Last data update: Oct 28, 2024. (Total: 48004 publications since 2009)
Records 1-30 (of 30 Records) |
Query Trace: Epperson M[original query] |
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Salivary immune responses after COVID-19 vaccination
Nguyen K , Relja B , Epperson M , Park SH , Thornburg NJ , Costantini VP , Vinjé J . PLoS One 2024 19 (9) e0307936 mRNA-based COVID-19 vaccines have played a critical role in reducing severe outcomes of COVID-19. Humoral immune responses against SARS-CoV-2 after vaccination have been extensively studied in blood; however, limited information is available on the presence and duration of SARS-CoV-2 specific antibodies in saliva and other mucosal fluids. Saliva offers a non-invasive sampling method that may also provide a better understanding of mucosal immunity at sites where the virus enters the body. Our objective was to evaluate the salivary immune response after vaccination with the COVID-19 Moderna mRNA-1273 vaccine. Two hundred three staff members of the U.S. Centers for Disease Control and Prevention were enrolled prior to receiving their first dose of the mRNA-1273 vaccine. Participants were asked to self-collect 6 saliva specimens at days 0 (prior to first dose), 14, 28 (prior to second dose), 42, and 56 using a SalivaBio saliva collection device. Saliva specimens were tested for anti-spike protein SARS-CoV-2 specific IgA and IgG enzyme immunoassays. Overall, SARS-CoV-2-specific salivary IgA titers peaked 2 weeks after each vaccine dose, followed by a sharp decrease during the following weeks. In contrast to IgA titers, IgG antibody titers increased substantially 2 weeks after the first vaccine dose, peaked 2 weeks after the second dose and persisted at an elevated level until at least 8 weeks after the first vaccine dose. Additionally, no significant differences in IgA/IgG titers were observed based on age, sex, or race/ethnicity. All participants mounted salivary IgA and IgG immune responses against SARS-CoV-2 after receiving the mRNA-1273 COVID-19 vaccine. Because of the limited follow-up time for this study, more data are needed to assess the antibody levels beyond 2 months after the first dose. Our results confirm the potential utility of saliva in assessing immune responses elicited by immunization and possibly by infection. |
Notes from the field: Potential outbreak of extrapulmonary mycobacterium abscessus subspecies massiliense infections from stem cell treatment clinics in Mexico - Arizona and Colorado, 2022
Nguyen MH , Hasan NA , De Moura VCN , Epperson LE , Czaja CA , Johnston H , Laramee N , Orten K , Rivas J , Prasai S , Grossman MK , Perkins KM , Griffith DE , Khare R , Strong M , Daley CL . MMWR Morb Mortal Wkly Rep 2024 73 (18) 420-422 Mycobacterium abscessus is an intrinsically drug-resistant, rapidly growing, nontuberculous mycobacterium; extrapulmonary infections have been reported in association with medical tourism (1). During November-December 2022, two Colorado hospitals (hospitals A and B) treated patient A, a Colorado woman aged 30-39 years, for M. abscessus meningitis. In October 2022, she had received intrathecal donor embryonic stem cell injections in Baja California, Mexico to treat multiple sclerosis and subsequently experienced headaches and fevers, consistent with meningitis. Her cerebrospinal fluid revealed neutrophilic pleocytosis and grew M. abscessus in culture at hospital A. Hospital A's physicians consulted hospital B's infectious diseases (ID) physicians to co-manage this patient (2). |
Immune response kinetics to SARS-CoV-2 infection and COVID-19 vaccination among nursing home residents-Georgia, October 2020-July 2022
Chisty ZA , Li DD , Haile M , Houston H , DaSilva J , Overton R , Schuh AJ , Haynie J , Clemente J , Branch AG , Arons MM , Tsang CA , Pellegrini GJ Jr , Bugrysheva J , Ilutsik J , Mohelsky R , Comer P , Hundia SB , Oh H , Stuckey MJ , Bohannon CD , Rasheed MAU , Epperson M , Thornburg NJ , McDonald LC , Brown AC , Kutty PK . PLoS One 2024 19 (4) e0301367 BACKGROUND: Understanding the immune response kinetics to SARS-CoV-2 infection and COVID-19 vaccination is important in nursing home (NH) residents, a high-risk population. METHODS: An observational longitudinal evaluation of 37 consenting vaccinated NH residents with/without SARS-CoV-2 infection from October 2020 to July 2022 was conducted to characterize the immune response to spike protein due to infection and/or mRNA COVID-19 vaccine. Antibodies (IgG) to SARS-CoV-2 full-length spike, nucleocapsid, and receptor binding domain protein antigens were measured, and surrogate virus neutralization capacity was assessed using Meso Scale Discovery immunoassays. The participant's spike exposure status varied depending on the acquisition of infection or receipt of a vaccine dose. Longitudinal linear mixed effects modeling was used to describe trajectories based on the participant's last infection or vaccination; the primary series mRNA COVID-19 vaccine was considered two spike exposures. Mean antibody titer values from participants who developed an infection post receipt of mRNA COVID-19 vaccine were compared with those who did not. In a subset of participants (n = 15), memory B cell (MBC) S-specific IgG (%S IgG) responses were assessed using an ELISPOT assay. RESULTS: The median age of the 37 participants at enrollment was 70.5 years; 30 (81%) had prior SARS-CoV-2 infection, and 76% received Pfizer-BioNTech and 24% Moderna homologous vaccines. After an observed augmented effect with each spike exposure, a decline in the immune response, including %S IgG MBCs, was observed over time; the percent decline decreased with increasing spike exposures. Participants who developed an infection at least two weeks post-receipt of a vaccine were observed to have lower humoral antibody levels than those who did not develop an infection post-receipt. CONCLUSIONS: These findings suggest that understanding the durability of immune responses in this vulnerable NH population can help inform public health policy regarding the timing of booster vaccinations as new variants display immune escape. |
Serologic immunity to tetanus in the United States, National Health and Nutrition Examination Survey, 2015-2016
Bampoe VD , Brown N , Deng L , Schiffer J , Jia LT , Epperson M , Gorantla Y , Park SH , Ao J , Acosta AM , Hariri S . Clin Infect Dis 2023 BACKGROUND: Tetanus, a life-threatening infection, has become rare in the United States since introduction of tetanus toxoid-containing vaccines (TTCVs), recommended as a childhood series followed by decennial boosters beginning at age 11-12 years; vaccination uptake is high in children but suboptimal in adults. The objective of this study was to estimate the prevalence of sero-immunity to tetanus among persons aged ≥6 years in the United States and to identify factors associated with tetanus sero-immunity. Understanding population protection against tetanus informs current and future vaccine recommendations. METHODS: Anti-tetanus toxoid antibody concentrations were measured for participants of the 2015-2016 National Health and Nutrition Examination Survey (NHANES) aged ≥6 years for whom surplus serum samples were available using a microsphere-based multiplex antibody capture assay. Prevalence of sero-immunity, defined as ≥0.10 IU/mL, was estimated overall and by demographic characteristics. Factors associated with tetanus sero-immunity were examined using multivariable regression. RESULTS: Overall, 93.8% of the U.S. population aged ≥6 years had sero-protection against tetanus. Prevalence of sero-immunity was above 90% across racial/ethnic categories, sex, and poverty levels. By age, ≥90% had protective sero-immunity through age 69 years but prevalence of sero-immunity declined thereafter, with 75.8% of those aged ≥80 years having protective sero-immunity. Older age (adjusted prevalence ratio (aPR): 0.89, 95% CI: 0.85-0.92) and being born outside the United States (aPR: 0.96, 95% CI: 0.93-0.98) were significantly associated with lower prevalence of sero-immunity. CONCLUSION: The majority of the U.S. population has vaccine-induced sero-immunity to tetanus, demonstrating the success of the vaccination program. |
Assessment of anti-SARS-CoV-2 antibody levels among university students vaccinated with different COVID-19 primary and booster doses - fall 2021, Wisconsin
DeJonge PM , Lambrou AS , Segaloff HE , Bateman A , Sterkel A , Griggs C , Baggott J , Kelly P , Thornburg N , Epperson M , Desamu-Thorpe R , Abedi G , Hsu CH , Nakayama JY , Ruffin J , Turner-Harper D , Matanock A , Almendares O , Whaley M , Chakrabarti A , DeGruy K , Daly M , Westergaard R , Tate JE , Kirking HL . BMC Infect Dis 2023 23 (1) 374 BACKGROUND: University students commonly received COVID-19 vaccinations before returning to U.S. campuses in the Fall of 2021. Given likely immunologic variation among students based on differences in type of primary series and/or booster dose vaccine received, we conducted serologic investigations in September and December 2021 on a large university campus in Wisconsin to assess anti-SARS-CoV-2 antibody levels. METHODS: We collected blood samples, demographic information, and COVID-19 illness and vaccination history from a convenience sample of students. Sera were analyzed for both anti-spike (anti-S) and anti-nucleocapsid (anti-N) antibody levels using World Health Organization standardized binding antibody units per milliliter (BAU/mL). Levels were compared across categorical primary COVID-19 vaccine series received and binary COVID-19 mRNA booster status. The association between anti-S levels and time since most recent vaccination dose was estimated by mixed-effects linear regression. RESULTS: In total, 356 students participated, of whom 219 (61.5%) had received a primary vaccine series of Pfizer-BioNTech or Moderna mRNA vaccines and 85 (23.9%) had received vaccines from Sinovac or Sinopharm. Median anti-S levels were significantly higher for mRNA primary vaccine series recipients (2.90 and 2.86 log [BAU/mL], respectively), compared with those who received Sinopharm or Sinovac vaccines (1.63 and 1.95 log [BAU/mL], respectively). Sinopharm and Sinovac vaccine recipients were associated with a significantly faster anti-S decline over time, compared with mRNA vaccine recipients (P <.001). By December, 48/172 (27.9%) participants reported receiving an mRNA COVID-19 vaccine booster, which reduced the anti-S antibody discrepancies between primary series vaccine types. CONCLUSIONS: Our work supports the benefit of heterologous boosting against COVID-19. COVID-19 mRNA vaccine booster doses were associated with increases in anti-SARS-CoV-2 antibody levels; following an mRNA booster dose, students with both mRNA and non-mRNA primary series receipt were associated with comparable levels of anti-S IgG. |
Maternal Tdap vaccination during pregnancy: Impact on infant anti-pertussis antibody concentrations by maternal pertussis priming series
Havers FP , Skoff TH , Rench MA , Epperson M , Rajam G , Schiffer J , Hariri S , Swaim LS , Baker CJ , Mary Healy C . Clin Infect Dis 2022 76 (3) e1087-e1093 BACKGROUND: Acellular pertussis (aP) vaccines replaced whole cell pertussis (wP) vaccines for the U.S. childhood primary series in 1997. As women primed with aP vaccines enter childbearing age, protection of infants through Tdap (tetanus toxoid, reduced diphtheria toxoid and acellular pertussis) vaccination during pregnancy may be impacted. METHODS: Term infants born to women vaccinated with Tdap during pregnancy were included. Geometric mean concentrations (GMC) of pertussis-specific IgG antibodies (IU/mL) in cord blood of infants born to women born after 1997 (aP-primed) were compared with those born to women born before 1992 (wP-primed). RESULTS: 253 and 506 infants born to aP- and wP-primed women, respectively, were included. Compared with wP-primed women, aP-primed women were younger, more likely to be Hispanic or non-Hispanic Black, and had lower birthweight infants (p < 0.01 for all). Antibodies against pertussis toxin (PT) and filamentous hemagglutinin (FHA) were lower among infants born to aP-primed versus wP-primed women (PT: 17.3 vs. 36.4, GMC ratio 0.475 (95% Confidence Interval [CI], 0.408-0.552); FHA: 104.6 vs. 121.4, GMC ratio 0.861 (95% CI, 0.776-0.958)). No differences were observed for anti-fimbriae or anti-pertactin antibodies. CONCLUSIONS: Transplacental anti-pertussis antibody concentrations in infants of women vaccinated with Tdap during pregnancy differed by type of childhood vaccine the woman received. Notably, anti-PT antibody levels, considered most important in preventing severe infant disease, were lower in infants born to aP- vs. wP-primed women. Maternal Tdap vaccination may confer less protection against pertussis in young infants born to aP-primed than those born to wP-primed women. |
Comparative Effectiveness and Antibody Responses to Moderna and Pfizer-BioNTech COVID-19 Vaccines among Hospitalized Veterans - Five Veterans Affairs Medical Centers, United States, February 1-September 30, 2021.
Bajema KL , Dahl RM , Evener SL , Prill MM , Rodriguez-Barradas MC , Marconi VC , Beenhouwer DO , Holodniy M , Lucero-Obusan C , Brown ST , Tremarelli M , Epperson M , Mills L , Park SH , Rivera-Dominguez G , Morones RG , Ahmadi-Izadi G , Deovic R , Mendoza C , Jeong C , Schrag SJ , Meites E , Hall AJ , Kobayashi M , McMorrow M , Verani JR , Thornburg NJ , Surie D . MMWR Morb Mortal Wkly Rep 2021 70 (49) 1700-1705 The mRNA COVID-19 vaccines (Moderna and Pfizer-BioNTech) provide strong protection against severe COVID-19, including hospitalization, for at least several months after receipt of the second dose (1,2). However, studies examining immune responses and differences in protection against COVID-19-associated hospitalization in real-world settings, including by vaccine product, are limited. To understand how vaccine effectiveness (VE) might change with time, CDC and collaborators assessed the comparative effectiveness of Moderna and Pfizer-BioNTech vaccines in preventing COVID-19-associated hospitalization at two periods (14-119 days and ≥120 days) after receipt of the second vaccine dose among 1,896 U.S. veterans at five Veterans Affairs medical centers (VAMCs) during February 1-September 30, 2021. Among 234 U.S. veterans fully vaccinated with an mRNA COVID-19 vaccine and without evidence of current or prior SARS-CoV-2 infection, serum antibody levels (anti-spike immunoglobulin G [IgG] and anti-receptor binding domain [RBD] IgG) to SARS-CoV-2 were also compared. Adjusted VE 14-119 days following second Moderna vaccine dose was 89.6% (95% CI = 80.1%-94.5%) and after the second Pfizer-BioNTech dose was 86.0% (95% CI = 77.6%-91.3%); at ≥120 days VE was 86.1% (95% CI = 77.7%-91.3%) for Moderna and 75.1% (95% CI = 64.6%-82.4%) for Pfizer-BioNTech. Antibody levels were significantly higher among Moderna recipients than Pfizer-BioNTech recipients across all age groups and periods since vaccination; however, antibody levels among recipients of both products declined between 14-119 days and ≥120 days. These findings from a cohort of older, hospitalized veterans with high prevalences of underlying conditions suggest the importance of booster doses to help maintain long-term protection against severe COVID-19.(†). |
Changes in SARS CoV-2 Seroprevalence Over Time in Ten Sites in the United States, March - August, 2020.
Lim T , Delorey M , Bestul N , Johannsen M , Reed C , Hall AJ , Fry AM , Edens C , Semenova V , Li H , Browning P , Desai R , Epperson M , Jia T , Thornburg NJ , Schiffer J , Havers FP . Clin Infect Dis 2021 73 (10) 1831-1839 BACKGROUND: Monitoring of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody prevalence can complement case reporting to inform more accurate estimates of SARS-CoV-2 infection burden, but few studies have undertaken repeated sampling over time on a broad geographic scale. METHODS: We performed serologic testing on a convenience sample of residual sera obtained from persons of all ages, at ten sites in the United States from March 23 through August 14, 2020, from routine clinical testing at commercial laboratories. We age-sex-standardized our seroprevalence rates using census population projections and adjusted for laboratory assay performance. Confidence intervals were generated with a two-stage bootstrap. We used Bayesian modeling to test whether seroprevalence changes over time were statistically significant. RESULTS: Seroprevalence remained below 10% at all sites except New York and Florida, where it reached 23.2% and 13.3%, respectively. Statistically significant increases in seroprevalence followed peaks in reported cases in New York, South Florida, Utah, Missouri and Louisiana. In the absence of such peaks, some significant decreases were observed over time in New York, Missouri, Utah, and Western Washington. The estimated cumulative number of infections with detectable antibody response continued to exceed reported cases in all sites. CONCLUSIONS: Estimated seroprevalence was low in most sites, indicating that most people in the U.S. have not been infected with SARS-CoV-2 as of July 2020. The majority of infections are likely not reported. Decreases in seroprevalence may be related to changes in healthcare-seeking behavior, or evidence of waning of detectable anti-SARS CoV-2 antibody levels at the population level. Thus, seroprevalence estimates may underestimate the cumulative incidence of infection. |
Comparison of Estimated SARS-CoV-2 Seroprevalence through Commercial Laboratory Residual Sera Testing and a Community Survey.
Bajema KL , Dahlgren FS , Lim TW , Bestul N , Biggs HM , Tate JE , Owusu C , Szablewski CM , Drenzek C , Drobeniuc J , Semenova V , Li H , Browning P , Desai R , Epperson M , Jia LT , Thornburg NJ , Edens C , Fry AM , Hall AJ , Schiffer J , Havers FP . Clin Infect Dis 2020 73 (9) e3120-e3123 We compared severe acute respiratory syndrome-related coronavirus-2 seroprevalence estimated from commercial laboratory residual sera and a community household survey in metropolitan Atlanta during April-May 2020 and found these two estimates to be similar (4.94% versus 3.18%). Compared with more representative surveys, commercial sera can provide an approximate measure of seroprevalence. |
Serologic testing of U.S. blood donations to identify SARS-CoV-2-reactive antibodies: December 2019-January 2020.
Basavaraju SV , Patton ME , Grimm K , Rasheed MAU , Lester S , Mills L , Stumpf M , Freeman B , Tamin A , Harcourt J , Schiffer J , Semenova V , Li H , Alston B , Ategbole M , Bolcen S , Boulay D , Browning P , Cronin L , David E , Desai R , Epperson M , Gorantla Y , Jia T , Maniatis P , Moss K , Ortiz K , Park SH , Patel P , Qin Y , Steward-Clark E , Tatum H , Vogan A , Zellner B , Drobeniuc J , Sapiano MRP , Havers F , Reed C , Gerber S , Thornburg NJ , Stramer SL . Clin Infect Dis 2020 72 (12) e1004-e1009 BACKGROUND: SARS-CoV-2, the virus that causes COVID-19 disease, was first identified in Wuhan, China in December 2019, with subsequent worldwide spread. The first U.S. cases were identified in January 2020. METHODS: To determine if SARS-CoV-2 reactive antibodies were present in sera prior to the first identified case in the U.S. on January 19, 2020, residual archived samples from 7,389 routine blood donations collected by the American Red Cross from December 13, 2019 to January 17, 2020, from donors resident in nine states (California, Connecticut, Iowa, Massachusetts, Michigan, Oregon, Rhode Island, Washington, and Wisconsin) were tested at CDC for anti-SARS-CoV-2 antibodies. Specimens reactive by pan-immunoglobulin (pan Ig) enzyme linked immunosorbent assay (ELISA) against the full spike protein were tested by IgG and IgM ELISAs, microneutralization test, Ortho total Ig S1 ELISA, and receptor binding domain / Ace2 blocking activity assay. RESULTS: Of the 7,389 samples, 106 were reactive by pan Ig. Of these 106 specimens, 90 were available for further testing. Eighty four of 90 had neutralizing activity, 1 had S1 binding activity, and 1 had receptor binding domain / Ace2 blocking activity >50%, suggesting the presence of anti-SARS-CoV-2-reactive antibodies. Donations with reactivity occurred in all nine states. CONCLUSIONS: These findings suggest that SARS-CoV-2 may have been introduced into the United States prior to January 19, 2020. |
Asymptomatic orthopoxvirus circulation in humans in the wake of a monkeypox outbreak among chimpanzees in Cameroon
Guagliardo SAJ , Monroe B , Moundjoa C , Athanase A , Okpu G , Burgado J , Townsend MB , Satheshkumar PS , Epperson S , Doty JB , Reynolds MG , Dibongue EE , Etoundi GA , Mathieu E , McCollum AM . Am J Trop Med Hyg 2019 102 (1) 206-212 Monkeypox virus is a zoonotic Orthopoxvirus (OPXV) that causes smallpox-like illness in humans. In Cameroon, human monkeypox cases were confirmed in 2018, and outbreaks in captive chimpanzees occurred in 2014 and 2016. We investigated the OPXV serological status among staff at a primate sanctuary (where the 2016 chimpanzee outbreak occurred) and residents from nearby villages, and describe contact with possible monkeypox reservoirs. We focused specifically on Gambian rats (Cricetomys spp.) because it is a recognized possible reservoir and because contact with this species was common enough to render sufficient statistical power. We collected one 5-mL whole blood specimen from each participant to perform a generic anti-OPXV ELISA test for IgG and IgM antibodies and administered a questionnaire about prior symptoms of monkeypox-like illness and contact with possible reservoirs. Our results showed evidence of OPXV exposures (IgG positive, 6.3%; IgM positive, 1.6%) among some of those too young to have received smallpox vaccination (born after 1980, n = 63). No participants reported prior symptoms consistent with monkeypox. After adjusting for the education level, participants who frequently visited the forest were more likely to have recently eaten Gambian rats (OR: 3.36, 95% CI: 1.91-5.92, P < 0.001) and primate sanctuary staff were less likely to have touched or sold Gambian rats (OR: 0.23, 95% CI: 0.19-0.28, P < 0.001). The asymptomatic or undetected circulation of OPXVs in humans in Cameroon is likely, and contact with monkeypox reservoirs is common, raising the need for continued surveillance for human and animal disease. |
Update: Influenza Activity - United States and Worldwide, May 19-September 28, 2019, and Composition of the 2020 Southern Hemisphere Influenza Vaccine
Epperson S , Davis CT , Brammer L , Abd Elal AI , Ajayi N , Barnes J , Budd AP , Burns E , Daly P , Dugan VG , Fry AM , Jang Y , Johnson SJ , Kniss K , Kondor R , Grohskopf LA , Gubareva L , Merced-Morales A , Sessions W , Stevens J , Wentworth DE , Xu X , Jernigan D . MMWR Morb Mortal Wkly Rep 2019 68 (40) 880-884 During May 19-September 28, 2019,* low levels of influenza activity were reported in the United States, with cocirculation of influenza A and influenza B viruses. In the Southern Hemisphere seasonal influenza viruses circulated widely, with influenza A(H3) predominating in many regions; however, influenza A(H1N1)pdm09 and influenza B viruses were predominant in some countries. In late September, the World Health Organization (WHO) recommended components for the 2020 Southern Hemisphere influenza vaccine and included an update to the A(H3N2) and B/Victoria-lineage components. Annual influenza vaccination is the best means for preventing influenza illness and its complications, and vaccination before influenza activity increases is optimal. Health care providers should recommend vaccination for all persons aged >/=6 months who do not have contraindications to vaccination (1). |
Genomic Analysis of Cardiac Surgery-Associated Mycobacterium chimaera Infections, United States.
Hasan NA , Epperson LE , Lawsin A , Rodger RR , Perkins KM , Halpin AL , Perry KA , Moulton-Meissner H , Diekema DJ , Crist MB , Perz JF , Salfinger M , Daley CL , Strong M . Emerg Infect Dis 2019 25 (3) 559-563 A surgical heater-cooler unit has been implicated as the source for Mycobacterium chimaera infections among cardiac surgery patients in several countries. We isolated M. chimaera from heater-cooler units and patient infections in the United States. Whole-genome sequencing corroborated a risk for these units acting as a reservoir for this pathogen. |
Community-wide recreational water-associated outbreak of cryptosporidiosis and control strategies - Maricopa County, Arizona, 2016
Iverson SA , Fowle N , Epperson G , Collins J , Zusy S , Narang J , Matthews J , Hlavsa MC , Roellig D , Sylvester T , Klein R , Sunenshine R . J Environ Health 2018 81 (4) 14-21 We describe a 2016 community-wide recreational water-associated cryptosporidiosis outbreak investigation and response in Maricopa County, Arizona. Persons with a laboratory-confirmed illness were interviewed using a standardized questionnaire that assessed exposures 2 weeks before symptom onset. A convenience sample of managers and operators of chlorine-treated public aquatic facilities was surveyed regarding permanent supplemental treatment systems for Cryptosporidium. Among 437 cases identified (median age 12, range <1-75 years), 260 persons were interviewed. Public-treated recreational water was the most frequently reported exposure (177, 68%) of interviewed persons; almost 1 in 5 (43, 17%) swam when diarrhea was ongoing. After the 2016 outbreak, managers of some facilities expressed intentions to install supplementary water treatment systems, and by May 2017, at least one large facility installed an ultraviolet light system. Strategies to prevent additional illness included community messaging, education, and targeted remediation of affected facilities on the basis of interviews. Challenges to remediation during a cryptosporidiosis outbreak in a large jurisdiction with primarily outdoor pools underscore the importance of promoting healthy swimming practices that help prevent contamination from occurring. |
Multi-laboratory comparison of three commercially available Zika IgM enzyme-linked immunosorbent assays
Basile AJ , Goodman C , Horiuchi K , Sloan A , Johnson BW , Kosoy O , Laven J , Panella AJ , Sheets I , Medina F , Mendoza EJ , Epperson M , Maniatis P , Semenova V , Steward-Clark E , Wong E , Biggerstaff BJ , Lanciotti R , Drebot M , Safronetz D , Schiffer J . J Virol Methods 2018 260 26-33 Zika virus (ZIKV) is an enveloped, positive-sense RNA virus in the family Flaviviridae, genus Flavivirus. It was first discovered in rhesus monkeys in 1947 in the Zika Forest of Uganda (Dick et al., 1952) and historically of unclear importance given the rarity of reported cases and to relatively mild symptoms in humans. The virus is chiefly transmitted by Aedes mosquitoes, the carrier of other flaviviruses of medical importance such as the dengue viruses (DENVs) and yellow fever virus (YFV). Little research had been conducted on ZIKV prior to a 2007 outbreak in Yap, Federated States of Micronesia (Duffy et al., 2009), at which point the virus was sequenced and molecular and serological tests were developed (Lanciotti et al., 2008). |
Using molecular characterization to support investigations of aquatic facility-associated outbreaks of cryptosporidiosis - Alabama, Arizona, and Ohio, 2016
Hlavsa MC , Roellig DM , Seabolt MH , Kahler AM , Murphy JL , McKitt TK , Geeter EF , Dawsey R , Davidson SL , Kim TN , Tucker TH , Iverson SA , Garrett B , Fowle N , Collins J , Epperson G , Zusy S , Weiss JR , Komatsu K , Rodriguez E , Patterson JG , Sunenshine R , Taylor B , Cibulskas K , Denny L , Omura K , Tsorin B , Fullerton KE , Xiao L . MMWR Morb Mortal Wkly Rep 2017 66 (19) 493-497 Cryptosporidiosis is a nationally notifiable gastrointestinal illness caused by parasitic protozoa of the genus Cryptosporidium, which can cause profuse, watery diarrhea that can last up to 2-3 weeks in immunocompetent patients and can lead to life-threatening wasting and malabsorption in immunocompromised patients. Fecal-oral transmission of Cryptosporidium oocysts, the parasite's infectious life stage, occurs via ingestion of contaminated recreational water, drinking water, or food, or following contact with infected persons or animals, particularly preweaned bovine calves (1). The typical incubation period is 2-10 days. Since 2004, the annual incidence of nationally notified cryptosporidiosis has risen approximately threefold in the United States (1). Cryptosporidium also has emerged as the leading etiology of nationally notified recreational water-associated outbreaks, particularly those associated with aquatic facilities (i.e., physical places that contain one or more aquatic venues [e.g., pools] and support infrastructure) (2). As of February 24, 2017, a total of 13 (54%) of 24 states reporting provisional data detected at least 32 aquatic facility-associated cryptosporidiosis outbreaks in 2016. In comparison, 20 such outbreaks were voluntarily reported to CDC via the National Outbreak Reporting System for 2011, 16 for 2012, 13 for 2013, and 16 for 2014. This report highlights cryptosporidiosis outbreaks associated with aquatic facilities in three states (Alabama, Arizona, and Ohio) in 2016. This report also illustrates the use of CryptoNet, the first U.S. molecularly based surveillance system for a parasitic disease, to further elucidate Cryptosporidium chains of transmission and cryptosporidiosis epidemiology. CryptoNet data can be used to optimize evidence-based prevention strategies. Not swimming when ill with diarrhea is key to preventing and controlling aquatic facility-associated cryptosporidiosis outbreaks (https://www.cdc.gov/healthywater/swimming/swimmers/steps-healthy-swimming.html). |
Validation of high throughput screening of human sera for detection of anti-PA IgG by Enzyme-Linked Immunosorbent Assay (ELISA) as an emergency response to an anthrax incident
Semenova VA , Steward-Clark E , Maniatis P , Epperson M , Sabnis A , Schiffer J . Biologicals 2016 45 61-68 To improve surge testing capability for a response to a release of Bacillus anthracis, the CDC anti-Protective Antigen (PA) IgG Enzyme-Linked Immunosorbent Assay (ELISA) was re-designed into a high throughput screening format. The following assay performance parameters were evaluated: goodness of fit (measured as the mean reference standard r2), accuracy (measured as percent error), precision (measured as coefficient of variance (CV)), lower limit of detection (LLOD), lower limit of quantification (LLOQ), dilutional linearity, diagnostic sensitivity (DSN) and diagnostic specificity (DSP). The paired sets of data for each sample were evaluated by Concordance Correlation Coefficient (CCC) analysis. The goodness of fit was 0.999; percent error between the expected and observed concentration for each sample ranged from -4.6% to 14.4%. The coefficient of variance ranged from 9.0% to 21.2%. The assay LLOQ was 2.6 mug/mL. The regression analysis results for dilutional linearity data were r2 = 0.952, slope = 1.02 and intercept = -0.03. CCC between assays was 0.974 for the median concentration of serum samples. The accuracy and precision components of CCC were 0.997 and 0.977, respectively. This high throughput screening assay is precise, accurate, sensitive and specific. Anti-PA IgG concentrations determined using two different assays proved high levels of agreement. The method will improve surge testing capability 18-fold from 4 to 72 sera per assay plate. |
Immediate closures and violations identified during routine inspections of public aquatic facilities - Network for Aquatic Facility Inspection Surveillance, five states, 2013
Hlavsa MC , Gerth TR , Collier SA , Dunbar EL , Rao G , Epperson G , Bramlett B , Ludwig DF , Gomez D , Stansbury MM , Miller F , Warren J , Nichol J , Bowman H , Huynh BA , Loewe KM , Vincent B , Tarrier AL , Shay T , Wright R , Brown AC , Kunz JM , Fullerton KE , Cope JR , Beach MJ . MMWR Surveill Summ 2016 65 (5) 1-26 PROBLEM/CONDITION: Aquatic facility-associated illness and injury in the United States include disease outbreaks of infectious or chemical etiology, drowning, and pool chemical-associated health events (e.g., respiratory distress or burns). These conditions affect persons of all ages, particularly young children, and can lead to disability or even death. A total of 650 aquatic facility-associated outbreaks have been reported to CDC for 1978-2012. During 1999-2010, drownings resulted in approximately 4,000 deaths each year in the United States. Drowning is the leading cause of injury deaths in children aged 1-4 years, and approximately half of fatal drownings in this age group occur in swimming pools. During 2003-2012, pool chemical-associated health events resulted in an estimated 3,000-5,000 visits to U.S. emergency departments each year, and approximately half of the patients were aged <18 years. In August 2014, CDC released the Model Aquatic Health Code (MAHC), national guidance that can be adopted voluntarily by state and local jurisdictions to minimize the risk for illness and injury at public aquatic facilities. REPORTING PERIOD COVERED: 2013. DESCRIPTION OF SYSTEM: The Network for Aquatic Facility Inspection Surveillance (NAFIS) was established by CDC in 2013. NAFIS receives aquatic facility inspection data collected by environmental health practitioners when assessing the operation and maintenance of public aquatic facilities. This report presents inspection data that were reported by 16 public health agencies in five states (Arizona, California, Florida, New York, and Texas) and focuses on 15 MAHC elements deemed critical to minimizing the risk for illness and injury associated with aquatic facilities (e.g., disinfection to prevent transmission of infectious pathogens, safety equipment to rescue distressed bathers, and pool chemical safety). Although these data (the first and most recent that are available) are not nationally representative, 15.7% of the estimated 309,000 U.S. public aquatic venues are located in the 16 reporting jurisdictions. RESULTS: During 2013, environmental health practitioners in the 16 reporting NAFIS jurisdictions conducted 84,187 routine inspections of 48,632 public aquatic venues. Of the 84,187 routine inspection records for individual aquatic venues, 78.5% (66,098) included data on immediate closure; 12.3% (8,118) of routine inspections resulted in immediate closure because of at least one identified violation that represented a serious threat to public health. Disinfectant concentration violations were identified during 11.9% (7,662/64,580) of routine inspections, representing risk for aquatic facility-associated outbreaks of infectious etiology. Safety equipment violations were identified during 12.7% (7,845/61,648) of routine inspections, representing risk for drowning. Pool chemical safety violations were identified during 4.6% (471/10,264) of routine inspections, representing risk for pool chemical-associated health events. INTERPRETATION: Routine inspections frequently resulted in immediate closure and identified violations of inspection items corresponding to 15 MAHC elements critical to protecting public health, highlighting the need to improve operation and maintenance of U.S. public aquatic facilities. These findings also underscore the public health function that code enforcement, conducted by environmental health practitioners, has in preventing illness and injury at public aquatic facilities. PUBLIC HEALTH ACTION: Findings from the routine analyses of aquatic facility inspection data can inform program planning, implementation, and evaluation. At the state and local level, these inspection data can be used to identify aquatic facilities and venues in need of more frequent inspections and to select topics to cover in training for aquatic facility operators. At the national level, these data can be used to evaluate whether the adoption of MAHC elements minimizes the risk for aquatic facility-associated illness and injury. These findings also can be used to prioritize revisions or updates to the MAHC. To optimize the collection and analysis of aquatic facility inspection data and thus application of findings, environmental health practitioners and epidemiologists need to collaborate extensively to identify public aquatic facility code elements deemed critical to protecting public health and determine the best way to assess and document compliance during inspections. |
Investigation of an outbreak of variant influenza A (H3N2) virus associated with an agricultural fair - Ohio, August 2012
Greenbaum A , Quinn C , Bailer J , Su S , Havers F , Durand LO , Jiang V , Page S , Budd J , Shaw M , Biggerstaff M , de Fijter S , Smith K , Reed C , Epperson S , Brammer L , Feltz D , Sohner K , Ford J , Jain S , Gargiullo P , Weiss E , Burg P , DiOrio M , Fowler B , Finelli L , Jhung MA . J Infect Dis 2015 212 (10) 1592-9 BACKGROUND: In 2012, one third of cases in a multi-state outbreak of variant influenza A(H3N2) virus [(H3N2)v] occurred in Ohio. We conducted an investigation of (H3N2)v cases associated with agricultural Fair A in Ohio. METHODS: We surveyed Fair A swine exhibitors and their household members. Confirmed cases had influenza-like illness (ILI) and a positive laboratory test for (H3N2)v virus and probable cases had ILI. We calculated attack rates. We determined risk factors for infection using multivariable log-binomial regression. RESULTS: We identified a total of 20 confirmed and 94 probable cases associated with Fair A. Among 114 cases, the median age was 10 years, there were no hospitalizations or deaths, and 85% had swine exposure. In the exhibitor household cohort of 359 persons (83 households), we identified 6 confirmed (2%) and 40 probable (11%) cases. Age <10 years was a significant risk factor (p<0.01) for illness. One instance of likely human-to-human transmission was identified. CONCLUSIONS: In this (H3N2)v outbreak, no evidence of sustained human-to-human (H3N2)v transmission was found. Our risk factor analysis contributed to the development of recommendations that those at increased risk of influenza complications, including children aged <5 years, avoid swine barns at fairs during the 2012 fair season. |
Influenza activity - United States, 2013-14 season and composition of the 2014-15 influenza vaccines
Epperson S , Blanton L , Kniss K , Mustaquim D , Steffens C , Wallis T , Dhara R , Leon M , Perez A , Chaves SS , Elal AA , Gubareva L , Xu X , Villanueva J , Bresee J , Cox N , Finelli L , Brammer L . MMWR Morb Mortal Wkly Rep 2014 63 (22) 483-90 During the 2013-14 influenza season in the United States, influenza activity increased through November and December before peaking in late December. Influenza A (H1N1)pdm09 (pH1N1) viruses predominated overall, but influenza B viruses and, to a lesser extent, influenza A (H3N2) viruses also were reported in the United States. This influenza season was the first since the 2009 pH1N1 pandemic in which pH1N1 viruses predominated and was characterized overall by lower levels of outpatient illness and mortality than influenza A (H3N2)-predominant seasons, but higher rates of hospitalization among adults aged 50-64 years compared with recent years. This report summarizes influenza activity in the United States for the 2013-14 influenza season (September 29, 2013-May 17, 2014dagger) and reports recommendations for the components of the 2014-15 Northern Hemisphere influenza vaccines. |
Update: influenza activity - United States, September 29, 2013-February 8, 2014
Arriola CS , Brammer L , Epperson S , Blanton L , Kniss K , Mustaquim D , Steffens C , Dhara R , Leon M , Perez A , Chaves SS , Katz J , Wallis T , Villanueva J , Xu X , Abd Elal AI , Gubareva L , Cox N , Finelli L , Bresee J , Jhung M . MMWR Morb Mortal Wkly Rep 2014 63 (7) 148-54 Influenza activity in the United States began to increase in mid-November and remained elevated through February 8, 2014. During that time, influenza A (H1N1)pdm09 (pH1N1) viruses predominated overall, while few B and A (H3N2) viruses were detected. This report summarizes U.S. influenza activity* during September 29, 2013-February 8, 2014, and updates the previous summary. |
Outbreak of variant influenza A(H3N2) virus in the United States
Jhung MA , Epperson S , Biggerstaff M , Allen D , Balish A , Barnes N , Beaudoin A , Berman L , Bidol S , Blanton L , Blythe D , Brammer L , D'Mello T , Danila R , Davis W , de Fijter S , Diorio M , Durand LO , Emery S , Fowler B , Garten R , Grant Y , Greenbaum A , Gubareva L , Havers F , Haupt T , House J , Ibrahim S , Jiang V , Jain S , Jernigan D , Kazmierczak J , Klimov A , Lindstrom S , Longenberger A , Lucas P , Lynfield R , McMorrow M , Moll M , Morin C , Ostroff S , Page SL , Park SY , Peters S , Quinn C , Reed C , Richards S , Scheftel J , Simwale O , Shu B , Soyemi K , Stauffer J , Steffens C , Su S , Torso L , Uyeki TM , Vetter S , Villanueva J , Wong KK , Shaw M , Bresee JS , Cox N , Finelli L . Clin Infect Dis 2013 57 (12) 1703-12 BACKGROUND: Variant influenza virus infections are rare but may have pandemic potential if person-to-person transmission is efficient. We describe the epidemiology of a multistate outbreak of an influenza A(H3N2) variant virus (H3N2v) first identified in 2011. METHODS: We identified laboratory-confirmed cases of H3N2v and used a standard case report form to characterize illness and exposures. We considered illness to result from person-to-person H3N2v transmission if swine contact was not identified within 4 days prior to illness onset. RESULTS: From 9 July to 7 September 2012, we identified 306 cases of H3N2v in 10 states. The median age of all patients was 7 years. Commonly reported signs and symptoms included fever (98%), cough (85%), and fatigue (83%). Sixteen patients (5.2%) were hospitalized, and 1 fatal case was identified. The majority of those infected reported agricultural fair attendance (93%) and/or contact with swine (95%) prior to illness. We identified 15 cases of possible person-to-person transmission of H3N2v. Viruses recovered from patients were 93%-100% identical and similar to viruses recovered from previous cases of H3N2v. All H3N2v viruses examined were susceptible to oseltamivir and zanamivir and resistant to adamantane antiviral medications. CONCLUSIONS: In a large outbreak of variant influenza, the majority of infected persons reported exposures, suggesting that swine contact at an agricultural fair was a risk for H3N2v infection. We identified limited person-to-person H3N2v virus transmission, but found no evidence of efficient or sustained person-to-person transmission. Fair managers and attendees should be aware of the risk of swine-to-human transmission of influenza viruses in these settings. |
Human infections with influenza A(H3N2) variant virus in the United States, 2011-2012
Epperson S , Jhung M , Richards S , Quinlisk P , Ball L , Moll M , Boulton R , Haddy L , Biggerstaff M , Brammer L , Trock S , Burns E , Gomez T , Wong KK , Katz J , Lindstrom S , Klimov A , Bresee JS , Jernigan DB , Cox N , Finelli L . Clin Infect Dis 2013 57 Suppl 1 S4-S11 BACKGROUND: During August 2011-April 2012, 13 human infections with influenza A(H3N2) variant (H3N2v) virus were identified in the United States; 8 occurred in the prior 2 years. This virus differs from previous variant influenza viruses in that it contains the matrix (M) gene from the Influenza A(H1N1)pdm09 pandemic influenza virus. METHODS: A case was defined as a person with laboratory-confirmed H3N2v virus infection. Cases and contacts were interviewed to determine exposure to swine and other animals and to assess potential person-to-person transmission. RESULTS: Median age of cases was 4 years, and 12 of 13 (92%) were children. Pig exposure was identified in 7 (54%) cases. Six of 7 cases with swine exposure (86%) touched pigs, and 1 (14%) was close to pigs without known direct contact. Six cases had no swine exposure, including 2 clusters of suspected person-to-person transmission. All cases had fever; 12 (92%) had respiratory symptoms, and 3 (23%) were hospitalized for influenza. All 13 cases recovered. CONCLUSIONS: H3N2v virus infections were identified at a high rate from August 2011 to April 2012, and cases without swine exposure were identified in influenza-like illness outbreaks, indicating that limited person-to-person transmission likely occurred. Variant influenza viruses rarely result in sustained person-to-person transmission; however, the potential for this H3N2v virus to transmit efficiently is of concern. With minimal preexisting immunity in children and the limited cross-protective effect from seasonal influenza vaccine, the majority of children are susceptible to infection with this novel influenza virus. |
Using routine surveillance data to estimate the epidemic potential of emerging zoonoses: application to the emergence of US swine origin influenza A H3N2v virus
Cauchemez S , Epperson S , Biggerstaff M , Swerdlow D , Finelli L , Ferguson NM . PLoS Med 2013 10 (3) e1001399 BACKGROUND: Prior to emergence in human populations, zoonoses such as SARS cause occasional infections in human populations exposed to reservoir species. The risk of widespread epidemics in humans can be assessed by monitoring the reproduction number R (average number of persons infected by a human case). However, until now, estimating R required detailed outbreak investigations of human clusters, for which resources and expertise are not always available. Additionally, existing methods do not correct for important selection and under-ascertainment biases. Here, we present simple estimation methods that overcome many of these limitations. METHODS AND FINDINGS: Our approach is based on a parsimonious mathematical model of disease transmission and only requires data collected through routine surveillance and standard case investigations. We apply it to assess the transmissibility of swine-origin influenza A H3N2v-M virus in the US, Nipah virus in Malaysia and Bangladesh, and also present a non-zoonotic example (cholera in the Dominican Republic). Estimation is based on two simple summary statistics, the proportion infected by the natural reservoir among detected cases (G) and among the subset of the first detected cases in each cluster (F). If detection of a case does not affect detection of other cases from the same cluster, we find that R can be estimated by 1-G; otherwise R can be estimated by 1-F when the case detection rate is low. In more general cases, bounds on R can still be derived. CONCLUSIONS: We have developed a simple approach with limited data requirements that enables robust assessment of the risks posed by emerging zoonoses. We illustrate this by deriving transmissibility estimates for the H3N2v-M virus, an important step in evaluating the possible pandemic threat posed by this virus. Please see later in the article for the Editors' Summary. |
Outbreak of influenza A (H3N2) variant virus infection among attendees of an agricultural fair, Pennsylvania, USA, 2011
Wong KK , Greenbaum A , Moll ME , Lando J , Moore EL , Ganatra R , Biggerstaff M , Lam E , Smith EE , Storms AD , Miller JR , Dato V , Nalluswami K , Nambiar A , Silvestri SA , Lute JR , Ostroff S , Hancock K , Branch A , Trock SC , Klimov A , Shu B , Brammer L , Epperson S , Finelli L , Jhung MA . Emerg Infect Dis 2012 18 (12) 1937-44 During August 2011, influenza A (H3N2) variant [A(H3N2)v] virus infection developed in a child who attended an agricultural fair in Pennsylvania, USA; the virus resulted from reassortment of a swine influenza virus with influenza A(H1N1)pdm09. We interviewed fair attendees and conducted a retrospective cohort study among members of an agricultural club who attended the fair. Probable and confirmed cases of A(H3N2)v virus infection were defined by serology and genomic sequencing results, respectively. We identified 82 suspected, 4 probable, and 3 confirmed case-patients who attended the fair. Among 127 cohort study members, the risk for suspected case status increased as swine exposure increased from none (4%; referent) to visiting swine exhibits (8%; relative risk 2.1; 95% CI 0.2-53.4) to touching swine (16%; relative risk 4.4; 95% CI 0.8-116.3). Fairs may be venues for zoonotic transmission of viruses with epidemic potential; thus, health officials should investigate respiratory illness outbreaks associated with agricultural events. |
Expanding the recommendations for annual influenza vaccination to school-age children in the United States
Fiore AE , Epperson S , Perrotta D , Bernstein H , Neuzil K . Pediatrics 2012 129 Suppl 2 S54-62 BACKGROUND: Despite long-standing recommendations to vaccinate children who have underlying chronic medical conditions or who are contacts of high-risk persons, vaccination coverage among school-age children remains low. Community studies have indicated that school-age children have the highest incidence of influenza and are an important source of amplifying and sustaining community transmission that affects all age groups. METHODS: A consultation to discuss the advantages and disadvantages of a universal recommendation for annual influenza vaccination of all children age ≥6 months was held in Atlanta, Georgia, in September 2007. Consultants provided summaries of current data on vaccine effectiveness, safety, supply, successful program implementation, and economics studies and discussed challenges associated with continuing a risk- and contact-based vaccination strategy compared with a universal vaccination recommendation. RESULTS: Consultants noted that school-age children had a substantial illness burden caused by influenza, that vaccine was safe and effective for children aged 6 months through 18 years, and that evidence suggested that vaccinating school-age children would provide benefits to both the vaccinated children and their unvaccinated household and community contacts. However, implementation of an annual recommendation for all school-age children would pose major challenges to parents, medical providers and health care systems. Alternative vaccination venues were needed, and of these school-located vaccination programs might offer the most promise as an alternative vaccination site for school-age children. CONCLUSIONS: Expansion of recommendations to include all school-age children will require additional development of an infrastructure to support implementation and methods to adequately evaluate impact. |
Influenza viruses in Thailand: 7 years of sentinel surveillance data, 2004-2010
Chittaganpitch M , Supawat K , Olsen SJ , Waicharoen S , Patthamadilok S , Yingyong T , Brammer L , Epperson SP , Akrasewi P , Sawanpanyalert P . Influenza Other Respir Viruses 2011 6 (4) 276-83 BACKGROUND: The re-emergence of avian influenza A (H5N1) in 2004 and the pandemic of influenza A (H1N1) in 2009 highlight the need for routine surveillance systems to monitor influenza viruses, particularly in Southeast Asia where H5N1 is endemic in poultry. In 2004, the Thai National Institute of Health, in collaboration with the US Centers for Disease Control and Prevention, established influenza sentinel surveillance throughout Thailand. OBJECTIVES: To review routine epidemiologic and virologic surveillance for influenza viruses for public health action. METHODS: Throat swabs from persons with influenza-like illness and severe acute respiratory illness were collected at 11 sentinel sites during 2004-2010. Influenza viruses were identified using the standard protocol for polymerase chain reaction. Viruses were cultured and identified by immunofluorescence assay; strains were identified by hemagglutination inhibition assay. Data were analyzed to describe frequency, seasonality, and distribution of circulating strains. RESULTS: Of the 19,457 throat swabs, 3967 (20%) were positive for influenza viruses: 2663 (67%) were influenza A and able to be subtyped [21% H1N1, 25% H3N2, 21% pandemic (pdm) H1N1] and 1304 (33%) were influenza B. During 2009-2010, the surveillance system detected three waves of pdm H1N1. Influenza annually presents two peaks, a major peak during the rainy season (June-August) and a minor peak in winter (October-February). CONCLUSIONS: These data suggest that March-April may be the most appropriate months for seasonal influenza vaccination in Thailand. This system provides a robust profile of the epidemiology of influenza viruses in Thailand and has proven useful for public health planning. |
Surveillance for influenza during the 2009 influenza A (H1N1) pandemic-United States, April 2009-March 2010
Brammer L , Blanton L , Epperson S , Mustaquim D , Bishop A , Kniss K , Dhara R , Nowell M , Kamimoto L , Finelli L . Clin Infect Dis 2011 52 S27-S35 The emergence in April 2009 and subsequent spread of the 2009 pandemic influenza A (H1N1) virus resulted in the first pandemic of the 21st century. This historic event was associated with unusual patterns of influenza activity in terms of the timing and persons affected in the United States throughout the summer and fall months of 2009 and the winter of 2010. The US Influenza Surveillance System identified 2 distinct waves of pandemic influenza H1N1 activity - the first peaking in June 2009, followed by a second peak in October 2009. All influenza surveillance components showed levels of influenza activity above that typically seen during late summer and early fall. During this period, influenza activity reached its highest level during the week ending 24 October 2009. This report summarizes US influenza surveillance data from 12 April 2009 through 27 March 2010. |
Effects of adverse events on the projected population benefits and cost-effectiveness of using live attenuated influenza vaccine in children aged 6 months to 4 years
Prosser LA , Meltzer MI , Fiore A , Epperson S , Bridges CB , Hinrichsen V , Lieu TA . Arch Pediatr Adolesc Med 2010 165 (2) 112-8 OBJECTIVE: To evaluate the effect of adverse events associated with live attenuated influenza vaccine (LAIV) in children younger than 5 years on the cost-effectiveness of influenza vaccination. DESIGN: A decision analytic model was developed to predict costs and health effects of no vaccination, vaccination with LAIV, and vaccination with inactivated influenza vaccine (IIV). Probabilities, costs, and quality adjustments for uncomplicated influenza, outpatient visits, hospitalizations, deaths, vaccination, and vaccine adverse events were based on primary and published data. The analysis included the possible increased incidence of adverse events following vaccination with LAIV for children younger than 5 years, including fever, wheezing, and hospitalization. A societal perspective was used. Sensitivity analyses, including probabilistic sensitivity analysis, were conducted. SETTING: Vaccination in the physician office setting in the United States. PARTICIPANTS: Hypothetical cohorts of healthy children aged 6 months to 4 years. INTERVENTION: Vaccination with LAIV or IIV. MAIN OUTCOME MEASURE: Incremental cost-effectiveness ratio in dollars per quality-adjusted life-year (QALY). RESULTS: Cost-effectiveness ratios ranged from $20,000/QALY (age 6-23 months) to $33,000/QALY (age 3-4 years) for LAIV and from $21,000/QALY to $37,000/QALY for IIV for healthy children aged 6 months to 4 years. Inclusion of possible new adverse events for LAIV had varying effects on cost-effectiveness results. Results were not sensitive to the inclusion of wheezing as an adverse event but were sensitive to a possible increase in the probability of hospitalization. CONCLUSION: Live attenuated influenza vaccine had comparable cost-effectiveness compared with IIV for children younger than 5 years under a wide range of assumptions about the incidence of adverse events. |
Episodic illness, chronic disease, and health care use among homeless persons in metropolitan Atlanta, Georgia, 2007
Wiersma P , Epperson S , Terp S , Lacourse S , Finton B , Drenzek C , Arnold K , Finelli L . South Med J 2009 103 (1) 18-24 BACKGROUND: Homeless persons are at higher risk for morbidity and mortality from both chronic and episodic illness than the general population. Few data are available on the prevalence of these conditions and uptake of vaccination for prevention. METHODS: In March 2007, we administered a cross-sectional survey to a convenience sample of homeless persons in Atlanta. RESULTS: Approximately half (46.2%) of the survey participants reported at least one chronic medical condition. Acute respiratory symptoms within the previous 30 days were reported by up to 57.7% of survey participants. Receipt of influenza vaccination was reported by 31.9% of survey participants, receipt of pneumococcal vaccine by 18.7%. Vaccination rates varied by age and risk group. DISCUSSION: The survey demonstrated high rates of morbidity in this population. Influenza and pneumococcal vaccination rates were suboptimal. Culturally appropriate interventions must be developed to prevent respiratory and other diseases in this important group. |
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