Last data update: Apr 29, 2024. (Total: 46658 publications since 2009)
Records 1-16 (of 16 Records) |
Query Trace: Rhea S [original query] |
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Telehealth Practice Among Health Centers During the COVID-19 Pandemic - United States, July 11-17, 2020.
Demeke HB , Pao LZ , Clark H , Romero L , Neri A , Shah R , McDow KB , Tindall E , Iqbal NJ , Hatfield-Timajchy K , Bolton J , Le X , Hair B , Campbell S , Bui C , Sandhu P , Nwaise I , Armstrong PA , Rose MA . MMWR Morb Mortal Wkly Rep 2020 69 (50) 1902-1905 Early in the coronavirus disease 2019 (COVID-19) pandemic, in-person ambulatory health care visits declined by 60% across the United States, while telehealth* visits increased, accounting for up to 30% of total care provided in some locations (1,2). In March 2020, the Centers for Medicare & Medicaid Services (CMS) released updated regulations and guidance changing telehealth provisions during the COVID-19 Public Health Emergency, including the elimination of geographic barriers and enhanced reimbursement for telehealth services(†) (3-6). The Health Resources and Services Administration (HRSA) administers a voluntary weekly Health Center COVID-19 Survey(§) to track health centers' COVID-19 testing capacity and the impact of COVID-19 on operations, patients, and staff. CDC and HRSA analyzed data from the weekly COVID-19 survey completed by 1,009 HRSA-funded health centers (health centers(¶)) for the week of July 11-17, 2020, to describe telehealth service use in the United States by U.S. Census region,** urbanicity,(††) staffing capacity, change in visit volume, and personal protective equipment (PPE) supply. Among the 1,009 health center respondents, 963 (95.4%) reported providing telehealth services. Health centers in urban areas were more likely to provide >30% of health care visits virtually (i.e., via telehealth) than were health centers in rural areas. Telehealth is a promising approach to promoting access to care and can facilitate public health mitigation strategies and help prevent transmission of SARS-CoV-2 and other respiratory illnesses, while supporting continuity of care. Although CMS's change of its telehealth provisions enabled health centers to expand telehealth by aligning guidance and leveraging federal resources, sustaining expanded use of telehealth services might require additional policies and resources. |
Coronavirus Disease among Workers in Food Processing, Food Manufacturing, and Agriculture Workplaces.
Waltenburg MA , Rose CE , Victoroff T , Butterfield M , Dillaha JA , Heinzerling A , Chuey M , Fierro M , Jervis RH , Fedak KM , Leapley A , Gabel JA , Feldpausch A , Dunne EM , Austin C , Pedati CS , Ahmed FS , Tubach S , Rhea C , Tonzel J , Krueger A , Crum DA , Vostok J , Moore MJ , Kempher H , Scheftel J , Turabelidze G , Stover D , Donahue M , Thomas D , Edge K , Gutierrez B , Berl E , McLafferty M , Kline KE , Martz N , Rajotte JC , Julian E , Diedhiou A , Radcliffe R , Clayton JL , Ortbahn D , Cummins J , Barbeau B , Carpenter S , Pringle JC , Murphy J , Darby B , Graff NR , Dostal TKH , Pray IW , Tillman C , Rose DA , Honein MA . Emerg Infect Dis 2020 27 (1) 243-9 We describe coronavirus disease (COVID-19) among US food manufacturing and agriculture workers and provide updated information on meat and poultry processing workers. Among 742 food and agriculture workplaces in 30 states, 8,978 workers had confirmed COVID-19; 55 workers died. Racial and ethnic minority workers could be disproportionately affected by COVID-19. |
Update: COVID-19 Among Workers in Meat and Poultry Processing Facilities - United States, April-May 2020.
Waltenburg MA , Victoroff T , Rose CE , Butterfield M , Jervis RH , Fedak KM , Gabel JA , Feldpausch A , Dunne EM , Austin C , Ahmed FS , Tubach S , Rhea C , Krueger A , Crum DA , Vostok J , Moore MJ , Turabelidze G , Stover D , Donahue M , Edge K , Gutierrez B , Kline KE , Martz N , Rajotte JC , Julian E , Diedhiou A , Radcliffe R , Clayton JL , Ortbahn D , Cummins J , Barbeau B , Murphy J , Darby B , Graff NR , Dostal TKH , Pray IW , Tillman C , Dittrich MM , Burns-Grant G , Lee S , Spieckerman A , Iqbal K , Griffing SM , Lawson A , Mainzer HM , Bealle AE , Edding E , Arnold KE , Rodriguez T , Merkle S , Pettrone K , Schlanger K , LaBar K , Hendricks K , Lasry A , Krishnasamy V , Walke HT , Rose DA , Honein MA . MMWR Morb Mortal Wkly Rep 2020 69 (27) 887-892 Meat and poultry processing facilities face distinctive challenges in the control of infectious diseases, including coronavirus disease 2019 (COVID-19) (1). COVID-19 outbreaks among meat and poultry processing facility workers can rapidly affect large numbers of persons. Assessment of COVID-19 cases among workers in 115 meat and poultry processing facilities through April 27, 2020, documented 4,913 cases and 20 deaths reported by 19 states (1). This report provides updated aggregate data from states regarding the number of meat and poultry processing facilities affected by COVID-19, the number and demographic characteristics of affected workers, and the number of COVID-19-associated deaths among workers, as well as descriptions of interventions and prevention efforts at these facilities. Aggregate data on confirmed COVID-19 cases and deaths among workers identified and reported through May 31, 2020, were obtained from 239 affected facilities (those with a laboratory-confirmed COVID-19 case in one or more workers) in 23 states.* COVID-19 was confirmed in 16,233 workers, including 86 COVID-19-related deaths. Among 14 states reporting the total number of workers in affected meat and poultry processing facilities (112,616), COVID-19 was diagnosed in 9.1% of workers. Among 9,919 (61%) cases in 21 states with reported race/ethnicity, 87% occurred among racial and ethnic minority workers. Commonly reported interventions and prevention efforts at facilities included implementing worker temperature or symptom screening and COVID-19 education, mandating face coverings, adding hand hygiene stations, and adding physical barriers between workers. Targeted workplace interventions and prevention efforts that are appropriately tailored to the groups most affected by COVID-19 are critical to reducing both COVID-19-associated occupational risk and health disparities among vulnerable populations. Implementation of these interventions and prevention efforts(dagger) across meat and poultry processing facilities nationally could help protect workers in this critical infrastructure industry. |
Modeling inpatient and outpatient antibiotic stewardship interventions to reduce the burden of Clostridioides difficile infection in a regional healthcare network
Rhea S , Jones K , Endres-Dighe S , Munoz B , Weber DJ , Hilscher R , MacFarquhar J , Sickbert-Bennett E , DiBiase L , Marx A , Rineer J , Lewis J , Bobashev G . PLoS One 2020 15 (6) e0234031 Antibiotic exposure can lead to unintended outcomes, including drug-drug interactions, adverse drug events, and healthcare-associated infections like Clostridioides difficile infection (CDI). Improving antibiotic use is critical to reduce an individual's CDI risk. Antibiotic stewardship initiatives can reduce inappropriate antibiotic prescribing (e.g., unnecessary antibiotic prescribing, inappropriate antibiotic selection), impacting both hospital (healthcare)-onset (HO)-CDI and community-associated (CA)-CDI. Previous computational and mathematical modeling studies have demonstrated a reduction in CDI incidence associated with antibiotic stewardship initiatives in hospital settings. Although the impact of antibiotic stewardship initiatives in long-term care facilities (LTCFs), including nursing homes, and in outpatient settings have been documented, the effects of specific interventions on CDI incidence are not well understood. We examined the relative effectiveness of antibiotic stewardship interventions on CDI incidence using a geospatially explicit agent-based model of a regional healthcare network in North Carolina. We simulated reductions in unnecessary antibiotic prescribing and inappropriate antibiotic selection with intervention scenarios at individual and network healthcare facilities, including short-term acute care hospitals (STACHs), nursing homes, and outpatient locations. Modeled antibiotic prescription rates were calculated using patient-level data on antibiotic length of therapy for the 10 modeled network STACHs. By simulating a 30% reduction in antibiotics prescribed across all inpatient and outpatient locations, we found the greatest reductions on network CDI incidence among tested scenarios, namely a 17% decrease in HO-CDI incidence and 7% decrease in CA-CDI. Among intervention scenarios of reducing inappropriate antibiotic selection, we found a greater impact on network CDI incidence when modeling this reduction in nursing homes alone compared to the same intervention in STACHs alone. These results support the potential importance of LTCF and outpatient antibiotic stewardship efforts on network CDI burden and add to the evidence that a coordinated approach to antibiotic stewardship across multiple facilities, including inpatient and outpatient settings, within a regional healthcare network could be an effective strategy to reduce network CDI burden. |
COVID-19 Among Workers in Meat and Poultry Processing Facilities - 19 States, April 2020.
Dyal JW , Grant MP , Broadwater K , Bjork A , Waltenburg MA , Gibbins JD , Hale C , Silver M , Fischer M , Steinberg J , Basler CA , Jacobs JR , Kennedy ED , Tomasi S , Trout D , Hornsby-Myers J , Oussayef NL , Delaney LJ , Patel K , Shetty V , Kline KE , Schroeder B , Herlihy RK , House J , Jervis R , Clayton JL , Ortbahn D , Austin C , Berl E , Moore Z , Buss BF , Stover D , Westergaard R , Pray I , DeBolt M , Person A , Gabel J , Kittle TS , Hendren P , Rhea C , Holsinger C , Dunn J , Turabelidze G , Ahmed FS , deFijter S , Pedati CS , Rattay K , Smith EE , Luna-Pinto C , Cooley LA , Saydah S , Preacely ND , Maddox RA , Lundeen E , Goodwin B , Karpathy SE , Griffing S , Jenkins MM , Lowry G , Schwarz RD , Yoder J , Peacock G , Walke HT , Rose DA , Honein MA . MMWR Morb Mortal Wkly Rep 2020 69 (18) Congregate work and residential locations are at increased risk for infectious disease transmission including respiratory illness outbreaks. SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), is primarily spread person to person through respiratory droplets. Nationwide, the meat and poultry processing industry, an essential component of the U.S. food infrastructure, employs approximately 500,000 persons, many of whom work in proximity to other workers (1). Because of reports of initial cases of COVID-19, in some meat processing facilities, states were asked to provide aggregated data concerning the number of meat and poultry processing facilities affected by COVID-19 and the number of workers with COVID-19 in these facilities, including COVID-19-related deaths. Qualitative data gathered by CDC during on-site and remote assessments were analyzed and summarized. During April 9-27, aggregate data on COVID-19 cases among 115 meat or poultry processing facilities in 19 states were reported to CDC. Among these facilities, COVID-19 was diagnosed in 4,913 (approximately 3%) workers, and 20 COVID-19-related deaths were reported. Facility barriers to effective prevention and control of COVID-19 included difficulty distancing workers at least 6 feet (2 meters) from one another (2) and in implementing COVID-19-specific disinfection guidelines.* Among workers, socioeconomic challenges might contribute to working while feeling ill, particularly if there are management practices such as bonuses that incentivize attendance. Methods to decrease transmission within the facility include worker symptom screening programs, policies to discourage working while experiencing symptoms compatible with COVID-19, and social distancing by workers. Source control measures (e.g., the use of cloth face covers) as well as increased disinfection of high-touch surfaces are also important means of preventing SARS-CoV-2 exposure. Mitigation efforts to reduce transmission in the community should also be considered. Many of these measures might also reduce asymptomatic and presymptomatic transmission (3). Implementation of these public health strategies will help protect workers from COVID-19 in this industry and assist in preserving the critical meat and poultry production infrastructure (4). |
Modeling Infectious Diseases in Healthcare Network (MInD-Healthcare) framework for describing and reporting multidrug resistant organism and healthcare-associated infections agent-based modeling methods
Slayton RB , O'Hagan JJ , Barnes S , Rhea S , Hilscher R , Rubin M , Lofgren E , Singh B , Segre A , Paul P . Clin Infect Dis 2020 71 (9) 2527-2532 Mathematical modeling of healthcare associated infections (HAIs) and multidrug resistant organisms (MDROs) improves our understanding of pathogens transmission dynamics and provides a framework for evaluating prevention strategies. One way of improving the communication among modelers is by providing a standardized way of describing and reporting models thereby instilling confidence in the reproducibility and generalizability of such models. We updated the Overview, Design concepts, and Details protocol developed by Grimm et al. for describing agent-based models (ABMs) to better align with elements commonly included in healthcare-related ABMs. The MInD-Healthcare framework includes the following nine key elements: 1. Purpose and scope; 2. Entities, state variables, and scales; 3. Initialization; 4. Process overview and scheduling; 5. Input data; 6. Agent interactions and organism transmission; 7. Stochasticity; 8. Submodels; 9. Model verification, calibration, and validation. Our objective is that this framework will improve the quality of evidence generated utilizing these models. |
Creation of a geospatially explicit, agent-based model of a regional healthcare network with application to Clostridioides difficile infection
Rhea S , Hilscher R , Rineer JI , Munoz B , Jones K , Endres-Dighe SM , DiBiase LM , Sickbert-Bennett EE , Weber DJ , MacFarquhar JK , Dubendris H , Bobashev G . Health Secur 2019 17 (4) 276-290 Agent-based models (ABMs) describe and simulate complex systems comprising unique agents, or individuals, while accounting for geospatial and temporal variability among dynamic processes. ABMs are increasingly used to study healthcare-associated infections (ie, infections acquired during admission to a healthcare facility), including Clostridioides difficile infection, currently the most common healthcare-associated infection in the United States. The overall burden and transmission dynamics of healthcare-associated infections, including C difficile infection, may be influenced by community sources and movement of people among healthcare facilities and communities. These complex dynamics warrant geospatially explicit ABMs that extend beyond single healthcare facilities to include entire systems (eg, hospitals, nursing homes and extended care facilities, the community). The agents in ABMs can be built on a synthetic population, a model-generated representation of the actual population with associated spatial (eg, home residence), temporal (eg, change in location over time), and nonspatial (eg, sociodemographic features) attributes. We describe our methods to create a geospatially explicit ABM of a major regional healthcare network using a synthetic population as microdata input. We illustrate agent movement in the healthcare network and the community, informed by patient-level medical records, aggregate hospital discharge data, healthcare facility licensing data, and published literature. We apply the ABM output to visualize agent movement in the healthcare network and the community served by the network. We provide an application example of the ABM to C difficile infection using a natural history submodel. We discuss the ABM's potential to detect network areas where disease risk is high; simulate and evaluate interventions to protect public health; adapt to other geographic locations and healthcare-associated infections, including emerging pathogens; and meaningfully translate results to public health practitioners, healthcare providers, and policymakers. |
Integrated hepatitis C testing and linkage to care at a local health department STD clinic: Determining essential resources and evaluating outcomes
Rhea S , Sena AC , Hilton A , Hurt CB , Wohl D , Fleischauer A . Sex Transm Dis 2017 45 (4) 229-232 Guidance about integration of comprehensive hepatitis C virus (HCV)-related services in sexually transmitted disease (STD) clinics is limited. We evaluated a federally-funded HCV testing and linkage-to-care program at an STD clinic in Durham County, North Carolina. During December 10, 2012-March 31, 2015, the program tested 733 patients for HCV who reported >/=1 HCV risk factor; 81 (11%) were HCV-infected (i.e., HCV antibody-positive and HCV ribonucleic acid-positive). Fifty-one infected patients (63%) were linked to care. We concluded that essential program resources include reflex HCV ribonucleic acid testing; a dedicated bridge counselor to provide test results, health education, and linkage-to-care assistance; and referral relationships for local HCV management and treatment. |
Hospitalizations for endocarditis and associated health care costs among persons with diagnosed drug dependence - North Carolina, 2010-2015
Fleischauer AT , Ruhl L , Rhea S , Barnes E . MMWR Morb Mortal Wkly Rep 2017 66 (22) 569-573 Opioid dependence and overdose have increased to epidemic levels in the United States. The 2014 National Survey on Drug Use and Health estimated that 4.3 million persons were nonmedical users of prescription pain relievers (1). These users are 40 times more likely than the general population to use heroin or other injection drugs (2). Furthermore, CDC estimated a near quadrupling of heroin-related overdose deaths during 2002-2014 (3). Although overdose contributes most to drug-associated mortality, infectious complications of intravenous drug use constitute a major cause of morbidity leading to hospitalization (4). In addition to infections from hepatitis C virus (HCV) and human immunodeficiency virus (HIV), injecting drug users are at increased risk for acquiring invasive bacterial infections, including endocarditis (5,6). Evidence that hospitalizations for endocarditis are increasing in association with the current opioid epidemic exists (7-9). To examine trends in hospitalizations for endocarditis among persons in North Carolina with drug dependence during 2010-2015, data from the North Carolina Hospital Discharge database were analyzed. The incidence of hospital discharge diagnoses for drug dependence combined with endocarditis increased more than twelvefold from 0.2 to 2.7 per 100,000 persons per year over this 6-year period. Correspondingly, hospital costs for these patients increased eighteenfold, from $1.1 million in 2010 to $22.2 million in 2015. To reduce the risk for morbidity and mortality related to opioid-associated endocarditis, public health programs and health care systems should consider collaborating to implement syringe service programs, harm reduction strategies, and opioid treatment programs. |
Impact of delays between the Clinical and Laboratory Standards Institute (CLSI) and the Food and Drug Administration (FDA) revising interpretive criteria for carbapenem-resistant Enterobacteriaceae (CRE)
Bartsch SM , Huang SS , Wong KF , Slayton RB , McKinnell JA , Sahm DF , Kazmierczak K , Mueller LE , Jernigan JA , Lee BY . J Clin Microbiol 2016 54 (11) 2757-2762 Delays often occur between CLSI and FDA revisions of antimicrobial interpretive criteria. Using our RHEA simulation model, we found the 32-month delay in changing CRE breakpoints might have resulted in 1,821 additional carriers in Orange County, CA that could have been avoided by identifying CRE and initiating contact precautions. Policy makers should aim to minimize the delay in the adoption of new breakpoints for antimicrobials for emerging pathogens where containment of spread is paramount, with delays under 1.5 years being ideal. |
Hepatitis C in North Carolina: Two epidemics with one public health response
Rhea S , Fleischauer A , Foust E , Davies M . N C Med J 2016 77 (3) 190-2 Hepatitis C virus (HCV) infection, the most common blood-borne infection in the United States, is most | frequently transmitted through injection drug use [1]. | Although HCV infection can be acute and self-limiting, | approximately 75%–85% of infected persons will develop | chronic illness. Of the estimated 3.5 million persons in the | United States with chronic HCV infection, approximately | 75% were born during the period 1945–1965 (ie, baby | boomers) [1-3]. Chronic HCV infection has been referred | to as a silent epidemic. Approximately 50% of those | with chronic infection are unaware of their status and do | not receive recommended medical care and treatment, | increasing the possibility of progression to liver disease, | cirrhosis, liver cancer, and death [1, 2]. |
Hepatitis B Reverse Seroconversion and Transmission in a Hemodialysis Center: A Public Health Investigation and Case Report.
Rhea S , Moorman A , Pace R , Mobley V , MacFarquhar J , Robinson E , Hayden T , Thai H , Drobeniuc J , Brooks JT , Moore Z , Patel PR . Am J Kidney Dis 2016 68 (2) 292-295 In March 2013, public health authorities were notified of a new hepatitis B virus (HBV) infection in a patient receiving hemodialysis. We investigated to identify the source and prevent additional infections. We reviewed medical records, interviewed the index patient regarding hepatitis B risk factors, performed HBV molecular analysis, and observed infection control practices at the outpatient hemodialysis facility where she received care. The index patient's only identified hepatitis B risk factor was hemodialysis treatment. The facility had no other patients with known active HBV infection. One patient had evidence of a resolved HBV infection. Investigation of this individual, who was identified as the source patient, indicated that HBV reverse seroconversion and reactivation had occurred in the setting of HIV (human immunodeficiency virus) infection and a failed kidney transplant. HBV whole genome sequences analysis from the index and source patients indicated 99.9% genetic homology. Facility observations revealed multiple infection control breaches. Inadequate dilution of the source patient's sample during HBV testing might have led to a false-negative result, delaying initiation of hemodialysis in isolation. In conclusion, HBV transmission occurred after an HIV-positive hemodialysis patient with transplant-related immunosuppression experienced HBV reverse seroconversion and reactivation. Providers should be aware of this possibility, especially among severely immunosuppressed patients, and maintain stringent infection control. |
The potential trajectory of carbapenem-resistant Enterobacteriaceae, an emerging threat to health-care facilities, and the impact of the Centers for Disease Control and Prevention toolkit
Lee BY , Bartsch SM , Wong KF , McKinnell JA , Slayton RB , Miller LG , Cao C , Kim DS , Kallen AJ , Jernigan JA , Huang SS . Am J Epidemiol 2016 183 (5) 471-9 Carbapenem-resistant Enterobacteriaceae (CRE), a group of pathogens resistant to most antibiotics and associated with high mortality, are a rising emerging public health threat. Current approaches to infection control and prevention have not been adequate to prevent spread. An important but unproven approach is to have hospitals in a region coordinate surveillance and infection control measures. Using our Regional Healthcare Ecosystem Analyst (RHEA) simulation model and detailed Orange County, California, patient-level data on adult inpatient hospital and nursing home admissions (2011-2012), we simulated the spread of CRE throughout Orange County health-care facilities under 3 scenarios: no specific control measures, facility-level infection control efforts (uncoordinated control measures), and a coordinated regional effort. Aggressive uncoordinated and coordinated approaches were highly similar, averting 2,976 and 2,789 CRE transmission events, respectively (72.2% and 77.0% of transmission events), by year 5. With moderate control measures, coordinated regional control resulted in 21.3% more averted cases (n = 408) than did uncoordinated control at year 5. Our model suggests that without increased infection control approaches, CRE would become endemic in nearly all Orange County health-care facilities within 10 years. While implementing the interventions in the Centers for Disease Control and Prevention's CRE toolkit would not completely stop the spread of CRE, it would cut its spread substantially, by half. |
Notes from the field: atypical pneumonia in three members of an extended family - South Carolina and north Carolina, July-August 2013
Rhea SK , Cox SW , Moore ZS , Mays ER , Benitez AJ , Diaz MH , Winchell JM . MMWR Morb Mortal Wkly Rep 2014 63 (33) 734-5 On August 5, 2013, the South Carolina Department of Health and Environmental Control was notified of a case of acute respiratory failure in a previously healthy woman. A family interview revealed the patient's uncle and cousin had also been hospitalized with similar symptoms in North Carolina. The South Carolina Department of Health and Environmental Control and the North Carolina Division of Public Health collaborated to identify the cause of the respiratory illness cluster and to prevent additional illnesses. |
Using near real-time morbidity data to identify heat-related illness prevention strategies in North Carolina
Rhea S , Ising A , Fleischauer AT , Deyneka L , Vaughan-Batten H , Waller A . J Community Health 2012 37 (2) 495-500 Timely public health interventions reduce heat-related illnesses (HRIs). HRI emergency department (ED) visit data provide near real-time morbidity information to local and state public health practitioners and may be useful in directing HRI prevention efforts. This study examined statewide HRI ED visits in North Carolina (NC) from 2008-2010 by age group, month, ED disposition, chief complaint, and triage notes. The mean number of HRI ED visits per day was compared to the maximum daily temperature. The percentage of HRI ED visits to all ED visits was highest in June (0.25%). 15-18 year-olds had the highest percentage of HRI visits and were often seen for sports-related heat exposures. Work-related HRI ED visits were more common than other causes in 19-45 year-olds. Individuals ≥65 years were more likely admitted to the hospital than younger individuals. The mean daily number of HRI ED visits increased by 1.4 for each 1 degrees F (degree Fahrenheit) increase from 90 degrees F to 98 degrees F and by 15.8 for each 1 degrees F increase from 98 degrees F to 100 degrees F. Results indicate that HRI prevention efforts in NC should be emphasized in early summer and targeted to adolescents involved in organized sports, young adults with outdoor occupations, and seniors. At a maximum daily temperature of 98 degrees F, there was a substantial increase in the average daily number of HRI ED visits. ED visit data provide timely, sentinel HRI information. Analysis of this near real-time morbidity data may assist local and state public health practitioners in identification of HRI prevention strategies that are especially relevant to their jurisdictions. |
Receptor specificity of influenza A H3N2 viruses isolated in mammalian cells and embryonated chicken eggs
Stevens J , Chen LM , Carney PJ , Garten R , Foust A , Le J , Pokorny BA , Manojkumar R , Silverman J , Devis R , Rhea K , Xu X , Bucher DJ , Paulson J , Cox NJ , Klimov A , Donis RO . J Virol 2010 84 (16) 8287-99 Isolation of human subtype H3N2 influenza viruses in embryonated chicken eggs yields viruses with amino acid substitutions in the hemagglutinin (HA) that often affect binding to sialic acid receptors. We used a glycan array approach to analyze the repertoire of sialylated glycans recognized by viruses from the same clinical specimen isolated in eggs or cell cultures. The binding profiles of whole virions to 85 sialoglycans on the microarray allowed the categorization of cell isolates into 2 groups. Group 1 cell isolates displayed binding to a restricted set of alpha2-6 and alpha2-3 sialoglycans whereas Group 2 cell isolates revealed broader receptor specificity relative to their egg counterparts. Egg isolates from Group 1 showed similar binding specificity as cell isolates, whereas Group 2 egg isolates showed a significantly reduced binding to alpha2-6 and alpha2-3-type receptors but retained substantial binding to specific O- and N-linked alpha2-3 glycans, including alpha2-3GalNAc and fucosylated alpha2-3 glycans (including sialyl Lewis x), both of which may be important receptors for H3N2 virus replication in eggs. These results revealed an unexpected diversity in receptor binding specificities among recent H3N2 viruses; with distinct patterns of amino acid substitution in the HA upon isolation and/or propagation in eggs. These findings also suggest that clinical specimens containing viruses with Group 1-like receptor binding profiles would be less prone to undergoing receptor binding or antigenic changes upon isolation in eggs. Screening cell isolates for appropriate receptor binding properties might help focus efforts to isolate the most suitable viruses in eggs for production of antigenically well-matched influenza vaccines. |
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