Last data update: May 13, 2024. (Total: 46773 publications since 2009)
Records 1-30 (of 54 Records) |
Query Trace: Feldman L[original query] |
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Racial, ethnic, sex, and age differences in COVID-19 cases, hospitalizations, and deaths among incarcerated people and staff in correctional facilities in six jurisdictions, United States, March-July 2020
D'Inverno AS , Myles RL , Jamison CR , Williams SP , Hagan LM , Handanagic S , Lambert LA , Clarke KEN , Allen J , Beard O , Dusseau C , Feldman R , Huebsch R , Hutchinson J , Kall D , King-Mohr J , Long M , McClure ES , Meddaugh P , Pontones P , Rose J , Sredl M , VonBank B , Zipprich J . J Racial Ethn Health Disparities 2023 OBJECTIVES: To examine disparities by sex, age group, and race and ethnicity in COVID-19 confirmed cases, hospitalizations, and deaths among incarcerated people and staff in correctional facilities. METHODS: Six U.S. jurisdictions reported data on COVID-19 confirmed cases, hospitalizations, and deaths stratified by sex, age group, and race and ethnicity for incarcerated people and staff in correctional facilities during March 1- July 31, 2020. We calculated incidence rates and rate ratios (RR) and absolute rate differences (RD) by sex, age group, and race and ethnicity, and made comparisons to the U.S. general population. RESULTS: Compared with the U.S. general population, incarcerated people and staff had higher COVID-19 case incidence (RR = 14.1, 95% CI = 13.9-14.3; RD = 6,692.2, CI = 6,598.8-6,785.5; RR = 6.0, CI = 5.7-6.3; RD = 2523.0, CI = 2368.1-2677.9, respectively); incarcerated people also had higher rates of COVID-19-related deaths (RR = 1.6, CI = 1.4-1.9; RD = 23.6, CI = 14.9-32.2). Rates of COVID-19 cases, hospitalizations, and deaths among incarcerated people and corrections staff differed by sex, age group, and race and ethnicity. The COVID-19 hospitalization (RR = 0.9, CI = 0.8-1.0; RD = -48.0, CI = -79.1- -16.8) and death rates (RR = 0.8, CI = 0.6-1.0; RD = -11.8, CI = -23.5- -0.1) for Black incarcerated people were lower than those for Black people in the general population. COVID-19 case incidence, hospitalizations, and deaths were higher among older incarcerated people, but not among staff. CONCLUSIONS: With a few exceptions, living or working in a correctional setting was associated with higher risk of COVID-19 infection and resulted in worse health outcomes compared with the general population; however, Black incarcerated people fared better than their U.S. general population counterparts. |
Association of E484K and L452R spike protein mutations with SARS-CoV-2 infection in vaccinated persons---Maryland, January – May 2021 (preprint)
Feder KA , Patel A , Vepachedu VR , Dominguez C , Keller EN , Klein L , Kim C , Blood T , Hyun J , Williams TW , Feldman KA , Mostafa HH , Morris CP , Ravel J , Duwell M , Blythe D , Myers R . medRxiv 2021 2021.07.29.21261006 Background The E484K and L452R amino acid substitutions on the spike protein of SARS-CoV-2 are associated with reduced neutralization by antibodies from acquired immunity. This study examines the respective association of these mutations with infection in persons who had previously received a COVID-19 vaccine.Methods Genetic sequences from SARS-CoV-2 specimens collected from Maryland residents and reported to Maryland Department of Health were linked to vaccination history. The prevalence of infections in fully vaccinated persons -- defined as being at least two weeks past receiving the final scheduled dose of a COVID-19 vaccine series -- was compared between infections caused by viruses carrying E484K to those not carrying E484K, and between infections caused by viruses carrying L452R to those not carrying L452R, using logistic regression to adjust for confounding.Results Of 9,048 sequenced SARS-CoV-2 specimens examined, 265 (2.9%) were collected from fully vaccinated persons. In adjusted analysis, the E484K substitution was associated with an increase in the odds of the sequenced specimen being collected from a fully vaccinated person (OR 1.96, 95% CI, 1.36 to 2.83). The L452R mutation was not significantly associated with infections in vaccinated persons (OR 1.07, 95% CI, 0.69 to 1.68).Conclusion Though more than 97% of SARS-CoV-2 infections were in persons who were not fully vaccinated, the E484K mutation was associated with increased odds of SARS-CoV-2 infection in vaccinated persons. Linking vaccination and sequencing data can help identify and estimate the impact SARS-CoV-2 mutations may have on vaccine effectiveness.Summary In viruses sequenced for Maryland’s routine SARS-CoV-2 genomic surveillance, the spike protein amino acid substitution E484K was more prevalent in viruses that infected vaccinated people than in viruses that infected people who were not vaccinated.Competing Interest StatementThe authors have declared no competing interest.Funding StatementNo external funding to report.Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:Case investigation, data collection, and analysis were conducted for public health purposes. This project was reviewed by the Division of Scientific Education and Professional Development within the Center for Surveillance, Epidemiology, and Laboratory Services at the Centers for Disease Control and Prevention (CDC). The project was determined to meet the requirements of public health surveillance covered by the U.S. Department of Health and Human Services Policy for the Protection of Human Research Subjects as defined in 45 C.F.R. part 46.102(l)(2), 21 C.F.R. part 56; 42 U.S.C. Sec.241(d); 5 U.S.C. Sec.552a; 44 U.S.C. Sec.3501 et seq. In., and the decision was made that this project was nonresearch and did not require ethical review by the CDC Human Research Protection Office. Ethical approval was waived and informed consent was not required.All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesData are the property of the U.S. state of Maryland and are collected for public health surveillance purposes. They are not available to the ublic. |
Systematic contact investigation: an essential infection prevention skill to prevent tuberculosis transmission in healthcare settings
Adams T , Miller K , Law M , Pitcher E , Chinpar B , White K , Deutsch-Feldman M , Li R , Filardo TD , Romieu-Hernandez AC , Schwartz NG , Haddad MB , Glowicz J . Am J Infect Control 2023 A systematic approach to contact investigations has long been a cornerstone of interrupting transmission of tuberculosis (TB) in community settings. This paper describes the implementation of a systematic 10-step contact investigation within an acute care setting during a multistate outbreak of healthcare-associated TB. A systematic approach to contact investigations might have applicability to the prevention of other communicable infections within healthcare settings. |
Tuberculosis Outbreak in a State Prison System - Washington, 2021-2022.
Stalter RM , Pecha M , Dov L , Miller D , Ghazal Z , Wortham J , Althomsons S , Deutsch-Feldman M , Stewart R , Felix D , Hsu S , Strick LB . MMWR Morb Mortal Wkly Rep 2023 72 (12) 309-312 During 2014-2020, no tuberculosis (TB) cases were reported within the Washington state prison system. However, during July 2021-June 2022, 25 TB cases were reported among persons incarcerated or formerly incarcerated in two Washington state prisons. Phylogenetic analyses of whole genome sequencing data indicated that Mycobacterium tuberculosis isolates from all 11 patients with culture-confirmed TB were closely related, suggesting that these cases represented a single outbreak. The median infectious period for 12 patients who were considered likely contagious was 170 days. As of November 15, 2022, the Washington State Department of Corrections (WADOC) and Washington State Department of Health (WADOH), with technical assistance from CDC, had identified 3,075 contacts among incarcerated residents and staff members at five state prisons, and 244 contacts without a known TB history received a diagnosis of latent TB infection (LTBI). Persons who were evaluated for TB disease were isolated; those receiving a diagnosis of TB then initiated antituberculosis therapy. Persons with LTBI were offered treatment to prevent progression to TB disease. This ongoing TB outbreak is the largest in Washington in 20 years. Suspension of annual TB screening while limited resources were redirected toward the COVID-19 response resulted in delayed case detection that facilitated TB transmission. In addition, fear of isolation might discourage residents and staff members from reporting symptoms, which likely also leads to delayed TB diagnoses. Continued close collaboration between WADOC and WADOH is needed to end this outbreak and prevent future outbreaks. |
Transmission of Mycobacterium tuberculosis to healthcare personnel resulting from contaminated bone graft material, United States, June 2021- August 2022
Li R , Deutsch-Feldman M , Adams T , Law M , Biak C , Pitcher E , Drees M , Hernandez-Romieu AC , Filardo TD , Cropper T , Martinez A , Wilson WW , Althomsons SP , Morris SB , Wortham JM , Benowitz I , Schwartz NG , White K , Haddad MB , Glowicz JB . Clin Infect Dis 2023 76 (10) 1847-1849 A nationwide tuberculosis outbreak linked to a viable bone allograft product contaminated with Mycobacterium tuberculosis was identified in June 2021. Our subsequent investigation identified 73 healthcare personnel with new latent tuberculosis infection following exposure to the contaminated product, product recipients, surgical instruments, or medical waste. |
Innovative Approaches to COVID-19 Case Investigation and Contact Tracing.
Haddad MB , McLean JE , Feldman SS , Sizemore EE , Taylor MM . Public Health Rep 2022 137 333549221120454 Until COVID-19, the greatest national public health crisis was the 1918 influenza pandemic, which was covered extensively by Public Health Reports.1 -6 Extrapolating from their knowledge of tuberculosis, public health authorities at that time exhorted ill people to remain home to break the chain of respiratory transmission. 7 Other contemporaneous appeals that reverberate a century later include “avoid needless crowding,” “stay in the open air,” “wear a gauze mask over the nose and mouth,” and “keep away from houses where there are influenza cases.” 2 |
Nationwide tuberculosis outbreak in the USA linked to a bone graft product: an outbreak report.
Schwartz NG , Hernandez-Romieu AC , Annambhotla P , Filardo TD , Althomsons SP , Free RJ , Li R , Wyatt Wilson W , Deutsch-Feldman M , Drees M , Hanlin E , White K , Lehman KA , Thacker TC , Brubaker SA , Clark B , Basavaraju SV , Benowitz I , Burton Glowicz J , Cowan LS , Starks AM , Bamrah Morris S , LoBue P , Stewart RJ , Wortham JM , Haddad MB . Lancet Infect Dis 2022 22 (11) 1617-1625 BACKGROUND: Mycobacterium tuberculosis transmission through solid organ transplantation has been well described, but transmission through transplanted tissues is rare. We investigated a tuberculosis outbreak in the USA linked to a bone graft product containing live cells derived from a single deceased donor. METHODS: In this outbreak report, we describe the management and severity of the outbreak and identify opportunities to improve tissue transplant safety in the USA. During early June, 2021, the US Centers for Disease Control and Prevention (CDC) worked with state and local health departments and health-care facilities to locate and sequester unused units from the recalled lot and notify, evaluate, and treat all identified product recipients. Investigators from CDC and the US Food and Drug Administration (FDA) reviewed donor screening and tissue processing. Unused product units from the recalled and other donor lots were tested for the presence of M tuberculosis using real-time PCR (rt PCR) assays and culture. M tuberculosis isolates from unused product and recipients were compared using phylogenetic analysis. FINDINGS: The tissue donor (a man aged 80 years) had unrecognised risk factors, symptoms, and signs consistent with tuberculosis. Bone was procured from the deceased donor and processed into 154 units of bone allograft product containing live cells, which were distributed to 37 hospitals and ambulatory surgical centres in 20 US states between March 1 and April 2, 2021. From March 3 to June 1, 2021, 136 (88%) units were implanted into 113 recipients aged 24-87 years in 18 states (some individuals received multiple units). The remaining 18 units (12%) were located and sequestered. 87 (77%) of 113 identified product recipients had microbiological or imaging evidence of tuberculosis disease. Eight product recipients died 8-99 days after product implantation (three deaths were attributed to tuberculosis after recognition of the outbreak). All 105 living recipients started treatment for tuberculosis disease at a median of 69 days (IQR 56-81) after product implantation. M tuberculosis was detected in all eight sequestered unused units tested from the recalled donor lot, but not in lots from other donors. M tuberculosis isolates from unused product and recipients were more than 99·99% genetically identical. INTERPRETATION: Donor-derived transmission of M tuberculosis via bone allograft resulted in substantial morbidity and mortality. All prospective tissue and organ donors should be routinely assessed for tuberculosis risk factors and clinical findings. When these are present, laboratory testing for M tuberculosis should be strongly considered. FUNDING: None. |
Tuberculosis among native Hawaiian and other Pacific Islander persons: United States and U.S.-affiliated Pacific Islands, 2010-2019
Deutsch-Feldman M , Springer YP , Felix D , Tsang CA , Brostrom R , Haddad M . Health Equity 2022 6 (1) 476-484 BACKGROUND: In recent years, tuberculosis (TB) incidence in the United States has declined overall but remained high among Native Hawaiian and Other Pacific Islander (NH/PI) persons. Few studies have examined the epidemiology of TB among NH/PI persons, particularly in the U.S.-Affiliated Pacific Islands (USAPI). We describe TB incidence and characteristics of NH/PI patients during 2010-2019. METHODS: We used data from the National Tuberculosis Surveillance System to characterize TB cases reported among NH/PI persons born in the 50 U.S. states (defined to include District of Columbia) and the USAPI. We calculated annual TB incidence among NH/PI patients, stratified by place of birth (U.S. states or USAPI). Using Asian persons born outside the United States-persons historically grouped with NH/PI persons as one racial category-as the reference, we compared demographic, clinical, and socio-behavioral characteristics of NH/PI TB patients. RESULTS: During 2010-2019, 4359 TB cases were reported among NH/PI patients born in the U.S. states (n=205) or the USAPI (n=4154). Median annual incidence per 100,000 persons was 6.5 cases (persons born in the U.S. states) and 150.7 cases (persons born in the USAPI). The proportion of TB patients aged <15 years was higher among NH/PI persons (U.S. states: 54%, USAPI: 24%) than among Asian persons born outside the United States (1%). CONCLUSIONS: TB incidence among NH/PI persons is high, particularly among persons born in the USAPI, emphasizing the need to enhance TB prevention strategies in these communities. Interventions should be tailored toward those who experience the highest risk, including NH/PI children and adolescents. |
Association of E484K Spike Protein Mutation With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Vaccinated Persons: Maryland, January-May 2021.
Feder KA , Patel A , Vepachedu VR , Dominguez C , Keller EN , Klein L , Kim C , Blood T , Hyun J , Williams TW , Feldman KA , Mostafa HH , Morris CP , Ravel J , Duwell M , Blythe D , Myers R . Clin Infect Dis 2022 74 (11) 2053-2056 Among 9048 people infected with SARS-CoV-2 between January and May 2021 in Maryland, in regression-adjusted analysis, SARS-CoV-2 viruses carrying the spike protein mutation E484K were disproportionately prevalent among persons infected after full vaccination against COVID-19 compared with infected persons who were not fully vaccinated (aOR, 1.96; 95% CI: 1.36-2.83). |
Notes from the Field: HIV Outbreak During the COVID-19 Pandemic Among Persons Who Inject Drugs - Kanawha County, West Virginia, 2019-2021.
Hershow RB , Wilson S , Bonacci RA , Deutsch-Feldman M , Russell OO , Young S , McBee S , Thomasson E , Balleydier S , Boltz M , Hogan V , Atkins A , Worthington N , McDonald R , Adams M , Moorman A , Bixler D , Kowalewski S , Salmon M , McClung RP , Oster AM , Curran KG . MMWR Morb Mortal Wkly Rep 2022 71 (2) 66-68 During October 2019, the West Virginia Bureau for Public Health (WVBPH) noted that an increasing number of persons who inject drugs (PWID) in Kanawha County received a diagnosis of HIV. The number of HIV diagnoses among PWID increased from less than five annually during 2016-2018 to 11 during January-October 2019 (Figure). Kanawha County (with an approximate population of 180,000*) has high rates of opioid use disorder and overdose deaths, which have been increasing since 2016,(†) and the county is located near Cabell County, which experienced an HIV outbreak among PWID during 2018-2019 (1,2). In response to the increase in HIV diagnoses among PWID in 2019, WVBPH released a Health Advisory(§); and WVBPH and Kanawha-Charleston Health Department (KCHD) convened an HIV task force, conducted care coordination meetings, received CDC remote assistance to support response activities, and expanded HIV testing and outreach. |
Performance characteristics of the Abbott BinaxNOW SARS-CoV-2 antigen test in comparison to real-time RT-PCR and viral culture in community testing sites during November 2020.
Almendares O , Prince-Guerra JL , Nolen LD , Gunn JKL , Dale AP , Buono SA , Deutsch-Feldman M , Suppiah S , Hao L , Zeng Y , Stevens VA , Knipe K , Pompey J , Atherstone C , Bui DP , Powell T , Tamin A , Harcourt JL , Petway M , Bohannon C , Folster JM , MacNeil A , Salerno R , Kuhnert-Tallman W , Tate JE , Thornburg N , Kirking HL , Villanueva JM , Rose DA , Neatherlin JC , Anderson M , Rota PA , Honein MA , Bower WA . J Clin Microbiol 2021 60 (1) Jcm0174221 Point-of-care antigen tests are an important tool for SARS-CoV-2 detection. Antigen tests are less sensitive than real-time reverse-transcriptase PCR (rRT-PCR). Data on the performance of the BinaxNOW antigen test compared to rRT-PCR and viral culture by symptom and known exposure status, timing during disease or exposure period and demographic variables are limited. During November 3(rd)-17(th), 2020, we collected paired upper respiratory swab specimens to test for SARS-CoV-2 by rRT-PCR and Abbott BinaxNOW (BinaxNOW) antigen test at two community testing sites in Pima County, Arizona. We administered a questionnaire to capture symptoms, known exposure status and previous SARS-CoV-2 test results. Specimens positive by either test were analyzed by viral culture. Previously we showed overall BinaxNOW sensitivity was 52.5%. Here we showed BinaxNOW sensitivity increased to 65.7% among currently symptomatic individuals reporting a known exposure. BinaxNOW sensitivity was lower among participants with a known exposure and previously symptomatic (32.4%) or never symptomatic (47.1%) within 14 days of testing. Sensitivity was 71.1% in participants within a week of symptom onset. In participants with a known exposure, sensitivity was highest 8-10 days post-exposure (75%). The positive predictive value for recovery of virus in cell culture was 56.7% for BinaxNOW-positive and 35.4% for rRT-PCR-positive specimens. Result reporting time was 2.5 hours for BinaxNOW and 26 hours for rRT-PCR. Point-of-care antigen tests have a shorter turn-around time compared to laboratory-based nucleic acid amplification tests, which allows for more rapid identification of infected individuals. Antigen test sensitivity limitations are important to consider when developing a testing program. |
Special Report from the CDC: Readiness to surge: State health departments workforce infrastructure during the opioid crisis
Cruz K , Deokar A , Feldman SJ , Patrick H . J Safety Res 2021 77 324-327 Introduction: As part of scaling up the response to the opioid overdose epidemic, there is an opportunity to examine how state public health departments addressed workforce and other infrastructure needs to implement a large-scale opioid overdose prevention program. Understanding how this was done—and any lessons learned from the process—can inform future workforce development and capital improvement efforts. Methods: Administrative data from the Centers for Disease Control and Prevention (CDC) Prescription Drug Overdose Prevention for States (PfS) program were analyzed to understand how states adapted to this emerging public health priority. Results: Six months into the first year of funding, 6 of the 16 state health departments had filled all anticipated staffing positions. States faced challenges obtaining timely expenditure authority and hiring staff. However, states were able to overcome these challenges by strategically reassigning staff, hiring from within, and utilizing existing contract mechanisms. Conclusion: Our analysis revealed how planning, using existing infrastructure, and maintaining a prepared workforce are critical to ensure that public health agencies have the ability to surge to meet emerging challenges and effectively utilize resources to achieve program goals. practical applications: Greater attention should be directed toward strategically addressing known barriers and timelines in work plans and budgets during the application and selection process to ensure implementation readiness. © 2021 |
Tenofovir Alafenamide (TAF) for HIV Prevention: Review of the Proceedings from the Gates Foundation Long Acting (LA) TAF Product Development Meeting
Romano JW , Baum M , Demkovich ZR , Diana F , Dobard C , Feldman PL , Garcia-Lerma JG , Grattoni A , Gunawardana M , Ho DK , Hope TJ , Massud I , Milad M , Moss J , Pons-Faudoa FP , Roller S , van der Straten A , Srinivasan S , Veazey R , Zane D . AIDS Res Hum Retroviruses 2021 37 (6) 409-420 The ability to successfully develop a safe and effective vaccine for the prevention of HIV infection has proven challenging. Consequently, alternative approaches to HIV infection prevention have been pursued, and there have been a number of successes with differing levels of efficacy. Currently, only two oral pre-exposure prophylaxis (PrEP) products are available, Truvada and Descovy. Descovy is a newer product not yet indicated in individuals at risk of HIV-1 infection from receptive vaginal sex, since it still needs to be evaluated in this population. A topical dapivirine vaginal ring is currently under regulatory review, and a long acting (LA) injectable cabotegravir product shows strong promise. Although demonstrably effective, daily oral PrEP presents adherence challenges for many users, particularly adolescent girls and young women, key target populations. This limitation has triggered development efforts in LA HIV prevention options. This article reviews efforts supported by the Bill & Melinda Gates Foundation, as well as similar work by other groups, to identify and develop optimal LA HIV prevention products. Specifically, this article is a summary review of a meeting convened by the foundation in early 2020 that focused on the development of LA products designed for extended delivery of tenofovir alafenamide (TAF) for HIV prevention. The review broadly serves as technical guidance for preclinical development of LA HIV prevention products. The meeting examined the technical feasibility of multiple delivery technologies, in vivo pharmacokinetics, and safety of subcutaneous delivery of TAF in animal models. Ultimately, the foundation concluded that there are technologies available for long-term delivery of TAF. However, due to potentially limited efficacy and possible toxicity issues with subcutaneous (SC) delivery, the foundation will not continue investing in the development of LA, SC delivery of TAF products for HIV prevention. |
Linked Clusters of SARS-CoV-2 Variant B.1.351 - Maryland, January-February 2021.
Feder KA , Pearlowitz M , Goode A , Duwell M , Williams TW , Chen-Carrington PA , Patel A , Dominguez C , Keller EN , Klein L , Rivera-Colon A , Mostafa HH , Morris CP , Patel N , Schauer AM , Myers R , Blythe D , Feldman KA . MMWR Morb Mortal Wkly Rep 2021 70 (17) 627-631 In late January 2021, a clinical laboratory notified the Maryland Department of Health (MDH) that the SARS-CoV-2 variant of concern B.1.351 had been identified in a specimen collected from a Maryland resident with COVID-19 (1). The SARS-CoV-2 B.1.351 lineage was first identified in South Africa (2) and might be neutralized less effectively by antibodies produced after vaccination or natural infection with other strains (3-6). To limit SARS-CoV-2 chains of transmission associated with this index patient, MDH used contact tracing to identify the source of infection and any linked infections among other persons. The investigation identified two linked clusters of SARS-CoV-2 infection that included 17 patients. Three additional specimens from these clusters were sequenced; all three had the B.1.351 variant and all sequences were closely related to the sequence from the index patient's specimen. Among the 17 patients identified, none reported recent international travel or contact with international travelers. Two patients, including the index patient, had received the first of a 2-dose COVID-19 vaccination series in the 2 weeks before their likely exposure; one additional patient had a confirmed SARS-CoV-2 infection 5 months before exposure. Two patients were hospitalized with COVID-19, and one died. These first identified linked clusters of B.1.351 infections in the United States with no apparent link to international travel highlight the importance of expanding the scope and volume of genetic surveillance programs to identify variants, completing contact investigations for SARS-CoV-2 infections, and using universal prevention strategies, including vaccination, masking, and physical distancing, to control the spread of variants of concern. |
Tuberculosis - United States, 2020
Deutsch-Feldman M , Pratt RH , Price SF , Tsang CA , Self JL . MMWR Morb Mortal Wkly Rep 2021 70 (12) 409-414 Tuberculosis (TB) disease incidence has decreased steadily since 1993 (1), a result of decades of work by local TB programs to detect, treat, and prevent TB disease and transmission. During 2020, a total of 7,163 TB cases were provisionally reported to CDC's National Tuberculosis Surveillance System (NTSS) by the 50 U.S. states and the District of Columbia (DC), a relative reduction of 20%, compared with the number of cases reported during 2019.* TB incidence per 100,000 persons was 2.2 during 2020, compared with 2.7 during 2019. Since 2010, TB incidence has decreased by an average of 2%-3% annually (1). Pandemic mitigation efforts and reduced travel might have contributed to the reported decrease. The magnitude and breadth of the decrease suggest potentially missed or delayed TB diagnoses. Health care providers should consider TB disease when evaluating patients with signs and symptoms consistent with TB (e.g., cough of >2 weeks in duration, unintentional weight loss, and hemoptysis), especially when diagnostic tests are negative for SARS-CoV-2, the virus that causes COVID-19. In addition, members of the public should be encouraged to follow up with their health care providers for any respiratory illness that persists or returns after initial treatment. The steep, unexpected decline in TB cases raises concerns of missed cases, and further work is in progress to better understand factors associated with the decline. |
Willingness to Pay for Select Tick-Borne Disease Prevention Measures in Endemic Areas
Niesobecki S , Rutz H , Niccolai L , Hook S , Feldman K , Hinckley A . J Public Health Manag Pract 2021 28 (1) E37-E42 Tick-borne diseases (TBDs) are increasing despite prevention recommendations. We explored whether cost is a barrier to prevention use in Connecticut and Maryland, using a cross-sectional survey. Respondents were queried regarding their willingness to pay for chemical, natural, and rodent-targeted yard pesticide treatments and permethrin-treated clothing. We evaluated associations between demographics, TBD knowledge and attitudes, and willingness to pay for prevention methods. Most respondents would pay for yard treatments (85%); 95% preferring natural pesticide, and 82% would pay for permethrin-treated clothing. Most did not want to pay more than $99 for any of the yard treatments. Having a household income of $100 000 was associated with willingness to pay $100 or more for chemical, natural, or rodent-targeted treatments and $25 or more for permethrin self-treated and pretreated clothing. Yard treatments, especially natural pesticides, were acceptable for TBD prevention; however, current pricing may be cost-prohibitive. Permethrin-treated clothing may be an affordable and acceptable prevention method. |
Human-tick encounters as a measure of tickborne disease risk in lyme disease endemic areas
Hook SA , Nawrocki CC , Meek JI , Feldman KA , White JL , Connally NP , Hinckley AF . Zoonoses Public Health 2021 68 (5) 384-392 Entomological measures have long served as proxies for human risk of Lyme disease (LD) and other tickborne diseases (TBDs) in endemic areas of the United States, despite conflicting results regarding the correlation between these measures and human disease outcomes. Using data from a previous TBD intervention study in Connecticut, Maryland and New York, we evaluated whether human-tick encounters can serve as an accurate proxy for risk of TBDs in areas where LD and other Ixodes scapularis-transmitted infections are common. Among 2,590 households consisting of 4,210 individuals, experiencing a tick encounter was associated with an increased risk of both self-reported (RR = 3.17, 95% CI: 2.05, 4.91) and verified TBD (RR = 2.60, 95% CI: 1.39, 4.84) at the household level. Household characteristics associated with experiencing any tick encounter were residence in Connecticut (aOR = 1.86, 95% CI: 1.38, 2.51) or New York (aOR = 1.66, 95% CI: 1.25, 2.22), head of household having a graduate level education (aOR = 1.46, 95% CI: 1.04, 2.08), owning a pet (aOR = 1.80, 95% CI: 1.46, 2.23) and a property size of 2 acres or larger (aOR = 2.30, 95% CI: 1.42, 3.70). Results for individual characteristics were similar to those for households. Future prevention studies in LD endemic areas should consider using human-tick encounters as a robust proxy for TBD risk. |
Evaluation of health system readiness and coverage of intermittent preventive treatment of malaria in infants (IPTi) in Kambia district to inform national scale-up in Sierra Leone.
Lahuerta M , Sutton R , Mansaray A , Eleeza O , Gleason B , Akinjeji A , Jalloh MF , Toure M , Kassa G , Meshnick SR , Deutsch-Feldman M , Parmley L , Friedman M , Smith SJ , Rabkin M , Steinhardt L . Malar J 2021 20 (1) 74 BACKGROUND: Intermittent preventive treatment of malaria in infants (IPTi) with sulfadoxine-pyrimethamine (SP) is a proven strategy to protect infants against malaria. Sierra Leone is the first country to implement IPTi nationwide. IPTi implementation was evaluated in Kambia, one of two initial pilot districts, to assess quality and coverage of IPTi services. METHODS: This mixed-methods evaluation had two phases, conducted 3 (phase 1) and 15-17 months (phase 2) after IPTi implementation. Methods included: assessments of 18 health facilities (HF), including register data abstraction (phases 1 and 2); a knowledge, attitudes and practices survey with 20 health workers (HWs) in phase 1; second-generation sequencing of SP resistance markers (pre-IPTi and phase 2); and a cluster-sample household survey among caregivers of children aged 3-15 months (phase 2). IPTi and vaccination coverage from the household survey were calculated from child health cards and maternal recall and weighted for the complex sampling design. Interrupted time series analysis using a Poisson regression model was used to assess changes in malaria cases at HF before and after IPTi implementation. RESULTS: Most HWs (19/20) interviewed had been trained on IPTi; 16/19 reported feeling well prepared to administer it. Nearly all HFs (17/18 in phase 1; 18/18 in phase 2) had SP for IPTi in stock. The proportion of parasite alleles with dhps K540E mutations increased but remained below the 50% WHO-recommended threshold for IPTi (4.1% pre-IPTi [95%CI 2-7%]; 11% post-IPTi [95%CI 8-15%], p < 0.01). From the household survey, 299/459 (67.4%) children ≥ 10 weeks old received the first dose of IPTi (versus 80.4% for second pentavalent vaccine, given simultaneously); 274/444 (62.5%) children ≥ 14 weeks old received the second IPTi dose (versus 65.4% for third pentavalent vaccine); and 83/217 (36.4%) children ≥ 9 months old received the third IPTi dose (versus 52.2% for first measles vaccine dose). HF register data indicated no change in confirmed malaria cases among infants after IPTi implementation. CONCLUSIONS: Kambia district was able to scale up IPTi swiftly and provide necessary health systems support. The gaps between IPTi and childhood vaccine coverage need to be further investigated and addressed to optimize the success of the national IPTi programme. |
Evaluation of Abbott BinaxNOW Rapid Antigen Test for SARS-CoV-2 Infection at Two Community-Based Testing Sites - Pima County, Arizona, November 3-17, 2020.
Prince-Guerra JL , Almendares O , Nolen LD , Gunn JKL , Dale AP , Buono SA , Deutsch-Feldman M , Suppiah S , Hao L , Zeng Y , Stevens VA , Knipe K , Pompey J , Atherstone C , Bui DP , Powell T , Tamin A , Harcourt JL , Shewmaker PL , Medrzycki M , Wong P , Jain S , Tejada-Strop A , Rogers S , Emery B , Wang H , Petway M , Bohannon C , Folster JM , MacNeil A , Salerno R , Kuhnert-Tallman W , Tate JE , Thornburg NJ , Kirking HL , Sheiban K , Kudrna J , Cullen T , Komatsu KK , Villanueva JM , Rose DA , Neatherlin JC , Anderson M , Rota PA , Honein MA , Bower WA . MMWR Morb Mortal Wkly Rep 2021 70 (3) 100-105 Rapid antigen tests, such as the Abbott BinaxNOW COVID-19 Ag Card (BinaxNOW), offer results more rapidly (approximately 15-30 minutes) and at a lower cost than do highly sensitive nucleic acid amplification tests (NAATs) (1). Rapid antigen tests have received Food and Drug Administration (FDA) Emergency Use Authorization (EUA) for use in symptomatic persons (2), but data are lacking on test performance in asymptomatic persons to inform expanded screening testing to rapidly identify and isolate infected persons (3). To evaluate the performance of the BinaxNOW rapid antigen test, it was used along with real-time reverse transcription-polymerase chain reaction (RT-PCR) testing to analyze 3,419 paired specimens collected from persons aged ≥10 years at two community testing sites in Pima County, Arizona, during November 3-17, 2020. Viral culture was performed on 274 of 303 residual real-time RT-PCR specimens with positive results by either test (29 were not available for culture). Compared with real-time RT-PCR testing, the BinaxNOW antigen test had a sensitivity of 64.2% for specimens from symptomatic persons and 35.8% for specimens from asymptomatic persons, with near 100% specificity in specimens from both groups. Virus was cultured from 96 of 274 (35.0%) specimens, including 85 (57.8%) of 147 with concordant antigen and real-time RT-PCR positive results, 11 (8.9%) of 124 with false-negative antigen test results, and none of three with false-positive antigen test results. Among specimens positive for viral culture, sensitivity was 92.6% for symptomatic and 78.6% for asymptomatic individuals. When the pretest probability for receiving positive test results for SARS-CoV-2 is elevated (e.g., in symptomatic persons or in persons with a known COVID-19 exposure), a negative antigen test result should be confirmed by NAAT (1). Despite a lower sensitivity to detect infection, rapid antigen tests can be an important tool for screening because of their quick turnaround time, lower costs and resource needs, high specificity, and high positive predictive value (PPV) in settings of high pretest probability. The faster turnaround time of the antigen test can help limit transmission by more rapidly identifying infectious persons for isolation, particularly when used as a component of serial testing strategies. |
Summary of current guidelines for cervical cancer screening and management of abnormal test results: 2016-2020
Perkins RB , Guido RL , Saraiya M , Sawaya GF , Wentzensen N , Schiffman M , Feldman S . J Womens Health (Larchmt) 2021 30 (1) 5-13 Cervical cancer can be prevented through routine screening and follow-up of abnormal results. Several guidelines have been published in the last 4 years from various medical societies and organizations. These guidelines aim to personalize screening and management, reducing unnecessary testing in low-risk patients and managing high-risk patients with more intensive follow-up. However, the resulting complexity can lead to confusion among providers. The CDC, NCI, and obstetrician-gynecologists involved in guideline development summarized current screening and management guidelines. For screening, guidelines for average-risk and high-risk populations are summarized and presented. For management, differences between the 2012 and 2019 consensus guidelines for managing abnormal cervical cancer screening tests and cancer precursors are summarized. Current screening guidelines for average-risk individuals have minor differences, but are evolving toward an HPV-based strategy. For management, HPV testing is preferred to cytology because it is a more sensitive test for cancer precursor detection and also allows for precise risk stratification. Current risk-based screening and management strategies can improve care by reducing unnecessary tests and procedures in low-risk patients and focusing resources on high-risk patients. Knowledge of screening and management guidelines is important to improve adherence and avoid both over- and under-use of screening and colposcopy. |
Love the ones you're with: Characteristics and behaviour of Maryland pets and their owners in relation to tick encounters
de Wet S , Rutz H , Hinckley AF , Hook SA , Campbell S , Feldman KA . Zoonoses Public Health 2020 67 (8) 876-881 We conducted a cross-sectional study to evaluate associations between pet characteristics and behaviours and risk of tick encounters among pets and pet owners. We defined a tick encounter as ticks found crawling on or attached to a pet or pet owner. Information about pet characteristics, interactions between owners and pets, and tick encounters were captured through an online survey. Associations were evaluated using univariate and multivariable analyses. In univariate analysis, walking dogs only on pavement reduced risk of tick encounter among owners (prevalence ratio (PR) = 0.51, 95% confidence interval (CI): 0.30, 0.84). Having a dog or cat that hunted small animals increased risk of tick encounter among owners (PR = 1.66, 95% CI: 1.30, 2.13; PR = 1.57, 95% CI: 1.05, 2.34, respectively). No direct interactions between owners and pets (e.g., pets sleeping on owners' beds) were associated with increased risk of tick encounters among owners. In multivariable analysis among dog owners, having a pet with a tick encounter within the last six months was associated with increased risk of owner tick encounter (adjusted odds ratio (aOR) = 4.17, 95% CI: 2.94, 5.92); in addition, having a dog that hunts small animals was associated with increased risk of owner tick encounter (aOR = 1.97, 95% CI: 1.25, 3.11). These results suggest that the location of pet-owner interactions may be more important than the type of interactions. Pet owners should avoid tick habitat with pets; when that is not possible, proper use of tick preventive products for pets, wearing repellents by owners and conducting tick checks for both pets and owners is critical for prevention of tick encounters and tick-borne disease. |
An international cohort study of birth outcomes associated with hospitalized acute respiratory infection during pregnancy
Regan AK , Feldman B , Azziz-Baumgartner E , Naleway AL , Williams J , Wyant BE , Simmonds K , Effler PV , Booth S , Ball SW , Katz MA , Fink RV , Thompson MG , Chung H , Kwong JC , Fell DB . J Infect 2020 81 (1) 48-56 OBJECTIVES: Findings during the 2009 pandemic suggest severe maternal infection with pandemic influenza had adverse perinatal health consequences. Limited data exist evaluating the perinatal health effects of severe seasonal influenza and non-influenza infections during pregnancy. METHODS: A retrospective cohort of pregnant women from Australia, Canada, Israel, and the United States was established using birth records to identify pregnancies and birth outcomes and hospital and laboratory testing records to identify influenza and non-influenza associated acute respiratory or febrile illness (ARFI) hospitalizations. ARFI hospitalized women were matched to non-hospitalized women (1:4) by country and season of conception. Log-binomial logistic regression was used to estimate the relative risk (aRR) of preterm birth (PTB), small-for-gestational-age (SGA), and low birthweight (LBW) birth, adjusting for pre-existing medical conditions, maternal age, and parity. RESULTS: 950 pregnant women hospitalized with an ARFI were matched with 3,800 non-hospitalized pregnant women. Compared to non-hospitalized women, risk of PTB was greater among women hospitalized with influenza-associated ARFI (aRR: 1.57; 95% CI: 1.15-2.15) and non-influenza ARFI (aRR: 2.78; 95% CI: 2.12-3.65). Similar results were observed for LBW; there were no associations with SGA birth. CONCLUSIONS: ARFI hospitalization during pregnancy was associated with increased risk of PTB and LBW. |
Knowledge and prevention of tickborne diseases among Hispanic and non-Hispanic residents of Maryland and Virginia
Hu SY , Starr JA , Gharpure R , Mehta SP , Feldman KA , Nelson CA . Zoonoses Public Health 2019 66 (7) 805-812 Tickborne diseases (TBDs) such as Lyme disease (LD), babesiosis, ehrlichiosis and Rocky Mountain spotted fever cause substantial morbidity and even mortality in the USA. Data indicate that Hispanic populations may be at greater risk for occupational exposure to ticks and disseminated LD; however, information on knowledge and practices of Hispanic populations regarding TBDs is limited. We surveyed 153 Hispanic and 153 non-Hispanic residents of Maryland and Virginia to assess awareness of TBDs, prevention practices and risk of tick encounters. Hispanic respondents were less likely than non-Hispanics to report familiarity with LD symptoms (21% vs. 53%, p < 0.001) and correctly identify ticks as vectors of LD (40% vs. 85%, p < 0.001). Although there was no significant difference in overall proportion of respondents who routinely take one or more preventive measures to prevent tick bites (59% vs. 61%, p = 0.65), Hispanics were more likely to report showering after coming indoors (36% vs. 25%, p = 0.04) but less likely to conduct daily tick checks compared with non-Hispanics (17% vs. 35%, p < 0.001). History of tick bite or finding a tick crawling on oneself or a household member in the past year did not significantly differ between Hispanics and non-Hispanics (19% vs. 24%, p = 0.26). Notably, after controlling for Hispanic/non-Hispanic ethnicity, primary language (English vs. Spanish) was a significant predictor of whether an individual had knowledge of LD symptoms, correctly identified ticks as vectors for LD and performed daily tick checks. These results provide guidance for future development of more targeted and effective TBD prevention education for both Hispanic and non-Hispanic communities. |
Knowledge, attitudes, and behaviors regarding tick-borne disease prevention in endemic areas
Niesobecki S , Hansen A , Rutz H , Mehta S , Feldman K , Meek J , Niccolai L , Hook S , Hinckley A . Ticks Tick Borne Dis 2019 10 (6) 101264 As part of a TickNET collaboration we evaluated the knowledge, attitudes, and behaviors related to tick-borne disease (TBD) prevention among persons living in endemic areas of Connecticut (CT) and Maryland (MD). Up-to-date information on the use of various prevention methods, as well as attitudes toward available and potential prevention options, is critical for effective promotion of recommended behaviors. During 2016-2017, printed invitations were mailed via the post office to 27,029 households requesting participation in an online survey regarding knowledge of TBD, risk perceptions, and prevention behaviors. Prevention behaviors included tick checks, showering/bathing, insect repellents, pet tick control, and chemical or natural pesticide use on residential properties. Associations of sociodemographic characteristics and knowledge and attitude variables with prevention behaviors were assessed in unadjusted analyses and multivariable models to calculate adjusted odds ratios (aOR). Participants were also asked if they would be willing to get a Lyme disease (LD) vaccine, if one becomes available. Overall, 1883 (7%) persons completed the survey. Participants reported using preventive behaviors most of the time or always as follows: pet tick control (83%), tick checks (58%), showering/bathing (42%), insect repellent (31%), and chemical (23%) or natural (15%) pesticides on property. Self-rated knowledge of LD, perceived prevalence of LD, perceived severity of LD, and perceived likelihood of contracting LD or another TBD were significantly (p < 0.05) associated with performing a tick check [aOR 2.5, aOR 1.71, aOR 1.36, aOR 1.83, respectively]. Female gender and perceived prevalence of LD were significantly associated with applying insect repellent [aOR 1.56, aOR 1.64, respectively]. Perceived prevalence of LD was significantly associated with showering or bathing, insect repellents, and pet tick control [aOR 1.42, aOR 1.64, aOR 1.92, respectively]. Income > $100,000 was significantly associated with applying a chemical or natural pesticide to one's property [aOR 1.29, aOR 1.40, respectively]. A majority of respondents (84%) reported that they were very likely or somewhat likely to get a LD vaccine if one were available. Few behaviors (tick checks and pet tick control) were reported to be practiced by more than half of the respondents living in LD endemic areas. Perceived prevalence of LD was the only factor associated with performing most of the prevention behaviors (tick checks, showering/bathing, use of insect repellents, and pet tick control). Use of chemical or natural pesticides appears to be driven by income. Greater efforts are needed to encourage use of prevention behaviors in endemic areas, and this may be facilitated by increasing awareness of local prevalence. |
Estimating vaccine effectiveness against hospitalized influenza during pregnancy: Multicountry protocol for a retrospective cohort study
Naleway AL , Ball S , Kwong JC , Wyant BE , Katz MA , Regan AK , Russell ML , Klein NP , Chung H , Simmonds KA , Azziz-Baumgartner E , Feldman BS , Levy A , Fell DB , Drews SJ , Garg S , Effler P , Barda N , Irving SA , Shifflett P , Jackson ML , Thompson MG . JMIR Res Protoc 2019 8 (1) e11333 BACKGROUND: Although pregnant women are believed to have elevated risks of severe influenza infection and are targeted for influenza vaccination, no study to date has examined influenza vaccine effectiveness (IVE) against laboratory-confirmed influenza-associated hospitalizations during pregnancy, primarily because this outcome poses many methodological challenges. OBJECTIVE: The Pregnancy Influenza Vaccine Effectiveness Network (PREVENT) was formed in 2016 as an international collaboration with the Centers for Disease Control and Prevention; Abt Associates; and study sites in Australia, Canada, Israel, and the United States. The primary goal of this collaboration is to estimate IVE in preventing acute respiratory or febrile illness (ARFI) hospitalizations associated with laboratory-confirmed influenza virus infection during pregnancy. Secondary aims include (1) describing the incidence, clinical course, and severity of influenza-associated ARFI hospitalization during pregnancy; (2) comparing the characteristics of ARFI-hospitalized pregnant women who were tested for influenza with those who were not tested; (3) describing influenza vaccination coverage in pregnant women; and (4) comparing birth outcomes among women with laboratory-confirmed influenza-associated hospitalization versus other noninfluenza ARFI hospitalizations. METHODS: For an initial assessment of IVE, sites identified a retrospective cohort of pregnant women aged from 18 to 50 years whose pregnancies overlapped with local influenza seasons from 2010 to 2016. Pregnancies were defined as those that ended in a live birth or stillbirth of at least 20 weeks gestation. The analytic sample for the primary IVE analysis was restricted to pregnant women who were hospitalized for ARFI during site-specific influenza seasons and clinically tested for influenza virus infection using real-time reverse transcription polymerase chain reaction. RESULTS: We identified approximately 2 million women whose pregnancies overlapped with influenza seasons; 550,344 had at least one hospitalization during this time. After restricting to women who were hospitalized for ARFI and tested for influenza, the IVE analytic sample included 1005 women. CONCLUSIONS: In addition to addressing the primary question about the effectiveness of influenza vaccination, PREVENT data will address other important knowledge gaps including understanding the incidence, clinical course, and severity of influenza-related hospitalizations during pregnancy. The data infrastructure and international partnerships created for these analyses may be useful and informative for future influenza studies. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/11333. |
Completeness of HIV nucleotide sequence ascertainment and its potential impact on understanding HIV transmission - Maryland, 2011-2013.
Brooks RB , Feldman KA , Blythe D , Flynn C . AIDS Care 2018 31 (5) 1-8 HIV nucleotide sequences generated through routine drug resistance testing (DRT) and reported to Maryland's Molecular HIV Surveillance system are most effective for elucidating transmission patterns and identifying outbreaks if DRT is ordered promptly and sequences are reported completely. Among reported cases of HIV infection newly diagnosed during 2011-2013 in Maryland residents aged >/=13 years, we assessed sequence ascertainment completeness. To better understand which populations were most likely to have a sequence, we examined associations between sequence ascertainment and clinical and demographic characteristics. During 2011-2013, 4423 new HIV infection diagnoses were reported; sequences were ascertained for 1282 (29.0%). Among 3267 cases with complete data, odds for having a sequence ascertained were highest for cases in persons living inside Maryland's Central Region with initial CD4 counts </=500 cells/mm(3) (adjusted odds ratio [aOR] 2.4, 95% confidence interval [CI] 1.9-3.1). Sequence ascertainment did not vary significantly by patient age, sex, race/ethnicity or HIV transmission category. Educational interventions, policy changes and improved processes to increase timely DRT and subsequent sequence reporting with a focus on testing at entry to care, particularly for those with higher CD4 counts and those living outside the Central Region, might improve ascertainment completeness. |
Influenza A(H3N2) variant virus outbreak at three fairs - Maryland, 2017
Duwell MM , Blythe D , Radebaugh MW , Kough EM , Bachaus B , Crum DA , Perkins KAJr , Blanton L , Davis CT , Jang Y , Vincent A , Chang J , Abney DE , Gudmundson L , Brewster MG , Polsky L , Rose DC , Feldman KA . MMWR Morb Mortal Wkly Rep 2018 67 (42) 1169-1173 On September 17, 2017, the Maryland Department of Agriculture (MDA) was notified by fair and 4-H officials of ill swine at agricultural fair A, held September 14-17. That day, investigation of the 107 swine at fair A revealed five swine with fever and signs of upper respiratory tract illness. All five respiratory specimens collected from these swine tested positive for influenza A virus at the MDA Animal Health Laboratory, and influenza A(H3N2) virus was confirmed in all specimens by the U.S. Department of Agriculture National Veterinary Services Laboratory (NVSL). On September 18, MDA was notified by fair and 4-H officials that swine exhibitors were also ill. MDA alerted the Maryland Department of Health (MDH). A joint investigation with MDH and the local health department was started and later broadened to Maryland agricultural fairs B (September 13-17) and C (September 15-23). In total, 76 persons underwent testing for variant influenza, and influenza A(H3N2) variant (A(H3N2)v) virus infection was identified in 40 patients with exposure to swine at these fairs (Figure), including 30 (75%) who had more than one characteristic putting them at high risk for serious influenza complications; 24 (60%) of these were children aged <5 years. Twenty-six (65%) patients reported direct contact with swine (i.e., touching swine or swine enclosure), but 14 (35%) reported only indirect contact (e.g., walking through a swine barn). Two children required hospitalization; all patients recovered. This outbreak highlights the risk, particularly among children, for contracting variant influenza virus at agricultural fairs after direct or indirect swine contact. Publicizing CDC's recommendation that persons at high risk for serious influenza complications avoid pigs and swine barns might help prevent future variant influenza outbreaks among vulnerable groups (1). |
Influenza vaccine effectiveness in preventing influenza-associated hospitalizations during pregnancy: A multi-country retrospective test negative design study, 2010-2016
Thompson MG , Kwong JC , Regan AK , Katz MA , Drews SJ , Azziz-Baumgartner E , Klein NP , Chung H , Effler PV , Feldman BS , Simmonds K , Wyant BE , Dawood FS , Jackson ML , Fell DB , Levy A , Barda N , Svenson LW , Fink RV , Ball SW , Naleway A . Clin Infect Dis 2018 68 (9) 1444-1453 Background: To date, no study has examined influenza vaccine effectiveness (IVE) against laboratory-confirmed influenza-associated hospitalizations during pregnancy. Methods: The Pregnancy Influenza Vaccine Effectiveness Network (PREVENT) consisted of public health or healthcare systems with integrated laboratory, medical, and vaccination records in Australia, Canada (Alberta and Ontario), Israel, and the United States (California, Oregon, and Washington). Sites identified pregnant women aged 18 through 50 years whose pregnancies overlapped with local influenza seasons from 2010 through 2016. Administrative data were used to identify hospitalizations with acute respiratory or febrile illness (ARFI) and clinician-ordered real-time reverse transcription polymerase chain reaction (rRT-PCR) testing for influenza viruses. Overall IVE was estimated using the test-negative design and adjusting for site, season, season timing, and high-risk medical conditions. Results: Among 19450 hospitalizations with an ARFI discharge diagnosis (across 25 site-specific study seasons), only 1030 (6%) of the pregnant women were tested for influenza viruses by rRT-PCR. Approximately half of these women had pneumonia or influenza discharge diagnoses (54%). Influenza A or B virus infections were detected in 598/1030 (58%) of the ARFI hospitalizations with influenza testing. Across sites and seasons, 13% of rRT-PCR-confirmed influenza-positive pregnant women were vaccinated compared with 22% of influenza-negative pregnant women; the adjusted overall IVE was 40% (95% confidence interval = 12%-59%) against influenza-associated hospitalization during pregnancy. Conclusion: Between 2010 and 2016, influenza vaccines offered moderate protection against laboratory-confirmed influenza-associated hospitalizations during pregnancy, which may further inform the benefits of maternal influenza vaccination programs. |
Impacts of misclassification on Lyme disease surveillance
Rutz H , Hogan B , Hook S , Hinckley A , Feldman K . Zoonoses Public Health 2018 66 (1) 174-178 In Maryland, Lyme disease (LD) is the most widely reported tickborne disease. All laboratories and healthcare providers are required to report LD cases to the local health department. Given the large volume of LD reports, the nuances of diagnosing and reporting LD, and the effort required for investigations by local health department staff, surveillance for LD is burdensome and subject to underreporting. To determine the degree to which misclassification occurs in Maryland, we reviewed medical records for a sample of LD reports from 2009. We characterized what proportion of suspected and "not a case" reports could be reclassified as confirmed or probable once additional information was obtained from medical record review, explored the reasons for misclassification, and determined multipliers for a more accurate number of LD cases. We reviewed medical records for reports originally classified as suspected (n = 44) and "not a case" (n = 92). Of these 136 records, 31 (23%) suspected cases and "not a case" reports were reclassified. We calculated multipliers and applied them to the case counts from 2009, and estimate an additional 269 confirmed and probable cases, a 13.3% increase. Reasons for misclassification fell into three general categories: lack of clinical or diagnostic information from the provider; surveillance process errors; and incomplete information provided on laboratory reports. These multipliers can be used to calculate a better approximation of the true number of LD cases in Maryland, but these multipliers only account for underreporting due to misclassification, and do not account for cases that are not reported at all (e.g., LD diagnoses based on erythema migrans alone that are not reported) or for cases that are not investigated. Knowing that misclassification of cases occurs during the existing LD surveillance process underscores the complexities of LD surveillance, which further reinforces the need to find alternative approaches to LD surveillance. |
Respiratory syncytial virus hospitalization during pregnancy in four high-income countries, 2010-2016
Regan AK , Klein NP , Langley G , Drews SJ , Buchan S , Ball S , Kwong JC , Naleway A , Thompson M , Wyant BE , Levy A , Chung H , Feldman B , Katz M . Clin Infect Dis 2018 67 (12) 1915-1918 Few studies have addressed respiratory syncytial virus (RSV) infection during pregnancy. Among 846 pregnant women hospitalized with respiratory illness and tested for RSV, 21 (2%) were RSV positive, of whom 8 (38%) were diagnosed with pneumonia. Despite study limitations, these data can help inform decisions about RSV prevention strategies. |
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