Last data update: Nov 11, 2024. (Total: 48109 publications since 2009)
Records 1-30 (of 58 Records) |
Query Trace: Petersen LR[original query] |
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Intrinsic risk factors for alpha-gal syndrome in a case-control study, 2019-2020
Taylor ML , Kersh GJ , Salzer JS , Jones ES , Binder AM , Armstrong PA , Choudhary SK , Commins GK , Amelio CL , Biggerstaff BJ , Beard CB , Petersen LR , Commins SP . Ann Allergy Asthma Immunol 2024 BACKGROUND: Alpha-gal syndrome (AGS) is an allergy to galactose-α-1,3-galactose (alpha-gal), a carbohydrate found in most mammals. Evidence indicates that AGS develops following a tick bite, and in the United States, AGS is most associated with bites from Amblyomma americanum (lone star tick); however, not all persons bitten by ticks develop clinical AGS. OBJECTIVE: This study investigated intrinsic risk factors associated with the development of AGS. METHODS: We performed a case-control study among adults presenting for diagnosis or management of AGS at an allergy clinic in North Carolina during 2019-2020 and compared them to controls enrolled from two nearby internal medicine clinics. A questionnaire gathered epidemiologic and tick exposure data and blood was obtained for alpha-gal specific IgE (sIgE) and other testing. RESULTS: The 82 enrolled case patients and 191 controls did not differ significantly by age or sex. Case patients were more likely than controls to have A or O blood types (non-B-antigen), have experienced childhood allergies, and have a family history of AGS and other food allergies. Case patients were also more likely to report experiencing long healing times for insect bites or stings and a family history of allergy to stinging or biting insects. CONCLUSION: This study suggests that intrinsic factors contribute to risk of developing AGS. Some traits are genetic, but common behaviors among households and family units likely also contribute. Identification of these risk factors can inform personal risk, aid healthcare providers in understanding susceptible populations, and contribute to ongoing understanding of AGS epidemiology. |
Multi-model prediction of West Nile virus neuroinvasive disease with machine learning for identification of important regional climatic drivers
Holcomb KM , Staples JE , Nett RJ , Beard CB , Petersen LR , Benjamin SG , Green BW , Jones H , Johansson MA . Geohealth 2023 7 (11) e2023GH000906 West Nile virus (WNV) is the leading cause of mosquito-borne illness in the continental United States (CONUS). Spatial heterogeneity in historical incidence, environmental factors, and complex ecology make prediction of spatiotemporal variation in WNV transmission challenging. Machine learning provides promising tools for identification of important variables in such situations. To predict annual WNV neuroinvasive disease (WNND) cases in CONUS (2015-2021), we fitted 10 probabilistic models with variation in complexity from naïve to machine learning algorithm and an ensemble. We made predictions in each of nine climate regions on a hexagonal grid and evaluated each model's predictive accuracy. Using the machine learning models (random forest and neural network), we identified the relative importance and variation in ranking of predictors (historical WNND cases, climate anomalies, human demographics, and land use) across regions. We found that historical WNND cases and population density were among the most important factors while anomalies in temperature and precipitation often had relatively low importance. While the relative performance of each model varied across climatic regions, the magnitude of difference between models was small. All models except the naïve model had non-significant differences in performance relative to the baseline model (negative binomial model fit per hexagon). No model, including the ensemble or more complex machine learning models, outperformed models based on historical case counts on the hexagon or region level; these models are good forecasting benchmarks. Further work is needed to assess if predictive capacity can be improved beyond that of these historical baselines. |
Zika Virus
Petersen LR , Jamieson DJ , Honein MA . N Engl J Med 2016 375 (3) 294-5 Petersen et al. (April 21 issue)1 provide a detailed review of Zika virus. We have some concern regarding diagnostic criteria for microcephaly in fetuses and newborns exposed to the virus. According to the Centers for Disease Control and Prevention (CDC) recommendation that microcephaly should be defined as an occipitofrontal circumference below the third percentile, nearly 3% of newborns would be categorized as having microcephaly. | In Brazil, where there are 3 million live births per year, the application of this definition would result in nearly 90,000 infants being labeled as having microcephaly — a far greater number than any studies to date would indicate. The comparable number in the United States would not be 2 to 12 cases per 10,000 live births, as noted in the article, but rather 3% of 4 million live births, or 120,000 newborns. The “benchmark” of an average of 6 cases per 10,000 live births in the United States is based on the most commonly used criterion of 3 SD from the mean,2-4 which would encompass 0.27% of newborns. A comparison of prevalence with the use of such radically different criteria will lead to grossly inappropriate conclusions and hysteria among pregnant patients. Unfortunately, this error has been repeated in press releases and needs to be corrected. |
Zika virus as a cause of birth defects: Were the teratogenic effects of Zika virus missed for decades?
Gilbert RK , Petersen LR , Honein MA , Moore CA , Rasmussen SA . Birth Defects Res 2022 115 (3) 265-274 Zika virus (ZIKV) was identified as a teratogen in 2016 when an increase in severe microcephaly and other brain defects was observed in fetuses and newborns following outbreaks in French Polynesia (2013-2014) and Brazil (2015-2016) and among travelers to other countries experiencing outbreaks. Some have questioned why ZIKV was not recognized as a teratogen before these outbreaks: whether novel genetic changes in ZIKV had increased its teratogenicity or whether its association with birth defects had previously been undetected. Here we examine the evidence for these two possibilities. We describe evidence for specific mutations that arose before the French Polynesia outbreak that might have increased ZIKV teratogenicity. We also present information on children born with findings consistent with congenital Zika syndrome (CZS) as early as 2009 and epidemiological evidence that suggests increases in CZS-type birth defects before 2013. We also explore reasons why a link between ZIKV and birth defects might have been missed, including issues with surveillance of ZIKV infections and of birth defects, challenges to ZIKV diagnostic testing, and the susceptibility of different populations to ZIKV infection at the time of pregnancy. Although it is not possible to prove definitively that ZIKV had teratogenic properties before 2013, several pieces of evidence support the hypothesis that its teratogenicity had been missed in the past. These findings emphasize the need for further investments in global surveillance for emerging infections and for birth defects so that infectious teratogens can be identified more expeditiously in the future. |
Tick bite as a risk factor for alpha-gal specific IgE antibodies and development of alpha-gal syndrome
Kersh GJ , Salzer J , Jones ES , Binder AM , Armstrong PA , Choudhary SK , Commins GK , Amelio CL , Kato CY , Singleton J , Biggerstaff BJ , Beard CB , Petersen LR , Commins SP . Ann Allergy Asthma Immunol 2023 130 (4) 472-478 BACKGROUND: The disaccharide galactose-α-1,3-galactose (alpha-gal) is expressed in mammals other than humans, apes, and old-world monkeys. In humans, elevated immunoglobulin E (IgE) antibodies specific for alpha-gal can result in allergic hypersensitivity known as alpha-gal syndrome (AGS). Case reports and series suggest that tick bites can induce alpha-gal-specific IgE (sIgE) antibodies. OBJECTIVE: To evaluate tick exposure as a risk factor for AGS and elevated alpha-gal sIgE level. METHODS: We conducted a case-control study comparing patients with AGS from a North Carolina allergy clinic with controls who were patients at a nearby internal medicine clinic. Cases and controls were administered a questionnaire to obtain information about demographics, home environment, outdoor activities, and recollection of tick bite. Serum samples taken at the time of enrollment were tested for total IgE, alpha-gal sIgE, and antibodies to other tick-borne pathogens. RESULTS: The patients with AGS were more likely to recall finding a tick on themselves (odds ratio [OR], 11.20; 95% confidence interval [CI], 4.97-25.15), live near wooded forest (OR, 2.27; 95% CI, 0.92-5.55), and spend 17 or more hours per week outdoors in wooded areas (OR, 5.58; 95% CI, 2.56-12.19). The patients with AGS were also more likely to report 4 or more tick bites (OR, 33.05; 95% CI, 9.92-155.12) and reactions at the site of tick bites (OR, 7.93; 95% CI, 3.74-16.80). Furthermore, elevated alpha-gal sIgE level was observed in 33% of the controls and was associated with tick exposure in the controls (OR, 4.25; 95% CI, 2.21-8.18). CONCLUSION: The results define tick bite as a risk factor for AGS and elevated alpha-gal sIgE level. |
Clinical and laboratory features of patients diagnosed with Alpha-gal Syndrome - 2010-2019
Binder AM , Cherry-Brown D , Biggerstaff BJ , Jones ES , Amelio CL , Beard CB , Petersen LR , Kersh GJ , Commins SP , Armstrong PA . Allergy 2022 78 (2) 477-487 BACKGROUND: Alpha-gal syndrome (AGS) is an IgE-mediated allergy to galactose-alpha-1,3-galactose. Clinical presentation ranges from hives to anaphylaxis; episodes typically occur 2-6 hours after exposure to alpha-gal-containing products. In the United States, lone star tick bites are associated with development of AGS. To characterize features of AGS, we evaluated a cohort of patients presenting for care at the University of North Carolina, focusing on symptoms, severity, and identifying features unique to specific alpha-gal-containing product exposures. METHODS: We performed a chart review and descriptive analysis of 100 randomly selected patients with AGS during 2010-2019. RESULTS: Median age at onset was 53years, 56% were female, 95% reported White race, 86% reported a history of tick bite, and 75% met criteria for anaphylaxis based on involvement of 2 organ systems. Those reporting dairy reactions were significantly less likely to report isolated mucocutaneous symptoms (3% vs 24%; ratio [95% CI]: 0.1 [0.1, 0.3]) than those who tolerated dairy, and were more likely to report gastrointestinal symptoms (79% vs 59%; ratio [95% CI]: 1.3 [0.7, 2.6]), although this difference was not statistically significant. Dairy-tolerant patients demonstrated higher alpha-gal sIgE titers (as a percentage of total IgE) than dairy-reactive patients (GM 4.1[95% CI: 2.7, 6.1] vs. GM 2.5 [95% CI: 1.3, 4.8], respectively; ratio - 1.6 [95% CI: -1.0, 3.9]). CONCLUSION: While tick exposure is common in the southern United States, nearly all AGS patients reported a tick bite. Gastrointestinal symptoms were prominent among those reporting reactions to dairy. Anaphylaxis was common, underscoring the severity and need to raise awareness of AGS among patients and providers. |
Reinfection with SARS-CoV-2 among previously infected healthcare personnel and first responders.
Akinbami LJ , Biggerstaff BJ , Petersen LR . Clin Infect Dis 2021 75 (1) e201-e207 BACKGROUND: SARS-CoV-2 virus testing among first responders and healthcare personnel who participated in a May-August 2020 serosurvey which assessed spike protein antibodies (S1 region) provided an opportunity to assess reinfection. METHODS: Serology survey data were merged with virus testing results from Rhode Island (March 1, 2020-February 17, 2021) and New York City (March 10-December 14, 2020). Participants with a positive virus test ≥14 days before their serology test were included. Reinfection was defined as a second positive SARS-CoV-2 test result ≥90 days after the first positive test. The association between serostatus and reinfection was assessed with a proportional hazards model adjusting for demographics, exposures, and virus testing frequency. RESULTS: Among 1,572 previously infected persons, 40 (2.5%) were reinfected. Reinfection differed by serostatus: 8.4% among seronegative versus 1.9% among seropositive participants (p<0.0001). Most reinfections occurred among Rhode Island nursing home and corrections (RINHC) personnel (n=30) who were most frequently tested (mean 30.3 tests versus 4.6 for other Rhode Island and 2.3 for New York City participants). The adjusted hazard ratio (aHR) for reinfection in seropositive versus seronegative persons was 0.41 (95% CI 0.20, 0.81). Exposure to a household member with COVID-19 before the serosurvey was also protective (aHR 0.34, 95% CI 0.13, 0.89). CONCLUSIONS: Reinfections were uncommon among previously infected persons over a 9-month period that preceded widespread variant circulation. Seropositivity decreased reinfection risk. Lower reinfection risk associated with exposure to a household member with COVID-19 before the serosurvey may reflect subsequently reduced household transmission among members of previously infected households. |
Duration of Viral Nucleic Acid Shedding and Early Reinfection with the Severe Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in Health Care Workers and First Responders.
Biggerstaff BJ , Akinbami LJ , Hales C , Chan PA , Petersen LR . J Infect Dis 2021 224 (11) 1873-1877 We estimated the distributions of duration of SARS-CoV-2 nucleic acid shedding and time to reinfection among 137 persons with at least two positive nucleic acid amplification test (NAAT) results from March to September 2020. We analyzed gaps of varying length between subsequent positive and negative NAAT results and estimated a mean duration of nucleic acid shedding of 30.1 (95% CI 26.3, 34.5) days. The mean time to reinfection was 89.1 (95% CI 75.3, 103.5) days. Together, these indicate that a 90-day period between positive NAAT results can reliably define reinfection in immunocompetent persons although reinfection can occur at shorter intervals. |
Evaluating Differences in Whole Blood, Serum, and Urine Screening Tests for Zika Virus, Puerto Rico, USA, 2016
Rosinger AY , Olson SM , Ellington SR , Perez-Padilla J , Simeone RM , Pedati CS , Schroeder BA , Santiago GA , Medina FA , Muñoz-Jordán JL , Adams LE , Galang RR , Valencia-Prado M , Bakkour S , Colón C , Goodwin M , Meaney-Delman D , Read JS , Petersen LR , Jamieson DJ , Deseda CC , Honein MA , Rivera-García B , Shapiro-Mendoza CK . Emerg Infect Dis 2021 27 (5) 1505-1508 We evaluated nucleic acid amplification testing (NAAT) for Zika virus on whole-blood specimens compared with NAAT on serum and urine specimens among asymptomatic pregnant women during the 2015-2016 Puerto Rico Zika outbreak. Using NAAT, more infections were detected in serum and urine than in whole blood specimens. |
Prevalence of SARS-CoV-2 Antibodies in First Responders and Public Safety Personnel, New York City, New York, USA, May-July 2020.
Sami S , Akinbami LJ , Petersen LR , Crawley A , Lukacs SL , Weiss D , Henseler RA , Vuong N , Mackey L , Patel A , Grohskopf LA , Morgenthau BM , Daskalakis D , Pathela P . Emerg Infect Dis 2021 27 (3) 796-804 We conducted a serologic survey in public service agencies in New York City, New York, USA, during May-July 2020 to determine prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among first responders. Of 22,647 participants, 22.5% tested positive for SARS-CoV-2-specific antibodies. Seroprevalence for police and firefighters was similar to overall seroprevalence; seroprevalence was highest in correctional staff (39.2%) and emergency medical technicians (38.3%) and lowest in laboratory technicians (10.1%) and medicolegal death investigators (10.8%). Adjusted analyses demonstrated association between seropositivity and exposure to SARS-CoV-2-positive household members (adjusted odds ratio [aOR] 3.52 [95% CI 3.19-3.87]), non-Hispanic Black race or ethnicity (aOR 1.50 [95% CI 1.33-1.68]), and severe obesity (aOR 1.31 [95% CI 1.05-1.65]). Consistent glove use (aOR 1.19 [95% CI 1.06-1.33]) increased likelihood of seropositivity; use of other personal protective equipment had no association. Infection control measures, including vaccination, should be prioritized for frontline workers. |
Severe Acute Respiratory Syndrome Coronavirus 2 Seropositivity among Healthcare Personnel in Hospitals and Nursing Homes, Rhode Island, USA, July-August 2020.
Akinbami LJ , Chan PA , Vuong N , Sami S , Lewis D , Sheridan PE , Lukacs SL , Mackey L , Grohskopf LA , Patel A , Petersen LR . Emerg Infect Dis 2021 27 (3) 823-834 Healthcare personnel are recognized to be at higher risk for infection with severe acute respiratory syndrome coronavirus 2. We conducted a serologic survey in 15 hospitals and 56 nursing homes across Rhode Island, USA, during July 17-August 28, 2020. Overall seropositivity among 9,863 healthcare personnel was 4.6% (95% CI 4.2%-5.0%) but varied 4-fold between hospital personnel (3.1%, 95% CI 2.7%-3.5%) and nursing home personnel (13.1%, 95% CI 11.5%-14.9%). Within nursing homes, prevalence was highest among personnel working in coronavirus disease units (24.1%; 95% CI 20.6%-27.8%). Adjusted analysis showed that in hospitals, nurses and receptionists/medical assistants had a higher likelihood of seropositivity than physicians. In nursing homes, nursing assistants and social workers/case managers had higher likelihoods of seropositivity than occupational/physical/speech therapists. Nursing home personnel in all occupations had elevated seropositivity compared with hospital counterparts. Additional mitigation strategies are needed to protect nursing home personnel from infection, regardless of occupation. |
COVID-19 symptoms and SARS-CoV-2 antibody positivity in a large survey of first responders and healthcare personnel, May-July 2020.
Akinbami LJ , Petersen LR , Sami S , Vuong N , Lukacs SL , Mackey L , Atas J , LaFleur BJ . Clin Infect Dis 2021 73 (3) e822-e825 A SARS-CoV-2 serosurvey among first responder/healthcare personnel showed that loss of taste/smell was most predictive of seropositivity; percent seropositivity increased with number of COVID-19 symptoms. However, 22.9% with nine symptoms were seronegative, and 8.3% with no symptoms were seropositive. These findings demonstrate limitations of symptom-based surveillance and importance of testing. |
SARS-CoV-2 Infection and Mitigation Efforts among Office Workers, Washington, DC, USA.
Sami S , Vuong N , Miller H , Priestley R , Payne M , Licata-Portentoso G , Drobeniuc J , Petersen LR . Emerg Infect Dis 2021 27 (2) 669-672 Despite mitigation efforts, 2 coronavirus disease outbreaks were identified among office workers in Washington, DC. Moderate adherence to workplace mitigation efforts was reported in a serologic survey; activities outside of the workplace were associated with infection. Adherence to safety measures are critical for returning to work during the pandemic. |
SARS-CoV-2 Serologic Assay Needs for the Next Phase of the US COVID-19 Pandemic Response.
Gundlapalli AV , Salerno RM , Brooks JT , Averhoff F , Petersen LR , McDonald LC , Iademarco MF . Open Forum Infect Dis 2021 8 (1) ofaa555 BACKGROUND: There is a need for validated and standardized severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) quantitative immunoglobulin G (IgG) and neutralization assays that can be used to understand the immunology and pathogenesis of SARS-CoV-2 infection and support the coronavirus disease 2019 (COVID-19) pandemic response. METHODS: Literature searches were conducted to identify English language publications from peer-reviewed journals and preprints from January 2020 through November 6, 2020. Relevant publications were reviewed for mention of IgG or neutralization assays for SARS-CoV-2, or both, and the methods of reporting assay results. RESULTS: Quantitative SARS-CoV-2 IgG results have been reported from a limited number of studies; most studies used in-house laboratory-developed tests in limited settings, and only two semiquantitative tests have received US Food and Drug Administration (FDA) Emergency Use Authorization (EUA). As of November 6, 2020, there is only one SARS-CoV-2 neutralization assay with FDA EUA. Relatively few studies have attempted correlation of quantitative IgG titers with neutralization results to estimate surrogates of protection. The number of individuals tested is small compared with the magnitude of the pandemic, and persons tested are not representative of disproportionately affected populations. Methods of reporting quantitative results are not standardized to enable comparisons and meta-analyses. CONCLUSIONS: Lack of standardized SARS-CoV-2 quantitative IgG and neutralization assays precludes comparison of results from published studies. Interassay and interlaboratory validation and standardization of assays will support efforts to better understand antibody kinetics and longevity of humoral immune responses postillness, surrogates of immune protection, and vaccine immunogenicity and efficacy. Public-private partnerships could facilitate realization of these advances in the United States and worldwide. |
Diagnostic testing for Galactose-alpha-1,3-galactose (Alpha-gal), United States, 2010-2018
Binder AM , Commins S , Altrich ML , Wachs T , Biggerstaff BJ , Beard CB , Petersen LR , Kersh GJ , Armstrong PA . Ann Allergy Asthma Immunol 2021 126 (4) 411-416 e1 BACKGROUND: Alpha-gal syndrome (AGS) is an emerging immunoglobulin E (IgE)mediated allergy to galactose-alpha-1,3-galactose (alpha-gal). The geographic distribution and burden of AGS in the United States is unknown. OBJECTIVE: To characterizes alpha-gal IgE testing patterns and describes trends and distribution during 2010-2018 in the United States. METHODS: This retrospective analysis included all persons tested for alpha-gal IgE antibodies by Viracor-IBT Laboratories (Lee's Summit, MO), the primary site of testing in the United States. Data included age and sex of person tested, specimen state of origin, collection date, and result value; persons with at least one positive test (≥0.1 kU/L) were compared to negatives. Proportions tested and with positive test results were calculated using U.S. Census population estimates. RESULTS: Overall, 122,068 specimens from 105,674 persons were tested for alpha-gal IgE during July 1, 2010-December 31, 2018. Nearly one-third (34,256, 32.4%) had at least one positive result. The number of persons testing positive increased 6-fold from 1,110 in 2011 to 7,798 in 2018. Of those testing positive, mean [SD] age was 46.9 [19.8] years; males were more likely to test positive than females (43.3% vs 26.0%). Arkansas, Virginia, Kentucky, Oklahoma, and Missouri had the highest number of persons who were tested and had a positive result per 100,000 population. CONCLUSION: More than 34,000 persons, most presumably symptomatic, have tested positive for IgE antibodies to alpha-gal, suggesting AGS is an increasingly recognized public health problem. The geographic distribution of persons who tested positive is consistent with exposure to Amblyomma americanum ticks. |
SARS-CoV-2 Seroprevalence among Healthcare, First Response, and Public Safety Personnel, Detroit Metropolitan Area, Michigan, USA, May-June 2020.
Akinbami LJ , Vuong N , Petersen LR , Sami S , Patel A , Lukacs SL , Mackey L , Grohskopf LA , Shehu A , Atas J . Emerg Infect Dis 2020 26 (12) 2863-2871 To estimate seroprevalence of severe acute respiratory syndrome 2 (SARS-CoV-2) among healthcare, first response, and public safety personnel, antibody testing was conducted in emergency medical service agencies and 27 hospitals in the Detroit, Michigan, USA, metropolitan area during May-June 2020. Of 16,403 participants, 6.9% had SARS-CoV-2 antibodies. In adjusted analyses, seropositivity was associated with exposure to SARS-CoV-2-positive household members (adjusted odds ratio [aOR] 6.18, 95% CI 4.81-7.93) and working within 15 km of Detroit (aOR 5.60, 95% CI 3.98-7.89). Nurse assistants (aOR 1.88, 95% CI 1.24-2.83) and nurses (aOR 1.52, 95% CI 1.18-1.95) had higher likelihood of seropositivity than physicians. Working in a hospital emergency department increased the likelihood of seropositivity (aOR 1.16, 95% CI 1.002-1.35). Consistently using N95 respirators (aOR 0.83, 95% CI 0.72-0.95) and surgical facemasks (aOR 0.86, 95% CI 0.75-0.98) decreased the likelihood of seropositivity. |
Estimated SARS-CoV-2 Seroprevalence in the US as of September 2020.
Bajema KL , Wiegand RE , Cuffe K , Patel SV , Iachan R , Lim T , Lee A , Moyse D , Havers FP , Harding L , Fry AM , Hall AJ , Martin K , Biel M , Deng Y , Meyer WA3rd , Mathur M , Kyle T , Gundlapalli AV , Thornburg NJ , Petersen LR , Edens C . JAMA Intern Med 2020 181 (4) 450-460 IMPORTANCE: Case-based surveillance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection likely underestimates the true prevalence of infections. Large-scale seroprevalence surveys can better estimate infection across many geographic regions. OBJECTIVE: To estimate the prevalence of persons with SARS-CoV-2 antibodies using residual sera from commercial laboratories across the US and assess changes over time. DESIGN, SETTING, AND PARTICIPANTS: This repeated, cross-sectional study conducted across all 50 states, the District of Columbia, and Puerto Rico used a convenience sample of residual serum specimens provided by persons of all ages that were originally submitted for routine screening or clinical management from 2 private clinical commercial laboratories. Samples were obtained during 4 collection periods: July 27 to August 13, August 10 to August 27, August 24 to September 10, and September 7 to September 24, 2020. EXPOSURES: Infection with SARS-CoV-2. MAIN OUTCOMES AND MEASURES: The proportion of persons previously infected with SARS-CoV-2 as measured by the presence of antibodies to SARS-CoV-2 by 1 of 3 chemiluminescent immunoassays. Iterative poststratification was used to adjust seroprevalence estimates to the demographic profile and urbanicity of each jurisdiction. Seroprevalence was estimated by jurisdiction, sex, age group (0-17, 18-49, 50-64, and ≥65 years), and metropolitan/nonmetropolitan status. RESULTS: Of 177 919 serum samples tested, 103 771 (58.3%) were from women, 26 716 (15.0%) from persons 17 years or younger, 47 513 (26.7%) from persons 65 years or older, and 26 290 (14.8%) from individuals living in nonmetropolitan areas. Jurisdiction-level seroprevalence over 4 collection periods ranged from less than 1% to 23%. In 42 of 49 jurisdictions with sufficient samples to estimate seroprevalence across all periods, fewer than 10% of people had detectable SARS-CoV-2 antibodies. Seroprevalence estimates varied between sexes, across age groups, and between metropolitan/nonmetropolitan areas. Changes from period 1 to 4 were less than 7 percentage points in all jurisdictions and varied across sites. CONCLUSIONS AND RELEVANCE: This cross-sectional study found that as of September 2020, most persons in the US did not have serologic evidence of previous SARS-CoV-2 infection, although prevalence varied widely by jurisdiction. Biweekly nationwide testing of commercial clinical laboratory sera can play an important role in helping track the spread of SARS-CoV-2 in the US. |
Lack of antibodies to SARS-CoV-2 in a large cohort of previously infected persons.
Petersen LR , Sami S , Vuong N , Pathela P , Weiss D , Morgenthau BM , Henseler RA , Daskalakis DC , Atas J , Patel A , Lukacs S , Mackey L , Grohskopf LA , Thornburg N , Akinbami LJ . Clin Infect Dis 2020 73 (9) e3066-e3073 BACKGROUND: Reports suggest that some persons previously infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) lack detectable IgG antibodies. We aimed to determine the proportion IgG seronegative and predictors for seronegativity among persons previously infected with SARS-CoV-2. METHODS: We analyzed serologic data collected from health care workers and first responders in New York City and the Detroit metropolitan area with history of a positive SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) test result and who were tested for IgG antibodies to SARS-CoV-2 spike protein at least 2 weeks after symptom onset. RESULTS: Of 2,547 persons with previous confirmed SARS-CoV-2 infection, 160 (6.3%) were seronegative. Of 2,112 previously symptomatic persons, the proportion seronegative slightly increased from 14 to 90 days post symptom onset (p=0.06). The proportion seronegative ranged from 0% among 79 persons previously hospitalized to 11.0% among 308 persons with asymptomatic infections. In a multivariable model, persons taking immunosuppressive medications were more likely to be seronegative (31.9%, 95% confidence interval [CI] 10.7%-64.7%), while participants of non-Hispanic Black race/ethnicity (versus non-Hispanic White) (2.7%, 95% CI 1.5%-4.8%), with severe obesity (versus under/normal weight) (3.9%, 95% CI 1.7%-8.6%), or with more symptoms were less likely to be seronegative. CONCLUSIONS: In our population with previous RT-PCR confirmed infection, approximately one in 16 persons lacked IgG antibodies. Absence of antibodies varied independently by illness severity, race/ethnicity, obesity, and immunosuppressive drug therapy. The proportion seronegative remained relatively stable among persons tested up to 90 days post symptom onset. |
Learning about Zika virus epidemiology and diagnostics from blood donor studies
Petersen LR , Cassetti MC . Lancet Infect Dis 2020 20 (12) 1357-1359 Arbovirus transmission risk from blood transfusion relates to the incidence of infection in the blood donor pool and the length of time that the blood of newly infected people remains infectious.1 Identification of 23 transfusion transmissions during the 2002 West Nile virus outbreak in midwestern USA and models estimating transfusion transmission risk as high as 4.7 per 10 000 donors in certain areas led to the realisation that high infection incidence during mosquito-borne arbovirus outbreaks creates considerable transfusion transmission risk despite viraemia of short duration.2,3 To mitigate this risk, blood donors have been universally screened with nucleic acid amplification tests (NAATs) for West Nile virus since 2003.4 Although transfusion transmission of Zika virus has not been documented in the USA, NAAT screening was implemented in 2016 to mitigate risk of transfusion to susceptible populations, including pregnant women, to prevent complications, such as adverse fetal outcomes.4 |
The COVID-19 Serology Studies Workshop: Recommendations and Challenges.
Lerner AM , Eisinger RW , Lowy DR , Petersen LR , Humes R , Hepburn M , Cassetti MC . Immunity 2020 53 (1) 1-5 The development, validation, and appropriate application of serological assays to detect antibodies to SARS-CoV-2 are essential to determining seroprevalence of this virus in the United States and globally and in guiding government leadership and the private sector on back-to-work policies. An interagency working group of the US Department of Health and Human Services convened a virtual workshop to identify knowledge gaps and key outstanding scientific issues and to develop strategies to fill them. Key outcomes of the workshop included recommendations for (1) advancing serology assays as a tool to better understand SARS-CoV-2 infection and (2) conducting crucial serology field studies to advance an understanding of immunity to SARS-CoV-2, leading to protection and duration of protection, including the correlation between serological test results and risk of reinfection. |
Entomological investigation detects dengue virus type 1 in Aedes (Stegomyia) albopictus (Skuse) during the 2015-16 outbreak in Hawaii
Hasty JM , Felix GE , Amador M , Barrera R , Santiago GS , Nakasone L , Park SY , Okoji S , Honda E , Asuncion B , Save M , Munoz-Jordan JL , Martinez-Conde S , Medina FA , Waterman SH , Petersen LR , Johnston DI , Hemme RR . Am J Trop Med Hyg 2020 102 (4) 869-875 A dengue outbreak occurred on Hawaii Island between September 2015 and March 2016. Entomological investigations were undertaken between December 2015 and February 2016 to determine which Aedes mosquito species were responsible for the outbreak. A total of 3,259 mosquitoes were collected using a combination of CDC autocidal gravid ovitraps, Biogents BG-Sentinel traps, and hand-nets; immature mosquitoes were collected during environmental surveys. The composition of species was Aedes albopictus (58%), Aedes aegypti (25%), Wyeomyia mitchelli (7%), Aedes vexans (5%), Culex quinquefasciatus (4%), and Aedes japonicus (1%). Adult mosquitoes were analyzed by real-time reverse transcription polymerase chain reaction (PCR) for the presence of dengue virus (DENV) RNA. Of the 185 pools of female mosquitoes tested, 15 containing Ae. albopictus were positive for the presence of DENV type 1 RNA. No virus was detected in pools of the remaining species. Phylogenetic analysis showed the virus strain belonged to genotype I and was closely related to strains that were circulating in the Pacific between 2008 and 2014. This is the first report of detection of DENV in Ae. albopictus from Hawaii. |
Epidemiology of West Nile virus in the United States: Implications for arbovirology and public health
Petersen LR . J Med Entomol 2019 56 (6) 1456-1462 Since West Nile virus (WNV) emerged in the United States in 1999, 22,999 neuroinvasive disease cases in humans were reported through 2017. These cases have arisen from an estimated seven million human infections. Population incidence is geographically heterogeneous and is highest in the West and Midwest. Upwards of 2% of the population in some jurisdictions may become infected during outbreaks. Before universal screening of the United States blood supply, this high infection incidence and that approximately 75% of those infected remain asymptomatic translated into a considerable risk of WNV transfusion transmission despite the short duration of viremia following infection. Universal blood donor screening has nearly eliminated the risk of WNV transfusion transmission, but at enormous cost. WNV transmission via transplanted organs carries extremely high morbidity and mortality. Improved vector surveillance and timely and effective response to surveillance data can reduce the impact of WNV and should remain public health priorities. |
The need for a national strategy to address vector-borne disease threats in the United States
Beard CB , Visser SN , Petersen LR . J Med Entomol 2019 56 (5) 1199-1203 Vector-borne diseases (VBDs) cause significant morbidity and mortality each year in the United States. Over the last 14 yr, over 700,000 cases of diseases carried by ticks, mosquitoes, and fleas have been reported from U.S. states and territories to the Centers for Disease Control and Prevention. The number of reported cases has been increasing annually with two major trends: a steady increase in tick-borne diseases and increasing intermittent outbreaks of mosquito-borne arboviruses. The factors that are driving VBD introduction and emergence vary among diseases but are not likely to disappear, indicating that current trends will continue and probably worsen in the absence of effective prevention and control tools and implementation capacity. There are a number of challenges to preventing VBDs, including the lack of vaccines and effective vector control tools, insecticide resistance, and eroding technical capacities in public health entomology at federal, state, and local levels. For these reasons, a national strategy is needed to address VBD threats and to reverse the alarming trend in morbidity and mortality associated with these diseases. |
Combatting the increasing threat of vector-borne disease in the United States with a national vector-borne disease prevention and control system
Petersen LR , Beard CB , Visser SN . Am J Trop Med Hyg 2018 100 (2) 242-245 Reported cases of vector-borne diseases in the United States have more than tripled since 2004, characterized by steadily increasing incidence of tick-borne diseases and sporadic outbreaks of domestic and invasive mosquito-borne diseases. An effective public health response to these trends relies on public health surveillance and laboratory systems, proven prevention and mitigation measures, scalable capacity to implement these measures, sensitive and specific diagnostics, and effective therapeutics. However, significant obstacles hinder successful implementation of these public health strategies. The recent emergence of Haemaphysalis longicornis, the first invasive tick to emerge in the United States in approximately 80 years, serves as the most recent example of the need for a coordinated public health response. Addressing the dual needs for innovation and discovery and for building state and local capacities may overcome current challenges in vector-borne disease prevention and control, but will require coordination across a national network of collaborators operating under a national strategy. Such an effort should reduce the impact of emerging vectors and could reverse the increasing trend of vector-borne disease incidence and associated morbidity and mortality. |
Update: Interim guidance for preconception counseling and prevention of sexual transmission of Zika virus for men with possible Zika virus exposure - United States, August 2018
Polen KD , Gilboa SM , Hills S , Oduyebo T , Kohl KS , Brooks JT , Adamski A , Simeone RM , Walker AT , Kissin DM , Petersen LR , Honein MA , Meaney-Delman D . MMWR Morb Mortal Wkly Rep 2018 67 (31) 868-871 Zika virus infection can occur as a result of mosquitoborne or sexual transmission of the virus. Infection during pregnancy is a cause of fetal brain abnormalities and other serious birth defects (1,2). CDC has updated the interim guidance for men with possible Zika virus exposure who 1) are planning to conceive with their partner, or 2) want to prevent sexual transmission of Zika virus at any time (3). CDC now recommends that men with possible Zika virus exposure who are planning to conceive with their partner wait for at least 3 months after symptom onset (if symptomatic) or their last possible Zika virus exposure (if asymptomatic) before engaging in unprotected sex. CDC now also recommends that for couples who are not trying to conceive, men can consider using condoms or abstaining from sex for at least 3 months after symptom onset (if symptomatic) or their last possible Zika virus exposure (if asymptomatic) to minimize their risk for sexual transmission of Zika virus. All other guidance for Zika virus remains unchanged. The definition of possible Zika virus exposure remains unchanged and includes travel to or residence in an area with risk for Zika virus transmission (https://wwwnc.cdc.gov/travel/page/world-map-areas-with-zika) or sex without a condom with a partner who traveled to or lives in an area with risk for Zika virus transmission. CDC will continue to update recommendations as new information becomes available. |
Possible congenital Zika syndrome in older children due to earlier circulation of Zika virus
Chu V , Petersen LR , Moore CA , Meaney-Delman D , Nelson G , Christian Sonne D , Dodge NN , Glaser C , Rasmussen SA . Am J Med Genet A 2018 176 (9) 1882-1889 Congenital Zika syndrome (CZS) was identified following a large Zika virus (ZIKV) outbreak in Brazil in 2015. Two children with clinical presentations consistent with CZS, ages 7 and 8 years old, are described. Both mothers lived in Cambodia, a region with known ZIKV, during their pregnancies and reported fever and rash in the second trimester. The infants were born with severe microcephaly. Testing for congenital infection at birth and genetic testing were unremarkable. In 2017, serologic testing for both mothers were consistent with prior ZIKV infection. Review of infant neuroimaging demonstrated ventriculomegaly, severe cerebral atrophy, and subcortical calcifications consistent with CZS. Given the maternal symptoms suggesting ZIKV infection during pregnancy and the combination of clinical and radiological features unique to CZS, CZS is strongly suspected in these children, suggesting that CZS occurred before the 2013-2014 French Polynesia outbreak. As such, CZS should be considered in older children with congenital microcephaly of unknown etiology and a history consistent with possible ZIKV exposure. |
Vital Signs: Trends in reported vectorborne disease cases - United States and Territories, 2004-2016
Rosenberg R , Lindsey NP , Fischer M , Gregory CJ , Hinckley AF , Mead PS , Paz-Bailey G , Waterman SH , Drexler NA , Kersh GJ , Hooks H , Partridge SK , Visser SN , Beard CB , Petersen LR . MMWR Morb Mortal Wkly Rep 2018 67 (17) 496-501 INTRODUCTION: Vectorborne diseases are major causes of death and illness worldwide. In the United States, the most common vectorborne pathogens are transmitted by ticks or mosquitoes, including those causing Lyme disease; Rocky Mountain spotted fever; and West Nile, dengue, and Zika virus diseases. This report examines trends in occurrence of nationally reportable vectorborne diseases during 2004-2016. METHODS: Data reported to the National Notifiable Diseases Surveillance System for 16 notifiable vectorborne diseases during 2004-2016 were analyzed; findings were tabulated by disease, vector type, location, and year. RESULTS: A total 642,602 cases were reported. The number of annual reports of tickborne bacterial and protozoan diseases more than doubled during this period, from >22,000 in 2004 to >48,000 in 2016. Lyme disease accounted for 82% of all tickborne disease reports during 2004-2016. The occurrence of mosquitoborne diseases was marked by virus epidemics. Transmission in Puerto Rico, the U.S. Virgin Islands, and American Samoa accounted for most reports of dengue, chikungunya, and Zika virus diseases; West Nile virus was endemic, and periodically epidemic, in the continental United States. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Vectorborne diseases are a large and growing public health problem in the United States, characterized by geographic specificity and frequent pathogen emergence and introduction. Differences in distribution and transmission dynamics of tickborne and mosquitoborne diseases are often rooted in biologic differences of the vectors. To effectively reduce transmission and respond to outbreaks will require major national improvement of surveillance, diagnostics, reporting, and vector control, as well as new tools, including vaccines. |
Epidemiology of Zika virus infection
Hills SL , Fischer M , Petersen LR . J Infect Dis 2017 216 S868-s874 Long known to be endemic in Africa and Southeast Asia and a rare cause of acute febrile illness, Zika virus (ZIKAV) arose from obscurity when an Asian genotype ZIKAV caused an outbreak of mild febrile illness in 2007 in Yap State, Federated States of Micronesia. Subsequent viral spread in the Pacific led to a large outbreak in French Polynesia commencing in 2013. After its recognition in the Americas through March 2017, the Pan American Health Organization has received reports of >750000 suspected and laboratory-confirmed cases of autochthonous ZIKAV transmission. Outbreaks in most countries in the Americas peaked in early to mid-2016. Increased surveillance in several Southeast Asian counties has led to increased case recognition, including an outbreak in Singapore, and the first reports of birth defects linked to ZIKAV in the region. As of April 2017, the World Health Organization reported 84 countries or territories with current or previous ZIKAV transmission. |
Modes of transmission of Zika virus
Gregory CJ , Oduyebo T , Brault AC , Brooks JT , Chung KW , Hills S , Kuehnert MJ , Mead P , Meaney-Delman D , Rabe I , Staples E , Petersen LR . J Infect Dis 2017 216 S875-s883 For >60 years, Zika virus (ZIKV) has been recognized as an arthropod-borne virus with Aedes species mosquitoes as the primary vector. However in the past 10 years, multiple alternative routes of ZIKV transmission have been identified. We review the available data on vector and non-vector-borne modes of transmission and interventions undertaken, to date, to reduce the risk of human infection through these routes. Although much has been learned during the outbreak in the Americas on the underlying mechanisms and pathogenesis of non-vector-borne ZIKV infections, significant gaps remain in our understanding of the relative incidence of, and risk from, these modes compared to mosquito transmission. Additional research is urgently needed on the risk, pathogenesis, and effectiveness of measures to mitigate non-vector-borne ZIKV transmission. |
Update: Interim guidance for health care providers caring for pregnant women with possible Zika virus exposure - United States (including U.S. territories), July 2017
Oduyebo T , Polen KD , Walke HT , Reagan-Steiner S , Lathrop E , Rabe IB , Kuhnert-Tallman WL , Martin SW , Walker AT , Gregory CJ , Ades EW , Carroll DS , Rivera M , Perez-Padilla J , Gould C , Nemhauser JB , Ben Beard C , Harcourt JL , Viens L , Johansson M , Ellington SR , Petersen E , Smith LA , Reichard J , Munoz-Jordan J , Beach MJ , Rose DA , Barzilay E , Noonan-Smith M , Jamieson DJ , Zaki SR , Petersen LR , Honein MA , Meaney-Delman D . MMWR Morb Mortal Wkly Rep 2017 66 (29) 781-793 CDC has updated the interim guidance for U.S. health care providers caring for pregnant women with possible Zika virus exposure in response to 1) declining prevalence of Zika virus disease in the World Health Organization's Region of the Americas (Americas) and 2) emerging evidence indicating prolonged detection of Zika virus immunoglobulin M (IgM) antibodies. Zika virus cases were first reported in the Americas during 2015-2016; however, the incidence of Zika virus disease has since declined. As the prevalence of Zika virus disease declines, the likelihood of false-positive test results increases. In addition, emerging epidemiologic and laboratory data indicate that, as is the case with other flaviviruses, Zika virus IgM antibodies can persist beyond 12 weeks after infection. Therefore, IgM test results cannot always reliably distinguish between an infection that occurred during the current pregnancy and one that occurred before the current pregnancy, particularly for women with possible Zika virus exposure before the current pregnancy. These limitations should be considered when counseling pregnant women about the risks and benefits of testing for Zika virus infection during pregnancy. This updated guidance emphasizes a shared decision-making model for testing and screening pregnant women, one in which patients and providers work together to make decisions about testing and care plans based on patient preferences and values, clinical judgment, and a balanced assessment of risks and expected outcomes. |
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