Last data update: Dec 02, 2024. (Total: 48272 publications since 2009)
Records 1-22 (of 22 Records) |
Query Trace: Eggers C[original query] |
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Sudan virus disease super-spreading, Uganda, 2022
Komakech A , Whitmer S , Izudi J , Kizito C , Ninsiima M , Ahirirwe SR , Kabami Z , Ario AR , Kadobera D , Kwesiga B , Gidudu S , Migisha R , Makumbi I , Eurien D , Kayiwa J , Bulage L , Gonahasa DN , Kyamwine I , Okello PE , Nansikombi HT , Atuhaire I , Asio A , Elayeete S , Nsubuga EJ , Masanja V , Migamba SM , Mwine P , Nakamya P , Nampeera R , Kwiringira A , Akunzirwe R , Naiga HN , Namubiru SK , Agaba B , Zalwango JF , Zalwango MG , King P , Simbwa BN , Zavuga R , Wanyana MW , Kiggundu T , Oonyu L , Ndyabakira A , Komugisha M , Kibwika B , Ssemanda I , Nuwamanya Y , Kamukama A , Aanyu D , Kizza D , Ayen DO , Mulei S , Balinandi S , Nyakarahuka L , Baluku J , Kyondo J , Tumusiime A , Aliddeki D , Masiira B , Muwanguzi E , Kimuli I , Bulwadda D , Isabirye H , Aujo D , Kasambula A , Okware S , Ochien E , Komakech I , Okot C , Choi M , Cossaboom CM , Eggers C , Klena JD , Osinubi MO , Sadigh KS , Worrell MC , Boore AL , Shoemaker T , Montgomery JM , Nabadda SN , Mwanga M , Muruta AN , Harris JR . BMC Infect Dis 2024 24 (1) 520 BACKGROUND: On 20 September 2022, Uganda declared its fifth Sudan virus disease (SVD) outbreak, culminating in 142 confirmed and 22 probable cases. The reproductive rate (R) of this outbreak was 1.25. We described persons who were exposed to the virus, became infected, and they led to the infection of an unusually high number of cases during the outbreak. METHODS: In this descriptive cross-sectional study, we defined a super-spreader person (SSP) as any person with real-time polymerase chain reaction (RT-PCR) confirmed SVD linked to the infection of ≥ 13 other persons (10-fold the outbreak R). We reviewed illness narratives for SSPs collected through interviews. Whole-genome sequencing was used to support epidemiologic linkages between cases. RESULTS: Two SSPs (Patient A, a 33-year-old male, and Patient B, a 26-year-old male) were identified, and linked to the infection of one probable and 50 confirmed secondary cases. Both SSPs lived in the same parish and were likely infected by a single ill healthcare worker in early October while receiving healthcare. Both sought treatment at multiple health facilities, but neither was ever isolated at an Ebola Treatment Unit (ETU). In total, 18 secondary cases (17 confirmed, one probable), including three deaths (17%), were linked to Patient A; 33 secondary cases (all confirmed), including 14 (42%) deaths, were linked to Patient B. Secondary cases linked to Patient A included family members, neighbours, and contacts at health facilities, including healthcare workers. Those linked to Patient B included healthcare workers, friends, and family members who interacted with him throughout his illness, prayed over him while he was nearing death, or exhumed his body. Intensive community engagement and awareness-building were initiated based on narratives collected about patients A and B; 49 (96%) of the secondary cases were isolated in an ETU, a median of three days after onset. Only nine tertiary cases were linked to the 51 secondary cases. Sequencing suggested plausible direct transmission from the SSPs to 37 of 39 secondary cases with sequence data. CONCLUSION: Extended time in the community while ill, social interactions, cross-district travel for treatment, and religious practices contributed to SVD super-spreading. Intensive community engagement and awareness may have reduced the number of tertiary infections. Intensive follow-up of contacts of case-patients may help reduce the impact of super-spreading events. |
Assessment of the integrated disease surveillance and response system implementation in health zones at risk for viral hemorrhagic fever outbreaks in North Kivu, Democratic Republic of the Congo, following a major Ebola outbreak, 2021
Kallay R , Mbuyi G , Eggers C , Coulibaly S , Kangoye DT , Kubuya J , Soke GN , Mossoko M , Kazambu D , Magazani A , Fonjungo P , Luce R , Aruna A . BMC Public Health 2024 24 (1) 1150 BACKGROUND: The Democratic Republic of the Congo (DRC) experienced its largest Ebola Virus Disease Outbreak in 2018-2020. As a result of the outbreak, significant funding and international support were provided to Eastern DRC to improve disease surveillance. The Integrated Disease Surveillance and Response (IDSR) strategy has been used in the DRC as a framework to strengthen public health surveillance, and full implementation could be critical as the DRC continues to face threats of various epidemic-prone diseases. In 2021, the DRC initiated an IDSR assessment in North Kivu province to assess the capabilities of the public health system to detect and respond to new public health threats. METHODS: The study utilized a mixed-methods design consisting of quantitative and qualitative methods. Quantitative assessment of the performance in IDSR core functions was conducted at multiple levels of the tiered health system through a standardized questionnaire and analysis of health data. Qualitative data were also collected through observations, focus groups and open-ended questions. Data were collected at the North Kivu provincial public health office, five health zones, 66 healthcare facilities, and from community health workers in 15 health areas. RESULTS: Thirty-six percent of health facilities had no case definition documents and 53% had no blank case reporting forms, limiting identification and reporting. Data completeness and timeliness among health facilities were 53% and 75% overall but varied widely by health zone. While these indicators seemingly improved at the health zone level at 100% and 97% respectively, the health facility data feeding into the reporting structure were inconsistent. The use of electronic Integrated Disease Surveillance and Response is not widely implemented. Rapid response teams were generally available, but functionality was low with lack of guidance documents and long response times. CONCLUSION: Support is needed at the lower levels of the public health system and to address specific zones with low performance. Limitations in materials, resources for communication and transportation, and workforce training continue to be challenges. This assessment highlights the need to move from outbreak-focused support and funding to building systems that can improve the long-term functionality of the routine disease surveillance system. |
Implementing a DHIS2 Ebola virus disease module during the 2021 Guinea Ebola outbreak.
Eggers C , Martel L , Dismer A , Kallay R , Sayre D , Choi M , Corvil S , Kaba A , Keita B , Diallo L , Balde MM , Bah M , Camara SM , Koivogui E , Montgomery J , Keita S . BMJ Glob Health 2022 7 (5) In 2017, the national agency for health security (L'Agence Nationale de Sécurité Sanitaire-ANSS) in Guinea implemented the District Health Information Software (DHIS2) as the Ministry of Health national surveillance system to capture and report aggregate disease data. During 2019, the ANSS started using DHIS2 Tracker to collect case-based (individual-level) data for epidemic-prone diseases. In 2020, the capability was expanded, and it was used during the COVID-19 pandemic to capture data relevant to the COVID-19 response. When an Ebola virus disease (EVD) outbreak was announced in February 2021, the Tracker module was updated, and enhanced functionalities were developed to meet the needs for the emerging epidemic. This novel EVD module has components to capture information on cases, contacts, alerts, laboratory and vaccinations and provides a centralised site for all EVD outbreak data. It has since been expanded for use with future viral haemorrhagic fever outbreaks. |
Health Center Testing for SARS-CoV-2 During the COVID-19 Pandemic - United States, June 5-October 2, 2020.
Romero L , Pao LZ , Clark H , Riley C , Merali S , Park M , Eggers C , Campbell S , Bui C , Bolton J , Le X , Fanfair RN , Rose M , Hinckley A , Siza C . MMWR Morb Mortal Wkly Rep 2020 69 (50) 1895-1901 Long-standing social inequities and health disparities have resulted in increased risk for coronavirus disease 2019 (COVID-19) infection, severe illness, and death among racial and ethnic minority populations. The Health Resources and Services Administration (HRSA) Health Center Program supports nearly 1,400 health centers that provide comprehensive primary health care* to approximately 30 million patients in 13,000 service sites across the United States.(†) In 2019, 63% of HRSA health center patients who reported race and ethnicity identified as members of racial ethnic minority populations (1). Historically underserved communities and populations served by health centers have a need for access to important information and resources for preventing exposure to SARS-CoV-2, the virus that causes COVID-19, to testing for those at risk, and to follow-up services for those with positive test results.(§) During the COVID-19 public health emergency, health centers(¶) have provided and continue to provide testing and follow-up care to medically underserved populations**; these centers are capable of reaching areas disproportionately affected by the pandemic.(††) HRSA administers a weekly, voluntary Health Center COVID-19 Survey(§§) to track health center COVID-19 testing capacity and the impact of COVID-19 on operations, patients, and personnel. Potential respondents can include up to 1,382 HRSA-funded health centers.(¶¶) To assess health centers' capacity to reach racial and ethnic minority groups at increased risk for COVID-19 and to provide access to testing, CDC and HRSA analyzed survey data for the weeks June 5-October 2, 2020*** to describe all patients tested (3,194,838) and those who received positive SARS-CoV-2 test results (308,780) by race/ethnicity and state of residence. Among persons with known race/ethnicity who received testing (2,506,935), 36% were Hispanic/Latino (Hispanic), 38% were non-Hispanic White (White), and 20% were non-Hispanic Black (Black); among those with known race/ethnicity with positive test results, 56% were Hispanic, 24% were White, and 15% were Black. Improving health centers' ability to reach groups at increased risk for COVID-19 might reduce transmission by identifying cases and supporting contact tracing and isolation. Efforts to improve coordination of COVID-19 response-related activities between state and local public health departments and HRSA-funded health centers can increase access to testing and follow-up care for populations at increased risk for COVID-19. |
Notes from the field: Identification of a Triatoma sanguisuga "kissing bug" - Delaware, 2018
Eggers P , Offutt-Powell TN , Lopez K , Montgomery SP , Lawrence GG . MMWR Morb Mortal Wkly Rep 2019 68 (15) 359 In July 2018, a family from Kent County, Delaware contacted the Delaware Division of Public Health (DPH) and the Delaware Department of Agriculture (DDA) to request assistance identifying an insect that had bitten their child’s face while she was watching television in her bedroom during the late evening hours. The parents were concerned about possible disease transmission from the insect. Upon investigation, DPH learned that the family resided in an older single-family home near a heavily wooded area. A window air conditioning unit was located in the bedroom where the bite occurred. The family reported no recent travel outside the local area. |
Notes from the Field: Contact tracing investigation after first case of Andes virus in the United States - Delaware, February 2018
Kofman A , Eggers P , Kjemtrup A , Hall R , Brown SM , Morales-Betoulle M , Graziano J , Zufan SE , Whitmer SLM , Cannon DL , Chiang CF , Choi MJ , Rollin PE , Cetron MS , Yaglom HD , Duwell M , Kuhar DT , Kretschmer M , Knust B , Klena JD , Alvarado-Ramy F , Shoemaker T , Towner JS , Nichol ST . MMWR Morb Mortal Wkly Rep 2018 67 (41) 1162-1163 In January 2018, a woman admitted to a Delaware hospital tested positive for New World hantavirus immunoglobulin M (IgM) and immunoglobulin G (IgG) by enzyme-linked immunosorbent assay (ELISA). Subsequent testing by CDC’s Viral Special Pathogens Branch detected New World hantavirus by nested reverse transcription–polymerase chain reaction (RT-PCR) and Andes virus by nucleic acid sequencing. This case represents the first confirmed importation of Andes virus infection into the United States; two imported cases have also been reported in Switzerland (1). Before her illness, the patient had traveled to the Andes region of Argentina and Chile from December 20, 2017, to January 3, 2018. She stayed in cabins and youth hostels in reportedly poor condition. No rodent exposures were reported. After returning to the United States on January 10, she developed fever, malaise, and myalgias on January 14. On January 17, while ill, she traveled on two commercial domestic flights. She was hospitalized during January 20–25 in Delaware and discharged to her home after clinical recovery. |
Experiences and lessons from polio eradication applied to immunization in 10 focus countries of the Polio Endgame Strategic Plan
Van Den Ent M M V X , Mallya A , Sandhu H , Anya BP , Yusuf N , Ntakibirora M , Hasman A , Fahmy K , Agbor J , Corkum M , Sumaili K , Siddique AR , Bammeke J , Braka F , Andriamihantanirina R , Ziao AMC , Djumo C , Yapi MD , Sosler S , Eggers R . J Infect Dis 2017 216 S250-S259 Nine polio areas of expertise were applied to broader immunization and mother, newborn and child health goals in ten focus countries of the Polio Eradication Endgame Strategic Plan: policy & strategy development, planning, management and oversight (accountability framework), implementation & service delivery, monitoring, communications & community engagement, disease surveillance & data analysis, technical quality & capacity building, and partnerships. Although coverage improvements depend on multiple factors and increased coverage cannot be attributed to the use of polio assets alone, 6 out of the 10 focus countries improved coverage in three doses of diphtheria tetanus pertussis containing vaccine between 2013 and 2015. Government leadership, evidence-based programming, country-driven comprehensive operational annual plans, community partnership and strong accountability systems are critical for all programs and polio eradication has illustrated these can be leveraged to increase immunization coverage and equity and enhance global health security in the focus countries. |
Contribution of Global Polio Eradication Initiative-funded personnel to the strengthening of routine immunization programs in the 10 focus countries of the Polio Eradication and Endgame Strategic Plan
Van Den Ent MMVX , Swift RD , Anaokar S , Hegg LA , Eggers R , Cochi SL . J Infect Dis 2017 216 S244-S249 Background. The Polio Eradication and Endgame Strategic Plan (PEESP) established a target that at least 50% of the time of personnel receiving funding from the Global Polio Eradication Initiative (GPEI) for polio eradication activities (hereafter, "GPEI-funded personnel") should be dedicated to the strengthening of immunization systems. This article describes the self-reported profile of how GPEI-funded personnel allocate their time toward immunization goals and activities beyond those associated with polio, the training they have received to conduct tasks to strengthen routine immunization systems, and the type of tasks they have conducted. Methods. A survey of approximately 1000 field managers of frontline GPEI-funded personnel was conducted by Boston Consulting Group in the 10 focus countries of the PEESP during 2 phases, in 2013 and 2014, to determine time allocation among frontline staff. Country-specific reports on the training of GPEI-funded personnel were reviewed, and an analysis of the types of tasks that were reported was conducted. Results. A total of 467 managers responded to the survey. Forty-seven percent of the time (range, 23%-61%) of GPEI-funded personnel was dedicated to tasks related to strengthening immunization programs, other than polio eradication. Less time was spent on polio-associated activities in countries that had already interrupted wild poliovirus (WPV) transmission, compared with findings for WPV-endemic countries. All countries conducted periodic trainings of the GPEI-funded personnel. The types of non-polio-related tasks performed by GPEI-funded personnel varied among countries and included surveillance, microplanning, newborn registration and defaulter tracing, monitoring of routine immunization activities, and support of district immunization task teams, as well as promotion of health behaviors, such as clean-water use and good hygiene and sanitation practices. Conclusion. In all countries, GPEI-funded personnel perform critical tasks in the strengthening of routine immunization programs and the control of measles and rubella. In certain countries with very weak immunization systems, GPEI-funded personnel provide critical support for the immunization programs, and sudden discontinuation of their employment would potentially disrupt the immunization programs in their countries and create a setback in capacity and effectiveness that would put children at higher risk for vaccine-preventable diseases. |
Fish-associated foodborne disease outbreaks: United States, 1998-2015
Barrett KA , Nakao JH , Taylor EV , Eggers C , Gould LH . Foodborne Pathog Dis 2017 14 (9) 537-543 Each year in the United States, approximately 260,000 people get sick from contaminated fish. Fish is also the most commonly implicated food category in outbreaks. We reviewed the Centers for Disease Control and Prevention Foodborne Disease Outbreak Surveillance System for outbreaks resulting from consumption of fish during the period 1998-2015. We found 857 outbreaks associated with fish, resulting in 4815 illnesses, 359 hospitalizations, and 4 deaths. The median number of illnesses per outbreak was three (range: 2-425). The annual number of fish-associated outbreaks declined from an average of 62 per year during the period 1998-2006 to 34 per year during the period 2007-2015. Hawaii (221 outbreaks [26%]) and Florida (203 [24%]) reported the most outbreaks. Among 637 outbreaks (74%) with a confirmed etiology, scombrotoxin (349 [55%]) and ciguatoxin (227 [36%]) were by far most common. Most outbreak-associated illnesses were caused by scombrotoxin (1299 [34%]), Salmonella (978 [26%]), and ciguatoxin (894 [23%]). Most hospitalizations were caused by Salmonella (97 [31%]) and ciguatoxin (96 [31%]). Norovirus (105 average illnesses; range: [6-380]) and Salmonella (54 [3-425]) caused the largest outbreaks. Fish types implicated most often were tuna (37%), mahi-mahi (10%), and grouper (9%). The etiology-fish pairs responsible for the most outbreaks were scombrotoxin and tuna (223 outbreaks), scombrotoxin and mahi-mahi (64), and ciguatoxin and grouper (54). The pairs responsible for the most illnesses were scombrotoxin and tuna (720 illnesses) and Salmonella and tuna (660). Of the 840 outbreaks (98%) with a single location of food preparation, 52% were associated with fish prepared in a restaurant and 33% with fish prepared in a private home. Upstream control measures targeted to the most common etiologies and controls during processing and preparation could further reduce outbreaks caused by fish. |
Possible Zika virus infection among pregnant women - United States and Territories, May 2016
Simeone RM , Shapiro-Mendoza CK , Meaney-Delman D , Petersen EE , Galang RR , Oduyebo T , Rivera-Garcia B , Valencia-Prado M , Newsome KB , Perez-Padilla J , Williams TR , Biggerstaff M , Jamieson DJ , Honein MA , Ahmed F , Anesi S , Arnold KE , Barradas D , Barter D , Bertolli J , Bingham AM , Bollock J , Bosse T , Bradley KK , Brady D , Brown CM , Bryan K , Buchanan V , Bullard PD , Carrigan A , Clouse M , Cook S , Cooper M , Davidson S , DeBarr A , Dobbs T , Dunams T , Eason J , Eckert A , Eggers P , Ellington SR , Feldpausch A , Fredette CR , Gabel J , Glover M , Gosciminski M , Gay M , Haddock R , Hand S , Hardy J , Hartel ME , Hennenfent AK , Hills SL , House J , Igbinosa I , Im L , Jeff H , Khan S , Kightlinger L , Ko JY , Koirala S , Korhonen L , Krishnasamy V , Kurkjian K , Lampe M , Larson S , Lee EH , Lind L , Lindquist S , Long J , Macdonald J , MacFarquhar J , Mackie DP , Mark-Carew M , Martin B , Martinez-Quinones A , Matthews-Greer J , McGee SA , McLaughlin J , Mock V , Muna E , Oltean H , O'Mallan J , Pagano HP , Park SY , Peterson D , Polen KN , Porse CC , Rao CY , Ropri A , Rinsky J , Robinson S , Rosinger AY , Ruberto I , Schiffman E , Scott-Waldron C , Semple S , Sharp T , Short K , Signs K , Slavinski SA , Stevens T , Sweatlock J , Talbot EA , Tonzel J , Traxler R , Tubach S , Van Houten C , VinHatton E , Viray M , Virginie D , Warren MD , Waters C , White P , Williams T , Winters AI , Wood S , Zaganjor I . MMWR Morb Mortal Wkly Rep 2016 65 (20) 514-9 Zika virus is a cause of microcephaly and brain abnormalities (1), and it is the first known mosquito-borne infection to cause congenital anomalies in humans. The establishment of a comprehensive surveillance system to monitor pregnant women with Zika virus infection will provide data to further elucidate the full range of potential outcomes for fetuses and infants of mothers with asymptomatic and symptomatic Zika virus infection during pregnancy. In February 2016, Zika virus disease and congenital Zika virus infections became nationally notifiable conditions in the United States (2). Cases in pregnant women with laboratory evidence of Zika virus infection who have either 1) symptomatic infection or 2) asymptomatic infection with diagnosed complications of pregnancy can be reported as cases of Zika virus disease to ArboNET* (2), CDC's national arboviral diseases surveillance system. Under existing interim guidelines from the Council for State and Territorial Epidemiologists (CSTE), asymptomatic Zika virus infections in pregnant women who do not have known pregnancy complications are not reportable. ArboNET does not currently include pregnancy surveillance information (e.g., gestational age or pregnancy exposures) or pregnancy outcomes. To understand the full impact of infection on the fetus and neonate, other systems are needed for reporting and active monitoring of pregnant women with laboratory evidence of possible Zika virus infection during pregnancy. Thus, in collaboration with state, local, tribal, and territorial health departments, CDC established two surveillance systems to monitor pregnancies and congenital outcomes among women with laboratory evidence of Zika virus infection(dagger) in the United States and territories: 1) the U.S. Zika Pregnancy Registry (USZPR),( section sign) which monitors pregnant women residing in U.S. states and all U.S. territories except Puerto Rico, and 2) the Zika Active Pregnancy Surveillance System (ZAPSS), which monitors pregnant women residing in Puerto Rico. As of May 12, 2016, the surveillance systems were monitoring 157 and 122 pregnant women with laboratory evidence of possible Zika virus infection from participating U.S. states and territories, respectively. Tracking and monitoring clinical presentation of Zika virus infection, all prenatal testing, and adverse consequences of Zika virus infection during pregnancy are critical to better characterize the risk for congenital infection, the performance of prenatal diagnostic testing, and the spectrum of adverse congenital outcomes. These data will improve clinical guidance, inform counseling messages for pregnant women, and facilitate planning for clinical and public health services for affected families. |
Global routine vaccination coverage, 2014
Subaiya S , Dumolard L , Lydon P , Gacic-Dobo M , Eggers R , Conklin L . MMWR Morb Mortal Wkly Rep 2015 64 (44) 1252-1255 The year 2014 marked the 40th anniversary of the World Health Organization's (WHO) Expanded Program on Immunization, which was established to ensure equitable access to routine immunization services (1). Since 1974, global coverage with the four core vaccines (Bacille Calmette- Guerin vaccine [BCG; for protection against tuberculosis], diphtheria-tetanus-pertussis [DTP] vaccine, poliovirus vaccine, and measles vaccine) has increased from <5% to >/=85%, and additional vaccines have been added to the recommended schedule. Coverage with the 3rd dose of DTP vaccine (DTP3) by age 12 months is an indicator of immunization program performance because it reflects completion of the basic infant immunization schedule; coverage with other vaccines, including the 3rd dose of poliovirus vaccine (polio3); the 1st dose of measles-containing vaccine (MCV1) is also assessed. Estimated global DTP3 coverage has remained at 84%-86% since 2009, with estimated 2014 coverage at 86%. Estimated global coverage for the 2nd routine dose of measles-containing vaccine (MCV2) was 38% by age 24 months and 56% when older age groups were included, similar to levels reported in 2013 (36% and 55%, respectively). To reach and sustain high immunization coverage in all countries, adequate vaccine stock management and additional opportunities for immunization, such as through routine visits in the second year of life, are integral components to strengthening immunization programs and reducing morbidity and mortality from vaccine preventable diseases. |
Vancomycin-resistant Staphylococcus aureus - Delaware, 2015
Walters MS , Eggers P , Albrecht V , Travis T , Lonsway D , Hovan G , Taylor D , Rasheed K , Limbago B , Kallen A . MMWR Morb Mortal Wkly Rep 2015 64 (37) 1056 Vancomycin-resistant Staphylococcus aureus (VRSA) is a rare, multidrug-resistant bacterium of public health concern that emerged in the United States in 2002. VRSA (S. aureus with vancomycin minimum inhibitory concentration [MIC] ≥16 µg/mL) arises when vancomycin resistance genes (e.g., the vanA operon, which codes for enzymes that result in modification or elimination of the vancomycin binding site) from vancomycin-resistant enterococci (VRE) are transferred to S. aureus (1). To date, all VRSA strains have arisen from methicillin-resistant S. aureus (MRSA). The fourteenth VRSA isolate (VRSA 14) identified in the United States was reported to CDC in February 2015. | VRSA 14 was cultured from the chronic toe wound of a patient in Delaware with diabetes mellitus and end-stage renal disease requiring hemodialysis; vancomycin-resistant Enterococcus faecalis was also isolated from this culture. The wound was first noted during an inpatient admission in April 2014. MRSA was isolated in August and October 2014, and MRSA and VRE were isolated in January 2015; these isolates are not available for further characterization. No antibiotic use was reported in the 4 months before VRSA isolation. | The VRSA and VRE toe wound isolates (February 2015) and an MRSA isolate from a nasal swab from the patient (March 2015) were sent to CDC for further characterization. The VRSA and VRE were confirmed to be resistant to vancomycin (MICs = 512 µg/mL for both); polymerase chain reaction testing confirmed the presence of vanA in both isolates. Pulsed-field gel electrophoresis and S. aureus protein A (spa) typing identified both the VRSA and MRSA as types USA100 and t002, placing them in staphylococcal clonal complex 5. This indicates that VRSA 14 has a health care–associated strain background, as do VRSA 1–12. Among VRSA isolated in the United States, only VRSA 13 had a community-associated strain background (2). |
Global routine vaccination coverage, 2013
Harris JB , Gacic-Dobo M , Eggers R , Brown DW , Sodha SV . MMWR Morb Mortal Wkly Rep 2014 63 (46) 1055-8 In 1974, the World Health Organization (WHO) established the Expanded Program on Immunization to ensure that all children have access to routinely recommended vaccines. Since then, global coverage with the four core vaccines (Bacille Calmette-Guerin vaccine [for protection against tuberculosis], diphtheria-tetanus-pertussis vaccine [DTP], polio vaccine, and measles vaccine) has increased from <5% to ≥84%, and additional vaccines have been added to the recommended schedule. Coverage with the third dose of DTP vaccine (DTP3) by age 12 months is a key indicator of immunization program performance. Estimated global DTP3 coverage has remained at 83%-84% since 2009, with estimated 2013 coverage at 84%. Global coverage estimates for the second routine dose of measles-containing vaccine (MCV2) are reported for the first time in 2013; global coverage was 35% by the end of the second year of life and 53% when including older age groups. Improvements in equity of access and use of immunization services will help ensure that all children are protected from vaccine-preventable diseases. |
Strengthening the partnership between routine immunization and the global polio eradication initiative to achieve eradication and assure sustainability
Abdelwahab J , Dietz V , Eggers R , Maher C , Olaniran M , Sandhu H , Vandelaer J . J Infect Dis 2014 210 Suppl 1 S498-503 Since the launch of the Global Polio Eradication Initiative (GPEI) in 1988, the number of polio endemic countries has declined from 125 to 3 in 2013. Despite this remarkable achievement, ongoing circulation of wild poliovirus in polio-endemic countries and the increase in the number of circulating vaccine-derived poliovirus cases, especially those caused by type 2, is a cause for concern. The Polio Eradication and Endgame Strategic Plan 2013-2018 (PEESP) was developed and includes 4 objectives: detection and interruption of poliovirus transmission, containment and certification, legacy planning, and a renewed emphasis on strengthening routine immunization (RI) programs. This is critical for the phased withdrawal of oral poliovirus vaccine, beginning with the type 2 component, and the introduction of a single dose of inactivated polio vaccine into RI programs. This objective has inspired renewed consideration of how the GPEI and RI programs can mutually benefit one another, how the infrastructure from the GPEI can be used to strengthen RI, and how a strengthened RI can facilitate polio eradication. The PEESP is the first GPEI strategic plan that places strong and clear emphasis on the necessity of improving RI to achieve and sustain global polio eradication. |
At your fingertips
Eggers C . J Environ Health 2014 77 (1) 34-6 A group of blind men surrounds an elephant, and in an attempt to discern what the object is, each man reaches out and begins touching it. As each man feels a different part, he shares his observation. One man feels a leg and proclaims the pillar-like object to be a stout tree. Another one feels the trunk and declares the curved subject a snake. Still another touches an ear and pronounces the thing a fan. Although their observations are singularly plausible, it is only when all viewpoints are combined that the whole object becomes known as an elephant. | Although the tale may vary in its retelling, the message is clear. When separate information is shared and brought together, we are able to see a more complete picture. | Bringing varied and disparate information together to effect knowledge is a cornerstone of informatics. Public health informatics is the systematic application of knowledge about systems that capture, manage, analyze, and use information to improve population health. We use informatics to move from our current understanding to a more knowledgeable comprehension through acquiring and using information. |
Survival on dialysis among American Indians and Alaska Natives with diabetes in the United States, 1995-2010
Burrows NR , Cho P , McKeever Bullard K , Narva AS , Eggers PW . Am J Public Health 2014 104 Suppl 3 S490-5 OBJECTIVES: We assessed survival in American Indians and Alaska Natives (AI/ANs) with end-stage renal disease attributed to diabetes who initiated hemodialysis between 1995 and 2009. METHODS: Follow-up extended from the first date of dialysis in the United States Renal Data System until December 31, 2010, kidney transplantation, or death. We used the Kaplan-Meier method to compute survival on dialysis by age and race/ethnicity and Cox regression analysis to compute adjusted hazard ratios (HRs). RESULTS: Our study included 510 666 persons-48% Whites, 2% AI/AN persons, and 50% others. Median follow-up was 2.2 years (interquartile range = 1.1-4.1 years). At any age, AI/AN persons survived longer on hemodialysis than Whites; this finding persisted after adjusting for baseline differences. Among AI/AN individuals, those with full Indian blood ancestry had the lowest adjusted risk of death compared with Whites (HR = 0.58; 95% confidence interval = 0.55, 0.61). The risk increased with declining proportion of AI/AN ancestry. CONCLUSIONS: Survival on dialysis was better among AI/AN than White persons with diabetes. Among AI/AN persons, the inverse relationship between risk of death and level of AI/AN ancestry suggested that cultural or hereditary factors played a role in survival. |
Report of the 13th vancomycin-resistant Staphylococcus aureus from the United States
Limbago BM , Kallen AJ , Zhu W , Eggers P , McDougal LK , Albrecht VS . J Clin Microbiol 2013 52 (3) 998-1002 Vancomycin-resistant Staphylococcus aureus (VRSA), important multidrug-resistant organisms of public health concern, have been infrequently identified in the United States since 2002. All previous VRSA belonged to clonal complex 5, a lineage associated primarily with healthcare. This report describes the most recent (13th) U.S. VRSA; the first in a community strain. |
Albuminuria prevalence in first morning void compared with previous random urine from adults in the National Health and Nutrition Examination Survey, 2009-2010
Saydah SH , Pavkov ME , Zhang C , Lacher DA , Eberhardt MS , Burrows NR , Narva AS , Eggers PW , Williams DE . Clin Chem 2013 59 (4) 675-83 BACKGROUND: Albuminuria, defined as urine albumin/creatinine ratio (ACR) ≥30 mg/g, is a diagnostic component of chronic kidney disease (CKD). National estimates of ACR and CKD prevalence have been based on single random urine samples. Although 2 urine samples or a first morning void are known to produce different estimates of ACR, the impact of differing urine sampling schemes on nationally estimated rates of CKD is unknown. METHODS: In 2009-2010, the National Health and Nutrition Examination Survey (NHANES) participants provided 2 untimed urine samples for sequential ACR measurement: an initial random urine collected in the NHANES mobile examination center and a subsequent first morning void collected at home. Rates of albuminuria were calculated in the overall population and broken down by demographics, diagnosed diabetes and hypertension status, and estimated glomerular filtration rate (eGFR). RESULTS: Overall, 43.5% of adults with increased ACR (≥30 mg/g) in a random urine also had increased ACR in a first morning urine. This percentage was higher among individuals ≥50 years old (48.9%), males (53.3%), participants with diagnosed diabetes (56.3%) and hypertension (51.5%), and eGFR <60 mL/min/1.72m(2) (56.9%). The use of confirmed increased ACR (defined as the presence of ACR ≥30 mg/g in both samples taken within 10 days) to define CKD resulted in a lower overall prevalence (11.6%) than first morning urine (12.7%) or random spot urine only (15.2%). CONCLUSIONS: ACR measured on random urine samples appears to overestimate the prevalence of albuminuria compared to first morning urine collections. |
Estimating prevalence of CKD stages 3-5 using health system data
Shahinian VB , Hedgeman E , Gillespie BW , Young EW , Robinson B , Hsu CY , Plantinga LC , Burrows NR , Eggers P , Saydah S , Powe NR , Saran R . Am J Kidney Dis 2013 61 (6) 930-8 BACKGROUND: The feasibility of using health system data to estimate prevalence of chronic kidney disease (CKD) stages 3-5 was explored. STUDY DESIGN: Cohort study. SETTING & PARTICIPANTS: A 5% national random sample of patients from the Veterans Affairs (VA) health care system, enrollees in a managed care plan in Michigan (M-CARE), and participants from the 2005-2006 National Health and Nutrition Examination Survey (NHANES). PREDICTOR: Observed CKD prevalence estimates in the health system population were calculated as patients with an available outpatient serum creatinine measurement with estimated glomerular filtration rate <60 mL/min/1.73 m2, among those with at least one outpatient visit during the year. OUTCOMES & MEASUREMENTS: A logistic regression model was fitted using data from the 2005-2006 NHANES to predict CKD prevalence in those untested for serum creatinine in the health system population, adjusted for demographics and comorbid conditions. Model results then were combined with the observed prevalence in tested patients to derive an overall predicted prevalence of CKD within the health systems. RESULTS: Patients in the VA system were older, had more comorbid conditions, and were more likely to be tested for serum creatinine than those in the M-CARE system. Observed prevalences of CKD stages 3-5 were 15.6% and 0.9% in the VA and M-CARE systems, respectively. Using data from NHANES, the overall predicted prevalences of CKD were 20.4% and 1.6% in the VA and M-CARE systems, respectively. LIMITATIONS: Health system data quality was limited by missing data for laboratory results and race. A single estimated glomerular filtration rate value was used to define CKD, rather than persistence over 3 months. CONCLUSIONS: Estimation of CKD prevalence within health care systems is feasible, but discrepancies between observed and predicted prevalences suggest that this approach is dependent on data availability and quality of information for comorbid conditions, as well as the frequency of testing for CKD in the health care system. |
A health policy model of CKD: 1. Model construction, assumptions, and validation of health consequences
Hoerger TJ , Wittenborn JS , Segel JE , Burrows NR , Imai K , Eggers P , Pavkov ME , Jordan R , Hailpern SM , Schoolwerth AC , Williams DE , Centers for Disease Control and Prevention CKD Initiative . Am J Kidney Dis 2010 55 (3) 452-62 BACKGROUND: A cost-effectiveness model that accurately represents disease progression, outcomes, and associated costs is necessary to evaluate the cost-effectiveness of interventions for chronic kidney disease (CKD). STUDY DESIGN: We developed a microsimulation model of the incidence, progression, and treatment of CKD. The model was validated by comparing its predictions with survey and epidemiologic data sources. SETTING & POPULATION: US patients. MODEL, PERSPECTIVE, & TIMEFRAME: The model follows up disease progression in a cohort of simulated patients aged 30 until age 90 years or death. The model consists of 7 mutually exclusive states representing no CKD, 5 stages of CKD, and death. Progression through the stages is governed by a person's glomerular filtration rate and albuminuria status. Diabetes, hypertension, and other risk factors influence CKD and the development of CKD complications in the model. Costs are evaluated from the health care system perspective. INTERVENTION: Usual care, including incidental screening for persons with diabetes or hypertension. OUTCOMES: Progression to CKD stages, complications, and mortality. RESULTS: The model provides reasonably accurate estimates of CKD prevalence by stage. The model predicts that 47.1% of 30-year-olds will develop CKD during their lifetime, with 1.7%, 6.9%, 27.3%, 6.9%, and 4.4% ending at stages 1-5, respectively. Approximately 11% of persons who reach stage 3 will eventually progress to stage 5. The model also predicts that 3.7% of persons will develop end-stage renal disease compared with an estimate of 3.0% based on current end-stage renal disease lifetime incidence. LIMITATIONS: The model synthesizes data from multiple sources rather than a single source and relies on explicit assumptions about progression. The model does not include acute kidney failure. CONCLUSION: The model is well validated and can be used to evaluate the cost-effectiveness of CKD interventions. The model also can be updated as better data for CKD progression become available. |
A health policy model of CKD: 2. The cost-effectiveness of microalbuminuria screening
Hoerger TJ , Wittenborn JS , Segel JE , Burrows NR , Imai K , Eggers P , Pavkov ME , Jordan R , Hailpern SM , Schoolwerth AC , Williams DE , Centers for Disease Control and Prevention CKD Initiative . Am J Kidney Dis 2010 55 (3) 463-73 BACKGROUND: Microalbuminuria screening may detect chronic kidney disease in its early stages, allowing for treatment that delays or prevents disease progression. The cost-effectiveness of microalbuminuria screening has not been determined. STUDY DESIGN: A cost-effectiveness model simulating disease progression and costs. SETTING & POPULATION: US patients. MODEL, PERSPECTIVE, AND TIMEFRAME: The microsimulation model follows up disease progression and costs in a cohort of simulated patients from age 50 to 90 years or death. Costs are evaluated from the health care system perspective. INTERVENTION: Microalbuminuria screening at 1-, 2-, 5-, or 10-year intervals followed by treatment with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. We considered universal screening, as well as screening targeted at persons with diabetes, persons with hypertension but no diabetes, and persons with neither diabetes nor hypertension. OUTCOMES: Costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. RESULTS: For the full model population, universal screening increases costs and increases QALYs. Universal annual screening starting at age 50 years has a cost-effectiveness ratio of $73,000/QALY relative to no screening and $145,000/QALY relative to usual care. Cost-effectiveness ratios improved with longer screening intervals. Relative to no screening, targeted annual screening has cost-effectiveness ratios of $21,000/QALY, $55,000/QALY, and $155,000/QALY for persons with diabetes, those with hypertension, and those with neither current diabetes nor current hypertension, respectively. LIMITATIONS: Results necessarily are based on a microsimulation model because of the long time horizon appropriate for chronic kidney disease. The model includes only health care costs. CONCLUSIONS: Microalbuminuria screening is cost-effective for patients with diabetes or hypertension, but is not cost-effective for patients with neither diabetes nor hypertension unless screening is conducted at longer intervals or as part of existing physician visits. |
H1N1 2009 influenza virus infection during pregnancy in the USA
Jamieson DJ , Honein MA , Rasmussen SA , Williams JL , Swerdlow DL , Biggerstaff MS , Lindstrom S , Louie JK , Christ CM , Bohm SR , Fonseca VP , Ritger KA , Kuhles DJ , Eggers P , Bruce H , Davidson HA , Lutterloh E , Harris ML , Burke C , Cocoros N , Finelli L , Macfarlane KF , Shu B , Olsen SJ , Novel Influenza A Pregnancy Working Group . Lancet 2009 374 (9688) 451-8 BACKGROUND: Pandemic H1N1 2009 influenza virus has been identified as the cause of a widespread outbreak of febrile respiratory infection in the USA and worldwide. We summarised cases of infection with pandemic H1N1 virus in pregnant women identified in the USA during the first month of the present outbreak, and deaths associated with this virus during the first 2 months of the outbreak. METHODS: After initial reports of infection in pregnant women, the US Centers for Disease Control and Prevention (CDC) began systematically collecting additional information about cases and deaths in pregnant women in the USA with pandemic H1N1 virus infection as part of enhanced surveillance. A confirmed case was defined as an acute respiratory illness with laboratory-confirmed pandemic H1N1 virus infection by real-time reverse-transcriptase PCR or viral culture; a probable case was defined as a person with an acute febrile respiratory illness who was positive for influenza A, but negative for H1 and H3. We used population estimates derived from the 2007 census data to calculate rates of admission to hospital and illness. FINDINGS: From April 15 to May 18, 2009, 34 confirmed or probable cases of pandemic H1N1 in pregnant women were reported to CDC from 13 states. 11 (32%) women were admitted to hospital. The estimated rate of admission for pandemic H1N1 influenza virus infection in pregnant women during the first month of the outbreak was higher than it was in the general population (0.32 per 100 000 pregnant women, 95% CI 0.13-0.52 vs 0.076 per 100 000 population at risk, 95% CI 0.07-0.09). Between April 15 and June 16, 2009, six deaths in pregnant women were reported to the CDC; all were in women who had developed pneumonia and subsequent acute respiratory distress syndrome requiring mechanical ventilation. INTERPRETATION: Pregnant women might be at increased risk for complications from pandemic H1N1 virus infection. These data lend support to the present recommendation to promptly treat pregnant women with H1N1 influenza virus infection with anti-influenza drugs. FUNDING: US CDC. |
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