Last data update: May 20, 2024. (Total: 46824 publications since 2009)
Records 1-10 (of 10 Records) |
Query Trace: Nakashima AK [original query] |
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Enhancing surveillance protocols for acute hepatitis C virus infection, Utah, 2014-2019
Lewis NM , Eason J , Barbeau B , Boulton R , Nakashima AK , Dunn AC . Public Health Rep 2022 138 (3) 333549221101381 During 2014-2019, the Utah Department of Health (UDOH) enhanced its surveillance program for acute hepatitis C virus (HCV) infections by mandating electronic reporting of negative HCV test results in 2015 and liver function test results in 2016. UDOH also engaged with blood and plasma donation centers beginning in 2014 and syringe exchange programs in 2018 to encourage manual reporting of negative HCV test results from facilities without electronic reporting capabilities. UDOH hepatitis surveillance staff also provided training for case investigations in 2017. The number of cases detected increased 14-fold, from 9 during 2012 to 127 during 2019. In 2019, of 127 cases, 55% (n = 70) were detected through negative HCV test results reported electronically before positive test results (ie, recent seroconversions), 25% (n = 32) through positive HCV test results and elevated liver function test results, 18% (n = 23) through manually reported negative HCV test results, and 2% (n = 2) through positive HCV test results and clinical evidence. Challenges to surveillance included accessing patients for investigations and engaging donation centers in reporting negative test results. Utah's experience demonstrates practical considerations for improving surveillance of acute HCV infections. |
Characteristics of Adults Who Use Both Marijuana and E-Cigarette, or Vaping, Products : A Cross-Sectional Study, Utah, 2018
Lewis NM , Friedrichs M , Wagstaff SS , Nakashima AK , Dunn AC . Public Health Rep 2021 137 (4) 333549211018679 OBJECTIVES: Among young people, dual use of marijuana and e-cigarette, or vaping, products (EVPs) is linked with using more inhalant substances and other substances, and poorer mental health. To understand antecedents and potential risks of dual use in adults, we analyzed a representative adult population in Utah. METHODS: We used data from the 2018 Utah Behavioral Risk Factor Surveillance System (n = 10 380) and multivariable logistic regression to evaluate differences in sociodemographic characteristics, comorbidities, and risk factors among adults aged ≥18 who reported currently using both EVPs (any substance) and marijuana (any intake mode), compared with a referent group of adults who used either or neither. RESULTS: Compared with the referent group, adults using EVPs and marijuana had greater odds of being aged 18-29 (adjusted odds ratio [aOR] = 12.44; 95% CI, 6.15-25.14) or 30-39 (aOR = 3.75; 95% CI, 1.73-8.12) versus ≥40, being male (aOR = 3.29; 95% CI, 1.82-5.96) versus female, reporting ≥14 days of poor mental health in previous 30 days (aOR = 2.30; 95% CI, 1.23-4.32) versus <14 days, and reporting asthma (aOR = 2.09; 95% CI, 1.02-4.31), chronic obstructive pulmonary disorder (aOR = 2.94; 95% CI, 1.19-7.93), currently smoking cigarettes (aOR = 4.56; 95% CI, 2.63-7.93), or past-year use of prescribed chronic pain medications (aOR = 2.13; 95% CI, 1.06-4.30), all versus not. CONCLUSIONS: Clinicians and health promotion specialists working with adults using both EVPs and marijuana should assess risk factors and comorbidities that could contribute to dual use or associated outcomes and tailor prevention messaging accordingly. |
Infection control response to an outbreak of OXA-23 carbapenemase-producing carbapenem-resistant Acinetobacter baumannii in a skilled nursing facility in Utah.
Smith AR , Vowles M , Horth RZ , Smith L , Rider L , Wagner JM , Sangster A , Young EL , Schuckel H , Stewart J , Gruninger RJ , Rossi A , Oakeson KF , Nakashima AK . Am J Infect Control 2020 49 (6) 792-799 BACKGROUND: Antibiotic-resistant Acinetobacter spp. are a growing public health threat, yet are not nationally notifiable, and most states do not mandate reporting. Additionally, there are no standardized methods to detect Acinetobacter spp. colonization. METHODS: An outbreak of carbapenem-resistant Acinetobacter baumannii (CRAB) was identified at a Utah skilled nursing facility with a ventilator unit (vSNF). An investigation was conducted to identify transmission modes in order to control spread of CRAB. Culture-based methods were used to identify patient colonization and environmental contamination in the facility. RESULTS: Of the 47 patients screened, OXA-23-producing CRAB were detected in 10 patients (21%), with 7 patients (15%) having been transferred from out-of-state facilities. Of patients who screened positive, 60% did not exhibit any signs or symptoms of active infection by chart review. A total of 38 environmental samples were collected and CRAB was recovered from 37% of those samples. Whole genome sequencing analyses of patient and environmental isolates suggested repeated CRAB introduction into the facility and highlighted the role of shared equipment in transmission. CONCLUSION: The investigation demonstrated this vSNF was an important reservoir for CRAB in the community and highlights the need for improved surveillance, strengthened infection control and inter-facility communication within and across states. |
Sepsis Attributed to Bacterial Contamination of Platelets Associated with a Potential Common Source - Multiple States, 2018.
Jones SA , Jones JM , Leung V , Nakashima AK , Oakeson KF , Smith AR , Hunter R , Kim JJ , Cumming M , McHale E , Young PP , Fridey JL , Kelley WE , Stramer SL , Wagner SJ , West FB , Herron R , Snyder E , Hendrickson JE , Peaper DR , Gundlapalli AV , Langelier C , Miller S , Nambiar A , Moayeri M , Kamm J , Moulton-Meissner H , Annambhotla P , Gable P , McAllister GA , Breaker E , Sula E , Halpin AL , Basavaraju SV . MMWR Morb Mortal Wkly Rep 2019 68 (23) 519-523 During May-October 2018, four patients from three states experienced sepsis after transfusion of apheresis platelets contaminated with Acinetobacter calcoaceticus-baumannii complex (ACBC) and Staphylococcus saprophyticus; one patient died. ACBC isolates from patients' blood, transfused platelet residuals, and two environmental samples were closely related by whole genome sequencing. S. saprophyticus isolates from two patients' blood, three transfused platelet residuals, and one hospital environmental sample formed two whole genome sequencing clusters. This whole genome sequencing analysis indicated a potential common source of bacterial contamination; investigation into the contamination source continues. All platelet donations were collected using apheresis cell separator machines and collection sets from the same manufacturer; two of three collection sets were from the same lot. One implicated platelet unit had been treated with pathogen-inactivation technology, and two had tested negative with a rapid bacterial detection device after negative primary culture. Because platelets are usually stored at room temperature, bacteria in contaminated platelet units can proliferate to clinically relevant levels by the time of transfusion. Clinicians should monitor for sepsis after platelet transfusions even after implementation of bacterial contamination mitigation strategies. Recognizing adverse transfusion reactions and reporting to the platelet supplier and hemovigilance systems is crucial for public health practitioners to detect and prevent sepsis associated with contaminated platelets. |
Fatal Sepsis Associated with Bacterial Contamination of Platelets - Utah and California, August 2017.
Horth RZ , Jones JM , Kim JJ , Lopansri BK , Ilstrup SJ , Fridey J , Kelley WE , Stramer SL , Nambiar A , Ramirez-Avila L , Nichols A , Garcia W , Oakeson KF , Vlachos N , McAllister G , Hunter R , Nakashima AK , Basavaraju SV . MMWR Morb Mortal Wkly Rep 2018 67 (25) 718-722 During August 2017, two separate clusters of platelet transfusion-associated bacterial sepsis were reported in Utah and California. In Utah, two patients died after platelet transfusions from the same donation. Clostridium perfringens isolates from one patient's blood, the other patient's platelet bag, and donor skin swabs were highly related by whole genome sequencing (WGS). In California, one patient died after platelet transfusion; Klebsiella pneumoniae isolates from the patient's blood and platelet bag residuals and a nontransfused platelet unit were matched using WGS. Investigation revealed no deviations in blood supplier or hospital procedures. Findings in this report highlight that even when following current procedures, the risk for transfusion-related infection and fatality persists, making additional interventions necessary. Clinicians need to be vigilant in monitoring for platelet-transmitted bacterial infections and report adverse reactions to blood suppliers and hemovigilance systems. Blood suppliers and hospitals could consider additional evidence-based bacterial contamination risk mitigation strategies, including pathogen inactivation, rapid detection devices, and modified screening of bacterial culture protocols. |
Zika Virus Infection in Patient with No Known Risk Factors, Utah, USA, 2016
Krow-Lucal ER , Novosad SA , Dunn AC , Brent CR , Savage HM , Faraji A , Peterson D , Dibbs A , Vietor B , Christensen K , Laven JJ , Godsey MS Jr , Christensen B , Beyer B , Cortese MM , Johnson NC , Panella AJ , Biggerstaff BJ , Rubin M , Fridkin SK , Staples JE , Nakashima AK . Emerg Infect Dis 2017 23 (8) 1260-1267 In 2016, Zika virus disease developed in a man (patient A) who had no known risk factors beyond caring for a relative who died of this disease (index patient). We investigated the source of infection for patient A by surveying other family contacts, healthcare personnel, and community members, and testing samples for Zika virus. We identified 19 family contacts who had similar exposures to the index patient; 86 healthcare personnel had contact with the index patient, including 57 (66%) who had contact with body fluids. Of 218 community members interviewed, 28 (13%) reported signs/symptoms and 132 (61%) provided a sample. Except for patient A, no other persons tested had laboratory evidence of recent Zika virus infection. Of 5,875 mosquitoes collected, none were known vectors of Zika virus and all were negative for Zika virus. The mechanism of transmission to patient A remains unknown but was likely person-to-person contact with the index patient. |
Performance of clinical screening algorithms for tuberculosis intensified case finding among people living with HIV in western Kenya
Modi S , Cavanaugh JS , Shiraishi RW , Alexander HL , McCarthy KD , Burmen B , Muttai H , Heilig CM , Nakashima AK , Cain KP . PLoS One 2016 11 (12) e0167685 OBJECTIVE: To assess the performance of symptom-based screening for tuberculosis (TB), alone and with chest radiography among people living with HIV (PLHIV), including pregnant women, in Western Kenya. DESIGN: Prospective cohort study. METHODS: PLHIV from 15 randomly-selected HIV clinics were screened with three clinical algorithms [World Health Organization (WHO), Ministry of Health (MOH), and "Improving Diagnosis of TB in HIV-infected persons" (ID-TB/HIV) study], underwent chest radiography (unless pregnant), and provided two or more sputum specimens for smear microscopy, liquid culture, and Xpert MTB/RIF. Performance of clinical screening was compared to laboratory results, controlling for the complex design of the survey. RESULTS: Overall, 738 (85.6%) of 862 PLHIV enrolled were included in the analysis. Estimated TB prevalence was 11.2% (95% CI, 9.9-12.7). Sensitivity of the three screening algorithms was similar [WHO, 74.1% (95% CI, 64.1-82.2); MOH, 77.5% (95% CI, 68.6-84.5); and ID-TB/HIV, 72.5% (95% CI, 60.9-81.7)]. Sensitivity of the WHO algorithm was significantly lower among HIV-infected pregnant women [28.2% (95% CI, 14.9-46.7)] compared to non-pregnant women [78.3% (95% CI, 67.3-86.4)] and men [77.2% (95% CI, 68.3-84.2)]. Chest radiography increased WHO algorithm sensitivity and negative predictive value to 90.9% (95% CI, 86.4-93.9) and 96.1% (95% CI, 94.4-97.3), respectively, among asymptomatic men and non-pregnant women. CONCLUSIONS: Clinical screening missed approximately 25% of laboratory-confirmed TB cases among all PLHIV and more than 70% among HIV-infected pregnant women. National HIV programs should evaluate the feasibility of laboratory-based screening for TB, such as a single Xpert MTB/RIF test for all PLHIV, especially pregnant women, at enrollment in HIV services. |
Evaluation of a TB infection control implementation initiative in out-patient HIV clinics in Zambia and Botswana
Emerson C , Lipke V , Kapata N , Mwananyambe N , Mwinga A , Garekwe M , Lanje S , Moshe Y , Pals SL , Nakashima AK , Miller B . Int J Tuberc Lung Dis 2016 20 (7) 941-7 SETTING: Out-patient human immunodeficiency virus (HIV) care and treatment clinics in Zambia and Botswana, countries with a high burden of HIV and TB infection. OBJECTIVE: To develop a tuberculosis infection control (TB IC) training and implementation package and evaluate the implementation of TB IC activities in facilities implementing the package. DESIGN: Prospective program evaluation of a TB IC training and implementation package using a standardized facility risk assessment tool, qualitative interviews with facility health care workers and measures of pre- and post-test performance. RESULTS: A composite measure of facility performance in TB IC improved from 32% at baseline to 50% at 1 year among eight facilities in Zambia, and from 27% to 80% at 6 months among 10 facilities in Botswana. Although there was marked improvement in indicators of managerial, administrative and environmental controls, key ongoing challenges remained in ensuring access to personal protective equipment and implementing TB screening in health care workers. CONCLUSION: TB IC activities at out-patient HIV clinics in Zambia and Botswana improved after training using the implementation package. Continued infrastructure support, as well as monitoring and evaluation, are needed to support the scale-up and sustainability of TB IC programs in facilities in low-resource countries. |
Campylobacter jejuni infections associated with raw milk consumption - Utah, 2014
Davis KR , Dunn AC , Burnett C , McCullough L , Dimond M , Wagner J , Smith L , Carter A , Willardson S , Nakashima AK . MMWR Morb Mortal Wkly Rep 2016 65 (12) 301-305 In May 2014, the Utah Public Health Laboratory (UPHL) notified the Utah Department of Health (UDOH) of specimens from three patients infected with Campylobacter jejuni yielding indistinguishable pulsed-field gel electrophoresis (PFGE) patterns. All three patients had consumed raw (unpasteurized and nonhomogenized) milk from dairy A. In Utah, raw milk sales are legal from farm to consumer with a sales permit from the Utah Department of Agriculture and Food (UDAF). Raw milk dairies are required to submit monthly milk samples to UDAF for somatic cell and coliform counts, both of which are indicators of raw milk contamination. Before this cluster's identification, dairy A's routine test results were within acceptable levels (<400,000 somatic cells/mL and <10 coliform colony forming units/mL). Subsequent enhanced testing procedures recovered C. jejuni, a fastidious organism, in dairy A raw milk; the isolate matched the cluster pattern. UDAF suspended dairy A's raw milk permit during August 4-October 1, and reinstated the permit when follow-up cultures were negative. Additional cases of C. jejuni infection were identified in October, and UDAF permanently revoked dairy A's permit to sell raw milk on December 1. During May 9-November 6, 2014, a total of 99 cases of C. jejuni infection were identified. Routine somatic cell and coliform counts of raw milk do not ensure its safety. Consumers should be educated that raw milk might be unsafe even if it meets routine testing standards. |
Antiretroviral therapy uptake among adult tuberculosis patients newly diagnosed with HIV in Nyanza Province, Kenya
Muttai H , Laserson KF , Akello I , Nyabiage L , Gondi J , Mutegi J , Williamson J , Nakashima AK , Ackers ML . Public Health Action 2013 3 (4) 286-293 SETTING: In 2008, the Kenya tuberculosis (TB) program reported low (31%) antiretroviral therapy (ART) uptake among human immunodeficiency virus (HIV) infected TB patients. OBJECTIVE: To confirm ART coverage and identify factors associated with HIV clinic enrollment and ART initiation among TB patients. DESIGN: Retrospective chart abstraction of adult TB patients newly diagnosed with HIV and eligible for ART at 58 Nyanza Province TB clinics between October 2006 and April 2008. TB data were linked to HIV clinic data at 50 facilities that provided ART. Associations with HIV clinic enrollment and ART were evaluated. RESULTS: Among 1137 ART-eligible TB patient records sampled, 32% documented HIV clinic enrollment and 29% ART. Date fields were largely incomplete; 11% of the patient records included HIV testing dates and <=1% had dates for cotrimoxazole prophylaxis, HIV clinic enrollment and ART initiation. Adding HIV clinic data increased HIV clinic enrollment and ART documentation to respectively 62% and 44%. Among TB patients in HIV care, female sex, older age group and baseline CD4 documentation were associated with ART initiation. CONCLUSION: Linking data increased documentation of HIV clinic enrollment and ART uptake. Continued efforts are required to improve the documentation of HIV service delivery, especially in TB clinics. Interventions to increase ART uptake are needed for younger patients and men. |
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