Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-17 (of 17 Records) |
Query Trace: Ertl A[original query] |
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Cross-sectional survey of SARS-CoV-2 testing at US airports and one health department's proactive management of travelers.
Shaum A , Figueroa A , Lee D , Ertl A , Rothney E , Borntrager D , Davenport E , Gulati RK , Brown CM . Trop Dis Travel Med Vaccines 2022 8 (1) 8 BACKGROUND: Many health departments and private enterprises began offering SARS-CoV-2 testing to travelers at US airports in 2020. Persons with positive SARS-CoV-2 test results who have planned upcoming travel may be subject to US federal public health travel restrictions. We assessed availability of testing for SARS-CoV-2 at major US airports. We then describe the management of cases and close contacts at Denver International Airport's testing site. METHODS: We selected 100 US airports. Online surveys were conducted during November-December 2020 and assessed availability of testing for air travelers, flight crew, and airport employees. Respondents included health department (HD) staff or airport directors. We analyzed testing data and management practices for persons who tested positive and their close contacts at one airport (Denver International) from 12/21/2020 to 3/31/2021. RESULTS: Among the 100 selected airports, we received information on 77 airports; 38 (49%) had a testing site and several more planned to offer one (N=7; 9%). Most sites began testing in the fall of 2020. The most frequently offered tests were RT-PCR or other NAAT tests (N=28). Denver International Airport offered voluntary SARS-CoV-2 testing. Fifty-four people had positive results among 5724 tests conducted from 12/21/2020 to 3/31/2021 for a total positivity of <1%. Of these, 15 were travelers with imminent flights. The Denver HD issued an order requiring the testing site to immediately report cases and notify airlines to cancel upcoming flight itineraries for infected travelers and their traveling close contacts, minimizing the use of federal travel restrictions. CONCLUSIONS: As of December 2020, nearly half of surveyed US airports had SARS-CoV-2 testing sites. Such large-scale adoption of airport testing for a communicable disease is unprecedented and presents new challenges for travelers, airlines, airports, and public health authorities. This assessment was completed before the US and other countries began enforcing entry testing requirements; testing at airports will likely increase as travel demand returns and test requirements for travel evolve. Lessons from Denver demonstrate how HDs can play a key role in engaging airport testing sites to ensure people who test positive for SARS-CoV-2 immediately before travel do not travel on commercial aircraft. |
HIV care outcomes in relation to racial redlining and structural factors affecting medical care access among black and white persons with diagnosed HIV-United States, 2017
Logan J , Crepaz N , Luo F , Dong X , Gant Z , Ertl A , Girod C , Patel N , Jin C , Balaji A , Sweeney P . AIDS Behav 2022 26 (9) 2941-2953 Black/African American (Black) versus White persons are unequally burdened by human immunodeficiency virus (HIV) in the United States. Structural factors can influence social determinants of health, key components in reducing HIV-related health inequality by race. This analysis examined HIV care outcomes among Black and White persons with diagnosed HIV (PWDH) in relation to three structural factors: racial redlining, Medicaid expansion, and Ryan White HIV/AIDS Program (RWHAP) use. Using National HIV Surveillance System, U.S. Census, and Home Mortgage Disclosure Act data, we examined linkage to HIV care and viral suppression (i.e., viral load < 200 copies/mL) in relation to the structural factors among 12,996 Black and White PWDH with HIV diagnosed in 2017/alive at year-end 2018, aged ≥ 18 years, and residing in 38 U.S. jurisdictions with complete laboratory data, geocoding, and census tract-level redlining indexes. Compared to White PWDH, a lower proportion of Black PWDH were linked to HIV care within 1 month after diagnosis and were virally suppressed in 2018. Redlining was not associated with the HIV care outcomes. A higher prevalence of PWDH residing (v. not residing) in states with Medicaid expansion were linked to HIV care ≤ 1 month after diagnosis. A higher prevalence of those residing (v. not residing) in states with > 50% of PWDH in RWHAP had viral suppression. Direct exposure to redlining was not associated with poor HIV care outcomes. Structural factors that reduce the financial burden of HIV care and improve care access like Medicaid expansion and RWHAP might improve HIV care outcomes of PWDH. |
Circumstances associated with suicides among females-16 states, United States, 2005-2016
Crosby AE , Ertl A , Lyons BH , Ivey-Stephenson AZ , Jack SPD . Med Care 2021 59 S92-s99 BACKGROUND: Suicide rates in the United States have been consistently increasing since 2005 and increasing faster among females than among males. Understanding circumstances related to the changes in suicide may help inform prevention programs. This study describes the circumstances associated with suicides among females in the United States using the National Violent Death Reporting System. METHODS: We analyzed the circumstances of suicides occurring from 2005 to 2016 in 16 states (Alaska, Colorado, Georgia, Kentucky, Maryland, Massachusetts, New Jersey, New Mexico, North Carolina, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Virginia, and Wisconsin) among females aged 10 years and above. We compared the percentages of circumstances reported for the entire sample, by age group, and by race/ethnicity. Trends in changes in the leading circumstances were analyzed using Joinpoint regression. RESULTS: From 2005 to 2016, there were 27,809 suicides among females 10 years and older in the 16 states. Overall, the 2 leading precipitating circumstances were current mental health problem and ever treated for mental health problem. The leading circumstances differed by demographics. Joinpoint analysis showed inflection points in reports of job problems, financial problems, and non-intimate partner relationship problems during 2005-2009. During 2010-2016, downward inflections were seen in reports of job problems and financial problems and upward inflections in substance abuse problems and a recent or impending crisis. CONCLUSIONS: These findings show changes by age group and race/ethnicity in the circumstances associated with suicides among females in the 16 states have occurred. Studying these shifts and identifying the most salient circumstances among female suicide decedents may help prevention programs adapt to different needs. |
Surveillance for violent deaths - National Violent Death Reporting System, 34 states, four California counties, the District of Columbia, and Puerto Rico, 2017
Petrosky E , Ertl A , Sheats KJ , Wilson R , Betz CJ , Blair JM . MMWR Surveill Summ 2020 69 (8) 1-37 PROBLEM/CONDITION: In 2017, approximately 67,000 persons died of violence-related injuries in the United States. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) on violent deaths that occurred in 34 states, four California counties, the District of Columbia, and Puerto Rico in 2017. Results are reported by sex, age group, race/ethnicity, method of injury, type of location where the injury occurred, circumstances of injury, and other selected characteristics. PERIOD COVERED: 2017. DESCRIPTION OF SYSTEM: NVDRS collects data regarding violent deaths obtained from death certificates, coroner and medical examiner reports, and law enforcement reports. This report includes data collected for violent deaths that occurred in 2017. Data were collected from 34 states (Alaska, Arizona, Colorado, Connecticut, Delaware, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Utah, Vermont, Virginia, Washington, West Virginia, and Wisconsin), four California counties (Los Angeles, Sacramento, Shasta, and Siskiyou), the District of Columbia, and Puerto Rico. NVDRS collates information for each death and links deaths that are related (e.g., multiple homicides, homicide followed by suicide, or multiple suicides) into a single incident. RESULTS: For 2017, NVDRS collected information on 45,141 fatal incidents involving 46,389 deaths that occurred in 34 states, four California counties, and the District of Columbia; in addition, information was collected on 961 fatal incidents involving 1,027 deaths in Puerto Rico. Data for Puerto Rico were analyzed separately. Of the 46,389 deaths in the 34 states, four California counties, and District of Columbia, the majority (63.5%) were suicides, followed by homicides (24.9%), deaths of undetermined intent (9.7%), legal intervention deaths (1.4%) (i.e., deaths caused by law enforcement and other persons with legal authority to use deadly force acting in the line of duty, excluding legal executions), and unintentional firearm deaths (<1.0%). (The term "legal intervention" is a classification incorporated into the International Classification of Diseases, Tenth Revision, and does not denote the lawfulness or legality of the circumstances surrounding a death caused by law enforcement.) Demographic patterns and circumstances varied by manner of death. The suicide rate was higher among males than among females and was highest among adults aged 45-64 years and ≥85 years and non-Hispanic American Indians/Alaska Natives and non-Hispanic Whites. The most common method of injury for suicide was a firearm among males and poisoning among females. Suicide was most often preceded by a mental health, intimate partner, or physical health problem or a recent or impending crisis during the previous or upcoming 2 weeks. The homicide rate was highest among persons aged 20-24 years and was higher among males than females. Non-Hispanic Black males had the highest homicide rate of any racial/ethnic group. The most common method of injury for homicide was a firearm. When the relationship between a homicide victim and a suspect was known, the suspect was most frequently an acquaintance or friend for male victims and a current or former intimate partner for female victims. Homicide most often was precipitated by an argument or conflict, occurred in conjunction with another crime, or, for female victims, was related to intimate partner violence. Among intimate partner violence-related homicides, the largest proportion occurred among adults aged 35-54 years, and the most common method of injury was a firearm. When the relationship between an intimate partner violence-related homicide victim and a suspect was known, most female victims were killed by a current or former intimate partner, whereas approximately half of male victims were killed by a suspect who was not their intimate partner. Almost all legal intervention deaths were among males, and the legal intervention death rate was highest among men aged 25-29 years. Non-Hispanic American Indian/Alaska Native males had the highest legal intervention death rate, followed by non-Hispanic Black males. A firearm was used in the majority of legal intervention deaths. When a specific type of crime was known to have precipitated a legal intervention death, the type of crime was most frequently assault/homicide. The most frequent circumstances for legal intervention deaths were reported use of a weapon by the victim in the incident and a mental health or substance use problem (other than alcohol use). Unintentional firearm deaths more frequently occurred among males, non-Hispanic Whites, and persons aged 15-24 years. These deaths most often occurred while the shooter was playing with a firearm and most frequently were precipitated by a person unintentionally pulling the trigger or mistakenly thinking the firearm was unloaded. The rate of death when the manner was of undetermined intent was highest among males, particularly among non-Hispanic Black and non-Hispanic American Indian/Alaska Native males, and persons aged 30-34 years. Poisoning was the most common method of injury in deaths of undetermined intent, and opioids were detected in nearly 80% of decedents tested for those substances. INTERPRETATION: This report provides a detailed summary of data from NVDRS on violent deaths that occurred in 2017. The suicide rate was highest among non-Hispanic American Indian/Alaska Native and non-Hispanic White males, whereas the homicide rate was highest among non-Hispanic Black males. Intimate partner violence precipitated a large proportion of homicides for females. Mental health problems, intimate partner problems, interpersonal conflicts, and acute life stressors were primary circumstances for multiple types of violent death. PUBLIC HEALTH ACTION: NVDRS data are used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in developing, implementing, and evaluating programs and policies to reduce and prevent violent deaths. For example, South Carolina VDRS and Colorado VDRS are using their data to support suicide prevention programs through systems change and the Zero Suicide framework. North Carolina VDRS and Kentucky VDRS data were used to examine intimate partner violence-related deaths beyond homicides to inform prevention efforts. Findings from these studies suggest that intimate partner violence might also contribute to other manners of violent death, such as suicide, and preventing intimate partner violence might reduce the overall number of violent deaths. In 2019, NVDRS expanded data collection to include all 50 states, the District of Columbia, and Puerto Rico, providing more comprehensive and actionable violent death information for public health efforts to reduce violent deaths. |
Youth suicide: An opportunity for prevention
Ertl A , Crosby AE , Blair JM . J Am Acad Child Adolesc Psychiatry 2020 59 (9) 1019-1021 In the United States, youth suicide is a large and growing public health problem that contributes to health care costs, lost productivity, morbidity, and premature death. In 2017, an estimated 199,877 youths aged 10 to 24 years were treated in emergency departments in the United States for self-harm,(1) and 7.4% of high school students reported that they attempted suicide one or more times in the past year.(2) Suicide was the second leading cause of death among youths aged 10 to 24 years in 2017,(1) and the suicide rate increased significantly for both male and female youths from 1999 to 2017.(3). |
Shared correlates of prescription drug misuse and severe suicide ideation among clinical patients at risk for suicide
Logan JE , Ertl AM , Rostad WL , Herbst JH , Ashby Plant E . Suicide Life Threat Behav 2020 50 (6) 1276-1287 OBJECTIVE: Unintentional drug overdose and suicide have emerged as public health problems. Prescription drug misuse can elevate risk of overdose. Severe suicidal ideation increases risk of suicide. We identified shared correlates of both risk factors to inform cross-cutting prevention efforts. METHODS: We conducted a cross-sectional study using the Military Suicide Research Consortium's Common Data Elements survey; 2012-2017 baseline data collected from 10 research sites were analyzed. The sample included 3962 clinical patients at risk of suicide. Factors examined in relation to the outcomes, prescription drug misuse and severe suicidal ideation, included demographic characteristics and symptoms of: hopelessness; anxiety; post-traumatic stress disorder; alcohol use; other substance use; prior head/neck injury; insomnia; and belongingness. Poisson regression models with robust estimates provided adjusted prevalence ratios (aPRs) and 97.5% confidence intervals (CIs). RESULTS: Medium and high (vs. low) levels of insomnia were positively associated with prescription drug misuse (aPRs p < 0.025). Medium (vs. low) level of insomnia was positively associated with severe suicidal ideation (aPR: 1.09; CI: 1.01-1.18). Medium and high (vs. low) levels of perceived belongingness were inversely associated with both outcomes (aPRs p < 0.025). CONCLUSIONS: Research should evaluate whether addressing sleep problems and improving belongingness can reduce prescription drug misuse and suicidal ideation simultaneously. |
Suicides among incarcerated persons in 18 U.S. states: Findings From the National Violent Death Reporting System, 2003-2014
Dixon KJ , Ertl AM , Leavitt RA , Sheats KJ , Fowler KA , Jack SPD . J Correct Health Care 2020 26 (3) 279-291 Using data from the National Violent Death Reporting System (2003-2014), this study examined the characteristics and contributing circumstances of suicides in correctional facilities. χ(2) and logistic regression analyses revealed that, compared to nonincarcerated suicide decedents, incarcerated suicide decedents had significantly lower odds of positive toxicology for substances but significantly higher odds of substance abuse problems. Descriptive subanalyses indicated that incarcerated suicide decedents often were incarcerated for personal crimes. They often died ≤ 1 week of incarceration, in a cell (frequently single-person or segregation), by hanging, using bedding material. Positive toxicology was more common for incarcerated decedents who died shortly after versus later in their incarceration. Findings highlight the need for enhanced detection and treatment of suicidal behavior, especially during early and vulnerable periods of incarceration. |
Towards rabies elimination in the Asia-Pacific region: From theory to practice
Rupprecht CE , Abela-Ridder B , Abila R , Amparo AC , Banyard A , Blanton J , Chanachai K , Dallmeier K , de Balogh K , Del Rio Vilas V , Ertl H , Freuling C , Hill R , Houillon G , Jakava-Viljanen M , Kasemsuwan S , Lechenet J , Nel L , Panichabhongse P , Rahman SA , Tantawichien T , Vandeputte J , Viriyabancha W , Vos A , Wallace R , Yale G , Yurachai O , Mueller T . Biologicals 2020 64 83-95 Rabies is a major neglected zoonotic disease and causes a substantial burden in the Asian region. Currently, Pacific Oceania is free of rabies but enzootic areas throughout southeast Asia represent a major risk of disease introduction to this region. On September 25-26, 2019, researchers, government officials and related stakeholders met at an IABS conference in Bangkok, Thailand to engage on the topic of human rabies mediated by dogs. The objective of the meeting was focused upon snowballing efforts towards achieving substantial progress in rabies prevention, control and elimination within Asia by 2030, and thereby to safeguard the Pacific region. Individual sessions focused upon domestic animal, wildlife and human vaccination; the production and evaluation of quality, safety and efficacy of existing rabies biologics; and the future development of new products. Participants reviewed the progress to date in eliminating canine rabies by mass vaccination, described supportive methods to parenteral administration by oral vaccine application, considered updated global and local approaches at human prophylaxis and discussed the considerable challenges ahead. Such opportunities provide continuous engagement on disease management among professionals at a trans-disciplinary level and promote new applied research collaborations in a modern One Health context. |
Surveillance for violent deaths - National Violent Death Reporting System, 32 States, 2016
Ertl A , Sheats KJ , Petrosky E , Betz CJ , Yuan K , Fowler KA . MMWR Surveill Summ 2019 68 (9) 1-36 PROBLEM/CONDITION: In 2016, approximately 65,000 persons died in the United States as a result of violence-related injuries. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) regarding violent deaths from 32 U.S. states for 2016. Results are reported by sex, age group, race/ethnicity, type of location where injured, method of injury, circumstances of injury, and other selected characteristics. PERIOD COVERED: 2016. DESCRIPTION OF SYSTEM: NVDRS collects data regarding violent deaths obtained from death certificates, coroner/medical examiner reports, law enforcement reports, and secondary sources (e.g., child fatality review team data, Supplementary Homicide Reports, hospital data, and crime laboratory data). This report includes data collected from 32 states for 2016 (Alaska, Arizona, Colorado, Connecticut, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Utah, Vermont, Virginia, Washington, and Wisconsin). NVDRS collates information for each death and links deaths that are related (e.g., multiple homicides, homicide followed by suicide, or multiple suicides) into a single incident. RESULTS: For 2016, NVDRS captured 40,374 fatal incidents involving 41,466 deaths in the 32 states included in this report. The majority (62.3%) of deaths were suicides, followed by homicides (24.9%), deaths of undetermined intent (10.8%), legal intervention deaths (1.2%) (i.e., deaths caused by law enforcement and other persons with legal authority to use deadly force acting in the line of duty, excluding legal executions), and unintentional firearm deaths (<1.0%). (The term legal intervention is a classification incorporated into the International Classification of Diseases, Tenth Revision [ICD-10] and does not denote the lawfulness or legality of the circumstances surrounding a death caused by law enforcement.) Demographic patterns varied by manner of death. Suicide rates were highest among males, non-Hispanic American Indians/Alaska Natives, non-Hispanic whites, adults aged 45-64 years, and men aged >/=75 years. The most common method of injury was a firearm among males and poisoning among females. Suicides were most often preceded by a mental health, intimate partner, substance abuse, or physical health problem or a recent or impending crisis during the previous or upcoming 2 weeks. Homicide rates were highest among males and persons aged <1 year and 15-44 years. Among males, non-Hispanic blacks accounted for most homicides and had the highest rate of any racial/ethnic group. The most common method of injury was a firearm. Homicides were most often precipitated by an argument or conflict, occurred in conjunction with another crime, or for females, were related to intimate partner violence. When the relationship between a homicide victim and a suspected perpetrator was known, the suspect was most frequently an acquaintance/friend among males and a current or former intimate partner among females. Legal intervention death rates were highest among men aged 20-44 years, and the rate among non-Hispanic black males was three times the rate among non-Hispanic white males. Precipitating circumstances for legal intervention deaths most frequently were an alleged criminal activity in progress, reported use of a weapon by the victim in the incident, a mental health or substance abuse problem (other than alcohol abuse), an argument or conflict, or a recent or impending crisis. Unintentional firearm deaths were more frequent among males, non-Hispanic whites, and persons aged 15-24 years. These deaths most often occurred while the shooter was playing with a firearm and most often were precipitated by a person unintentionally pulling the trigger or mistakenly thinking the firearm was unloaded. Rates of deaths of undetermined intent were highest among males, particularly non-Hispanic black and American Indian/Alaska Native males, and adults aged 25-64 years. Substance abuse, mental health problems, physical health problems, and a recent or impending crisis were the most common circumstances preceding deaths of undetermined intent. In 2016, a total of 3,655 youths aged 10-24 years died by suicide. The majority of these decedents were male, non-Hispanic white, and aged 18-24 years. Most decedents aged 10-17 years died by hanging/strangulation/suffocation (49.3%), followed by a firearm (40.4%), and suicides among this age group were most often precipitated by mental health, family relationship, and school problems. Most suicides among decedents aged 18-24 years were by a firearm (46.2%), followed by hanging/strangulation/suffocation (37.4%), and were precipitated by mental health, substance abuse, intimate partner, and family problems. A recent crisis, an argument or conflict, or both were common precipitating circumstances among all youth suicide decedents. INTERPRETATION: This report provides a detailed summary of data from NVDRS for 2016. Suicides rates were highest among non-Hispanic American Indian/Alaska Native and white males, whereas homicide rates were highest among non-Hispanic black males. Mental health problems, intimate partner problems, interpersonal conflicts, and acute life stressors were primary precipitating events for multiple types of violent deaths, including suicides among youths aged 10-24 years. PUBLIC HEALTH ACTION: NVDRS data are used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in the development, implementation, and evaluation of programs and policies to reduce and prevent violent deaths. For example, Utah VDRS data were used to help identify suicide risk factors among youths aged 10-17 years, Rhode Island VDRS suicide data were analyzed to identify precipitating circumstances of youth suicides over a 10-year period, and Kansas VDRS data were used by the Kansas Youth Suicide Prevention Task Force. In 2019, NVDRS expanded data collection to include all 50 states, Puerto Rico, and the District of Columbia. This expansion is essential to public health efforts to reduce violent deaths. |
Correlates of intimate partner homicide among male suicide decedents with known intimate partner problems
Logan JE , Ertl A , Bossarte R . Suicide Life Threat Behav 2019 49 (6) 1693-1706 OBJECTIVE: Intimate partner (IP) problems are risk factors for suicide among men. However, there is little understanding of why some male suicide decedents who had such problems killed their partners before death (i.e., "IP homicide-suicide"), while most of these decedents did not. To inform prevention efforts, this study identified correlates of IP homicide among male suicide decedents with known IP problems. METHODS: We examined IP homicide correlates among male suicide decedents aged 18+ years who had known IP problems using 2003-2015 National Violent Death Reporting System data. Prevalence odds ratios and 95% confidence intervals were estimated for demographic, incident, and circumstance variables. IP homicide-suicide narratives were examined to identify additional prevention opportunities. RESULTS: An estimated 1,504 (5.0%) of 30,259 male suicide decedents who had IP problems killed their partner. IP homicide-suicide perpetration was positively correlated with suicide by firearm and precipitating civil legal problems but negatively correlated with mental health/substance abuse treatment. An estimated 33.7% of IP homicide-suicides occurred during a breakup; 21.9% of IP homicide-suicide perpetrators had domestic violence histories. CONCLUSIONS: Connections between the criminal justice and mental health systems as well as stronger enforcement of laws prohibiting firearm possession among domestic violence offenders may prevent IP homicide-suicides. |
Nonfatal assaults and homicides among adults aged 60 years - United States, 2002-2016
Logan JE , Haileyesus T , Ertl A , Rostad WL , Herbst JH . MMWR Morb Mortal Wkly Rep 2019 68 (13) 297-302 Since interpersonal violence was recognized as a public health problem in the 1970s, much attention has focused on preventing violence among young persons and intimate partners (1). Violence directed against older adults (>/=60 years) has received less attention, despite the faster growth of this population than that of younger groups (2). Using data from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) and the National Vital Statistics System (NVSS), CDC analyzed rates of nonfatal assaults and homicides against older adults during 2002-2016. Across the 15-year period, the nonfatal assault rate increased 75.4% (from 77.7 to 136.3 per 100,000) among men, and from 2007 to 2016, increased 35.4% (from 43.8 to 59.3) among women. From 2010 to 2016, the homicide rate increased among men by 7.1%, and a 19.3% increase was observed from 2013 to 2016 among men aged 60-69 years. Growth in both the older adult population and the rates of violence against this group, especially among men, suggests an important need for violence prevention strategies (3). Focusing prevention efforts for this population will require improved understanding of magnitude and trends in violence against older adults. |
Surveillance for violent deaths - National Violent Death Reporting System, 27 states, 2015
Jack SPD , Petrosky E , Lyons BH , Blair JM , Ertl AM , Sheats KJ , Betz CJ . MMWR Surveill Summ 2018 67 (11) 1-32 PROBLEM/CONDITION: In 2015, approximately 62,000 persons died in the United States as a result of violence-related injuries. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) regarding violent deaths from 27 U.S. states for 2015. Results are reported by sex, age group, race/ethnicity, location of injury, method of injury, circumstances of injury, and other selected characteristics. REPORTING PERIOD: 2015. DESCRIPTION OF SYSTEM: NVDRS collects data regarding violent deaths obtained from death certificates, coroner/medical examiner reports, law enforcement reports, and secondary sources (e.g., child fatality review team data, supplemental homicide reports, hospital data, and crime laboratory data). This report includes data from 27 states that collected statewide data for 2015 (Alaska, Arizona, Colorado, Connecticut, Georgia, Hawaii, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Vermont, Virginia, and Wisconsin). NVDRS collates documents for each death and links deaths that are related (e.g., multiple homicides, a homicide followed by a suicide, or multiple suicides) into a single incident. RESULTS: For 2015, NVDRS captured 30,628 fatal incidents involving 31,415 deaths in the 27 states included in this report. The majority (65.1%) of deaths were suicides, followed by homicides (23.5%), deaths of undetermined intent (9.5%), legal intervention deaths (1.3%) (i.e., deaths caused by law enforcement and other persons with legal authority to use deadly force, excluding legal executions), and unintentional firearm deaths (<1.0%). (The term "legal intervention" is a classification incorporated into the International Classification of Diseases, Tenth Revision [ICD-10] and does not denote the lawfulness or legality of the circumstances surrounding a death caused by law enforcement.) Demographic patterns varied by manner of death. Suicide rates were highest among males, non-Hispanic American Indian/Alaska Natives, non-Hispanic whites, adults aged 45-54 years, and men aged >/=75 years. The most common method of injury was a firearm. Suicides often were preceded by a mental health, intimate partner, substance abuse, or physical health problem, or a crisis during the previous or upcoming 2 weeks. Homicide rates were higher among males and persons aged <1 year and 20-34 years. Among males, non-Hispanic blacks accounted for the majority of homicides and had the highest rate of any racial/ethnic group. Homicides primarily involved a firearm, were precipitated by arguments and interpersonal conflicts, were related to intimate partner violence (particularly for females), or occurred in conjunction with another crime. When the relationship between a homicide victim and a suspected perpetrator was known, an acquaintance/friend or an intimate partner frequently was involved. Legal intervention death rates were highest among males and persons aged 20-54 years; rates among non-Hispanic black males were approximately double the rates of those among non-Hispanic white males. Precipitating circumstances for legal intervention deaths most frequently were an alleged criminal activity in progress, the victim reportedly using a weapon in the incident, a mental health or substance abuse problem (other than alcohol abuse), an argument or conflict, or a recent crisis (during the previous or upcoming 2 weeks). Unintentional firearm deaths were more frequent among males, non-Hispanic whites, and persons aged 10-24 years; these deaths most often occurred while the shooter was playing with a firearm and most often were precipitated by a person unintentionally pulling the trigger or mistakenly thinking the firearm was unloaded. Deaths of undetermined intent were more frequent among males, particularly non-Hispanic black and American Indian/Alaska Native males, and persons aged 30-54 years. Substance abuse, mental health problems, physical health problems, and a recent crisis were the most common circumstances preceding deaths of undetermined intent. In 2015, approximately 3,000 current or former military personnel died by suicide. The majority of these decedents were male, non-Hispanic white, and aged 45-74 years. Most suicides among military personnel involved a firearm and were precipitated by mental health, physical health, and intimate partner problems, as well as a recent crisis. INTERPRETATION: This report provides a detailed summary of data from NVDRS for 2015. The results indicate that deaths resulting from self-inflicted or interpersonal violence most frequently affect males and certain age groups and minority populations. Mental health problems, intimate partner problems, interpersonal conflicts, and general life stressors were primary precipitating events for multiple types of violent deaths, including suicides among current or former military personnel. PUBLIC HEALTH ACTION: NVDRS data are used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in the development, implementation, and evaluation of programs and policies to reduce and prevent violent deaths. For example, Virginia VDRS data are used to help identify suicide risk factors among active duty service members, Oregon VDRS suicide data are used to coordinate information and activities across community agencies that support veterans and active duty service members, and Arizona VDRS data are used to develop recommendations for primary care providers who deliver care to veterans. The continued development and expansion of NVDRS to include all 50 states, U.S. territories, and the District of Columbia are essential to public health efforts to reduce deaths due to violence. |
Additional progress in the development and application of a direct, rapid immunohistochemical test for rabies diagnosis
Rupprecht CE , Xiang Z , Servat A , Franka R , Kirby J , Ertl HCJ . Vet Sci 2018 5 (2) Laboratory-based surveillance is fundamental to effective rabies prevention and control. The direct fluorescent antibody (AB) test (FAT) is the gold standard for rabies diagnosis. Recently, additional tests besides the FAT have been developed, such as the direct rapid immunohistochemical test (DRIT). In this study, our objective was to further refine technical aspects of the DRIT using a combination of two monoclonal ABs (MABs), 502 and 802, conduct additional testing among rabies reference laboratories using a diversity of animal species and rabies virus (RV) variants and compare the potential utility of the DRIT for end users via proficiency testing (PT) against the FAT. Considering the ideal molar ratios of biotin to AB in formulation of the DRIT conjugate, 3.9 was found to be superior to 7.4, for detection of RV antigens in the brain of a naturally infected raccoon. Optimization of the DRIT conjugate may also be dependent upon the apparent choice of specific viral antigens for testing, as a gray fox RV variant reacted less strongly than a raccoon RV variant in determining the working dilution of the MAB cocktail. Using the same MABs and protocol, the DRIT was compared to the FAT using more than 800 samples of mammalian brains, representative of more than 25 taxa, including in excess of 250 animal rabies cases from Europe and North America. Sensitivity was determined at 98% (96(-)100%, 95% CI) and specificity was calculated at 95% (92(-)96%, 95% CI). In a comparison among end users, PT of laboratory personnel resulted in values of 77(-)100% sensitivity and 86-100% specificity. Based upon these and previously reported results, the DRIT appears to be a suitable alternative to the FAT for use in lyssavirus diagnosis. |
Suicides among American Indian/Alaska Natives - National Violent Death Reporting System, 18 states, 2003-2014
Leavitt RA , Ertl A , Sheats K , Petrosky E , Ivey-Stephenson A , Fowler KA . MMWR Morb Mortal Wkly Rep 2018 67 (8) 237-242 Suicide disproportionately affects American Indians/Alaska Natives (AI/AN). The suicide rate among AI/AN has been increasing since 2003 (1), and in 2015, AI/AN suicide rates in the 18 states participating in the National Violent Death Reporting System (NVDRS) were 21.5 per 100,000, more than 3.5 times higher than those among racial/ethnic groups with the lowest rates.* To study completed suicides across all ages of AI/AN, NVDRS data collected from 2003 to 2014 were analyzed by comparing differences in suicide characteristics and circumstances between AI/AN and white decedents. Group differences were assessed using chi-squared tests and logistic regression. Across multiple demographics, incident characteristics, and circumstances, AI/AN decedents were significantly different from white decedents. More than one third (35.7%) of AI/AN decedents were aged 10-24 years (versus 11.1% of whites). Compared with whites, AI/AN decedents had 6.6 times the odds of living in a nonmetropolitan area, 2.1 times the odds of a positive alcohol toxicology result, and 2.4 times the odds of a suicide of a friend or family member affecting their death. Suicide prevention efforts should incorporate evidence-based, culturally relevant strategies at individual, interpersonal, and community levels (2) and need to account for the heterogeneity among AI/AN communities (3,4). |
Live animal markets in Minnesota: a potential source for emergence of novel influenza A viruses and interspecies transmission.
Choi MJ , Torremorell M , Bender JB , Smith K , Boxrud D , Ertl JR , Yang M , Suwannakarn K , Her D , Nguyen J , Uyeki TM , Levine M , Lindstrom S , Katz JM , Jhung M , Vetter S , Wong KK , Sreevatsan S , Lynfield R . Clin Infect Dis 2015 61 (9) 1355-62 BACKGROUND: Live animal markets have been implicated in transmission of influenza A viruses (IAVs) from animals to people. We sought to characterize IAVs at two live animal markets in Minnesota to assess potential routes of occupational exposure and risk for interspecies transmission. METHODS: We implemented surveillance for IAVs among employees, swine, and environment (air and surfaces) during a 12-week period (October 2012-January 2013) at two markets epidemiologically associated with persons with swine-origin IAV (variant) infections. Real-time reverse transcription polymerase chain reaction (rRT-PCR), viral culture, and whole genome sequencing were performed on respiratory and environmental specimens, and serology on sera from employees at beginning and end of surveillance. RESULTS: Nasal swabs from 11 (65%) of 17 employees tested positive for IAVs by rRT-PCR; seven employees tested positive on multiple occasions and one employee reported influenza-like illness. Eleven (73%) of 15 employees had baseline hemagglutination-inhibition antibody titers ≥40 to swine-origin IAVs, but only one demonstrated a 4-fold titer increase to both swine-origin, and pandemic A/Mexico/4108/2009 IAVs. IAVs were isolated from swine (72/84), air (30/45) and pen railings (5/21). Whole genome sequencing of 122 IAVs isolated from swine and environmental specimens revealed multiple strains and subtype codetections. Multiple gene segment exchanges among and within subtypes were observed, resulting in new genetic constellations and reassortant viruses. Genetic sequence similarities of 99%-100% among IAVs of one market customer and swine indicated interspecies transmission. CONCLUSIONS: At markets where swine and persons are in close contact, swine-origin IAVs are prevalent and potentially provide conditions for novel IAV emergence. |
Protection of non-human primates against rabies with an adenovirus recombinant vaccine
Xiang ZQ , Greenberg L , Ertl HC , Rupprecht CE . Virology 2014 450-451 243-249 Rabies remains a major neglected global zoonosis. New vaccine strategies are needed for human rabies prophylaxis. A single intramuscular immunization with a moderate dose of an experimental chimpanzee adenovirus (Ad) vector serotype SAd-V24, also termed AdC68, expressing the rabies virus glycoprotein, resulted in sustained titers of rabies virus neutralizing antibodies and protection against a lethal rabies virus challenge infection in a non-human primate model. Taken together, these data demonstrate the safety, immunogenicity, and efficacy of the recombinant Ad-rabies vector for further consideration in human clinical trials. |
Neutralizing antibodies to human and simian adenoviruses in humans and New-World monkeys
Ersching J , Hernandez MI , Cezarotto FS , Ferreira JD , Martins AB , Switzer WM , Xiang Z , Ertl HC , Zanetti CR , Pinto AR . Virology 2010 407 (1) 1-6 Vaccines based on adenovirus (Ad) vectors are currently in development against several pathogens. However, neutralizing antibodies (NAb) to human adenovirus type 5 (AdHu5), the best-studied vector, are highly prevalent in humans worldwide. Less-prevalent adenoviruses, including human and simian serotypes, provide alternative vaccine platforms. In this study, sera from 200 Brazilian human subjects and New-World monkeys were tested for NAb titers to human serotypes AdHu5 and AdHu26 and chimpanzee-origin Ad viruses of serotype 6 (AdC6) and serotype 68 (AdC68). Seroprevalence rates of NAb in humans were 69.5% for AdHu5, 44% for AdHu26, 21% for AdC6 and 23.5% for AdC68. In addition, NAb titers to human Ad were consistently higher than those found to simian serotypes. Surprisingly, sera from some New-World monkey species were able to neutralize AdC6 and/or AdC68. A possible explanation for these findings and the implications for the development of Ad-vector vaccines are discussed in detail. |
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