Last data update: Sep 23, 2024. (Total: 47723 publications since 2009)
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Risk Factors for Ebola Virus Persistence in Semen of Survivors - Liberia.
Dyal J , Kofman A , Kollie JZ , Fankhauser J , Orone R , Soka MJ , Glaybo U , Kiawu A , Freeman E , Giah G , Tony HD , Faikai M , Jawara M , Kamara K , Kamara S , Flowers B , Kromah ML , Desamu-Thorpe R , Graziano J , Brown S , Morales-Betoulle ME , Cannon DL , Su K , Linderman SL , Plucinski M , Rogier E , Bradbury RS , Secor WE , Bowden KE , Phillips C , Carrington MN , Park YH , Martin MP , Del Pilar Aguinaga M , Mushi R , Haberling DL , Ervin ED , Klena JD , Massaquoi M , Nyenswah T , Nichol ST , Chiriboga DE , Williams DE , Hinrichs SH , Ahmed R , Vonhm BT , Rollin PE , Purpura LJ , Choi MJ . Clin Infect Dis 2022 76 (3) e849-e856 BACKGROUND: Long-term persistence of Ebola virus (EBOV) in immunologically-privileged sites has been implicated in recent outbreaks of Ebola Virus Disease (EVD) in Guinea and the Democratic Republic of Congo. This study was designed to understand how the acute course of EVD, convalescence, and host immune and genetic factors may play a role in prolonged viral persistence in semen. METHODS: A cohort of 131 male EVD survivors in Liberia were enrolled in a case-case study. "Early clearers" were defined as those with two consecutive negative EBOV semen tests by real-time reverse transcriptase polymerase chain reaction (rRT-PCR) at least two weeks apart within 1 year after discharge from the Ebola Treatment Unit (ETU) or acute EVD. "Late clearers" had detectable EBOV RNA by rRT-PCR over one year following ETU discharge or acute EVD. Retrospective histories of their EVD clinical course were collected by questionnaire, followed by complete physical exams and blood work. RESULTS: Compared to early clearers, late clearers were older (median 42.5 years, p = 0.0001) and experienced fewer severe clinical symptoms (median 2, p = 0.006). Late clearers had more lens opacifications (OR 3.9, 95%CI 1.1-13.3, p = 0.03), after accounting for age, higher total serum IgG3 titers (p = 0.007) and increased expression of the HLA-C*03:04 allele (OR 0.14, 95% CI 0.02-0.70, p = 0.007). CONCLUSIONS: Older age, decreased illness severity, elevated total serum IgG3 and HLA-C*03:04 allele expression may be risk factors for the persistence of EBOV in the semen of EVD survivors. EBOV persistence in semen may also be associated with its persistence in other immunologically protected sites, such as the eye. |
Antimicrobial susceptibility of urogenital and extragenital neisseria gonorrhoeae isolates among men who have sex with men - SURRG and eGISP, 2018-2019
Quilter LAS , St Cyr SB , Hong J , Asbel L , Bautista I , Carter B , Casimir Y , Denny M , Ervin M , Gomez R , Harvey A , Holderman JL , Johnson K , Kohn RP , Learner ER , Mauk K , Menza T , Mettenbrink C , Nettleton WD , Nicosia KR , Pham CD , Ried C , Schlanger K , Schneider A , Soge OO , Tabidze I , Taylor SN , Tilghman W , Toler C , Weinstock H , Torrone EA . Sex Transm Dis 2021 48 S111-S117 BACKGROUND: We investigated differences in gonococcal antimicrobial susceptibility by anatomic site among cisgender men who have sex with men (MSM) using specimens collected through CDC's enhanced Gonococcal Isolate Surveillance Project (eGISP) and Strengthening the U.S. Response to Resistant Gonorrhea (SURRG). METHODS: During January 1, 2018-December 31, 2019, 12 eGISP and 8 SURRG sites collected urogenital, pharyngeal, and rectal isolates from cisgender MSM in STD clinics. Gonococcal isolates were sent to regional laboratories for antimicrobial susceptibility testing by agar dilution. To account for correlated observations, linear mixed-effects models were used to calculate geometric mean minimum inhibitory concentrations (MICs) and mixed-effects logistic regression models were used to calculate the proportion of isolates with elevated or resistant MICs; comparisons were made across anatomic sites. RESULTS: Participating clinics collected 3,974 urethral, 1,553 rectal, and 1,049 pharyngeal isolates from 5,456 unique cisgender MSM. There were no significant differences in the geometric mean MICs for azithromycin, ciprofloxacin, penicillin, and tetracycline by anatomic site. For cefixime and ceftriaxone, geometric mean MICs for pharyngeal isolates were higher compared to anogenital isolates (p < 0.05). The proportion of isolates with elevated ceftriaxone MICs (≥0.125 μg/ml) at the pharynx (0.67%) was higher than at rectal (0.13%) and urethral (0.18%) sites (p < 0.05). CONCLUSIONS: Based on data collected from multi-jurisdictional sentinel surveillance projects, antimicrobial susceptibility patterns of N. gonorrhoeae isolates may differ among MSM at extragenital sites, particularly at the pharynx. Continued investigation into gonococcal susceptibility patterns by anatomic site may be an important strategy to monitor and detect the emergence of antimicrobial resistant gonorrhea over time. |
Persistence of Ebola virus in semen among Ebola virus disease survivors in Sierra Leone: A cohort study of frequency, duration, and risk factors.
Thorson AE , Deen GF , Bernstein KT , Liu WJ , Yamba F , Habib N , Sesay FR , Gaillard P , Massaquoi TA , McDonald SLR , Zhang Y , Durski KN , Singaravelu S , Ervin E , Liu H , Coursier A , Marrinan JE , Ariyarajah A , Carino M , Formenty P , Ströher U , Lamunu M , Wu G , Sahr F , Xu W , Knust B , Broutet N . PLoS Med 2021 18 (2) e1003273 BACKGROUND: Sexual transmission chains of Ebola virus (EBOV) have been verified and linked to EBOV RNA persistence in semen, post-recovery. The rate of semen persistence over time, including the average duration of persistence among Ebola virus disease (EVD) survivors, is not well known. This cohort study aimed to analyze population estimates of EBOV RNA persistence rates in semen over time, and associated risk factors in a population of survivors from Sierra Leone. METHODS AND FINDINGS: In this cohort study from May 2015 to April 2017 in Sierra Leone, recruitment was conducted in 2 phases; the first enrolled 100 male participants from the Western Area District in the capital of Freetown, and the second enrolled 120 men from the Western Area District and from Lungi, Port Loko District. Mean age of participants was 31 years. The men provided semen for testing, analyzed by quantitative reverse transcription PCR (qRT-PCR) for the presence of EBOV RNA. Follow-up occurred every 2 weeks until the endpoint, defined as 2 consecutive negative qRT-PCR results of semen specimen testing for EBOV RNA. Participants were matched with the Sierra Leone EVD case database to retrieve cycle threshold (Ct) values from the qRT-PCR analysis done in blood during acute disease. A purposive sampling strategy was used, and the included sample composition was compared to the national EVD survivor database to understand deviations from the general male survivor population. At 180 days (6 months) after Ebola treatment unit (ETU) discharge, the EBOV RNA semen positive rate was 75.4% (95% CI 66.9%-82.0%). The median persistence duration was 204 days, with 50% of men having cleared their semen of EBOV RNA after this time. At 270 days, persistence was 26.8% (95% CI 20.0%-34.2%), and at 360 days, 6.0% (95% CI 3.1%-10.2%). Longer persistence was significantly associated with severe acute disease, with probability of persistence in this population at 1 year at 10.1% (95% CI 4.6%-19.8%) compared to the probability approaching 0% for those with mild acute disease. Age showed a dose-response pattern, where the youngest men (≤25 years) were 3.17 (95% CI 1.60, 6.29) times more likely to be EBOV RNA negative in semen, and men aged 26-35 years were 1.85 (95% CI 1.04, 3.28) times more likely to be negative, than men aged >35 years. Among participants with both severe acute EVD and a higher age (>35 years), persistence remained above 20% (95% CI 6.0%-50.6%) at 1 year. Uptake of safe sex recommendations 3 months after ETU discharge was low among a third of survivors. The sample was largely representative of male survivors in Sierra Leone. A limitation of this study is the lack of knowledge about infectiousness. CONCLUSIONS: In this study we observed that EBOV RNA persistence in semen was a frequent phenomenon, with high population rates over time. This finding will inform forthcoming updated recommendations on risk reduction strategies relating to sexual transmission of EBOV. Our findings support implementation of a semen testing program as part of epidemic preparedness and response. Further, the results will enable planning of the magnitude of testing and targeted counseling needs over time. |
Use of Ebola vaccine: Recommendations of the Advisory Committee on Immunization Practices, United States, 2020
Choi MJ , Cossaboom CM , Whitesell AN , Dyal JW , Joyce A , Morgan RL , Campos-Outcalt D , Person M , Ervin E , Yu YC , Rollin PE , Harcourt BH , Atmar RL , Bell BP , Helfand R , Damon IK , Frey SE . MMWR Recomm Rep 2021 70 (1) 1-12 This report summarizes the recommendations of the Advisory Committee on Immunization Practices (ACIP) for use of the rVSVΔG-ZEBOV-GP Ebola vaccine (Ervebo) in the United States. The vaccine contains rice-derived recombinant human serum albumin and live attenuated recombinant vesicular stomatitis virus (VSV) in which the gene encoding the glycoprotein of VSV was replaced with the gene encoding the glycoprotein of Ebola virus species Zaire ebolavirus. Persons with a history of severe allergic reaction (e.g., anaphylaxis) to rice protein should not receive Ervebo. This is the first and only vaccine currently licensed by the Food and Drug Administration for the prevention of Ebola virus disease (EVD). These guidelines will be updated based on availability of new data or as new vaccines are licensed to protect against EVD.ACIP recommends preexposure vaccination with Ervebo for adults aged ≥18 years in the U.S. population who are at highest risk for potential occupational exposure to Ebola virus species Zaire ebolavirus because they are responding to an outbreak of EVD, work as health care personnel at federally designated Ebola treatment centers in the United States, or work as laboratorians or other staff at biosafety level 4 facilities in the United States. Recommendations for use of Ervebo in additional populations at risk for exposure and other settings will be considered and discussed by ACIP in the future. |
Characteristics of Ebola virus disease survivor blood and semen in Liberia: Serology and RT-PCR
Kofman A , Linderman S , Su K , Purpura LJ , Ervin E , Brown S , Morales-Betoulle M , Graziano J , Cannon DL , Klena JD , Desamu-Thorpe R , Fankhauser J , Orone R , Soka M , Glaybo U , Massaquoi M , Nysenswah T , Nichol ST , Kollie J , Kiawu A , Freeman E , Giah G , Tony H , Faikai M , Jawara M , Kamara K , Kamara S , Flowers B , Mohammed K , Chiriboga D , Williams DE , Hinrichs SH , Ahmed R , Vonhm B , Rollin PE , Choi MJ . Clin Infect Dis 2020 73 (11) e3641-e3646 INTRODUCTION: Ebola virus (EBOV), species Zaire ebolavirus, may persist in the semen of male survivors of Ebola Virus Disease (EVD). We conducted a study of male survivors of the 2014-2016 EVD outbreak in Liberia and evaluated their immune responses to EBOV. We report here findings from the serologic testing of blood for EBOV-specific antibodies, molecular testing for EBOV in blood and semen, and serologic testing of peripheral blood mononuclear cells (PBMCs) in a subset of study participants. METHODS: We tested for EBOV RNA in blood by qRT-PCR, and for anti-EBOV-specific IgM and IgG antibodies by enzyme-linked immunosorbent assay (ELISA) for 126 study participants. We performed peripheral blood mononuclear cell (PBMC) analysis on a subgroup of 26 IgG-negative participants. RESULTS: All 126 participants tested negative for EBOV RNA in blood by qRT-PCR. The blood of 26 participants tested negative for EBOV-specific IgG antibodies by ELISA. PBMCs were collected from 23/26 EBOV IgG-negative participants. Of these, 1/23 participants had PBMCs which produced anti-EBOV-specific IgG antibodies upon stimulation with EBOV-specific GP and NP antigens. DISCUSSION: The blood of EVD survivors, collected when they did not have symptoms meeting the case definition for acute or relapsed EVD, is unlikely to pose a risk for EBOV transmission. We identified one IgM/IgG negative participant who had PBMCs which produced anti-EBOV-specific antibodies upon stimulation. Immunogenicity following acute EBOV infection may exist along a spectrum and absence of antibody response should not be exclusionary in determining an individual's status as a survivor of EVD. |
Seoul virus infection and spread in US home-based ratteries-rat and human testing results from a multistate outbreak investigation.
Knust B , Brown S , de St Maurice A , Whitmer S , Koske SE , Ervin E , Patel K , Graziano J , Morales-Betoulle ME , House J , Cannon D , Kerins J , Holzbauer S , Austin C , Gibbons-Burgener S , Colton L , Dunn J , Zufan S , Choi MJ , Davis WR , Chiang CF , Manning CR , Roesch L , Shoemaker T , Purpura L , McQuiston J , Peterson D , Radcliffe R , Garvey A , Christel E , Morgan L , Scheftel J , Kazmierczak J , Klena JD , Nichol ST , Rollin PE . J Infect Dis 2020 222 (8) 1311-1319 BACKGROUND: During 2017, a multi-state outbreak investigation occurred following the confirmation of Seoul virus (SEOV) infections in people and pet rats. A total of 147 humans and 897 rats were tested. METHODS: In addition to IgG and IgM serology and traditional RT-PCR, novel quantitative RT-PCR primers/probe were developed, and whole genome sequencing was performed. RESULTS: Seventeen people had SEOV IgM, indicating recent infection; seven reported symptoms and three were hospitalized. All patients recovered. Thirty-one facilities in 11 US states had SEOV infection, and among those with >/=10 rats tested, rat IgG prevalence ranged 2-70% and SEOV RT-PCR positivity ranged 0-70%. Human lab-confirmed cases were significantly associated with rat IgG positivity and RT-PCR positivity (p=0.03 and p=0.006, respectively). Genomic sequencing identified >99.5% homology between SEOV sequences in this outbreak, and these were >99% identical to SEOV associated with previous pet rat infections in England, the Netherlands, and France. Frequent trade of rats between home-based ratteries contributed to transmission of SEOV between facilities. CONCLUSIONS: Pet rat owners, breeders, and the healthcare and public health community should be aware and take steps to prevent SEOV transmission in pet rats and to humans. Biosecurity measures and diagnostic testing can prevent further infections. |
Care of Ebola survivors and factors associated with clinical sequelae - Monrovia, Liberia
de St Maurice A , Ervin E , Orone R , Choi M , Dokubo EK , Rollin PE , Nichol ST , Williams D , Brown J , Sacra R , Fankhauser J , Knust B . Open Forum Infect Dis 2018 5 (10) ofy239 Background: The Eternal Love Winning Africa (ELWA) Clinic was the first clinic to provide free, comprehensive care to Ebola virus disease (EVD) survivors in Liberia. The objectives of this analysis were to describe the demographics and symptoms of EVD survivors at ELWA from January 2015 through March 2017 and to identify risk factors for development of sequelae. Methods: Patients' demographic and clinical information was collected by chart review in June 2016 and March 2017. Associations with clinical sequelae were analyzed using the chi-square test, t test, and multivariate logistic regression. Results: From January 2015 to March 2017, 329 EVD survivors were evaluated at ELWA. Most survivors experienced myalgia/arthralgia (73%; n = 239) and headache (53%; n = 173). The length of time from Ebola Treatment Unit (ETU) discharge to first clinic visit ranged from 0 to 30 months. Many visits (30%) occurred 24 or more months after ETU discharge. The proportion of visits for headache, weight loss, joint pain, visual problems, insomnia, fatigue, memory loss, decreased libido, depression, and uveitis decreased over time. More men than women had visits for depression; however, these differences were not significant. Symptom prevalence differed in adults and children; significantly more adults experienced myalgia/arthralgia (77% vs 44%), visual problems (41% vs 12%), post-EVD-related musculoskeletal pain (42% vs 15%), and insomnia (17% vs 2%). Conclusions: EVD survivors frequented ELWA for EVD-related symptoms many months after ETU discharge, indicating a long-term need for care. Reported symptoms changed over time, which may reflect eventual resolution of some sequelae. |
A case of Lassa fever diagnosed at a community hospital - Minnesota 2014
Choi MJ , Worku S , Knust B , Vang A , Lynfield R , Mount MR , Objio T , Brown S , Griffith J , Hulbert D , Lippold S , Ervin E , Stroher U , Holzbauer S , Slattery W , Washburn F , Harper J , Koeck M , Uher C , Rollin P , Nichol S , Else R , DeVries A . Open Forum Infect Dis 2018 5 (7) ofy131 Background: In April 2014, a 46-year-old returning traveler from Liberia was transported by emergency medical services to a community hospital in Minnesota with fever and altered mental status. Twenty-four hours later, he developed gingival bleeding. Blood samples tested positive for Lassa fever RNA by reverse transcriptase polymerase chain reaction. Methods: Blood and urine samples were obtained from the patient and tested for evidence of Lassa fever virus infection. Hospital infection control personnel and health department personnel reviewed infection control practices with health care personnel. In addition to standard precautions, infection control measures were upgraded to include contact, droplet, and airborne precautions. State and federal public health officials conducted contract tracing activities among family contacts, health care personnel, and fellow airline travelers. Results: The patient was discharged from the hospital after 14 days. However, his recovery was complicated by the development of near complete bilateral sensorineural hearing loss. Lassa virus RNA continued to be detected in his urine for several weeks after hospital discharge. State and federal public health authorities identified and monitored individuals who had contact with the patient while he was ill. No secondary cases of Lassa fever were identified among 75 contacts. Conclusions: Given the nonspecific presentation of viral hemorrhagic fevers, isolation of ill travelers and consistent implementation of basic infection control measures are key to preventing secondary transmission. When consistently applied, these measures can prevent secondary transmission even if travel history information is not obtained, not immediately available, or the diagnosis of a viral hemorrhagic fever is delayed. |
Prevalence and risk factors of Rift Valley fever in humans and animals from Kabale district in Southwestern Uganda, 2016
Nyakarahuka L , de St Maurice A , Purpura L , Ervin E , Balinandi S , Tumusiime A , Kyondo J , Mulei S , Tusiime P , Lutwama J , Klena J , Brown S , Knust B , Rollin PE , Nichol ST , Shoemaker TR . PLoS Negl Trop Dis 2018 12 (5) e0006412 BACKGROUND: Rift Valley fever (RVF) is a zoonotic disease caused by Rift Valley fever virus (RVFV) found in Africa and the Middle East. Outbreaks can cause extensive morbidity and mortality in humans and livestock. Following the diagnosis of two acute human RVF cases in Kabale district, Uganda, we conducted a serosurvey to estimate RVFV seroprevalence in humans and livestock and to identify associated risk factors. METHODS: Humans and animals at abattoirs and villages in Kabale district were sampled. Persons were interviewed about RVFV exposure risk factors. Human blood was tested for anti-RVFV IgM and IgG, and animal blood for anti-RVFV IgG. PRINCIPAL FINDINGS: 655 human and 1051 animal blood samples were collected. Anti-RVFV IgG was detected in 78 (12%) human samples; 3 human samples (0.5%) had detectable IgM only, and 7 (1%) had both IgM and IgG. Of the 10 IgM-positive persons, 2 samples were positive for RVFV by PCR, confirming recent infection. Odds of RVFV seropositivity were greater in participants who were butchers (odds ratio [OR] 5.1; 95% confidence interval [95% CI]: 1.7-15.1) and those who reported handling raw meat (OR 3.4; 95% CI 1.2-9.8). No persons under age 20 were RVFV seropositive. The overall animal seropositivity was 13%, with 27% of cattle, 7% of goats, and 4% of sheep seropositive. In a multivariate logistic regression, cattle species (OR 9.1; 95% CI 4.1-20.5), adult age (OR 3.0; 95% CI 1.6-5.6), and female sex (OR 2.1; 95%CI 1.0-4.3) were significantly associated with animal seropositivity. Individual human seropositivity was significantly associated with animal seropositivity by subcounty after adjusting for sex, age, and occupation (p < 0.05). CONCLUSIONS: Although no RVF cases had been detected in Uganda from 1968 to March 2016, our study suggests that RVFV has been circulating undetected in both humans and animals living in and around Kabale district. RVFV seropositivity in humans was associated with occupation, suggesting that the primary mode of RVFV transmission to humans in Kabale district could be through contact with animal blood or body fluids. |
Rift Valley Fever: A survey of knowledge, attitudes, and practice of slaughterhouse workers and community members in Kabale District, Uganda
de St Maurice A , Nyakarahuka L , Purpura L , Ervin E , Tumusiime A , Balinandi S , Kyondo J , Mulei S , Tusiime P , Manning C , Rollin PE , Knust B , Shoemaker T . PLoS Negl Trop Dis 2018 12 (3) e0006175 BACKGROUND: Rift Valley Fever virus (RVF) is a zoonotic virus in the Phenuiviridae family. RVF outbreaks can cause significant morbidity and mortality in humans and animals. Following the diagnosis of two RVF cases in March 2016 in southern Kabale district, Uganda, we conducted a knowledge, attitudes and practice (KAP) survey to identify knowledge gaps and at-risk behaviors related to RVF. METHODOLOGY/PRINCIPAL FINDINGS: A multidisciplinary team interviewed 657 community members, including abattoir workers, in and around Kabale District, Uganda. Most participants (90%) had knowledge of RVF and most (77%) cited radio as their primary information source. Greater proportions of farmers (68%), herdsmen (79%) and butchers (88%) thought they were at risk of contracting RVF compared to persons in other occupations (60%, p<0.01). Participants most frequently identified bleeding as a symptom of RVF. Less than half of all participants reported fever, vomiting, and diarrhea as common RVF symptoms in either humans or animals. The level of knowledge about human RVF symptoms did not vary by occupation; however more farmers and butchers (36% and 51%, respectively) had knowledge of RVF symptoms in animals compared to those in other occupations (30%, p<0.01). The use of personal protective equipment (PPE) when handling animals varied by occupation, with 77% of butchers using some PPE and 12% of farmers using PPE. Although most butchers said that they used PPE, most used gumboots (73%) and aprons (60%) and less than 20% of butchers used gloves or eye protection when slaughtering. CONCLUSIONS: Overall, knowledge, attitudes and practice regarding RVF in Kabale District Uganda could be improved through educational efforts targeting specific populations. |
Rapid increase in gonorrhea cases with reduced susceptibility to azithromycin in Columbus, Ohio
Bazan JA , Williams Roberts M , Soge OO , Torrone EA , Dennison A , Ervin M , Hun S , Fields KS , Turner AN . Sex Transm Dis 2018 45 (2) e5-e6 National data show an increasing trend of reduced azithromycin susceptibility (AZM-RS) among Neisseria gonorrhoeae (Ng) isolates, especially in the Midwest.1 Sentinel surveillance data from the Gonococcal Isolate Surveillance Project, which examines isolates from men with urethritis from 27 sites across the United States, indicates that the proportion of AZM-RS Ng isolates (minimum inhibitory concentration [MIC] ≥2 μg/mL) increased 4-fold between 2013 (0.6%) and 2014 (2.5%).1 Most AZM-RS Ng infections occur in men who have sex with men.1,2 |
Implementation of a study to examine the persistence of Ebola virus in the body fluids of Ebola virus disease survivors in Sierra Leone: Methodology and lessons learned
Deen GF , McDonald SLR , Marrinan JE , Sesay FR , Ervin E , Thorson AE , Xu W , Stroher U , Ongpin P , Abad N , Ariyarajah A , Malik T , Liu H , Ross C , Durski KN , Gaillard P , Morgan O , Formenty P , Knust B , Broutet N , Sahr F . PLoS Negl Trop Dis 2017 11 (9) e0005723 BACKGROUND: The 2013-2016 West African Ebola virus disease epidemic was unprecedented in terms of the number of cases and survivors. Prior to this epidemic there was limited data available on the persistence of Ebola virus in survivors' body fluids and the potential risk of transmission, including sexual transmission. METHODOLOGY/PRINCIPAL FINDINGS: Given the urgent need to determine the persistence of Ebola virus in survivors' body fluids, an observational cohort study was designed and implemented during the epidemic response operation in Sierra Leone. This publication describes study implementation methodology and the key lessons learned. Challenges encountered during implementation included unforeseen duration of follow-up, complexity of interpreting and communicating laboratory results to survivors, and the urgency of translating research findings into public health practice. Strong community engagement helped rapidly implement the study during the epidemic. The study was conducted in two phases. The first phase was initiated within five months of initial protocol discussions and assessed persistence of Ebola virus in semen of 100 adult men. The second phase assessed the persistence of virus in multiple body fluids (semen or vaginal fluid, menstrual blood, breast milk, and urine, rectal fluid, sweat, saliva, tears), of 120 men and 120 women. CONCLUSION/SIGNIFICANCE: Data from this study informed national and global guidelines in real time and demonstrated the need to implement semen testing programs among Ebola virus disease survivors. The lessons learned and study tools developed accelerated the implementation of such programs in Ebola virus disease affected countries, and also informed studies examining persistence of Zika virus. Research is a vital component of the public health response to an epidemic of a poorly characterized disease. Adequate resources should be rapidly made available to answer critical research questions, in order to better inform response efforts. |
Development of risk reduction behavioral counseling for Ebola virus disease survivors enrolled in the Sierra Leone Ebola Virus Persistence Study, 2015-2016
Abad N , Malik T , Ariyarajah A , Ongpin P , Hogben M , McDonald SLR , Marrinan J , Massaquoi T , Thorson A , Ervin E , Bernstein K , Ross C , Liu WJ , Kroeger K , Durski KN , Broutet N , Knust B , Deen GF . PLoS Negl Trop Dis 2017 11 (9) e0005827 BACKGROUND: During the 2014-2016 West Africa Ebola Virus Disease (EVD) epidemic, the public health community had concerns that sexual transmission of the Ebola virus (EBOV) from EVD survivors was a risk, due to EBOV persistence in body fluids of EVD survivors, particularly semen. The Sierra Leone Ebola Virus Persistence Study was initiated to investigate this risk by assessing EBOV persistence in numerous body fluids of EVD survivors and providing risk reduction counseling based on test results for semen, vaginal fluid, menstrual blood, urine, rectal fluid, sweat, tears, saliva, and breast milk. This publication describes implementation of the counseling protocol and the key lessons learned. METHODOLOGY/PRINCIPAL FINDINGS: The Ebola Virus Persistence Risk Reduction Behavioral Counseling Protocol was developed from a framework used to prevent transmission of HIV and other sexually transmitted infections. The framework helped to identify barriers to risk reduction and facilitated the development of a personalized risk-reduction plan, particularly around condom use and abstinence. Pre-test and post-test counseling sessions included risk reduction guidance, and post-test counseling was based on the participants' individual test results. The behavioral counseling protocol enabled study staff to translate the study's body fluid test results into individualized information for study participants. CONCLUSIONS/SIGNIFICANCE: The Ebola Virus Persistence Risk Reduction Behavioral Counseling Protocol provided guidance to mitigate the risk of EBOV transmission from EVD survivors. It has since been shared with and adapted by other EVD survivor body fluid testing programs and studies in Ebola-affected countries. |
Exposure characteristics of hantavirus pulmonary syndrome patients, United States, 1993-2015
de St Maurice A , Ervin E , Schumacher M , Yaglom H , VinHatton E , Melman S , Komatsu K , House J , Peterson D , Buttke D , Ryan A , Yazzie D , Manning C , Ettestad P , Rollin P , Knust B . Emerg Infect Dis 2017 23 (5) 733-739 Those at highest risk are persons in occupations with potential for rodent exposure and American Indian women 40--64 years of age. |
Large Cluster of Neisseria Meningitidis Urethritis in Columbus, Ohio, 2015.
Bazan JA , Turner AN , Kirkcaldy RD , Retchless AC , Kretz CB , Briere E , Tzeng YL , Stephens DS , Maierhofer C , Del Rio C , Abrams AJ , Trees DL , Ervin M , Licon DB , Fields KS , Roberts MW , Dennison A , Wang X . Clin Infect Dis 2017 65 (1) 92-99 Background.: Neisseria meningitidis (Nm) is a Gram-negative diplococcus that normally colonizes the nasopharynx and rarely infects the urogenital tract. On Gram stain of urethral exudates, Nm can be misidentified as the more common sexually transmitted pathogen Neisseria gonorrhoeae. Methods.: In response to a large increase in cases of Nm urethritis identified among men presenting for screening at a sexually transmitted disease clinic in Columbus, Ohio, we investigated the epidemiologic characteristics of men with Nm urethritis and the molecular and phylogenetic characteristics of their Nm isolates. The study was conducted between 1 January and 18 November 2015. Results.: Seventy-five Nm urethritis cases were confirmed by biochemical and polymerase chain reaction testing. Men with Nm urethritis were a median age of 31 years (interquartile range [IQR] = 24-38) and had a median of 2 sex partners in the last 3 months (IQR = 1-3). Nm cases were predominantly black (81%) and heterosexual (99%). Most had urethral discharge (91%), reported oral sex with a female in the last 12 months (96%), and were treated with a ceftriaxone-based regimen (95%). A minority (15%) also had urethral chlamydia coinfection. All urethral Nm isolates were nongroupable, ST-11 clonal complex (cc11), ET-15, and clustered together phylogenetically. Urethral Nm isolates were similar by fine typing (PorA P1.5-1,10-8, PorB 2-2, FetA F3-6), except 1, which had a different PorB type (2-78). Conclusions.: Between January and November 2015, 75 urethritis cases due to a distinct Nm clade occurred among primarily black, heterosexual men in Columbus, Ohio. Future urogenital Nm infection studies should focus on pathogenesis and modes of sexual transmission. |
Perspectives on West Africa Ebola virus disease outbreak, 2013-2016
Spengler JR , Ervin ED , Towner JS , Rollin PE , Nichol ST . Emerg Infect Dis 2016 22 (6) 956-63 The variety of factors that contributed to the initial undetected spread of Ebola virus disease in West Africa during 2013-2016 and the difficulty controlling the outbreak once the etiology was identified highlight priorities for disease prevention, detection, and response. These factors include occurrence in a region recovering from civil instability and lacking experience with Ebola response; inadequate surveillance, recognition of suspected cases, and Ebola diagnosis; mobile populations and extensive urban transmission; and the community's insufficient general understanding about the disease. The magnitude of the outbreak was not attributable to a substantial change of the virus. Continued efforts during the outbreak and in preparation for future outbreak response should involve identifying the reservoir, improving in-country detection and response capacity, conducting survivor studies and supporting survivors, engaging in culturally appropriate public education and risk communication, building productive interagency relationships, and continuing support for basic research. |
Notes from the Field: Rift Valley Fever Response - Kabale District, Uganda, March 2016
de St Maurice A , Nyakarahuka L , Purpura L , Ervin E , Tumusiime A , Balinandi S , Kayondo J , Mulei S , Namutebi AM , Tusiime P , Wiersma S , Nichol S , Rollin P , Klena J , Knust B , Shoemaker T . MMWR Morb Mortal Wkly Rep 2016 65 (43) 1200-1201 On March 9, 2016, a male butcher from Kabale District, Uganda, aged 45 years, reported to the Kabale Regional Referral Hospital with fever, fatigue, and headache associated with black tarry stools and bleeding from the nose. One day later, a student aged 16 years from a different sub-county in Kabale District developed similar symptoms and was admitted to the same hospital. The student also had a history of contact with livestock. Blood specimens collected from both patients were sent for testing for Marburg virus disease, Ebola virus disease, Rift Valley fever (RVF), and Crimean Congo Hemorrhagic fever at the Uganda Virus Research Institute, as part of the viral hemorrhagic fevers surveillance program. The Uganda Virus Research Institute serves as the national viral hemorrhagic fever reference laboratory and hosts the national surveillance program for viral hemorrhagic fevers, in collaboration with the CDC Viral Special Pathogens Branch and the Uganda Ministry of Health. |
Preliminary Evaluation of the Effect of Investigational Ebola Virus Disease Treatments on Viral Genome Sequences.
Whitmer SL , Albarino C , Shepard SS , Dudas G , Sheth M , Brown SC , Cannon D , Erickson BR , Gibbons A , Schuh A , Sealy T , Ervin E , Frace M , Uyeki TM , Nichol ST , Stroher U . J Infect Dis 2016 214 S333-S341 BACKGROUND: Several patients with Ebola virus disease (EVD) managed in the United States have received ZMapp monoclonal antibodies, TKM-Ebola small interfering RNA, brincidofovir, and/or convalescent plasma as investigational therapeutics. METHODS: To investigate whether treatment selected for Ebola virus (EBOV) mutations conferring resistance, viral sequencing was performed on RNA extracted from clinical blood specimens from patients with EVD following treatment, and putative viral targets were analyzed. RESULTS: We observed no major or minor EBOV mutations within regions targeted by therapeutics. CONCLUSIONS: This small subset of patients and clinical specimens suggests that evolution of resistance is not a direct consequence of antiviral treatment. As EVD antiviral treatments are introduced into wider use, it is essential that continuous viral full-genome surveillance is performed, to monitor for the emergence of escape mutations. |
Notes from the field: Ebola virus disease cluster - Northern Sierra Leone, January 2016
Alpren C , Sloan M , Boegler KA , Martin DW , Ervin E , Washburn F , Rickert R , Singh T , Redd JT . MMWR Morb Mortal Wkly Rep 2016 65 (26) 681-2 On January 14, 2016, the Sierra Leone Ministry of Health and Sanitation was notified that a buccal swab collected on January 12 from a deceased female aged 22 years (patient A) in Tonkolili District had tested positive for Ebola virus by reverse transcription-polymerase chain reaction (RT-PCR). The most recent case of Ebola virus disease (Ebola) in Sierra Leone had been reported 4 months earlier on September 13, 2015 (1), and the World Health Organization had declared the end of Ebola virus transmission in Sierra Leone on November 7, 2015 (2). The Government of Sierra Leone launched a response to prevent further transmission of Ebola virus by identifying contacts of the decedent and monitoring them for Ebola signs and symptoms, ensuring timely treatment for anyone with Ebola, and conducting an epidemiologic investigation to identify the source of infection. |
Ebola surveillance - Guinea, Liberia, and Sierra Leone
McNamara LA , Schafer IJ , Nolen LD , Gorina Y , Redd JT , Lo T , Ervin E , Henao O , Dahl BA , Morgan O , Hersey S , Knust B . MMWR Suppl 2016 65 (3) 35-43 Developing a surveillance system during a public health emergency is always challenging but is especially so in countries with limited public health infrastructure. Surveillance for Ebola virus disease (Ebola) in the West African countries heavily affected by Ebola (Guinea, Liberia, and Sierra Leone) faced numerous impediments, including insufficient numbers of trained staff, community reticence to report cases and contacts, limited information technology resources, limited telephone and Internet service, and overwhelming numbers of infected persons. Through the work of CDC and numerous partners, including the countries' ministries of health, the World Health Organization, and other government and nongovernment organizations, functional Ebola surveillance was established and maintained in these countries. CDC staff were heavily involved in implementing case-based surveillance systems, sustaining case surveillance and contact tracing, and interpreting surveillance data. In addition to helping the ministries of health and other partners understand and manage the epidemic, CDC's activities strengthened epidemiologic and data management capacity to improve routine surveillance in the countries affected, even after the Ebola epidemic ended, and enhanced local capacity to respond quickly to future public health emergencies. However, the many obstacles overcome during development of these Ebola surveillance systems highlight the need to have strong public health, surveillance, and information technology infrastructure in place before a public health emergency occurs. Intense, long-term focus on strengthening public health surveillance systems in developing countries, as described in the Global Health Security Agenda, is needed.The activities summarized in this report would not have been possible without collaboration with many U.S and international partners (http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/partners.html). |
Notes from the field: Increase in Neisseria meningitidis-associated urethritis among men at two sentinel clinics - Columbus, Ohio, and Oakland County, Michigan, 2015
Bazan JA , Peterson AS , Kirkcaldy RD , Briere EC , Maierhofer C , Turner AN , Licon DB , Parker N , Dennison A , Ervin M , Johnson L , Weberman B , Hackert P , Wang X , Kretz CB , Abrams AJ , Trees DL , Del Rio C , Stephens DS , Tzeng YL , DiOrio M , Roberts MW . MMWR Morb Mortal Wkly Rep 2016 65 (21) 550-2 Neisseria meningitidis (Nm) urogenital infections, although less common than infections caused by Neisseria gonorrhoeae (Ng), have been associated with urethritis, cervicitis, proctitis, and pelvic inflammatory disease. Nm can appear similar to Ng on Gram stain analysis (gram-negative intracellular diplococci). Because Nm colonizes the nasopharynx, men who receive oral sex (fellatio) can acquire urethral Nm infections. This report describes an increase in Nm-associated urethritis in men attending sexual health clinics in Columbus, Ohio, and Oakland County, Michigan. |
Recent biomarker-confirmed unprotected vaginal sex, but not self-reported unprotected sex, is associated with recurrent bacterial vaginosis
Turner AN , Carr Reese P , Snead MC , Fields K , Ervin M , Kourtis AP , Klebanoff MA , Gallo MF . Sex Transm Dis 2016 43 (3) 172-6 BACKGROUND: Self-reported unprotected vaginal sex seems to increase risk of bacterial vaginosis (BV). However, the validity of self-reports is questionable, given their inconsistency with more objective measures of recent semen exposure such as detection of prostate-specific antigen (PSA). We examined whether recent unprotected sex, as measured both by PSA detection on vaginal swabs and by self-report, was associated with increased BV recurrence. METHODS: We analyzed randomized trial data from nonpregnant, BV-positive adult women recruited from a sexually transmitted disease clinic. Participants received BV therapy at enrollment and were scheduled to return after 4, 12, and 24 weeks. Bacterial vaginosis (by Nugent score) and PSA were measured at each visit. We used Cox proportional hazards models to examine the association between PSA positivity and recurrent BV. We also evaluated associations between self-reported unprotected sex (ever/never since the last visit and in the last 48 hours, analyzed separately) and recurrent BV. RESULTS: Prostate-specific antigen and BV results were available for 96 women who contributed 226 follow-up visits. Prostate-specific antigen positivity was associated with increased BV recurrence (adjusted hazard ratio [aHR], 2.32; 95% confidence interval [CI], 1.28-4.21). In contrast, we observed no significant increase in BV recurrence among women self-reporting unprotected sex since the last visit (aHR, 1.63; 95% CI, 0.77-3.43) or in the last 48 hours (aHR, 1.28; 95% CI, 0.70-2.36). CONCLUSIONS: Estimates from earlier studies linking self-reported unprotected sex and BV may be biased by misclassification. Biomarkers can improve measurement of unprotected sex, a critical exposure variable in sexual health research. |
Ebola RNA persistence in semen of Ebola virus disease survivors
Deen GF , Knust B , Broutet N , Sesay FR , Formenty P , Ross C , Thorson AE , Massaquoi TA , Marrinan JE , Ervin E , Jambai A , McDonald SL , Bernstein K , Wurie AH , Dumbuya MS , Abad N , Idriss B , Wi T , Bennett SD , Davies T , Ebrahim FK , Meites E , Naidoo D , Smith S , Banerjee A , Erickson BR , Brault A , Durski KN , Winter J , Sealy T , Nichol ST , Lamunu M , Stroher U , Morgan O , Sahr F . N Engl J Med 2015 377 (15) 1428-1437 BACKGROUND: Ebola virus has been detected in the semen of men after their recovery from Ebola virus disease (EVD), but little information is available about its prevalence or the duration of its persistence. We report the initial findings of a pilot study involving survivors of EVD in Sierra Leone. METHODS: We enrolled a convenience sample of 100 male survivors of EVD in Sierra Leone, at different times after their recovery from EVD, and recorded self-reported information about sociodemographic characteristics, the EVD episode, and health status. Semen specimens obtained at baseline were tested by means of a quantitative reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay with the use of the target-gene sequences of NP and VP40. RESULTS: A total of 93 participants provided an initial semen specimen for analysis, of whom 46 (49%) had positive results on quantitative RT-PCR. Ebola virus RNA was detected in the semen of all 9 men who had a specimen obtained 2 to 3 months after the onset of EVD, in the semen of 26 of 40 (65%) who had a specimen obtained 4 to 6 months after onset, and in the semen of 11 of 43 (26%) who had a specimen obtained 7 to 9 months after onset; the results for 1 participant who had a specimen obtained at 10 months were indeterminate. The median cycle-threshold values (for which higher values indicate lower RNA levels) were 32.0 with the NP gene target and 31.1 with the VP40 gene target for specimens obtained at 2 to 3 months, 34.5 and 32.3, respectively, for specimens obtained at 4 to 6 months, and 37.0 and 35.6, respectively, for specimens obtained at 7 to 9 months. CONCLUSIONS: These data showed the persistence of Ebola virus RNA in semen and declining persistence with increasing months since the onset of EVD. We do not yet have data on the extent to which positivity on RT-PCR is associated with virus infectivity. Although cases of suspected sexual transmission of Ebola have been reported, they are rare; hence the risk of sexual transmission of the Ebola virus is being investigated. (Funded by the World Health Organization and others.). |
Associations between posterior functional contacts and nutrient intakes and serum nutrient values among adults in NHANES 2003-2004
Ervin RB , Dye BA . Oral Health Prev Dent 2014 12 (3) 265-76 PURPOSE: To examine the associations between the numbers of posterior functional contacts (FCs) and selected nutrient intakes and serum/plasma nutrient values in 3,554 adults 25 years of age and older from the 2003-2004 National Health and Nutrition Examination Survey (NHANES). MATERIALS AND METHODS: FCs consist of the number of zones of contact between the maxillary and opposing mandibular posterior teeth when the maxillary and mandibular posterior teeth are together. There were 16 possible zones of contact. Nutrient intakes were calculated from one 24-h dietary recall and selected nutritional biochemistries were measured. Multivariate linear regression was used to examine the association between the numbers of FCs and nutrient intakes or serum/plasma nutrient values, controlling for potential confounding variables. RESULTS: Males with 6 or more FCs had higher vitamin A (P < 0.05), C (P < 0.05), E (P < 0.01) and B-6 intakes (P < 0.05) than those with 5 or fewer FCs. Females with 6 or more FCs had higher dietary ber (P < 0.05), vitamin E (P < 0.05) and folate intakes (P < 0.05) than those with 5 or fewer FCs. Males and females with 6 or more FCs had higher serum beta-carotene than those with 5 or fewer FCs (P < 0.05 and P < 0.001, respectively). Males with 6 or more FCs had higher serum folate levels than those with 5 or fewer FCs (P < 0.01), and females with 6 or more FCs had higher serum vitamin C levels than those with 5 or fewer FCs (P < 0.05). CONCLUSIONS: Dietary intakes and serum levels of certain nutrients differ by the number of FCs present. |
Estimating the future number of cases in the Ebola epidemic - Liberia and Sierra Leone, 2014-2015
Meltzer MI , Atkins CY , Santibanez S , Knust B , Petersen BW , Ervin ED , Nichol ST , Damon IK , Washington ML . MMWR Suppl 2014 63 (3) 1-14 The first cases of the current West African epidemic of Ebola virus disease (hereafter referred to as Ebola) were reported on March 22, 2014, with a report of 49 cases in Guinea. By August 31, 2014, a total of 3,685 probable, confirmed, and suspected cases in West Africa had been reported. To aid in planning for additional disease-control efforts, CDC constructed a modeling tool called EbolaResponse to provide estimates of the potential number of future cases. If trends continue without scale-up of effective interventions, by September 30, 2014, Sierra Leone and Liberia will have a total of approximately 8,000 Ebola cases. A potential underreporting correction factor of 2.5 also was calculated. Using this correction factor, the model estimates that approximately 21,000 total cases will have occurred in Liberia and Sierra Leone by September 30, 2014. Reported cases in Liberia are doubling every 15-20 days, and those in Sierra Leone are doubling every 30-40 days. The EbolaResponse modeling tool also was used to estimate how control and prevention interventions can slow and eventually stop the epidemic. In a hypothetical scenario, the epidemic begins to decrease and eventually end if approximately 70% of persons with Ebola are in medical care facilities or Ebola treatment units (ETUs) or, when these settings are at capacity, in a non-ETU setting such that there is a reduced risk for disease transmission (including safe burial when needed). In another hypothetical scenario, every 30-day delay in increasing the percentage of patients in ETUs to 70% was associated with an approximate tripling in the number of daily cases that occur at the peak of the epidemic (however, the epidemic still eventually ends). Officials have developed a plan to rapidly increase ETU capacities and also are developing innovative methods that can be quickly scaled up to isolate patients in non-ETU settings in a way that can help disrupt Ebola transmission in communities. The U.S. government and international organizations recently announced commitments to support these measures. As these measures are rapidly implemented and sustained, the higher projections presented in this report become very unlikely. |
Strength and body weight in US children and adolescents
Ervin RB , Fryar CD , Wang CY , Miller IM , Ogden CL . Pediatrics 2014 134 (3) e782-9 BACKGROUND AND OBJECTIVES: Regular aerobic and muscle-strengthening physical activity in youth has been positively associated with health and may help prevent obesity. The purpose of this study is to provide reference values on 4 core, upper, and lower body measures of muscle strength among US children and adolescents and to investigate the association between these measures of strength and weight status. METHODS: We assessed muscular strength using 4 different tests (plank, modified pull-up, knee extension, and grip strength) in 1224 youth aged 6 to 15 years collected during the 2012 National Health and Nutrition Examination Survey National Youth Fitness Survey. Mean and median estimates are provided by gender, age, and weight status. Weight status was defined based on standard categories of obesity, overweight, normal weight, and underweight using the gender-specific BMI-for-age Centers for Disease Control and Prevention growth charts. RESULTS: There were significant positive trends with age for each of the strength tests (P < .001) except the modified pull-up among girls. The length of time the plank was held decreased as weight status increased for both girls and boys (P < .001). As weight status increased the number of modified pull-ups decreased (P < .001 boys and girls). Scores on the knee extension increased as weight status increased (P < .01). Grip strength increased as weight status increased (P < .01). CONCLUSIONS: Increasing weight status had a negative association with measures of strength that involved lifting the body, but was associated with improved performances on tests that did not involve lifting the body. |
Consumption of added sugar among U.S. children and adolescents, 2005-2000
Ervin RB , Kit BK , Carroll MD , Ogden CL . NCHS Data Brief 2012 (87) 1-8 The consumption of added sugars, which are sweeteners added to processed and prepared foods, has been associated with measures of cardiovascular disease risk among adolescents, including adverse cholesterol concentrations. Although the percent of daily calories derived from added sugars declined between 1999-2000 and 2007-2008, consumption of added sugars remains high in the diets of Americans. The 2010 Dietary Guidelines recommend limiting total intake of discretionary calories, which include added sugars and solid fats, to 5%-15% of daily caloric intake, yet many Americans continue to exceed these recommendations. This data brief presents results for added sugar consumption among U.S. children and adolescents for 2005-2008. |
Number of natural and prosthetic teeth impact nutrient intakes of older adults in the United States
Bethene Ervin R , Dye BA . Gerodontology 2011 29 (2) e693-702 OBJECTIVE: To examine the relationship between the number and type of teeth and nutrient intakes in adults, aged 60 years and above, in the National Health and Nutrition Examination Survey 1999-2004 using linear regression. METHODS: Four discrete dental status groups were created: complete natural dentition (reference group), incomplete natural dentition, complete mixed (natural and restored) dentition and incomplete mixed dentition. We ran both unadjusted and adjusted models, controlling for age, race/ethnicity, education and smoking status to examine the effect of these covariates on the association between dentition status and nutrient intakes. Separate models were run for men and women. RESULTS: There were significant associations between dental status and all the examined nutrients for men and for the carotenes and folate for women in the unadjusted model. Only caloric and vitamin C intakes were significant for men, and beta-carotene was significant for women in the adjusted model. For men for kilocalories and women for beta-carotene, those with a complete dentition had higher mean intakes than those with an incomplete dentition, regardless of the tooth type. Among men with an incomplete dentition, those with a mixed dentition had a significantly lower vitamin C intake than those with a natural dentition; there were no significant differences between the natural and mixed complete dentition groups. CONCLUSIONS: Demographic and behavioural variables explained many of the differences seen in nutrient intakes. After controlling for these variables, we found that a numeric threshold of teeth (i.e. a functional dentition) influenced some nutrient intakes while the number and type of teeth present affected other nutrient intakes. |
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