Last data update: Nov 04, 2024. (Total: 48056 publications since 2009)
Records 1-12 (of 12 Records) |
Query Trace: Fagan RP[original query] |
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The National Ebola Training and Education Center: Preparing the United States for Ebola and other special pathogens
Kratochvil CJ , Evans L , Ribner BS , Lowe JJ , Harvey MC , Hunt RC , Tumpey AJ , Fagan RP , Schwedhelm MM , Bell S , Maher J , Kraft CS , Cagliuso NV Sr , Vanairsdale S , Vasa A , Smith PW . Health Secur 2017 15 (3) 253-260 The National Ebola Training and Education Center (NETEC) was established in 2015 in response to the 2014-2016 Ebola virus disease outbreak in West Africa. The US Department of Health and Human Services office of the Assistant Secretary for Preparedness and Response and the US Centers for Disease Control and Prevention sought to increase the competency of healthcare and public health workers, as well as the capability of healthcare facilities in the United States, to deliver safe, efficient, and effective care to patients infected with Ebola and other special pathogens nationwide. NYC Health + Hospitals/Bellevue, Emory University, and the University of Nebraska Medical Center/Nebraska Medicine were awarded this cooperative agreement, based in part on their experience in safely and successfully evaluating and treating patients with Ebola virus disease in the United States. In 2016, NETEC received a supplemental award to expand on 3 initial primary tasks: (1) develop metrics and conduct peer review assessments; (2) develop and provide educational materials, resources, and tools, including exercise design templates; (3) provide expert training and technical assistance; and, to add a fourth task, create a special pathogens clinical research network. |
Investigation of the first seven reported cases of Candida auris, a globally emerging invasive, multidrug-resistant fungus - United States, May 2013-August 2016
Vallabhaneni S , Kallen A , Tsay S , Chow N , Welsh R , Kerins J , Kemble SK , Pacilli M , Black SR , Landon E , Ridgway J , Palmore TN , Zelzany A , Adams EH , Quinn M , Chaturvedi S , Greenko J , Fernandez R , Southwick K , Furuya EY , Calfee DP , Hamula C , Patel G , Barrett P , Lafaro P , Berkow EL , Moulton-Meissner H , Noble-Wang J , Fagan RP , Jackson BR , Lockhart SR , Litvintseva AP , Chiller TM . MMWR Morb Mortal Wkly Rep 2016 65 (44) 1234-1237 Candida auris, an emerging fungus that can cause invasive infections, is associated with high mortality and is often resistant to multiple antifungal drugs. C. auris was first described in 2009 after being isolated from external ear canal discharge of a patient in Japan. Since then, reports of C. auris infections, including bloodstream infections, have been published from several countries, including Colombia, India, Israel, Kenya, Kuwait, Pakistan, South Africa, South Korea, Venezuela, and the United Kingdom. To determine whether C. auris is present in the United States and to prepare for the possibility of transmission, CDC issued a clinical alert in June 2016 informing clinicians, laboratorians, infection control practitioners, and public health authorities about C. auris and requesting that C. auris cases be reported to state and local health departments and CDC. This report describes the first seven U.S. cases of C. auris infection reported to CDC as of August 31, 2016. Data from these cases suggest that transmission of C. auris might have occurred in U.S. health care facilities and demonstrate the need for attention to infection control measures to control the spread of this pathogen. |
Botulism mortality in the USA, 1975-2009
Jackson KA , Mahon BE , Copeland J , Fagan RP . Botulinum J 2016 3 (1) 6-17 Botulism had mortality rates >60% before the 1950s. We reviewed confirmed botulism cases in the USA during 1975-2009 including infant, foodborne, wound, and other/unknown acquisition categories, and calculated mortality ratios. We created a multivariate logistic regression model for non-infant cases (foodborne, wound, and other/unknown). Overall mortality was 3.0% with 109 botulism-related deaths among 3,618 botulism cases [18 (>1%) deaths among 2,352 infant botulism cases, 61 (7.1%) deaths among 854 foodborne botulism cases, 18 (5.0%) deaths among 359 wound botulism cases, and 12 (22.6%) deaths among 53 other/unknown botulism cases]. Mortality among all cases increased with age; it was lowest among infants (0.8%) and highest among persons ≤80 years old (34.4%). Toxin type F had higher mortality (13.8%) than types A, B, or E (range, 1.4% to 4.1%). Efforts to reduce botulism mortality should target non-infant transmission categories and older adults. |
Surgical site infection risk factors and risk stratification
Florschutz AV , Fagan RP , Matar WY , Sawyer RG , Berrios-Torres SI . J Am Acad Orthop Surg 2015 23 Suppl S8-s11 Preoperative identification of the risk factors for surgical site infection and patient risk stratification are essential for deciding whether surgery is appropriate, educating patients on their individual risk of complications, and managing postoperative expectations. Early identification of these factors is also necessary to help guide both patient medical optimization and perioperative care planning. Several resources are currently available to track and analyze healthcare-associated infections, including the Centers for Disease Control and Prevention's National Healthcare Safety Network. In addition, the Centers for Disease Control and Prevention and the American Academy of Orthopaedic Surgeons are exploring collaborative opportunities for the codevelopment of a hip and/or knee arthroplasty national quality measure for periprosthetic joint infection. |
Incidence Trends in Pathogen-Specific Central Line-Associated Bloodstream Infections in US Intensive Care Units, 1990-2010
Fagan RP , Edwards JR , Park BJ , Fridkin SK , Magill SS . Infect Control Hosp Epidemiol 2013 34 (9) 893-9 OBJECTIVE: To quantify historical trends in rates of central line-associated bloodstream infections (CLABSIs) in US intensive care units (ICUs) caused by major pathogen groups, including Candida spp., Enterococcus spp., specified gram-negative rods, and Staphylococcus aureus. DESIGN:. Active surveillance in a cohort of participating ICUs through the Centers for Disease Control and Prevention, the National Nosocomial Infections Surveillance system during 1990-2004, and the National Healthcare Safety Network during 2006-2010. Setting. ICUs. Participants. Patients who were admitted to participating ICUs. RESULTS: The CLABSI incidence density rate for S. aureus decreased annually starting in 2002 and remained lower than for other pathogen groups. Since 2006, the annual decrease for S. aureus CLABSIs in nonpediatric ICU types was -18.3% (95% confidence interval [CI], -20.8% to -15.8%), whereas the incidence density rate for S. aureus among pediatric ICUs did not change. The annual decrease for all ICUs combined since 2006 was -17.8% (95% CI, -19.4% to -16.1%) for Enterococcus spp., -16.4% (95% CI, -18.2% to -14.7%) for gram-negative rods, and -13.5% (95% CI, -15.4% to -11.5%) for Candida spp. CONCLUSIONS:. Patterns of ICU CLABSI incidence density rates among major pathogen groups have changed considerably during recent decades. CLABSI incidence declined steeply since 2006, except for CLABSI due to S. aureus in pediatric ICUs. There is a need to better understand CLABSIs that still do occur, on the basis of microbiological and patient characteristics. New prevention approaches may be needed in addition to central line insertion and maintenance practices. |
Asymmetric type F botulism with cranial nerve demyelination
Filozov A , Kattan JA , Jitendranath L , Smith CG , Luquez C , Phan QN , Fagan RP . Emerg Infect Dis 2012 18 (1) 102-4 We report a case of type F botulism in a patient with bilateral but asymmetric neurologic deficits. Cranial nerve demyelination was found during autopsy. Bilateral, asymmetric clinical signs, although rare, do not rule out botulism. Demyelination of cranial nerves might be underrecognized during autopsy of botulism patients. |
Initial recovery and rebound of type F intestinal colonization botulism after administration of investigational heptavalent botulinum antitoxin
Fagan RP , Neil KP , Sasich R , Luquez C , Asaad H , Maslanka S , Khalil W . Clin Infect Dis 2011 53 (9) e125-8 Investigational heptavalent botulinum antitoxin (HBAT) is now the primary antitoxin for US noninfant botulism patients. HBAT consists of equine Fab/F(ab')2 IgG fragments, which are cleared from circulation faster than whole immunoglobulins. Rebound botulism after antitoxin administration is not previously documented but occurred in our patient 10 days after HBAT administration. |
Multistate outbreak of Listeria monocytogenes associated with Mexican-style cheese made from pasteurized milk among pregnant, Hispanic women
Jackson KA , Biggerstaff M , Tobin-D'Angelo M , Sweat D , Klos R , Nosari J , Garrison O , Boothe E , Saathoff-Huber L , Hainstock L , Fagan RP . J Food Prot 2011 74 (6) 949-53 Listeriosis is a severe infection caused by Listeria monocytogenes. Since 2004, the Centers for Disease Control and Prevention has requested that listeriosis patients be interviewed using a standardized Listeria Initiative (LI) questionnaire. In January 2009, states and the Centers for Disease Control and Prevention began investigating a multistate outbreak of listeriosis among pregnant, Hispanic women. We defined a case as an illness occurring between October 2008 and March 2009 with an L. monocytogenes isolate indistinguishable from the outbreak strain by pulsed-field gel electrophoresis. We conducted a multistate case-control study using controls that were selected from L. monocytogenes illnesses in non-outbreak-related pregnant, Hispanic women that were reported to the LI during 2004 to 2008. Eight cases in five states were identified. Seven of these were pregnant, Hispanic females aged 21 to 43 years, and one was a 3-year-old Hispanic girl, who was excluded from the study. Seven (100%) cases but only 26 (60%) of 43 controls had consumed Mexican-style cheese in the month before illness (odds ratio, 5.89; 95% confidence interval, 1.07 to infinity; P = 0.04). Cultures of asadero cheese made from pasteurized milk collected at a manufacturing facility during routine sampling by the Michigan Department of Agriculture on 23 February 2009 yielded the outbreak strain, leading to a recall of cheeses produced in the plant. Recalled product was traced to stores where at least three of the women had purchased cheese. This investigation highlights the usefulness of routine product sampling for identifying contaminated foods, of pulsed-field gel electrophoresis analysis to detect multistate outbreaks, and of the LI for providing timely exposure information for case-control analyses. Recalls of contaminated cheeses likely prevented additional illnesses. |
Role of social networks in shaping disease transmission during a community outbreak of 2009 H1N1 pandemic influenza
Cauchemez S , Bhattarai A , Marchbanks TL , Fagan RP , Ostroff S , Ferguson NM , Swerdlow D . Proc Natl Acad Sci U S A 2011 108 (7) 2825-30 Evaluating the impact of different social networks on the spread of respiratory diseases has been limited by a lack of detailed data on transmission outside the household setting as well as appropriate statistical methods. Here, from data collected during a H1N1 pandemic (pdm) influenza outbreak that started in an elementary school and spread in a semirural community in Pennsylvania, we quantify how transmission of influenza is affected by social networks. We set up a transmission model for which parameters are estimated from the data via Markov chain Monte Carlo sampling. Sitting next to a case or being the playmate of a case did not significantly increase the risk of infection; but the structuring of the school into classes and grades strongly affected spread. There was evidence that boys were more likely to transmit influenza to other boys than to girls (and vice versa), which mimicked the observed assortative mixing among playmates. We also investigated the presence of abnormally high transmission occurring on specific days of the outbreak. Late closure of the school (i.e., when 27% of students already had symptoms) had no significant impact on spread. School-aged individuals (6-18 y) facilitated the introduction and spread of influenza in households, but only about one in five cases aged >18 y was infected by a school-aged household member. This analysis shows the extent to which clearly defined social networks affect influenza transmission, revealing strong between-place interactions with back-and-forth waves of transmission between the school, the community, and the household. |
Endemic foodborne botulism among Alaska Native persons--Alaska, 1947-2007
Fagan RP , McLaughlin JB , Castrodale LJ , Gessner BD , Jenkerson SA , Funk EA , Hennessy TW , Middaugh JP , Butler JC . Clin Infect Dis 2011 52 (5) 585-92 BACKGROUND: Foodborne botulism resulting from consumption of uncooked aquatic game foods has been an endemic hazard among Alaska Native populations for centuries. Our review was conducted to help target botulism prevention and response activities. METHODS: Records of Alaska botulism investigations for the period 1947-2007 were reviewed. We used the Centers for Disease Control and Prevention case definitions for foodborne botulism and linear regression to evaluate incidence trends and chi(2) or Fisher's Exact tests to evaluate categorical data. RESULTS: A total of 317 patients (61% of whom were female) and 159 outbreaks were reported. Overall mean annual incidence was 6.9 cases per 100,000 Alaska Native persons; mean incidence was lower in 2000 (5.7 cases per 100,000 Alaska Native persons) than in any period since 1965-1969 (0.8 cases per 100,000 Alaska Native persons). Age-specific incidence was highest (26.6 cases per 100,000 Alaska Native persons) among persons aged ≥60 years. The overall case-fatality rate was 8.2%, and the case-fatality rate was ≤4.0% since 1980. Misdiagnosis was associated with a higher case-fatality rate and delayed antitoxin administration. CONCLUSIONS: Foodborne botulism remains a public health problem in Alaska. Incidence might be decreasing, but it remains >800 times the overall US rate (0.0068 cases per 100,000 persons). Prevention messages should highlight the additional risk to female individuals and older persons. Early diagnosis is critical for timely access to antitoxin and supportive care. (See the editorial commentary by Austin, on pages 593-594.) |
An outbreak of 2009 pandemic influenza A (H1N1) virus infection in an elementary school in Pennsylvania
Marchbanks TL , Bhattarai A , Fagan RP , Ostroff S , Sodha SV , Moll ME , Lee BY , Chang CCH , Ennis B , Britz P , Fiore A , Nguyen M , Palekar R , Archer WR , Gift TL , Leap R , Nygren BL , Cauchemez S , Angulo FJ , Swerdlow D . Clin Infect Dis 2011 52 S154-S160 In May 2009, one of the earliest outbreaks of 2009 pandemic influenza A virus (pH1N1) infection resulted in the closure of a semi-rural Pennsylvania elementary school. Two sequential telephone surveys were administered to 1345 students (85% of the students enrolled in the school) and household members in 313 households to collect data on influenza-like illness (ILI). A total of 167 persons (12.4%) among those in the surveyed households, including 93 (24.0%) of the School A students, reported ILI. Students were 3.1 times more likely than were other household members to develop ILI (95% confidence interval [CI], 2.3-4.1). Fourth-grade students were more likely to be affected than were students in other grades (relative risk, 2.2; 95% CI, 1.2-3.9). pH1N1 was confirmed in 26 (72.2%) of the individuals tested by real-time reverse-transcriptase polymerase chain reaction. The outbreak did not resume upon the reopening of the school after the 7-day closure. This investigation found that pH1N1 outbreaks at schools can have substantial attack rates; however, grades and classrooms are affected variably. Additioanl study is warranted to determine the effectiveness of school closure during outbreaks. |
Household effects of school closure during Pandemic (H1N1) 2009, Pennsylvania, USA
Gift TL , Palekar RS , Sodha SV , Kent CK , Fagan RP , Archer WR , Edelson PJ , Marchbanks T , Bhattarai A , Swerdlow D , Ostroff S , Meltzer MI . Emerg Infect Dis 2010 16 (8) 1315-1317 To determine the effects of school closure, we surveyed 214 households after a 1-week elementary school closure because of pandemic (H1N1) 2009. Students spent 77% of the closure days at home, 69% of students visited at least 1 other location, and 79% of households reported that adults missed no days of work to watch children. |
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