately 20-kb sequence near the cps locus. Surprisingly, these isolates had acquired by gene conversion the complete gonococcal denitrification norB-aniA gene cassette, and strains grow well anaerobically. The cc11 US_NmUC isolates causing urethritis clusters in the United States may have adapted to a urogenital environment by loss of capsule and gene conversion of the Neisseria gonorrheae norB-aniA cassette promoting anaerobic growth. |
An inter- laboratory proficiency testing exercise for rabies diagnosis in Latin America and the Caribbean
Clavijo A , Freire de Carvalho MH , Orciari LA , Velasco-Villa A , Ellison J , Greenberg L , Yager PA , Green DB , Vigilato MA , Cosivi O , Del Rio-Vilas VJ . PLoS Negl Trop Dis 2017 11 (4) e0005427 The direct fluorescent antibody test (DFA), is performed in all rabies reference laboratories across Latin America and the Caribbean (LAC). Despite DFA being a critical capacity in the control of rabies, there is not a standardized protocol in the region. We describe the results of the first inter-laboratory proficiency exercise of national rabies laboratories in LAC countries as part of the regional efforts towards dog-maintained rabies elimination in the American region. Twenty three laboratories affiliated to the Ministries of Health and Ministries of Agriculture participated in this exercise. In addition, the laboratories completed an online questionnaire to assess laboratory practices. Answers to the online questionnaire indicated large variability in the laboratories throughput, equipment used, protocols availability, quality control standards and biosafety requirements. Our results will inform actions to improve and harmonize laboratory rabies capacities across LAC in support for the regional efforts towards elimination of dog-maintained rabies. |
Infectious disease physicians' perceptions about Ebola preparedness early in the US response: a qualitative analysis and lessons for the future
Santibanez S , Polgreen PM , Beekmann SE , Rupp ME , Del Rio C . Health Secur 2016 14 (5) 345-50 On September 30, 2014, the first US patient with Ebola virus disease was diagnosed. Hospitals and healthcare systems identified many complex issues that needed to be addressed to prepare for possible future outbreaks. Here we summarize themes identified in free text responses from a query of infectious disease physicians from the Infectious Disease Society of America's (IDSA) Emerging Infections Network (EIN) early in the domestic Ebola response and place them into the context of biopreparedness for possible future events. We queried infectious disease physician members of the EIN from October 21-November 11, 2014, about their institutions' experience with Ebola preparedness at that time. Of 1,566 EIN physicians, 869 replied to this query, and 318 provided 448 write-in comments in response to the question, "What gaps have been identified in order for facilities to safely care for suspected Ebola patients?" or in a section for general comments. Six themes emerged from the responses: the unique challenges faced by small community hospitals (87 comments), the burden placed on infectious disease and infection control staff (61), ethical questions and planning for vulnerable populations (40), misinformation and stigma (29), financial issues faced by response staff (27), and long-term sustainability (16). This qualitative analysis provides insights into early thinking about challenges in preparing for Ebola and other emerging infections in the United States. The themes identified here should be considered during local, state, and national planning. |
Socioecological factors influencing women's HIV risk in the United States: Qualitative findings from the women's HIV seroIncidence study (HPTN 064)
Frew PM , Parker K , Vo L , Haley D , O'Leary A , Diallo DD , Golin CE , Kuo I , Soto-Torres L , Wang J , Adimora AA , Randall LA , Del Rio C , Hodder S . BMC Public Health 2016 16 (1) 803 BACKGROUND: We sought to understand the multilevel syndemic factors that are concurrently contributing to the HIV epidemic among women living in the US. We specifically examined community, network, dyadic, and individual factors to explain HIV vulnerability within a socioecological framework. METHODS: We gathered qualitative data (120 interviews and 31 focus groups) from a subset of women ages 18-44 years (N = 2,099) enrolled in the HPTN 064 HIV seroincidence estimation study across 10 US communities. We analyzed data from 4 diverse locations: Atlanta, New York City (the Bronx), Raleigh, and Washington, DC. Data were thematically coded using grounded theory methodology. Intercoder reliability was assessed to evaluate consistency of team-based coding practices. RESULTS: The following themes were identified at 4 levels including 1) exosystem (community): poverty prevalence, discrimination, gender imbalances, community violence, and housing challenges; 2) mesosystem (network): organizational social support and sexual concurrency; 3) microsystem (dyadic): sex exchange, interpersonal social support, intimate partner violence; and 4) individual: HIV/STI awareness, risk taking, and substance use. A strong theme emerged with over 80 % of responses linked to the fundamental role of financial insecurity underlying risk-taking behavioral pathways. CONCLUSIONS: Multilevel syndemic factors contribute to women's vulnerability to HIV in the US. Financial insecurity is a predominant theme, suggesting the need for tailored programming for women to reduce HIV risk. TRIAL REGISTRATION: Clinicaltrials.gov, NCT00995176. |
Knockdown Resistance Mutations in Aedes aegypti (Diptera: Culicidae) From Puerto Rico.
Ponce-Garcia G , Del Rio-Galvan S , Barrera R , Saavedra-Rodriguez K , Villanueva-Segura K , Felix G , Amador M , Flores AE . J Med Entomol 2016 53 (6) 1410-1414 Permethrin resistance is widespread in Aedes aegypti (L.), the main dengue, zika, and chikungunya virus vector in Latin America and the Caribbean. A common mechanism of resistance to pyrethroids-knockdown resistance (kdr)-is conferred through mutations in the insect's voltage-dependent sodium channel. In this mosquito, around 10 replacement substitutions in the voltage-gated sodium channel gene (vgsc) have been reported in pyrethroid-resistant strains. Two of these mutations, named Ile1,016 and Cys1,534, are widespread in mosquito populations from Latin America and the Caribbean. This study assessed the levels of permethrin resistance and the frequency of two kdr mutations in eight Ae. aegypti populations collected in Puerto Rico in 2013. Permethrin resistance factors ranged from 33-214-fold relative to the New Orleans reference strain. The frequency of kdr mutation Ile1,016 ranged from 0.65 to fixation (1.0), and for Cys1,534 frequencies varied from 0.8 to fixation. Alarmingly, two populations-Carolina and Caguas-reached fixation at both loci. Our results suggest that permethrin effectiveness for Ae. aegypti control is compromised in these collections from Puerto Rico. |
Innovation in graduate education for health professionals in humanitarian emergencies
Evans DP , Anderson M , Shahpar C , Del Rio C , Curran JW . Prehosp Disaster Med 2016 31 (5) 1-7 The objective of this report was to show how the Center for Humanitarian Emergencies (the Center) at Emory University (Atlanta, Georgia USA) has trained graduate students to respond to complex humanitarian emergencies (CHEs) through innovative educational programs, with the goal of increasing the number of trained humanitarian workers. Natural disasters are on the rise with more than twice as many occurring from 2000-2009 as there were from 1980-1989. In 2012 alone, 144 million people were affected by a natural disaster or displaced by conflict worldwide. This has created an immense need for trained humanitarian workers to respond effectively to such disasters. The Center has developed a model for educational programming that targets learners along an educational continuum ranging from the undergraduate level through continuing professional education. These programs, based in the Rollins School of Public Health (RSPH) of Emory University, include: a competency-based graduate certificate program (the Certificate) in humanitarian emergencies; a fellowship program for mid-career professionals; and funded field practica. The competency-based Certificate program began in 2010 with a cohort of 14 students. Since then, 101 students have received the Certificate with 50 more due for completion in 2016 and 2017 combined. The fellowship program for mid-career professionals has hosted four fellows from conflict-affected or resource-poor countries, who have then gone on to assume leadership positions with humanitarian organizations. From 2009-2015, the field practicum program supported 34 students in international summer practicum experiences related to emergency response or preparedness. Students have participated in summer field experiences on every continent but Australia. Together the Certificate, funded field practicum opportunities, and the fellowship comprise current efforts in providing innovative education and training for graduate and post-graduate students of public health in humanitarian response. These modest efforts are just the beginning in terms of addressing the global shortage of skilled public health professionals that can coordinate humanitarian response. Evaluating existing programs will allow for refinement of current programs. Ultimately, these programs may influence the development of new programs and inform others interested in this area. |
Appreciation: Philip S. Brachman, 1927-2016
Flannery B , Del Rio C . Int J Epidemiol 2016 45 (3) 602-4 I have gone to heaven to teach an epidemiology course. At this point no return is planned… So we imagine his parting message. Philip Brachman served on the editorial board of the IJE from 1991 during the tenure of Peter Pharaoh as editor, until 2014 with George Davey Smith and Shah Ebrahim. He began when associate editors sent letters and thick envelopes to invited reviewers, and acknowledged their contributions on postcards; when he stepped down, all of these functions were done electronically, depriving his correspondents of his neatly hand-written notes. Not immune to bias, he stated in 2014 that IJE was his favorite epidemiology journal. One of his regrets was that he had not been able in all those years to attend a single meeting of the editorial board, most likely because of conflicts with his teaching schedule. Because, first and foremost, Philip was an educator. His concern was not just science but rather people, and how that science could change the quality of life for people. His is a great legacy. |
Neisseria gonorrhoeae antimicrobial susceptibility surveillance - the Gonococcal Isolate Surveillance Project, 27 Sites, United States, 2014
Kirkcaldy RD , Harvey A , Papp JR , Del Rio C , Soge OO , Holmes KK , Hook EW 3rd , Kubin G , Riedel S , Zenilman J , Pettus K , Sanders T , Sharpe S , Torrone E . MMWR Surveill Summ 2016 65 (7) 1-19 PROBLEM/CONDITION: Gonorrhea is the second most commonly reported notifiable disease in the United States; 350,062 gonorrhea cases were reported in 2014. Sexually transmitted infections caused by Neisseria gonorrhoeae are a cause of pelvic inflammatory disease in women, which can lead to serious reproductive complications including tubal infertility, ectopic pregnancy, and chronic pelvic pain. Prevention of sequelae and of transmission to sexual partners relies largely on prompt detection and effective antimicrobial treatment. However, treatment has been compromised by the absence of routine antimicrobial susceptibility testing in clinical care and evolution of antimicrobial resistance to the antibiotics used to treat gonorrhea. PERIOD COVERED: 2014. DESCRIPTION OF THE SYSTEM: The Gonococcal Isolate Surveillance Project (GISP) was established in 1986 as a sentinel surveillance system to monitor trends in antimicrobial susceptibilities of N. gonorrhoeae strains in the United States. Each month, N. gonorrhoeae isolates are collected from up to the first 25 men with gonococcal urethritis attending each of the participating sexually transmitted disease (STD) clinics at 27 sites. The number of participating sites has varied over time (21-30 per year). Selected demographic and clinical data are abstracted from medical records. Isolates are tested for antimicrobial susceptibility using agar dilution at one of five regional laboratories. RESULTS: A total of 5,093 isolates were collected in 2014. Of these, 25.3% were resistant to tetracycline, 19.2% to ciprofloxacin, and 16.2% to penicillin (plasmid-based, chromosomal, or both). Reduced azithromycin susceptibility (Azi-RS) (defined as minimum inhibitory concentration [MIC] ≥2.0 microg/mL) increased from 0.6% in 2013 to 2.5% in 2014. The increase occurred in all geographic regions, but was greatest in the Midwest, and among all categories of sex of sex partners (men who have sex with men [MSM], men who have sex with men and women [MSMW], and men who have sex with women [MSW]). No Azi-RS isolates exhibited reduced cefixime or ceftriaxone susceptibility (Cfx-RS and Cro-RS, respectively). The prevalence of Cfx-RS (MIC ≥0.25 microg/mL) increased from 0.1% in 2006 to 1.4% in both 2010 and 2011, decreased to 0.4% in 2013, and increased to 0.8% in 2014. Cro-RS (MIC ≥0.125 microg/mL) increased following a similar pattern but at lesser percentages (increased from 0.1% in 2008 to 0.4% in 2011 and decreased to 0.1% in 2013 and 2014). The percentage of isolates resistant to tetracycline, ciprofloxacin, penicillin, or all three antimicrobials, was greater in isolates from MSM than from MSW. INTERPRETATION: This is the first report to present comprehensive surveillance data from GISP and summarize gonococcal susceptibility over time, as well as underscore the history and public health implications of emerging cephalosporin resistance. Antimicrobial susceptibility patterns vary by geographic region within the United States and by sex of sex partner. Because dual therapy with ceftriaxone plus azithromycin is the only recommended gonorrhea treatment, increases in azithromycin and cephalosporin MICs are cause for concern that resistance to these antimicrobial agents might be emerging. It is unclear whether increases in the percentage of isolates with Azi-RS mark the beginning of a trend. The percentage of isolates with elevated cefixime MICs increased during 2009-2010, then decreased during 2012-2013 after treatment recommendations were changed in 2010 to recommend dual therapy (with a cephalosporin and a second antibiotic) and a higher dosage of ceftriaxone. Subsequently, the treatment recommendations were changed again in 2012 to no longer recommend cefixime as part of first-line therapy (leaving ceftriaxone-based dual therapy as the only recommended therapy). Despite the MIC decrease (i.e., trend of improved cefixime susceptibility) during 2012-2013, the increase in the number of strains with Cfx-RS in 2014 underscores the potential threat of cephalosporin-resistant N. gonorrhoeae. PUBLIC HEALTH ACTION: The National Strategy for Combating Antibiotic-Resistant Bacteria identifies prevention, rapid detection, and control of outbreaks of ceftriaxone-resistant N. gonorrhoeae infection as a priority for U.S. PUBLIC HEALTH ACTION: Antimicrobial susceptibility surveillance is conducted to guide development of treatment recommendations for effective therapy and prevention of complications from and transmission of gonorrhea. Federal agencies can use GISP data to develop national treatment recommendations and set research and prevention priorities. Local and state health departments can use GISP data to determine allocation of STD prevention services and resources, guide prevention planning, and communicate best treatment practices to health care providers. Continued surveillance, appropriate treatment, development of new antibiotics, and prevention of transmission remain the best strategies to reduce gonorrhea incidence and morbidity. |
Susceptibility to temephos and spinosad in Aedes aegypti (Diptera: Culicidae) from Puerto Rico
Del Rio-Galvan SL , Flores AE , Barrera R , Lopez-Monroy B , Felix G , Amador M , Ponce-Garcia G . J Med Entomol 2016 53 (5) 1211-1217 We examined the susceptibility to temephos and spinosad (Natular EC) of eight Aedes aegypti (L.) populations from Puerto Rico, following WHO method (WHO 2005). Enzyme activity was measured for alpha- and beta-esterases, multiple function oxidases, glutathione-s-transferases, and insensitive acetylcholinesterase and was tested for correlation with the susceptibility level. The results showed that larval populations from Puerto Rico obtained during 2014 were found to be susceptible to both larvicides, with low (resistance factor) RRLC50 values (<5 fold) and altered and incipiently altered enzyme expression for all populations, except the insensitive acetylcholinesterase enzyme, where only the population of Ponce showed overexpression (53.3%) above the threshold established with the New Orleans susceptible strain. We recommend the use of both larvicides for mosquito control in the study area and encourage further susceptibility monitoring. |
Faster entry into HIV care among HIV-infected drug users who had been in drug-use treatment programs
Gardner LI , Marks G , Strathdee SA , Loughlin AM , Del Rio C , Kerndt P , Mahoney P , Pitasi MA , Metsch LR . Drug Alcohol Depend 2016 165 15-21 OBJECTIVE: We evaluated whether being in drug use treatment improves linkage to HIV medical care for HIV-infected drug users. We assessed whether an evidence-based intervention for linkage to care ['ARTAS'] works better for HIV-infected drug users who had been in drug use treatment than those who had not. DESIGN: Randomized trial. METHODS: 295 Participants in the Antiretroviral Treatment Access Study ['ARTAS'] trial were followed for time to first HIV medical care. Drug use (injected and non-injected drugs) in the last 30days and being in drug treatment in the last 12 months were assessed by audio-CASI. We used a proportional hazards model of time to care in drug users with and without drug treatment, adjusting for barriers to care, AIDS symptoms, and demographic factors. We tested whether drug treatment modified the intervention effect by using a drug use/drug treatment*intervention interaction term. RESULTS: Ninety-nine participants (30%) reported drug use in the 30days before enrollment. Fifty-three (18%) reported being in a drug treatment program in the last 12 months. Drug users reporting methadone maintenance became engaged in care in less than half the time of drug users without a treatment history [HR 2.97 (1.20, 6.21)]. The ARTAS intervention effect was significantly larger for drug users with a treatment history compared to drug users without a treatment history (AHR 5.40, [95% CI, 2.03-14.38]). CONCLUSIONS: Having been in drug treatment programs facilitated earlier entry into care among drug users diagnosed with HIV infection, and improved their response to the ARTAS linkage intervention. |
Notes from the field: Increase in Neisseria meningitidis-associated urethritis among men at two sentinel clinics - Columbus, Ohio, and Oakland County, Michigan, 2015
Bazan JA , Peterson AS , Kirkcaldy RD , Briere EC , Maierhofer C , Turner AN , Licon DB , Parker N , Dennison A , Ervin M , Johnson L , Weberman B , Hackert P , Wang X , Kretz CB , Abrams AJ , Trees DL , Del Rio C , Stephens DS , Tzeng YL , DiOrio M , Roberts MW . MMWR Morb Mortal Wkly Rep 2016 65 (21) 550-2 Neisseria meningitidis (Nm) urogenital infections, although less common than infections caused by Neisseria gonorrhoeae (Ng), have been associated with urethritis, cervicitis, proctitis, and pelvic inflammatory disease. Nm can appear similar to Ng on Gram stain analysis (gram-negative intracellular diplococci). Because Nm colonizes the nasopharynx, men who receive oral sex (fellatio) can acquire urethral Nm infections. This report describes an increase in Nm-associated urethritis in men attending sexual health clinics in Columbus, Ohio, and Oakland County, Michigan. |
Establishment of a canine rabies burden in Haiti through the implementation of a novel surveillance program
Wallace RM , Reses H , Franka R , Dilius P , Fenelon N , Orciari L , Etheart M , Destine A , Crowdis K , Blanton JD , Francisco C , Ludder F , Del Rio Vilas V , Haim J , Millien M . PLoS Negl Trop Dis 2015 9 (11) e0004245 The Republic of Haiti is one of only several countries in the Western Hemisphere in which canine rabies is still endemic. Estimation methods have predicted that 130 human deaths occur per year, yet existing surveillance mechanisms have detected few of these rabies cases. Likewise, canine rabies surveillance capacity has had only limited capacity, detecting only two rabid dogs per year, on average. In 2013, Haiti initiated a community-based animal rabies surveillance program comprised of two components: active community bite investigation and passive animal rabies investigation. From January 2013 -December 2014, 778 rabies suspect animals were reported for investigation. Rabies was laboratory-confirmed in 70 animals (9%) and an additional 36 cases were identified based on clinical diagnosis (5%), representing an 18-fold increase in reporting of rabid animals compared to the three years before the program was implemented. Dogs were the most frequent rabid animal (90%). Testing and observation ruled out rabies in 61% of animals investigated. A total of 639 bite victims were reported to the program and an additional 364 bite victims who had not sought medical care were identified during the course of investigations. Only 31% of people with likely rabies exposures had initiated rabies post-exposure prophylaxis prior to the investigation. Rabies is a neglected disease in-part due to a lack of surveillance and understanding about the burden. The surveillance methods employed by this program established a much higher burden of canine rabies in Haiti than previously recognized. The active, community-based bite investigations identified numerous additional rabies exposures and bite victims were referred for appropriate medical care, averting potential human rabies deaths. The use of community-based rabies surveillance programs such as HARSP should be considered in canine rabies endemic countries. |
Trends in Neisseria gonorrhoeae susceptibility to cephalosporins in the United States, 2006-2014
Kirkcaldy RD , Hook EW 3rd , Soge OO , del Rio C , Kubin G , Zenilman JM , Papp JR . JAMA 2015 314 (17) 1869-71 Gonorrhea is a common sexually transmitted disease that, if untreated, can cause reproductive health complications. Gonorrhea treatment has been repeatedly jeopardized by antimicrobial resistance. To ensure effective treatment, the Centers for Disease Control and Prevention (CDC) periodically updates treatment guidelines based on resistance trends. In 2010 and following declining cephalosporin susceptibility in several countries, CDC updated its treatment recommendation from single-dose cephalosporin (injectable ceftriaxone or oral cefixime) to intensified combination therapy of either ceftriaxone (at a higher dose than previously recommended) or cefixime, plus a second antimicrobial.1 CDC again updated guidelines in 2012 to recommend ceftriaxone-based combination therapy as the single recommended therapy.1 We describe recent gonococcal cephalosporin susceptibility trends emphasizing changes following publication of these guidelines. |
Infectious disease physician assessment of hospital preparedness for Ebola virus disease
Polgreen PM , Santibanez S , Koonin LM , Rupp ME , Beekmann SE , Del Rio C . Open Forum Infect Dis 2015 2 (3) ofv087 BACKGROUND: The first case of Ebola diagnosed in the United States and subsequent cases among 2 healthcare workers caring for that patient highlighted the importance of hospital preparedness in caring for Ebola patients. METHODS: From October 21, 2014 to November 11, 2014, infectious disease physicians who are part of the Emerging Infections Network (EIN) were surveyed about current Ebola preparedness at their institutions. RESULTS: Of 1566 EIN physician members, 869 (55.5%) responded to this survey. Almost all institutions represented in this survey showed a substantial degree of preparation for the management of patients with suspected and confirmed Ebola virus disease. Despite concerns regarding shortages of personal protective equipment, approximately two thirds of all respondents reported that their facilities had sufficient and ready availability of hoods, full body coveralls, and fluid-resistant or impermeable aprons. The majority of respondents indicated preference for transfer of Ebola patients to specialized treatment centers rather than caring for them locally. In general, we found that larger hospitals and teaching hospitals reported higher levels of preparedness. CONCLUSIONS: Prior to the Centers for Disease Control and Prevention's plan for a tiered approach that identified specific roles for frontline, assessment, and designated treatment facilities, our query of infectious disease physicians suggested that healthcare facilities across the United States were making preparations for screening, diagnosis, and treatment of Ebola patients. Nevertheless, respondents from some hospitals indicated that they were relatively unprepared. |
Control of dog mMediated human rabies in Haiti: no time to spare
Millien MF , Pierre-Louis JB , Wallace R , Caldas E , Rwangabgoba JM , Poncelet JL , Cosivi O , Del Rio Vilas VJ . PLoS Negl Trop Dis 2015 9 (6) e0003806 The American region has pledged to eliminate dog-mediated human rabies by 2015. As part of these efforts, we describe the findings of a desk and field mission review of Haiti's rabies situation by the end of 2013. While government officials recognize the importance of dog-mediated rabies control, and the national rabies plan adequately contemplates the basic capacities to that effect, regular and sufficient implementation, for example, of dog vaccination, is hampered by limited funding. Compounding insufficient funding and human resources, official surveillance figures do not accurately reflect the risk to the population, as evidenced by the large number of rabid dogs detected by focalized and enhanced surveillance activities conducted by the Ministry of Agriculture, Natural Resources and Rural Development (MARNDR) and the Health and Population Ministry (MSPP) with the technical assistance of the United States Centers for Disease Control and Prevention. Although international support is common, either in the form of on-the-ground technical support or donations of immunobiologicals, it is not comprehensive. In addition, there is limited coordination with MARNDR/MSPP and with other actors at the strategic or operational level due to human resources limitations. Given these findings, the 2015 elimination goal in the region is compromised by the situation in Haiti where control of the disease is not yet in sight despite the best efforts of the resolute national officials. More importantly, dog-mediated rabies is still a threat to the Haitian population. |
Addressing the challenges of the HIV continuum of care in high-prevalence cities in the United States
Greenberg AE , Purcell DW , Gordon CM , Barasky RJ , Del Rio C . J Acquir Immune Defic Syndr 2015 69 Suppl 1 S1-7 In summary, addressing the challenges of the HIV care continuum is critical so that the goals of the NHAS can be achieved. CDC is working closely with federal partners, public health departments, and communities throughout the United States on multiple surveillance, programmatic, and research initiatives to inform and improve outcomes along the HIV care continuum. Currently, a large number of research projects are being conducted to describe the care continuum in various populations, assess and model the impact of interventions, and monitor the quality of care. To contribute to this knowledge base, NIH is working with its academic partners to support research that will inform the optimization of HIV treatment and prevention programs. As part of this focus, the CFAR/APC HIV Continuum of Care Working Group was formed to encourage communication between academic investigators and their local DOHs and to support joint research initiatives that are both timely and relevant to their own cities and environments. Finally, the results presented in this supplement may have implications for jurisdictions beyond those in which the studies were conducted. |
Analysis of Neisseria gonorrhoeae azithromycin susceptibility in the United States by the Gonococcal Isolate Surveillance Project, 2005 to 2013
Kirkcaldy RD , Soge O , Papp JR , Hook EW 3rd , Del Rio C , Kubin G , Weinstock HS . Antimicrob Agents Chemother 2014 59 (2) 998-1003 BACKGROUND: Azithromycin, administered with ceftriaxone, is recommended by CDC for treatment of gonorrhea. Many experts have expressed concern about the ease with which Neisseria gonorrhoeae can acquire macrolide resistance. OBJECTIVE: We sought to describe gonococcal azithromycin susceptibility in the United States and determine whether azithromycin susceptibility has changed over time. METHODS: We analyzed 2005-2013 data from the Gonococcal Isolate Surveillance Project, a CDC-supported sentinel surveillance network that monitors gonococcal antimicrobial susceptibility. RESULTS: 44,144 N. gonorrhoeae isolates were tested for azithromycin susceptibility by agar dilution methods. The overall azithromycin MIC50 was 0.25 mug/ml and the MIC90 was 0.5 mug/ml. There were no overall temporal trends in geometric means. Isolates from men who had sex with men had significantly higher geometric mean MICs than isolates from men who have sex exclusively with women. The overall prevalence of reduced azithromycin susceptibility (MIC ≥2 mug/ml) was 0.4% and varied by year from 0.3% (2006 and 2009) to 0.6% (2013). CONCLUSION: We did not find a clear temporal trend in gonococcal azithromycin MICs in the United States and the prevalence of reduced azithromycin susceptibility remains low. These findings support continued use of azithromycin in the combination therapy regimen for gonorrhea. |
Lung function, airway inflammation, and polycyclic aromatic hydrocarbons exposure in Mexican schoolchildren: a pilot study
Barraza-Villarreal A , Escamilla-Nunez MC , Schilmann A , Hernandez-Cadena L , Li Z , Romanoff L , Sjodin A , Del Rio-Navarro BE , Diaz-Sanchez D , Diaz-Barriga F , Sly P , Romieu I . J Occup Environ Med 2014 56 (4) 415-9 OBJECTIVE: To determine the association of exposure to polycyclic aromatic hydrocarbons (PAHs) with lung function and pH of exhaled breath condensate (EBC) in Mexican schoolchildren. METHODS: A pilot study was performed in a subsample of 64 schoolchildren from Mexico City. Lung function and pH of EBC were measured and metabolites of PAHs in urine samples were determined. The association was analyzed using robust regression models. RESULTS: A 10% increase in the concentrations of 2-hydroxyfluorene was significantly negatively associated with forced expiratory volume in 1 second (-11.2 mL, 95% CI: -22.2 to -0.02), forced vital capacity (-11.6 mL, 95% CI: -22.9 to -0.2), and pH of EBC (-0.035, 95% CI: -0.066 to -0.005). CONCLUSION: Biomarkers of PAHs exposure were inversely associated with lung function and decrease of ph of EBC as a marker of airway inflammation in Mexican schoolchildren. |
HIV and menopause: a systematic review of the effects of HIV infection on age at menopause and the effects of menopause on response to antiretroviral therapy
Imai K , Sutton MY , Mdodo R , Del Rio C . Obstet Gynecol Int 2013 2013 340309 More than half of persons living with HIV infection in the United States (U.S.) will be ≥50 years of age by 2020, including postmenopausal women. We conducted a systematic literature review about the effects of (1) HIV infection on age at menopause and (2) menopause on antiretroviral therapy (ART) response, in order to inform optimal treatment strategies for menopausal women living with HIV infection. We used the Ovid Medline database from 1980 to 2012. We included studies that focused on HIV-infected persons, included postmenopausal women, and reported outcome data for either age at menopause or response to ART across menopause. We identified six original research articles for age at menopause and five for response to ART across menopause. Our review revealed that current data were conflicting and inconclusive; more rigorous studies are needed. Disentangling the effects of menopause requires well-designed studies with adequate numbers of HIV-infected and HIV-uninfected women, especially disproportionately affected women of color. Future studies should follow women from premenopause through menopause, use both surveys and laboratory measurements for menopause diagnoses, and control for confounders related to normal aging processes, in order to inform optimal clinical management for menopausal women living with HIV. |
Haemophilus influenzae acute endometritis with bacteremia: case report and literature review
Martin D , Dbouk RH , Deleon-Carnes M , Del Rio C , Guarner J . Diagn Microbiol Infect Dis 2013 76 (2) 235-6 Haemophilus influenzae rarely causes acute endometritis and the few published cases have always been associated with intrauterine devices (IUD). A 48-year-old female presented to the emergency department with a 3-day history of lower abdominal pain and fever. On physical examination she was tachycardic, hypotensive and had fundic tenderness to palpation. Imaging showed uterine leiomyomas and no IUD. Blood cultures grew a non-typable H. influenzae. Endometrial biopsy demonstrated acute endometritis. Tissue Gram stains and cervico-vaginal cultures were negative; however, polymerase chain reaction (PCR) determined presence of H. influenzae on the formalin-fixed, paraffin-embedded tissue biopsy. Evidence of H. influenzae in the endometrium demonstrates that the uterus can be the nidus for sepsis when invasive H. influenzae is found with no distinct usual primary focus. This case underscores the importance pathologic diagnosis and molecular testing. |
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