Invasive meningococcal disease (IMD), caused by infection with the bacterium Neisseria meningitidis, usually manifests as meningitis or septicemia and can be severe and life-threatening (1). Six serogroups (A, B, C, W, X, and Y) account for most cases (2). N. meningitidis is transmitted person-to-person via respiratory droplets and oropharyngeal secretions. Asymptomatic persons can carry N. meningitidis and transmit the bacteria to others, potentially causing illness among susceptible persons. Outbreaks can occur in conjunction with large gatherings (3,4). Vaccines are available to prevent meningococcal disease. Antibiotic prophylaxis for close contacts of infected persons is critical to preventing secondary cases (2).

Microscopy performed on stained films of peripheral blood for detection, identification and quantification of malaria parasites is an essential reference standard for clinical trials of drugs, vaccines and diagnostic tests for malaria. The value of data from such research is greatly enhanced if this reference standard is consistent across time and geography. Adherence to common standards and practices is a prerequisite to achieve this. The rationale for proposed research standards and procedures for the preparation, staining and microscopic examination of blood films for malaria parasites is presented here with the aim of improving the consistency and reliability of malaria microscopy performed in such studies. These standards constitute the core of a quality management system for clinical research studies employing microscopy as a reference standard. They can be used as the basis for the design of training and proficiency testing programmes as well as for procedures and quality assurance of malaria microscopy in clinical research.

Two decades ago, a wave of effectiveness trials demonstrating the enormous potential to reduce both diabetes and its complications gave a new stimulus to implementation research intended to find the best ways to translate, implement, and evaluate prevention through mediums of public health action.1–3 This burgeoning research portfolio largely used approaches that were limited by the available data infrastructures and study designs of the day. For example, translating primary prevention of diabetes employed pragmatic, randomized implementation studies, using the proof of concept of prevention but modifying the target population, context, dosage, or delivery mode.4 Similarly, translation studies to improve care for diabetes focused on trials or observations of the health care delivery unit and how changes in team composition and workflows, information sharing, communication, or decision support could improve real-world delivery of care.5,6 These efforts contributed to long-term reductions in diabetes complications in the United States and laid the groundwork for broader efforts to scale up primary prevention.7,8 Despite these successes, though, the impact of the diabetes epidemic is persistent and unpredictable.9 National surveillance data of diabetes complications and the cascades of care have shown that the diffusion of effective interventions is often patchwork and selective, and there has been no narrowing of the socioeconomic disparities that have characterized the diabetes epidemic.10–12 Further, there is new evidence of an increasing divide along age and socioeconomic lines.13

Purpose: Using the Academy of Nutrition and Dietetics benchmarks as a framework, this study examined childcare providers' (Head Start [HS], Child and Adult Care Food Program [CACFP] funded, and non-CACFP) perspectives regarding communicating with parents about nutrition to promote children's health. Design: Qualitative. Setting: State-licensed center-based childcare programs. Participants: Full-time childcare providers (n = 18) caring for children 2 to 5 years old from varying childcare contexts (HS, CACFP funded, and non-CACFP), race, education, and years of experience. Methods: In-person interviews using semi-structured interview protocol until saturation were achieved. Thematic analysis was conducted. Results: Two overarching themes were barriers and strategies to communicate with parents about children's nutrition. Barriers to communication included - (a) parents are too busy to talk with providers, (b) parents offer unhealthy foods, (c) parents prioritize talking about child food issues over nutrition, (d) providers are unsure of how to communicate about nutrition without offending parents, and (e) providers are concerned if parents are receptive to nutrition education materials. Strategies for communication included - (a) recognize the benefits of communicating with parents about nutrition to support child health, (b) build a partnership with parents through education, (c) leverage policy (federal and state) to communicate positively and avoid conflict, (d) implement center-level practices to reinforce policy, and (e) foster a respectful relationship between providers and parents. Conclusion: Policy and environmental changes were recommended for fostering a respectful relationship and building a bridge between providers and parents to improve communication about children's nutrition and health.

BACKGROUND: Ebola virus disease (EVD) in health workers (HWs) has been a major challenge during the 2014-2015 outbreak. We examined factors associated with Ebola virus exposure and mortality in HWs in Kenema District, Sierra Leone. METHODS: We analyzed data from the Sierra Leone National Viral Hemorrhagic Fever Database, contact tracing records, Kenema Government Hospital (KGH) staff and Ebola Treatment Unit (ETU) rosters, and burial logs. RESULTS: From May 2014 through January 2015, 600 cases of EVD originated in Kenema District, including 92 (15%) HWs, 66 (72%) of whom worked at KGH. Among KGH medical staff and international volunteers, 18 of 62 (29%) who worked in the ETU developed EVD, compared with 48 of 83 (58%) who worked elsewhere in the hospital. Thirteen percent of HWs with EVD reported contact with EVD patients, while 27% reported contact with other infected HWs. The number of HW EVD cases at KGH declined roughly 1 month after implementation of a new triage system at KGH and the opening of a second ETU within the district. The case fatality ratio for HWs and non-HWs with EVD was 69% and 74%, respectively. CONCLUSIONS: The cluster of HW EVD cases in Kenema District is one of the largest ever reported. Most HWs with EVD had potential virus exposure both inside and outside of hospitals. Prevention measures for HWs must address a spectrum of infection risks in both formal and informal care settings as well as in the community.

During 2013, we collected and tested ticks for Heartland virus (HRTV), a recently described human pathogen in the genus Phlebovirus (Bunyaviridae), from six sites in northwestern Missouri. Five sites were properties owned by HRTV patients, and the sixth was a conservation area that yielded virus in ticks during 2012. We collected 39,096 ticks representing five species; however, two species, Amblyomma americanum (L.) (97.6%) and Dermacentor variabilis (Say) (2.3%), accounted for nearly all ticks collected. We detected 60 HRTV-positive tick pools and all were composed of A. americanum: 53 pools of nymphs, six pools of male adults, and one pool of female adults. This is the first record of HRTV in adult ticks. Virus was detected at five properties that yielded A. americanum ticks, including properties owned by four of five patients. Virus was detected at two sites that yielded virus in 2012. Detection of virus in multiple years indicates that the virus persists in ticks within a relatively small geographic area, although infection rates (IR) may vary greatly among sites and between years at a site. IR per 1,000 A. americanumin northwestern Missouri during the April-July 2013 study period were as follows: all adults, IR = 1.13; adult females, IR = 0.33; adult males, IR = 1.90; and nymphs, IR = 1.79. The IR in nymphs, the stage with the largest data set, corresponds to 1/559 infected ticks. Having robust estimates of IR in various stages for A. americanum should lead to more accurate public health messaging and a better understanding of virus transmission.

Molecular data are now widely used in epidemiological studies to investigate the transmission, distribution, biology, and diversity of pathogens. Our objective was to establish recommendations to support good scientific reporting of molecular epidemiological studies to encourage authors to consider specific threats to valid inference. The statement Strengthening the Reporting of Molecular Epidemiology for Infectious Diseases (STROME-ID) builds upon the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiative. The STROME-ID statement was developed by a working group of epidemiologists, statisticians, bioinformaticians, virologists, and microbiologists with expertise in control of infection and communicable diseases. The statement focuses on issues relating to the reporting of epidemiological studies of infectious diseases using molecular data that were not addressed by STROBE. STROME-ID addresses terminology, measures of genetic diversity within pathogen populations, laboratory methods, sample collection, use of molecular markers, molecular clocks, timeframe, multiple-strain infections, non-independence of infectious-disease data, missing data, ascertainment bias, consistency between molecular and epidemiological data, and ethical considerations with respect to infectious-disease research. In total, 20 items were added to the 22 item STROBE checklist. When used, the STROME-ID recommendations should advance the quality and transparency of scientific reporting, with clear benefits for evidence reviews and health-policy decision making.

We describe a 26-year-old man treated with azathioprine for myasthenia gravis who developed acute left-sided peripheral facial weakness. Brain magnetic resonance imaging (MRI) revealed enhancement in the left geniculate ganglion and in the intracanalicular and tympanic segments of the facial nerve. Analysis of cerebrospinal fluid (CSF) and serum revealed intrathecal synthesis of anti-varicella zoster virus (VZV) IgG antibody. Although previous analyses of saliva, blood mononuclear cells, serum antibodies, middle ear fluid, and auricular and geniculate zone skin scrapings have shown that a small but definite proportion of patients with idiopathic peripheral facial palsy ("Bell's palsy") have the Ramsay Hunt syndrome zoster sine herpete (RHS ZSH), this is the first confirmation of RHS ZSH by intrathecal synthesis of anti-VZV IgG antibody. In addition, herpes simplex virus (HSV)-1 DNA was found in saliva of the patient on 3 consecutive days. Simultaneous reactivation of two alphaherpesviruses (HSV-1 and VZV) in our immunosuppressed patient underscores the need to consider opportunistic infection as a cause of facial weakness.

OBJECTIVES: The aim of this study is to examine a large cohort of adults who received the zoster vaccine for evidence of an increased risk of pre-specified adverse events requiring medical attention. DESIGN: Two self-comparison approaches, including a case-centered approach and a self-controlled case series (SCCS) analysis were used. SETTING: Eight managed care organizations participating in the Vaccine Safety Datalink project in the United States. SUBJECTS: A total of 193,083 adults aged 50 and older receiving a zoster vaccine from January 1(st) 2007 to December 31(st) 2008 were included. MAIN OUTCOME MEASURES: Pre-specified adverse events were identified by aggregated International Classification of Diseases, Ninth Revision (ICD-9) codes in automated health plan datasets. RESULTS: The risk of allergic reaction was significantly increased within 1-7 days of vaccination (relative risk =2.13, 95% Confidence Interval (CI): 1.87-2.40 by case-centered method and relative rate=2.32, 95% CI: 1.85-2.91 by SCCS). No increased risk was found for the following adverse event groupings: cerebrovascular events; cardiovascular events; meningitis, encephalitis, and encephalopathy; and Ramsay-Hunt syndrome and Bell's palsy. CONCLUSIONS: The results of this study support the findings from the pre-licensure clinical trials, providing reassurance that the zoster vaccine is generally safe and well tolerated with a small increased risk of allergic reactions in 1-7 days after vaccination.