Last data update: May 06, 2024. (Total: 46732 publications since 2009)
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Query Trace: Hawley B[original query] |
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Clinical characteristics and factors associated with COVID-19-related mortality and hospital admission during the first two epidemic waves in 5 rural provinces in Indonesia: A retrospective cohort study
Surendra H , Praptiningsih CY , Ersanti AM , Rahmat M , Noviyanti W , Harmani JAD , Mansur ENA , Suleman YY , Sudrani S , Rosalina R , Mukhtar I , Rosadi D , Fauzi L , Elyazar IRF , Hawley WA , Wibisono H . PLoS One 2023 18 (3) e0283805 BACKGROUND: Data on coronavirus disease 2019 (COVID-19) clinical characteristics and severity from resource-limited settings are limited. This study examined clinical characteristics and factors associated with COVID-19 mortality and hospitalisation in rural settings of Indonesia, from 1 January to 31 July, 2021. METHODS: This retrospective cohort included individuals diagnosed with COVID-19 based on polymerase chain reaction or rapid antigen diagnostic test, from five rural provinces in Indonesia. We extracted demographic and clinical data, including hospitalisation and mortality from a new piloted COVID-19 information system named Sistem Informasi Surveilans Epidemiologi (SISUGI). We used mixed-effect logistic regression to examine factors associated with COVID-19-related mortality and hospitalisation. RESULTS: Of 6,583 confirmed cases, 205 (3.1%) died and 1,727 (26.2%) were hospitalised. The median age was 37 years (Interquartile range 26-51), with 825 (12.6%) under 20 years, and 3,371 (51.2%) females. Most cases were symptomatic (4,533; 68.9%); 319 (4.9%) had a clinical diagnosis of pneumonia and 945 (14.3%) presented with at least one pre-existing comorbidity. Age-specific mortality rates were 0.9% (2/215) for 0-4 years; 0% (0/112) for 5-9 years; 0% (1/498) for 10-19 years; 0.8% (11/1,385) for 20-29 years; 0.9% (12/1,382) for 30-39 years; 2.1% (23/1,095) for 40-49 years; 5.4% (57/1,064) for 50-59 years; 10.8% (62/576) for 60-69 years; 15.9% (37/232) for ≥70 years. Older age, pre-existing diabetes, chronic kidney disease, liver diseases, malignancy, and pneumonia were associated with higher risk of mortality and hospitalisation. Pre-existing hypertension, cardiac diseases, COPD, and immunocompromised condition were associated with risk of hospitalisation but not with mortality. There was no association between province-level density of healthcare workers with mortality and hospitalisation. CONCLUSION: The risk of COVID-19-related mortality and hospitalisation was associated with higher age, pre-existing chronic comorbidities, and clinical pneumonia. The findings highlight the need for prioritising enhanced context-specific public health action to reduce mortality and hospitalisation risk among older and comorbid rural populations. |
2021 U.S. Virgin Islands Zika health brigade: Providing recommended pediatric health screenings for children born to mothers with laboratory evidence of possible Zika virus infection during pregnancy
deWilde LH , Harrison CJ , Ceesay BE , Mayers CS , Ferrol-Hawley J , Canton J , Godfred-Cato S , Reynolds MR , Brown-Shuler L , Randhawa S , Schoelles D , Hillman B , Carlos MP , Ambrose T , Bitner D , Holgado S , Jones C , Lattin DJ , Mulkey SB , Nguyen A , Payne M , Prakalapakorn SG , Shue A , Ellis EM . Birth Defects Res 2022 BACKGROUND: The United States Virgin Islands (USVI) Department of Health (DOH) conducted a second Zika health brigade (ZHB) in 2021 to provide recommended Zika-related pediatric health screenings, including vision, hearing, neurologic, and developmental screenings, for children in the USVI. This was replicated after the success of the first ZHB in 2018, which provided recommended Zika-related pediatric health screenings to 88 infants and children exposed to Zika virus (ZIKV) during pregnancy. METHODS: Ten specialty pediatric care providers were recruited and traveled to the USVI to conduct the screenings. USVI DOH scheduled appointments for children included in CDC's U.S. Zika Pregnancy and Infant Registry (USZPIR). During the ZHB, participants were examined by pediatric ophthalmologists, pediatric audiologists, and pediatric neurologists. We report the percentage of participants who were referred for additional follow-up care or given follow-up recommendations in the 2021 ZHB and compare these referrals and recommendations to those given in the 2018 ZHB. RESULTS: Thirty-three children born to mothers with laboratory evidence of ZIKV infection during pregnancy completed screenings at the 2021 ZHB, of which 15 (45%) children were referred for additional follow-up care. Ophthalmological screenings resulted in the highest number of new referrals for a specialty provider among ZHB participants, with 6 (18%) children receiving referrals for that specialty. Speech therapy was the most common therapy referral, with 10 (30%) children referred, of which 9 (90%) were among those who attended the 2018 ZHB. CONCLUSIONS: Thirty-three children in a jurisdiction with reduced access to healthcare specialists received recommended Zika-related pediatric health screenings at the ZHB. New and continuing medical and developmental concerns were identified and appropriate referrals for follow-up care and services were provided. The ZHB model was successful in creating connections to health services not previously received by the participants. |
SARS-CoV-2 Antibody Seroprevalence in Jakarta, Indonesia
Ariawan I , Jusril H , Farid MN , Riono P , Wahyuningsih W , Widyastuti , Handayani DOTL , Wahyuningsih ES , Daulay R , Henderiawati R , Malik SG , Noviyanti R , Trianty L , Fadila N , Myint KSA , Yudhaputri FA , Venkateswaran N , Venkateswaran K , Udhayakumar V , Hawley WA , Morgan J , Pronyk PM . Kesmas 2022 17 (3) 169-174 The SARS-CoV-2 transmission dynamics in low- and middle-income countries remain poorly understood. This study aimed to estimate the SARS-CoV-2 antibodies seroprevalence in Jakarta, Indonesia, and to increase knowledge of SARS-CoV-2 transmission in urban settings. A population-based serosurvey among individuals aged one year or older was conducted in Jakarta. Employing a multistage sampling design, samples were stratified by district, slum and non-slum residency, sex, and age group. Blood samples were tested for IgG against three different SARS-CoV-2 antigens. Seroprevalence was estimated after applying sample weights and adjusting for cluster characteristics. In March 2021, this study collected 4,919 respondents. The weighted estimate of seroprevalence was 44.5% (95% CI = 42.5-46.5). Seroprevalence was highest among adults aged 30-49 years, with higher seroprevalence in women and the overweight/obese group. Respondents residing in slum areas were 1.3-fold more likely to be seropositive than non-slum residents. It was estimated that 4,717,000 of Jakarta's 10.6 million residents had prior SARS-CoV-2 infection. This suggests that approximately 10 infections were undiagnosed/underreported for every reported case. About one year after the first COVID-19 case was confirmed, close to half of Jakarta's residents have been infected by SARS-CoV-2. Copyright © 2022, Kesmas: Jurnal Kesehatan Masyarakat Nasional (National Public Health Journal) |
Seroprevalence of SARS-CoV-2 antibodies in Bali Province: Indonesia shows underdetection of COVID-19 cases by routine surveillance
Sawitri AAS , Yuliyatni PCD , Astuti PAS , Ajis E , Prasetyowati EB , Husni , Morgan J , Mika J , Praptiningsih CY , Mangiri A , Mulyadi E , Noviyanti R , Trianty L , Hawley WA . PLoS Glob Public Health 2022 2 (8) e0000727 The international tourist destination of Bali reported its first case of Coronavirus Disease 2019 or COVID-19 in March 2020. To better understand the extent of exposure of Bali's 4.3 million inhabitants to the COVID-19 virus, we performed two repeated cross-sectional serosurveys stratified by urban and rural areas. We used a highly specific multiplex assay that detects antibodies to three different viral antigens. We also assessed demographic and social risk factors and history of symptoms. Our results show that the virus was widespread in Bali by late 2020, with 16.73% (95% CI 12.22-21.12) of the population having been infected by that time. We saw no differences in seroprevalence between urban and rural areas, possibly due to extensive population mixing, and similar levels of seroprevalence by gender and among age groups, except for lower seroprevalence in the very young. We observed no difference in seroprevalence between our two closely spaced surveys. Individuals reporting symptoms in the past six months were about twice as likely to be seropositive as those not reporting symptoms. Based upon official statistics for laboratory diagnosed cases for the six months prior to the survey, we estimate that for every reported case an additional 52 cases, at least, were undetected. Our results support the hypothesis that by late 2020 the virus was widespread in Bali, but largely undetected by surveillance. |
Quality of National Disease Surveillance Reporting before and during COVID-19: A Mixed-Method Study in Indonesia.
Hardhantyo M , Djasri H , Nursetyo AA , Yulianti A , Adipradipta BR , Hawley W , Mika J , Praptiningsih CY , Mangiri A , Prasetyowati EB , Brye L . Int J Environ Res Public Health 2022 19 (5) Background: Global COVID-19 outbreaks in early 2020 have burdened health workers, among them surveillance workers who have the responsibility to undertake routine disease surveillance activities. The aim of this study was to describe the quality of the implementation of Indonesia’s Early Warning and Response Alert System (EWARS) for disease surveillance and to measure the burden of disease surveillance reporting quality before and during the COVID-19 epidemic in Indonesia. Methods: A mixed-method approach was used. A total of 38 informants from regional health offices participated in Focus Group Discussion (FGD) and In-Depth Interview (IDI) for informants from Ministry of Health. The FGD and IDI were conducted using online video communication. Yearly completeness and timeliness of reporting of 34 provinces were collected from the application. Qualitative data were analyzed thematically, and quantitative data were analyzed descriptively. Results: Major implementation gaps were found in poorly distributed human resources and regional infrastructure inequity. National reporting from 2017–2019 showed an increasing trend of completeness (55%, 64%, and 75%, respectively) and timeliness (55%, 64%, and 75%, respectively). However, the quality of the reporting dropped to 53% and 34% in 2020 concomitant with the SARS-CoV2 epidemic. Conclusions: Report completeness and timeliness are likely related to regional infrastructure inequity and the COVID-19 epidemic. It is recommended to increase report capacities with an automatic EWARS application linked systems in hospitals and laboratories. © 2022 by the authors. Licensee MDPI, Basel, Switzerland. |
Stability of Zika virus antibodies in specimens from a retrospective serological study
Sasmono RT , Johar E , Yohan B , Ma'roef CN , Soebandrio A , Myint KS , Pronyk P , Hadinegoro SR , Soepardi EJ , Bouckenooghe A , Hawley W , Rosenberg R , Powers AM . Am J Trop Med Hyg 2021 105 (3) 853 We would like to respond to the letter by Zhang and others regarding our study published in the American Journal of Tropical Medicine and Hygiene.1 Our serum samples were all stored in annually calibrated –80°C freezers. The samples were only thawed once. In general, antibodies are known to remain stable in frozen storage over lengthy periods. There are numerous publications regarding antibody stability during storage,2–6 and we believe that all antibodies, including antibodies against Zika virus, will remain stable during storage. |
Spatiotemporal Heterogeneity of Zika Virus Transmission in Indonesia: Serosurveillance Data from a Pediatric Population
Sasmono RT , Johar E , Yohan B , Ma'roef CN , Pronyk P , Hadinegoro SR , Soepardi EJ , Bouckenooghe A , Hawley WA , Rosenberg R , Powers AM , Soebandrio A , Myint KSA . Am J Trop Med Hyg 2021 104 (6) 2220-3 The presence of Zika virus (ZIKV) in Indonesia has been recognized since the 1970s, but its transmission dynamics there have been poorly understood. To understand more fully the geographic distribution and burden of ZIKV disease, we performed retrospective serological tests on specimens collected from asymptomatic children age 5 to 9 years old living at 30 sites in 14 provinces. Of 870 serum samples tested, 9.2% were found to be positive for anti-ZIKV antibodies, as confirmed by plaque reduction neutralization assays. This was the same overall prevalence reported previously for 1- to 4-year-old children collected at the same sites at the same time. Together with geographic differences in seroprevalence between the age groups, these data suggest that, although ZIKV might be endemic in Indonesia, its occurrence has been focal and episodic. |
Common and Unique Barriers to the Exchange of Administrative Healthcare Data in Environmental Public Health Tracking Program
Shin M , Hawley C , Strosnider H . Int J Environ Res Public Health 2021 18 (8) CDC's National Environmental Public Health Tracking Program (Tracking Program) receives administrative data annually from 25-30 states to track potential environmental exposures and to make data available for public access. In 2019, the CDC Tracking Program conducted a cross-sectional survey among principal investigators or program managers of the 26 funded programs to improve access to timely, accurate, and local data. All 26 funding recipients reported having access to hospital inpatient data, and most states (69.2%) regularly update data user agreements to receive the data. Among the respondents, 15 receive record-level data with protected health information (PHI) and seven receive record-level data without PHI. Regarding geospatial resolution, approximately 50.0% of recipients have access to the street address or census tract information, 34.6% have access to ZIP code, and 11.5% have other sub-county geographies (e.g., town). Only three states receive administrative data for their residents from all border states. The survey results will help the Tracking Program to identify knowledge gaps and perceived barriers to the use and accessibility of administrative data for the CDC Tracking Program. The information collected will inform the development of resources that can provide solutions for more efficient and timely data exchange. |
Maternal urinary concentrations of organophosphate ester metabolites: associations with gestational weight gain, early life anthropometry, and infant eating behaviors among mothers-infant pairs in Rhode Island
Crawford KA , Hawley N , Calafat AM , Jayatilaka NK , Froehlich RJ , Has P , Gallagher LG , Savitz DA , Braun JM , Werner EF , Romano ME . Environ Health 2020 19 (1) 97 BACKGROUND: Organophosphate esters (OPEs)-used as flame retardants and plasticizers-are associated with adverse pregnancy outcomes such as reduced fecundity and live births and increased preterm delivery. OPEs may interfere with growth and metabolism via endocrine-disruption, but few studies have investigated endocrine-related outcomes. The objective of this pilot study (n = 56 mother-infant pairs) was to evaluate associations of OPEs with gestational weight gain (GWG), gestational age at delivery, infant anthropometry, and infant feeding behaviors. METHODS: We quantified OPE metabolites (bis-2-chloroethyl phosphate [BCEP], bis (1,3-dichloro-2-propyl) phosphate [BDCPP], diphenyl phosphate [DPHP]) in pooled maternal spot urine collected throughout pregnancy (~ 12, 28, and 35 weeks' gestation). We obtained maternal sociodemographic characteristics from questionnaires administered at enrollment and perinatal characteristics from medical record abstraction. Trained research assistants measured infant weight, length, head and abdominal circumferences, and skinfold thicknesses at birth and 6 weeks postpartum. Mothers reported infant feeding behavior via the Baby Eating Behavior Questionnaire (BEBQ). Using multiple linear regression, we assessed associations of log(2)-transformed maternal urinary OPE metabolites with GWG, gestational age at delivery, infant anthropometry at birth, weekly growth rate, and BEBQ scores at 6 weeks postpartum. We used linear mixed effects (LME) models to analyze overall infant anthropometry during the first 6 weeks of life. Additionally, we considered effect modification by infant sex. RESULTS: We observed weak positive associations between all OPE metabolites and GWG. In LME models, BDCPP was associated with increased infant length (β = 0.44 cm, 95%CI = 0.01, 0.87) and weight in males (β = 0.14 kg, 95%CI = 0.03, 0.24). BDCPP was also associated with increased food responsiveness (β = 0.23, 95%CI = 0.06, 0.40). DPHP was inversely associated with infant abdominal circumference (β = - 0.50 cm, 95%CI = - 0.86, - 0.14) and female weight (β = - 0.19 kg, 95%CI = - 0.36, - 0.02), but positively associated with weekly growth in iliac skinfold thickness (β = 0.10 mm/wk., 95%CI = 0.02, 0.19). Further, DPHP was weakly associated with increased feeding speed. BCEP was associated with greater infant thigh skinfold thickness (β = 0.34 mm, 95%CI = 0.16, 0.52) and subscapular skinfold thickness in males (β = 0.14 mm, 95%CI = 0.002, 0.28). CONCLUSIONS: Collectively, these findings suggest that select OPEs may affect infant anthropometry and feeding behavior, with the most compelling evidence for BDCPP and DPHP. |
Work tasks as determinants of respirable and inhalable indium exposure among workers at an indium-tin oxide production and reclamation facility
Hawley Blackley B , Cummings KJ , Stanton M , Stefaniak AB , Gibbs JL , Park JY , Harvey RR , Virji MA . Ann Work Expo Health 2019 64 (2) 175-184 Increased global demand for touch screens, photovoltaics, and optoelectronics has resulted in an increase in the production of indium-tin oxide (ITO). Occupational exposure to indium compounds is associated with the development of indium lung disease. Although many previous epidemiologic investigations highlight an excess of lung abnormalities in workplaces where ITO is produced, few assessments of occupational exposure to respirable and inhalable indium are reported to date. The objective of this study was to identify the determinants of respirable and inhalable indium at an ITO production facility to target exposure interventions. In 2012 and 2014, we conducted exposure assessments at an ITO production facility and collected full-shift personal respirable (n = 159) and inhalable (n = 57) indium samples. We also observed workers and recorded information on task duration and location, materials used, and use of personal protective equipment (PPE). Tasks (n = 121) recorded in task diaries were categorized into 40 similar task groups using the Advanced REACH Tool and process-related information. Mixed-effects models were fit separately for log-transformed respirable and inhalable indium, with random effect of subject and fixed effects of task groups. Overall, respirable and inhalable indium measurements ranged from 0.1 to 796.6 microg m-3 and 1.6 to 10 585.7 microg m-3, respectively, and were highly correlated with Spearman correlation coefficient of 0.90. The final model for respirable indium explained 36.3% of total variance and identified sanding, powder transfer tasks in reclaim, powder transfer tasks in refinery, handling indium materials, and liquid transfer tasks in ITO production as tasks associated with increased respirable indium exposure. The final model for inhalable indium explained 24.6% of total variance and included powder transfer tasks in ITO production, cleaning cylinder or tile, and handling indium material tasks. Tasks identified as strong predictors of full-shift exposure to respirable and inhalable indium can guide the use of engineering, administrative, and PPE controls designed to mitigate occupational exposure to indium. Moreover, since the tasks were aligned with REACH activities, results from this study can also be used to inform REACH activity scenarios. |
Integrated vector management with additional pre-transmission season thermal fogging is associated with a reduction in dengue incidence in Makassar, Indonesia: Results of an 8-year observational study
Wahid I , Ishak H , Hafid A , Fajri M , Sidjal S , Nurdin A , Azikin NT , Sudirman R , Hasan H , Yusuf M , Bachtiar I , Hawley WA , Rosenberg R , Lobo NF . PLoS Negl Trop Dis 2019 13 (8) e0007606 Dengue virus transmission is endemic in Makassar, Indonesia, with the majority of cases reported soon after the start of the annual rainy season. Before 2006, larval source reduction, larvaciding, and reactive routine, outdoor, insecticide fogging campaigns did not result in a reduction in seasonal dengue incidence. Beginning in 2006, village volunteers conducted comprehensive surveys for immature Aedes during the dry season, when vector populations were at their lowest. Based on this pre-season vector data, a single additional pre-emptive outdoor fogging with Malathion was conducted once annually before the rains began in villages with a pre-defined proportion of sampled houses positive for Aedes immatures. This additional procedure was associated with reduced temporal larval indices as well as an 83% reduction in reported cases during the transmission season over the 8-year period of implementation. Two cities adjacent to Makassar experienced substantial but smaller reductions in dengue incidence; while other cities further from the intervention area did not. This represents the first time an integrated intervention strategy has been coupled with substantially reduced dengue transmission in Indonesia. |
2018 U.S. Virgin Islands Zika health brigade: Providing recommended pediatric health screenings for infants born to mothers with laboratory evidence of Zika virus exposure during pregnancy
Hillman B , Petersen DN , Galang RR , Godfred-Cato S , Mayers C , Thomas Y , Prosper A , Hawley J , Halbert M , Noe M , Reynolds M , Schoelles D , Brown-Shuler L , Fehrenbach N , Ellis EM . Birth Defects Res 2019 111 (7) 360-362 On March 19–24, 2018, the U.S. Virgin Islands (USVI) Department of Health (DOH) hosted a health brigade on the islands of St. Thomas and St. Croix to provide recommended Zika-related pediatric health screenings to infants born to mothers with laboratory evidence of Zika virus exposure during pregnancy (Adebanjo et al., 2017). For families in USVI, challenges to accessing recommended Zika-related pediatric health screenings include a lack of pediatric healthcare specialists, cost of screenings, and complexity of planning visits with multiple providers between and off the islands. |
Potential hazards not communicated in safety data sheets of flavoring formulations, including diacetyl and 2,3-pentanedione
LeBouf RF , Hawley B , Cummings KJ . Ann Work Expo Health 2018 63 (1) 124-130 Objectives: Workers using flavoring formulations containing diacetyl and 2,3-pentanedione may be at risk of inhalational exposure, as these volatile hazardous chemicals are emitted from the bulk material, especially at elevated temperatures. However, flavoring formulations that contain diacetyl and 2,3-pentanedione might not list these ingredients because they are generally recognized as safe to ingest, may be part of a proprietary mixture deemed a trade secret, or may not be required to be listed if they are present at <1% composition. The objective of this study was to investigate whether potential inhalational hazards present in flavoring samples were reported as chemical ingredients on their corresponding safety data sheets (SDSs). Methods: A convenience sample of 26 bulk liquid flavorings obtained from two coffee roasting and packaging facilities in the USA was analyzed for 20 volatile organic chemicals present in the headspaces of vials containing flavoring liquids using gas chromatography-mass spectrometry. Flavoring samples were included in the study if headspace analysis results and SDSs were available. Flavoring samples included hazelnut, French vanilla, amaretto, chocolate, and caramel as well as some flavoring mixtures containing added fruit flavors such as cherry and raspberry. The presence of a chemical in the flavoring formulation was then compared to the ingredient list on the SDSs. Results: All the flavoring SDSs contained trade secret designations. None of the SDSs listed diacetyl or 2,3-pentanedione. Headspace analyte concentrations revealed that diacetyl was present in 21 of 26 samples (81%) with a maximum concentration of 5.84 x 104 microg m-3 in flavor 18 (caramel). 2,3-Pentanedione was present in 15 flavors (58%) with a maximum concentration of 3.79 x 105 microg m-3 in flavor 24 (oatmeal cookies). Conclusions: A majority of the flavorings tested had diacetyl, 2,3-pentanedione, or both as volatile constituents in the headspace. These chemicals were not listed on the SDSs, but inclusion of diacetyl and 2,3-pentanedione on SDSs would serve to protect downstream users from unrecognized exposure and potential respiratory disease. The headspace technique presented here is a viable tool to rapidly screen for volatile hazardous chemicals that may be present in flavoring formulations. Facilities that use flavorings should be aware that constituents in flavorings may present a potential inhalational hazard even if not identified as such by the SDS. A precautionary approach is warranted when working with flavorings, including exposure monitoring and effective exposure control strategies such as containment and local exhaust ventilation. |
A field evaluation of a single sampler for respirable and inhalable indium and dust measurements at an indium-tin oxide manufacturing facility
Hawley B , Gibbs JL , Cummings K , Stefaniak AB , Park JY , Stanton M , Virji MA . J Occup Environ Hyg 2018 16 (1) 1-30 Indium-tin oxide production has increased greatly in the last twenty years subsequent to increased global demand for touch screens and photovoltaics. Previous studies used measurements of indium in blood as an indicator of indium exposure and observed associations with adverse respiratory outcomes. However, correlations between measurements of blood indium and airborne respirable indium are inconsistent, in part because of the long half-life of indium in blood, but also because respirable indium measurements do not incorporate inhalable indium that can contribute to the observed biological burden. Information is lacking on relationships between respirable and inhalable indium exposure, which have implications for biological indicators like blood indium. The dual IOM sampler includes the foam disc insert and can simultaneously collect respirable and inhalable aerosol. Here, the field performance of the dual IOM sampler was evaluated by comparing performance with the respirable cyclone and traditional IOM for respirable and inhalable indium and dust exposure, respectively. Side-by-side area air samples were collected throughout an indium-tin oxide manufacturing facility. Cascade impactors were used to determine particle size distribution. Several statistical methods were used to evaluate the agreement between the pairs of samplers including calculating the concordance correlation coefficient and its accuracy and precision components. One-way ANOVA was used to evaluate the effect of dust concentration on sampler differences. Respirable indium measurements showed better agreement (concordance correlation coefficient: 0.932) compared to respirable dust measurements (concordance correlation coefficient: 0.777) with significant differences observed in respirable dust measurements. The dual IOM measurements had high agreement with the traditional IOM for inhalable indium (concordance correlation coefficient: 0.997) but lower agreement for inhalable dust (concordance correlation coefficient: 0.886 and accuracy: 0.896) with a significantly large mean bias (-146.5 microg/m(3)). Dust concentration significantly affected sampler measurements of inhalable dust and inhalable indium. Results from this study suggest that the dual IOM is a useful single sampler for simultaneous measurements of occupational exposure to respirable and inhalable indium. |
Zika virus seropositivity in 1-4-year-old children, Indonesia, 2014
Sasmono RT , Dhenni R , Yohan B , Pronyk P , Hadinegoro SR , Soepardi EJ , Ma'roef CN , Satari HI , Menzies H , Hawley WA , Powers AM , Rosenberg R , Myint KSA , Soebandrio A . Emerg Infect Dis 2018 24 (9) 1740-3 We assessed Zika virus seroprevalence among healthy 1-4-year-old children using a serum sample collection assembled in 2014 representing 30 urban sites across Indonesia. Of 662 samples, 9.1% were Zika virus seropositive, suggesting widespread recent Zika virus transmission and immunity. Larger studies are needed to better determine endemicity in Indonesia. |
Quantifying primaquine effectiveness and improving adherence: a round table discussion of the APMEN Vivax Working Group
Thriemer K , Bobogare A , Ley B , Gudo CS , Alam MS , Anstey NM , Ashley E , Baird JK , Gryseels C , Jambert E , Lacerda M , Laihad F , Marfurt J , Pasaribu AP , Poespoprodjo JR , Sutanto I , Taylor WR , van den Boogaard C , Battle KE , Dysoley L , Ghimire P , Hawley B , Hwang J , Khan WA , Mudin RNB , Sumiwi ME , Ahmed R , Aktaruzzaman MM , Awasthi KR , Bardaji A , Bell D , Boaz L , Burdam FH , Chandramohan D , Cheng Q , Chindawongsa K , Culpepper J , Das S , Deray R , Desai M , Domingo G , Duoquan W , Duparc S , Floranita R , Gerth-Guyette E , Howes RE , Hugo C , Jagoe G , Sariwati E , Jhora ST , Jinwei W , Karunajeewa H , Kenangalem E , Lal BK , Landuwulang C , Le Perru E , Lee SE , Makita LS , McCarthy J , Mekuria A , Mishra N , Naket E , Nambanya S , Nausien J , Duc TN , Thi TN , Noviyanti R , Pfeffer D , Qi G , Rahmalia A , Rogerson S , Samad I , Sattabongkot J , Satyagraha A , Shanks D , Sharma SN , Sibley CH , Sungkar A , Syafruddin D , Talukdar A , Tarning J , Kuile FT , Thapa S , Theodora M , Huy TT , Waramin E , Waramori G , Woyessa A , Wongsrichanalai C , Xa NX , Yeom JS , Hermawan L , Devine A , Nowak S , Jaya I , Supargiyono S , Grietens KP , Price RN . Malar J 2018 17 (1) 241 The goal to eliminate malaria from the Asia-Pacific by 2030 will require the safe and widespread delivery of effective radical cure of malaria. In October 2017, the Asia Pacific Malaria Elimination Network Vivax Working Group met to discuss the impediments to primaquine (PQ) radical cure, how these can be overcome and the methodological difficulties in assessing clinical effectiveness of radical cure. The salient discussions of this meeting which involved 110 representatives from 18 partner countries and 21 institutional partner organizations are reported. Context specific strategies to improve adherence are needed to increase understanding and awareness of PQ within affected communities; these must include education and health promotion programs. Lessons learned from other disease programs highlight that a package of approaches has the greatest potential to change patient and prescriber habits, however optimizing the components of this approach and quantifying their effectiveness is challenging. In a trial setting, the reactivity of participants results in patients altering their behaviour and creates inherent bias. Although bias can be reduced by integrating data collection into the routine health care and surveillance systems, this comes at a cost of decreasing the detection of clinical outcomes. Measuring adherence and the factors that relate to it, also requires an in-depth understanding of the context and the underlying sociocultural logic that supports it. Reaching the elimination goal will require innovative approaches to improve radical cure for vivax malaria, as well as the methods to evaluate its effectiveness. |
Malaria elimination in Indonesia: halfway there
Sitohang V , Sariwati E , Fajariyani SB , Hwang D , Kurnia B , Hapsari RK , Laihad FJ , Sumiwi ME , Pronyk P , Hawley WA . Lancet Glob Health 2018 6 (6) e604-e606 Indonesia marked a major milestone in 2017, with more than half of districts officially declared malaria free. This is an important accomplishment for an equatorial country with 25 species of malaria-receptive Anopheles mosquitoes; a dual Plasmodium falciparum and Plasmodium vivax caseload in almost equal proportions; a large, dispersed population (>260 million and >5000 inhabited islands); high internal migration; socioeconomic inequality; and decentralised governance.1 |
Comparative evaluation of anopheline sampling methods in three localities in Indonesia
St Laurent B , Sukowati S , Burton TA , Bretz D , Zio M , Firman S , Sumardi , Sudibyo H , Safitri A , Suwito , Asih PB , Kosasih S , Shinta , Hawley WA , Burkot TR , Collins FH , Syafruddin D , Lobo NF . Malar J 2018 17 (1) 13 BACKGROUND: The effectiveness of vector control efforts can vary based on the interventions used and local mosquito behaviour and adaptability. In many settings, biting patterns of Anopheles mosquitoes can shift in response to interventions targeting indoor-biting mosquitoes, often resulting in higher proportions of mosquitoes feeding outside or at times when people are not protected. These behaviourally resistant mosquitoes have been shown to sustain residual malaria transmission and limit control efforts. Therefore, it is important to accurately sample mosquitoes to understand their behaviour. METHODS: A variety of traps were evaluated in three geographically diverse sites in malaria-endemic Indonesia to investigate local mosquito feeding behaviour and determine effective traps for surveillance. RESULTS: Eight traps were evaluated in three sites: Canti village, Lampung, Kaliharjo village, Purworejo, and Saketa village, Halmahera, Indonesia, including the gold standard human landing collection (HLC) and a variety of traps targeting host-seeking and resting mosquitoes both indoors and outdoors. Trapping, using indoor and outdoor HLC, the Ifakara tent trap C, goat and human-occupied tents, resting pots and boxes, and CDC miniature light traps was conducted for 16 nights in two sites and 8 nights in a third site, using a Latin square design. Trap efficacy varied by site, with outdoor HLC yielding the highest catch rates in Canti and Kaliharjo and a goat-baited tent trap proving most effective in Saketa. In Canti village, anthropophilic Anopheles sundaicus were caught indoors and outdoors using HLCs, peaking in the early morning. In Kaliharjo, a variety of mosquitoes were caught, mostly outdoors throughout the night. HLC was ineffective in Saketa, the only site where a goat-baited tent trap was tested. This trap was effective in catching zoophilic vectors outdoors before midnight. CONCLUSIONS: Different trapping methods were suitable for different species, likely reflecting differences in behaviour among species. The three villages, each located on a different island in the Indonesian archipelago, contained mosquito populations with unique behaviours. These data suggest that the effectiveness of specific vector monitoring and control measures may vary by location. |
Serum YKL-40 in workers at an indium-tin oxide production facility
Harvey RR , Hawley BM , Virji MA , Cummings KJ . Respirology 2017 23 (3) 341-342 We read with great interest the study by Bonella et al., in which the authors evaluated the utility of serum YKL-40 as a biomarker for pulmonary alveolar proteinosis (PAP).1 They found that YKL-40 correlated with respiratory impairment and disease outcome. The study subjects had primary autoimmune PAP, characterized by elevated GM-CSF antibodies. Less commonly, secondary PAP can occur in association with immunosuppression, haematological disorders and occupational inhalation exposure to certain dusts or fumes. GM-CSF antibodies are generally within the normal range in cases of secondary PAP, although the role of GM-CSF antibodies in secondary PAP due to occupational dust exposure remains an area of active inquiry.2 |
Respiratory symptoms in hospital cleaning staff exposed to a product containing hydrogen peroxide, peracetic acid, and acetic acid
Hawley B , Casey M , Virji MA , Cummings KJ , Johnson A , Cox-Ganser J . Ann Work Expo Health 2017 62 (1) 28-40 Cleaning and disinfecting products consisting of a mixture of hydrogen peroxide (HP), peracetic acid (PAA), and acetic acid (AA) are widely used as sporicidal agents in health care, childcare, agricultural, food service, and food production industries. HP and PAA are strong oxidants and their mixture is a recognized asthmagen. However, few exposure assessment studies to date have measured HP, PAA, and AA in a health care setting. In 2015, we performed a health and exposure assessment at a hospital where a new sporicidal product, consisting of HP, PAA, and AA was introduced 16 months prior. We collected 49 full-shift time-weighted average (TWA) air samples and analyzed samples for HP, AA, and PAA content. Study participants were observed while they performed cleaning duties, and duration and frequency of cleaning product use was recorded. Acute upper airway, eye, and lower airway symptoms were recorded in a post-shift survey (n = 50). A subset of 35 cleaning staff also completed an extended questionnaire that assessed symptoms reported by workers as regularly occurring or as having occurred in the previous 12 months. Air samples for HP (range: 5.5 to 511.4 ppb) and AA (range: 6.7 to 530.3 ppb) were all below established US occupational exposure limits (OEL). To date, no full-shift TWA OEL for PAA has been established in the United States, however an OEL of 0.2 ppm has been suggested by several research groups. Air samples for PAA ranged from 1.1 to 48.0 ppb and were well below the suggested OEL of 0.2 ppm. Hospital cleaning staff using a sporicidal product containing HP, PAA, and AA reported work-shift eye (44%), upper airway (58%), and lower airway (34%) symptoms. Acute nasal and eye irritation were significantly positively associated with increased exposure to the mixture of the two oxidants: HP and PAA, as well as the total mixture (TM)of HP, PAA, and AA. Shortness of breath when hurrying on level ground or walking up a slight hill was significantly associated with increased exposure to the oxidant mixture (P = 0.017), as well as the TM (P = 0.026). Our results suggest that exposure to a product containing HP, PAA, and AA contributed to eye and respiratory symptoms reported by hospital cleaning staff at low levels of measured exposure. |
Carbon monoxide exposure in workplaces, including coffee processing facilities
Hawley B , Cox-Ganser JM , Cummings KJ . Am J Respir Crit Care Med 2017 196 (8) 1080-1081 We read the recent review of carbon monoxide (CO) poisoning by Rose and colleagues (1) with great interest. To their excellent summary, we would add mention of the burden of occupational CO exposure: 13% of nonfatal carbon monoxide poisoning cases seen in U.S. emergency departments during a 3-year period were exposed at work (2), and CO exposure is the leading cause of fatality resulting from acute chemical inhalation among US workers (3). Because CO is odorless and tasteless, patients may not be aware of workplace CO exposures. Thus, it is important for clinicians to be familiar with occupational sources of CO. | Occupations that are known to have greater risk for CO poisoning include jobs that require working around combustion sources such as engines and fires and include mechanics, firefighters, longshore workers, diesel engine and forklift operators, and tunnel or toll booth attendants (3). Other occupations that have been largely overlooked but also carry risk for CO exposure include those as varied as warehouse workers, who use propane or diesel forklifts, and restaurant workers, such as charcoal meat grillers and indoor barbeque workers (4). |
Host attraction and biting behaviour of Anopheles mosquitoes in South Halmahera, Indonesia
St Laurent B , Burton TA , Zubaidah S , Miller HC , Asih PB , Baharuddin A , Kosasih S , Shinta , Firman S , Hawley WA , Burkot TR , Syafruddin D , Sukowati S , Collins FH , Lobo NF . Malar J 2017 16 (1) 310 BACKGROUND: Indonesia is home to a variety of malaria vectors whose specific bionomic traits remain largely uncharacterized. Species-specific behaviours, such as host feeding preferences, impact the dynamics of malaria transmission and the effectiveness of vector control interventions. METHODS: To examine species-specific host attraction and feeding behaviours, a Latin square design was used to compare Anopheles mosquitoes attracted to human, cow, and goat-baited tents. Anopheles mosquitoes were collected hourly from the inside walls of each baited tent. Species were morphologically and then molecularly identified using rDNA ITS2 sequences. The head and thorax of individual specimens were analysed for Plasmodium DNA using PCR. Bloodmeals were identified using a multiplex PCR. RESULTS: A total of 1024, 137, and 74 Anopheles were collected over 12 nights in cow, goat, and human-baited tents, respectively. The species were identified as Anopheles kochi, Anopheles farauti s.s., Anopheles hackeri, Anopheles hinesorum, Anopheles indefinitus, Anopheles punctulatus, Anopheles tessellatus, Anopheles vagus, and Anopheles vanus, many of which are known to transmit human malaria. Molecular analysis of blood meals revealed a high level of feeding on multiple host species in a single night. Anopheles kochi, An. indefinitus, and An. vanus were infected with Plasmodium vivax at rates comparable to primary malaria vectors. CONCLUSIONS: The species distributions of Anopheles mosquitoes attracted to human, goat, and cow hosts were similar. Eight of nine sporozoite positive samples were captured with animal-baited traps, indicating that even predominantly zoophilic mosquitoes may be contributing to malaria transmission. Multiple host feeding and flexibility in blood feeding behaviour have important implications for malaria transmission, malaria control, and the effectiveness of intervention and monitoring methods, particularly those that target human-feeding vectors. |
Experimental evaluation of respirable dust and crystalline silica controls during simulated performance of stone countertop fabrication tasks with powered hand tools
Johnson DL , Phillips ML , Qi C , Van AT , Hawley DA . Ann Work Expo Health 2017 61 (6) 711-23 Objectives: Workers who fabricate stone countertops using hand tools are at risk of silicosis from overexposure to respirable crystalline silica. This study explored the efficacy of simple engineering controls that can be used for dust suppression during use of hand tools by stone countertop fabricators. Methods: Controlled experiments were conducted to measure whether wet methods and on-tool local exhaust ventilation (LEV) reduced respirable dust (RD) exposures during use of various powered hand tools on quartz-rich engineered stone. RD samples collected during edge grinding with a diamond cup wheel and a silicon carbide abrasive wheel were analyzed gravimetrically as well as by X-ray diffraction to determine silica content. A personal optical aerosol monitor was used simultaneously with the RD samples and also for rapid assessment of controls for polishing, blade cutting, and core drilling. Results: On-tool LEV and sheet-flow-wetting were effective in reducing exposures, especially when used in combination. Sheet-flow-wetting with LEV reduced geometric mean exposures by as much as 95%. However, typical water-spray-wetting on a grinding cup was less effective when combined with LEV than without LEV. Mean silica content of RD samples from grinding operations was 53%, and respirable mass and silica mass were very highly correlated (r = 0.980). Optical concentration measures were moderately well correlated with gravimetric measures (r = 0.817), but on average the optical measures during a single trial using the factory calibration were only one-fifth the simultaneous gravimetric measures. Conclusions: Sheet-flow-wetting combined with on-tool LEV is an effective engineering control for reducing RD exposures during engineered stone edge grinding and blade cutting. On the other hand, addition of LEV to some water-spray-wetted tools may reduce the effectiveness of the wet method. |
Health problems and disinfectant product exposure among staff at a large multispecialty hospital
Casey ML , Hawley B , Edwards N , Cox-Ganser JM , Cummings KJ . Am J Infect Control 2017 45 (10) 1133-1138 BACKGROUND: Hospital staff expressed health concerns after a surface disinfectant product containing hydrogen peroxide, peracetic acid, and acetic acid was introduced. We sought to determine if this product posed a health hazard. METHODS: An interviewer-administered questionnaire on work and health characteristics was completed by 163 current staff. Symptoms that improved away from work were considered work-related. Forty-nine air samples were taken for hydrogen peroxide, peracetic acid, and acetic acid. Prevalence ratios (PRs) were calculated using Poisson regression, and standardized morbidity ratios (SMRs) were calculated using nationally representative data. RESULTS: Product users reported higher prevalence of work-related wheeze and watery eyes than nonusers (P < .05). Workers in the department with the highest air measurements had significantly higher prevalence of watery eyes (PR, 2.88; 95% confidence interval [CI], 1.18-7.05) than those in departments with lower air measurements, and they also had a >3-fold excess of current asthma (SMR, 3.47; 95% CI, 1.48-8.13) compared with the U.S. POPULATION: CONCLUSIONS: This disinfectant product was associated with mucous membrane and respiratory health effects. Risks of mucous membrane irritation and asthma in health care workers should be considered in development of disinfection protocols to protect patients from hospital-acquired infections. Identification of optimal protocols that reduce worker exposures while maintaining patient safety is needed. |
Allergic sinusitis and severe asthma caused by occupational exposure to locust bean gum: Case report
Hawley B , Cummings KJ , Mohammed M , Dimmock AE , Bascom R . Am J Ind Med 2017 60 (7) 658-663 We present a case that highlights the difficulties with diagnosis and the dangers of occupational allergic sinusitis and asthma left unrecognized. We describe the case history of a man who experienced work-related symptoms 1 year after beginning work as a cheesemaker at a creamery, and whose respiratory symptoms progressively worsened over 16 years before an occupational cause of his asthma was identified. His initial discrete episodes of sinusitis and acute bronchitis evolved into persistent asthma of increasing severity with exacerbations requiring repeated emergency room treatment. The case described in our report emphasizes the importance of clinician diagnosis of OA, and subsequent removal from exposure, such that asthma severity does not progress to near-fatal or fatal asthma in the sensitized worker. As demonstrated by this case report, identification of an occupational cause of asthma relies on a high degree of suspicion and excellent detective work by the clinician. |
Variability and predictors of urinary concentrations of organophosphate flame retardant metabolites among pregnant women in Rhode Island
Romano ME , Hawley NL , Eliot M , Calafat AM , Jayatilaka NK , Kelsey K , McGarvey S , Phipps MG , Savitz DA , Werner EF , Braun JM . Environ Health 2017 16 (1) 40 BACKGROUND: Organophospate flame retardants (PFRs) are chemicals of emerging concern due to restrictions on polybrominated diphenyl ether flame retardant formulations. We describe the occurrence, variability, and predictors of urinary metabolites of PFRs among pregnant women. METHODS: In 2014-2015, 59 women from Providence, RI provided up to 3 spot urine samples during pregnancy (~12, 28, and 35 weeks' gestation). We created a pooled urine sample per woman and measured nine relevant metabolites in individual and pooled samples. We used linear mixed models to calculate intraclass correlation coefficients (ICCs) across the 3 measurements and to assess sociodemographic and dietary predictors of PFRs. RESULTS: The median (IQR) of bis-2-chloroethyl phosphate (BCEP), bis(1,3-dichloro-2-propyl) phosphate (BDCPP), and diphenyl phosphate (DPhP), the metabolites most frequently detected, from pooled samples were: 0.31 mug/L (0.17-0.54), 1.18 mug/L (0.64-2.19), 0.93 mug/L (0.72-1.97), respectively. We observed fair to good reproducibility for BCEP (ICC = 0.50), BDCPP (ICC = 0.60), and DPhP (ICC = 0.43), and excellent agreement between the urinary flame retardant metabolite concentrations averaged across pregnancy versus pooled urine sample concentrations for BCEP (ICC = 0.95), BDCPP (ICC = 0.89), and DPhP (ICC = 0.93). Adjusting for pertinent sociodemographic factors and gestational week of urine collection, each 1 kg increase in pre-pregnancy weight was associated with greater BCEP (1.1%; 95% CI: 0.1, 2.1), BDCPP (1.5%; 95% CI: 0.3, 2.7), and DPhP (0.5%; 95% CI: 0.0, 1.1). Dietary factors were generally not associated with urinary flame retardant metabolites. CONCLUSIONS: Urinary concentrations of BCEP, BDCPP, and DPhP were frequently detected among women in this pilot study and had fair reproducibility across pregnancy. Body size may be an important predictor of urinary flame retardant metabolite concentrations. |
Murine precision-cut lung slices exhibit acute responses following exposure to gasoline direct injection engine emissions
Maikawa CL , Zimmerman N , Rais K , Shah M , Hawley B , Pant P , Jeong CH , Delgado-Saborit JM , Volckens J , Evans G , Wallace JS , Godri Pollitt KJ . Sci Total Environ 2016 568 1102-1109 Gasoline direct injection (GDI) engines are increasingly prevalent in the global vehicle fleet. Particulate matter emissions from GDI engines are elevated compared to conventional gasoline engines. The pulmonary effects of these higher particulate emissions are unclear. This study investigated the pulmonary responses induced by GDI engine exhaust using an ex vivo model. The physiochemical properties of GDI engine exhaust were assessed. Precision cut lung slices were prepared using Balb/c mice to evaluate the pulmonary response induced by one-hour exposure to engine-out exhaust from a laboratory GDI engine operated at conditions equivalent to vehicle highway cruise conditions. Lung slices were exposed at an air-liquid interface using an electrostatic aerosol in vitro exposure system. Particulate and gaseous exhaust was fractionated to contrast mRNA production related to polycyclic aromatic hydrocarbon (PAH) metabolism and oxidative stress. Exposure to GDI engine exhaust upregulated genes involved in PAH metabolism, including Cyp1a1 (2.71, SE=0.22), and Cyp1b1 (3.24, SE=0.12) compared to HEPA filtered air (p<0.05). GDI engine exhaust further increased Cyp1b1 expression compared to filtered GDI engine exhaust (i.e., gas fraction only), suggesting this response was associated with the particulate fraction. Exhaust particulate was dominated by high molecular weight PAHs. Hmox1, an oxidative stress marker, exhibited increased expression after exposure to GDI (1.63, SE=0.03) and filtered GDI (1.55, SE=0.04) engine exhaust compared to HEPA filtered air (p<0.05), likely attributable to a combination of the gas and particulate fractions. Exposure to GDI engine exhaust contributes to upregulation of genes related to the metabolism of PAHs and oxidative stress. |
Notes from the Field: Respiratory Symptoms and Skin Irritation Among Hospital Workers Using a New Disinfection Product - Pennsylvania, 2015
Hawley B , Casey ML , Cox-Ganser JM , Edwards N , Fedan KB , Cummings KJ . MMWR Morb Mortal Wkly Rep 2016 65 (15) 400-1 In March 2014, a new disinfection product, consisting of hydrogen peroxide, peroxyacetic acid, and acetic acid, was introduced at a Pennsylvania hospital to aid in the control of health care-associated infections. The product is an Environmental Protection Agency-registered non-bleach sporicide advertised as a one-step cleaner, disinfectant, and deodorizer. According to the manufacturer's safety data sheet, the product requires no personal protective equipment when it is diluted with water by an automated dispenser before use. On January 30, 2015, CDC's National Institute for Occupational Health (NIOSH) received a confidential employee request to conduct a health hazard evaluation at the hospital. The request cited concerns about exposure of hospital environmental services staff members to the product and reported symptoms among persons who had used the product that included eye and nasal problems, asthma-like symptoms, shortness of breath, skin problems, wheeze, chest tightness, and cough. |
Genetic diversity of Plasmodium falciparum parasite by microsatellite markers after scale-up of insecticide-treated bed nets in western Kenya.
Gatei W , Gimnig JE , Hawley W , Ter Kuile F , Odero C , Iriemenam NC , Shah MP , Howard PP , Omosun YO , Terlouw DJ , Nahlen B , Slutsker L , Hamel MJ , Kariuki S , Walker E , Shi YP . Malar J 2014 13 Suppl 1 495 BACKGROUND: An initial study of genetic diversity of Plasmodium falciparum in Asembo, western Kenya showed that the parasite maintained overall genetic stability 5 years after insecticide-treated bed net (ITN) introduction in 1997. This study investigates further the genetic diversity of P. falciparum 10 years after initial ITN introduction in the same study area and compares this with two other neighbouring areas, where ITNs were introduced in 1998 (Gem) and 2004 (Karemo). METHODS: From a cross-sectional survey conducted in 2007, 235 smear-positive blood samples collected from children ≤15-year-old in the original study area and two comparison areas were genotyped employing eight neutral microsatellites. Differences in multiple infections, allele frequency, parasite genetic diversity and parasite population structure between the three areas were assessed. Further, molecular data reported previously (1996 and 2001) were compared to the 2007 results in the original study area Asembo. RESULTS: Overall proportion of multiple infections (MA) declined with time in the original study area Asembo (from 95.9 %-2001 to 87.7 %-2007). In the neighbouring areas, MA was lower in the site where ITNs were introduced in 1998 (Gem 83.7 %) compared to where they were introduced in 2004 (Karemo 96.7 %) in 2007. Overall mean allele count (MAC ~ 2.65) and overall unbiased heterozygosity (H e ~ 0.77) remained unchanged in 1996, 2001 and 2007 in Asembo and was the same level across the two neighbouring areas in 2007. Overall parasite population differentiation remained low over time and in the three areas at FST < 0.04. Both pairwise and multilocus linkage disequilibrium showed limited to no significant association between alleles in Asembo (1996, 2001 and 2007) and between three areas. CONCLUSIONS: This study showed the P. falciparum high genetic diversity and parasite population resilience on samples collected 10 years apart and in different areas in western Kenya. The results highlight the need for long-term molecular monitoring after implementation and use of combined and intensive prevention and intervention measures in the region. |
Outbreak of human pneumonic plague with dog-to-human and possible human-to-human transmission - Colorado, June-July 2014
Runfola JK , House J , Miller L , Colton L , Hite D , Hawley A , Mead P , Schriefer M , Petersen J , Casaceli C , Erlandson KM , Foster C , Pabilonia KL , Mason G , Douglas JM . MMWR Morb Mortal Wkly Rep 2015 64 (16) 429-34 On July 8, 2014, the Colorado Department of Public Health and Environment (CDPHE) laboratory identified Yersinia pestis, the bacterium that causes plague, in a blood specimen collected from a man (patient A) hospitalized with pneumonia. The organism had been previously misidentified as Pseudomonas luteola by an automated system in the hospital laboratory. An investigation led by Tri-County Health Department (TCHD) revealed that patient A's dog had died recently with hemoptysis. Three other persons who had contact with the dog, one of whom also had contact with patient A, were ill with fever and respiratory symptoms, including two with radiographic evidence of pneumonia. Specimens from the dog and all three human contacts yielded evidence of acute Y. pestis infection. One of the pneumonia cases might have resulted through human-to-human transmission from patient A, which would be the first such event reported in the United States since 1924. This outbreak highlights 1) the need to consider plague in the differential diagnosis of ill domestic animals, including dogs, in areas where plague is endemic; 2) the limitations of automated diagnostic systems for identifying rare bacteria such as Y. pestis; and 3) the potential for milder plague illness in patients taking antimicrobial agents. Hospital laboratorians should be aware of the limitations of automated identification systems, and clinicians should suspect plague in patients with clinically compatible symptoms from whom P. luteola is isolated. |
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