Last data update: May 20, 2024. (Total: 46824 publications since 2009)
Records 1-16 (of 16 Records) |
Query Trace: Merlin T[original query] |
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Opportunities to enhance the utility of cause of death information from death certificates
Ling SM , Warner M , Anderson RN . Am J Public Health 2022 112 S42-s44 In this issue of AJPH, Merlin et al. (p. S36) describe the implications for improved reporting of cause of death (COD) as it applies to the opioid crisis. They go on to suggest that the current death certificate process forces a chain of linear, single diagnoses, and to suggest the enhancement of processes to improve the accuracy and validity of COD data. While a single, underlying cause is still desirable from a statistical standpoint to avoid double counting of deaths in tabulations, the authors are correct that the underlying cause does not always adequately describe the complexity of COD, especially for decedents with multiple comorbid diseases and other health conditions. |
Prevalence of and risk factors associated with nonfatal overdose among veterans who have experienced homelessness
Riggs KR , Hoge AE , DeRussy AJ , Montgomery AE , Holmes SK , Austin EL , Pollio DE , Kim YI , Varley AL , Gelberg L , Gabrielian SE , Blosnich JR , Merlin J , Gundlapalli AV , Jones AL , Gordon AJ , Kertesz SG . JAMA Netw Open 2020 3 (3) e201190 Importance: Individuals with a history of homelessness are at increased risk for drug or alcohol overdose, although the proportion who have had recent nonfatal overdose is unknown. Understanding risk factors associated with nonfatal overdose could guide efforts to prevent fatal overdose. Objectives: To determine the prevalence of recent overdose and the individual contributions of drugs and alcohol to overdose and to identify characteristics associated with overdose among veterans who have experienced homelessness. Design, Setting, and Participants: This survey study was conducted from November 15, 2017, to October 1, 2018, via mailed surveys with telephone follow-up for nonrespondents. Eligible participants were selected from the records of 26 US Department of Veterans Affairs medical centers and included veterans who had received primary care at 1 of these Veterans Affairs medical centers and had a history of experiencing homelessness according to administrative data. Preliminary analyses were conducted in October 2018, and final analyses were conducted in January 2020. Main Outcomes and Measures: Self-report of overdose (such that emergent medical care was obtained) in the previous 3 years and substances used during the most recent overdose. All percentages are weighted according to propensity to respond to the survey, modeled from clinical characteristics obtained in electronic health records. Results: A total of 5766 veterans completed the survey (completion rate, 40.2%), and data on overdose were available for 5694 veterans. After adjusting for the propensity to respond to the survey, the mean (SD) age was 56.4 (18.3) years; 5100 veterans (91.6%) were men, 2225 veterans (38.1%) were black, and 2345 veterans (40.7%) were white. A total of 379 veterans (7.4%) reported any overdose during the past 3 years; 228 veterans (4.6%) reported overdose involving drugs, including 83 veterans (1.7%) who reported overdose involving opioids. Overdose involving alcohol was reported by 192 veterans (3.7%). In multivariable analyses, white race (odds ratio, 2.44 [95% CI, 2.00-2.98]), self-reporting a drug problem (odds ratio, 1.66 [95% CI, 1.39-1.98]) or alcohol problem (odds ratio, 2.54 [95% CI, 2.16-2.99]), and having witnessed someone else overdose (odds ratio, 2.34 [95% CI, 1.98-2.76]) were associated with increased risk of overdose. Conclusions and Relevance: These findings suggest that nonfatal overdose is relatively common among veterans who have experienced homelessness. While overdose involving alcohol was more common than any specific drug, 1.7% of veterans reported overdose involving opioids. Improving access to addiction treatment for veterans who are experiencing homelessness or who are recently housed, especially for those who have experienced or witnessed overdose, could help to protect this population. |
Safety and immunogenicity of a multivalent HIV vaccine comprising envelope protein with either DNA or NYVAC vectors (HVTN 096): a phase 1b, double-blind, placebo-controlled trial.
Pantaleo G , Janes H , Karuna S , Grant S , Ouedraogo GL , Allen M , Tomaras GD , Frahm N , Montefiori DC , Ferrari G , Ding S , Lee C , Robb ML , Esteban M , Wagner R , Bart PA , Rettby N , McElrath MJ , Gilbert PB , Kublin JG , Corey L . Lancet HIV 2019 6 (11) e737-e749 BACKGROUND: Up to now, immunisation regimens that have been assessed for development of HIV vaccines have included purified envelope (Env) protein among the boosting components of the regimen. We postulated that co-administration of Env protein with either a DNA or NYVAC vector during priming would result in early generation of antibody responses to the Env V1/V2 region, which are important markers for effective protection against infection. We aimed to assess the safety and immunogenicity of a multivalent HIV vaccine including either DNA or NYVAC vectors alone or in combination with Env glycoprotein (gp120) followed by a co-delivered NYVAC and Env protein boost. METHODS: We did a single-centre, double-blind, placebo-controlled phase 1b trial at the Centre Hospitalier Universitaire Vaudois (Lausanne, Switzerland). We included healthy volunteers aged 18-50 years who were at low risk of HIV infection. We randomly allocated participants using computer-generated random numbers to one of four vaccination schedules or placebo (4:1), and within these schedules participants were allocated either active treatment (T1, T2, T3, and T4) or placebo (C1, C2, C3, and C4). T1 consisted of two doses of NYVAC vector followed by two doses of NYVAC vector and gp120 Env protein; T2 comprised four doses of NYVAC vector and gp120 Env protein; T3 was two doses of DNA vector followed by two doses of NYVAC vector and gp120 Env protein; and T4 was two doses of DNA vector and gp120 Env protein followed by two doses of NYVAC vector and gp120 Env protein. Placebo injections were matched to the corresponding active treatment group. Doses were administered by injection at months 0, 1, 3, and 6. Primary outcomes were safety and immunogenicity of the vaccine schedules. Immune response measures included cross-clade and epitope-specific binding antibodies, neutralising antibodies, and antibody-dependent cell-mediated cytotoxicity measured 2 weeks after the month 1, 3, and 6 vaccinations. This trial is registered with ClinicalTrials.gov, NCT01799954. FINDINGS: Between Aug 23, 2012, and April 18, 2013, 148 healthy adult volunteers were screened for the trial, of whom 96 participants were enrolled. 20 individuals were allocated to each active treatment group (groups T1-4; n=80) and four were assigned to each placebo group (groups C1-4; n=16). Vaccines containing the NYVAC vector (groups T1 and T2) were associated with more frequent severe reactogenicity and more adverse events than were vaccines containing the DNA vector (groups T3 and T4). The most frequent adverse events judged related to study product were lymphadenopathy (n=9) and hypoaesthesia (n=2). Two participants, one in the placebo group and one in the DNA-primed T3 group, had serious adverse events that were judged unrelated to study product. One participant in the T3 group died from cranial trauma after a motor vehicle accident. Across the active treatment groups, IgG responses 2 weeks after the 6-month dose of vaccine were 74-95%. Early administration of gp120 Env protein (groups T2 and T4) was associated with a substantially earlier and higher area under the curve for gp120 Env binding, production of anti-V1/V2 and neutralising antibodies, and better antibody-response coverage over a period of 18 months, compared with vaccination regimens that delayed administration of gp120 Env protein until the 3-month vaccination (groups T1 and T3). INTERPRETATION: Co-administration of gp120 Env protein components with DNA or NYVAC vectors during priming led to early and potent induction of Env V1/V2 IgG binding antibody responses. This immunisation approach should be considered for induction of preventive antibodies in future HIV vaccine efficacy trials. FUNDING: National Institutes of Health, National Institute of Allergy and Infectious Diseases, and the Bill & Melinda Gates Foundation. |
Enhancing laboratory response network capacity in South Korea
Parker JT , Juren AC , Lowe L , Santibanez S , Rhie GE , Merlin TL . Emerg Infect Dis 2017 23 (13) S126-30 Laboratory Response Network (LRN) laboratories help protect populations from biological and chemical public health threats. We examined the role of LRN biological laboratories in enhancing capacity to detect and respond to public health infectious disease emergencies in South Korea. The model for responding to infectious disease emergencies leverages standardized laboratory testing procedures, a repository of standardized testing reagents, laboratory testing cooperation among hospital sentinel laboratories and reference laboratories, and maintenance of a trained workforce through traditional and on-demand training. Cooperation among all network stakeholders helps ensure that laboratory response is an integrated part of the national response. The added laboratory testing capacity provided by the US Centers for Disease Control and Prevention LRN assets helps protect persons who reside in South Korea, US military personnel and civilians in South Korea, and those who reside in the continental United States. |
EMERGEncy ID NET: Review of a 20-Year Multisite Emergency Department Emerging Infections Research Network
Santibanez S , Fischer LS , Krishnadasan A , Sederdahl B , Merlin T , Moran GJ , Talan DA . Open Forum Infect Dis 2017 4 (4) ofx218 As providers of frontline clinical care for patients with acute and potentially life-threatening infections, emergency departments (EDs) have the priorities of saving lives and providing care quickly and efficiently. Although these facilities see a diversity of patients 24 hours per day and can collect prospective data in real time, their ability to conduct timely research on infectious syndromes is not well recognized. EMERGEncy ID NET is a national network that demonstrates that EDs can also collect data and conduct research in real time. This network collaborates with the Centers for Disease Control and Prevention (CDC) and other partners to study and address a wide range of infectious diseases and clinical syndromes. In this paper, we review selected highlights of EMERGEncy ID NET's history from 1995 to 2017. We focus on the establishment of this multisite research network and the network's collaborative research on a wide range of ED clinical topics. |
How is CDC funded to respond to public health emergencies? Federal appropriations and budget execution process for non-financial experts
Fischer LS , Santibanez S , Jones G , Anderson B , Merlin T . Health Secur 2017 15 (3) 307-311 The federal budgeting process affects a wide range of people who work in public health, including those who work for government at local, state, and federal levels; those who work with government; those who operate government-funded programs; and those who receive program services. However, many people who are affected by the federal budget are not aware of or do not understand how it is appropriated or executed. This commentary is intended to give non-financial experts an overview of the federal budget process to address public health emergencies. Using CDC as an example, we provide: (1) a brief overview of the annual budget formulation and appropriation process; (2) a description of execution and implementation of the federal budget; and (3) an overview of emergency supplemental appropriations, using as examples the 2009 H1N1 influenza pandemic, the 2014-15 Ebola outbreak, and the 2016 Zika epidemic. Public health emergencies require rapid coordinated responses among Congress, government agencies, partners, and sometimes foreign, state, and local governments. It is important to have an understanding of the appropriation process, including supplemental appropriations that might come into play during public health emergencies, as well as the constraints under which Congress and federal agencies operate throughout the federal budget formulation process and execution. |
Modeling in real time during the Ebola response
Meltzer MI , Santibanez S , Fischer LS , Merlin TL , Adhikari BB , Atkins CY , Campbell C , Fung IC , Gambhir M , Gift T , Greening B , Gu W , Jacobson EU , Kahn EB , Carias C , Nerlander L , Rainisch G , Shankar M , Wong K , Washington ML . MMWR Suppl 2016 65 (3) 85-9 To aid decision-making during CDC's response to the 2014-2016 Ebola virus disease (Ebola) epidemic in West Africa, CDC activated a Modeling Task Force to generate estimates on various topics related to the response in West Africa and the risk for importation of cases into the United States. Analysis of eight Ebola response modeling projects conducted during August 2014-July 2015 provided insight into the types of questions addressed by modeling, the impact of the estimates generated, and the difficulties encountered during the modeling. This time frame was selected to cover the three phases of the West African epidemic curve. Questions posed to the Modeling Task Force changed as the epidemic progressed. Initially, the task force was asked to estimate the number of cases that might occur if no interventions were implemented compared with cases that might occur if interventions were implemented; however, at the peak of the epidemic, the focus shifted to estimating resource needs for Ebola treatment units. Then, as the epidemic decelerated, requests for modeling changed to generating estimates of the potential number of sexually transmitted Ebola cases. Modeling to provide information for decision-making during the CDC Ebola response involved limited data, a short turnaround time, and difficulty communicating the modeling process, including assumptions and interpretation of results. Despite these challenges, modeling yielded estimates and projections that public health officials used to make key decisions regarding response strategy and resources required. The impact of modeling during the Ebola response demonstrates the usefulness of modeling in future responses, particularly in the early stages and when data are scarce. Future modeling can be enhanced by planning ahead for data needs and data sharing, and by open communication among modelers, scientists, and others to ensure that modeling and its limitations are more clearly understood. The activities summarized in this report would not have been possible without collaboration with many U.S. and international partners (http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/partners.html). |
Early identification and prevention of the spread of Ebola - United States
Van Beneden CA , Pietz H , Kirkcaldy RD , Koonin LM , Uyeki TM , Oster AM , Levy DA , Glover M , Arduino MJ , Merlin TL , Kuhar DT , Kosmos C , Bell BP . MMWR Suppl 2016 65 (3) 75-84 In response to the 2014-2016 Ebola virus disease (Ebola) epidemic in West Africa, CDC prepared for the potential introduction of Ebola into the United States. The immediate goals were to rapidly identify and isolate any cases of Ebola, prevent transmission, and promote timely treatment of affected patients. CDC's technical expertise and the collaboration of multiple partners in state, local, and municipal public health departments; health care facilities; emergency medical services; and U.S. government agencies were essential to the domestic preparedness and response to the Ebola epidemic and relied on longstanding partnerships. CDC established a comprehensive response that included two new strategies: 1) active monitoring of travelers arriving from countries affected by Ebola and other persons at risk for Ebola and 2) a tiered system of hospital facility preparedness that enabled prioritization of training. CDC rapidly deployed a diagnostic assay for Ebola virus (EBOV) to public health laboratories. Guidance was developed to assist in evaluation of patients possibly infected with EBOV, for appropriate infection control, to support emergency responders, and for handling of infectious waste. CDC rapid response teams were formed to provide assistance within 24 hours to a health care facility managing a patient with Ebola. As a result of the collaborations to rapidly identify, isolate, and manage Ebola patients and the extensive preparations to prevent spread of EBOV, the United States is now better prepared to address the next global infectious disease threat.The activities summarized in this report would not have been possible without collaboration with many U.S. and international partners (http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/partners.html). |
Regional spread of Ebola virus, West Africa, 2014
Rainisch G , Shankar M , Wellman M , Merlin T , Meltzer MI . Emerg Infect Dis 2015 21 (3) 444-7 To explain the spread of the 2014 Ebola epidemic in West Africa, and thus help with response planning, we analyzed publicly available data. We found that the risk for infection in an area can be predicted by case counts, population data, and distances between affected and nonaffected areas. |
Melioidosis Diagnostic Workshop, 2013
Hoffmaster AR , AuCoin D , Baccam P , Baggett HC , Baird R , Bhengsri S , Blaney DD , Brett PJ , Brooks TJ , Brown KA , Chantratita N , Cheng AC , Dance DA , Decuypere S , Defenbaugh D , Gee JE , Houghton R , Jorakate P , Lertmemongkolchai G , Limmathurotsakul D , Merlin TL , Mukhopadhyay C , Norton R , Peacock SJ , Rolim DB , Simpson AJ , Steinmetz I , Stoddard RA , Stokes MM , Sue D , Tuanyok A , Whistler T , Wuthiekanun V , Walke HT . Emerg Infect Dis 2015 21 (2) Melioidosis is a severe disease that can be difficult to diagnose because of its diverse clinical manifestations and a lack of adequate diagnostic capabilities for suspected cases. There is broad interest in improving detection and diagnosis of this disease not only in melioidosis-endemic regions but also outside these regions because melioidosis may be underreported and poses a potential bioterrorism challenge for public health authorities. Therefore, a workshop of academic, government, and private sector personnel from around the world was convened to discuss the current state of melioidosis diagnostics, diagnostic needs, and future directions. |
Peramivir use for treatment of hospitalized patients with influenza A(H1N1)pdm09 under Emergency Use Authorization, October 2009 - June 2010
Yu Y , Garg S , Yu PA , Kim HJ , Patel A , Merlin T , Redd S , Uyeki TM . Clin Infect Dis 2012 55 (1) 8-15 BACKGROUND: In response to the influenza A(H1N1)pdm09 [pH1N1] pandemic, peramivir, an investigational intravenous neuraminidase inhibitor, was made available for treatment of hospitalized patients with pH1N1 in the U.S. under Emergency Use Authorization (EUA). The Centers for Disease Control and Prevention (CDC) implemented a program to manage peramivir distribution to requesting clinicians under EUA. We describe results of CDC's peramivir program and three related surveys. METHODS: We analyzed data on peramivir requests made by clinicians to CDC through an electronic request system. Three surveys were administered to enhance clinician compliance with adverse event reporting, to conduct product accountability, and to collect data on peramivir-treated patients. Descriptive analyses were performed and two-source capture-recapture analysis, based upon the three surveys, was used to estimate the number of patients who received peramivir through the EUA. RESULTS: During October 23, 2009 to June 23, 2010, CDC received 1,371 clinician requests for peramivir and delivered 2,129 five-day adult treatment course equivalents of peramivir to 563 hospitals. Based on survey responses, at least 1,274 patients (median age 43 years, range 0-92 years, 49% male) received one or more doses of peramivir (median duration 6 days). Capture-recapture analysis yielded estimates for the potential total number of peramivir recipients ranging from 1,185 (95% CI: 1,076-1,293) to 1,490 (95% CI: 1,321-1,659). CONCLUSIONS: Approximately 1,274 hospitalized patients received peramivir through EUA program during the pH1N1 pandemic. Further analyses are needed to assess the clinical effectiveness of peramivir treatment of hospitalized patients with pH1N1. |
CDC's 2009 H1N1 Vaccine Pharmacy Initiative in the United States: implications for future public health and pharmacy collaborations for emergency response
Koonin LM , Beauvais DR , Shimabukuro T , Wortley PM , Palmier JB , Stanley TR , Theofilos J , Merlin TL . Disaster Med Public Health Prep 2011 5 (4) 253-255 During the 2009 H1N1 influenza pandemic, the CDC contacted the 50 state, New York City, and District of Columbia health departments and the health department in Puerto Rico through the Association of State and Territorial Health Officials (ASTHO), to discuss distributing 2009 H1N1 influenza vaccine directly to large pharmacy chains (“pharmacies”) to supplement state vaccination efforts. By the end of December 2009, most states had opened vaccination to all members of the public and a vaccine surplus was projected. All but three states opted to take part in this CDC 2009 H1N1 Vaccine Pharmacy Initiative.* The CDC subsequently invited the largest 15 US pharmacies (by prescription share) to participate, 12 of these pharmacies expressed interest and 10 ultimately participated.1 From December 2009-February 2010, the CDC distributed 5 483 900 doses of 2009 H1N1 vaccine to these pharmacy chains; they in turn, distributed it to more than 10 700 retail stores nationwide. The amount of 2009 H1N1 vaccine that the CDC directly distributed to pharmacy chains comprised approximately 23% of all vaccine distributed during the same time period to the same states and accounted for approximately 4.3% of all 2009 H1N1 vaccine distributed during October 2009-February 2010. Approximately 10% of adults who received 2009 H1N1 influenza vaccine reported getting vaccinated at a pharmacy.2 This included vaccinations given with vaccine provided to pharmacies by state health officials and directly by the CDC (Figure). |
Estimating effect of antiviral drug use during pandemic (H1N1) 2009 outbreak, United States
Atkins CY , Patel A , Taylor TH Jr , Biggerstaff M , Merlin TL , Dulin SM , Erickson BA , Borse RH , Hunkler R , Meltzer MI . Emerg Infect Dis 2011 17 (9) 1591-8 From April 2009 through March 2010, during the pandemic (H1N1) 2009 outbreak, approximately 8.2 million prescriptions for influenza neuraminidase-inhibiting antiviral drugs were filled in the United States. We estimated the number of hospitalizations likely averted due to use of these antiviral medications. After adjusting for prescriptions that were used for prophylaxis and personal stockpiles, as well as for patients who did not complete their drug regimen, we estimated the filled prescriptions prevented approximately 8,400-12,600 hospitalizations (on the basis of median values). Approximately 60% of these prevented hospitalizations were among adults 18-64 years of age, with the remainder almost equally divided between children 0-17 years of age and adults >65 years of age. Public health officials should consider these estimates an indication of success of treating patients during the 2009 pandemic and a warning of the need for renewed planning to cope with the next pandemic. |
Estimating the burden of 2009 pandemic influenza A (H1N1) in the United States (April 2009-April 2010)
Shrestha SS , Swerdlow DL , Borse RH , Prabhu VS , Finelli L , Atkins CY , Owusu-Edusei K , Bell B , Mead PS , Biggerstaff M , Brammer L , Davidson H , Jernigan D , Jhung MA , Kamimoto LA , Merlin TL , Nowell M , Redd SC , Reed C , Schuchat A , Meltzer MI . Clin Infect Dis 2011 52 S75-S82 To calculate the burden of 2009 pandemic influenza A (pH1N1) in the United States, we extrapolated from the Centers for Disease Control and Prevention's Emerging Infections Program laboratory-confirmed hospitalizations across the entire United States, and then corrected for underreporting. From 12 April 2009 to 10 April 2010, we estimate that approximately 60.8 million cases (range: 43.3-89.3 million), 274,304 hospitalizations (195,086-402,719), and 12,469 deaths (8,868-18,306) occurred in the United States due to pH1N1. Eighty-seven percent of deaths occurred in those under 65 years of age with children and working adults having risks of hospitalization and death 4 to 7 times and 8 to 12 times greater, respectively, than estimates of impact due to seasonal influenza covering the years 1976-2001. In our study, adults 65 years of age or older were found to have rates of hospitalization and death that were up to 75% and 81%, respectively, lower than seasonal influenza. These results confirm the necessity of a concerted public health response to pH1N1. |
A primer on strategies for prevention and control of seasonal and pandemic influenza
Santibanez S , Fiore AE , Merlin TL , Redd S . Am J Public Health 2009 99 S216-24 The United States has made considerable progress in pandemic preparedness. Limited attention, however, has been given to the challenges faced by populations that will be at increased risk of the consequences of the pandemic, including challenges caused by societal, economic, and health-related factors. This supplement to the American Journal of Public Health focuses on the challenges faced by at-risk and vulnerable populations in preparing for and responding to an influenza pandemic. Here, we provide background information for subsequent articles throughout the supplement. We summarize (1) seasonal influenza epidemiology, transmission, clinical illness, diagnosis, vaccines, and antiviral medications; (2) H5N1 avian influenza; and (3) pandemic influenza vaccines, antiviral medications, and nonpharmaceutical interventions. |
Protecting vulnerable populations from pandemic influenza in the United States: a strategic imperative
Hutchins SS , Truman BI , Merlin TL , Redd SC . Am J Public Health 2009 99 S243-8 Protecting vulnerable populations from pandemic influenza is a strategic imperative. The US national strategy for pandemic influenza preparedness and response assigns roles to governments, businesses, civic and community-based organizations, individuals, and families. Because influenza is highly contagious, inadequate preparedness or untimely response in vulnerable populations increases the risk of infection for the general population. Recent public health emergencies have reinforced the importance of preparedness and the challenges of effective response among vulnerable populations. We explore definitions and determinants of vulnerable, at-risk, and special populations and highlight approaches for ensuring that pandemic influenza preparedness includes these populations and enables them to respond appropriately. We also provide an overview of population-specific and cross-cutting articles in this theme issue on influenza preparedness for vulnerable populations. |
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