Last data update: Apr 29, 2024. (Total: 46658 publications since 2009)
Records 1-30 (of 80 Records) |
Query Trace: Hills S [original query] |
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Recommendations for use of a booster dose of inactivated vero cell culture-derived Japanese encephalitis vaccine: advisory committee on immunization practices, 2011
Centers for Disease Control and Prevention , Hills SL , Fischer M . MMWR Morb Mortal Wkly Rep 2011 60 (20) 661-3 Japanese encephalitis (JE) virus, a mosquito-borne flavivirus, is an important cause of encephalitis in Asia with a case fatality rate of 20%--30% and neurologic or psychiatric sequelae in 30%--50% of survivors (1). Travelers to JE-endemic countries and laboratory personnel who work with infectious JE virus are at potential risk for JE virus infection. In 2010, CDC's Advisory Committee on Immunization Practices (ACIP) updated recommendations for prevention of JE. The updated recommendations included information on use of a new inactivated, Vero cell culture--derived JE vaccine (JE-VC [manufactured as Ixiaro]) that was licensed in the United States in 2009. Data on the need for and timing of booster doses with JE-VC were not available when the vaccine was licensed. This report summarizes new data on the persistence of neutralizing antibodies following primary vaccination with JE-VC and the safety and immunogenicity of a booster dose of JE-VC. The report also provides updated guidance to health-care personnel regarding use of a booster dose of JE-VC for U.S. travelers and laboratory personnel. ACIP recommends that if the primary series of JE-VC was administered >1 year previously, a booster dose may be given before potential JE virus exposure. |
Use of Japanese encephalitis vaccine in children: recommendations of the advisory committee on immunization practices, 2013
Centers for Disease Control and Prevention , Bocchini JA , Rubin L , Fischer M , Hills SL , Staples JE . MMWR Morb Mortal Wkly Rep 2013 62 (45) 898-900 On June 19, 2013, the Advisory Committee on Immunization Practices (ACIP) voted to extend existing recommendations for use of inactivated Vero cell culture-derived Japanese encephalitis (JE) vaccine (JE-VC) (Ixiaro, Intercell Biomedical) to include children aged 2 months through 16 years. The ACIP JE Vaccine Workgroup reviewed the epidemiology of JE in travelers and evaluated published and unpublished data on JE-VC immunogenicity and safety in adults and children. The evidence for benefits and risks associated with JE-VC vaccination of children was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. This report summarizes the evidence considered by ACIP and outlines the recommendations for use of JE-VC in children traveling to JE-endemic countries. |
Japanese encephalitis vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP)
Fischer M , Lindsey N , Staples JE , Hills S . MMWR Recomm Rep 2010 59 1-27 This report updates the 1993 recommendations by CDC's Advisory Committee on Immunization Practices (ACIP) regarding the prevention of Japanese encephalitis (JE) among travelers (CDC. Inactivated Japanese encephalitis virus vaccine: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 1993;42[No. RR-1]). This report summarizes the epidemiology of JE, describes the two JE vaccines that are licensed in the United States, and provides recommendations for their use among travelers and laboratory workers. JE virus (JEV), a mosquito-borne flavivirus, is the most common vaccine-preventable cause of encephalitis in Asia. JE occurs throughout most of Asia and parts of the western Pacific. Among an estimated 35,000-50,000 annual cases, 20%-30% of patients die, and 30%-50% of survivors have neurologic or psychiatric sequelae. No treatment exists. For most travelers to Asia, the risk for JE is very low but varies on the basis of destination, duration, season, and activities. JE vaccine is recommended for travelers who plan to spend a month or longer in endemic areas during the JEV transmission season and for laboratory workers with a potential for exposure to infectious JEV. JE vaccine should be considered for 1) short-term (<1 month) travelers to endemic areas during the JEV transmission season if they plan to travel outside of an urban area and will have an increased risk for JEV exposure; 2) travelers to an area with an ongoing JE outbreak; and 3) travelers to endemic areas who are uncertain of specific destinations, activities, or duration of travel. JE vaccine is not recommended for short-term travelers whose visit will be restricted to urban areas or times outside of a well-defined JEV transmission season. Two JE vaccines are licensed in the United States. An inactivated mouse brain--derived JE vaccine (JE-VAX [JE-MB]) has been licensed since 1992 to prevent JE in persons aged >or=1 year traveling to JE-endemic countries. Supplies of this vaccine are limited because production has ceased. In March 2009, an inactivated Vero cell culture-derived vaccine (IXIARO [JE-VC]) was licensed for use in persons aged >or=17 years. JE-MB is the only JE vaccine available for use in children aged 1-16 years, and remaining supplies will be reserved for use in this group. |
Tick-borne encephalitis vaccine: Recommendations of the Advisory Committee on Immunization Practices, United States, 2023
Hills SL , Poehling KA , Chen WH , Staples JE . MMWR Recomm Rep 2023 72 (5) 1-29 TICK-BORNE ENCEPHALITIS (TBE) VIRUS IS FOCALLY ENDEMIC IN PARTS OF EUROPE AND ASIA. THE VIRUS IS PRIMARILY TRANSMITTED TO HUMANS BY THE BITES OF INFECTED: Ixodes species ticks but can also be acquired less frequently by alimentary transmission. Other rare modes of transmission include through breastfeeding, blood transfusion, solid organ transplantation, and slaughtering of viremic animals. TBE virus can cause acute neurologic disease, which usually results in hospitalization, often permanent neurologic or cognitive sequelae, and sometimes death. TBE virus infection is a risk for certain travelers and for laboratory workers who work with the virus. In August 2021, the Food and Drug Administration approved Ticovac TBE vaccine for use among persons aged ≥1 year. This report summarizes the epidemiology of and risks for infection with TBE virus, provides information on the immunogenicity and safety of TBE vaccine, and summarizes the recommendations of the Advisory Committee on Immunization Practices (ACIP) for use of TBE vaccine among U.S. travelers and laboratory workers. |
Arboviral vaccines for use in pregnant travelers
Hills SL , Wong JM , Staples JE . Travel Med Infect Dis 2023 55 102624 Pregnant women traveling abroad can be exposed to a variety of arboviruses, primarily spread by mosquitoes or ticks. Some arboviral infections can be of particular concern for pregnant women or their fetuses. Vaccination is one preventive measure that can reduce the risk for infection. Several arboviral vaccines have been licensed for many years and can be used to prevent infection in travelers, namely Japanese encephalitis, yellow fever, and tick-borne encephalitis vaccines. Recommendations on use of these vaccines in pregnancy vary. Other arboviral vaccines have been licensed but are not indicated for use in pregnant travelers (e.g., dengue vaccines) or are in development (e.g., chikungunya, Zika vaccines). This review describes arboviral vaccines for travelers, focusing on women who are pregnant and those planning travel during pregnancy. |
Notes from the field: Chikungunya outbreak - Paraguay, 2022-2023
Torales M , Beeson A , Grau L , Galeano M , Ojeda A , Martinez B , León N , Cabello A , Rojas F , de Egea V , Galeano R , Ocampos S , Vazquez C , Montoya R , Hills S , Sequera G . MMWR Morb Mortal Wkly Rep 2023 72 (23) 636-638 Local transmission of chikungunya virus (CHIKV) was first reported in the Americas during December 2013, followed by widespread regional transmission (1). CHIKV is transmitted primarily by Aedes aegypti and Aedes albopictus mosquitoes. Most infected persons (72%–97%) experience symptomatic illness, typically including fever and often severe polyarthralgia (which can persist for months or years) (2). Rare complications include neurologic, cardiac, or renal disease (2). | | Paraguay reported its first autochthonous chikungunya case during 2015 (3). The subsequent outbreak, concentrated in the capital city of Asunción and the neighboring Central Department, resulted in 5,221 cases during 2015–2016.* A second outbreak (1,239 cases) occurred during 2018 in the north-central Amambay Department. Beginning the first week of October 2022, an increase in reported cases was again noted; this report provides preliminary information on this outbreak as of March 11, 2023. | | During October 1, 2022–March 11, 2023, a total of 81,037 suspected, probable, or confirmed† chikungunya cases was recorded by the Paraguayan Ministry of Health§; among these, 75,911 (94%) occurred during 2023. Most cases occurred in Central Department (49,070; 61%) and Asunción (16,094; 20%). Cumulative national incidence was 1,073 cases per 100,000 population (3,088 per 100,000 population in Asunción).¶ Weekly case counts in Asunción and Central Department declined slightly after epidemiologic week 6, but an increasing number and proportion of cases were subsequently reported from outlying regions, including along borders with Brazil and Argentina. |
Fatal case of heartland virus disease acquired in the Mid-Atlantic Region, United States
Liu S , Kannan S , Meeks M , Sanchez S , Girone KW , Broyhill JC , Martines RB , Bernick J , Flammia L , Murphy J , Hills SL , Burkhalter KL , Laven JJ , Gaines D , Hoffmann CJ . Emerg Infect Dis 2023 29 (5) 992-996 Heartland virus (HRTV) disease is an emerging tickborne illness in the midwestern and southern United States. We describe a reported fatal case of HRTV infection in the Maryland and Virginia region, states not widely recognized to have human HRTV disease cases. The range of HRTV could be expanding in the United States. |
Japanese encephalitis among adults: A review
Hills SL , Netravathi M , Solomon T . Am J Trop Med Hyg 2023 108 (5) 860-864 Japanese encephalitis (JE) is becoming an increasingly important issue among adults. The reasons for this are multifactorial. During the past decades, new areas of Japanese encephalitis virus (JEV) transmission have occurred in several locations, most notably in a markedly expanded area of Australia during 2021-2022. When JEV enters new areas, cases in adults frequently occur. This is unlike the typical pattern in endemic areas where the burden of disease is in children because most adults are protected through natural immunity following earlier exposure to the virus. Even in endemic areas, JEV has become relatively more important in adults because improved JE control through childhood immunization programs has resulted in a substantial decrease in pediatric JE cases and thus more prominence of adult JE cases. Finally, increases in tourism to JE risk areas have resulted in more exposure of adult travelers, who are usually non-immune, to infection in JE risk areas. In this review we describe the increasing importance of JE in adults in some areas and then consider the comparative clinical presentation and severity of illness among children and adults. |
Comparative frequency of specified adverse events following Vero cell culture-derived Japanese encephalitis and Vi capsular polysaccharide typhoid vaccines in U.S. military personnel, July 2011-August 2019
Seshadri S , Martin SW , Hills SL , Collins LC Jr . Vaccine 2023 41 (9) 1537-1540 Vero cell culture-derived Japanese encephalitis (JE) vaccine (JE-VC; Ixiaro) was approved in the United States in 2009. The previous JE vaccine, an inactivated mouse brain-derived vaccine, had been associated with rare, but serious, allergic and neurologic adverse events (AE). Studies and AE surveillance have supported JE-VC's safety, but one evaluation among military personnel found elevated hypersensitivity and neurologic AE rates. However, co-administration of multiple vaccines to some personnel might have affected results. We retrospectively compared rates of hypersensitivity and neurologic AEs within 28 days following vaccination of military personnel with JE-VC or parenteral Vi capsular polysaccharide typhoid vaccine administered without other vaccines from July 1, 2011, through August 31, 2019. Rates of most events were similar between the vaccines. Only delayed hypersensitivity reactions occurred more frequently following JE-VC (rate ratio: 4.2, 95 % CI 1.2-15.3; p = 0.03), but rates were low for both vaccines. These results support JE-VC's safety. |
Japanese encephalitis in a U.S. traveler returning from Vietnam, 2022
Janatpour ZC , Boatwright MA , Yousif SM , Bonilla MF , Fitzpatrick KA , Hills SL , Decker CF . Travel Med Infect Dis 2023 52 102536 Japanese encephalitis virus (JEV) is a mosquito-borne flavivirus which is endemic throughout most of Asia and parts of the Western Pacific [1,2]. Since the availability of a JE vaccine in the United States (U.S.) in 1993, a total of 13 JE cases in U.S. travelers or expatriates have been reported [[3], [4], [5], [6]]. We describe a case of severe JE in an unvaccinated returning traveler. | | A 37-year-old woman presented to Cleveland Clinic in Abu Dhabi, United Arab Emirates with 4 days of headache, fever and confusion. The patient is a U.S. citizen and had been living in Abu Dhabi for the past 2 years. She had returned from a 2-week vacation to Vietnam, where she primarily stayed in urban locales. However, she did participate in a 2-day hike within the Sa Pa region of Northern Vietnam, where she stayed in unscreened lodging and sustained multiple mosquito bites despite using preventive measures. She had not received the JE vaccine prior to travel. Her symptoms began while still in country on day 13 of the 14-day trip. |
Improving community coverage of Japanese encephalitis vaccination: lessons learned from a mass campaign in Battambang Province, Cambodia
Thigpen MC , Sarath S , Soeung SC , Vichit O , Kitsutani P , Sandhu H , Gregory C , Fischer M , Morn C , Hills SL . BMC Public Health 2022 22 (1) 2244 A mass Japanese encephalitis (JE) immunization campaign for children aged 9 months through 12 years was conducted in 2013 in Battambang province, western Cambodia. Vaccinators working at almost 2,000 immunization posts in approximately 800 villages provided vaccinations to almost 310,000 children using one dose of Chengdu Institute of Biological Products' live, attenuated SA14-14-2 JE vaccine (CD-JEV), achieving a coverage rate of greater than 90%. Lessons learned, in general for mass vaccination campaigns and specifically for vaccination with CD-JEV, are described. These observations will be of benefit for public health officials and to help inform planning for future campaigns for JE or other vaccine-preventable diseases in Cambodia and elsewhere. |
An evaluation of adverse events following an immunization campaign with the live, attenuated SA14-14-2 Japanese encephalitis vaccine in Cambodia
Hills SL , Soeung SC , Sarath S , Morn C , Dara C , Fischer M , Thigpen MC . PLoS One 2022 17 (6) e0269480 INTRODUCTION: Japanese encephalitis (JE) virus is the most common cause of vaccine-preventable encephalitis in Asia. The SA14-14-2 JE vaccine manufactured by Chengdu Institute of Biological Products has been shown to be safe and effective in clinical trials and childhood routine immunization programs. However, there are few published reports describing results of surveillance for adverse events following immunization (AEFI) when the vaccine is used in mass campaigns. We describe the results of AEFI surveillance following a 2013 vaccination campaign among almost 310,000 children aged 9 months-12 years in Battambang Province, Cambodia. METHODS: Routine AEFI surveillance was strengthened by staff training and supplemented by active hospital surveillance. An AEFI was defined as any sign, symptom, or disease temporally associated (i.e., within 4 weeks) with receipt of the vaccine, irrespective of whether it was considered related to immunization. Data were collected on standardized forms and causality assessments were conducted for serious AEFI. RESULTS: Passive and active surveillance detected 28 AEFI for an overall incidence of 9.0 AEFI per 100,000 doses administered. The most frequent events were vasovagal episodes (n = 7, 25%) and rash (n = 6, 21%), and most other events were common childhood conditions such as fever and vomiting. Three AEFI were classified as serious, including one hypersensitivity reaction and two meningoencephalitis cases. Of these, the hypersensitivity event was the only serious AEFI classified as being consistent with a causal association to immunization. CONCLUSIONS: Most reported adverse events were conditions that commonly occur after other childhood vaccinations or independently of vaccination, and in the context of careful monitoring for serious AEFI only one serious event consistent with a causal association with immunization was identified. These results support the good safety profile of the SA14-14-2 JE vaccine, and provide reassuring data as the vaccine's use expands. |
COVID-19 Case Investigations Among Federally Quarantined Evacuees From Wuhan, China, and Exposed Personnel at a US Military Base, United States, February 5-21, 2020.
Chuey MeaganR , Stewart RebekahJ , Walters Maroya , Curren EmilyJ , Hills SusanL , Moser KathleenS , Staples JErin , Braden ChristopherR , McDonald Eric . Public Health Rep 2022 137 (2) 203-207 In February 2020, during the early days of the COVID-19 pandemic, 232 evacuees from Wuhan, China, were placed under federal 14-day quarantine upon arrival at a US military base in San Diego, California. We describe the monitoring of evacuees and responders for symptoms of COVID-19, case and contact investigations, infection control procedures, and lessons learned to inform future quarantine protocols for evacuated people from a hot spot resulting from a novel pathogen. Thirteen (5.6%) evacuees had COVID-19compatible symptoms and 2 (0.9%) had laboratory-confirmed SARS-CoV-2. Two case investigations identified 43 contacts; 3 (7.0%) contacts had symptoms but tested negative for SARS-CoV-2 infection. Daily symptom and temperature screening of evacuees and enacted infection control procedures resulted in rapid case identification and isolation and no detected secondary transmission among evacuees or responders. Lessons learned highlight the challenges associated with public health response to a novel pathogen and the evolution of mitigation strategies as knowledge of the pathogen evolves. |
Tick-borne encephalitis among US travellers, 2010-20
Hills SL , Broussard KR , Broyhill JC , Shastry LG , Cossaboom CM , White JL , Machesky KD , Kosoy O , Girone K , Klena JD , Backenson BP , Gould CV , Lind L , Hieronimus A , Gaines DN , Wong SJ , Choi MJ , Laven JJ , Staples JE , Fischer M . J Travel Med 2021 29 (2) BACKGROUND: Tick-borne encephalitis (TBE) is an arboviral disease that is focally endemic in parts of Europe and Asia. TBE cases among US travellers are rare, with previous reports of only six cases among civilian travellers through 2009 and nine military-related cases through 2020. A TBE vaccine was licenced in the USA in August 2021. Understanding TBE epidemiology and risks among US travellers can help with the counselling of travellers going to TBE-endemic areas. METHODS: Diagnostic testing for TBE in the USA is typically performed at the Centers for Disease Control and Prevention (CDC) because no commercial testing is available. Diagnostic testing for TBE at CDC since 2010 was reviewed. For individuals with evidence of TBE virus infection, information was gathered on demographics, clinical presentations and risk factors for infection. RESULTS: From 2010-20, six patients with TBE were identified. Cases occurred among both paediatric and adult travellers and all were male. Patients were diagnosed with meningitis (n = 2) or encephalitis (n = 4); none died. Cases had travelled to various countries in Europe or Russia. Three cases reported visiting friends or relatives. Activities reported included hiking, camping, trail running, or working outdoors, and two cases had a recognized tick bite. CONCLUSIONS: TBE cases among US travellers are uncommon, with these six cases being the only known TBE cases among civilian travellers during this 11-year period. Nonetheless, given potential disease severity, pre-travel counselling for travellers to TBE-endemic areas should include information on measures to reduce the risk for TBE and other tick-borne diseases, including possible TBE vaccine use if a traveller's itinerary puts them at higher risk for infection. Clinicians should consider the diagnosis of TBE in a patient with a neurologic or febrile illness recently returned from a TBE-endemic country, particularly if a tick bite or possible tick exposure is reported. |
Exposure to particulate matter and estimation of volatile organic compounds across wildland firefighter job tasks
Navarro KM , West MR , O'Dell K , Sen P , Chen IC , Fischer EV , Hornbrook RS , Apel EC , Hills AJ , Jarnot A , DeMott P , Domitrovich JW . Environ Sci Technol 2021 55 (17) 11795-11804 Wildland firefighters are exposed to smoke-containing particulate matter (PM) and volatile organic compounds (VOCs) while suppressing wildfires. From 2015 to 2017, the U.S. Forest Service conducted a field study collecting breathing zone measurements of PM(4) (particulate matter with aerodynamic diameter ≤4 μm) on wildland firefighters from different crew types and while performing various fire suppression tasks on wildfires. Emission ratios of VOC (parts per billion; ppb): PM(1) (particulate matter with aerodynamic diameter ≤1 μm; mg/m(3)) were calculated using data from a separate field study conducted in summer 2018, the Western Wildfire Experiment for Cloud Chemistry, Aerosol Absorption, and Nitrogen (WE-CAN) Campaign. These emission ratios were used to estimate wildland firefighter exposure to acrolein, benzene, and formaldehyde. Results of this field sampling campaign reported that exposure to PM(4) and VOC varied across wildland firefighter crew type and job task. Type 1 crews had greater exposures to both PM(4) and VOCs than type 2 or type 2 initial attack crews, and wildland firefighters performing direct suppression had statistically higher exposures than those performing staging and other tasks (mean differences = 0.82 and 0.75 mg/m(3); 95% confidence intervals = 0.38-1.26 and 0.41-1.08 mg/m(3), respectively). Of the 81 personal exposure samples collected, 19% of measured PM(4) exposures exceeded the recommended National Wildland Fire Coordinating Group occupational exposure limit (0.7 mg/m(3)). Wildland fire management should continue to find strategies to reduce smoke exposures for wildland firefighters. |
Frequency of Zika Virus Immunoglobulin M Antibody in Persons with West Nile Virus Infection
Hills SL , Laven J , Biggerstaff BJ , Kosoy O , Staples JE , Panella A . Vector Borne Zoonotic Dis 2021 21 (10) 817-821 West Nile virus (WNV) and Zika virus (ZIKV) are mosquito-borne viruses in the family Flaviviridae. Residents in, and travelers to, areas where the viruses are circulating are at risk for infection, and both viruses can cause an acute febrile illness. Given known cross-reactivity in flavivirus serologic assays, it is possible a patient with acute WNV infection could be misdiagnosed as having ZIKV infection if appropriate testing is not conducted. To understand how frequently persons with WNV infection have detectable cross-reactive ZIKV immunoglobulin M (IgM) antibody, we used archived serum samples from patients in the United States with recent WNV infection confirmed by a microsphere-based immunoassay test for IgM antibody and neutralizing antibody testing. Samples were tested for ZIKV IgM antibody with the Centers for Disease Control and Prevention (CDC) ZIKV IgM antibody capture enzyme-linked immunosorbent assay. Among 153 sera from patients with acute WNV infection, the ZIKV IgM antibody result was positive in 56 (37%; 95% confidence interval [CI] 29-44%) and equivocal in 28 (18%; 95% CI 13-25%). With 55% of samples having cross-reactive antibodies, it is important for health care providers to request appropriate testing based on the most likely cause of a patient's possible arboviral infection considering their clinical symptoms and signs, travel history, and place of residence. For cases where the epidemiology does not support the preliminary IgM findings, confirmatory neutralizing antibody testing should be performed. These measures will avoid an incorrect diagnosis of ZIKV infection, based on cross-reactive antibodies, in a person truly infected with WNV. |
La Crosse Virus Disease in the United States, 2003-2019
Vahey GM , Lindsey NP , Staples JE , Hills SL . Am J Trop Med Hyg 2021 105 (3) 807-812 La Crosse virus (LACV) is an arthropod-borne virus that can cause a nonspecific febrile illness, meningitis, or encephalitis. We reviewed U.S. LACV surveillance data for 2003-2019, including human disease cases and nonhuman infections. Overall, 318 counties in 27 states, principally in the Great Lakes, mid-Atlantic, and southeastern regions, reported LACV activity. A total of 1,281 human LACV disease cases were reported, including 1,183 (92%) neuroinvasive disease cases. The median age of cases was 8 years (range: 1 month-95 years); 1,130 (88%) were aged < 18 years, and 754 (59%) were male. The most common clinical syndromes were encephalitis (N = 960; 75%) and meningitis (N = 219, 17%). The case fatality rate was 1% (N = 15). A median of 74 cases (range: 35-130) was reported per year. The average annual national incidence of neuroinvasive disease cases was 0.02 per 100,000 persons. West Virginia, North Carolina, Tennessee, and Ohio had the highest average annual state incidences (0.16-0.61 per 100,000), accounting for 80% (N = 1,030) of cases. No animal LACV infections were reported. Nine states reported LACV-positive mosquito pools, including three states with no reported human disease cases. La Crosse virus is the most common cause of pediatric neuroinvasive arboviral disease in the United States. However, surveillance data likely underestimate LACV disease incidence. Healthcare providers should consider LACV disease in patients, especially children, with febrile illness, meningitis, or encephalitis in areas where the virus circulates and advise their patients on ways to prevent mosquito bites. |
The future of Japanese encephalitis vaccination: expert recommendations for achieving and maintaining optimal JE control
Vannice KS , Hills SL , Schwartz LM , Barrett AD , Heffelfinger J , Hombach J , Letson GW , Solomon T , Marfin AA . NPJ Vaccines 2021 6 (1) 82 Vaccines against Japanese encephalitis (JE) have been available for decades. Currently, most JE-endemic countries have vaccination programs for their at-risk populations. Even so, JE remains the leading recognized cause of viral encephalitis in Asia. In 2018, the U.S. Centers for Disease Control and Prevention and PATH co-convened a group of independent experts to review JE prevention and control successes, identify remaining scientific and operational issues that need to be addressed, discuss opportunities to further strengthen JE vaccination programs, and identify strategies and solutions to ensure sustainability of JE control during the next decade. This paper summarizes the key discussion points and recommendations to sustain and expand JE control. |
Case Series of Laboratory-Associated Zika Virus Disease, United States, 2016-2019
Hills SL , Morrison A , Stuck S , Sandhu K , Mason KL , Stanek D , Gabel J , Osborne MA , Schroeder BA , Rico E , Drenzek CL , Gallagher GR , Fiddner J , Heberlein-Larson LA , Brown CM , Fischer M . Emerg Infect Dis 2021 27 (5) 1296-1300 Zika virus diagnostic testing and laboratory research increased considerably when Zika virus began spreading through the Americas in 2015, increasing the risk for potential Zika virus exposure of laboratory workers and biomedical researchers. We report 4 cases of laboratory-associated Zika virus disease in the United States during 2016-2019. Of these, 2 were associated with needlestick injuries; for the other 2 cases, the route of transmission was undetermined. In laboratories in which work with Zika virus is performed, good laboratory biosafety practices must be implemented and practiced to reduce the risk for infection among laboratory personnel. |
Risk estimation of sexual transmission of Zika virus-United States, 2016-2017
Major CG , Paz-Bailey G , Hills SL , Rodriguez DM , Biggerstaff BJ , Johansson M . J Infect Dis 2021 224 (10) 1756-1764 BACKGROUND: Zika virus (ZIKV) can be transmitted sexually, but the risk of sexual transmission remains unknown. Most evidence of sexual transmission is from partners of infected travelers returning from areas with ZIKV circulation. METHODS: We used data from the U.S. national arboviral disease surveillance system (ArboNET) on travel- and sexually-acquired ZIKV disease cases during 2016-2017 to develop individual-level simulations for estimating risk of male-to-female, male-to-male, and female-to-male sexual transmission of ZIKV via vaginal and/or anal intercourse. We specified parametric distributions to characterize individual-level variability of parameters for ZIKV persistence and sexual behaviors. RESULTS: Using ZIKV RNA persistence in semen/vaginal fluids to approximate infectiousness duration, male-to-male transmission had the highest estimated probability [1.3% (95% CI: 0.4-6.0) per anal sex act], followed by male-to-female and female-to-male transmission [0.4% (95% CI: 0.3-0.6) per vaginal/anal sex act and 0.1% (95% CI:0-0.8) per vaginal sex act, respectively]. Models using viral isolation in semen vs. RNA detection to approximate infectiousness duration predicted greater risk of sexual transmission. CONCLUSIONS: While likely insufficient to maintain sustained transmission, the estimated risk of ZIKV transmission through unprotected sex is not trivial and is especially important for pregnant women, as ZIKV infection can cause severe congenital disorders. |
Measles outbreak among children 15 years old, Jaintia Hills District, Meghalaya, India, 2017
Lowang D , Dhuria M , Yadav R , Mylliem P , Sodha SV , Khasnobis P . Indian J Public Health 2021 65 S5-s9 BACKGROUND: Of 1115 measles outbreaks during 2015 in India, 61,255 suspected measles cases were reported. In 2016, a measles outbreak was reported at East and West Jaintia Hills districts in Meghalaya State, India. OBJECTIVES: The outbreak was investigated to describe the epidemiology, estimate vaccination coverage and vaccine effectiveness (VE), determine risk factors for the disease, and recommend control and prevention measures. METHODS: A measles case was defined as new-onset fever with maculopapular rash occurring between May 1, 2016, and January 21, 2017, in a resident of East and West Jaintia Hills. Cases were identified by active and passive surveillance. Serum and urine samples were collected from cases with laboratory diagnosis for confirmation. A retrospective cohort study was conducted to estimate vaccination coverage, VE, and risk factors for the disease. RESULTS: We identified 382 cases (51% female). The attack rate was 24% with three deaths. The case fatality rate was <1%. The median age was 4 years (range: 3 months-12 years). Among children 12-60 months, 128 (56%) received measles-containing-vaccine first-dose (MCV1), 85 (37%) received measles-containing-vaccine second-dose (MCV2), and 80 (35%) received Vitamin A. VE for MCV1 was 78% and for MCV2 94%. Being unvaccinated for MCV1 (relative risk [RR] = 9.7, 95% confidence interval [CI] = 4.6-20.5) and MCV2 (RR = 17.4, 95% CI = 4.3-69.4) were both strongly associated with illness. CONCLUSIONS: Poor vaccination coverage led to the measles outbreak in East and West Jaintia Hills districts of Meghalaya. Strengthening the routine immunization systems and improving Vitamin A uptake is essential to prevent further outbreaks. |
Persistence of IgM antibodies after vaccination with live attenuated Japanese encephalitis vaccine
Hills S , Van Keulen A , Feser J , Panella A , Letson B , Staples E , Marfin T , Brault A . Am J Trop Med Hyg 2020 104 (2) 576-579 Japanese encephalitis (JE) is a vaccine-preventable, mosquito-borne disease. Substantial progress with JE control in Asia has been made during the past decade, with most endemic countries now having JE vaccination programs, commonly using live attenuated SA14-14-2 JE vaccine (CD-JEV). If a child develops encephalitis during the weeks to months following CD-JEV vaccination and anti-JE virus IgM (JE IgM) antibody is detected in serum, the question arises if this is JE virus infection indicating vaccine failure, or persistent JE IgM antibody postvaccination. To better understand JE IgM seropositivity following vaccination, sera from 268 children from a previous CD-JEV study were tested by two different JE IgM assays to determine JE IgM antibody frequency on days 28, 180, and 365 postvaccination. With the CDC JE IgM antibody capture ELISA (MAC-ELISA), 110 children (41%) had JE IgM positive or equivocal results on their day 28 sample, and eight (3%) and two (1%) had positive or equivocal results on day 180 and day 365 samples, respectively. With the Inbios JE Detect™ MAC-ELISA, 118 (44%) children had positive or equivocal results on day 28 sample, and three (1%) and one (0.4%) had positive or equivocal results on day 180 and day 365 samples, respectively. Our results indicate that more than 40% children vaccinated with CD-JEV can have JE IgM antibodies in their serum at 1 month postvaccination but JE IgM antibody is rare by 6 months. These data will help healthcare workers assess the likelihood that JE IgM antibodies in the serum of a child with encephalitis after vaccination are vaccine related. |
Japanese encephalitis virus as cause of acute encephalitis, Bhutan
Wangchuk S , Tamang TD , Darnal JB , Pelden S , Lhazeen K , Mynak ML , Letson GW , Khare S , Leader BT , Marfin AA , Hills SL . Emerg Infect Dis 2020 26 (9) 2239-2242 In 2011, Bhutan's Royal Centre for Disease Control began Japanese encephalitis (JE) surveillance at 5 sentinel hospitals throughout Bhutan. During 2011-2018, a total of 20 JE cases were detected, indicating JE virus causes encephalitis in Bhutan. Maintaining JE surveillance will help improve understanding of JE epidemiology in this country. |
Immune response at 12-23months following a single dose of Vero cell culture-derived Japanese encephalitis (JE) vaccine in adults previously vaccinated with mouse brain-derived JE vaccine
Krow-Lucal ER , Laven J , Perry L , Biggerstaff BJ , Johnson BW , Hollis E , Fischer M , Woolpert T , Hills SL . Vaccine 2020 38 (44) 6899-6903 BACKGROUND: Japanese encephalitis (JE) virus is an important cause of neurological disease in Asia. JE vaccine is recommended for travelers with higher JE risk itineraries. Inactivated Vero cell culture-derived JE vaccine (JE-VC) is the only JE vaccine currently available in the United States. An inactivated mouse brain-derived JE vaccine (JE-MB) previously was available but production was discontinued. One JE-VC dose administered to adults previously vaccinated with ≥3 doses of JE-MB provides good short-term protection for at least one month, but data on longer-term protection are limited. We evaluated non-inferiority of the JE virus neutralizing antibody response at 12-23 months in JE-MB-vaccinated adults administered one JE-VC dose compared with JE vaccine-naïve adults administered a JE-VC two-dose primary series. METHODS: We obtained archived sera from U.S. military personnel and performed a 50% plaque reduction neutralization test for anti-JE virus neutralizing antibodies. We compared the geometric mean titer (GMT) and seroprotection rate at 12-23 months after one JE-VC dose in previously JE-MB-vaccinated personnel and after the second JE-VC dose in previously JE vaccine-naïve personnel. Non-inferiority was concluded if the lower bound of the two-sided 95% confidence interval (CI) of the GMT ratio in previously vaccinated to vaccine-naïve personnel was >1/1.5. RESULTS: The GMT in previously JE-MB-vaccinated persons was 75 (95% CI 63-90) and in previously JE vaccine-naïve persons was 12 (95% CI 11-14), and seroprotection rates were 94% (235/250) and 54% (135/250), respectively. The ratio of GMTs was 6.3 (95% CI: 5.0-7.7), satisfying the criterion for non-inferiority. CONCLUSIONS: One JE-VC dose in previously JE-MB-vaccinated military personnel provides good protection for at least 1-2 years. The benefits of administration of a single JE-VC dose in previously JE-MB-vaccinated adults include a shorter time to completion of re-vaccination before travel, a decrease in the risk of adverse events, and reduced costs. |
Hospital-based surveillance for Japanese encephalitis in Bangladesh, 2007-2016: Implications for introduction of immunization
Paul KK , Sazzad HMS , Rahman M , Sultana S , Hossain MJ , Ledermann JP , Burns P , Friedman MS , Flora MS , Fischer M , Hills S , Luby SP , Gurley ES . Int J Infect Dis 2020 99 69-74 BACKGROUND: Japanese encephalitis (JE) virus is recognized as a major cause of encephalitis in Bangladesh. The World Health Organization (WHO) recommends human immunization as the most effective means to control JE. Several WHO-prequalified vaccines are available to prevent JE but no vaccination program has been implemented in Bangladesh. METHODS: We conducted hospital-based surveillance for acute meningitis-encephalitis syndrome (AMES) to describe JE epidemiology and help inform policy decisions about possible immunization strategies for Bangladesh. RESULTS: During 2007-2016, a total of 6,543 AMES patients were identified at four tertiary hospitals. Of the 6,525 patients tested, 548 (8%) were classified as JE cases. These 548 patients resided in 36 (56%) out of 64 districts of Bangladesh, with the highest proportion of JE cases among AMES patients (12% and 7%) presenting at two hospitals in the northwestern part of the country. The median age of JE cases was 30 years, and 193 (35%) were aged ≤15 years. The majority of JE cases (80%) were identified from July through November. CONCLUSIONS: Surveillance results suggest that JE continues to be an important cause of meningo-encephalitis in Bangladesh. Immunization strategies including JE vaccine introduction into the routine childhood immunization program or mass vaccination in certain age groups or geographic areas need to be examined, taking into consideration the cost-effectiveness ratio of the approach and potential for decreasing disease burden. |
Screening for SARS-CoV-2 Infection Within a Psychiatric Hospital and Considerations for Limiting Transmission Within Residential Psychiatric Facilities - Wyoming, 2020.
Callaghan AW , Chard AN , Arnold P , Loveland C , Hull N , Saraiya M , Saydah S , Dumont W , Frakes LG , Johnson D , Peltier R , Van Houten C , Trujillo AA , Moore J , Rose DA , Honein MA , Carrington D , Harrist A , Hills SL . MMWR Morb Mortal Wkly Rep 2020 69 (26) 825-829 In the United States, approximately 180,000 patients receive mental health services each day at approximately 4,000 inpatient and residential psychiatric facilities (1). SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), can spread rapidly within congregate residential settings (2-4), including psychiatric facilities. On April 13, 2020, two patients were transferred to Wyoming's state psychiatric hospital from a private psychiatric hospital that had confirmed COVID-19 cases among its residents and staff members (5). Although both patients were asymptomatic at the time of transfer and one had a negative test result for SARS-CoV-2 at the originating facility, they were both isolated and received testing upon arrival at the state facility. On April 16, 2020, the test results indicated that both patients had SARS-CoV-2 infection. In response, the state hospital implemented expanded COVID-19 infection prevention and control (IPC) procedures (e.g., enhanced screening, testing, and management of new patient admissions) and adapted some standard IPC measures to facilitate implementation within the psychiatric patient population (e.g., use of modified face coverings). To assess the likely effectiveness of these procedures and determine SARS-CoV-2 infection prevalence among patients and health care personnel (HCP) (6) at the state hospital, a point prevalence survey was conducted. On May 1, 2020, 18 days after the patients' arrival, 46 (61%) of 76 patients and 171 (61%) of 282 HCP had nasopharyngeal swabs collected and tested for SARS-CoV-2 RNA by reverse transcription-polymerase chain reaction. All patients and HCP who received testing had negative test results, suggesting that the hospital's expanded IPC strategies might have been effective in preventing the introduction and spread of SARS-CoV-2 infection within the facility. In congregate residential settings, prompt identification of COVID-19 cases and application of strong IPC procedures are critical to ensuring the protection of other patients and staff members. Although standard guidance exists for other congregate facilities (7) and for HCP in general (8), modifications and nonstandard solutions might be needed to account for the specific needs of psychiatric facilities, their patients, and staff members. |
Investigation of Japanese encephalitis virus as a cause of acute encephalitis in southern Pakistan, April 2015-January 2018
Fatima T , Rais A , Khan E , Hills SL , Chambers TV , Hotwani A , Qureshi S , Shafquat S , Malik S , Qamar F , Mir F , Marfin AA , Zaidi A , Khowaja AR , Shakoor S . PLoS One 2020 15 (6) e0234584 BACKGROUND: Japanese encephalitis (JE) occurs in fewer than 1% of JE virus (JEV) infections, often with catastrophic sequelae including death and neuropsychiatric disability. JEV transmission in Pakistan was documented in 1980s and 1990s, but recent evidence is lacking. Our objective was to investigate JEV as a cause of acute encephalitis in Pakistan. METHODS: Persons aged >/=1 month with possible JE admitted to two acute care hospitals in Karachi, Pakistan from April 2015 to January 2018 were enrolled. Cerebrospinal fluid (CSF) or serum samples were tested for JEV immunoglobulin M (IgM) using the InBios JE DetectTM assay. Positive or equivocal samples had confirmatory testing using plaque reduction neutralization tests. RESULTS: Among 227 patients, testing was performed on CSF in 174 (77%) and on serum in 53 (23%) patients. Six of eight patient samples positive or equivocal for JEV IgM had sufficient volume for confirmatory testing. One patient had evidence of recent West Nile virus (WNV) neurologic infection based on CSF testing. One patient each had recent dengue virus (DENV) infection and WNV infection based on serum results. Recent flavivirus infections were identified in two persons, one each based on CSF and serum results. Specific flaviviruses could not be identified due to serologic cross-reactivity. For the sixth person, JEV neutralizing antibodies were confirmed in CSF but there was insufficient volume for further testing. CONCLUSIONS: Hospital-based JE surveillance in Karachi, Pakistan could not confirm or exclude local JEV transmission. Nonetheless, Pakistan remains at risk for JE due to presence of the mosquito vector, amplifying hosts, and rice irrigation. Laboratory surveillance for JE should continue among persons with acute encephalitis. However, in view of serological cross-reactivity, confirmatory testing of JE IgM positive samples at a reference laboratory is essential. |
Factors associated with vaginal detection of prostate-specific antigen among participants in a clinical trial in Malawi
Zia Y , Davis N , Wiener J , Hobbs MM , Lapple D , Chinula L , Tegha G , Msika A , Tang J , Kourtis AP . Sex Transm Infect 2020 97 (1) 77 Self-report of sexual behaviours in clinical studies is often subject to misreporting due to recall or social desirability bias or misinterpretation of the study questionnaires.1 Use of biomarkers of semen exposure, such as the detection of prostate-specific antigen (PSA) in vaginal secretions, offers an additional means of assessing sexual behaviours and condom use that is not subject to reporting biases.2 In a secondary analysis of a clinical trial of hormonal contraception in Malawi,3 we examined associations of discordance between PSA detection and self-report of condomless sex over time with participant characteristics using log-binomial regression analyses with generalised estimating equations for repeated measures. All analyses were conducted using SAS V.9.3 (SAS Institute, Cary, North Carolina, USA). Testing for PSA was performed using the ABAcard p30 rapid immunochromatographic strip test (Abacus Diagnostics, West Hills, California, USA); samples containing ≥1.0 ng PSA/mL were considered positive for detection of semen, as previously described.4 Discordance between PSA detection and self-report was defined as detection of PSA in the vaginal samples, with report of condom use at last sex or no sex since last study visit. Given the rapid clearance of PSA, negative results for PSA were not considered in the definition of discordance or concordance, regardless of whether condomless sex was self-reported or not.4 |
Assessment of immunoglobulin M enzyme-linked immunosorbent assay ratios to identify West Nile Virus and St. Louis Encephalitis virus infections during concurrent outbreaks of West Nile Virus and St. Louis encephalitis virus diseases, Arizona 2015
Curren EJ , Venkat H , Sunenshine R , Fitzpatrick K , Kosoy O , Krow-Lucal E , Zabel K , Adams L , Kretschmer M , Fischer M , Hills SL . Vector Borne Zoonotic Dis 2020 20 (8) 619-623 West Nile virus (WNV) and St. Louis encephalitis virus (SLEV) are closely related mosquito-borne flaviviruses that cause clinical disease ranging from febrile illness to encephalitis. The standard for serological diagnosis is immunoglobulin M (IgM) testing followed by confirmatory plaque reduction neutralization test (PRNT) to differentiate the infecting virus. However, the PRNT is time-consuming and requires manipulation of live virus. During concurrent WNV and SLEV outbreaks in Arizona in 2015, we assessed use of a diagnostic algorithm to simplify testing. It incorporated WNV and SLEV ratios based on positive-to-negative (P/N) values derived from the IgM antibody-capture enzyme-linked immunosorbent assay. We compared each sample's ratio-based result with the confirmed WNV or SLEV sample result indicated by PRNT or PCR testing. We analyzed data from 70 patients with 77 serum and cerebrospinal fluid samples, including 53 patients with confirmed WNV infection and 17 patients with confirmed SLEV infection. Both WNV and SLEV ratios had specificity >/=95%, indicating a high likelihood that each ratio was correctly identifying the infecting virus. The SLEV ratio sensitivity of 30% was much lower than the WNV ratio sensitivity of 91%, likely because of higher cross-reactivity of SLEV antibodies and generation of lower P/N values. The standard for serological diagnosis of WNV and SLEV infections remains IgM testing followed by PRNT. However, these results suggest the ratios could potentially be used as part of a diagnostic algorithm in outbreaks to substantially reduce the need for PRNTs. |
Comparison of characteristics of patients with West Nile virus or St. Louis encephalitis virus neuroinvasive disease during concurrent outbreaks, Maricopa County, Arizona, 2015
Venkat H , Krow-Lucal E , Kretschmer M , Sylvester T , Levy C , Adams L , Fitzpatrick K , Laven J , Kosoy O , Sunenshine R , Smith K , Townsend J , Chevinsky J , Hennessey M , Jones J , Komatsu K , Fischer M , Hills S . Vector Borne Zoonotic Dis 2020 20 (8) 624-629 West Nile virus (WNV) and St. Louis encephalitis virus (SLEV) are closely related mosquito-borne flaviviruses that can cause neuroinvasive disease. No concurrent WNV and SLEV disease outbreaks have previously been identified. When concurrent outbreaks occurred in 2015 in Maricopa County, Arizona, we collected data to describe the epidemiology, and to compare features of patients with WNV and SLEV neuroinvasive disease. We performed enhanced case finding, and gathered information from medical records and patient interviews. A case was defined as a clinically compatible illness and laboratory evidence of WNV, SLEV, or unspecified flavivirus infection in a person residing in Maricopa County in 2015. We compared demographic and clinical features of WNV and SLEV neuroinvasive cases; for this analysis, a case was defined as physician-documented encephalitis or meningitis and a white blood cell count >5 cells/mm(3) in cerebrospinal fluid. In total, we identified 82 cases, including 39 WNV, 21 SLEV, and 22 unspecified flavivirus cases. The comparative analysis included 21 WNV and 14 SLEV neuroinvasive cases. Among neuroinvasive cases, the median age of patients with SLEV (63 years) was higher than WNV (52 years). Patients had similar symptoms; rash was identified more frequently in WNV (33%) neuroinvasive cases than in SLEV (7%) cases, but this difference was not statistically significant (p = 0.11). In summary, during the first known concurrent WNV and SLEV disease outbreaks, no specific clinical features were identified that could differentiate between WNV and SLEV neuroinvasive cases. Health care providers should consider both infections in patients with aseptic meningitis or encephalitis. |
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