Last data update: Jun 03, 2024. (Total: 46935 publications since 2009)
Records 1-13 (of 13 Records) |
Query Trace: Edmunds S [original query] |
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Combining serological and contact data to derive target immunity levels for achieving and maintaining measles elimination (preprint)
Funk S , Knapp JK , Lebo E , Reef SE , Dabbagh AJ , Kretsinger K , Jit M , Edmunds WJ , Strebel PM . bioRxiv 2019 201574 Background Vaccination has reduced the global incidence of measles to the lowest rates in history. However, local interruption of measles virus transmission requires sustained high levels of population immunity that can be challenging to achieve and maintain. The herd immunity threshold for measles is typically stipulated at 90–95%. This figure does not easily translate into age-specific immunity levels required to interrupt transmission. Previous estimates of such levels were based on speculative contact patterns based on historical data from high-income countries. The aim of this study was to determine age-specific immunity levels that would ensure elimination of measles when taking into account empirically observed contact patterns.Methods We combined estimated immunity levels from serological data in 17 countries with studies of age-specific mixing patterns to derive contact-adjusted immunity levels. We then compared these to case data from the 10 years following the seroprevalence studies to establish a contact-adjusted immunity threshold for elimination. We lastly combined a range of hypothetical immunity profiles with contact data from a wide range of socioeconomic and demographic settings to determine whether they would be sufficient for elimination.Results We found that contact-adjusted immunity levels were able to predict whether countries would experience outbreaks in the decade following the serological studies in about 70% of countries. The corresponding threshold level of contact-adjusted immunity was found to be 93%, corresponding to an average basic reproduction number of approximately 14. Testing different scenarios of immunity with this threshold level using contact studies from around the world, we found that 95% immunity would have to be achieved by the age of five and maintained across older age groups to guarantee elimination. This reflects a greater level of immunity required in 5–9 year olds than established previously.Conclusions The immunity levels we found necessary for measles elimination are higher than previous guidance. The importance of achieving high immunity levels in 5–9 year olds presents both a challenge and an opportunity. While such high levels can be difficult to achieve, school entry provides an opportunity to ensure sufficient vaccination coverage. Combined with observations of contact patterns, further national and sub-national serological studies could serve to highlight key gaps in immunity that need to be filled in order to achieve national and regional measles elimination.ESEN2European Sero-Epidemiology Network 2EUROEuropean RegionMCEMisclassification errorWHOWorld Health Organization |
Inadequate refrigeration of some commercial foods is a continued cause of foodborne botulism in the United States, 1994-2021
Edmunds S , Vugia DJ , Rosen HE , Wong KK , Dykes JK , Griffin PM , Chatham-Stephens K . Foodborne Pathog Dis 2022 19 (6) 417-422 Foodborne botulism is a rapidly progressive potentially fatal paralyzing illness caused by the consumption of botulinum neurotoxin, which is most commonly produced by Clostridium botulinum. Refrigeration is the primary barrier to botulinum neurotoxin production in many processed foods. C. botulinum toxin production has occurred and caused botulism in the United States when foods that were not processed to destroy spores of C. botulinum were stored in an anaerobic environment and not properly refrigerated. We identified 37 cases, including 4 deaths, that occurred during 1994-2021 in the United States from 13 events associated with inadequate refrigeration of commercially produced products. In 11 events, the patient stored the product unrefrigerated at home; in 2 events, a product was kept unrefrigerated at the store before the consumer purchased it. In three events, refrigeration instructions were inadequate or not easily accessible (one label printed on outer but not inner packaging, one label not clearly visible, and one label was not in English). The number of people affected per event ranged from 1 to 16. Using enhanced cost estimates for foodborne botulism cases from a published economic model, these events were estimated to cost >$79M. Potential solutions to this recurring problem include the addition of a secondary barrier, such as an acidifier, to prevent botulinum toxin production, and better labeling to convey risks of refrigerated foods that have not been processed to destroy spores of C. botulinum and to decrease the occurrence of improper storage and handling. |
Notes from the field: Botulism type B after intravenous methamphetamine use - New Jersey, 2020
Waltenburg MA , Larson VA , Naor EH , Webster TG , Dykes J , Foltz V , Edmunds S , Thomas D , Kim J , Edwards L . MMWR Morb Mortal Wkly Rep 2020 69 (39) 1425-1426 On May 15, 2020, a White man aged 41 years arrived at an emergency department in New Jersey with a 2-day history of new onset blurred vision, double vision, ptosis, and difficulty swallowing. He was evaluated for cerebrovascular accident (CVA [stroke]), was found to have unremarkable computed tomography and magnetic resonance imaging brain scans, and was discharged with a diagnosis of diplopia (double vision). The following day, his symptoms worsened, and he visited a second emergency department with slurred speech, oral thrush, and facial weakness. Thorough skin and scalp examinations revealed peripheral phlebitis and sites of induration, but no abscesses or open wounds. He was admitted to the hospital with a diagnosis of CVA and treated with antifungal medications for oral and laryngeal candidiasis. |
Human monkeypox - After 40 years, an unintended consequence of smallpox eradication.
Simpson K , Heymann D , Brown CS , Edmunds WJ , Elsgaard J , Fine P , Hochrein H , Hoff NA , Green A , Ihekweazu C , Jones TC , Lule S , Maclennan J , McCollum A , Muhlemann B , Nightingale E , Ogoina D , Ogunleye A , Petersen B , Powell J , Quantick O , Rimoin AW , Ulaeato D , Wapling A . Vaccine 2020 38 (33) 5077-5081 Smallpox eradication, coordinated by the WHO and certified 40 years ago, led to the cessation of routine smallpox vaccination in most countries. It is estimated that over 70% of the world's population is no longer protected against smallpox, and through cross-immunity, to closely related orthopox viruses such as monkeypox. Monkeypox is now a re-emerging disease. Monkeypox is endemic in as yet unconfirmed animal reservoirs in sub-Saharan Africa, while its human epidemiology appears to be changing. Monkeypox in small animals imported from Ghana as exotic pets was at the origin of an outbreak of human monkeypox in the USA in 2003. Travellers infected in Nigeria were at the origin of monkeypox cases in the UK in 2018 and 2019, Israel in 2018 and Singapore in2019. Together with sporadic reports of human infections with other orthopox viruses, these facts invite speculation that emergent or re-emergent human monkeypox might fill the epidemiological niche vacated by smallpox. An ad-hoc and unofficial group of interested experts met to consider these issues at Chatham House, London in June 2019, in order to review available data and identify monkeypox-related research gaps. Gaps identified by the experts included:The experts further agreed on the need for a better understanding of the genomic evolution and changing epidemiology of orthopox viruses, the usefulness of in-field genomic diagnostics, and the best disease control strategies, including the possibility of vaccination with new generation non-replicating smallpox vaccines and treatment with recently developed antivirals. |
Evolving epidemiology of poliovirus serotype 2 following withdrawal of the type 2 oral poliovirus vaccine
Macklin GR , O'Reilly KM , Grassly NC , Edmunds WJ , Mach O , Santhana Gopala Krishnan R , Voorman A , Vertefeuille JF , Abdelwahab J , Gumede N , Goel A , Sosler S , Sever J , Bandyopadhyay AS , Pallansch MA , Nandy R , Mkanda P , Diop OM , Sutter RW . Science 2020 368 (6489) 401-405 While there have been no cases of type-2 wild poliovirus for over 20 years, transmission of type-2 vaccine-derived poliovirus (VDPV2) and associated paralytic cases in several continents represent a threat to eradication. The withdrawal of the type-2 component of oral poliovirus vaccine (OPV2) was implemented in April 2016 to stop VDPV2 emergence and secure eradication of all poliovirus type 2. Globally, children born after this date have limited immunity to prevent transmission. Using a statistical model, we estimate the emergence date and source of VDPV2s detected between May 2016 and November 2019. Outbreak response campaigns with monovalent OPV2 are the only available method to induce immunity to prevent transmission. Yet, our analysis shows that using monovalent OPV2 is generating more paralytic VDPV2 outbreaks with the potential for establishing endemic transmission. The novel OPV2 is urgently required, alongside a contingency strategy if this vaccine does not materialize or perform as anticipated. |
Combining serological and contact data to derive target immunity levels for achieving and maintaining measles elimination
Funk S , Knapp JK , Lebo E , Reef SE , Dabbagh AJ , Kretsinger K , Jit M , Edmunds WJ , Strebel PM . BMC Med 2019 17 (1) 180 BACKGROUND: Vaccination has reduced the global incidence of measles to the lowest rates in history. However, local interruption of measles virus transmission requires sustained high levels of population immunity that can be challenging to achieve and maintain. The herd immunity threshold for measles is typically stipulated at 90-95%. This figure does not easily translate into age-specific immunity levels required to interrupt transmission. Previous estimates of such levels were based on speculative contact patterns based on historical data from high-income countries. The aim of this study was to determine age-specific immunity levels that would ensure elimination of measles when taking into account empirically observed contact patterns. METHODS: We combined estimated immunity levels from serological data in 17 countries with studies of age-specific mixing patterns to derive contact-adjusted immunity levels. We then compared these to case data from the 10 years following the seroprevalence studies to establish a contact-adjusted immunity threshold for elimination. We lastly combined a range of hypothetical immunity profiles with contact data from a wide range of socioeconomic and demographic settings to determine whether they would be sufficient for elimination. RESULTS: We found that contact-adjusted immunity levels were able to predict whether countries would experience outbreaks in the decade following the serological studies in about 70% of countries. The corresponding threshold level of contact-adjusted immunity was found to be 93%, corresponding to an average basic reproduction number of approximately 14. Testing different scenarios of immunity with this threshold level using contact studies from around the world, we found that 95% immunity would have to be achieved by the age of five and maintained across older age groups to guarantee elimination. This reflects a greater level of immunity required in 5-9-year-olds than established previously. CONCLUSIONS: The immunity levels we found necessary for measles elimination are higher than previous guidance. The importance of achieving high immunity levels in 5-9-year-olds presents both a challenge and an opportunity. While such high levels can be difficult to achieve, school entry provides an opportunity to ensure sufficient vaccination coverage. Combined with observations of contact patterns, further national and sub-national serological studies could serve to highlight key gaps in immunity that need to be filled in order to achieve national and regional measles elimination. |
An online decision tree for vaccine efficacy trial design during infectious disease epidemics: The InterVax-Tool
Bellan SE , Eggo RM , Gsell PS , Kucharski AJ , Dean NE , Donohue R , Zook M , Edmunds WJ , Odhiambo F , Longini IM Jr , Brisson M , Mahon BE , Henao-Restrepo AM . Vaccine 2019 37 (31) 4376-4381 BACKGROUND: Licensed vaccines are urgently needed for emerging infectious diseases, but the nature of these epidemics causes challenges for the design of phase III trials to evaluate vaccine efficacy. Designing and executing rigorous, fast, and ethical, vaccine efficacy trials is difficult, and the decisions and limitations in the design of these trials encompass epidemiological, logistical, regulatory, statistical, and ethical dimensions. RESULTS: Trial design decisions are complex and interrelated, but current guidance documents do not lend themselves to efficient decision-making. We created InterVax-Tool (http://vaxeval.com), an online, interactive decision-support tool, to help diverse stakeholders navigate the decisions in the design of phase III vaccine trials. InterVax-Tool offers high-level visual and interactive assistance through a set of four decision trees, guiding users through selection of the: (1) Primary Endpoint, (2) Target Population, (3) Randomization Scheme, and, (4) Comparator. We provide guidance on how key considerations - grouped as Epidemiological, Vaccine-related, Infrastructural, or Sociocultural - inform each decision in the trial design process. CONCLUSIONS: InterVax-Tool facilitates structured, transparent, and collaborative discussion of trial design, while recording the decision-making process. Users can save and share their decisions, which is useful both for comparing proposed trial designs, and for justifying particular design choices. Here, we describe the goals and features of InterVax-Tool as well as its application to the design of a Zika vaccine efficacy trial. |
Notes from the Field: Botulism outbreak associated with home-canned peas - New York City, 2018
Bergeron G , Latash J , Da Costa-Carter CA , Egan C , Stavinsky F , Kileci JA , Winstead A , Zhao B , Perry MJ , Chatham-Stephens K , Sarpel D , Hughes S , Conlon MA , Edmunds S , Mohanraj M , Rakeman JL , Centurioni DA , Luquez C , Chiefari AK , Harper S . MMWR Morb Mortal Wkly Rep 2019 68 (10) 251-252 On June 6, 2018, at 1:30 p.m., the New York City Department of Health and Mental Hygiene was notified of three related women who had arrived at a hospital 4 hours earlier for evaluation for acute nausea, dizziness, blurred vision, slurred speech, ptosis, thick-feeling tongue, and shortness of breath. Two patients developed respiratory failure, requiring intubation and mechanical ventilation in the emergency department, and the third patient was intubated at 7 p.m. that evening. The combination of cranial nerve palsies and respiratory failure in multiple patients suggested botulism, a paralytic illness caused by botulinum neurotoxin (BoNT), most commonly produced by Clostridium botulinum. |
Phylogeographical analysis of the dominant multidrug-resistant H58 clade of Salmonella Typhi identifies inter- and intracontinental transmission events.
Wong VK , Baker S , Pickard DJ , Parkhill J , Page AJ , Feasey NA , Kingsley RA , Thomson NR , Keane JA , Weill FX , Edwards DJ , Hawkey J , Harris SR , Mather AE , Cain AK , Hadfield J , Hart PJ , Thieu NT , Klemm EJ , Glinos DA , Breiman RF , Watson CH , Kariuki S , Gordon MA , Heyderman RS , Okoro C , Jacobs J , Lunguya O , Edmunds WJ , Msefula C , Chabalgoity JA , Kama M , Jenkins K , Dutta S , Marks F , Campos J , Thompson C , Obaro S , MacLennan CA , Dolecek C , Keddy KH , Smith AM , Parry CM , Karkey A , Mulholland EK , Campbell JI , Dongol S , Basnyat B , Dufour M , Bandaranayake D , Naseri TT , Singh SP , Hatta M , Newton P , Onsare RS , Isaia L , Dance D , Davong V , Thwaites G , Wijedoru L , Crump JA , De Pinna E , Nair S , Nilles EJ , Thanh DP , Turner P , Soeng S , Valcanis M , Powling J , Dimovski K , Hogg G , Farrar J , Holt KE , Dougan G . Nat Genet 2015 47 (6) 632-9 The emergence of multidrug-resistant (MDR) typhoid is a major global health threat affecting many countries where the disease is endemic. Here whole-genome sequence analysis of 1,832 Salmonella enterica serovar Typhi (S. Typhi) identifies a single dominant MDR lineage, H58, that has emerged and spread throughout Asia and Africa over the last 30 years. Our analysis identifies numerous transmissions of H58, including multiple transfers from Asia to Africa and an ongoing, unrecognized MDR epidemic within Africa itself. Notably, our analysis indicates that H58 lineages are displacing antibiotic-sensitive isolates, transforming the global population structure of this pathogen. H58 isolates can harbor a complex MDR element residing either on transmissible IncHI1 plasmids or within multiple chromosomal integration sites. We also identify new mutations that define the H58 lineage. This phylogeographical analysis provides a framework to facilitate global management of MDR typhoid and is applicable to similar MDR lineages emerging in other bacterial species. |
Neighborhood disparities in prevalence of childhood obesity among low-income children before and after implementation of New York City child care regulations
Sekhobo JP , Edmunds LS , Dalenius K , Jernigan J , Davis CF , Giddings M , Lesesne C , Kettel Khan L . Prev Chronic Dis 2014 11 E181 INTRODUCTION: New York City Article 47 regulations, implemented in 2007, require licensed child care centers to improve the nutrition, physical activity, and television-viewing behaviors of enrolled children. To supplement an evaluation of the Article 47 regulations, we conducted an exploratory ecologic study to examine changes in childhood obesity prevalence among low-income preschool children enrolled in the Nutrition Program for Women, Infants, and Children (WIC) in New York City neighborhoods with or without a district public health office. We conducted the study 3 years before (from 2004 through 2006) and after (from 2008 through 2010) the implementation of the regulations in 2007. METHODS: We used an ecologic, time-trend analysis to compare 3-year cumulative obesity prevalence among WIC-enrolled preschool children during 2004 to 2006 and 2008 to 2010. Outcome data were obtained from the New York State component of the Centers for Disease Control and Prevention's Pediatric Nutrition Surveillance System. RESULTS: Early childhood obesity prevalence declined in all study neighborhoods from 2004-2006 to 2008-2010. The greatest decline occurred in Manhattan high-risk neighborhoods where obesity prevalence decreased from 18.6% in 2004-2006 to 15.3% in 2008-2010. The results showed a narrowing of the gap in obesity prevalence between high-risk and low-risk neighborhoods in Manhattan and the Bronx, but not in Brooklyn. CONCLUSION: The reductions in early childhood obesity prevalence in some high-risk and low-risk neighborhoods in New York City suggest that progress was made in reducing health disparities during the years just before and after implementation of the 2007 regulations. Future research should consider the built environment and markers of differential exposure to known interventions and policies related to childhood obesity prevention. |
Direct and indirect effects of rotavirus vaccination: comparing predictions from transmission dynamic models
Pitzer VE , Atkins KE , de Blasio BF , Van Effelterre T , Atchison CJ , Harris JP , Shim E , Galvani AP , Edmunds WJ , Viboud C , Patel MM , Grenfell BT , Parashar UD , Lopman BA . PLoS One 2012 7 (8) e42320 Early observations from countries that have introduced rotavirus vaccination suggest that there may be indirect protection for unvaccinated individuals, but it is unclear whether these benefits will extend to the long term. Transmission dynamic models have attempted to quantify the indirect protection that might be expected from rotavirus vaccination in developed countries, but results have varied. To better understand the magnitude and sources of variability in model projections, we undertook a comparative analysis of transmission dynamic models for rotavirus. We fit five models to reported rotavirus gastroenteritis (RVGE) data from England and Wales, and evaluated outcomes for short- and long-term vaccination effects. All of our models reproduced the important features of rotavirus epidemics in England and Wales. Models predicted that during the initial year after vaccine introduction, incidence of severe RVGE would be reduced 1.8-2.9 times more than expected from the direct effects of the vaccine alone (28-50% at 90% coverage), but over a 5-year period following vaccine introduction severe RVGE would be reduced only by 1.1-1.7 times more than expected from the direct effects (54-90% at 90% coverage). Projections for the long-term reduction of severe RVGE ranged from a 55% reduction at full coverage to elimination with at least 80% coverage. Our models predicted short-term reductions in the incidence of RVGE that exceeded estimates of the direct effects, consistent with observations from the United States and other countries. Some of the models predicted that the short-term indirect benefits may be offset by a partial shifting of the burden of RVGE to older unvaccinated individuals. Nonetheless, even when such a shift occurs, the overall reduction in severe RVGE is considerable. Discrepancies among model predictions reflect uncertainties about age variation in the risk and reporting of RVGE, and the duration of natural and vaccine-induced immunity, highlighting important questions for future research. |
Understanding reduced rotavirus vaccine efficacy in low socio-economic settings
Lopman BA , Pitzer VE , Sarkar R , Gladstone B , Patel M , Glasser J , Gambhir M , Atchison C , Grenfell BT , Edmunds WJ , Kang G , Parashar UD . PLoS One 2012 7 (8) e41720 INTRODUCTION: Rotavirus vaccine efficacy ranges from >90% in high socio-economic settings (SES) to 50% in low SES. With the imminent introduction of rotavirus vaccine in low SES countries, understanding reasons for reduced efficacy in these settings could identify strategies to improve vaccine performance. METHODS: We developed a mathematical model to predict rotavirus vaccine efficacy in high, middle and low SES based on data specific for each setting on incidence, protection conferred by natural infection and immune response to vaccination. We then examined factors affecting efficacy. RESULTS: Vaccination was predicted to prevent 93%, 86% and 51% of severe rotavirus gastroenteritis in high, middle and low SES, respectively. Also predicted was that vaccines are most effective against severe disease and efficacy declines with age in low but not high SES. Reduced immunogenicity of vaccination and reduced protection conferred by natural infection are the main factors that compromise efficacy in low SES. DISCUSSION: The continued risk of severe disease in non-primary natural infections in low SES is a key factor underpinning reduced efficacy of rotavirus vaccines. Predicted efficacy was remarkably consistent with observed clinical trial results from different SES, validating the model. The phenomenon of reduced vaccine efficacy can be predicted by intrinsic immunological and epidemiological factors of low SES populations. Modifying aspects of the vaccine (e.g. improving immunogenicity in low SES) and vaccination program (e.g. additional doses) may bring improvements. |
Trends in prevalence of obesity and overweight among children enrolled in the New York State WIC program, 2002-2007
Sekhobo JP , Edmunds LS , Reynolds DK , Dalenius K , Sharma A . Public Health Rep 2010 125 (2) 218-24 OBJECTIVES: We examined recent overweight and obesity trends in a multiethnic population of low-income preschool children. METHODS: We defined overweight as sex-specific body mass index (BMI)-forage > or = 85th and < 95th percentile and obesity as sex-specific BMI-for-age > or = 95th percentile, and calculated them using demographic data and randomly selected height and weight measurements that were recorded while 2- to < 5-year-old children were enrolled in the New York State (NYS) Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) during 2002-2007. RESULTS: Obesity prevalence peaked at 16.7% in 2003, declined from 2003 through 2005, and stabilized at 14.7% through 2007. Among both boys and girls, the downward trend in annual prevalence of obesity was evident only among Hispanic children (22.8% boys and 20.9% girls in 2002 vs. 19.3% boys and 17.5% girls in 2007) and non-Hispanic black children (15.6% boys and 14.2% girls in 2002 vs. 13.6% boys and 12.4% girls in 2007). In contrast, the annual prevalence estimate for overweight showed an increasing trend from 2002 through 2007. CONCLUSIONS: These results showed a slight decline in prevalence of childhood obesity and a continuing rise in prevalence of childhood overweight among children enrolled in the NYS WIC program during 2002-2007. Future research should investigate the extent to which the slight decline in childhood obesity prevalence may be attributable to population-based and high-risk obesity prevention efforts in NYS. |
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