Last data update: May 28, 2024. (Total: 46864 publications since 2009)
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Query Trace: Kidd S [original query] |
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Surveillance for acute flaccid myelitis - United States, 2018-2022
Whitehouse ER , Lopez A , English R , Getachew H , Ng TFF , Emery B , Rogers S , Kidd S . MMWR Morb Mortal Wkly Rep 2024 73 (4) 70-76 Acute flaccid myelitis (AFM) is a serious neurologic condition primarily affecting children; AFM can cause acute respiratory failure and permanent paralysis. AFM is a rare but known complication of various viral infections, particularly those of enteroviruses (EVs). Increases in AFM cases during 2014, 2016, and 2018 were associated with EV-D68 infection. This report examines trends in confirmed AFM cases during 2018-2022 and patients' clinical and laboratory characteristics. The number of AFM cases was low during 2019-2022 (28-47 cases per year); the number of cases remained low in 2022 despite evidence of increased EV-D68 circulation in the United States. Compared with cases during the most recent peak year (2018), fewer cases during 2019-2021 had upper limb involvement, prodromal respiratory or febrile illness, or cerebrospinal fluid pleocytosis, and more were associated with lower limb involvement. It is unclear why EV-D68 circulation in 2022 was not associated with an increase in AFM cases or when the next increase in AFM cases will occur. Nonetheless, clinicians should continue to suspect AFM in any child with acute flaccid limb weakness, especially those with a recent respiratory or febrile illness. |
Trade-offs of different poliovirus vaccine options for outbreak response in the United States and other countries that only use inactivated poliovirus vaccine (IPV) in routine immunization
Thompson KM , Kalkowska DA , Kidd SE , Burns CC , Badizadegan K . Vaccine 2024 Delays in achieving polio eradication have led to ongoing risks of poliovirus importations that may cause outbreaks in polio-free countries. Because of the low, but non-zero risk of paralysis with oral poliovirus vaccines (OPVs), countries that achieve and maintain high national routine immunization coverage have increasingly shifted to exclusive use of inactivated poliovirus vaccine (IPV) for all preventive immunizations. However, immunization coverage within countries varies, with under-vaccinated subpopulations potentially able to sustain transmission of imported polioviruses and experience local outbreaks. Due to its cost, ease-of-use, and ability to induce mucosal immunity, using OPV as an outbreak control measure offers a more cost-effective option in countries in which OPV remains in use. However, recent polio outbreaks in IPV-only countries raise questions about whether and when IPV use for outbreak response may fail to stop poliovirus transmission and what consequences may follow from using OPV for outbreak response in these countries. We systematically reviewed the literature to identify modeling studies that explored the use of IPV for outbreak response in IPV-only countries. In addition, applying a model of the 2022 type 2 poliovirus outbreak in New York, we characterized the implications of using different OPV formulations for outbreak response instead of IPV. We also explored the hypothetical scenario of the same outbreak except for type 1 poliovirus instead of type 2. We find that using IPV for outbreak response will likely only stop outbreaks for polioviruses of relatively low transmission potential in countries with very high overall immunization coverage, seasonal transmission dynamics, and only if IPV immunization interventions reach some unvaccinated individuals. Using OPV for outbreak response in IPV-only countries poses substantial risks and challenges that require careful consideration, but may represent an option to consider for some outbreaks in some populations depending on the properties of the available vaccines and coverage attainable. |
Use of inactivated polio vaccine among U.S. adults: Updated recommendations of the Advisory Committee on Immunization Practices - United States, 2023
Kidd S , Clark T , Routh J , Cineas S , Bahta L , Brooks O . MMWR Morb Mortal Wkly Rep 2023 72 (49) 1327-1330 Poliovirus can cause poliomyelitis and lifelong paralysis. Although wild poliovirus types 2 and 3 have been eradicated, wild poliovirus type 1 and vaccine-derived polioviruses are still circulating in multiple countries worldwide. In 2022, a case of paralytic polio caused by vaccine-derived poliovirus type 2 was identified in an unvaccinated young adult in New York. This case and subsequent detection of community transmission underscored the ongoing risk for importation of poliovirus into the United States and risk for poliomyelitis among unvaccinated persons. However, previous Advisory Committee on Immunization Practices (ACIP) recommendations for adult polio vaccination were limited to adults known to be at increased risk for exposure. During October 2022-June 2023, the ACIP Polio Vaccine Work Group reviewed data on poliovirus surveillance and epidemiology, safety and effectiveness of inactivated poliovirus vaccine (IPV), and other considerations outlined in the ACIP Evidence to Recommendations Framework. On June 21, 2023, ACIP voted to recommend that all U.S. adults aged ≥18 years who are known or suspected to be unvaccinated or incompletely vaccinated against polio complete a primary polio vaccination series with IPV. This report summarizes evidence considered for this recommendation and provides clinical guidance for the use of IPV in adults. |
Six- and 12-month functional outcomes among patients with confirmed acute flaccid myelitis (AFM) with onset in 2018, United States
Lopez AS , Kidd S , Yee E , Dooling K , Routh JA . J Pediatr Rehabil Med 2023 16 (2) 391-400 PURPOSE: Acute flaccid myelitis (AFM), an uncommon but serious neurologic condition, primarily affects children, and can progress quickly to paralysis and respiratory failure. Data on long-term outcomes of patients with AFM are limited. This study reports on functional status through 12 months for AFM patients who became ill in 2018 in the United States. METHODS: Health departments collected information on outcomes at 6 and 12 months after onset of AFM using a standardized form that asked patients or their parents/guardians about functional status. Analyses were restricted to confirmed cases. RESULTS: Of the 238 confirmed AFM cases reported to CDC in 2018, 90 (38%) had assessments at 6 months, 82 (34%) at 12 months, and 49 (21%) at both 6 and 12 months. Among the 49 patients with data at both time points, the proportion of patients reporting significant or severe impairment at 6 months ranged from 2% to 59% depending on the outcome. Although proportions decreased by 12 months and ranged from 2% to 51%, most patients had some impairment at 12 months. No deaths were reported. CONCLUSION: Six- and 12-month outcomes in patients with onset of AFM in 2018 span a wide range of functionality, particularly of upper and lower extremities. Importantly, improvement appears to occur over time in some patients. |
Wastewater Testing and Detection of Poliovirus Type 2 Genetically Linked to Virus Isolated from a Paralytic Polio Case - New York, March 9-October 11, 2022.
Ryerson AB , Lang D , Alazawi MA , Neyra M , Hill DT , St George K , Fuschino M , Lutterloh E , Backenson B , Rulli S , Ruppert PS , Lawler J , McGraw N , Knecht A , Gelman I , Zucker JR , Omoregie E , Kidd S , Sugerman DE , Jorba J , Gerloff N , Ng TFF , Lopez A , Masters NB , Leung J , Burns CC , Routh J , Bialek SR , Oberste MS , Rosenberg ES . MMWR Morb Mortal Wkly Rep 2022 71 (44) 1418-1424 In July 2022, a case of paralytic poliomyelitis resulting from infection with vaccine-derived poliovirus (VDPV) type 2 (VDPV2)(§) was confirmed in an unvaccinated adult resident of Rockland County, New York (1). As of August 10, 2022, poliovirus type 2 (PV2)(¶) genetically linked to this VDPV2 had been detected in wastewater** in Rockland County and neighboring Orange County (1). This report describes the results of additional poliovirus testing of wastewater samples collected during March 9-October 11, 2022, and tested as of October 20, 2022, from 48 sewersheds (the community area served by a wastewater collection system) serving parts of Rockland County and 12 surrounding counties. Among 1,076 wastewater samples collected, 89 (8.3%) from 10 sewersheds tested positive for PV2. As part of a broad epidemiologic investigation, wastewater testing can provide information about where poliovirus might be circulating in a community in which a paralytic case has been identified; however, the most important public health actions for preventing paralytic poliomyelitis in the United States remain ongoing case detection through national acute flaccid myelitis (AFM) surveillance(††) and improving vaccination coverage in undervaccinated communities. Although most persons in the United States are sufficiently immunized, unvaccinated or undervaccinated persons living or working in Kings, Orange, Queens, Rockland, or Sullivan counties, New York should complete the polio vaccination series as soon as possible. |
Public health response to a case of paralytic poliomyelitis in an unvaccinated person and detection of poliovirus in wastewater - New York, June-August 2022
Link-Gelles R , Lutterloh E , Schnabel Ruppert P , Backenson PB , St George K , Rosenberg ES , Anderson BJ , Fuschino M , Popowich M , Punjabi C , Souto M , McKay K , Rulli S , Insaf T , Hill D , Kumar J , Gelman I , Jorba J , Ng TFF , Gerloff N , Masters NB , Lopez A , Dooling K , Stokley S , Kidd S , Oberste MS , Routh J . MMWR Morb Mortal Wkly Rep 2022 71 (33) 1065-1068 On July 18, 2022, the New York State Department of Health (NYSDOH) notified CDC of detection of poliovirus type 2 in stool specimens from an unvaccinated immunocompetent young adult from Rockland County, New York, who was experiencing acute flaccid weakness. The patient initially experienced fever, neck stiffness, gastrointestinal symptoms, and limb weakness. The patient was hospitalized with possible acute flaccid myelitis (AFM). Vaccine-derived poliovirus type 2 (VDPV2) was detected in stool specimens obtained on days 11 and 12 after initial symptom onset. To date, related Sabin-like type 2 polioviruses have been detected in wastewater* in the patient's county of residence and in neighboring Orange County up to 25 days before (from samples originally collected for SARS-CoV-2 wastewater monitoring) and 41 days after the patient's symptom onset. The last U.S. case of polio caused by wild poliovirus occurred in 1979, and the World Health Organization Region of the Americas was declared polio-free in 1994. This report describes the second identification of community transmission of poliovirus in the United States since 1979; the previous instance, in 2005, was a type 1 VDPV (1). The occurrence of this case, combined with the identification of poliovirus in wastewater in neighboring Orange County, underscores the importance of maintaining high vaccination coverage to prevent paralytic polio in persons of all ages. |
National Surveillance for Acute Flaccid Myelitis - United States, 2018-2020
Kidd S , Yee E , English R , Rogers S , Emery B , Getachew H , Routh JA , Lopez AS . MMWR Morb Mortal Wkly Rep 2021 70 (44) 1534-1538 Acute flaccid myelitis (AFM), a recognized complication of certain viral infections, is a serious neurologic condition that predominantly affects previously healthy children and can progress rapidly, leading to respiratory insufficiency and permanent paralysis. After national AFM surveillance began in 2014, peaks in AFM cases were observed in the United States in 2014, 2016, and 2018 (1). On the basis of this biennial pattern, an increase in AFM was anticipated in 2020. To describe the epidemiology of confirmed AFM cases since 2018, demographic, clinical, and laboratory information collected as part of national AFM surveillance was reviewed. In 2018, a total of 238 confirmed AFM cases were reported to CDC, compared with 47 cases in 2019 and 32 in 2020. Enterovirus D68 (EV-D68) was detected in specimens from 37 cases reported in 2018, one case in 2019 and none in 2020. Compared with 2018, cases reported during 2019-2020 occurred in older children and were less frequently associated with upper limb involvement, febrile or respiratory prodromal illness, or cerebrospinal fluid (CSF) pleocytosis. These findings suggest that the etiologies of AFM in 2019 and 2020 differed from those in 2018. The absence of an increase in cases in 2020 reflects a deviation from the previously observed biennial pattern, and it is unclear when the next increase in AFM should be expected. Clinicians should continue to maintain vigilance and suspect AFM in any child with acute flaccid limb weakness, particularly in the setting of recent febrile or respiratory illness. |
Enterovirus D68-associated acute flaccid myelitis, United States, 2020
Kidd S , Lopez AS , Konopka-Anstadt JL , Nix WA , Routh JA , Oberste MS . Emerg Infect Dis 2020 26 (10) Acute flaccid myelitis (AFM) is a serious neurologic condition that causes limb weakness or paralysis in previously healthy children. Since clusters of cases were first reported in 2014, nationwide surveillance has demonstrated sharp increases in AFM cases in the United States every 2 years, most occurring during late summer and early fall. Given this current biennial pattern, another peak AFM season is expected during fall 2020 in the United States. Scientific understanding of the etiology and the factors driving the biennial increases in AFM has advanced rapidly in the past few years, although areas of uncertainty remain. The Centers for Disease Control and Prevention and AFM partners are focused on answering key questions about AFM epidemiology and mechanisms of disease. This article summarizes the current understanding of AFM etiology and outlines priorities for surveillance and research as we prepare for a likely surge in cases in 2020. |
Vital Signs: Clinical characteristics of patients with confirmed acute flaccid myelitis, United States, 2018
Kidd S , Lopez A , Nix WA , Anyalechi G , Itoh M , Yee E , Oberste MS , Routh J . MMWR Morb Mortal Wkly Rep 2020 69 (31) 1031-1038 BACKGROUND: Acute flaccid myelitis (AFM) is a serious neurologic syndrome that affects mostly children and is characterized by the acute onset of limb weakness or paralysis. Since U.S. surveillance for AFM began in 2014, reported cases have peaked biennially. This report describes the clinical characteristics of AFM patients during 2018, the most recent peak year. METHODS: Medical records from persons meeting AFM clinical criterion (acute onset of flaccid limb weakness) were submitted to CDC. Patients with confirmed AFM met the clinical criterion and had magnetic resonance imaging indicating spinal cord lesions largely restricted to gray matter and spanning one or more vertebral segments. Symptoms, physical findings, test and imaging results, and hospitalization data were abstracted and described. RESULTS: Among 238 patients with confirmed AFM during 2018, median age was 5.3 years. Among the 238 patients, 205 (86%) had onset during August-November. Most (92%) had prodromal fever, respiratory illness, or both beginning a median of 6 days before weakness onset. In addition to weakness, common symptoms at clinical evaluation were gait difficulty (52%), neck or back pain (47%), fever (35%), and limb pain (34%). Among 211 who were outpatients when weakness began, most (76%) sought medical care within 1 day, and 64% first sought treatment at an emergency department. Overall, 98% of patients were hospitalized, 54% were admitted to an intensive care unit, and 23% required endotracheal intubation and mechanical ventilation. CONCLUSION: Clinicians should suspect AFM in children with acute flaccid limb weakness, especially during August-November and when accompanied by neck or back pain and a recent history of febrile respiratory illness. Increasing awareness in frontline settings such as emergency departments should aid rapid recognition and hospitalization for AFM. |
Prevalence of self-reported neurologic and ocular symptoms in early syphilis cases
Quilter LAS , de Voux A , Amiya RM , Davies E , Hennessy RR , Kerani RP , Madera R , Matthias J , Pearson VM , Walters JK , Wilson C , Kidd S , Torrone E . Clin Infect Dis 2020 72 (6) 961-967 BACKGROUND: Neurosyphilis, a complication of syphilis, can occur at any stage of infection. Measuring the prevalence of neurosyphilis is challenging and there are limited data on the prevalence of neurologic or ocular symptoms among patients with syphilis. We sought to describe the prevalence of neurologic and/or ocular symptoms among early syphilis (ES) cases and the clinical management of symptomatic cases enrolled in the STD Surveillance Network (SSuN) Neuro/Ocular Syphilis Surveillance project. METHODS: Persons diagnosed with ES were selected for interviews based on current health department protocols in five participating SSuN jurisdictions from November 2016-October 2017. All interviewed ES cases were screened for self-reported neurologic and/or ocular symptoms. Additional clinical information on diagnostic testing and treatment for cases concerning for neurosyphilis/ocular syphilis was obtained from providers. RESULTS: Among 9,123 patients with ES who were interviewed, 151 (1.7%, 95% CI: 1.4-1.9) reported >/=1 neurologic or ocular symptom. Of the 53 (35%) who underwent lumbar puncture (LP), 22 (42%) had documented abnormal cerebrospinal fluid, of which 21 (95%) were treated for neurosyphilis/ocular syphilis. Among the remaining 98 symptomatic patients with no documented LP (65%), 12 (12%) were treated for and/or clinically diagnosed with neurosyphilis/ocular syphilis. CONCLUSIONS: We observed a low prevalence of self-reported neurologic and/or ocular symptoms in interviewed ES cases. Approximately one-third of ES cases who self-reported symptoms underwent further recommended diagnostic evaluation. Understanding barriers to appropriate clinical evaluation is important to ensuring appropriate management of patients with possible neurologic and/or ocular manifestations of syphilis. |
Characteristics of patients with acute flaccid myelitis, United States, 2015-2018
McLaren N , Lopez A , Kidd S , Zhang JX , Nix WA , Link-Gelles R , Lee A , Routh JA . Emerg Infect Dis 2020 26 (2) 212-219 Observed peaks of acute flaccid myelitis (AFM) cases have occurred biennially since 2014 in the United States. We aimed to determine if AFM etiology differed between peak and nonpeak years, considering that clinical features of AFM differ by virus etiology. We compared clinical and laboratory characteristics of AFM cases that occurred during peak (2016 and 2018, n = 366) and nonpeak (2015 and 2017, n = 50) years. AFM patients in peak years were younger (5.2 years) than those in nonpeak years (8.3 years). A higher percentage of patients in peak years than nonpeak years had pleocytosis (86% vs. 60%), upper extremity involvement (33% vs. 16%), and an illness preceding limb weakness (90% vs. 62%) and were positive for enterovirus or rhinovirus RNA (38% vs. 16%). Enterovirus D68 infection was associated with AFM only in peak years. Our findings suggest AFM etiology differs between peak and nonpeak years. |
Increased methamphetamine, injection drug, and heroin use among women and heterosexual men with primary and secondary syphilis - United States, 2013-2017
Kidd SE , Grey JA , Torrone EA , Weinstock HS . MMWR Morb Mortal Wkly Rep 2019 68 (6) 144-148 During 2013-2017, the national annual rate of reported primary and secondary (P&S) syphilis cases in the United States increased 72.7%, from 5.5 to 9.5 cases per 100,000 population (1). The highest rates of P&S syphilis are seen among gay, bisexual, and other men who have sex with men (collectively referred to as MSM) (2), and MSM continued to account for the majority of cases in 2017 (1). However, during 2013-2017, the P&S syphilis rate among women increased 155.6% (from 0.9 to 2.3 cases per 100,000 women), and the rate among all men increased 65.7% (from 10.2 to 16.9 cases per 100,000 men), indicating increasing transmission between men and women in addition to increasing transmission between men (1). To further understand these trends, CDC analyzed national P&S syphilis surveillance data for 2013-2017 and assessed the percentage of cases among women, men who have sex with women only (MSW), and MSM who reported drug-related risk behaviors during the past 12 months. Among women and MSW with P&S syphilis, reported use of methamphetamine, injection drugs, and heroin more than doubled during 2013-2017. In 2017, 16.6% of women with P&S syphilis used methamphetamine, 10.5% used injection drugs, and 5.8% used heroin during the preceding 12 months. Similar trends were seen among MSW, but not among MSM. These findings indicate that a substantial percentage of heterosexual syphilis transmission is occurring among persons who use these drugs, particularly methamphetamine. Collaboration between sexually transmitted disease (STD) control programs and partners that provide substance use disorder services will be important to address recent increases in heterosexual syphilis. |
National trends and reported risk factors among pregnant women with syphilis in the United States, 2012-2016
Trivedi S , Williams C , Torrone E , Kidd S . Obstet Gynecol 2018 133 (1) 27-32 OBJECTIVE: To describe recent syphilis trends among pregnant women and to evaluate the prevalence of reported high-risk behaviors in this population. METHODS: We analyzed U.S. national case report data for 2012-2016 to assess trends among pregnant women with all stages of syphilis. Risk behavior data collected through case interviews during routine local health department investigation of syphilis cases were used to evaluate the number of pregnant women with syphilis reporting these behaviors. RESULTS: During 2012-2016, the number of syphilis cases among pregnant women increased 61%, from 1,561 to 2,508, and this increase was observed across all races and ethnicities, all women aged 15-45 years, and all U.S. regions. Of 15 queried risk factors, including high-risk sexual behaviors and drug use, 49% of pregnant women with syphilis did not report any in the past year. The most commonly reported risk behaviors were a history of a sexually transmitted disease (43%) and more than one sex partner in the past year (30%). CONCLUSION: Syphilis cases among pregnant women increased from 2012 to 2016, and in half, no traditional behavioral risk factors were reported. Efforts to reduce syphilis among pregnant women should involve increasing health care provider awareness of the Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists' recommendations, which include screening all pregnant women for syphilis at the first prenatal visit and rescreening high-risk women during the third trimester and at delivery. Health care providers should also consider local syphilis prevalence in addition to individual reported risk factors when deciding whether to repeat screening. |
Increasing syphilis diagnoses among females giving birth in US hospitals, 2010-2014
Aslam MV , Owusu-Edusei K , Kidd SE , Torrone EA , Dietz PM . Sex Transm Dis 2018 46 (3) 147-152 BACKGROUND: National trends in syphilis rates among females delivering newborns are not well characterized. We assessed 2010-2014 trends in syphilis diagnoses documented on discharge records and associated factors among females who have given birth in US hospitals. METHODS: We calculated quarterly trends in syphilis rates (per 100,000 deliveries) by using ICD-9 codes on delivery discharge records from the National Inpatient Sample. Changes in trends were determined by using Joinpoint software. We estimated relative risks (RR) to assess the association of syphilis diagnoses with race/ethnicity, age, insurance status, household income, and census region. RESULTS: Overall, estimated syphilis rates decreased during 2010-2012 at 1.0% per quarter (P < .001) and increased afterwards at 1.8% (P < .001). The syphilis rate increase was statistically significant across all sociodemographic groups and all US regions, with substantial increases identified among whites (35.2% per quarter; P < .001) and Medicaid recipients (15.1%; P < .001). In 2014, the risk of syphilis diagnosis was greater among blacks (RR, 13.02; 95% confidence interval [CI], 9.46-17.92) or Hispanics (RR, 4.53; 95% CI, 3.19-6.42), compared with whites; Medicaid recipients (RR, 4.63; 95% CI, 3.38-6.33) or uninsured persons (RR, 2.84; 95% CI, 1.74-4.63), compared with privately insured patients; females with the lowest household income (RR, 5.32; 95% CI, 3.55-7.97), compared with the highest income; and females in the South (RR, 2.42; 95% CI, 1.66-3.53), compared with the West. CONCLUSIONS: Increasing syphilis rates among pregnant females of all backgrounds reinforce the importance of prenatal screening and treatment. |
Reactor grids for prioritizing syphilis investigations: Are primary syphilis cases being missed
Cha S , Matthias JM , Rahman M , Schillinger JA , Furness BW , Pugsley RA , Kidd S , Bernstein KT , Peterman TA . Sex Transm Dis 2018 45 (10) 648-654 BACKGROUND: Health departments prioritize investigations of reported reactive serologic tests based on age, gender, and titer using reactor grids. We wondered how reactor grids are used in different programs, and if administratively closing investigations of low-titer tests could lead to missed primary syphilis cases. METHODS: We obtained a convenience sample of reactor grids from 13 health departments. Interviews with staff from several jurisdictions described the role of grids in surveillance and intervention. From 5 jurisdictions, trends in reactive nontreponemal tests and syphilis cases over time (2006-2015) were assessed by gender, age, and titer. In addition, nationally-reported primary syphilis cases (2013-2015) were analyzed to determine what proportion had low titers (</=1:4) that might be administratively closed by grids without further investigation. RESULTS: Grids and follow-up approaches varied widely. Health departments in the study received a total of 48,573 to 496,503 reactive serologies over a 10-year period (3044-57,242 per year). In 2006 to 2015, the number of reactive serologies increased 37% to 169%. Increases were largely driven by tests for men although the ratios of tests per reported case remained stable over time. Almost one quarter of reported primary syphilis had low titers that would be excluded by most grids. The number of potentially missed primary syphilis cases varied by gender and age with 41- to 54-year-old men accounting for most. CONCLUSIONS: Reactor grids that close tests with low titers or from older individuals may miss some primary syphilis cases. Automatic, computerized record searches of all reactive serologic tests could help improve prioritization. |
Trends in deaths due to syphilis, United States, 1968-2015
Peterman TA , Kidd SE . Sex Transm Dis 2018 46 (1) 37-40 BACKGROUND: Before penicillin, the syphilis case-fatality rate was 10% within 40 years. Late complications, such as cardiovascular syphilis, were still common in the 1950s but now seem quite rare even though some infections likely go undetected. We studied trends in syphilis mortality as an indicator of trends in severe complications of syphilis. METHODS: We assessed underlying cause of death from U.S. death certificates for 1968-2015. We examined death trends by type of syphilis (cardiovascular, neuro, congenital, other). We compared trends in deaths to trends in primary and secondary syphilis from national STD surveillance data. RESULTS: During 1968-2015 there were 6,498 deaths attributed to syphilis; 4,149 males and 2,349 females. Annual syphilis deaths decreased from 586 in 1968 to 94 in 1984, then leveled off to between 24-46 since 1998. Between 1968 and 2015, the decrease in annual cardiovascular syphilis deaths (from 338 to 3) exceeded the decrease in annual neurosyphilis deaths (from 191 to 33). Congenital syphilis deaths (which do not include stillbirths) generally decreased from 28 to 2 per year. An increase in primary and secondary syphilis among women in the late 1980s was accompanied by a 4-fold increase in congenital syphilis deaths (from 9 in 1986 to 35 in 1990) but there was no subsequent increase in syphilis deaths among women. CONCLUSION: Adults now rarely die from syphilis. Increases in infections in the late 1980s did not lead to an increase in adult syphilis deaths. Congenital syphilis deaths still increase when syphilis increases among women. |
State requirements for prenatal syphilis screening in the United States, 2016
Warren HP , Cramer R , Kidd S , Leichliter JS . Matern Child Health J 2018 22 (9) 1227-1232 Objectives This study assesses U.S. state laws related to prenatal syphilis screening, including whether these laws align with CDC screening recommendations and include legal penalties for failing to screen. Methods Statutes and regulations regarding syphilis screening during pregnancy and at delivery effective in 2016 were examined for all 50 U.S. states and the District of Columbia (DC). Targeted search terms were used to identify laws in legal research databases. The timing of the screening mandates for each state law was coded for: (1) first visit, (2) third trimester, and (3) delivery. Descriptive statistics were calculated to examine the number of states with each type of requirement and whether requirements adhered to the CDC STD treatment guidelines. Results Only six states (11.8%) do not require prenatal syphilis screening. Of states with screening requirements (n = 45), the majority (84.3%) require testing at first prenatal visit or soon after. 17 states (33.3%) require screening during the third trimester with five requiring screening only if the patient is considered at high risk. 8 (15.7%) states require screening at delivery with five requiring testing only if the woman is at high risk. 14 (27.5%) states include punishments for failing to screen (civil penalties, criminal penalties and license revocation). Conclusions for Practice Most states had prenatal syphilis screening requirements; a minority corresponded to or extended CDC recommendations. States vary in when they require testing, who must be tested, and whether a failure to screen could result in a punishment for the provider. |
Use of national syphilis surveillance data to develop a congenital syphilis prevention cascade and estimate the number of potential congenital syphilis cases averted
Kidd S , Bowen VB , Torrone EA , Bolan G . Sex Transm Dis 2018 45 S23-S28 BACKGROUND: Recent increases in reported congenital syphilis have led to an urgent need to identify interventions that will have the greatest impact on congenital syphilis prevention. We sought to create a congenital syphilis prevention cascade using national syphilis surveillance data to (1) estimate the proportion of potential congenital syphilis cases averted with current prevention efforts, and (2) develop a classification framework to better describe why reported cases were not averted. METHODS: We reviewed national syphilis and congenital syphilis case report data from 2016, including pregnancy status of all reported female syphilis cases and data on prenatal care, testing, and treatment status of mothers of reported congenital syphilis cases to derive estimates of the proportion of pregnant women with syphilis who received prenatal care, syphilis testing, and adequate syphilis treatment at least 30 days prior to delivery, as well as the proportion of potential congenital syphilis cases averted. RESULTS: Among the 2,508 pregnant women who were reported to have syphilis, an estimated 88.0% received prenatal care at least 30 days prior to delivery, 89.4% were tested for syphilis at least 30 days prior to delivery, and 76.9% received an adequate treatment regimen that began at least 30 days prior to delivery. Overall, an estimated 1,928 (75.0%) potential congenital syphilis cases in the United States were successfully averted. Among states that reported at least 10 syphilis cases among pregnant women, the estimated proportion of potential congenital syphilis cases averted ranged from 55.0% to 92.3%. CONCLUSIONS: While the majority of potential congenital syphilis cases in the United States were averted in 2016, there was substantial geographic variation, and significant gaps in delivering timely prenatal care, syphilis testing, and adequate treatment to pregnant women with syphilis were identified. The congenital syphilis prevention cascade is a useful tool to quantify programmatic successes and identify where improvements are needed. |
Reported primary and secondary syphilis cases in the United States: Implications for HIV infection
Kidd S , Torrone E , Su J , Weinstock H . Sex Transm Dis 2018 45 S42-S47 BACKGROUND: Recent increases in syphilis among men who have sex with men (MSM) are especially concerning, given the biologic and epidemiologic associations between syphilis and HIV infection. We sought to better describe the current epidemiology of primary and secondary (P&S) syphilis and the prevalence of HIV infection among reported P&S syphilis cases by demographic group, including sex of sex partner, in the United States in 2016. METHODS: We reviewed national P&S syphilis case report data from 2016, including available risk factor information such as sex of sex partner and HIV status. Data were extracted from the National Electronic Telecommunications System for Surveillance, the system through which CDC receives notifiable STD data from all 50 states and the District of Columbia. The proportion of cases with HIV co-infection was calculated using cases with known HIV status as the denominator. RESULTS: Of 27,814 P&S syphilis cases reported in 2016, 58.1% were among MSM, 13.9% were among men who have sex with women only (MSW), 11.0% were among women, and 16.9% were among men without data on sex of sex partners. Similar patterns were observed across geographic regions, race/ethnicity groups, and most age groups. Overall, 38.5% of reported P&S syphilis cases with known HIV status were co-infected with HIV. The prevalence of HIV co-infection was highest among MSM (47.0%) compared with MSW (10.7%) or women (4.1%). Among MSM with P&S syphilis, the prevalence of HIV co-infection was highest among black MSM, ranging from 33.8% among black MSM aged 15-19 years to 77.8% among black MSM aged 45-49 years. CONCLUSIONS: These data underscore the epidemiologic linkages between syphilis and HIV, particularly among MSM. P&S syphilis may represent an opportunity to prevent HIV infection among persons who are HIV-negative and identify and link to care persons living with HIV infection but not currently engaged in care. |
Reported cases of neurosyphilis among early syphilis cases - United States, 2009 to 2015
de Voux A , Kidd S , Torrone EA . Sex Transm Dis 2017 45 (1) 39-41 The surveillance of neurosyphilis, an uncommon but severe consequence of syphilis, is complex; surveillance classification of neurosyphilis requires a lumbar puncture and cerebrospinal fluid analysis. We examined the prevalence of reported neurosyphilis among primary, secondary, and early latent syphilis cases reported in the United States from 2009 to 2015. Overall, the prevalence of reported neurosyphilis from 2009 to 2015 was low (0.84%); however, this is likely an underestimate of the true burden in the United States. |
Rates of primary and secondary syphilis among white and black non-Hispanic men who have sex with men, US states, 2014
Grey JA , Bernstein KT , Sullivan PS , Kidd SE , Gift TL , Hall EW , Hankin-Wei A , Weinstock HS , Rosenberg ES . J Acquir Immune Defic Syndr 2017 76 (3) e65-e73 BACKGROUND: Men who have sex with men (MSM) in the United States experience an approximately 100-fold greater rate of primary and secondary (P&S) syphilis diagnoses compared to men who have sex with women only. As in the general population, racial/ethnic disparities in P&S syphilis diagnosis rates may exist among MSM, but MSM-specific P&S syphilis rates by race/ethnicity are unavailable. We enhanced a published modeling approach to estimate area-level MSM populations by race/ethnicity and provide the first estimates of P&S syphilis among black and white non-Hispanic MSM. METHODS: We used data from the American Community Survey (ACS), published findings from the National Health and Nutrition Examination Survey (NHANES), and national syphilis surveillance data to estimate state-level rates of P&S syphilis diagnoses among MSM, overall and for black and white non-Hispanic MSM. We also used variability around ACS and NHANES estimates to calculate 95% confidence intervals for each rate. RESULTS: Among 11,359 cases of P&S syphilis among MSM with known race/ethnicity in 2014, 72.5% were among white (40.3%) or black (32.2%) MSM. The national rate of P&S syphilis diagnosis was 168.4/100,000 for white MSM and 583.9/100,000 for black MSM. Regional rates for black MSM ranged from 602.0/100,000 (South) to 521.5/100,000 (Midwest) and were consistently higher than those for white MSM. CONCLUSIONS: Although white MSM accounted for the majority of P&S syphilis diagnoses in 2014, when evaluating diagnoses based on rate per 100,000, black MSM had consistently and markedly higher rates than white MSM, with the highest-impacted states located in the US South. |
FORWARD: A Registry and Longitudinal Clinical Database to Study Fragile X Syndrome.
Sherman SL , Kidd SA , Riley C , Berry-Kravis E , Andrews HF , Miller RM , Lincoln S , Swanson M , Kaufmann WE , Brown WT . Pediatrics 2017 139 S183-S193 Background and objective: Advances in the care of patients with fragile X syndrome (FXS) have been hampered by lack of data. This deficiency has produced fragmentary knowledge regarding the natural history of this condition, healthcare needs, and the effects of the disease on caregivers. To remedy this deficiency, the Fragile X Clinic and Research Consortium was established to facilitate research. Through a collective effort, the Fragile X Clinic and Research Consortium developed the Fragile X Online Registry With Accessible Research Database (FORWARD) to facilitate multisite data collection. This report describes FORWARD and the way it can be used to improve health and quality of life of FXS patients and their relatives and caregivers. Methods: FORWARD collects demographic information on individuals with FXS and their family members (affected and unaffected) through a 1-time registry form. The longitudinal database collects clinician- and parent-reported data on individuals diagnosed with FXS, focused on those who are 0 to 24 years of age, although individuals of any age can participate. Results: The registry includes >2300 registrants (data collected September 7, 2009 to August 31, 2014). The longitudinal database includes data on 713 individuals diagnosed with FXS (data collected September 7, 2012 to August 31, 2014). Longitudinal data continue to be collected on enrolled patients along with baseline data on new patients. Conclusions: FORWARD represents the largest resource of clinical and demographic data for the FXS population in the United States. These data can be used to advance our understanding of FXS: the impact of cooccurring conditions, the impact on the day-today lives of individuals living with FXS and their families, and short-term and long-term outcomes. |
Autism Spectrum Disorder in Fragile X Syndrome: Cooccurring Conditions and Current Treatment.
Kaufmann WE , Kidd SA , Andrews HF , Budimirovic DB , Esler A , Haas-Givler B , Stackhouse T , Riley C , Peacock G , Sherman SL , Brown WT , Berry-Kravis E . Pediatrics 2017 139 S194-S206 Background and objective: Individuals with fragile X syndrome (FXS) are frequently codiagnosed with autism spectrum disorder (ASD). Most of our current knowledge about ASD in FXS comes from family surveys and small studies. The objective of this study was to examine the impact of the ASD diagnosis in a large clinic-based FXS population to better inform the care of people with FXS. Methods: The study employed a data set populated by data from individuals with FXS seen at specialty clinics across the country. The data were collected by clinicians at the patient visit and by parent report for nonclinical and behavioral outcomes from September 7, 2012 through August 31, 2014. Data analyses were performed by using chi2 tests for association, t tests, and multiple logistic regression to examine the association between clinical and other factors with ASD status. Results: Half of the males and nearly 20% of females met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for current ASD. Relative to the FXS-only group, the FXS with ASD (FXS+ASD) group had a higher prevalence of seizures (20.7% vs 7.6%, P < .001), persistence of sleep problems later in childhood, increased behavior problems, especially aggressive/disruptive behavior, and higher use of alpha-agonists and antipsychotics. Behavioral services, including applied behavior analysis, appeared to be underused in children with FXS+ASD (only 26% and 16% in prekindergarten and school-age periods, respectively) relative to other populations with idiopathic ASD. Conclusions: These findings confirm among individuals with FXS an association of an ASD diagnosis with important cooccurring conditions and identify gaps between expected and observed treatments among individuals with FXS+ASD. |
State-specific rates of primary and secondary syphilis among men who have sex with men - United States, 2015
de Voux A , Kidd S , Grey JA , Rosenberg ES , Gift TL , Weinstock H , Bernstein KT . MMWR Morb Mortal Wkly Rep 2017 66 (13) 349-354 In 2015, the rate of reported primary and secondary syphilis in the United States was 7.5 cases per 100,000 population, nearly four times the previous lowest documented rate of 2.1 in 2000. In 2015, 81.7% of male primary and secondary syphilis cases with information on the sex of the sex partner were among gay, bisexual, and other men who have sex with men (collectively referred to as MSM) (1). These data suggest a disproportionate incidence of disease among MSM. However, attempts to quantify this disparity have been hindered by limited data on the size of the MSM population at the state level. To produce the first estimates of state-specific rates of primary and secondary syphilis among MSM, CDC used MSM population estimates based on a new methodology and primary and secondary syphilis case counts reported in 2015 to the National Notifiable Diseases Surveillance System. Among 44 states reporting information on the sex of sex partners for ≥70% of male cases, the overall rate of primary and secondary syphilis among all men (aged ≥18 years) in the United States in 2015 was 17.5 per 100,000, compared with 309.0 among MSM and 2.9 among men who reported sex with women only. The overall rate of primary and secondary syphilis among MSM was 106.0 times the rate among men who have sex with women only and 167.5 times the rate among women.* These data highlight the disproportionate impact of syphilis among MSM and underscore the need for innovative and targeted syphilis prevention measures at the state and local level, especially among MSM. It is important that health care providers recognize the signs and symptoms of syphilis, screen sexually active MSM for syphilis at least annually, and provide timely treatment according to national sexually transmitted diseases treatment guidelines. |
The cost-effectiveness of syphilis screening among men who have sex with men: An exploratory modeling analysis
Chesson HW , Kidd S , Bernstein KT , Fanfair RN , Gift TL . Sex Transm Dis 2016 43 (7) 429-32 We adapted a published model to estimate the costs and benefits of screening men who have sex with men for syphilis, including the benefits of preventing syphilis-attributable human immunodeficiency virus. The cost per quality-adjusted life year gained by screening was <US $0 (cost-saving) and US $16,100 in the dynamic and static versions of the model, respectively. |
Management of gonorrhea in adolescents and adults in the United States
Kidd S , Workowski KA . Clin Infect Dis 2015 61 Suppl 8 S785-801 Gonorrhea is the second most commonly reported notifiable disease in the United States and is associated with serious health sequelae, including pelvic inflammatory disease, infertility, and ectopic pregnancy. Treatment for gonorrhea has been complicated by antimicrobial resistance. Neisseria gonorrhoeae has developed resistance to each of the antimicrobials that were previously recommended as first-line treatment regimens, and current treatment options are severely limited. This article summarizes the key questions and data that were discussed at the Sexually Transmitted Diseases (STD) Treatment Guidelines Expert Consultation meeting in April 2013, and the rationale for the 2015 Centers for Disease Control and Prevention STD treatment guidelines for gonococcal infections in adolescents and adults. Key issues addressed include whether to change the dosage of ceftriaxone and azithromycin used in the recommended dual treatment regimen, whether to continue to list dual treatment with cefixime and azithromycin as an alternative treatment regimen, and management of gonococcal infections in persons with severe cephalosporin allergy or suspected treatment failure. |
Multicenter study of epidemiological cutoff values and detection of resistance in Candida spp. to anidulafungin, caspofungin, and micafungin using the Sensititre Yeast One colorimetric method
Espinel-Ingroff A , Alvarez-Fernandez M , Canton E , Carver PL , Chen SC , Eschenauer G , Getsinger DL , Gonzalez GM , Govender NP , Grancini A , Hanson KE , Kidd SE , Klinker K , Kubin CJ , Kus JV , Lockhart SR , Meletiadis J , Morris AJ , Pelaez T , Quindos G , Rodriguez-Iglesias M , Sanchez-Reus F , Shoham S , Wengenack NL , Borrell Sole N , Echeverria J , Esperalba J , Gomez Gde la Pedrosa E , Garcia Garcia I , Linares MJ , Marco F , Merino P , Peman J , Perez Del Molino L , Rosello Mayans E , Rubio Calvo C , Ruiz Perez de Pipaon M , Yague G , Garcia-Effron G , Guinea J , Perlin DS , Sanguinetti M , Shields R , Turnidge J . Antimicrob Agents Chemother 2015 59 (11) 6725-32 Neither breakpoints (BPs) nor epidemiological cutoff values (ECVs) have been established for Candida spp. with anidulafungin, caspofungin, and micafungin when using the Sensititre YeastOne (SYO) broth dilution colorimetric method. In addition, reference caspofungin MICs have so far proven to be unreliable. Candida species wild-type (WT) MIC distributions (for microorganisms in a species/drug combination with no detectable phenotypic resistance) were established for 6,007 Candida albicans, 186 C. dubliniensis, 3,188 C. glabrata complex, 119 C. guilliermondii, 493 C. krusei, 205 C. lusitaniae, 3,136 C. parapsilosis complex, and 1,016 C. tropicalis isolates. SYO MIC data gathered from 38 laboratories in Australia, Canada, Europe, Mexico, New Zealand, South Africa, and the United States were pooled to statistically define SYO ECVs. ECVs for anidulafungin, caspofungin, and micafungin encompassing ≥97.5% of the statistically modeled population were, respectively, 0.12, 0.25, and 0.06 mug/ml for C. albicans, 0.12, 0.25, and 0.03 mug/ml for C. glabrata complex, 4, 2, and 4 mug/ml for C. parapsilosis complex, 0.5, 0.25, and 0.06 mug/ml for C. tropicalis, 0.25, 1, and 0.25 mug/ml for C. krusei, 0.25, 1, and 0.12 mug/ml for C. lusitaniae, 4, 2, and 2 mug/ml for C. guilliermondii, and 0.25, 0.25, and 0.12 mug/ml for C. dubliniensis. Species-specific SYO ECVs for anidulafungin, caspofungin, and micafungin correctly classified 72 (88.9%), 74 (91.4%), 76 (93.8%), respectively, of 81 Candida isolates with identified fks mutations. SYO ECVs may aid in detecting non-WT isolates with reduced susceptibility to anidulafungin, micafungin, and especially caspofungin, since testing the susceptibilities of Candida spp. to caspofungin by reference methodologies is not recommended. |
Increase in incidence of congenital syphilis - United States, 2012-2014
Bowen V , Su J , Torrone E , Kidd S , Weinstock H . MMWR Morb Mortal Wkly Rep 2015 64 (44) 1241-1245 Congenital syphilis (CS) occurs when a mother infected with syphilis transmits the infection to her child during pregnancy. CS can cause severe illness, miscarriage, stillbirth, and early infant death. However, among pregnant women with syphilis who deliver after 20 weeks gestation, maternal treatment with penicillin is 98% effective at preventing CS (1). In the United States, the rate of CS decreased during 1991-2005 but increased slightly during 2005-2008 (2). To assess recent trends in CS, CDC analyzed national surveillance data reported during 2008-2014, calculated rates, and described selected characteristics of infants with CS and their mothers. The overall rate of reported CS decreased from 10.5 to 8.4 cases per 100,000 live births during 2008-2012, and then increased to 11.6 cases per 100,000 live births in 2014, the highest CS rate reported since 2001. From 2012 to 2014, reported cases and rates of CS increased across all regions of the United States. To reduce CS, the timely identification of and response to increases in syphilis among women of reproductive age and men who have sex with women are essential. All women should have access to quality prenatal care, including syphilis screening and adequate treatment, during pregnancy (3). |
Comparison of antimicrobial susceptibility of urogenital Neisseria gonorrhoeae isolates obtained from women and men
Kidd S , Moore PC , Kirkcaldy RD , Philip SS , Wiesenfeld HC , Papp JR , Kerndt PR , Venkatasubramanian L , Ghanem KG , Hook EW 3rd . Sex Transm Dis 2015 42 (8) 434-9 BACKGROUND: The US system for gonococcal antimicrobial susceptibility surveillance monitors trends exclusively among men with urethral infection, the population from whom the yield of gonococcal culture is highest. Little is known about the susceptibility of female urogenital isolates, and it is unclear whether gonococcal susceptibility among men who report sex exclusively with women (MSW) is representative of susceptibility among women. METHODS: Using isolates collected during a recent treatment trial in 5 US cities, we performed a secondary analysis to compare antimicrobial susceptibilities of Neisseria gonorrhoeae urogenital isolates obtained from women, MSW, and men who have sex with men (MSM). Pretreatment isolates were collected from trial participants; minimum inhibitory concentrations (MICs) were determined by agar dilution. Geometric mean MICs were adjusted for geographic location using general linear models. RESULTS: Susceptibility data for urogenital isolates from 56 women, 252 MSW, and 170 MSM were studied. The adjusted geometric mean ceftriaxone MIC was similar among women (0.0067 mug/mL; 95% confidence interval [CI], 0.0049-0.0092 mug/mL) and MSW (0.0060 mug/mL; 95% CI, 0.0053-0.0066 mug/mL). In contrast, the adjusted geometric mean ceftriaxone MIC was higher among MSM (0.0098 mug/mL; 95% CI, 0.0082-0.0119 mug/mL) than among MSW. This same pattern was observed for other antimicrobials, including cefixime and azithromycin CONCLUSIONS: Ceftriaxone, cefixime, and azithromycin MICs were higher among MSM than among MSW, but were similar among women and MSW. These findings suggest that gonococcal antimicrobial susceptibility surveillance based on urethral isolates from MSW may adequately represent susceptibility of urogenital N. gonorrhoeae in women. |
Comparison of antimicrobial susceptibility of pharyngeal, rectal, and urethral Neisseria gonorrhoeae isolates among men who have sex with men
Kidd S , Zaidi A , Asbel L , Baldwin T , Gratzer B , Guerry S , Kerani RP , Pathela P , Pettus K , Soge OO , Stirland A , Weinstock HS . Antimicrob Agents Chemother 2015 59 (5) 2588-95 The United States' surveillance for Neisseria gonorrhoeae antimicrobial susceptibility is based exclusively on male urethral isolates. These data inform gonorrhea treatment guidelines, including recommendations for treatment of extra-genital infection, but data on the susceptibility of extra-genital isolates are limited. We compared the antimicrobial susceptibility of pharyngeal, rectal, and urethral gonococcal isolates collected from men who have sex with men (MSM) at five sentinel sites throughout the United States. Minimum inhibitory concentrations (MICs) were determined by the agar dilution method. Generalized linear models were used to compare (1) the proportions of isolates with elevated MICs and (2) geometric mean MICs by anatomic site adjusted for city. During December 2011-September 2013, a total of 205 pharyngeal, 261 rectal, and 976 urethral isolates were obtained. The proportion of isolates with elevated ceftriaxone MICs (≥0.125 mug/ml) did not differ by anatomic site (0.5% of pharyngeal, 1.5% of rectal, and 1.7% of urethral isolates; city-adjusted odds ratio [95% CI] 0.4 [0.0, 3.9] for pharyngeal vs. urethral isolates, 0.9 [0.2, 4.2] for rectal vs. urethral isolates). The city-adjusted geometric mean ceftriaxone MICs of pharyngeal (0.0153 mug/ml) and rectal (0.0157 mug/ml) isolates did not differ from that of urethral isolates (0.0150 mug/ml) (ratio of geometric mean MICs [95% CI] 1.02 [0.90, 117] and 1.05 [0.93, 1.19], respectively). Similar results were observed for other antimicrobials, including cefixime and azithromycin. These findings suggest that, at the population level, gonococcal antimicrobial susceptibility surveillance based on urethral isolates from MSM adequately represents the susceptibility of N. gonorrhoeae circulating among MSM. |
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