Last data update: Apr 29, 2024. (Total: 46658 publications since 2009)
Records 1-7 (of 7 Records) |
Query Trace: Mandra A[original query] |
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Human rabies despite post-exposure prophylaxis: a systematic review of fatal breakthrough infections after zoonotic exposures
Whitehouse ER , Mandra A , Bonwitt J , Beasley EA , Taliano J , Rao AK . Lancet Infect Dis 2022 23 (5) e167-e174 Post-exposure prophylaxis (PEP) for rabies is widely administered and highly effective. Nevertheless, sporadic breakthrough infections (ie, rabies in people who have started PEP) have been reported. We conducted a systematic review of articles published between Jan 1, 1980 and June 1, 2022 to characterise breakthrough infections. After reviewing 3380 articles from across all continents, we identified 52 articles, which included a total of 122 breakthrough infections. We classified breakthrough infections on the basis of adherence to core practices (ie, wound cleaning and vaccine administration). Of 86 breakthrough infections with data, median time from exposure to symptom onset was 20 days (IQR 16-24). Most (89 [77%] of 115) participants received PEP within 2 days of an exposure. Severe wounds (defined as those involving multiple wound sites or bites to the head, face, or neck) were common (80 [69%] of 116 [with data]). Deviations from core practices were reported in 68 (56%) of 122 cases. Other possible causes for breakthrough infections included errors in the administration of rabies immunoglobulin, delays in seeking health care, and comorbidities or immunosuppression. Cold-chain integrity assessments and potency testing of PEP biologics were only rarely assessed (8 [7%] of 122 cases), neither of which were found to be a cause of breakthrough infections. Timely and appropriate administration of PEP is crucial to prevent rabies, and although people with high-risk exposures or immunosuppression can develop rabies despite adherence to core practices, this occurrence remains exceedingly rare. |
Myopericarditis Associated With Smallpox Vaccination Among US Army Personnel - Fort Hood, Texas, 2018
Mandra AM , Superior MJ , Guagliardo SAJ , Hesse E , Pacha LA , Stidham RA , Colbeck DC , Hrncir DE , Hall N , Petersen BW , Rao AK . Disaster Med Public Health Prep 2021 16 (3) 1-7 OBJECTIVE: In March 2018, the US Department of Defense (DOD) added the smallpox vaccination, using ACAM2000, to its routine immunizations, increasing the number of persons receiving the vaccine. The following month, Fort Hood reported a cluster of 5 myopericarditis cases. The Centers for Disease Control and Prevention and the DOD launched an investigation. METHODS: The investigation consisted of a review of medical records, establishment of case definitions, causality assessment, patient interviews, and active surveillance. A 2-sided exact rate ratio test was used to compare myopericarditis incidence rates. RESULTS: This investigation identified 4 cases of probable myopericarditis and 1 case of suspected myopericarditis. No alternative etiology was identified as a cause. No additional cases were identified. There was no statistically significant difference in incidence rates between the observed cluster (5.23 per 1000 vaccinated individuals, 95% CI: 1.7-12.2) and the ACAM2000 clinical trial outcomes for symptomatic persons, which was 2.29 per 1000 vaccinated individuals (95% CI: 0.3-8.3). CONCLUSIONS: Vaccination with ACAM2000 is the presumptive cause of this cluster. Caution should be exercised before considering vaccination campaigns for smallpox given the clinical morbidity and costs incurred by a case of myopericarditis. Risk of myopericarditis should be carefully weighed with risk of exposure to smallpox. |
Rabies in a dog imported from egypt - Kansas, 2019
Raybern C , Zaldivar A , Tubach S , Ahmed FS , Moore S , Kintner C , Wallace RM , Mandra AM , Stauffer K , Condori RE , Garrison I . MMWR Morb Mortal Wkly Rep 2020 69 (38) 1374-1377 Although canine rabies virus variant (CRVV) was successfully eliminated from the United States after approximately 6 decades of vaccination campaigns, licensing requirements, and stray animal control, dogs remain the principal source of human rabies infections worldwide. A rabies vaccination certificate is required for dogs entering the United States from approximately 100 countries with endemic CRVV, including Egypt (1). On February 25, 2019, rabies was diagnosed in a dog imported from Egypt, representing the third canine rabies case imported from Egypt in 4 years (2,3). This dog and 25 others were imported by a pet rescue organization in the Kansas City metropolitan area on January 29. Upon entry into the United States, all 26 dogs had certificates of veterinary inspection, rabies vaccination certificates, and documentation of serologic conversion from a government-affiliated rabies laboratory in Egypt. CDC confirmed that the dog was infected with a CRVV that circulates in Egypt, underscoring the continued risk for CRVV reintroduction and concern regarding the legitimacy of vaccine documentation of dogs imported from countries considered at high risk for CRVV. Vaccination documentation of dogs imported from these countries should be critically evaluated before entry into the United States is permitted, and public health should be consulted upon suspicion of questionable documents. |
Exportation of Monkeypox virus from the African continent.
Mauldin MR , McCollum AM , Nakazawa YJ , Mandra A , Whitehouse ER , Davidson W , Zhao H , Gao J , Li Y , Doty J , Yinka-Ogunleye A , Akinpelu A , Aruna O , Naidoo D , Lewandowski K , Afrough B , Graham V , Aarons E , Hewson R , Vipond R , Dunning J , Chand M , Brown C , Cohen-Gihon I , Erez N , Shifman O , Israeli O , Sharon M , Schwartz E , Beth-Din A , Zvi A , Mak TM , Ng YK , Cui L , Lin RTP , Olson VA , Brooks T , Paran N , Ihekweazu C , Reynolds MG . J Infect Dis 2020 225 (8) 1367-1376 BACKGROUND: The largest West African monkeypox outbreak began September 2017, in Nigeria. Four individuals traveling from Nigeria to the UK (2), Israel, and Singapore became the first human monkeypox cases exported from Africa, and a related nosocomial transmission event in the UK became the first confirmed human-to-human monkeypox transmission event outside of Africa. METHODS: Epidemiological and molecular data for exported and Nigerian cases were analyzed jointly to better understand the exportations in the temporal and geographic context of the outbreak. RESULTS: Isolates from all travelers and a Bayelsa case shared a most recent common ancestor and traveled to Bayelsa, Delta, or Rivers states. Genetic variation for this cluster was lower than would be expected from a random sampling of genomes from this outbreak, but data did not support direct links between travelers. CONCLUSIONS: Monophyly of exportation cases and the Bayelsa sample, along with the intermediate levels of genetic variation suggest a small pool of related isolates is the likely source for the exported infections. This may be the result of the level of genetic variation present in monkeypox isolates circulating within the contiguous region of Bayelsa, Delta, and Rivers states, or another more restricted, yet unidentified source pool. |
Notes from the field: A multipartner response to prevent a binational rabies outbreak - Anse-a-Pitre, Haiti, 2019
Adrien J , Georges Y , Augustin PD , Monroe B , Gibson AD , Fenelon N , Fleurinord L , Crowdis K , Mandra A , Joseph HC , Etheart MD , Wallace RM . MMWR Morb Mortal Wkly Rep 2019 68 (32) 707-709 Sustained investments in dog rabies vaccination programs and increased access to postexposure prophylaxis have led to a substantial decrease in rabies deaths associated with dogs in the Western Hemisphere (1). Despite recent dog vaccination campaigns in Pedernales, Dominican Republic, three human rabies deaths associated with dogs were reported during July–December 2018 in Pedernales, which shares a border with Anse-à-Pitre, Haiti (2). Canine rabies is endemic in Haiti and the Dominican Republic; over the past decade, Haiti has reported an eighteenfold increase in laboratory-confirmed canine rabies cases after implementation of an active rabies surveillance program, although none were reported from Anse-à-Pitre (3). Haiti conducted a three-phase national dog rabies vaccination campaign during 2017–2018, with the last round occurring during October 16, 2017–May 22, 2018, in the southern third of the country. However, the campaign did not reach the southeastern community of Anse-à-Pitre because of difficult terrain and funding constraints. Although no human or animal rabies cases had been reported from Anse-à-Pitre, health experts from Haiti and Dominican Republic were concerned that dogs from this community could be part of a cross-border enzootic rabies transmission cycle. At the invitation of the Haiti Ministry of Agriculture, a multiagency team deployed to Haiti to vaccinate dogs, conduct human and animal rabies case surveillance, collect retrospective animal and human rabies exposure and case detection data, and evaluate border crossings by dogs. Because it was an emergency outbreak response, CDC determined the activities to be nonresearch. |
Notes from the Field: Rabies outbreak investigation - Pedernales, Dominican Republic, 2019
Mandra A , Moran D , Santana PV , Marrero MC , Diaz E , Gil M , Nolasco RR , Capellan R , Acosta X , Perez R , Cespedes C , Baez B , Condori RE , Smith T , Ellison J , Greenberg L , Monroe B , Gibson A , Wallace RM , Petersen B . MMWR Morb Mortal Wkly Rep 2019 68 (32) 704-706 On July 13, 2018, a child from Pedernales, Dominican Republic, died after developing clinical signs and symptoms consistent with rabies. Because of the child’s signs and symptoms, history of having been bitten by a dog 4 months earlier, and not having a received postexposure prophylaxis (PEP) (1), the patient was reported as having a probable case of rabies to the Ministerio de Salud Pública (MSP; i.e., Ministry of Public Health) (1). This case was the first reported from Pedernales Province in >30 years. During November 29–December 20, 2018, two additional probable rabies cases (based on clinical signs and history of dog bites) in children were reported from this province. The second patient did not receive any PEP. The third patient began PEP 10 days after being bitten and received 4 doses of vaccine before symptom onset; no rabies immunoglobulin was available in the province. All three children died from rabies encephalitis. |
Notes from the Field: Responding to an outbreak of monkeypox using the One Health approach - Nigeria, 2017-2018
Eteng WE , Mandra A , Doty J , Yinka-Ogunleye A , Aruna S , Reynolds MG , McCollum AM , Davidson W , Wilkins K , Saleh M , Ipadeola O , Manneh L , Anebonam U , Abdulkareem Z , Okoli N , Agenyi J , Dan-Nwafor C , Mahmodu I , Ihekweazu C . MMWR Morb Mortal Wkly Rep 2018 67 (37) 1040-1041 On September 22, 2017, a suspected human case of monkeypox was reported to the Nigeria Centre for Disease Control (NCDC) from Bayelsa State in southern Nigeria. Because monkeypox had not been reported in Nigeria since 1978 (1), the case raised national and international concern. A multisectoral, international outbreak investigation was undertaken to identify sources and risk factors, establish surveillance, and enhance preparedness. A suspected case was defined as the sudden onset of fever, followed by a vesiculopustular rash primarily on the face, palms, and soles. A confirmed case was any suspected case with laboratory confirmation (by serology, molecular detection of viral DNA, or virus isolation). A probable case was a suspected case epidemiologically linked to a confirmed case. As of February 25, 2018, a total of 228 suspected cases (including 89 confirmed and three probable cases) had been investigated in 24 of Nigeria’s 36 states and the Federal Capital Territory. Six deaths (6.7%) were recorded among the 89 confirmed cases. The outbreak has not been declared over, and NCDC continues to collect data to develop a baseline level for this disease, which had not been reported in 40 years and now might be endemic to Nigeria. Given the zoonotic nature of the disease, this outbreak has required a robust One Health outbreak collaboration among human, animal, and environmental health institutions. |
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