Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-15 (of 15 Records) |
Query Trace: Patel MR[original query] |
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Monitoring Incidence of COVID-19 Cases, Hospitalizations, and Deaths, by Vaccination Status - 13 U.S. Jurisdictions, April 4-July 17, 2021.
Scobie HM , Johnson AG , Suthar AB , Severson R , Alden NB , Balter S , Bertolino D , Blythe D , Brady S , Cadwell B , Cheng I , Davidson S , Delgadillo J , Devinney K , Duchin J , Duwell M , Fisher R , Fleischauer A , Grant A , Griffin J , Haddix M , Hand J , Hanson M , Hawkins E , Herlihy RK , Hicks L , Holtzman C , Hoskins M , Hyun J , Kaur R , Kay M , Kidrowski H , Kim C , Komatsu K , Kugeler K , Lewis M , Lyons BC , Lyons S , Lynfield R , McCaffrey K , McMullen C , Milroy L , Meyer S , Nolen L , Patel MR , Pogosjans S , Reese HE , Saupe A , Sell J , Sokol T , Sosin D , Stanislawski E , Stevens K , Vest H , White K , Wilson E , MacNeil A , Ritchey MD , Silk BJ . MMWR Morb Mortal Wkly Rep 2021 70 (37) 1284-1290 COVID-19 vaccine breakthrough infection surveillance helps monitor trends in disease incidence and severe outcomes in fully vaccinated persons, including the impact of the highly transmissible B.1.617.2 (Delta) variant of SARS-CoV-2, the virus that causes COVID-19. Reported COVID-19 cases, hospitalizations, and deaths occurring among persons aged ≥18 years during April 4-July 17, 2021, were analyzed by vaccination status across 13 U.S. jurisdictions that routinely linked case surveillance and immunization registry data. Averaged weekly, age-standardized incidence rate ratios (IRRs) for cases among persons who were not fully vaccinated compared with those among fully vaccinated persons decreased from 11.1 (95% confidence interval [CI] = 7.8-15.8) to 4.6 (95% CI = 2.5-8.5) between two periods when prevalence of the Delta variant was lower (<50% of sequenced isolates; April 4-June 19) and higher (≥50%; June 20-July 17), and IRRs for hospitalizations and deaths decreased between the same two periods, from 13.3 (95% CI = 11.3-15.6) to 10.4 (95% CI = 8.1-13.3) and from 16.6 (95% CI = 13.5-20.4) to 11.3 (95% CI = 9.1-13.9). Findings were consistent with a potential decline in vaccine protection against confirmed SARS-CoV-2 infection and continued strong protection against COVID-19-associated hospitalization and death. Getting vaccinated protects against severe illness from COVID-19, including the Delta variant, and monitoring COVID-19 incidence by vaccination status might provide early signals of changes in vaccine-related protection that can be confirmed through well-controlled vaccine effectiveness (VE) studies. |
HIV-exposed uninfected infant morbidity and mortality within a nationally representative prospective cohort of mother-infant pairs in Zimbabwe
Patel MR , Mushavi A , Balachandra S , Shambira G , Nyakura J , Mugurungi O , Kilmarx PH , Rivadeneira E , Dinh TH . AIDS 2020 34 (9) 1339-1346 OBJECTIVE: To examine morbidity and mortality risk among HIV-exposed uninfected (HEU) infants. DESIGN: Secondary data analysis of HEU infants in a prospective cohort study of mother-infant pairs. METHODS: Infants were recruited from immunization clinics (n = 151) in Zimbabwe from February to August 2013, enrolled at 4-12 weeks age, and followed every 3 months until incident HIV-infection, death, or 18-month follow-up. We estimated cumulative mortality probability and hazard ratios with 95% confidence intervals (CIs) using Kaplan-Meier curves and Cox regression, respectively. We also described reported reasons for infant hospitalization and symptoms preceding death. Median weight-for-age z-scores (WAZ) and median age were calculated and analyzed across study visits. RESULTS: Of 1188 HIV-exposed infants, 73 (6.1%) contracted HIV; we analyzed the remaining 1115 HEU infants. In total, 54 (4.8%) infants died, with median time to death of 5.5 months since birth (interquartile range: 3.6-9.8 months). Diarrhea, difficulty breathing, not eating, fever, and cough were commonly reported (range: 7.4-22.2%) as symptoms preceding infant death. Low birth weight was associated with higher mortality (adjusted hazard ratio 2.66, CI: 1.35-5.25), whereas maternal antiretroviral therapy predelivery (adjusted hazard ratio 0.34, CI: 0.18-0.64) and exclusive breastfeeding (adjusted hazard ratio 0.50, CI: 0.28-0.91) were associated with lower mortality. Overall, 9.6% of infants were hospitalized. Infant median WAZ declined after 3 months of age, reaching a minimum at 14.5 months of age, at which 50% of infants were underweight (WAZ below -2.0). CONCLUSION: Clinical interventions including maternal antiretroviral therapy; breastfeeding and infant feeding counseling and support; and early prevention, identification, and management of childhood illness; are needed to reduce HEU infant morbidity and mortality. |
Performance of Oropharyngeal Swab Testing Compared With Nasopharyngeal Swab Testing for Diagnosis of Coronavirus Disease 2019-United States, January 2020-February 2020.
Patel MR , Carroll D , Ussery E , Whitham H , Elkins CA , Noble-Wang J , Rasheed JK , Lu X , Lindstrom S , Bowen V , Waller J , Armstrong G , Gerber S , Brooks JT . Clin Infect Dis 2020 72 (3) 403-410 Among 146 nasopharyngeal (NP) and oropharyngeal (OP) swab pairs collected </=7 days since illness onset, CDC real-time RT-PCR SARS-CoV-2 assay diagnostic results were 95.2% concordant. However, NP swab Ct values were lower (indicating more virus) in 66.7% of concordant-positive pairs, suggesting NP swabs may more accurately detect amount of SARS-CoV-2. |
Performance of oropharyngeal swab testing compared to nasopharyngeal swab testing for diagnosis of COVID-19 -United States, January-February 2020
Patel MR , Carroll D , Ussery E , Whitham H , Elkins CA , Noble-Wang J , Rasheed JK , Lu X , Lindstrom S , Bowen V , Waller J , Armstrong G , Gerber S , Brooks JT . Clin Infect Dis 2020 72 (3) 403-410 Among 146 nasopharyngeal (NP) and oropharyngeal (OP) swab pairs collected </=7 days since illness onset, CDC real-time RT-PCR SARS-CoV-2 assay diagnostic results were 95.2% concordant. However, NP swab Ct values were lower (indicating more virus) in 66.7% of concordant-positive pairs, suggesting NP swabs may more accurately detect amount of SARS-CoV-2. |
SARS-CoV-2 Infections and Serologic Responses from a Sample of U.S. Navy Service Members - USS Theodore Roosevelt, April 2020.
Payne DC , Smith-Jeffcoat SE , Nowak G , Chukwuma U , Geibe JR , Hawkins RJ , Johnson JA , Thornburg NJ , Schiffer J , Weiner Z , Bankamp B , Bowen MD , MacNeil A , Patel MR , Deussing E , CDC COVID-19 Surge Laboratory Group , Tiller Rebekah , Galloway Rene , Rogers Shannon , Whitaker Brett , Kondas Ashley , Smith Peyton , Lee Christopher , Graziano James , Gillingham BL . MMWR Morb Mortal Wkly Rep 2020 69 (23) 714-721 Compared with the volume of data on coronavirus disease 2019 (COVID-19) outbreaks among older adults, relatively few data are available concerning COVID-19 in younger, healthy persons in the United States (1,2). In late March 2020, the aircraft carrier USS Theodore Roosevelt arrived at port in Guam after numerous U.S. service members onboard developed COVID-19. In April, the U.S. Navy and CDC investigated this outbreak, and the demographic, epidemiologic, and laboratory findings among a convenience sample of 382 service members serving aboard the aircraft carrier are reported in this study. The outbreak was characterized by widespread transmission with relatively mild symptoms and asymptomatic infection among this sample of mostly young, healthy adults with close, congregate exposures. Service members who reported taking preventive measures had a lower infection rate than did those who did not report taking these measures (e.g., wearing a face covering, 55.8% versus 80.8%; avoiding common areas, 53.8% versus 67.5%; and observing social distancing, 54.7% versus 70.0%, respectively). The presence of neutralizing antibodies, which represent antibodies that inhibit SARS-CoV-2, among the majority (59.2%) of those with antibody responses is a promising indicator of at least short-term immunity. This report improves the understanding of COVID-19 in the U.S. military and among young adults in congregate settings and reinforces the importance of preventive measures to lower risk for infection in similar environments. |
Policies, practices and barriers to implementing tuberculosis preventive treatment-35 countries, 2017
Surie D , Interrante JD , Pathmanathan I , Patel MR , Anyalechi G , Cavanaugh JS , Kirking HL . Int J Tuberc Lung Dis 2019 23 (12) 1308-1313 BACKGROUND: Tuberculosis preventive treatment (TPT) reduces the development of tuberculosis (TB) disease and mortality in people living with human immunodeficiency virus (HIV) infection. Despite this known effectiveness, global uptake of TPT has been slow. We aimed to assess current status of TPT implementation in countries supported by the US President's Emergency Plan for AIDS Relief (PEPFAR).METHODS: We surveyed TB-HIV program staff at US Centers for Disease Control and Prevention (CDC) country offices in 42 PEPFAR-supported countries about current TPT policies, practices, and barriers to implementation. Surveys completed from July to December 2017 were analyzed.RESULTS: Of 42 eligible PEPFAR-supported countries, staff from 35 (83%) CDC country offices completed the survey. TPT was included in national guidelines in 33 (94%) countries, but only 21 (60%) reported nationwide programmatic TPT implementation. HIV programs led TPT implementation in 20/32 (63%) countries, but TB programs led drug procurement in 18/32 (56%) countries. Stock outs were frequent, as 21/28 (75%) countries reported at least one isoniazid stock out in the previous year.CONCLUSION: Despite widespread inclusion of TPT in guidelines, programmatic TPT implementation lags. Successful scale-up of TPT requires uninterrupted drug supply chains facilitated by improved leadership and coordination between HIV and TB programs. |
Multiple injections per injection episode: High-risk injection practice among people who injected pills during the 2015 HIV outbreak in Indiana
Broz D , Zibbell J , Foote C , Roseberry JC , Patel MR , Conrad C , Chapman E , Peters PJ , Needle R , McAlister C , Duwve JM . Int J Drug Policy 2017 52 97-101 BACKGROUND: Misuse of prescription opioid analgesics (POA) has increased dramatically in the US, particularly in non-urban areas. We examined injection practices among persons who inject POA in a rural area that experienced a large HIV outbreak in 2015. METHODS: Between August-September 2015, 25 persons who injected drugs within the past 12 months were recruited in Scott County, Indiana for a qualitative study. Data from in-depth, semi-structured interviews were analyzed. RESULTS: All 25 participants were non-Hispanic white and the median age was 33 years (range: 19-57). All had ever injected extended-release oxymorphone (Opana((R)) ER) and most (n=20) described preparing Opana((R)) ER for multiple injections per injection episode (MIPIE). MIPIE comprised 2-4 injections during an injection episode resulting from needing >1mL water to prepare Opana((R)) ER solution using 1mL syringes and the frequent use of "rinse shots." MIPIE occurred up to 10 times/day (totaling 35 injections/day), often in the context of sharing drug and injection equipment. CONCLUSIONS: We describe a high-risk injection practice that may have contributed to the rapid spread of HIV in this community. Efforts to prevent bloodborne infections among people who inject POA need to assess for MIPIE so that provision of sterile injection equipment and safer injection education addresses the MIPIE risk environment. |
Reduction of injection-related risk behaviors following emergency implementation of a syringe services program during an HIV outbreak
Patel MR , Foote C , Duwve J , Chapman E , Combs B , Fry A , Hall P , Roseberry J , Brooks JT , Broz D . J Acquir Immune Defic Syndr 2017 77 (4) 373-382 OBJECTIVE: To describe injection-related HIV risk behaviors pre- and post-implementation of an emergency syringe services program (SSP) in Scott County, Indiana, following an HIV outbreak among persons who inject drugs (PWID). DESIGN: Mixed methods retrospective pre-post intervention analysis. METHODS: We analyzed routine SSP program data collected at first and most recent visit among clients with >/=2 visits, >/=7 days apart from April 4 to August 30, 2015 to quantify changes in injection-related risk behaviors. We also analyzed qualitative data collected from 56 PWID recruited in Scott County to understand factors contributing to these behaviors. RESULTS: SSP clients included in our analysis (n=148, 62% of all SSP clients) reported significant (p <0.001) reductions over a median 10 weeks (range 1-23) in syringe sharing to inject (18% to 2%) and divide drugs (19% to 4%), sharing other injection equipment (e.g., cookers) (24% to 5%), and number of uses of the same syringe (2 [IQR: 1-4] to 1 [IQR: 1-1]). Qualitative study participants described access to sterile syringes and safer injection education through the SSP, as explanatory factors for these reductions. Injection frequency findings were mixed, but overall suggested no change. The number of syringes returned by SSP clients increased from 0 at first visit to median 57. All qualitative study participants reported using sharps containers provided by the SSP. CONCLUSIONS: Analyses of an SSP program and in-depth qualitative interview data showed rapid reduction of injection-related HIV risk behaviors among PWID post-SSP implementation. Sterile syringe access as part of comprehensive HIV prevention is an important tool to control and prevent HIV outbreaks. |
Prevalence of gonorrhea and chlamydia testing by anatomical site among men who have sex with men in HIV medical care, United States, 2013-2014
Patel MR , Brooks JT , Tie Y , Garg S , Bradley H . Sex Transm Dis 2017 45 (1) 25-27 Fewer than one-third of men who have sex with men were tested for Neisseria gonorrhoeae or Chlamydia trachomatis as part of HIV medical care in the United States in 2013 to 2014, and only 11.6% were tested for either sexually transmitted disease at an extragenital site. |
An Official American Thoracic Society Workshop Report. A Framework for Addressing Multimorbidity in Clinical Practice Guidelines for Pulmonary Disease, Critical Illness, and Sleep Disorders
Wilson KC , Gould MK , Krishnan JA , Boyd CM , Brozek JL , Cooke CR , Douglas IS , Goodman RA , Joo MJ , Lareau S , Mularski RA , Patel MR , Rosenfeld RM , Shanawani H , Slatore C , Sockrider M , Sufian B , Thomson CC , Wiener RS . Ann Am Thorac Soc 2016 13 (3) S12-21 Coexistence of multiple chronic conditions (i.e., multimorbidity) is the most common chronic health problem in adults. However, clinical practice guidelines have primarily focused on patients with a single disease, resulting in uncertainty about the care of patients with multimorbidity. The American Thoracic Society convened a workshop with the goal of establishing a strategy to address multimorbidity within clinical practice guidelines. In this Workshop Report, we describe a framework that addresses multimorbidity in each of the key steps of guideline development: topic selection, panel composition, identifying clinical questions, searching for and synthesizing evidence, rating the quality of that evidence, summarizing benefits and harms, formulating recommendations, and rating the strength of the recommendations. For the consideration of multimorbidity in guidelines to be successful and sustainable, the process must be both feasible and pragmatic. It is likely that this will be achieved best by the step-wise addition and refinement of the various components of the framework. |
Secondary infections with Ebola virus in rural communities, Liberia and Guinea, 2014-2015
Lindblade KA , Nyenswah T , Keita S , Diallo B , Kateh F , Amoah A , Nagbe TK , Raghunathan P , Neatherlin JC , Kinzer M , Pillai SK , Attfield KR , Hajjeh R , Dweh E , Painter J , Barradas DT , Williams SG , Blackley DJ , Kirking HL , Patel MR , Dea M , Massoudi MS , Barskey AE , Zarecki SL , Fomba M , Grube S , Belcher L , Broyles LN , Maxwell TN , Hagan JE , Yeoman K , Westercamp M , Mott J , Mahoney F , Slutsker L , DeCock KM , Marston B , Dahl B . Emerg Infect Dis 2016 22 (9) 1653-5 Persons who died of Ebola virus disease at home in rural communities in Liberia and Guinea resulted in more secondary infections than persons admitted to Ebola treatment units. Intensified monitoring of contacts of persons who died of this disease in the community is an evidence-based approach to reduce virus transmission in rural communities. |
HIV Infection Linked to Injection Use of Oxymorphone in Indiana, 2014-2015.
Peters PJ , Pontones P , Hoover KW , Patel MR , Galang RR , Shields J , Blosser SJ , Spiller MW , Combs B , Switzer WM , Conrad C , Gentry J , Khudyakov Y , Waterhouse D , Owen SM , Chapman E , Roseberry JC , McCants V , Weidle PJ , Broz D , Samandari T , Mermin J , Walthall J , Brooks JT , Duwve JM . N Engl J Med 2016 375 (3) 229-39 Background In January 2015, a total of 11 new diagnoses of human immunodeficiency virus (HIV) infection were reported in a small community in Indiana. We investigated the extent and cause of the outbreak and implemented control measures. Methods We identified an outbreak-related case as laboratory-confirmed HIV infection newly diagnosed after October 1, 2014, in a person who either resided in Scott County, Indiana, or was named by another case patient as a syringe-sharing or sexual partner. HIV polymerase (pol) sequences from case patients were phylogenetically analyzed, and potential risk factors associated with HIV infection were ascertained. Results From November 18, 2014, to November 1, 2015, HIV infection was diagnosed in 181 case patients. Most of these patients (87.8%) reported having injected the extended-release formulation of the prescription opioid oxymorphone, and 92.3% were coinfected with hepatitis C virus. Among 159 case patients who had an HIV type 1 pol gene sequence, 157 (98.7%) had sequences that were highly related, as determined by phylogenetic analyses. Contact tracing investigations led to the identification of 536 persons who were named as contacts of case patients; 468 of these contacts (87.3%) were located, assessed for risk, tested for HIV, and, if infected, linked to care. The number of times a contact was named as a syringe-sharing partner by a case patient was significantly associated with the risk of HIV infection (adjusted risk ratio for each time named, 1.9; P<0.001). In response to this outbreak, a public health emergency was declared on March 26, 2015, and a syringe-service program in Indiana was established for the first time. Conclusions Injection-drug use of extended-release oxymorphone within a network of persons who inject drugs in Indiana led to the introduction and rapid transmission of HIV. (Funded by the state government of Indiana and others.). |
Reduction in Injection Risk Behaviors After Institution of an Emergency Syringe Exchange Program During an HIV Outbreak Among Persons Who Inject Drugs, Indiana 2015
Patel MR , Combs B , Hall P , Hough J , Chapman E , Perez A , Brooks JT , Peters PJ , Broz D . Open Forum Infect Dis 2015 2 Background. On April 6, 2015, an emergency syringe exchange program (SEP) was implemented in response to an unprecedented HIV outbreak linked to injection drug use in a small rural Indiana community. To assess impact of the SEP, we compared injection-related risk behaviors reported over time. | | Methods. At each SEP visit, clients received sterile syringes, a wound kit, harm reduction education, and referrals to health and substance abuse services. Returned syringes were safely disposed and clients were surveyed about current risk behaviors. We analyzed data on clients with >2 SEP visits ≥7 days apart through June 6, 2015. Differences in medians and percentages between clients' first and most recent visit were assessed using the Kruskal-Wallis test, or χ2 or Fisher exact test. | | Results. We evaluated data from 100 qualifying SEP clients who contributed a total of 361 visits (median: 3) and received 19,376 syringes: 55% were male, median age was 33 years (interquartile range [IQR]: 26–40). The median interval between first and most recent visit was 27 days (IQR: 16–40). Sharing syringes to inject declined significantly by 85% between the first and most recent visits (table). The frequency of reusing the same syringe also declined significantly. The number of syringes returned and distributed both increased significantly. Decreases in sharing syringes to divide drugs and sharing other injection equipment were not statistically significant. | | Conclusion. Among clients enrolled during the first two months of an emergency SEP, many injection-related risk behaviors declined significantly. Emergency SEPs can rapidly reduce risk behaviors capable of transmitting HIV in an outbreak setting. |
Decreased Ebola transmission after rapid response to outbreaks in remote areas, Liberia, 2014
Lindblade KA , Kateh F , Nagbe TK , Neatherlin JC , Pillai SK , Attfield KR , Dweh E , Barradas DT , Williams SG , Blackley DJ , Kirking HL , Patel MR , Dea M , Massoudi MS , Wannemuehler K , Barskey AE , Zarecki SL , Fomba M , Grube S , Belcher L , Broyles LN , Maxwell TN , Hagan JE , Yeoman K , Westercamp M , Forrester J , Mott J , Mahoney F , Slutsker L , DeCock KM , Nyenswah T . Emerg Infect Dis 2015 21 (10) 1800-7 We measured the reproduction number before and after interventions were implemented to reduce Ebola transmission in 9 outbreaks in Liberia during 2014. We evaluated risk factors for secondary cases and the association between patient admission to an Ebola treatment unit (ETU) and survival. The reproduction number declined 94% from 1.7 (95% CI 1.1-2.6) to 0.1 (95% CI 0.02-0.6) after interventions began. The risk for secondary infections was 90% lower for patients admitted to an ETU (risk ratio 0.1, 95% CI 0.04-0.3) than for those who died in the community. The case-fatality rate was 68% (95% CI 60-74), and ETU admission was associated with a 50% reduction in death (hazard ratio 0.5, 95% CI 0.4-0.8). Isolation and treatment of Ebola patients had the dual benefit of interrupting community transmission and improving survival. |
Community outbreak of HIV infection linked to injection drug use of oxymorphone - Indiana, 2015
Conrad C , Bradley HM , Broz D , Buddha S , Chapman EL , Galang RR , Hillman D , Hon J , Hoover KW , Patel MR , Perez A , Peters PJ , Pontones P , Roseberry JC , Sandoval M , Shields J , Walthall J , Waterhouse D , Weidle PJ , Wu H , Duwve JM . MMWR Morb Mortal Wkly Rep 2015 64 (16) 443-4 On January 23, 2015, the Indiana State Department of Health (ISDH) began an ongoing investigation of an outbreak of human immunodeficiency virus (HIV) infection, after Indiana disease intervention specialists reported 11 confirmed HIV cases traced to a rural county in southeastern Indiana. Historically, fewer than five cases of HIV infection have been reported annually in this county. The majority of cases were in residents of the same community and were linked to syringe-sharing partners injecting the prescription opioid oxymorphone (a powerful oral semi-synthetic opioid analgesic). As of April 21, ISDH had diagnosed HIV infection in 135 persons (129 with confirmed HIV infection and six with preliminarily positive results from rapid HIV testing that were pending confirmatory testing) in a community of 4,200 persons. |
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