Last data update: Oct 28, 2024. (Total: 48004 publications since 2009)
Records 1-30 (of 93 Records) |
Query Trace: Newton S[original query] |
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Birth outcomes related to prenatal Zika, Dengue, and other flavivirus infections in the Zika en Embarazadas y Niños prospective cohort study in Colombia
Tannis A , Newton S , Rico A , Gonzalez M , Benavides M , Ricaldi JN , Rodriguez H , Zambrano LD , Daza M , Godfred-Cato S , Thomas JD , Acosta J , Maniatis P , Daniels JB , Burkel V , Ailes EC , Valencia D , Gilboa SM , Jamieson DJ , Mercado M , Villanueva JM , Honein MA , Ospina ML , Tong VT . Am J Trop Med Hyg 2024 Zika virus (ZIKV) infection in pregnancy is associated with severe abnormalities of the brain and eye and other adverse outcomes. Zika en Embarazadas y Niños was a prospective cohort study conducted in multiple Colombian cities that enrolled pregnant women in their first trimester. Specimens collected from pregnant women (n = 1,519) during February 2017-September 2018 and their infants (n = 1,080) during June 2017-March 2019 were tested for prenatal ZIKV infection by nucleic acid amplification tests or IgM antibody testing. Zika virus infection in pregnancy was present in 3.2% of pregnant women (incidence rate [IR] per 1,000 person-months = 5.9, 95% CI: 4.3-7.8). Presumptive ZIKV infection was present in 0.8% of infants (IR = 1.6, 95% CI: 0.7-2.9). Five percent of infants with prenatal ZIKV exposure or infection presented with Zika-associated abnormalities; 4.7% were small for gestational age. Understanding the risk of ZIKV infection during pregnancy and associated adverse outcomes can help inform counseling efforts. |
Zika virus prevention behaviors and knowledge among male partners of pregnant people and lack of condom use as a prevention behavior from the Zika en Embarazadas y Niños (ZEN) prospective cohort study, Colombia
Sancken CL , Tannis A , Amouzou SA , Burkel V , Carlson JM , Newton S , Gilboa SM , Gonzalez M , Valencia D , Tong VT , Ospina M . BMC Res Notes 2024 17 (1) 87 OBJECTIVE: Zika virus (ZIKV) infection in pregnancy can cause brain and eye abnormalities and neurodevelopmental sequelae. In the absence of medical countermeasures, behavioral interventions were recommended to prevent mosquito bites and sexual transmission of ZIKV. This report uses data from the Zika en Embarazadas y Niños (ZEN) prospective cohort study in Colombia to describe the knowledge, attitudes, and behaviors (KAB) related to ZIKV prevention in male partners compared to those of their pregnant partners at study enrollment during February 2017-2018. RESULTS: Most male partners reported wearing protective clothing such as long pants (97.6%) and long sleeves (72.8%), as well as covering ankles and feet (89.1%) to prevent ZIKV infection. When comparing the preventive behavior of condom use between male and pregnant partners, 26 pairs (10.0%) both responded that they performed the behavior. Overall, 25.1% of male partners and 18.9% of pregnant people reported any condom use during the three months before enrolling in ZEN. When comparing other preventive behaviors between male and pregnant partners, the behavior which was most frequently reported by both partners was wearing long pants (85.4%), and the least frequently reported by both partners was using condoms after finding out about a partner's pregnancy (3.4%). |
Frequency of children diagnosed with perinatal hepatitis C, United States, 2018-2020
Newton SM , Woodworth KR , Chang D , Sizemore L , Wingate H , Pinckney L , Osinski A , Orkis L , Reynolds BD , Carpentieri C , Halai UA , Lyu C , Longcore N , Thomas N , Wills A , Akosa A , Olsen EO , Panagiotakopoulos L , Thompson ND , Gilboa SM , Tong VT . Emerg Infect Dis 2024 30 (1) 202-204 We describe hepatitis C testing of 47 (2%) of 2,266 children diagnosed with perinatal hepatitis C who were exposed during 2018-2020 in 7 jurisdictions in the United States. Expected frequency of perinatal transmission is 5.8%, indicating only one third of the cases in this cohort were reported to public health authorities. |
Examining the effects of gateway width on motorist yielding to pedestrians
Hochmuth J , Newton E , Van Houten R . Transp Res Rec 2023 The gateway in-street sign configuration has been demonstrated to be a low-cost method for increasing motorist yielding the right of way to pedestrians at crosswalks. It has previously been hypothesized that the gateway is effective because it visually narrows a travel lane. In the present study, gateway widths (i.e., distance between signs) were compared to determine whether there was a differential effect on motorist yielding. Experiment 1 was a parametric analysis of distance between the signs, varying in 2-ft intervals from 12 to 18 ft. The results showed that the percentage of motorists yielding increased as the distance between the signs decreased. Experiment 2 examined curb-top and gutter-pan placements of the edge signs at three different sites. Both placements produced substantial increases in yielding compared with baseline, though the difference between gutter-pan and curb-top placement was not significant at two of the three sites. Based on the distance between signs in these two configurations, the results at two of the sites aligned with those in Experiment 1, and one site demonstrated much higher yielding than would have been predicted. This suggests that small increases in the distance between signs may result in a minor decrease in yielding but may improve the survivability of the signs and reduce maintenance costs over time. The potential to combine this sign effect with other engineering treatments (e.g., curb extensions and bicycle lanes) was additionally explored. The results are discussed in relation to a perceived narrowing hypothesis, sign survival, cost effectiveness, and equity. © National Academy of Sciences: Transportation Research Board 2023. |
Immunization of health-care personnel: recommendations of the Advisory Committee on Immunization Practices (ACIP)
Shefer A , Atkinson W , Friedman C , Kuhar DT , Mootrey G , Bialek SR , Cohn A , Fiore A , Grohskopf L , Liang JL , Lorick SA , Marin M , Mintz E , Murphy TV , Newton A , Parker Fiebelkorn A , Seward J , Wallace G . MMWR Recomm Rep 2011 60 1-45 This report updates the previously published summary of recommendations for vaccinating health-care personnel (HCP) in the United States (CDC. Immunization of health-care workers: recommendations of the Advisory Committee on Immunization Practices [ACIP] and the Hospital Infection Control Practices Advisory Committee [HICPAC]. MMWR 1997;46[No. RR-18]). This report was reviewed by and includes input from the Healthcare (formerly Hospital) Infection Control Practices Advisory Committee. These updated recommendations can assist hospital administrators, infection-control practitioners, employee health clinicians, and HCP in optimizing infection prevention and control programs. The recommendations for vaccinating HCP are presented by disease in two categories: 1) those diseases for which vaccination or documentation of immunity is recommended because of risks to HCP in their work settings for acquiring disease or transmitting to patients and 2) those for which vaccination might be indicated in certain circumstances. Background information for each vaccine-preventable disease and specific recommendations for use of each vaccine are presented. Certain infection-control measures that relate to vaccination also are included in this report. In addition, ACIP recommendations for the remaining vaccines that are recommended for certain or all adults are summarized, as are considerations for catch-up and travel vaccinations and for work restrictions. This report summarizes all current ACIP recommendations for vaccination of HCP and does not contain any new recommendations or policies. The recommendations provided in this report apply, but are not limited, to HCP in acute-care hospitals; long-term-care facilities (e.g., nursing homes and skilled nursing facilities); physician's offices; rehabilitation centers; urgent care centers, and outpatient clinics as well as to persons who provide home health care and emergency medical services. |
Leveraging automated approaches to categorize birth defects from abstracted birth hospitalization data
Newton SM , Distler S , Woodworth KR , Chang D , Roth NM , Board A , Hutcherson H , Cragan JD , Gilboa SM , Tong VT . Birth Defects Res 2023 BACKGROUND: The Surveillance for Emerging Threats to Pregnant People and Infants Network (SET-NET) collects data abstracted from medical records and birth defects registries on pregnant people and their infants to understand outcomes associated with prenatal exposures. We developed an automated process to categorize possible birth defects for prenatal COVID-19, hepatitis C, and syphilis surveillance. By employing keyword searches, fuzzy matching, natural language processing (NLP), and machine learning (ML), we aimed to decrease the number of cases needing manual clinician review. METHODS: SET-NET captures International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes and free text describing birth defects. For unstructured data, we used keyword searches, and then conducted fuzzy matching with a cut-off match score of ≥90%. Finally, we employed NLP and ML by testing three predictive models to categorize birth defect data. RESULTS: As of June 2023, 8326 observations containing data on possible birth defects were submitted to SET-NET. The majority (n = 6758 [81%]) were matched to an ICD-10-CM code and 1568 (19%) were unable to be matched. Through keyword searches and fuzzy matching, we categorized 1387/1568 possible birth defects. Of the remaining 181 unmatched observations, we correctly categorized 144 (80%) using a predictive model. CONCLUSIONS: Using automated approaches allowed for categorization of 99.6% of reported possible birth defects, which helps detect possible patterns requiring further investigation. Without employing these analytic approaches, manual review would have been needed for 1568 observations. These methods can be employed to quickly and accurately sift through data to inform public health responses. |
Proteomic and genetic analyses of influenza A viruses identify pan-viral host targets
Haas KM , McGregor MJ , Bouhaddou M , Polacco BJ , Kim EY , Nguyen TT , Newton BW , Urbanowski M , Kim H , Williams MAP , Rezelj VV , Hardy A , Fossati A , Stevenson EJ , Sukerman E , Kim T , Penugonda S , Moreno E , Braberg H , Zhou Y , Metreveli G , Harjai B , Tummino TA , Melnyk JE , Soucheray M , Batra J , Pache L , Martin-Sancho L , Carlson-Stevermer J , Jureka AS , Basler CF , Shokat KM , Shoichet BK , Shriver LP , Johnson JR , Shaw ML , Chanda SK , Roden DM , Carter TC , Kottyan LC , Chisholm RL , Pacheco JA , Smith ME , Schrodi SJ , Albrecht RA , Vignuzzi M , Zuliani-Alvarez L , Swaney DL , Eckhardt M , Wolinsky SM , White KM , Hultquist JF , Kaake RM , García-Sastre A , Krogan NJ . Nat Commun 2023 14 (1) 6030 Influenza A Virus (IAV) is a recurring respiratory virus with limited availability of antiviral therapies. Understanding host proteins essential for IAV infection can identify targets for alternative host-directed therapies (HDTs). Using affinity purification-mass spectrometry and global phosphoproteomic and protein abundance analyses using three IAV strains (pH1N1, H3N2, H5N1) in three human cell types (A549, NHBE, THP-1), we map 332 IAV-human protein-protein interactions and identify 13 IAV-modulated kinases. Whole exome sequencing of patients who experienced severe influenza reveals several genes, including scaffold protein AHNAK, with predicted loss-of-function variants that are also identified in our proteomic analyses. Of our identified host factors, 54 significantly alter IAV infection upon siRNA knockdown, and two factors, AHNAK and coatomer subunit COPB1, are also essential for productive infection by SARS-CoV-2. Finally, 16 compounds targeting our identified host factors suppress IAV replication, with two targeting CDK2 and FLT3 showing pan-antiviral activity across influenza and coronavirus families. This study provides a comprehensive network model of IAV infection in human cells, identifying functional host targets for pan-viral HDT. |
Risk factors for illness severity among pregnant women with confirmed SARS-CoV-2 infection – Surveillance for Emerging Threats to Mothers and Babies Network, 20 state, local, and territorial health departments, March 29, 2020 -January 8, 2021 (preprint)
Galang RR , Newton SM , Woodworth KR , Griffin I , Oduyebo T , Sancken CL , Olsen EO , Aveni K , Wingate H , Shephard H , Fussman C , Alaali ZS , Silcox K , Siebman S , Halai UA , Lopez CD , Lush M , Sokale A , Barton J , Chaudhary I , Patrick PH , Schlosser L , Reynolds B , Gaarenstroom N , Chicchelly S , Read JS , de Wilde L , Mbotha D , Azziz-Baumgartner E , Hall AJ , Tong VT , Ellington S , Gilboa SM . medRxiv 2021 2021.02.27.21252169 Background Pregnant women with coronavirus disease 2019 (COVID-19) are at increased risk for severe illness compared with nonpregnant women. Data to assess risk factors for illness severity among pregnant women with COVID-19 are limited. This study aimed to determine risk factors associated with COVID-19 illness severity among pregnant women with SARS-CoV-2 infection.Methods Pregnant women with SARS-CoV-2 infection confirmed by molecular testing were reported during March 29, 2020–January 8, 2021 through the Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET). Criteria for illness severity (asymptomatic, mild, moderate-to-severe, or critical) were adapted from National Institutes of Health and World Health Organization criteria. Crude and adjusted risk ratios for moderate-to-severe or critical COVID-19 illness were calculated for selected demographic and clinical characteristics.Results Among 5,963 pregnant women with SARS-CoV-2 infection, moderate-to-severe or critical COVID-19 illness was associated with age 30–39 years, Black/Non-Hispanic race/ethnicity, healthcare occupation, pre-pregnancy obesity, chronic lung disease, chronic hypertension, cardiovascular disease, and pregestational diabetes mellitus. Risk of moderate-to-severe or critical illness increased with the number of underlying medical or pregnancy-related conditions.Conclusions Pregnant women with moderate-to-severe or critical COVID-19 illness were more likely to be older and have underlying medical conditions compared to pregnant women with asymptomatic infection or mild COVID-19 illness. This information might help pregnant women understand their risk for moderate-to-severe or critical COVID-19 illness and inform targeted public health messaging.Summary Among pregnant women with COVID-19, older age and underlying medical conditions were risk factors for increased illness severity. These findings can be used to inform pregnant women about their risk for severe COVID-19 illness and public health messaging.Competing Interest StatementThe authors have declared no competing interest.Clinical TrialThis activity was reviewed by CDC, determined to be a non-research, public health surveillance activity, and was conducted consistent with applicable federal law and CDC policy.Clinical Protocols https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7643898/ Funding StatementThis study was performed as regular work of the Centers for Disease Control and Prevention. This work is supported by the Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) Cooperative Agreement (ELC CK19-1904) and through contractual mechanisms, including the Local Health Department Initiative.Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:This activity was reviewed by the human subjects advisor of the U.S. Centers for Disease Control and Prevention (CDC), National Center on Birth Defects and Developmental Disorders and was determined to be non-research, public health surveillance and exempt from IRB review. This activity was conducted consistent with applicable federal law and CDC policy. (Department of Health and Human Services - 45 C.F.R. part 46, 21 C.F.R. part 56; 42 U.S.C. Sect. 241(d); 5 U.S.C. Sect. 552a; 44 U.S.C. Sect. 3501 et seq. Available from: https://www.hhs.gov/ohrp/sites/default/files/ohrp/policy/ohrpregulations.pdf.)All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, p ease provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesThese data are collected under relevant provisions of the Public Health Service Act and are protected at CDC by an Assurance of Confidentiality (Section 308(d) of the Public Health Service Act, 42 U.S.C. section 242 m(d)) (https://www.cdc.gov/od/science/integrity/confidentiality/), which prohibits use or disclosure of any identifiable or potentially identifiable information collected under the Assurance for purposes other than those set out in the Assurance. Publicly available aggregated data are available: https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/special-populations/birth-data-on-covid-19.html. Requests for access will be considered on a case by case basis, and inquiries should be directed to setnet@cdc.gov |
Variability in haemoglobin concentration by measurement tool and blood source: an analysis from seven countries
Rappaport AI , Karakochuk CD , Hess SY , Whitehead RD Jr , Namaste SML , Dary O , Parker ME , Neufeld LM , Larson LM , Newton S , Wegmuller R , Moorthy D . J Clin Pathol 2021 74 (10) 657-663 OBJECTIVE: We explore factors such as the blood sampling site (capillary vs venous), the equipment (HemoCue vs automated haematology analyser) and the model of the HemoCue device (201+ vs 301) that may impact haemoglobin measurements in capillary and venous blood. METHODS: Eleven studies were identified, and bias, concordance and measures of diagnostic performance were assessed within each study. FINDINGS: Our analysis included 11 studies from seven countries (Cambodia, India, The Gambia, Ghana, Laos, Rwanda and USA). Samples came from children, men, non-pregnant women and pregnant women. Mean bias ranged from -8.7 to 2.5 g/L in Cambodian women, 6.2 g/L in Laotian children, 2.4 g/L in Ghanaian women, 0.8 g/L in Gambian children 6-23 months and 1.4 g/L in Rwandan children 6-59 months when comparing capillary blood on a HemoCue to venous blood on a haematology analyser. Bias was 8.3 g/L in Indian non-pregnant women and 2.6 g/L in Laotian children and women and 1.5 g/L in the US population when comparing capillary to venous blood using a HemoCue. For venous blood measured on the HemoCue compared with the automated haematology analyser, bias was 5.3 g/L in Gambian pregnant women 18-45 years and 11.3 g/L in Laotian children 6-59 months. CONCLUSION: Our analysis found large variability in haemoglobin concentration measured on capillary or venous blood and using HemoCue Hb 201+ or Hb 301 or automated haematology analyser. We cannot ascertain whether the variation is due to differences in the equipment, differences in capillary and venous blood, or factors affecting blood collection techniques. |
Development of an international glossary for clinical guidelines collaboration
Christensen RE , Yi MD , Kang BY , Ibrahim SA , Anvery N , Dirr M , Adams S , Amer YS , Bisdorff A , Bradfield L , Brown S , Earley A , Fatheree LA , Fayoux P , Getchius T , Ginex P , Graham A , Green CR , Gresele P , Hanson H , Haynes N , Hegedüs L , Hussein H , Jakhmola P , Kantorova L , Krishnasamy R , Krist A , Landry G , Lease ED , Ley L , Marsden G , Meek T , Meremikwu M , Moga C , Mokrane S , Mujoomdar A , Newton S , O'Flynn N , Perkins GD , Smith EJ , Prematunge C , Rychert J , Saraco M , Schünemann HJ , Senerth E , Sinclair A , Shwayder J , Stec C , Tanni S , Taske N , Temple-Smolkin RL , Thomas L , Thomas S , Tonnessen B , Turner AS , Van Dam A , van Doormaal M , Wan YL , Ventura CB , McFarlane E , Morgan RL , Ogunremi T , Alam M . J Clin Epidemiol 2023 158 84-91 OBJECTIVE: Clinical practice guidelines are often created through collaboration among organizations. Use of inconsistent terminology may cause poor communication and delays. This study aimed to develop a glossary of terms related to collaboration in guideline development. STUDY DESIGN AND SETTING: A literature review of collaborative guidelines was performed to develop an initial list of terms related to guideline collaboration. The list of terms was presented to the members of the Guideline International Network Guidelines Collaboration Working Group, who provided presumptive definitions for each term and proposed additional terms to be included. The revised list was subsequently reviewed by an international, multidisciplinary panel of expert stakeholders. Recommendations received during this pre-Delphi review were implemented to augment an initial draft glossary. The glossary was then critically evaluated and refined through two rounds of Delphi surveys and a virtual consensus meeting with all panel members as Delphi participants. RESULTS: Forty-nine experts participated in the pre-Delphi survey and 44 participated in the two-round Delphi process. Consensus was reached for 37 terms and definitions. CONCLUSION: Uptake and utilization of this guideline collaboration glossary by key organizations and stakeholder groups may facilitate collaboration among guideline-producing organizations by improving communication, minimizing conflicts, and increasing guideline development efficiency. |
Fatal systemic fungal infection in eastern bongo antelope (Tragelaphus eurycerus isaaci): Six cases
Garner MM , Fredholm DVE , Citino SB , Keating MK , Ritter JM , Lockart S , Lysen C , Bradway DS , Koons AR , Newton J . J Zoo Wildl Med 2023 54 (1) 102-110 Over a span of 6 yr, six adult eastern bongo antelope (Tragelaphus eurycerus isaaci) from a single institution died due to systemic mycotic infections. All animals were of the same genetic lineage and in good body condition at the time of death. Gross findings in all cases included multifocal white-to-tan nodules up to 10 cm in diameter that were most numerous in the heart, lung, and kidney. Histologic examination identified these nodules as foci of granulomatous inflammation containing branching, septate, broad, undulating fungal elements. Identification of the fungal species was pursued using PCR with sequencing, immunohistochemistry, and culture. Multiple fungal species were identified using the various modalities, and commonality of species identification was limited to Cladosporium sp. in four of the cases. The clinical and postmortem findings in these cases were identical and were considered to be the same infectious disease. The Cladosporium sp. was considered a candidate as an emerging fatal infectious agent in this population of bongo antelopes. In all of these cases, death was attributed to conduction abnormalities associated with the cardiac lesions or euthanasia. |
Zika virus knowledge, attitudes and prevention behaviors among pregnant women in the ZEN cohort study, Colombia, 2017-2018
Burkel VK , Newton SM , Acosta J , Valencia D , Benavides M , Tong VT , Daza M , Sancken C , Gonzalez M , Polen K , Rodriguez H , Borbón M , Rao CY , Gilboa SM , Honein MA , Ospina ML , Johnson CY . Trans R Soc Trop Med Hyg 2023 117 (7) 496-504 BACKGROUND: Zika virus (ZIKV) infection during pregnancy can cause severe birth defects in the fetus and is associated with neurodevelopmental abnormalities in childhood. Our objective was to describe ZIKV knowledge and attitudes among pregnant women in Colombia while ZIKV was circulating and whether they predicted the adoption of behaviors to prevent ZIKV mosquito-borne and sexual transmission. METHODS: We used self-reported data from Zika en Embarazadas y Niños (ZEN), a cohort study of women in early pregnancy across three regions of Colombia during 2017-2018. We used Poisson regression to estimate associations between knowledge, attitudes and previous experience with mosquito-borne infection and preventative behaviors. RESULTS: Among 1519 women, knowledge of mosquito-borne transmission was high (1480; 97.8%) and 1275 (85.5%) participants were worried about ZIKV infection during pregnancy. The most common preventive behavior was wearing long pants (1355; 89.4%). Regular mosquito repellent use was uncommon (257; 17.0%). While ZIKV knowledge and attitudes were not associated with the adoption of ZIKV prevention behaviors, previous mosquito-borne infection was associated with increased condom use (prevalence ratio 1.4, 95% CI 1.1 to 1.7). CONCLUSIONS: Participants were well informed about ZIKV transmission and its health consequences. However, whether this knowledge resulted in behavior change is less certain. |
Prospective association of daily steps with cardiovascular disease: A harmonized meta-analysis
Paluch AE , Bajpai S , Ballin M , Bassett DR , Buford TW , Carnethon MR , Chernofsky A , Dooley EE , Ekelund U , Evenson KR , Galuska DA , Jefferis BJ , Kong L , Kraus WE , Larson MG , Lee IM , Matthews CE , Newton RL Jr , Nordström A , Nordström P , Palta P , Patel AV , Pettee Gabriel K , Pieper CF , Pompeii L , Rees-Punia E , Spartano NL , Vasan RS , Whincup PH , Yang S , Fulton JE . Circulation 2022 147 (2) 122-131 BACKGROUND: Taking fewer than the widely promoted "10 000 steps per day" has recently been associated with lower risk of all-cause mortality. The relationship of steps and cardiovascular disease (CVD) risk remains poorly described. A meta-analysis examining the dose-response relationship between steps per day and CVD can help inform clinical and public health guidelines. METHODS: Eight prospective studies (20 152 adults [ie, ≥18 years of age]) were included with device-measured steps and participants followed for CVD events. Studies quantified steps per day and CVD events were defined as fatal and nonfatal coronary heart disease, stroke, and heart failure. Cox proportional hazards regression analyses were completed using study-specific quartiles and hazard ratios (HR) and 95% CI were meta-analyzed with inverse-variance-weighted random effects models. RESULTS: The mean age of participants was 63.2±12.4 years and 52% were women. The mean follow-up was 6.2 years (123 209 person-years), with a total of 1523 CVD events (12.4 per 1000 participant-years) reported. There was a significant difference in the association of steps per day and CVD between older (ie, ≥60 years of age) and younger adults (ie, <60 years of age). For older adults, the HR for quartile 2 was 0.80 (95% CI, 0.69 to 0.93), 0.62 for quartile 3 (95% CI, 0.52 to 0.74), and 0.51 for quartile 4 (95% CI, 0.41 to 0.63) compared with the lowest quartile. For younger adults, the HR for quartile 2 was 0.79 (95% CI, 0.46 to 1.35), 0.90 for quartile 3 (95% CI, 0.64 to 1.25), and 0.95 for quartile 4 (95% CI, 0.61 to 1.48) compared with the lowest quartile. Restricted cubic splines demonstrated a nonlinear association whereby more steps were associated with decreased risk of CVD among older adults. CONCLUSIONS: For older adults, taking more daily steps was associated with a progressively decreased risk of CVD. Monitoring and promoting steps per day is a simple metric for clinician-patient communication and population health to reduce the risk of CVD. |
Timing of positive hepatitis C virus test results during and 1 year before pregnancy
Woodworth KR , Newton SM , Olsen EO , Tannis A , Sizemore L , Wingate H , Orkis L , Reynolds B , Longcore N , Thomas N , Bocour A , Wills A , Kim SY , Panagiotakopoulos L , Wester C , Delman Meaney D , Gilboa SM , Tong VT . Obstet Gynecol 2022 140 (6) 997-999 The incidence of hepatitis C virus (HCV) infection in reproductive-aged adults quadrupled during the past decade. Hepatitis C can progress to advanced liver disease and be transmitted perinatally. Highly effective curative hepatitis C treatment is available but is not recommended in pregnancy. Using the Surveillance for Emerging Threats to Mothers and Babies Network, we describe timing of positive RNA testing among pregnant people with HCV (HCV RNA detected during or within one year prior to pregnancy). Four US jurisdictions reported 1161 pregnancies during 2018-2021 among people with hepatitis C: 75.9% were multiparous; and 21.4% had their first peri-pregnancy HCV RNA detected prior to pregnancy, indicating potential missed treatment opportunities to improve maternal health and prevent perinatal transmission. |
Preterm birth among pregnant persons with severe acute respiratory syndrome Coronavirus 2 infection.
Newton SM , Reeves EL , O'Malley Olsen E , Woodworth KR , Farr SL , Galang RR , Reynolds MR , Harvey E , Shi J , Nestoridi E , Barton J , Ngo VP , Lush M , Longcore ND , Dzimira P , Im LK , Sokale A , Siebman S , Delgado López C , Chen T , Mobley EL , Khuwaja S , Romitti PA , Fredette C , Ellis EM , Silcox K , Hall AJ , Azziz-Baumgartner E , Gilboa SM , Shapiro-Mendoza CK , Tong VT . J Perinatol 2022 42 (10) 1-10 OBJECTIVE: We examined the relationship between trimester of SARS-CoV-2 infection, illness severity, and risk for preterm birth. STUDY DESIGN: We analyzed data for 6336 pregnant persons with SARS-CoV-2 infection in 2020 in the United States. Risk ratios for preterm birth were calculated for illness severity, trimester of infection, and illness severity stratified by trimester of infection adjusted for age, selected underlying medical conditions, and pregnancy complications. RESULT: Pregnant persons with critical COVID-19 or asymptomatic infection, compared to mild COVID-19, in the second or third trimester were at increased risk of preterm birth. Pregnant persons with moderate-to-severe COVID-19 did not show increased risk of preterm birth in any trimester. CONCLUSION: Critical COVID-19 in the second or third trimester was associated with increased risk of preterm birth. This finding can be used to guide prevention strategies, including vaccination, and inform clinical practices for pregnant persons. |
Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts
Paluch AE , Bajpai S , Bassett DR , Carnethon MR , Ekelund U , Evenson KR , Galuska DA , Jefferis BJ , Kraus WE , Lee IM , Matthews CE , Omura JD , Patel AV , Pieper CF , Rees-Punia E , Dallmeier D , Klenk J , Whincup PH , Dooley EE , PetteeGabriel K , Palta P , Pompeii LA , Chernofsky A , Larson MG , Vasan RS , Spartano N , Ballin M , Nordstrm P , Nordstrm A , Anderssen SA , Hansen BH , Cochrane JA , Dwyer T , Wang J , Ferrucci L , Liu F , Schrack J , Urbanek J , Saint-Maurice PF , Yamamoto N , Yoshitake Y , Newton RLJr , Yang S , Shiroma EJ , Fulton JE . Lancet Public Health 2022 7 (3) e219-e228 BACKGROUND: Although 10000 steps per day is widely promoted to have health benefits, there is little evidence to support this recommendation. We aimed to determine the association between number of steps per day and stepping rate with all-cause mortality. METHODS: In this meta-analysis, we identified studies investigating the effect of daily step count on all-cause mortality in adults (aged 18 years), via a previously published systematic review and expert knowledge of the field. We asked participating study investigators to process their participant-level data following a standardised protocol. The primary outcome was all-cause mortality collected from death certificates and country registries. We analysed the dose-response association of steps per day and stepping rate with all-cause mortality. We did Cox proportional hazards regression analyses using study-specific quartiles of steps per day and calculated hazard ratios (HRs) with inverse-variance weighted random effects models. FINDINGS: We identified 15 studies, of which seven were published and eight were unpublished, with study start dates between 1999 and 2018. The total sample included 47471 adults, among whom there were 3013 deaths (101 per 1000 participant-years) over a median follow-up of 71 years ([IQR 43-99]; total sum of follow-up across studies was 297837 person-years). Quartile median steps per day were 3553 for quartile 1, 5801 for quartile 2, 7842 for quartile 3, and 10901 for quartile 4. Compared with the lowest quartile, the adjusted HR for all-cause mortality was 060 (95% CI 051-071) for quartile 2, 055 (049-062) for quartile 3, and 047 (039-057) for quartile 4. Restricted cubic splines showed progressively decreasing risk of mortality among adults aged 60 years and older with increasing number of steps per day until 6000-8000 steps per day and among adults younger than 60 years until 8000-10000 steps per day. Adjusting for number of steps per day, comparing quartile 1 with quartile 4, the association between higher stepping rates and mortality was attenuated but remained significant for a peak of 30 min (HR 067 [95% CI 056-083]) and a peak of 60 min (067 [050-090]), but not significant for time (min per day) spent walking at 40 steps per min or faster (112 [096-132]) and 100 steps per min or faster (086 [058-128]). INTERPRETATION: Taking more steps per day was associated with a progressively lower risk of all-cause mortality, up to a level that varied by age. The findings from this meta-analysis can be used to inform step guidelines for public health promotion of physical activity. FUNDING: US Centers for Disease Control and Prevention. |
Timing of first positive hepatitis c polymerase chain reaction test among pregnant women with hepatitis c infection Surveillance for Emerging Threats to Mothers and Babies Network
Woodworth Kate , Newton Suzanne , Sizemore Lindsey , Wingate Heather , Wills Aprielle , Thomas Nadia , Reynolds Bethany , Foster Monique , Gupta Neil , Wester Carolyn , Meaney-Delman Data , Gilboa Suzanne , Tong Van . Am J Obstet Gynecol 2022 226 (2) 305-306 Incidence of hepatitis C virus (HCV) infection in women of reproductive age is increasing, leading to rising numbers of women with HCV infection in pregnancy and concerns of perinatal transmission. In April 2020, the Centers for Disease Control and Prevention (CDC) began recommending HCV screening during each pregnancy. We describe maternal characteristics and timing of HCV testing among pregnant women identified with HCV infection. | |
Enhancing response to foodborne disease outbreaks: Findings of the Foodborne Diseases Centers for Outbreak Response Enhancement (FoodCORE), 2010-2019
Tilashalski FP , Sillence EM , Newton AE , Biggerstaff GK . J Public Health Manag Pract 2021 28 (4) E702-E710 CONTEXT: Each year, foodborne diseases cause an estimated 48 million illnesses resulting in 128000 hospitalizations and 3000 deaths in the United States. Fast and effective outbreak investigations are needed to identify and remove contaminated food from the market to reduce the number of additional illnesses that occur. Many state and local health departments have insufficient resources to identify, respond to, and control the increasing burden of foodborne illnesses. PROGRAM: The Centers for Disease Control and Prevention (CDC) Foodborne Diseases Centers for Outbreak Response Enhancement (FoodCORE) program provides targeted resources to state and local health departments to improve completeness and timeliness of laboratory, epidemiology, and environmental health activities for foodborne disease surveillance and outbreak response. IMPLEMENTATION: In 2009, pilot FoodCORE centers were selected through a competitive application process and then implemented work plans to achieve faster and more complete surveillance and outbreak response activities in their jurisdiction. By 2019, 10 centers participated in FoodCORE: Colorado, Connecticut, Minnesota, New York City, Ohio, Oregon, South Carolina, Tennessee, Utah, and Wisconsin. EVALUATION: CDC and FoodCORE centers collaboratively developed performance metrics to evaluate the impact and effectiveness of FoodCORE activities. Centers used performance metrics to document successes, identify gaps, and set goals for their jurisdiction. CDC used performance metrics to evaluate the implementation of FoodCORE priorities and identify successful strategies to develop replicable model practices. This report provides a description of implementing the FoodCORE program during year 1 (October 2010 to September 2011) through year 9 (January 2019 to December 2019). DISCUSSION: FoodCORE centers address gaps in foodborne disease response through enhanced capacity to improve timeliness and completeness of surveillance and outbreak response activities. Strategies resulting in faster, more complete surveillance and response are documented as model practices and are shared with state and local foodborne disease programs across the country. |
Multisystem Inflammatory Syndrome in Adults After Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection and Coronavirus Disease 2019 (COVID-19) Vaccination.
Belay ED , Godfred Cato S , Rao AK , Abrams J , Wilson WW , Lim S , Newton-Cheh C , Melgar M , DeCuir J , Webb B , Marquez P , Su JR , Meng L , Grome HN , Schlaudecker E , Talaat K , Edwards K , Barnett E , Campbell AP , Broder KR , Bamrah Morris S . Clin Infect Dis 2021 75 (1) e741-e748 BACKGROUND: Multisystem inflammatory syndrome in adults (MIS-A) was reported in association with the COVID-19 pandemic. MIS-A was included in the list of adverse events to be monitored as part of the emergency use authorizations issued for COVID-19 vaccines. METHODS: Reports of MIS-A patients received by the Centers for Disease Control and Prevention (CDC) after COVID-19 vaccines became available were assessed. Data collected on the patients included clinical and demographic characteristics and their vaccine status. The Vaccine Adverse Events Reporting System (VAERS) was also reviewed for possible cases of MIS-A. RESULTS: From December 14, 2020 to April 30, 2021, 20 patients who met the case definition for MIS-A were reported to CDC. Their median age was 35 years (range, 21-66 years), and 13 (65%) were male. Overall, 16 (80%) patients had a preceding COVID-19-like illness a median of 26 days (range 11-78 days) before MIS-A onset. All 20 patients had laboratory evidence of SARS-CoV-2 infection. Seven MIS-A patients (35%) received COVID-19 vaccine a median of 10 days (range, 6-45 days) before MIS-A onset; 3 patients received a second dose of COVID-19 vaccine 4, 17, and 22 days before MIS-A onset. Patients with MIS-A predominantly had gastrointestinal and cardiac manifestations and hypotension or shock. CONCLUSIONS: Although 7 patients were reported to have received COVID-19 vaccine, all had evidence of prior SARS-CoV-2 infection. Given the widespread use of COVID-19 vaccines, the lack of reporting of MIS-A associated with vaccination alone, without evidence of underlying SARS-CoV-2 infection, is reassuring. |
A Comparison of Surface and Total Deltamethrin Levels of Insecticide-Treated Nets and Estimation of the Effective Insecticidal Lifetime
Green M , Maxyay M , Pongvongsa T , Phompida S , Swamidoss I , Smith S , Irish S , Newton P . Am J Trop Med Hyg 2021 106 (1) 334-337 The ability to anticipate the useful lifetime of an insecticide-treated mosquito net (ITN) would provide a proactive approach for planning net distribution programs. Therefore, we used an exponential decay model of deltamethrin depletion to predict the effective insecticidal lifetime of PermaNet® 2.0 nets used in the Lao PDR. Residual deltamethrin was measured using two nondestructive analytical field methods; X-ray fluorescence (total levels) and a colorimetric field test (surface levels) at 12 and 24 months postdistribution. The model assumes that the 12-month depletion rate can be used to predict future levels. The median total and surface deltamethrin levels for the Lao nets at 12 months were 31.2 and 0.0743 mg/m2, respectively. By defining a failed net as having total deltamethrin levels of less than 15 mg/m2 or a surface level less than 0.0028 mg/m2, it was predicted that 50% of the group of nets will fail at about 27 months after distribution. Insecticide-treated bednets (ITNs) are recognized as important tools for reducing malaria transmission in malaria-endemic regions.1-3 The effectiveness of ITNs at reducing malaria transmission relies on their ability to act as chemical as well as physical barriers. Over time, the accumulation of holes, rips, and tears as well as depletion of insecticide potency, reduces the efficacy of ITNs. Although the accumulation of holes results in decreased personal protection, the presence of remaining insecticide still has the potential to reduce malaria.4 It has been suggested by mathematical models that 94% of transmission can be prevented if 80% of the population continues to use these nets.4 Thus, monitoring insecticide levels along with physical integrity are important in recognizing when an ITN is no longer effective. Although damage to the nets can be visually ascertained, monitoring insecticidal potency is often assessed by using mosquito bioassays or chemical techniques. Mosquito bioassays, such as the WHO Cone Test, are the "Gold Standard" for assessing ITNs. Although mosquito bioassays are important elements in evaluating net efficacy, it is difficult to compare net performance across geographical regions where mosquito behavior and insecticide resistance are quite variable. Therefore, this report focuses on measuring surface and total residual insecticide levels by chemical means as a practical way to monitor and predict net longevity. The chemical techniques used to measure insecticide levels usually result in the partial destruction of an ITN. Spectroscopic methods such as X-ray fluorescence (XRF)5,6 and surface level measurements such as the colorimetric field test for cyanopyrethroids (CFT)7 provide alternative insecticide analysis techniques that are nondestructive to the net, thus allowing the same net to be monitored for insecticide levels over time. The XRF method measures the total (TL) amount of insecticide per area and the CFT measures available insecticide on the net surface (SL) via an abrasion technique using filter paper. Deltamethrin adhered to the filter paper is measured using a colorimetric cyanopyrethroid analysis method.7 The deltamethrin molecule contains both cyano and bromine groups, thus allowing it to be detected by the CFT and XRF, respectively.5,7 In this report, we describe the use of both XRF and CFT methods were on the same net after 12 and 24 months of use. The objectives of this report are to apply an exponential decay model for predicting the effective longevity of ITNs based on TL and SL deltamethrin measured after 12 months of use. The model is based on an assumption that by 12 months, factors contributing to insecticidal loss, such as washing and storage habits have become routinely established, thereby resulting in a depletion rate constant, from which future levels can be predicted. |
Patterns of Virus Exposure and Presumed Household Transmission among Persons with Coronavirus Disease, United States, January-April 2020
Burke RM , Calderwood L , Killerby ME , Ashworth CE , Berns AL , Brennan S , Bressler JM , Morano LH , Lewis NM , Markus TM , Newton SM , Read JS , Rissman T , Taylor J , Tate JE , Midgley CM . Emerg Infect Dis 2021 27 (9) 2323-2332 We characterized common exposures reported by a convenience sample of 202 US patients with coronavirus disease during January-April 2020 and identified factors associated with presumed household transmission. The most commonly reported settings of known exposure were households and healthcare facilities; among case-patients who had known contact with a confirmed case-patient compared with those who did not, healthcare occupations were more common. Among case-patients without known contact, use of public transportation was more common. Within the household, presumed transmission was highest from older (>65 years) index case-patients and from children to parents, independent of index case-patient age. These findings may inform guidance for limiting transmission and emphasize the value of testing to identify community-acquired infections. |
Clinical and neurodevelopmental outcomes based on brain imaging studies in a Colombian cohort of children with probable antenatal Zika virus exposure
Daza M , Mercado M , Moore CA , Valencia D , Lengua MF , Newton S , Rodríguez B , Tong VT , Acevedo P , Gilboa SM , Ospina ML , Mulkey SB . Birth Defects Res 2021 113 (18) 1299-1312 BACKGROUND: Our aim was to describe the neuroimaging and clinical evaluations of children with antenatal Zika-virus (ZIKV) exposure. METHODS: The Colombian National Institute of Health performed serial clinical evaluations of children with probable antenatal ZIKV exposure (i.e., born to ZIKV symptomatic mothers or born with birth defects compatible with ZIKV infection, regardless of laboratory results) over 2 years that included head circumference (HC), eye examination, and neurodevelopmental assessments. Clinical neuroimaging studies (head computed tomography and/or brain magnetic resonance imaging) were analyzed for abnormalities, two-dimensional measurements were made of the right and left frontal and occipital cortical thickness. Two abnormal patterns were defined: Pattern 1 (sum of four areas of cortex <6 cm) and Pattern 2 (sum of four areas of cortex ≥6 cm and < 10 cm). RESULTS: Thirty-one children had a neuroimaging study; in 24, cortical thickness was measured. The median age at the first visit was 8 (range: 6-9) months and 22 (range: 19-42) months at the last evaluation. In the 24 cases with cortical measurements, three were normal, 12 were in Pattern 1, and nine were in Pattern 2. Children within Pattern 1 had lower mean HC at birth and in follow-up (both p < .05) and a higher frequency of structural eye abnormalities (p < .01). A trend towards poorer neuromotor development was seen in Pattern 1, although not statistically significant (p = .06). CONCLUSION: Brain imaging classification based on cortical measurements correlate with ophthalmologic abnormalities and HC. Cortical thickness may be a marker for clinical outcomes in children with congenital ZIKV infection. |
Severity of illness by pregnancy status among laboratory-confirmed SARS-CoV-2 infections occurring in reproductive-aged women in Colombia.
Rozo N , Valencia D , Newton SM , Avila G , Gonzalez MA , Sancken CL , Burkel VK , Ellington SR , Gilboa SM , Rao CY , Azziz-Baumgartner E , Ospina ML , Prieto FE , Tong VT . Paediatr Perinat Epidemiol 2021 36 (4) 456-465 BACKGROUND: Multiple studies have described increased risk of severe coronavirus disease (COVID-19) among pregnant women compared to nonpregnant women. The risk in middle-income countries where the distributions of age groups and preexisting conditions may differ is less known. OBJECTIVES: To determine whether pregnant women with SARS-CoV-2 infection are at increased risk for severe COVID-19 compared to nonpregnant women in Colombia. METHODS: We analysed national surveillance data from Colombia, of women aged 15-44 years with laboratory-confirmed infection with SARS-CoV-2 by molecular or antigen testing, from 6 March 2020 to 12 December 2020. An enhanced follow-up of pregnant women with COVID-19 was established to monitor pregnancy and birth outcomes. RESULTS: Of 371,363 women aged 15-44 years with laboratory-confirmed SARS-CoV-2 infection, 1.5% (n = 5614) were reported as pregnant; among those, 2610 (46.5%) were considered a complete pregnancy for reporting purposes at the time of analysis. Hospitalisation (23.9%) and death (1.3%) occurred more frequently among pregnant symptomatic women compared to nonpregnant symptomatic women (2.9% and 0.3%, respectively). Compared to nonpregnant symptomatic women, pregnant symptomatic women were at increased risk of hospitalisation (adjusted risk ratio (RR) 2.19, 95% confidence interval (CI) 2.07, 2.32) and death (RR 1.82, 95% CI 1.60, 2.07), after adjusting for age, type of health insurance and presence of certain underlying medical conditions. Among complete pregnancies, 55 (2.1%) were pregnancy losses, 72 (2.8%) resulted in term low birthweight infants and 375 (14.4%) were preterm deliveries. CONCLUSIONS: Although pregnant women were infrequently reported with laboratory-confirmed SARS-CoV-2 infection, pregnant symptomatic women with COVID-19 were at increased risk for hospitalisation and death compared to nonpregnant symptomatic women. Almost all infections we reported on were third-trimester infections; ongoing follow-up is needed to determine pregnancy outcomes among women infected earlier in pregnancy. Healthcare providers should counsel pregnant women about preventive measures to protect from SARS-CoV-2 infection and when to seek care. |
Clinical phenotype in infants with negative Zika virus immunoglobulin M testing born to mothers with confirmed Zika virus infection during pregnancy
Godfred-Cato S , Newton S , Adams L , Valencia-Prado M , Lake-Burger H , Morrison A , Jones AM , Olson SM , Roth NM , Tong VT , Gilboa SM , Meaney Delman D , Honein MA , Staples JE , Moore CA . Birth Defects Res 2021 113 (17) 1267-1274 BACKGROUND: Recommended testing for both infants with Zika-associated birth defects (i.e., microcephaly and selected brain or eye anomalies) and infants without birth defects whose mothers had laboratory evidence of possible Zika virus (ZIKV) infection during pregnancy includes nucleic acid amplification testing (NAAT) and immunoglobulin M (IgM) testing within days after birth. Brain and eye defects highly specific for congenital ZIKV infection have been described; sporadic reports have documented negative ZIKV testing in such infants. METHODS: Infants from the U.S. Zika Pregnancy and Infant Registry and Zika Birth Defects Surveillance with Zika-associated birth defects and maternal and infant laboratory testing for ZIKV and two congenital infections (i.e., cytomegalovirus [CMV] and toxoplasmosis) were reviewed for phenotype and laboratory results. Infants with at least one defect considered highly specific for congenital ZIKV infection were designated as having congenital Zika syndrome (CZS) clinical phenotype for this study. RESULTS: Of 325 liveborn infants with Zika-associated birth defects and laboratory evidence of maternal ZIKV infection, 33 (10%) had CZS clinical phenotype; 171 (53%) had ZIKV IgM testing with negative or no ZIKV NAAT. ZIKV IgM was negative in the remaining 120 infants, and for 90%, testing for CMV and toxoplasmosis was missing/incomplete. Among 11 infants testing negative for ZIKV IgM, CMV, and toxoplasmosis, 2 infants had CZS clinical phenotype. CONCLUSIONS: These data add support to previous reports of negative ZIKV IgM testing in infants with clear maternal and phenotypic evidence of congenital ZIKV infection. Follow-up care consistent with the diagnosis is recommended regardless of infant ZIKV test results. |
Risk factors for illness severity among pregnant women with confirmed SARS-CoV-2 infection - Surveillance for Emerging Threats to Mothers and Babies Network, 22 state, local, and territorial health departments, March 29, 2020 -March 5, 2021.
Galang RR , Newton SM , Woodworth KR , Griffin I , Oduyebo T , Sancken CL , Olsen EO , Aveni K , Wingate H , Shephard H , Fussman C , Alaali ZS , Silcox K , Siebman S , Halai UA , Lopez CD , Lush M , Sokale A , Barton J , Chaudhary I , Patrick PH , Schlosser L , Reynolds B , Gaarenstroom N , Chicchelly S , Read JS , de Wilde L , Mbotha D , Azziz-Baumgartner E , Hall AJ , Tong VT , Ellington S , Gilboa SM . Clin Infect Dis 2021 73 S17-S23 BACKGROUND: Pregnant women with coronavirus disease 2019 (COVID-19) are at increased risk for severe illness compared with nonpregnant women. Data to assess risk factors for illness severity among pregnant women with COVID-19 are limited. This study aimed to determine risk factors associated with COVID-19 illness severity among pregnant women with SARS-CoV-2 infection. METHODS: Pregnant women with SARS-CoV-2 infection confirmed by molecular testing were reported during March 29, 2020-March 5, 2021 through the Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET). Criteria for illness severity (asymptomatic, mild, moderate-to-severe, or critical) were adapted from National Institutes of Health and World Health Organization criteria. Crude and adjusted risk ratios for moderate-to-severe or critical COVID-19 illness were calculated for selected demographic and clinical characteristics. RESULTS: Among 7,950 pregnant women with SARS-CoV-2 infection, moderate-to-severe or critical COVID-19 illness was associated with age 25 years and older, healthcare occupation, pre-pregnancy obesity, chronic lung disease, chronic hypertension, and pregestational diabetes mellitus. Risk of moderate-to-severe or critical illness increased with the number of underlying medical or pregnancy-related conditions. CONCLUSIONS: Older age and having underlying medical conditions were associated with increased risk of moderate-to-severe or critical COVID-19 illness among pregnant women. This information might help pregnant women understand their risk for moderate-to-severe or critical COVID-19 illness and inform targeted public health messaging. |
Acute Cardiovascular Events Associated With Influenza in Hospitalized Adults
Chow EJ , O'Halloran A , Rolfes MA , Reed C , Garg S . Ann Intern Med 2021 174 (4) 583-584 IN RESPONSE: We thank Drs. Newton and Yeh and Dr. Schattner for emphasizing the need to further understand the relationship between influenza virus infection and acute cardiovascular events. In our analysis based on ICD codes, 4412 patients hospitalized with laboratory-confirmed influenza had acute IHD. Among these, 4.6% had ST-segment elevation MI, 43.6% had non–ST-segment elevation MI, 12% had acute MI without specification of the presence of ST-segment elevation, and 38.4% had other acute IHD not otherwise specified; only 1.4% of patients had unstable angina as the only evidence of acute IHD. For patients with MI, we were unable to further differentiate between type I or II MI because of limitations of the ICD coding system. As for in-hospital outcomes among those with MI, patients in all 3 categories had a similar length of stay (median of 5 days). However, those with ST-segment elevation predictably had the highest percentage of intensive care unit admissions (59.7%), mechanical ventilatory support (32.6%), and in-hospital mortality (26.7%). |
Bias Correction in Estimating Proportions by Imperfect Pooled Testing
Hepworth G , Biggerstaff BJ . J Agric Biol Environ Stat 2021 26 (1) 90-104 In the estimation of proportions by pooled testing, the MLE is biased. Hepworth and Biggerstaff (JABES, 22:602–614, 2017) proposed an estimator based on the bias correction method of Firth (Biometrika 80:27–38, 1993) and showed that it is almost unbiased across a range of pooled testing problems involving no misclassification. We now extend their work to allow for imperfect testing. We derive the estimator, provide a Newton–Raphson iterative formula for its computation and test it in situations involving equal or unequal pool sizes, drawing on problems encountered in plant disease assessment and prevalence estimation of mosquito-borne viruses. Our estimator is highly effective at reducing the bias for prevalences consistent with the pooled testing procedure employed. © 2020, This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply. |
Mass SARS-CoV-2 Testing in a Dormitory-Style Correctional Facility in Arkansas.
Tompkins LK , Gunn JKL , Cherney B , Ham JE , Horth R , Rossetti R , Bower WA , Benson K , Hagan LM , Crist MB , Mettee Zarecki SL , Dixon MG , Dillaha JA , Patil N , Dusseau C , Ross T , Matthews HS , Garner K , Starks AM , Weiner Z , Bowen MD , Bankamp B , Newton AE , Logan N , Schuh AJ , Trimble S , Pfeiffer H , James AE , Tian N , Jacobs JR , Ruiz F , McDonald K , Thompson M , Cooley L , Honein MA , Rose DA . Am J Public Health 2021 111 (5) e1-e10 Objectives. To assess SARS-CoV-2 transmission within a correctional facility and recommend mitigation strategies.Methods. From April 29 to May 15, 2020, we established the point prevalence of COVID-19 among incarcerated persons and staff within a correctional facility in Arkansas. Participants provided respiratory specimens for SARS-CoV-2 testing and completed questionnaires on symptoms and factors associated with transmission.Results. Of 1647 incarcerated persons and 128 staff tested, 30.5% of incarcerated persons (range by housing unit = 0.0%-58.2%) and 2.3% of staff tested positive for SARS-CoV-2. Among those who tested positive and responded to symptom questions (431 incarcerated persons, 3 staff), 81.2% and 33.3% were asymptomatic, respectively. Most incarcerated persons (58.0%) reported wearing cloth face coverings 8 hours or less per day, and 63.3% reported close contact with someone other than their bunkmate.Conclusions. If testing remained limited to symptomatic individuals, fewer cases would have been detected or detection would have been delayed, allowing transmission to continue. Rapid implementation of mass testing and strict enforcement of infection prevention and control measures may be needed to mitigate spread of SARS-CoV-2 in this setting. (Am J Public Health. Published online ahead of print March 18, 2021: e1-e10. https://doi.org/10.2105/AJPH.2020.306117). |
Epidemiology of cytomegalovirus infection among mothers and infants in Colombia
Rico A , Dollard SC , Valencia D , Corchuelo S , Tong V , Laiton-Donato K , Amin MM , Benavides M , Wong P , Newton S , Daza M , Cates J , Gonzalez M , Zambrano LD , Mercado M , Ailes EC , Rodriguez H , Gilboa SM , Acosta J , Ricaldi J , Pelaez D , Honein MA , Ospina ML , Lanzieri TM . J Med Virol 2021 93 (11) 6393-6397 We assessed maternal and infant cytomegalovirus (CMV) infection in Colombia. Maternal serum was tested for CMV immunoglobulin G antibodies at a median of 10 (interquartile range: 8-12) weeks gestation (n=1,501). CMV DNA polymerase chain reaction was performed on infant urine to diagnose congenital (≤21 days of life) and postnatal (>21 days) infection. Maternal CMV seroprevalence was 98.1% (95% confidence interval [CI]: 97.5-98.8%). Congenital CMV prevalence was 8.4 (95% CI: 3.9-18.3; 6/711) per 1,000 live births. Among 472 infants without confirmed congenital CMV infection subsequently tested at age 6 months, 258 (54.7%, 95% CI: 50.2%-59.1%) had postnatal infection. This article is protected by copyright. All rights reserved. |
The risk of Plasmodium vivax parasitaemia after P. falciparum malaria: An individual patient data meta-analysis from the WorldWide Antimalarial Resistance Network
Hossain MS , Commons RJ , Douglas NM , Thriemer K , Alemayehu BH , Amaratunga C , Anvikar AR , Ashley EA , Asih PBS , Carrara VI , Lon C , D'Alessandro U , Davis TME , Dondorp AM , Edstein MD , Fairhurst RM , Ferreira MU , Hwang J , Janssens B , Karunajeewa H , Kiechel JR , Ladeia-Andrade S , Laman M , Mayxay M , McGready R , Moore BR , Mueller I , Newton PN , Thuy-Nhien NT , Noedl H , Nosten F , Phyo AP , Poespoprodjo JR , Saunders DL , Smithuis F , Spring MD , Stepniewska K , Suon S , Suputtamongkol Y , Syafruddin D , Tran HT , Valecha N , Van Herp M , Van Vugt M , White NJ , Guerin PJ , Simpson JA , Price RN . PLoS Med 2020 17 (11) e1003393 BACKGROUND: There is a high risk of Plasmodium vivax parasitaemia following treatment of falciparum malaria. Our study aimed to quantify this risk and the associated determinants using an individual patient data meta-analysis in order to identify populations in which a policy of universal radical cure, combining artemisinin-based combination therapy (ACT) with a hypnozoitocidal antimalarial drug, would be beneficial. METHODS AND FINDINGS: A systematic review of Medline, Embase, Web of Science, and the Cochrane Database of Systematic Reviews identified efficacy studies of uncomplicated falciparum malaria treated with ACT that were undertaken in regions coendemic for P. vivax between 1 January 1960 and 5 January 2018. Data from eligible studies were pooled using standardised methodology. The risk of P. vivax parasitaemia at days 42 and 63 and associated risk factors were investigated by multivariable Cox regression analyses. Study quality was assessed using a tool developed by the Joanna Briggs Institute. The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42018097400). In total, 42 studies enrolling 15,341 patients were included in the analysis, including 30 randomised controlled trials and 12 cohort studies. Overall, 14,146 (92.2%) patients had P. falciparum monoinfection and 1,195 (7.8%) mixed infection with P. falciparum and P. vivax. The median age was 17.0 years (interquartile range [IQR] = 9.0-29.0 years; range = 0-80 years), with 1,584 (10.3%) patients younger than 5 years. 2,711 (17.7%) patients were treated with artemether-lumefantrine (AL, 13 studies), 651 (4.2%) with artesunate-amodiaquine (AA, 6 studies), 7,340 (47.8%) with artesunate-mefloquine (AM, 25 studies), and 4,639 (30.2%) with dihydroartemisinin-piperaquine (DP, 16 studies). 14,537 patients (94.8%) were enrolled from the Asia-Pacific region, 684 (4.5%) from the Americas, and 120 (0.8%) from Africa. At day 42, the cumulative risk of vivax parasitaemia following treatment of P. falciparum was 31.1% (95% CI 28.9-33.4) after AL, 14.1% (95% CI 10.8-18.3) after AA, 7.4% (95% CI 6.7-8.1) after AM, and 4.5% (95% CI 3.9-5.3) after DP. By day 63, the risks had risen to 39.9% (95% CI 36.6-43.3), 42.4% (95% CI 34.7-51.2), 22.8% (95% CI 21.2-24.4), and 12.8% (95% CI 11.4-14.5), respectively. In multivariable analyses, the highest rate of P. vivax parasitaemia over 42 days of follow-up was in patients residing in areas of short relapse periodicity (adjusted hazard ratio [AHR] = 6.2, 95% CI 2.0-19.5; p = 0.002); patients treated with AL (AHR = 6.2, 95% CI 4.6-8.5; p < 0.001), AA (AHR = 2.3, 95% CI 1.4-3.7; p = 0.001), or AM (AHR = 1.4, 95% CI 1.0-1.9; p = 0.028) compared with DP; and patients who did not clear their initial parasitaemia within 2 days (AHR = 1.8, 95% CI 1.4-2.3; p < 0.001). The analysis was limited by heterogeneity between study populations and lack of data from very low transmission settings. Study quality was high. CONCLUSIONS: In this meta-analysis, we found a high risk of P. vivax parasitaemia after treatment of P. falciparum malaria that varied significantly between studies. These P. vivax infections are likely attributable to relapses that could be prevented with radical cure including a hypnozoitocidal agent; however, the benefits of such a novel strategy will vary considerably between geographical areas. |
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