Last data update: May 13, 2024. (Total: 46773 publications since 2009)
Records 1-30 (of 32 Records) |
Query Trace: Neal J[original query] |
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Impacts of COVID-19 on sexual risk behaviors, safe injection practices, and access to HIV services among key populations in Zambia: Findings from a rapid qualitative formative assessment
Parmley LE , Nkumbula T , Chilukutu L , Chelu L , Mulemfwe C , Hanunka B , Mwale J , Neal J , Handema R , Kasonde P , Mutale K , Sakala HM , Lahuerta M . PLoS One 2023 18 (8) e0289007 BACKGROUND: Despite achievements in the HIV response, social and structural barriers impede access to HIV services for key populations (KP) including men who have sex with men (MSM), transgender women (TGW), and people who inject drugs (PWID). This may be worsened by the COVID-19 pandemic or future pandemic threats. We explored the impact of COVID-19 on HIV services and sexual and substance use behaviors among MSM/TGW and PWID in Zambia as part of a formative assessment for two biobehavioral surveys. METHODS: From November-December 2020, 3 focus groups and 15 in-depth interviews (IDIs) with KP were conducted in Lusaka, Livingstone, Ndola, Solwezi, and Kitwe, Zambia. Overall, 45 PWID and 60 MSM/TGW participated in IDIs and 70 PWID and 89 MSM/TGW participated in focus groups. Qualitative data were analyzed using framework matrices according to deductive themes outlined in interview guides. RESULTS: KP reported barriers to HIV testing and HIV treatment due to COVID-19-related disruptions and fear of SARS-CoV-2 exposure at the health facility. MSM/TGW participants reported limited supply of condoms and lubricants at health facilities; limited access to condoms led to increased engagements in condomless sex. Restrictions in movement and closure of meet-up spots due to COVID-19 impeded opportunities to meet sex partners for MSM/TGW and clients for those who sold sex. COVID-19 restrictions led to unemployment and loss of income as well as to shortages and increased price of drugs, needles, and syringes for PWID. Due to COVID-19 economic effects, PWID reported increased needle-sharing and re-use of needles. CONCLUSIONS: Participants experienced barriers accessing HIV services due to COVID-19 and PWID attributed unsafe needle use and sharing to loss of income and lack of affordable needles during pandemic-related restrictions. To maintain gains in the HIV response in this context, strengthening harm reduction strategies and improvements in access to HIV services are necessary. |
Social Contact Patterns and Implications for Infectious Disease Transmission: A Systematic Review and Meta-Analysis of Contact Surveys (preprint)
Mousa A , Winskill P , Watson OJ , Ratmann O , Monod M , Ajelli M , Diallo A , Dodd PJ , Grijalva CG , Kiti MC , Krishnan A , Kumar R , Kumar S , Kwok KO , Lanata CF , Le Polain de Waroux O , Leung K , Mahikul W , Melegaro A , Morrow CD , Mossong J , Neal EF , Nokes DJ , Pan-Ngum W , Potter GE , Russell FM , Saha S , Sugimoto JD , Wei WI , Wood RR , Wu JT , Zhang J , Walker PG , Whittaker C . medRxiv 2021 BACKGROUND: Transmission of respiratory pathogens such as SARS-CoV-2 depends on patterns of contact and mixing across populations. Understanding this is crucial to predict pathogen spread and the effectiveness of control efforts. Most analyses of contact patterns to date have focussed on high-income settings. METHODS: Here, we conduct a systematic review and individual-participant meta-analysis of surveys carried out in low- and middle-income countries and compare patterns of contact in these settings to surveys previously carried out in high-income countries. Using individual-level data from 28,503 participants and 413,069 contacts across 27 surveys we explored how contact characteristics (number, location, duration and whether physical) vary across income settings. RESULTS: Contact rates declined with age in high- and upper-middle-income settings, but not in low-income settings, where adults aged 65+ made similar numbers of contacts as younger individuals and mixed with all age-groups. Across all settings, increasing household size was a key determinant of contact frequency and characteristics, but low-income settings were characterised by the largest, most intergenerational households. A higher proportion of contacts were made at home in low-income settings, and work/school contacts were more frequent in high-income strata. We also observed contrasting effects of gender across income-strata on the frequency, duration and type of contacts individuals made. CONCLUSIONS: These differences in contact patterns between settings have material consequences for both spread of respiratory pathogens, as well as the effectiveness of different non-pharmaceutical interventions. FUNDING: This work is primarily being funded by joint Centre funding from the UK Medical Research Council and DFID (MR/R015600/1). |
Early introductions and community transmission of SARS-CoV-2 variant B.1.1.7 in the United States (preprint)
Alpert T , Brito AF , Lasek-Nesselquist E , Rothman J , Valesano AL , MacKay MJ , Petrone ME , Breban MI , Watkins AE , Vogels CBF , Kalinich CC , Dellicour S , Russell A , Kelly JP , Shudt M , Plitnick J , Schneider E , Fitzsimmons WJ , Khullar G , Metti J , Dudley JT , Nash M , Beaubier N , Wang J , Liu C , Hui P , Muyombwe A , Downing R , Razeq J , Bart SM , Grills A , Morrison SM , Murphy S , Neal C , Laszlo E , Rennert H , Cushing M , Westblade L , Velu P , Craney A , Fauntleroy KA , Peaper DR , Landry ML , Cook PW , Fauver JR , Mason CE , Lauring AS , George KS , MacCannell DR , Grubaugh ND . medRxiv 2021 The emergence and spread of SARS-CoV-2 lineage B.1.1.7, first detected in the United Kingdom, has become a global public health concern because of its increased transmissibility. Over 2500 COVID-19 cases associated with this variant have been detected in the US since December 2020, but the extent of establishment is relatively unknown. Using travel, genomic, and diagnostic data, we highlight the primary ports of entry for B.1.1.7 in the US and locations of possible underreporting of B.1.1.7 cases. Furthermore, we found evidence for many independent B.1.1.7 establishments starting in early December 2020, followed by interstate spread by the end of the month. Finally, we project that B.1.1.7 will be the dominant lineage in many states by mid to late March. Thus, genomic surveillance for B.1.1.7 and other variants urgently needs to be enhanced to better inform the public health response. |
Life expectancy by county, race, and ethnicity in the USA, 2000-19: a systematic analysis of health disparities
GBD US Health Disparities Collaborators , Dwyer-Lindgren Laura , Kendrick Parkes , Kelly Yekaterina O , Sylte Dillon O , Schmidt Chris , Blacker Brigette F , Daoud Farah , Abdi Amal A , Baumann Mathew , Mouhanna Farah , Kahn Ethan , Hay Simon I , Mensah George A , Nápoles Anna M , Pérez-Stable Eliseo J , Shiels Meredith , Freedman Neal , Arias Elizabeth , George Stephanie A , Murray David M , Phillips John Wr , Spittel Michael L , Murray Christopher Jl , Mokdad Ali H . Lancet 2022 400 (10345) 25-38 BACKGROUND: There are large and persistent disparities in life expectancy among racial-ethnic groups in the USA, but the extent to which these patterns vary geographically on a local scale is not well understood. This analysis estimated life expectancy for five racial-ethnic groups, in 3110 US counties over 20 years, to describe spatial-temporal variations in life expectancy and disparities between racial-ethnic groups. METHODS: We applied novel small-area estimation models to death registration data from the US National Vital Statistics System and population data from the US National Center for Health Statistics to estimate annual sex-specific and age-specific mortality rates stratified by county and racial-ethnic group (non-Latino and non-Hispanic White [White], non-Latino and non-Hispanic Black [Black], non-Latino and non-Hispanic American Indian or Alaska Native [AIAN], non-Latino and non-Hispanic Asian or Pacific Islander [API], and Latino or Hispanic [Latino]) from 2000 to 2019. We adjusted these mortality rates to correct for misreporting of race and ethnicity on death certificates and then constructed abridged life tables to estimate life expectancy at birth. FINDINGS: Between 2000 and 2019, trends in life expectancy differed among racial-ethnic groups and among counties. Nationally, there was an increase in life expectancy for people who were Black (change 3·9 years [95% uncertainty interval 3·8 to 4·0]; life expectancy in 2019 75·3 years [75·2 to 75·4]), API (2·9 years [2·7 to 3·0]; 85·7 years [85·3 to 86·0]), Latino (2·7 years [2·6 to 2·8]; 82·2 years [82·0 to 82·5]), and White (1·7 years [1·6 to 1·7]; 78·9 years [78·9 to 79·0]), but remained the same for the AIAN population (0·0 years [-0·3 to 0·4]; 73·1 years [71·5 to 74·8]). At the national level, the negative difference in life expectancy for the Black population compared with the White population decreased during this period, whereas the negative difference for the AIAN population compared with the White population increased; in both cases, these patterns were widespread among counties. The positive difference in life expectancy for the API and Latino populations compared with the White population increased at the national level from 2000 to 2019; however, this difference declined in a sizeable minority of counties (615 [42·0%] of 1465 counties) for the Latino population and in most counties (401 [60·2%] of 666 counties) for the API population. For all racial-ethnic groups, improvements in life expectancy were more widespread across counties and larger from 2000 to 2010 than from 2010 to 2019. INTERPRETATION: Disparities in life expectancy among racial-ethnic groups are widespread and enduring. Local-level data are crucial to address the root causes of poor health and early death among disadvantaged groups in the USA, eliminate health disparities, and increase longevity for all. FUNDING: National Institute on Minority Health and Health Disparities; National Heart, Lung, and Blood Institute; National Cancer Institute; National Institute on Aging; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Office of Disease Prevention; and Office of Behavioral and Social Science Research, US National Institutes of Health. |
Social contact patterns and implications for infectious disease transmission: a systematic review and meta-analysis of contact surveys.
Mousa A , Winskill P , Watson OJ , Ratmann O , Monod M , Ajelli M , Diallo A , Dodd PJ , Grijalva CG , Kiti MC , Krishnan A , Kumar R , Kumar S , Kwok KO , Lanata CF , le Polain de Waroux O , Leung K , Mahikul W , Melegaro A , Morrow CD , Mossong J , Neal EF , Nokes DJ , Pan-Ngum W , Potter GE , Russell FM , Saha S , Sugimoto JD , Wei WI , Wood RR , Wu J , Zhang J , Walker P , Whittaker C . Elife 2021 10 Background: Transmission of respiratory pathogens such as SARS-CoV-2 depends on patterns of contact and mixing across populations. Understanding this is crucial to predict pathogen spread and the effectiveness of control efforts. Most analyses of contact patterns to date have focussed on high-income settings. Methods: Here, we conduct a systematic review and individual-participant meta-analysis of surveys carried out in low- and middle-income countries and compare patterns of contact in these settings to surveys previously carried out in high-income countries. Using individual-level data from 28,503 participants and 413,069 contacts across 27 surveys we explored how contact characteristics (number, location, duration and whether physical) vary across income settings. Results: Contact rates declined with age in high- and upper-middle-income settings, but not in low-income settings, where adults aged 65+ made similar numbers of contacts as younger individuals and mixed with all age-groups. Across all settings, increasing household size was a key determinant of contact frequency and characteristics, with low-income settings characterised by the largest, most intergenerational households. A higher proportion of contacts were made at home in low-income settings, and work/school contacts were more frequent in high-income strata. We also observed contrasting effects of gender across income-strata on the frequency, duration and type of contacts individuals made. Conclusions: These differences in contact patterns between settings have material consequences for both spread of respiratory pathogens, as well as the effectiveness of different non-pharmaceutical interventions. Funding: This work is primarily being funded by joint Centre funding from the UK Medical Research Council and DFID (MR/R015600/1). |
Tick extracellular vesicles enable arthropod feeding and promote distinct outcomes of bacterial infection
Oliva Chávez AS , Wang X , Marnin L , Archer NK , Hammond HL , Carroll EEM , Shaw DK , Tully BG , Buskirk AD , Ford SL , Butler LR , Shahi P , Morozova K , Clement CC , Lawres L , Neal AJO , Mamoun CB , Mason KL , Hobbs BE , Scoles GA , Barry EM , Sonenshine DE , Pal U , Valenzuela JG , Sztein MB , Pasetti MF , Levin ML , Kotsyfakis M , Jay SM , Huntley JF , Miller LS , Santambrogio L , Pedra JHF . Nat Commun 2021 12 (1) 3696 Extracellular vesicles are thought to facilitate pathogen transmission from arthropods to humans and other animals. Here, we reveal that pathogen spreading from arthropods to the mammalian host is multifaceted. Extracellular vesicles from Ixodes scapularis enable tick feeding and promote infection of the mildly virulent rickettsial agent Anaplasma phagocytophilum through the SNARE proteins Vamp33 and Synaptobrevin 2 and dendritic epidermal T cells. However, extracellular vesicles from the tick Dermacentor andersoni mitigate microbial spreading caused by the lethal pathogen Francisella tularensis. Collectively, we establish that tick extracellular vesicles foster distinct outcomes of bacterial infection and assist in vector feeding by acting on skin immunity. Thus, the biology of arthropods should be taken into consideration when developing strategies to control vector-borne diseases. |
Incidence of Multisystem Inflammatory Syndrome in Children Among US Persons Infected With SARS-CoV-2.
Payne AB , Gilani Z , Godfred-Cato S , Belay ED , Feldstein LR , Patel MM , Randolph AG , Newhams M , Thomas D , Magleby R , Hsu K , Burns M , Dufort E , Maxted A , Pietrowski M , Longenberger A , Bidol S , Henderson J , Sosa L , Edmundson A , Tobin-D'Angelo M , Edison L , Heidemann S , Singh AR , Giuliano JSJr , Kleinman LC , Tarquinio KM , Walsh RF , Fitzgerald JC , Clouser KN , Gertz SJ , Carroll RW , Carroll CL , Hoots BE , Reed C , Dahlgren FS , Oster ME , Pierce TJ , Curns AT , Langley GE , Campbell AP , Balachandran N , Murray TS , Burkholder C , Brancard T , Lifshitz J , Leach D , Charpie I , Tice C , Coffin SE , Perella D , Jones K , Marohn KL , Yager PH , Fernandes ND , Flori HR , Koncicki ML , Walker KS , Di Pentima MC , Li S , Horwitz SM , Gaur S , Coffey DC , Harwayne-Gidansky I , Hymes SR , Thomas NJ , Ackerman KG , Cholette JM . JAMA Netw Open 2021 4 (6) e2116420 IMPORTANCE: Multisystem inflammatory syndrome in children (MIS-C) is associated with recent or current SARS-CoV-2 infection. Information on MIS-C incidence is limited. OBJECTIVE: To estimate population-based MIS-C incidence per 1 000 000 person-months and to estimate MIS-C incidence per 1 000 000 SARS-CoV-2 infections in persons younger than 21 years. DESIGN, SETTING, AND PARTICIPANTS: This cohort study used enhanced surveillance data to identify persons with MIS-C during April to June 2020, in 7 jurisdictions reporting to both the Centers for Disease Control and Prevention national surveillance and to Overcoming COVID-19, a multicenter MIS-C study. Denominators for population-based estimates were derived from census estimates; denominators for incidence per 1 000 000 SARS-CoV-2 infections were estimated by applying published age- and month-specific multipliers accounting for underdetection of reported COVID-19 case counts. Jurisdictions included Connecticut, Georgia, Massachusetts, Michigan, New Jersey, New York (excluding New York City), and Pennsylvania. Data analyses were conducted from August to December 2020. EXPOSURES: Race/ethnicity, sex, and age group (ie, ≤5, 6-10, 11-15, and 16-20 years). MAIN OUTCOMES AND MEASURES: Overall and stratum-specific adjusted estimated MIS-C incidence per 1 000 000 person-months and per 1 000 000 SARS-CoV-2 infections. RESULTS: In the 7 jurisdictions examined, 248 persons with MIS-C were reported (median [interquartile range] age, 8 [4-13] years; 133 [53.6%] male; 96 persons [38.7%] were Hispanic or Latino; 75 persons [30.2%] were Black). The incidence of MIS-C per 1 000 000 person-months was 5.1 (95% CI, 4.5-5.8) persons. Compared with White persons, incidence per 1 000 000 person-months was higher among Black persons (adjusted incidence rate ratio [aIRR], 9.26 [95% CI, 6.15-13.93]), Hispanic or Latino persons (aIRR, 8.92 [95% CI, 6.00-13.26]), and Asian or Pacific Islander (aIRR, 2.94 [95% CI, 1.49-5.82]) persons. MIS-C incidence per 1 000 000 SARS-CoV-2 infections was 316 (95% CI, 278-357) persons and was higher among Black (aIRR, 5.62 [95% CI, 3.68-8.60]), Hispanic or Latino (aIRR, 4.26 [95% CI, 2.85-6.38]), and Asian or Pacific Islander persons (aIRR, 2.88 [95% CI, 1.42-5.83]) compared with White persons. For both analyses, incidence was highest among children aged 5 years or younger (4.9 [95% CI, 3.7-6.6] children per 1 000 000 person-months) and children aged 6 to 10 years (6.3 [95% CI, 4.8-8.3] children per 1 000 000 person-months). CONCLUSIONS AND RELEVANCE: In this cohort study, MIS-C was a rare complication associated with SARS-CoV-2 infection. Estimates for population-based incidence and incidence among persons with infection were higher among Black, Hispanic or Latino, and Asian or Pacific Islander persons. Further study is needed to understand variability by race/ethnicity and age group. |
Early introductions and transmission of SARS-CoV-2 variant B.1.1.7 in the United States.
Alpert T , Brito AF , Lasek-Nesselquist E , Rothman J , Valesano AL , MacKay MJ , Petrone ME , Breban MI , Watkins AE , Vogels CBF , Kalinich CC , Dellicour S , Russell A , Kelly JP , Shudt M , Plitnick J , Schneider E , Fitzsimmons WJ , Khullar G , Metti J , Dudley JT , Nash M , Beaubier N , Wang J , Liu C , Hui P , Muyombwe A , Downing R , Razeq J , Bart SM , Grills A , Morrison SM , Murphy S , Neal C , Laszlo E , Rennert H , Cushing M , Westblade L , Velu P , Craney A , Cong L , Peaper DR , Landry ML , Cook PW , Fauver JR , Mason CE , Lauring AS , St George K , MacCannell DR , Grubaugh ND . Cell 2021 184 (10) 2595-2604 e13 The emergence and spread of SARS-CoV-2 lineage B.1.1.7, first detected in the United Kingdom, has become a global public health concern because of its increased transmissibility. Over 2,500 COVID-19 cases associated with this variant have been detected in the United States (US) since December 2020, but the extent of establishment is relatively unknown. Using travel, genomic, and diagnostic data, we highlight that the primary ports of entry for B.1.1.7 in the US were in New York, California, and Florida. Furthermore, we found evidence for many independent B.1.1.7 establishments starting in early December 2020, followed by interstate spread by the end of the month. Finally, we project that B.1.1.7 will be the dominant lineage in many states by mid- to late March. Thus, genomic surveillance for B.1.1.7 and other variants urgently needs to be enhanced to better inform the public health response. |
Neurologic Involvement in Children and Adolescents Hospitalized in the United States for COVID-19 or Multisystem Inflammatory Syndrome.
LaRovere KL , Riggs BJ , Poussaint TY , Young CC , Newhams MM , Maamari M , Walker TC , Singh AR , Dapul H , Hobbs CV , McLaughlin GE , Son MBF , Maddux AB , Clouser KN , Rowan CM , McGuire JK , Fitzgerald JC , Gertz SJ , Shein SL , Munoz AC , Thomas NJ , Irby K , Levy ER , Staat MA , Tenforde MW , Feldstein LR , Halasa NB , Giuliano JS Jr , Hall MW , Kong M , Carroll CL , Schuster JE , Doymaz S , Loftis LL , Tarquinio KM , Babbitt CJ , Nofziger RA , Kleinman LC , Keenaghan MA , Cvijanovich NZ , Spinella PC , Hume JR , Wellnitz K , Mack EH , Michelson KN , Flori HR , Patel MM , Randolph AG . JAMA Neurol 2021 78 (5) 536-547 IMPORTANCE: Coronavirus disease 2019 (COVID-19) affects the nervous system in adult patients. The spectrum of neurologic involvement in children and adolescents is unclear. OBJECTIVE: To understand the range and severity of neurologic involvement among children and adolescents associated with COVID-19. SETTING, DESIGN, AND PARTICIPANTS: Case series of patients (age <21 years) hospitalized between March 15, 2020, and December 15, 2020, with positive severe acute respiratory syndrome coronavirus 2 test result (reverse transcriptase-polymerase chain reaction and/or antibody) at 61 US hospitals in the Overcoming COVID-19 public health registry, including 616 (36%) meeting criteria for multisystem inflammatory syndrome in children. Patients with neurologic involvement had acute neurologic signs, symptoms, or diseases on presentation or during hospitalization. Life-threatening involvement was adjudicated by experts based on clinical and/or neuroradiologic features. EXPOSURES: Severe acute respiratory syndrome coronavirus 2. MAIN OUTCOMES AND MEASURES: Type and severity of neurologic involvement, laboratory and imaging data, and outcomes (death or survival with new neurologic deficits) at hospital discharge. RESULTS: Of 1695 patients (909 [54%] male; median [interquartile range] age, 9.1 [2.4-15.3] years), 365 (22%) from 52 sites had documented neurologic involvement. Patients with neurologic involvement were more likely to have underlying neurologic disorders (81 of 365 [22%]) compared with those without (113 of 1330 [8%]), but a similar number were previously healthy (195 [53%] vs 723 [54%]) and met criteria for multisystem inflammatory syndrome in children (126 [35%] vs 490 [37%]). Among those with neurologic involvement, 322 (88%) had transient symptoms and survived, and 43 (12%) developed life-threatening conditions clinically adjudicated to be associated with COVID-19, including severe encephalopathy (n = 15; 5 with splenial lesions), stroke (n = 12), central nervous system infection/demyelination (n = 8), Guillain-Barré syndrome/variants (n = 4), and acute fulminant cerebral edema (n = 4). Compared with those without life-threatening conditions (n = 322), those with life-threatening neurologic conditions had higher neutrophil-to-lymphocyte ratios (median, 12.2 vs 4.4) and higher reported frequency of D-dimer greater than 3 μg/mL fibrinogen equivalent units (21 [49%] vs 72 [22%]). Of 43 patients who developed COVID-19-related life-threatening neurologic involvement, 17 survivors (40%) had new neurologic deficits at hospital discharge, and 11 patients (26%) died. CONCLUSIONS AND RELEVANCE: In this study, many children and adolescents hospitalized for COVID-19 or multisystem inflammatory syndrome in children had neurologic involvement, mostly transient symptoms. A range of life-threatening and fatal neurologic conditions associated with COVID-19 infrequently occurred. Effects on long-term neurodevelopmental outcomes are unknown. |
Immunoglobulin A Targets a Unique Subset of the Microbiota in Inflammatory Bowel Disease.
Shapiro JM , de Zoete MR , Palm NW , Laenen Y , Bright R , Mallette M , Bu K , Bielecka AA , Xu F , Hurtado-Lorenzo A , Shah SA , Cho JH , LeLeiko NS , Sands BE , Flavell RA , Clemente JC . Cell Host Microbe 2020 29 (1) 83-93 e3 The immunopathogenesis of inflammatory bowel disease (IBD) has been attributed to a combination of host genetics and intestinal dysbiosis. Previous work in a small cohort of IBD patients suggested that pro-inflammatory bacterial taxa are highly coated with secretory immunoglobulin IgA. Using bacterial fluorescence-activated cell sorting coupled with 16S rRNA gene sequencing (IgA-SEQ), we profiled IgA coating of intestinal microbiota in a large cohort of IBD patients and identified bacteria associated with disease and treatment. Forty-three bacterial taxa displayed significantly higher IgA coating in IBD compared with controls, including 8 taxa exhibiting differential IgA coating but similar relative abundance. Patients treated with anti-TNF-α therapies exhibited dramatically altered microbiota-specific IgA responses compared with controls. Furthermore, increased IgA coating of Oscillospira was associated with a delay in time to surgery. These results demonstrate that investigating IgA responses to microbiota can uncover potential disease-modifying taxa and reveal improved biomarkers of clinical course in IBD. |
Population size estimation methods: Searching for the holy grail
Neal JJ , Prybylski D , Sanchez T , Hladik W . JMIR Public Health Surveill 2020 6 (4) e25076 Accurate size estimates of key populations (eg, sex workers, people who inject drugs, transgender people, and men who have sex with men) can help to ensure adequate availability of services to prevent or treat HIV infection; inform HIV response planning, target setting, and resource allocation; and provide data for monitoring and evaluating program outcomes and impact. A gold standard method for population size estimation does not exist, but quality of estimates could be improved by using empirical methods, multiple data sources, and sound statistical concepts. To highlight such methods, a special collection of papers in JMIR Public Health and Surveillance has been released under the title "Key Population Size Estimations." We provide a summary of these papers to highlight advances in the use of empirical methods and call attention to persistent gaps in information. |
The International Consortium for Quality Research on Dietary Sodium/Salt (TRUE) position statement on the use of 24-hour, spot, and short duration (<24 hours) timed urine collections to assess dietary sodium intake
Campbell NRC , He FJ , Tan M , Cappuccio FP , Neal B , Woodward M , Cogswell ME , McLean R , Arcand J , MacGregor G , Whelton P , Jula A , L'Abbe MR , Cobb LK , Lackland DT . J Clin Hypertens (Greenwich) 2019 21 (6) 700-709 The International Consortium for Quality Research on Dietary Sodium/Salt (TRUE) is a coalition of intentional and national health and scientific organizations formed because of concerns low-quality research methods were creating controversy regarding dietary salt reduction. One of the main sources of controversy is believed related to errors in estimating sodium intake with urine studies. The recommendations and positions in this manuscript were generated following a series of systematic reviews and analyses by experts in hypertension, nutrition, statistics, and dietary sodium. To assess the population's current 24-hour dietary sodium ingestion, single complete 24-hour urine samples, collected over a series of days from a representative population sample, were recommended. To accurately estimate usual dietary sodium at the individual level, at least 3 non-consecutive complete 24-hour urine collections obtained over a series of days that reflect the usual short-term variations in dietary pattern were recommended. Multiple 24-hour urine collections over several years were recommended to estimate an individual's usual long-term sodium intake. The role of single spot or short duration timed urine collections in assessing population average sodium intake requires more research. Single or multiple spot or short duration timed urine collections are not recommended for assessing an individual's sodium intake especially in relationship to health outcomes. The recommendations should be applied by scientific review committees, granting agencies, editors and journal reviewers, investigators, policymakers, and those developing and creating dietary sodium recommendations. Low-quality research on dietary sodium/salt should not be funded, conducted, or published. |
Confluent impact of housing and geology on indoor radon concentrations in Atlanta, Georgia, United States
Dai D , Neal FB , Diem J , Deocampo DM , Stauber C , Dignam T . Sci Total Environ 2019 668 500-511 Radon is a naturally released radioactive carcinogenic gas. To estimate radon exposure, studies have examined various risk factors, but limited information exists pertaining to the confluent impact of housing characteristics and geology. This study evaluated the efficacy of housing and geological characteristics to predict radon risk in DeKalb County, Georgia, USA. Four major types of data were used: (1) three databases of indoor radon concentrations (n=6757); (2) geologic maps of rock types and fault zones; (3) a database of 402 in situ measurements of gamma emissions, and (4) two databases of housing characteristics. The Getis-Ord method was used to delineate hot spots of radon concentrations. Empirical Bayesian Kriging was used to predict gamma radiation at each radon test site. Chi-square tests, bivariate correlation coefficients, and logistic regression were used to examine the impact of geological and housing factors on radon. The results showed that indoor radon levels were more likely to exceed the action level-4 pCi/L (148Bq/m(3)) designated by the U.S. Environmental Protection Agency-in fault zones, were significantly positively correlated to gamma readings, but significantly negatively related to the presence of a crawlspace foundation and its combination with a slab. The findings suggest that fault mapping and in situ gamma ray measurements, coupled with analysis of foundation types and delineation of hot spots, may be used to prioritize areas for radon screening. |
Percentage of ingested sodium excreted in 24-hour urine collections: A systematic review and meta-analysis
Lucko AM , Doktorchik C , Woodward M , Cogswell M , Neal B , Rabi D , Anderson C , He FJ , MacGregor GA , L'Abbe M , Arcand J , Whelton PK , McLean R , Campbell NRC . J Clin Hypertens (Greenwich) 2018 20 (9) 1220-1229 High dietary sodium is estimated to be the leading dietary risk for death and disability according to the Global Burden of Disease Study.1, 2 The health risk associated with dietary sodium is largely related to a direct relationship between increasing dietary sodium and increasing blood pressure. Notably, increased blood pressure is a leading global risk factor for death and disability causing approximately 50% of cardiovascular disease.3 In both observational and interventional studies, 24‐hour urine sodium excretion is often used as the “gold standard” to estimate dietary sodium. Although it is generally stated that approximately 90% of dietary sodium is excreted in 24‐hour urine collections,4 to our knowledge, there has been no systematic review of the percentage of ingested sodium excreted in the urine. Previous studies in healthy people have reported that 24‐hour urine sodium excretion accounts for 61%‐107% of ingested sodium.5 We have conducted a systematic review of studies that examined the percentage of sodium excreted in 24‐hour urine collections in study participants ingesting known quantities of sodium. Accurately defining the percentage of dietary sodium excreted in urine is important to assess the validity of using urine excretion studies as the best evidence for assessing relationships between dietary sodium and health. |
Interlaboratory validation of an improved method for detection of Cyclospora cayetanensis in produce using a real-time PCR assay.
Murphy HR , Cinar HN , Gopinath G , Noe KE , Chatman LD , Miranda NE , Wetherington JH , Neal-McKinney J , Pires GS , Sachs E , Stanya KJ , Johnson CL , Nascimento FS , Santin M , Molokin A , Samadpour M , Janagama H , Kahler A , Miller C , da Silva AJ . Food Microbiol 2018 69 170-178 A collaborative validation study was performed to evaluate the performance of a new U.S. Food and Drug Administration method developed for detection of the protozoan parasite, Cyclospora cayetanensis, on cilantro and raspberries. The method includes a sample preparation step in which oocysts are recovered from produce using an enhanced produce washing solution containing 0.1% Alconox and a commercially available method to disrupt the C. cayetanensis oocysts and extract DNA. A real-time PCR assay targeting the C. cayetanensis 18S rDNA gene with an internal amplification control to monitor PCR inhibition provides species-specific identification. Five laboratories blindly analyzed a total of 319 samples consisting of 25 g of cilantro or 50 g of raspberries which were either uninoculated or artificially contaminated with C. cayetanensis oocysts. Detection rates for cilantro inoculated with 200, 10, and 5 oocysts, were 100%, 80%, and 31%, respectively. For raspberries, the detection rates for samples inoculated with 200, 10, and 5 oocysts were 100%, 90% and 50%, respectively. All uninoculated samples, DNA blank extracts, and no-template PCR controls were negative. Reproducibility between laboratories and analysts was high and the method was shown to be an effective analytical tool for detection of C. cayetanensis in produce. |
Reliable Quantification of the Potential for Equations Based on Spot Urine Samples to Estimate Population Salt Intake: Protocol for a Systematic Review and Meta-Analysis
Huang L , Crino M , Wu JH , Woodward M , Land MA , McLean R , Webster J , Enkhtungalag B , Nowson CA , Elliott P , Cogswell M , Toft U , Mill JG , Furlanetto TW , Ilich JZ , Hong YH , Cohall D , Luzardo L , Noboa O , Holm E , Gerbes AL , Senousy B , Pinar Kara S , Brewster LM , Ueshima H , Subramanian S , Teo BW , Allen N , Choudhury SR , Polonia J , Yasuda Y , Campbell NR , Neal B , Petersen KS . JMIR Res Protoc 2016 5 (3) e190 BACKGROUND: Methods based on spot urine samples (a single sample at one time-point) have been identified as a possible alternative approach to 24-hour urine samples for determining mean population salt intake. OBJECTIVE: The aim of this study is to identify a reliable method for estimating mean population salt intake from spot urine samples. This will be done by comparing the performance of existing equations against one other and against estimates derived from 24-hour urine samples. The effects of factors such as ethnicity, sex, age, body mass index, antihypertensive drug use, health status, and timing of spot urine collection will be explored. The capacity of spot urine samples to measure change in salt intake over time will also be determined. Finally, we aim to develop a novel equation (or equations) that performs better than existing equations to estimate mean population salt intake. METHODS: A systematic review and meta-analysis of individual participant data will be conducted. A search has been conducted to identify human studies that report salt (or sodium) excretion based upon 24-hour urine samples and spot urine samples. There were no restrictions on language, study sample size, or characteristics of the study population. MEDLINE via OvidSP (1946-present), Premedline via OvidSP, EMBASE, Global Health via OvidSP (1910-present), and the Cochrane Library were searched, and two reviewers identified eligible studies. The authors of these studies will be invited to contribute data according to a standard format. Individual participant records will be compiled and a series of analyses will be completed to: (1) compare existing equations for estimating 24-hour salt intake from spot urine samples with 24-hour urine samples, and assess the degree of bias according to key demographic and clinical characteristics; (2) assess the reliability of using spot urine samples to measure population changes in salt intake overtime; and (3) develop a novel equation that performs better than existing equations to estimate mean population salt intake. RESULTS: The search strategy identified 538 records; 100 records were obtained for review in full text and 73 have been confirmed as eligible. In addition, 68 abstracts were identified, some of which may contain data eligible for inclusion. Individual participant data will be requested from the authors of eligible studies. CONCLUSIONS: Many equations for estimating salt intake from spot urine samples have been developed and validated, although most have been studied in very specific settings. This meta-analysis of individual participant data will enable a much broader understanding of the capacity for spot urine samples to estimate population salt intake. |
Female chromosome X mosaicism is age-related and preferentially affects the inactivated X chromosome.
Machiela MJ , Zhou W , Karlins E , Sampson JN , Freedman ND , Yang Q , Hicks B , Dagnall C , Hautman C , Jacobs KB , Abnet CC , Aldrich MC , Amos C , Amundadottir LT , Arslan AA , Beane-Freeman LE , Berndt SI , Black A , Blot WJ , Bock CH , Bracci PM , Brinton LA , Bueno-de-Mesquita HB , Burdett L , Buring JE , Butler MA , Canzian F , Carreon T , Chaffee KG , Chang IS , Chatterjee N , Chen C , Chen C , Chen K , Chung CC , Cook LS , Crous Bou M , Cullen M , Davis FG , De Vivo I , Ding T , Doherty J , Duell EJ , Epstein CG , Fan JH , Figueroa JD , Fraumeni JF , Friedenreich CM , Fuchs CS , Gallinger S , Gao YT , Gapstur SM , Garcia-Closas M , Gaudet MM , Gaziano JM , Giles GG , Gillanders EM , Giovannucci EL , Goldin L , Goldstein AM , Haiman CA , Hallmans G , Hankinson SE , Harris CC , Henriksson R , Holly EA , Hong YC , Hoover RN , Hsiung CA , Hu N , Hu W , Hunter DJ , Hutchinson A , Jenab M , Johansen C , Khaw KT , Kim HN , Kim YH , Kim YT , Klein AP , Klein R , Koh WP , Kolonel LN , Kooperberg C , Kraft P , Krogh V , Kurtz RC , LaCroix A , Lan Q , Landi MT , Marchand LL , Li D , Liang X , Liao LM , Lin D , Liu J , Lissowska J , Lu L , Magliocco AM , Malats N , Matsuo K , McNeill LH , McWilliams RR , Melin BS , Mirabello L , Moore L , Olson SH , Orlow I , Park JY , Patino-Garcia A , Peplonska B , Peters U , Petersen GM , Pooler L , Prescott J , Prokunina-Olsson L , Purdue MP , Qiao YL , Rajaraman P , Real FX , Riboli E , Risch HA , Rodriguez-Santiago B , Ruder AM , Savage SA , Schumacher F , Schwartz AG , Schwartz KL , Seow A , Wendy Setiawan V , Severi G , Shen H , Sheng X , Shin MH , Shu XO , Silverman DT , Spitz MR , Stevens VL , Stolzenberg-Solomon R , Stram D , Tang ZZ , Taylor PR , Teras LR , Tobias GS , Van Den Berg D , Visvanathan K , Wacholder S , Wang JC , Wang Z , Wentzensen N , Wheeler W , White E , Wiencke JK , Wolpin BM , Wong MP , Wu C , Wu T , Wu X , Wu YL , Wunder JS , Xia L , Yang HP , Yang PC , Yu K , Zanetti KA , Zeleniuch-Jacquotte A , Zheng W , Zhou B , Ziegler RG , Perez-Jurado LA , Caporaso NE , Rothman N , Tucker M , Dean MC , Yeager M , Chanock SJ . Nat Commun 2016 7 11843 To investigate large structural clonal mosaicism of chromosome X, we analysed the SNP microarray intensity data of 38,303 women from cancer genome-wide association studies (20,878 cases and 17,425 controls) and detected 124 mosaic X events >2 Mb in 97 (0.25%) women. Here we show rates for X-chromosome mosaicism are four times higher than mean autosomal rates; X mosaic events more often include the entire chromosome and participants with X events more likely harbour autosomal mosaic events. X mosaicism frequency increases with age (0.11% in 50-year olds; 0.45% in 75-year olds), as reported for Y and autosomes. Methylation array analyses of 33 women with X mosaicism indicate events preferentially involve the inactive X chromosome. Our results provide further evidence that the sex chromosomes undergo mosaic events more frequently than autosomes, which could have implications for understanding the underlying mechanisms of mosaic events and their possible contribution to risk for chronic diseases. |
Plasmodium vivax malaria recurrence after radical treatment with chloroquine-primaquine standard regimen in Turbo, Colombia: Results from a prospective study.
Zuluaga-Idarraga L , Blair S , Akinyi Okoth S , Udhayakumar V , Marcet P , Escalante AA , Alexander N , Rojas C . Antimicrob Agents Chemother 2016 60 (8) 4610-9 BACKGROUND: Plasmodium vivax recurrences help maintain malaria transmission. They are caused by recrudescence, reinfection or relapse, which are not easily differentiated. METHODS: A longitudinal observational study took place in Turbo municipality, Colombia. Participants with uncomplicated P. vivax infection received supervised concomitantly treatment with chloroquine 25 mg/Kg and primaquine 0.25 mg/Kg/day for 14 days. Incidence of recurrence was assessed over 180 days. Samples were genotyped and origins of recurrences were established. RESULTS: 134 participants were enrolled between February 2012 and July 2013, and 87 were followed for 180 days in which 29 recurrences were detected. Cumulative incidence of first recurrence was 24.1% (21/87) (CI 95% 14.6 to 33.7) and 86% (18/21) of them occurred between days 51 and 110. High genetic diversity of P. vivax was found and 12.5% (16/128) of the infections were polyclonal. Among detected recurrences 93.1% were genotyped as genetically identical to the one from the previous episode and 65.5% (19/29) were classified as relapses. CONCLUSION: Our results indicate that there is a high incidence of P. vivax malaria recurrence after treatment in Turbo municipality, Colombia, a large majority of which are likely relapses from the previous infection. We attribute this to the primaquine regimen currently used in Colombia, which may be insufficient to eliminate hypnozoites. |
Controlling the last known cluster of Ebola virus disease - Liberia, January-February 2015
Nyenswah T , Fallah M , Sieh S , Kollie K , Badio M , Gray A , Dilah P , Shannon M , Duwor S , Ihekweazu C , Cordier-Lasalle T , Shinde SA , Hamblion E , Davies-Wayne G , Ratnesh M , Dye C , Yoder JS , McElroy P , Hoots B , Christie A , Vertefeuille J , Olsen SJ , Laney AS , Neal JJ , Navin TR , Coulter S , Pordell P , Lo T , Kinkade C , Mahoney F . MMWR Morb Mortal Wkly Rep 2015 64 (18) 500-4 As one of the three West African countries highly affected by the 2014-2015 Ebola virus disease (Ebola) epidemic, Liberia reported approximately 10,000 cases. The Ebola epidemic in Liberia was marked by intense urban transmission, multiple community outbreaks with source cases occurring in patients coming from the urban areas, and outbreaks in health care facilities (HCFs). This report, based on data from routine case investigations and contact tracing, describes efforts to stop the last known chain of Ebola transmission in Liberia. The index patient became ill on December 29, 2014, and the last of 21 associated cases was in a patient admitted into an Ebola treatment unit (ETU) on February 18, 2015. The chain of transmission was stopped because of early detection of new cases; identification, monitoring, and support of contacts in acceptable settings; effective triage within the health care system; and rapid isolation of symptomatic contacts. In addition, a "sector" approach, which divided Montserrado County into geographic units, facilitated the ability of response teams to rapidly respond to community needs. In the final stages of the outbreak, intensive coordination among partners and engagement of community leaders were needed to stop transmission in densely populated Montserrado County. A companion report describes the efforts to enhance infection prevention and control efforts in HCFs. After February 19, no additional clusters of Ebola cases have been detected in Liberia. On May 9, the World Health Organization declared the end of the Ebola outbreak in Liberia. |
Characterization of large structural genetic mosaicism in human autosomes.
Machiela MJ , Zhou W , Sampson JN , Dean MC , Jacobs KB , Black A , Brinton LA , Chang IS , Chen C , Chen C , Chen K , Cook LS , Crous Bou M , De Vivo I , Doherty J , Friedenreich CM , Gaudet MM , Haiman CA , Hankinson SE , Hartge P , Henderson BE , Hong YC , Hosgood HD 3rd , Hsiung CA , Hu W , Hunter DJ , Jessop L , Kim HN , Kim YH , Kim YT , Klein R , Kraft P , Lan Q , Lin D , Liu J , Le Marchand L , Liang X , Lissowska J , Lu L , Magliocco AM , Matsuo K , Olson SH , Orlow I , Park JY , Pooler L , Prescott J , Rastogi R , Risch HA , Schumacher F , Seow A , Setiawan VW , Shen H , Sheng X , Shin MH , Shu XO , VanDen Berg D , Wang JC , Wentzensen N , Wong MP , Wu C , Wu T , Wu YL , Xia L , Yang HP , Yang PC , Zheng W , Zhou B , Abnet CC , Albanes D , Aldrich MC , Amos C , Amundadottir LT , Berndt SI , Blot WJ , Bock CH , Bracci PM , Burdett L , Buring JE , Butler MA , Carreon T , Chatterjee N , Chung CC , Cook MB , Cullen M , Davis FG , Ding T , Duell EJ , Epstein CG , Fan JH , Figueroa JD , Fraumeni JF Jr , Freedman ND , Fuchs CS , Gao YT , Gapstur SM , Patino-Garcia A , Garcia-Closas M , Gaziano JM , Giles GG , Gillanders EM , Giovannucci EL , Goldin L , Goldstein AM , Greene MH , Hallmans G , Harris CC , Henriksson R , Holly EA , Hoover RN , Hu N , Hutchinson A , Jenab M , Johansen C , Khaw KT , Koh WP , Kolonel LN , Kooperberg C , Krogh V , Kurtz RC , LaCroix A , Landgren A , Landi MT , Li D , Liao LM , Malats N , McGlynn KA , McNeill LH , McWilliams RR , Melin BS , Mirabello L , Peplonska B , Peters U , Petersen GM , Prokunina-Olsson L , Purdue M , Qiao YL , Rabe KG , Rajaraman P , Real FX , Riboli E , Rodriguez-Santiago B , Rothman N , Ruder AM , Savage SA , Schwartz AG , Schwartz KL , Sesso HD , Severi G , Silverman DT , Spitz MR , Stevens VL , Stolzenberg-Solomon R , Stram D , Tang ZZ , Taylor PR , Teras LR , Tobias GS , Viswanathan K , Wacholder S , Wang Z , Weinstein SJ , Wheeler W , White E , Wiencke JK , Wolpin BM , Wu X , Wunder JS , Yu K , Zanetti KA , Zeleniuch-Jacquotte A , Ziegler RG , de Andrade M , Barnes KC , Beaty TH , Bierut LJ , Desch KC , Doheny KF , Feenstra B , Ginsburg D , Heit JA , Kang JH , Laurie CA , Li JZ , Lowe WL , Marazita ML , Melbye M , Mirel DB , Murray JC , Nelson SC , Pasquale LR , Rice K , Wiggs JL , Wise A , Tucker M , Perez-Jurado LA , Laurie CC , Caporaso NE , Yeager M , Chanock SJ . Am J Hum Genet 2015 96 (3) 487-97 Analyses of genome-wide association study (GWAS) data have revealed that detectable genetic mosaicism involving large (>2 Mb) structural autosomal alterations occurs in a fraction of individuals. We present results for a set of 24,849 genotyped individuals (total GWAS set II [TGSII]) in whom 341 large autosomal abnormalities were observed in 168 (0.68%) individuals. Merging data from the new TGSII set with data from two prior reports (the Gene-Environment Association Studies and the total GWAS set I) generated a large dataset of 127,179 individuals; we then conducted a meta-analysis to investigate the patterns of detectable autosomal mosaicism (n = 1,315 events in 925 [0.73%] individuals). Restricting to events >2 Mb in size, we observed an increase in event frequency as event size decreased. The combined results underscore that the rate of detectable mosaicism increases with age (p value = 5.5 x 10(-31)) and is higher in men (p value = 0.002) but lower in participants of African ancestry (p value = 0.003). In a subset of 47 individuals from whom serial samples were collected up to 6 years apart, complex changes were noted over time and showed an overall increase in the proportion of mosaic cells as age increased. Our large combined sample allowed for a unique ability to characterize detectable genetic mosaicism involving large structural events and strengthens the emerging evidence of non-random erosion of the genome in the aging population. |
Beta-diversity metrics of the upper digestive tract microbiome are associated with body mass index.
Lin SW , Freedman ND , Shi J , Gail MH , Vogtmann E , Yu G , Klepac-Ceraj V , Paster BJ , Dye BA , Wang GQ , Wei WQ , Fan JH , Qiao YL , Dawsey SM , Abnet CC . Obesity (Silver Spring) 2015 23 (4) 862-9 OBJECTIVE: Studies of the fecal microbiome have implicated the gut microbiota in obesity, but few studies have examined the microbial diversity at other sites. The association between obesity and the upper gastrointestinal (UGI) microbial diversity was explored. METHODS: The UGI microbiome of 659 healthy Chinese adults with a measured body mass index (BMI) range of 15.0 to 35.7 was characterized using the 16S rRNA gene DNA microarray (HOMIM). RESULTS: In multivariate-adjusted models, alpha diversity was not associated with BMI. However, beta diversity, assessed by principal coordinate vectors generated from an unweighted UniFrac distance matrix of pairwise comparisons, was associated with BMI (third and fourth vectors, P = 0.01 and P = 0.03, respectively). Moreover, beta diversity, assessed by cluster membership (three clusters), was also associated with BMI; individuals in the first cluster [median BMI 22.35, odds ratio (OR) = 0.48, 95% confidence interval (CI) = 0.05-4.34] and second cluster [median BMI 22.55, OR = 0.26, 95% CI = 0.09-0.75] were significantly less likely to be obese (BMI ≥ 27.5) than those in the third cluster (median BMI 23.59). CONCLUSIONS: A beta-diversity metric of the UGI microbiome is associated with a four fold difference in obesity risk in this Asian population. Future studies should address whether the UGI microbiome plays a causal role in obesity. |
Reducing the burden of disease and death from familial hypercholesterolemia: a call to action.
Knowles JW , O'Brien EC , Greendale K , Wilemon K , Genest J , Sperling LS , Neal WA , Rader DJ , Khoury MJ . Am Heart J 2014 168 (6) 807-11 Familial hypercholesterolemia (FH) is a genetic disease characterized by substantial elevations of low-density lipoprotein cholesterol, unrelated to diet or lifestyle. Untreated FH patients have 20 times the risk of developing coronary artery disease, compared with the general population. Estimates indicate that as many as 1 in 500 people of all ethnicities and 1 in 250 people of Northern European descent may have FH; nevertheless, the condition remains largely undiagnosed. In the United States alone, perhaps as little as 1% of FH patients have been diagnosed. Consequently, there are potentially millions of children and adults worldwide who are unaware that they have a life-threatening condition. In countries like the Netherlands, the United Kingdom, and Spain, cascade screening programs have led to dramatic improvements in FH case identification. Given that there are currently no systematic approaches in the United States to identify FH patients or affected relatives, the patient-centric nonprofit FH Foundation convened a national FH Summit in 2013, where participants issued a "call to action" to health care providers, professional organizations, public health programs, patient advocacy groups, and FH experts, in order to bring greater attention to this potentially deadly, but (with proper diagnosis) eminently treatable, condition. |
Awareness of HIV status, prevention knowledge and condom use among people living with HIV in Mozambique
Dokubo EK , Shiraishi RW , Young PW , Neal JJ , Aberle-Grasse J , Honwana N , Mbofana F . PLoS One 2014 9 (9) e106760 OBJECTIVE: To determine factors associated with HIV status unawareness and assess HIV prevention knowledge and condom use among people living with HIV/AIDS (PLHIV) in Mozambique. DESIGN: Cross-sectional household-based nationally representative AIDS Indicator Survey. METHODS: Analyses focused on HIV-infected adults and were weighted for the complex sampling design. We identified PLHIV who had never been tested for HIV or received their test results prior to this survey. Logistic regression was used to assess factors associated with HIV status unawareness. RESULTS: Of persons with positive HIV test results (N = 1182), 61% (95% confidence interval [CI] 57-65%) were unaware of their serostatus. Men had twice the odds of being unaware of their serostatus compared with women [adjusted odds ratio (aOR) 2.05, CI 1.40-2.98]. PLHIV in the poorest wealth quintile were most likely to be unaware of their serostatus (aOR 3.15, CI 1.09-9.12) compared to those in the middle wealth quintile. Most PLHIV (83%, CI 79-87%) reported not using a condom during their last sexual intercourse, and PLHIV who reported not using a condom during their last sexual intercourse were more likely to be unaware of their serostatus (aOR 2.32, CI 1.57-3.43) than those who used a condom. CONCLUSIONS: Knowledge of HIV-positive status is associated with more frequent condom use in Mozambique. However, most HIV-infected persons are unaware of their serostatus, with men and persons in the poorest wealth quintile being more likely to be unaware. These findings support calls for expanded HIV testing, especially among groups less likely to be aware of their HIV status and key populations at higher risk for infection. |
Imputation and subset-based association analysis across different cancer types identifies multiple independent risk loci in the TERT-CLPTM1L region on chromosome 5p15.33.
Wang Z , Zhu B , Zhang M , Parikh H , Jia J , Chung CC , Sampson JN , Hoskins JW , Hutchinson A , Burdette L , Ibrahim A , Hautman C , Raj PS , Abnet CC , Adjei AA , Ahlbom A , Albanes D , Allen NE , Ambrosone CB , Aldrich M , Amiano P , Amos C , Andersson U , Andriole G Jr , Andrulis IL , Arici C , Arslan AA , Austin MA , Baris D , Barkauskas DA , Bassig BA , Beane Freeman LE , Berg CD , Berndt SI , Bertazzi PA , Biritwum RB , Black A , Blot W , Boeing H , Boffetta P , Bolton K , Boutron-Ruault MC , Bracci PM , Brennan P , Brinton LA , Brotzman M , Bueno-de-Mesquita HB , Buring JE , Butler MA , Cai Q , Cancel-Tassin G , Canzian F , Cao G , Caporaso NE , Carrato A , Carreon T , Carta A , Chang GC , Chang IS , Chang-Claude J , Che X , Chen CJ , Chen CY , Chen CH , Chen C , Chen KY , Chen YM , Chokkalingam AP , Chu LW , Clavel-Chapelon F , Colditz GA , Colt JS , Conti D , Cook MB , Cortessis VK , Crawford ED , Cussenot O , Davis FG , De Vivo I , Deng X , Ding T , Dinney CP , Di Stefano AL , Diver WR , Duell EJ , Elena JW , Fan JH , Feigelson HS , Feychting M , Figueroa JD , Flanagan AM , Fraumeni JF Jr , Freedman ND , Fridley BL , Fuchs CS , Gago-Dominguez M , Gallinger S , Gao YT , Gapstur SM , Garcia-Closas M , Garcia-Closas R , Gastier-Foster JM , Gaziano JM , Gerhard DS , Giffen CA , Giles GG , Gillanders EM , Giovannucci EL , Goggins M , Gokgoz N , Goldstein AM , Gonzalez C , Gorlick R , Greene MH , Gross M , Grossman HB , Grubb R 3rd , Gu J , Guan P , Haiman CA , Hallmans G , Hankinson SE , Harris CC , Hartge P , Hattinger C , Hayes RB , He Q , Helman L , Henderson BE , Henriksson R , Hoffman-Bolton J , Hohensee C , Holly EA , Hong YC , Hoover RN , Hosgood HD 3rd , Hsiao CF , Hsing AW , Hsiung CA , Hu N , Hu W , Hu Z , Huang MS , Hunter DJ , Inskip PD , Ito H , Jacobs EJ , Jacobs KB , Jenab M , Ji BT , Johansen C , Johansson M , Johnson A , Kaaks R , Kamat AM , Kamineni A , Karagas M , Khanna C , Khaw KT , Kim C , Kim IS , Kim YH , Kim YC , Kim YT , Kang CH , Jung YJ , Kitahara CM , Klein AP , Klein R , Kogevinas M , Koh WP , Kohno T , Kolonel LN , Kooperberg C , Kratz CP , Krogh V , Kunitoh H , Kurtz RC , Kurucu N , Lan Q , Lathrop M , Lau CC , Lecanda F , Lee KM , Lee MP , Le Marchand L , Lerner SP , Li D , Liao LM , Lim WY , Lin D , Lin J , Lindstrom S , Linet MS , Lissowska J , Liu J , Ljungberg B , Lloreta J , Lu D , Ma J , Malats N , Mannisto S , Marina N , Mastrangelo G , Matsuo K , McGlynn KA , McKean-Cowdin R , McNeill LH , McWilliams RR , Melin BS , Meltzer PS , Mensah JE , Miao X , Michaud DS , Mondul AM , Moore LE , Muir K , Niwa S , Olson SH , Orr N , Panico S , Park JY , Patel AV , Patino-Garcia A , Pavanello S , Peeters PH , Peplonska B , Peters U , Petersen GM , Picci P , Pike MC , Porru S , Prescott J , Pu X , Purdue MP , Qiao YL , Rajaraman P , Riboli E , Risch HA , Rodabough RJ , Rothman N , Ruder AM , Ryu JS , Sanson M , Schned A , Schumacher FR , Schwartz AG , Schwartz KL , Schwenn M , Scotlandi K , Seow A , Serra C , Serra M , Sesso HD , Severi G , Shen H , Shen M , Shete S , Shiraishi K , Shu XO , Siddiq A , Sierrasesumaga L , Sierri S , Sihoe AD , Silverman DT , Simon M , Southey MC , Spector L , Spitz M , Stampfer M , Stattin P , Stern MC , Stevens VL , Stolzenberg-Solomon RZ , Stram DO , Strom SS , Su WC , Sund M , Sung SW , Swerdlow A , Tan W , Tanaka H , Tang W , Tang ZZ , Tardon A , Tay E , Taylor PR , Tettey Y , Thomas DM , Tirabosco R , Tjonneland A , Tobias GS , Toro JR , Travis RC , Trichopoulos D , Troisi R , Truelove A , Tsai YH , Tucker MA , Tumino R , Van Den Berg D , Van Den Eeden SK , Vermeulen R , Vineis P , Visvanathan K , Vogel U , Wang C , Wang C , Wang J , Wang SS , Weiderpass E , Weinstein SJ , Wentzensen N , Wheeler W , White E , Wiencke JK , Wolk A , Wolpin BM , Wong MP , Wrensch M , Wu C , Wu T , Wu X , Wu YL , Wunder JS , Xiang YB , Xu J , Yang HP , Yang PC , Yatabe Y , Ye Y , Yeboah ED , Yin Z , Ying C , Yu CJ , Yu K , Yuan JM , Zanetti KA , Zeleniuch-Jacquotte A , Zheng W , Zhou B , Mirabello L , Savage SA , Kraft P , Chanock SJ , Yeager M , Landi MT , Shi J , Chatterjee N , Amundadottir LT . Hum Mol Genet 2014 23 (24) 6616-33 Genome-wide association studies (GWAS) have mapped risk alleles for at least ten distinct cancers to a small region of 63,000 bp on chromosome 5p15.33. This region harbors the TERT and CLPTM1L genes; the former encodes the catalytic subunit of telomerase reverse transcriptase and the latter may play a role in apoptosis. To investigate further the genetic architecture of common susceptibility alleles in this region, we conducted an agnostic subset-based meta-analysis (ASSET) across six distinct cancers in 34,248 cases and 45,036 controls. Based on sequential conditional analysis, we identified as many as six independent risk loci marked by common single nucleotide polymorphisms (SNPs): five in the TERT gene (region 1: rs7726159, P=2.10x10-39; region 3: rs2853677, P=3.30x10-36 and PConditional=2.36x10-8; region 4: rs2736098, P=3.87x10-12 and PConditional=5.19x10-6, region 5: rs13172201, P=0.041 and PConditional=2.04x10-6; and region 6: rs10069690, P=7.49x10-15 and PConditional=5.35x10-7) and one in the neighboring CLPTM1L gene (region 2: rs451360; P=1.90x10-18 and PConditional=7.06x10-16). Between three and five cancers mapped to each independent locus with both risk-enhancing and protective effects. Allele specific effects on DNA methylation were seen for a subset of risk loci indicating that methylation and subsequent effects on gene expression may contribute to the biology of risk variants on 5p15.33. Our results provide strong support for extensive pleiotropy across this region of 5p15.33, to an extent not previously observed in other cancer susceptibility loci. |
Low-wind and other microclimatic factors in near-road black carbon variability: a case study and assessment implications
Liang MS , Keener TC , Birch ME , Baldauf R , Neal J , Yang YJ . Atmos Environ (1994) 2013 80 204-215 Airborne black carbon from urban traffic is a climate forcing agent and has been associated with health risks to near-road populations. In this paper, we describe a case study of black carbon concentration and compositional variability at and near a traffic-laden multi-lane highway in Cincinnati, Ohio, using an onsite aethalometer and filter-based NIOSH Method 5040 measurements; the former measured 1-min average black carbon concentrations and the latter determined the levels of organic and elemental carbon (OC and EC) averaged over an approximately 2-h time interval. The results show significant wind and temperature effects on black carbon concentration and composition in a way more complex than predicted by Gaussian dispersion models. Under oblique low winds, namely u x [ = u x sin ( θ )] ~ (0, -0.5 m s-1), which mostly occurred during morning hours, black carbon concentrations per unit traffic flow were highest and had large variation. The variability did not always follow Gaussian dispersion but was characteristic of a uniform distribution at a near-road distance. Under all other wind conditions, the near-road black carbon variation met Gaussian dispersion characteristics. Significant differences in roadside dispersion are observed between OC and EC fractions, between PM2.5 and PM10-2.5, and between the morning period and rest of the day. In a general case, the overall black carbon variability at the multi-lane highway can be stated as bimodal consisting of Gaussian dispersion and non-Gaussian uniform distribution. Transition between the two types depends on wind velocity and wind angle to the traffic flow. In the order of decreasing importance, the microclimatic controlling factors over the black carbon variability are: 1) wind velocity and the angle with traffic; 2) diurnal temperature variations due to thermal buoyancy; and 3) downwind Gaussian dispersion. Combinations of these factors may have created various traffic-microclimate interactions that have significant impact on near-road black carbon transport. |
A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010
Lim Stephen S , Vos Theo , Flaxman Abraham D , Danaei Goodarz , Shibuya Kenji , Adair-Rohani Heather , Amann Markus , Anderson H Ross , Andrews Kathryn G , Aryee Martin , Atkinson Charles , Bacchus Loraine J , Bahalim Adil N , Balakrishnan Kalpana , Balmes John , Barker-Collo Suzanne , Baxter Amanda , Bell Michelle L , Blore Jed D , Blyth Fiona , Bonner Carissa , Borges Guilherme , Bourne Rupert , Boussinesq Michel , Brauer Michael , Brooks Peter , Bruce Nigel G , Brunekreef Bert , Bryan-Hancock Claire , Bucello Chiara , Buchbinder Rachelle , Bull Fiona , Burnett Richard T , Byers Tim E , Calabria Bianca , Carapetis Jonathan , Carnahan Emily , Chafe Zoe , Charlson Fiona , Chen Honglei , Chen Jian Shen , Cheng Andrew Tai-Ann , Child Jennifer Christine , Cohen Aaron , Colson K Ellicott , Cowie Benjamin C , Darby Sarah , Darling Susan , Davis Adrian , Degenhardt Louisa , Dentener Frank , Des Jarlais Don C , Devries Karen , Dherani Mukesh , Ding Eric L , Dorsey E Ray , Driscoll Tim , Edmond Karen , Ali Suad Eltahir , Engell Rebecca E , Erwin Patricia J , Fahimi Saman , Falder Gail , Farzadfar Farshad , Ferrari Alize , Finucane Mariel M , Flaxman Seth , Fowkes Francis Gerry R , Freedman Greg , Freeman Michael K , Gakidou Emmanuela , Ghosh Santu , Giovannucci Edward , Gmel Gerhard , Graham Kathryn , Grainger Rebecca , Grant Bridget , Gunnell David , Gutierrez Hialy R , Hall Wayne , Hoek Hans W , Hogan Anthony , Hosgood H Dean 3rd , Hoy Damian , Hu Howard , Hubbell Bryan J , Hutchings Sally J , Ibeanusi Sydney E , Jacklyn Gemma L , Jasrasaria Rashmi , Jonas Jost B , Kan Haidong , Kanis John A , Kassebaum Nicholas , Kawakami Norito , Khang Young-Ho , Khatibzadeh Shahab , Khoo Jon-Paul , Kok Cindy , Laden Francine , Lalloo Ratilal , Lan Qing , Lathlean Tim , Leasher Janet L , Leigh James , Li Yang , Lin John Kent , Lipshultz Steven E , London Stephanie , Lozano Rafael , Lu Yuan , Mak Joelle , Malekzadeh Reza , Mallinger Leslie , Marcenes Wagner , March Lyn , Marks Robin , Martin Randall , McGale Paul , McGrath John , Mehta Sumi , Mensah George A , Merriman Tony R , Micha Renata , Michaud Catherine , Mishra Vinod , Hanafiah Khayriyyah Mohd , Mokdad Ali A , Morawska Lidia , Mozaffarian Dariush , Murphy Tasha , Naghavi Mohsen , Neal Bruce , Nelson Paul K , Nolla Joan Miquel , Norman Rosana , Olives Casey , Omer Saad B , Orchard Jessica , Osborne Richard , Ostro Bart , Page Andrew , Pandey Kiran D , Parry Charles D H , Passmore Erin , Patra Jayadeep , Pearce Neil , Pelizzari Pamela M , Petzold Max , Phillips Michael R , Pope Dan , Pope C Arden 3rd , Powles John , Rao Mayuree , Razavi Homie , Rehfuess Eva A , Rehm Jurgen T , Ritz Beate , Rivara Frederick P , Roberts Thomas , Robinson Carolyn , Rodriguez-Portales Jose A , Romieu Isabelle , Room Robin , Rosenfeld Lisa C , Roy Ananya , Rushton Lesley , Salomon Joshua A , Sampson Uchechukwu , Sanchez-Riera Lidia , Sanman Ella , Sapkota Amir , Seedat Soraya , Shi Peilin , Shield Kevin , Shivakoti Rupak , Singh Gitanjali M , Sleet David A , Smith Emma , Smith Kirk R , Stapelberg Nicolas J C , Steenland Kyle , Stockl Heidi , Stovner Lars Jacob , Straif Kurt , Straney Lahn , Thurston George D , Tran Jimmy H , Van Dingenen Rita , van Donkelaar Aaron , Veerman J Lennert , Vijayakumar Lakshmi , Weintraub Robert , Weissman Myrna M , White Richard A , Whiteford Harvey , Wiersma Steven T , Wilkinson James D , Williams Hywel C , Williams Warwick , Wilson Nicholas , Woolf Anthony D , Yip Paul , Zielinski Jan M , Lopez Alan D , Murray Christopher J L , Ezzati Majid , Global Burden of Disease Study 2010 . Lancet 2013 380 (9859) 2224-60 BACKGROUND: Quantification of the disease burden caused by different risks informs prevention by providing an account of health loss different to that provided by a disease-by-disease analysis. No complete revision of global disease burden caused by risk factors has been done since a comparative risk assessment in 2000, and no previous analysis has assessed changes in burden attributable to risk factors over time. METHODS: We estimated deaths and disability-adjusted life years (DALYs; sum of years lived with disability [YLD] and years of life lost [YLL]) attributable to the independent effects of 67 risk factors and clusters of risk factors for 21 regions in 1990 and 2010. We estimated exposure distributions for each year, region, sex, and age group, and relative risks per unit of exposure by systematically reviewing and synthesising published and unpublished data. We used these estimates, together with estimates of cause-specific deaths and DALYs from the Global Burden of Disease Study 2010, to calculate the burden attributable to each risk factor exposure compared with the theoretical-minimum-risk exposure. We incorporated uncertainty in disease burden, relative risks, and exposures into our estimates of attributable burden. FINDINGS: In 2010, the three leading risk factors for global disease burden were high blood pressure (7.0% [95% uncertainty interval 6.2-7.7] of global DALYs), tobacco smoking including second-hand smoke (6.3% [5.5-7.0]), and alcohol use (5.5% [5.0-5.9]). In 1990, the leading risks were childhood underweight (7.9% [6.8-9.4]), household air pollution from solid fuels (HAP; 7.0% [5.6-8.3]), and tobacco smoking including second-hand smoke (6.1% [5.4-6.8]). Dietary risk factors and physical inactivity collectively accounted for 10.0% (95% UI 9.2-10.8) of global DALYs in 2010, with the most prominent dietary risks being diets low in fruits and those high in sodium. Several risks that primarily affect childhood communicable diseases, including unimproved water and sanitation and childhood micronutrient deficiencies, fell in rank between 1990 and 2010, with unimproved water and sanitation accounting for 0.9% (0.4-1.6) of global DALYs in 2010. However, in most of sub-Saharan Africa childhood underweight, HAP, and non-exclusive and discontinued breastfeeding were the leading risks in 2010, while HAP was the leading risk in south Asia. The leading risk factor in Eastern Europe, most of Latin America, and southern sub-Saharan Africa in 2010 was alcohol use; in most of Asia, North Africa and Middle East, and central Europe it was high blood pressure. Despite declines, tobacco smoking including second-hand smoke remained the leading risk in high-income north America and western Europe. High body-mass index has increased globally and it is the leading risk in Australasia and southern Latin America, and also ranks high in other high-income regions, North Africa and Middle East, and Oceania. INTERPRETATION: Worldwide, the contribution of different risk factors to disease burden has changed substantially, with a shift away from risks for communicable diseases in children towards those for non-communicable diseases in adults. These changes are related to the ageing population, decreased mortality among children younger than 5 years, changes in cause-of-death composition, and changes in risk factor exposures. New evidence has led to changes in the magnitude of key risks including unimproved water and sanitation, vitamin A and zinc deficiencies, and ambient particulate matter pollution. The extent to which the epidemiological shift has occurred and what the leading risks currently are varies greatly across regions. In much of sub-Saharan Africa, the leading risks are still those associated with poverty and those that affect children. FUNDING: Bill & Melinda Gates Foundation. |
Pseudo-outbreak of Lecanicillium and Acremonium species in orthopedic surgery patients
Neal CO , Deak E , Chang LS , Gilmartin H , Gade L , Imanishi M , Price C , Brandt ME , Chiller T , Balajee SA . J Clin Microbiol 2012 50 (12) 4103-6 Acremonium species cause a variety of human infections, while Lecanicillium species have not been reported as human pathogens. We describe a pseudo-outbreak involving both organisms, highlighting the role and limitations of molecular methods in the characterization of rare fungal isolates. Repeated isolation of these fungi from patient tissue samples raises concerns about exogenous contamination in the hospital environment. |
Detectable clonal mosaicism and its relationship to aging and cancer.
Jacobs KB , Yeager M , Zhou W , Wacholder S , Wang Z , Rodriguez-Santiago B , Hutchinson A , Deng X , Liu C , Horner MJ , Cullen M , Epstein CG , Burdett L , Dean MC , Chatterjee N , Sampson J , Chung CC , Kovaks J , Gapstur SM , Stevens VL , Teras LT , Gaudet MM , Albanes D , Weinstein SJ , Virtamo J , Taylor PR , Freedman ND , Abnet CC , Goldstein AM , Hu N , Yu K , Yuan JM , Liao L , Ding T , Qiao YL , Gao YT , Koh WP , Xiang YB , Tang ZZ , Fan JH , Aldrich MC , Amos C , Blot WJ , Bock CH , Gillanders EM , Harris CC , Haiman CA , Henderson BE , Kolonel LN , Le Marchand L , McNeill LH , Rybicki BA , Schwartz AG , Signorello LB , Spitz MR , Wiencke JK , Wrensch M , Wu X , Zanetti KA , Ziegler RG , Figueroa JD , Garcia-Closas M , Malats N , Marenne G , Prokunina-Olsson L , Baris D , Schwenn M , Johnson A , Landi MT , Goldin L , Consonni D , Bertazzi PA , Rotunno M , Rajaraman P , Andersson U , Freeman LE , Berg CD , Buring JE , Butler MA , Carreon T , Feychting M , Ahlbom A , Gaziano JM , Giles GG , Hallmans G , Hankinson SE , Hartge P , Henriksson R , Inskip PD , Johansen C , Landgren A , McKean-Cowdin R , Michaud DS , Melin BS , Peters U , Ruder AM , Sesso HD , Severi G , Shu XO , Visvanathan K , White E , Wolk A , Zeleniuch-Jacquotte A , Zheng W , Silverman DT , Kogevinas M , Gonzalez JR , Villa O , Li D , Duell EJ , Risch HA , Olson SH , Kooperberg C , Wolpin BM , Jiao L , Hassan M , Wheeler W , Arslan AA , Bueno-de-Mesquita HB , Fuchs CS , Gallinger S , Gross MD , Holly EA , Klein AP , LaCroix A , Mandelson MT , Petersen G , Boutron-Ruault MC , Bracci PM , Canzian F , Chang K , Cotterchio M , Giovannucci EL , Goggins M , Hoffman Bolton JA , Jenab M , Khaw KT , Krogh V , Kurtz RC , McWilliams RR , Mendelsohn JB , Rabe KG , Riboli E , Tjønneland A , Tobias GS , Trichopoulos D , Elena JW , Yu H , Amundadottir L , Stolzenberg-Solomon RZ , Kraft P , Schumacher F , Stram D , Savage SA , Mirabello L , Andrulis IL , Wunder JS , Patiño García A , Sierrasesúmaga L , Barkauskas DA , Gorlick RG , Purdue M , Chow WH , Moore LE , Schwartz KL , Davis FG , Hsing AW , Berndt SI , Black A , Wentzensen N , Brinton LA , Lissowska J , Peplonska B , McGlynn KA , Cook MB , Graubard BI , Kratz CP , Greene MH , Erickson RL , Hunter DJ , Thomas G , Hoover RN , Real FX , Fraumeni JF Jr , Caporaso NE , Tucker M , Rothman N , Pérez-Jurado LA , Chanock SJ . Nat Genet 2012 44 (6) 651-8 In an analysis of 31,717 cancer cases and 26,136 cancer-free controls from 13 genome-wide association studies, we observed large chromosomal abnormalities in a subset of clones in DNA obtained from blood or buccal samples. We observed mosaic abnormalities, either aneuploidy or copy-neutral loss of heterozygosity, of >2 Mb in size in autosomes of 517 individuals (0.89%), with abnormal cell proportions of between 7% and 95%. In cancer-free individuals, frequency increased with age, from 0.23% under 50 years to 1.91% between 75 and 79 years (P = 4.8 x 10(-8)). Mosaic abnormalities were more frequent in individuals with solid tumors (0.97% versus 0.74% in cancer-free individuals; odds ratio (OR) = 1.25; P = 0.016), with stronger association with cases who had DNA collected before diagnosis or treatment (OR = 1.45; P = 0.0005). Detectable mosaicism was also more common in individuals for whom DNA was collected at least 1 year before diagnosis with leukemia compared to cancer-free individuals (OR = 35.4; P = 3.8 x 10(-11)). These findings underscore the time-dependent nature of somatic events in the etiology of cancer and potentially other late-onset diseases. |
Global population structure of Aspergillus terreus inferred by ISSR typing reveals geographical subclustering.
Neal CO , Richardson AO , Hurst SF , Tortorano AM , Viviani MA , Stevens DA , Balajee SA . BMC Microbiol 2011 11 203 BACKGROUND: Aspergillus terreus causes invasive aspergillosis (IA) in immunocompromised individuals and can be the leading cause of IA in certain medical centers. We examined a large isolate collection (n = 117) for the presence of cryptic A. terreus species and employed a genome scanning method, Inter-Simple Sequence Repeat (ISSR) PCR to determine A. terreus population structure. RESULTS: Comparative sequence analyses of the calmodulin locus revealed the presence of the recently recognized species A. alabamensis (n = 4) in this collection. Maximum parsimony, Neighbor joining, and Bayesian clustering of the ISSR data from the 113 sequence-confirmed A. terreus isolates demonstrated that one clade was composed exclusively of isolates from Europe and another clade was enriched for isolates from the US. CONCLUSIONS: This study provides evidence of a population structure linked to geographical origin in A. terreus. |
Understanding the role of human variation in vaccine adverse events: the Clinical Immunization Safety Assessment Network.
LaRussa PS , Edwards KM , Dekker CL , Klein NP , Halsey NA , Marchant C , Baxter R , Engler RJ , Kissner J , Slade BA . Pediatrics 2011 127 Suppl 1 S65-73 The Clinical Immunization Safety Assessment (CISA) Network is a collaboration between the Centers for Disease Control and Prevention (CDC) and 6 academic medical centers to provide support for immunization safety assessment and research. The CISA Network was established by the CDC in 2001 with 4 primary goals: (1) develop research protocols for clinical evaluation, diagnosis, and management of adverse events following immunization (AEFI); (2) improve the understanding of AEFI at the individual level, including determining possible genetic and other risk factors for predisposed people and subpopulations at high risk; (3) develop evidence-based algorithms for vaccination of people at risk of serious AEFI; and (4) serve as subject-matter experts for clinical vaccine-safety inquiries. CISA Network investigators bring in-depth clinical, pathophysiologic, and epidemiologic expertise to assessing causal relationships between vaccines and adverse events and to understanding the pathogenesis of AEFI. CISA Network researchers conduct expert reviews of clinically significant adverse events and determine the validity of the recorded diagnoses on the basis of clinical and laboratory criteria. They also conduct special studies to investigate the possible pathogenesis of adverse events, assess relationships between vaccines and adverse events, and maintain a centralized repository for clinical specimens. The CISA Network provides specific clinical guidance to both health care providers who administer vaccines and those who evaluate and treat patients with possible AEFI. The CISA Network plays an important role in providing critical immunization-safety data and expertise to inform vaccine policy-makers. The CISA Network serves as a unique resource for vaccine-safety monitoring efforts conducted at the CDC. |
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