Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
Records 1-21 (of 21 Records) |
Query Trace: Rose EB[original query] |
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Surveillance of human adenovirus types and the impact of the COVID-19 pandemic on reporting - United States, 2017-2023
Abdirizak F , Winn AK , Parikh R , Scobie HM , Lu X , Vega E , Almendares O , Kirking HL , Rose EB , Silk BJ . MMWR Morb Mortal Wkly Rep 2024 73 (50) 1136-1141 Human adenoviruses (HAdVs) are typically associated with mild respiratory illnesses, although severe disease and outbreaks in congregate settings occur. The National Adenovirus Type Reporting System (NATRS) is a passive, laboratory-based surveillance system that monitors trends in circulation of HAdV types in the United States. This report summarizes the distribution of HAdV types reported to NATRS during 2017-2023. During this 7-year period, 2,241 HAdV specimens with typing results were reported to NATRS. The number of specimens with HAdV typing results reported varied annually during 2017-2019 (range = 389-562) and declined during 2020-2023 (range = 58-356). During 2017-2023, six HAdV types (1-4, 7, and 14) accounted for 88.3% of typed specimens reported; 17.0% of specimens were identified as outbreak-related. An increase in type 41 reporting was associated with a hepatitis cluster during 2021-2022. Reporting to NATRS has declined since the COVID-19 pandemic, despite continued HAdV circulation reported through passive laboratory surveillance to the National Respiratory and Enteric Virus Surveillance System. Enhanced participation in NATRS is needed to improve monitoring of circulating HAdV types. |
Disparities in salmonellosis incidence for US counties with different social determinants of health profiles are also mediated by extreme weather: a counterfactual analysis of Laboratory Enteric Disease Surveillance (LEDS) data from 1997-2019
Weller DL , Tierney R , Verlander S , Bruce BB , Rose EB . J Food Prot 2024 87 (12) 100379 ![]() ![]() Understanding disparities in salmonellosis burden is critical for developing effective, equitable prevention programs. Past efforts to characterize disparities were limited in scope and by the analytical methods available when the study was conducted. We aim to address this gap by identifying disparities in salmonellosis incidence between counties with different determinants of health (DOH) profiles. Using national U.S. Laboratory-based Enteric Disease Surveillance (LEDS) data for 1997-2019, age-adjusted county-level salmonellosis incidence/100,000 persons was calculated and linked to publicly available DOH data. We used hurdle counterfactual random forest (CFRF) to quantify, for each DOH, the risk that (i) ≥1 versus no cases were reported by a county, and (ii) when ≥1 case was reported, whether a high (≥16 cases/100,000 persons) or low incidence (≥1 & <4 cases/100,000 persons) was reported. Risk in both models was significantly associated with demographic DOH, suggesting a disparity between counties with different demographic profiles. Risk was also significantly associated with food, healthcare, physical, and socioeconomic environment. The risk was generally greater for counties with more negative food resources, and for under-resourced counties (e.g., fewer healthcare and social services, fewer grocery stores). Risk was also significantly higher if any extreme weather event occurred. The study also found that underreporting and underascertainment appeared to result in underestimation of salmonellosis incidence in economically marginalized and under-resourced communities. Overall, our analyses indicated that, regardless of other county characteristics, extreme weather was associated with increased salmonellosis incidence, and that certain communities were differentially disadvantaged toward a higher incidence. This information can facilitate the development of community-specific prevention efforts. |
Genomic surveillance for SARS-CoV-2 variants: Circulation of Omicron XBB and JN.1 lineages - United States, May 2023-September 2024
Ma KC , Castro J , Lambrou AS , Rose EB , Cook PW , Batra D , Cubenas C , Hughes LJ , MacCannell DR , Mandal P , Mittal N , Sheth M , Smith C , Winn A , Hall AJ , Wentworth DE , Silk BJ , Thornburg NJ , Paden CR . MMWR Morb Mortal Wkly Rep 2024 73 (42) 938-945 ![]() ![]() CDC continues to track the evolution of SARS-CoV-2, including the Omicron variant and its descendants, using national genomic surveillance. This report summarizes U.S. trends in variant proportion estimates during May 2023-September 2024, a period when SARS-CoV-2 lineages primarily comprised descendants of Omicron variants XBB and JN.1. During summer and fall 2023, multiple descendants of XBB with immune escape substitutions emerged and reached >10% prevalence, including EG.5-like lineages by June 24, FL.1.5.1-like lineages by August 5, HV.1 lineage by September 30, and HK.3-like lineages by November 11. In winter 2023, the JN.1 variant emerged in the United States and rapidly attained predominance nationwide, representing a substantial genetic shift (>30 spike protein amino acid differences) from XBB lineages. Descendants of JN.1 subsequently circulated and reached >10% prevalence, including KQ.1-like and KP.2-like lineages by April 13, KP.3 and LB.1-like lineages by May 25, and KP.3.1.1 by July 20. Surges in COVID-19 cases occurred in winter 2024 during the shift to JN.1 predominance, as well as in summer 2023 and 2024 during circulation of multiple XBB and JN.1 descendants, respectively. The ongoing evolution of the Omicron variant highlights the importance of continued genomic surveillance to guide medical countermeasure development, including the selection of antigens for updated COVID-19 vaccines. |
Machine learning to attribute the source of Campylobacter infections in the United States: a retrospective analysis of national surveillance data
Pascoe B , Futcher G , Pensar J , Bayliss SC , Mourkas E , Calland JK , Hitchings MD , Joseph LA , Lane CG , Greenlee T , Arning N , Wilson DJ , Jolley KA , Corander J , Maiden MCJ , Parker CT , Cooper KK , Rose EB , Hiett K , Bruce BB , Sheppard SK . J Infect 2024 106265 ![]() ![]() ![]() OBJECTIVES: Integrating pathogen genomic surveillance with bioinformatics can enhance public health responses by identifying risk and guiding interventions. This study focusses on the two predominant Campylobacter species, which are commonly found in the gut of birds and mammals and often infect humans via contaminated food. Rising incidence and antimicrobial resistance (AMR) are a global concern and there is an urgent need to quantify the main routes to human infection. METHODS: During routine US national surveillance (2009-2019), 8,856 Campylobacter genomes from human infections and 16,703 from possible sources were sequenced. Using machine learning and probabilistic models, we target genetic variation associated with host adaptation to attribute the source of human infections and estimate the importance of different disease reservoirs. RESULTS: Poultry was identified as the primary source of human infections, responsible for an estimated 68% of cases, followed by cattle (28%), and only a small contribution from wild birds (3%) and pork sources (1%). There was also evidence of an increase in multidrug resistance, particularly among isolates attributed to chickens. CONCLUSIONS: National surveillance and source attribution can guide policy, and our study suggests that interventions targeting poultry will yield the greatest reductions in campylobacteriosis and spread of AMR in the US. DATA AVAILABILITY: All sequence reads were uploaded and shared on NCBI's Sequence Read Archive (SRA) associated with BioProjects; PRJNA239251 (CDC / PulseNet surveillance), PRJNA287430 (FSIS surveillance), PRJNA292668 & PRJNA292664 (NARMS) and PRJNA258022 (FDA surveillance). Publicly available genomes, including reference genomes and isolates sampled worldwide from wild birds are associated with BioProject accessions: PRJNA176480, PRJNA177352, PRJNA342755, PRJNA345429, PRJNA312235, PRJNA415188, PRJNA524300, PRJNA528879, PRJNA529798, PRJNA575343, PRJNA524315 and PRJNA689604. Contiguous assemblies of all genome sequences compared are available at Mendeley data (assembled C. coli genomes doi: 10.17632/gxswjvxyh3.1; assembled C. jejuni genomes doi: 10.17632/6ngsz3dtbd.1) and individual project and accession numbers can be found in Supplementary tables S1 and S2, which also includes pubMLST identifiers for assembled genomes. Figshare (10.6084/m9.figshare.20279928). Interactive phylogenies are hosted on microreact separately for C. jejuni (https://microreact.org/project/pascoe-us-cjejuni) and C. coli (https://microreact.org/project/pascoe-us-ccoli). |
Power law for estimating underdetection of foodborne disease outbreaks, United States
Ford L , Self JL , Wong KK , Hoekstra RM , Tauxe RV , Rose EB , Bruce BB . Emerg Infect Dis 2023 30 (2) 337-340 We fit a power law distribution to US foodborne disease outbreaks to assess underdetection and underreporting. We predicted that 788 fewer than expected small outbreaks were identified annually during 1998-2017 and 365 fewer during 2018-2019, after whole-genome sequencing was implemented. Power law can help assess effectiveness of public health interventions. |
A prediction tool to identify the causative agent of enteric disease outbreaks using outbreak surveillance data
Kisselburgh H , White A , Bruce BB , Rose EB , Scallan Walter E . Foodborne Pathog Dis 2024 21 (2) 83-91 ![]() Information on the causative agent in an enteric disease outbreak can be used to generate hypotheses about the route of transmission and possible vehicles, to guide environmental assessments, and to target outbreak control measures. However, only about 40% of outbreaks reported in the United States include a confirmed etiology. The goal of this project was to identify clinical and demographic characteristics that can be used to predict the causative agent in an enteric disease outbreak and to use these data to develop an online tool for investigators to use during an outbreak when hypothesizing about the causative agent. Using data on enteric disease outbreaks from all transmission routes (animal contact, environmental contamination, foodborne, person-to-person, waterborne, unknown) reported to the U.S. Centers for Disease Control and Prevention, we developed random forest models to predict the etiology of an outbreak based on aggregated clinical and demographic characteristics at both the etiology category (i.e., bacteria, parasites, toxins, viruses) and individual etiology (Clostridium perfringens, Campylobacter, Cryptosporidium, norovirus, Salmonella, Shiga toxin-producing Escherichia coli, and Shigella) levels. The etiology category model had a kappa of 0.85 and an accuracy of 0.92, whereas the etiology-specific model had a kappa of 0.75 and an accuracy of 0.86. The highest sensitivities in the etiology category model were for bacteria and viruses; all categories had high specificities (>0.90). For the etiology-specific model, norovirus and Salmonella had the highest sensitivity and all etiologies had high specificities. When laboratory confirmation is unavailable, information on the clinical signs and symptoms reported by people associated with the outbreak, with other characteristics including case demographics and illness severity, can be used to predict the etiology or etiology category. An online publicly available tool was developed to assist investigators in their enteric disease outbreak investigations. |
Epidemiology and antimicrobial resistance of Campylobacter infections in the United States, 2005-2018
Ford L , Healy JM , Cui Z , Ahart L , Medalla F , Ray LC , Reynolds J , Laughlin ME , Vugia DJ , Hanna S , Bennett C , Chen J , Rose EB , Bruce BB , Payne DC , Francois Watkins LK . Open Forum Infect Dis 2023 10 (8) ofad378 BACKGROUND: Campylobacter is the most common cause of bacterial diarrhea in the United States; resistance to macrolides and fluoroquinolones limits treatment options. We examined the epidemiology of US Campylobacter infections and changes in resistance over time. METHODS: The Foodborne Diseases Active Surveillance Network receives information on laboratory-confirmed Campylobacter cases from 10 US sites, and the National Antimicrobial Resistance Monitoring System receives a subset of isolates from these cases for antimicrobial susceptibility testing. We estimated trends in incidence of Campylobacter infection, adjusting for sex, age, and surveillance changes attributable to culture-independent diagnostic tests. We compared percentages of isolates resistant to erythromycin or ciprofloxacin during 2005-2016 with 2017-2018 and used multivariable logistic regression to examine the association of international travel with resistance. RESULTS: Adjusted Campylobacter incidence remained stable or decreased for all groups analyzed since 2012. Among 2449 linked records in 2017-2018, the median patient age was 40.2 years (interquartile range, 21.6-57.8 years), 54.8% of patients were male, 17.2% were hospitalized, and 0.2% died. The percentage of resistant infections increased from 24.5% in 2005-2016 to 29.7% in 2017-2018 for ciprofloxacin (P < .001) and from 2.6% to 3.3% for erythromycin (P = .04). Persons with recent international travel had higher odds than nontravelers of having isolates resistant to ciprofloxacin (adjusted odds ratio [aOR] varied from 1.7 to 10.6 by race/ethnicity) and erythromycin (aOR = 1.7; 95% confidence interval, 1.3-2.1). CONCLUSIONS: Campylobacter incidence has remained stable or decreased, whereas resistance to antimicrobials recommended for treatment has increased. Recent international travel increased the risk of resistance. |
An enhanced method for calculating trends in infections caused by pathogens transmitted commonly through food (preprint)
Weller DL , Ray LC , Payne DC , Griffin PM , Hoekstra RM , Rose EB , Bruce BB . medRxiv 2022 17 This brief methods paper is being published concomitantly with "Preliminary Incidence and Trends of Infections Caused by Pathogens Transmitted Commonly Through Food- Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 2016-2021" in Morbidity and Mortality Weekly Reports (MMWR). That article describes the application of the new model described here to analyze trends and evaluate progress towards the prevention of infection from enteric pathogens in the United States. Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. This article is a US Government work. It is not subject to copyright under 17 USC 105 and is also made available for use under a CC0 license. |
Middle East Respiratory Syndrome Coronavirus, Saudi Arabia, 2017-2018
Hakawi A , Rose EB , Biggs HM , Lu X , Mohammed M , Abdalla O , Abedi GR , Alsharef AA , Alamri AA , Bereagesh SA , Al Dosari KM , Ashehri SA , Fakhouri WG , Alzaid SZ , Lindstrom S , Gerber SI , Asiri A , Jokhdar H , Watson JT . Emerg Infect Dis 2019 25 (11) 2149-2151 We characterized exposures and demographics of Middle East respiratory syndrome coronavirus cases reported to the Saudi Arabia Ministry of Health during July 1-October 31, 2017, and June 1-September 16, 2018. Molecular characterization of available specimens showed that circulating viruses during these periods continued to cluster within lineage 5. |
Multisystem Inflammatory Syndrome in Children in the United States. Reply.
Feldstein LR , Rose EB , Randolph AG . N Engl J Med 2020 383 (18) 1794-1795 Dr. Feldstein and colleagues reply: We agree with Belot and Levy-Bruhl that, on the basis of the temporal relationship between hospitalizations for Covid-19 and cases of MIS-C, we can infer that MIS-C cases would be infrequent in the absence of a second wave of Covid-19. This correspondence provides an opportunity to update our initial report of the temporal representation of MIS-C cases observed between March 15 and May 20, 2020, by the Overcoming Covid-19 hospital surveillance system in the United States. Sites in our study reported 213 cases from March 15 to May 20, 2020, and an additional 38 cases from May 21 to July 4, 2020 (Figure 1). Similar to the Covid-19 outbreak data from France, the incidence of MIS-C cases in the United States decreased as the percentage of tests positive for SARS-CoV-2 decreased, starting in May. However, unlike France, the United States has had sustained high transmission of SARS-CoV-2 since the end of June 2020. Given the strong temporal association between SARS-CoV-2 activity and MIS-C in various locations of the world, as noted by Dufort et al. and others,1,2 it is possible we will see another increase in the incidence of MIS-C cases in the United States. Clinicians should be vigilant for signs of multisystem inflammatory disease in children who have had Covid-19 or have had exposure to others with SARS-CoV-2 infection. |
Preliminary Incidence and Trends of Infections Caused by Pathogens Transmitted Commonly Through Food - Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 2016-2021.
Collins JP , Shah HJ , Weller DL , Ray LC , Smith K , McGuire S , Trevejo RT , Jervis RH , Vugia DJ , Rissman T , Garman KN , Lathrop S , LaClair B , Boyle MM , Harris S , Kufel JZ , Tauxe RV , Bruce BB , Rose EB , Griffin PM , Payne DC . MMWR Morb Mortal Wkly Rep 2022 71 (40) 1260-1264 To evaluate progress toward prevention of enteric infections in the United States, the Foodborne Diseases Active Surveillance Network (FoodNet) conducts active population-based surveillance for laboratory-diagnosed infections caused by Campylobacter, Cyclospora, Listeria, Salmonella, Shiga toxin-producing Escherichia coli (STEC), Shigella, Vibrio, and Yersinia at 10 U.S. sites. This report summarizes preliminary 2021 data and describes changes in annual incidence compared with the average annual incidence for 2016-2018, the reference period for the U.S. Department of Health and Human Services' (HHS) Healthy People 2030 goals for some pathogens (1). During 2021, the incidence of infections caused by Salmonella decreased, incidence of infections caused by Cyclospora, Yersinia, and Vibrio increased, and incidence of infections caused by other pathogens did not change. As in 2020, behavioral modifications and public health interventions implemented to control the COVID-19 pandemic might have decreased transmission of enteric infections (2). Other factors (e.g., increased use of telemedicine and continued increase in use of culture-independent diagnostic tests [CIDTs]) might have altered their detection or reporting (2). Much work remains to achieve HHS Healthy People 2030 goals, particularly for Salmonella infections, which are frequently attributed to poultry products and produce, and Campylobacter infections, which are frequently attributed to chicken products (3). |
Respiratory Syncytial Virus-Associated Hospitalizations in Children With Neurological Disorders, 2006-2015
Rose EB , Dahl RM , Havers FP , Peacock G , Langley GE . J Pediatric Infect Dis Soc 2021 10 (10) 951-957 BACKGROUND: We quantified the risk of respiratory syncytial virus (RSV) hospitalizations and severe outcomes among children with neurological disorders. METHODS: We estimated RSV-specific and RSV-associated hospitalization rates using International Classification of Diseases, Ninth Revision (ICD-9) codes from 2 insurance claims IBM MarketScan Research Databases (Commercial and Multi-State Medicaid) from July 2006 through June 2015. For comparison, a simple random sample of 10% of all eligible children was selected to represent the general population. Relative rates (RRs) of RSV hospitalization were calculated by dividing rates for children with neurological disorders by rates for children in the general population by age group and season. RESULTS: The RSV-specific hospitalization rate for children with any neurological condition was 4.2 (95% confidence interval [CI]: 4.1, 4.4) per 1000 person-years, and the RSV-associated hospitalization rate was 7.0 (95% CI: 6.9, 7.2) per 1000 person-years among children <19 years of age. Among privately insured children, the overall RR of RSV hospitalization in children with neurological disorders compared with the general population was 10.7 (95% CI: 10.0, 11.4) for RSV-specific hospitalization and 11.1 (95% CI: 10.5, 11.7) for RSV-associated hospitalizations. Among children in Medicaid, the RSV-specific hospitalization RR was 6.1 (95% CI: 5.8, 6.5) and the RSV-associated hospitalization RR was 6.4 (95% CI: 6.2, 6.7) compared with the general population. CONCLUSIONS: Our population-based study of children with neurological disorders found that the risk of RSV hospitalization was 6 to 12 times higher among children with neurological disorders than among the general pediatric population. These findings should be considered when determining who should be targeted for current and future RSV interventions. |
Characteristics and Outcomes of US Children and Adolescents With Multisystem Inflammatory Syndrome in Children (MIS-C) Compared With Severe Acute COVID-19.
Feldstein LR , Tenforde MW , Friedman KG , Newhams M , Rose EB , Dapul H , Soma VL , Maddux AB , Mourani PM , Bowens C , Maamari M , Hall MW , Riggs BJ , Giuliano JSJr , Singh AR , Li S , Kong M , Schuster JE , McLaughlin GE , Schwartz SP , Walker TC , Loftis LL , Hobbs CV , Halasa NB , Doymaz S , Babbitt CJ , Hume JR , Gertz SJ , Irby K , Clouser KN , Cvijanovich NZ , Bradford TT , Smith LS , Heidemann SM , Zackai SP , Wellnitz K , Nofziger RA , Horwitz SM , Carroll RW , Rowan CM , Tarquinio KM , Mack EH , Fitzgerald JC , Coates BM , Jackson AM , Young CC , Son MBF , Patel MM , Newburger JW , Randolph AG . JAMA 2021 325 (11) 1074-1087 IMPORTANCE: Refinement of criteria for multisystem inflammatory syndrome in children (MIS-C) may inform efforts to improve health outcomes. OBJECTIVE: To compare clinical characteristics and outcomes of children and adolescents with MIS-C vs those with severe coronavirus disease 2019 (COVID-19). SETTING, DESIGN, AND PARTICIPANTS: Case series of 1116 patients aged younger than 21 years hospitalized between March 15 and October 31, 2020, at 66 US hospitals in 31 states. Final date of follow-up was January 5, 2021. Patients with MIS-C had fever, inflammation, multisystem involvement, and positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcriptase-polymerase chain reaction (RT-PCR) or antibody test results or recent exposure with no alternate diagnosis. Patients with COVID-19 had positive RT-PCR test results and severe organ system involvement. EXPOSURE: SARS-CoV-2. MAIN OUTCOMES AND MEASURES: Presenting symptoms, organ system complications, laboratory biomarkers, interventions, and clinical outcomes. Multivariable regression was used to compute adjusted risk ratios (aRRs) of factors associated with MIS-C vs COVID-19. RESULTS: Of 1116 patients (median age, 9.7 years; 45% female), 539 (48%) were diagnosed with MIS-C and 577 (52%) with COVID-19. Compared with patients with COVID-19, patients with MIS-C were more likely to be 6 to 12 years old (40.8% vs 19.4%; absolute risk difference [RD], 21.4% [95% CI, 16.1%-26.7%]; aRR, 1.51 [95% CI, 1.33-1.72] vs 0-5 years) and non-Hispanic Black (32.3% vs 21.5%; RD, 10.8% [95% CI, 5.6%-16.0%]; aRR, 1.43 [95% CI, 1.17-1.76] vs White). Compared with patients with COVID-19, patients with MIS-C were more likely to have cardiorespiratory involvement (56.0% vs 8.8%; RD, 47.2% [95% CI, 42.4%-52.0%]; aRR, 2.99 [95% CI, 2.55-3.50] vs respiratory involvement), cardiovascular without respiratory involvement (10.6% vs 2.9%; RD, 7.7% [95% CI, 4.7%-10.6%]; aRR, 2.49 [95% CI, 2.05-3.02] vs respiratory involvement), and mucocutaneous without cardiorespiratory involvement (7.1% vs 2.3%; RD, 4.8% [95% CI, 2.3%-7.3%]; aRR, 2.29 [95% CI, 1.84-2.85] vs respiratory involvement). Patients with MIS-C had higher neutrophil to lymphocyte ratio (median, 6.4 vs 2.7, P < .001), higher C-reactive protein level (median, 152 mg/L vs 33 mg/L; P < .001), and lower platelet count (<150 ×103 cells/μL [212/523 {41%} vs 84/486 {17%}, P < .001]). A total of 398 patients (73.8%) with MIS-C and 253 (43.8%) with COVID-19 were admitted to the intensive care unit, and 10 (1.9%) with MIS-C and 8 (1.4%) with COVID-19 died during hospitalization. Among patients with MIS-C with reduced left ventricular systolic function (172/503, 34.2%) and coronary artery aneurysm (57/424, 13.4%), an estimated 91.0% (95% CI, 86.0%-94.7%) and 79.1% (95% CI, 67.1%-89.1%), respectively, normalized within 30 days. CONCLUSIONS AND RELEVANCE: This case series of patients with MIS-C and with COVID-19 identified patterns of clinical presentation and organ system involvement. These patterns may help differentiate between MIS-C and COVID-19. |
Respiratory syncytial virus seasonality in three epidemiological zones of Kenya
Rose EB , Nyawanda BO , Munywoki PK , Murunga N , Bigogo GM , Otieno NA , Onyango C , Chaves SS , Verani JR , Emukule GO , Widdowson MA , Nokes DJ , Gerber SI , Langley GE . Influenza Other Respir Viruses 2020 15 (2) 195-201 Understanding respiratory syncytial virus (RSV) circulation patterns is necessary to guide the timing of limited-duration interventions such as vaccines. We describe RSV circulation over multiple seasons in three distinct counties of Kenya during 2006-2018. Kilifi and Siaya counties each had consistent but distinct RSV seasonality, lasting on average 18-22 weeks. Based on data from available years, RSV did not have a clear pattern of circulation in Nairobi. This information can help guide the timing of vaccines and immunoprophylaxis products that are under development. |
Associations between social media and suicidal behaviors during a youth suicide cluster in Ohio
Swedo EA , Beauregard JL , de Fijter S , Werhan L , Norris K , Montgomery MP , Rose EB , David-Ferdon C , Massetti GM , Hillis SD , Sumner SA . J Adolesc Health 2020 68 (2) 308-316 PURPOSE: Youth suicide clusters may be exacerbated by suicide contagion-the spread of suicidal behaviors. Factors promoting suicide contagion are poorly understood, particularly in the advent of social media. Using cross-sectional data from an ongoing youth suicide cluster in Ohio, this study examines associations between suicide cluster-related social media and suicidal behaviors. METHODS: We surveyed 7th- to 12th-grade students in northeastern Ohio during a 2017-2018 suicide cluster to assess the prevalence of suicidal ideation (SI), suicide attempts (SAs), and associations with potential contagion-promoting factors such as suicide cluster-related social media, vigils, memorials, news articles, and watching the Netflix series 13 Reasons Why before or during the cluster. Generalized estimating equations examined associations between potential contagion-promoting factors and SI/SA, adjusting for nonmodifiable risk factors. Subgroup analyses examined whether associations between cluster-related factors and SI/SA during the cluster varied by previous history of SI/SA. RESULTS: Among participating students, 9.0% (876/9,733) reported SI and 4.9% attempted suicide (481/9,733) during the suicide cluster. Among students who posted suicide cluster-related content to social media, 22.9% (267/1,167) reported SI and 15.0% (175/1,167) attempted suicide during the suicide cluster. Posting suicide cluster-related content was associated with both SI (adjusted odds ratio 1.7, 95% confidence interval 1.4-2.0) and SA during the cluster (adjusted odds ratio 1.7, 95% confidence interval 1.2-2.5). In subgroup analyses, seeing suicide cluster-related posts was uniquely associated with increased odds of SI and SA during the cluster among students with no previous history of SI/SA. CONCLUSIONS: Exposure to suicide cluster-related social media is associated with both SI and SA during a suicide cluster. Suicide interventions could benefit from efforts to mitigate potential negative effects of social media and promote prevention messages. |
Multisystem Inflammatory Syndrome in U.S. Children and Adolescents.
Feldstein LR , Rose EB , Horwitz SM , Collins JP , Newhams MM , Son MBF , Newburger JW , Kleinman LC , Heidemann SM , Martin AA , Singh AR , Li S , Tarquinio KM , Jaggi P , Oster ME , Zackai SP , Gillen J , Ratner AJ , Walsh RF , Fitzgerald JC , Keenaghan MA , Alharash H , Doymaz S , Clouser KN , Giuliano JS Jr , Gupta A , Parker RM , Maddux AB , Havalad V , Ramsingh S , Bukulmez H , Bradford TT , Smith LS , Tenforde MW , Carroll CL , Riggs BJ , Gertz SJ , Daube A , Lansell A , Coronado Munoz A , Hobbs CV , Marohn KL , Halasa NB , Patel MM , Randolph AG . N Engl J Med 2020 383 (4) 334-346 BACKGROUND: Understanding the epidemiology and clinical course of multisystem inflammatory syndrome in children (MIS-C) and its temporal association with coronavirus disease 2019 (Covid-19) is important, given the clinical and public health implications of the syndrome. METHODS: We conducted targeted surveillance for MIS-C from March 15 to May 20, 2020, in pediatric health centers across the United States. The case definition included six criteria: serious illness leading to hospitalization, an age of less than 21 years, fever that lasted for at least 24 hours, laboratory evidence of inflammation, multisystem organ involvement, and evidence of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) based on reverse-transcriptase polymerase chain reaction (RT-PCR), antibody testing, or exposure to persons with Covid-19 in the past month. Clinicians abstracted the data onto standardized forms. RESULTS: We report on 186 patients with MIS-C in 26 states. The median age was 8.3 years, 115 patients (62%) were male, 135 (73%) had previously been healthy, 131 (70%) were positive for SARS-CoV-2 by RT-PCR or antibody testing, and 164 (88%) were hospitalized after April 16, 2020. Organ-system involvement included the gastrointestinal system in 171 patients (92%), cardiovascular in 149 (80%), hematologic in 142 (76%), mucocutaneous in 137 (74%), and respiratory in 131 (70%). The median duration of hospitalization was 7 days (interquartile range, 4 to 10); 148 patients (80%) received intensive care, 37 (20%) received mechanical ventilation, 90 (48%) received vasoactive support, and 4 (2%) died. Coronary-artery aneurysms (z scores >/=2.5) were documented in 15 patients (8%), and Kawasaki's disease-like features were documented in 74 (40%). Most patients (171 [92%]) had elevations in at least four biomarkers indicating inflammation. The use of immunomodulating therapies was common: intravenous immune globulin was used in 144 (77%), glucocorticoids in 91 (49%), and interleukin-6 or 1RA inhibitors in 38 (20%). CONCLUSIONS: Multisystem inflammatory syndrome in children associated with SARS-CoV-2 led to serious and life-threatening illness in previously healthy children and adolescents. (Funded by the Centers for Disease Control and Prevention.). |
Adolescent opioid misuse attributable to adverse childhood experiences
Swedo EA , Sumner SA , de Fijter S , Werhan L , Norris K , Beauregard JL , Montgomery MP , Rose EB , Hillis SD , Massetti GM . J Pediatr 2020 224 102-109 e3 OBJECTIVES: To estimate the proportion of opioid misuse attributable to adverse childhood experiences (ACEs) among adolescents. STUDY DESIGN: A cross-sectional survey was administered to 10,546 7th12th grade students in northeastern Ohio in Spring 2018. Study measures included self-reported lifetime exposure to 10 ACEs and past 30 day use of nonmedical prescription opioid or heroin. Using generalized estimating equations, we evaluated associations between recent opioid misuse, individual ACEs, and cumulative number of ACEs. We calculated population attributable fractions (PAF) to determine the proportion of adolescents' recent opioid misuse attributable to ACEs. RESULTS: Nearly one in 50 adolescents reported opioid misuse within 30 days (1.9%); approximately 60% of youth experienced >/=1 ACE; 10.2% experienced >/=5 ACEs. Cumulative ACE exposure demonstrated a significant graded relationship with opioid misuse. Compared with youth with zero ACEs, youth with 1 ACE (adjusted odds ratio [AOR]: 1.9, 95% confidence interval [CI]: 0.93.9), 2 ACEs (AOR: 3.8, CI: 1.97.9), 3 ACEs (AOR: 3.7, CI: 2.26.5), 4 ACEs (AOR: 5.8, CI: 3.111.2), and >/=5 ACEs (AOR: 15.3, CI: 8.826.6) had higher odds of recent opioid misuse. The population attributable fraction of recent opioid misuse associated with experiencing >/=1 ACE was 71.6% (CI: 59.8-83.5). CONCLUSIONS: There was a significant graded relationship between number of ACEs and recent opioid misuse among adolescents. Over 70% of recent adolescent opioid misuse in our study population was attributable to ACEs. Efforts to decrease opioid misuse could include programmatic, policy, and clinical practice interventions to prevent and mitigate the negative effects of ACEs. |
Multiple Respiratory Syncytial Virus Introductions Into a Neonatal Intensive Care Unit.
Rose EB , Washington EJ , Wang L , Benowitz I , Thornburg NJ , Gerber SI , Peret TCT , Langley GE . J Pediatric Infect Dis Soc 2020 10 (2) 118-124 ![]() BACKGROUND: Outbreaks of respiratory syncytial virus (RSV) in neonatal intensive care units (NICUs) are of concern because of the risk of severe disease in young infants. We describe an outbreak of RSV in a NICU and use whole genome sequencing (WGS) to better understand the relatedness of viruses among patients.SummaryUsing whole genome sequencing, we found 2 introductions of respiratory syncytial virus (RSV) into a neonatal intensive care unit causing 7 infections. This outbreak highlights the risk of healthcare-associated infections during RSV season; early recognition is critical to limit transmission. METHODS: An investigation was conducted to identify patients and describe their clinical course. Infection control measures were implemented to prevent further spread. Respiratory specimens from outbreak-related patients and the community were tested using WGS. Phylogenetic trees were constructed to understand relatedness of the viruses. RESULTS: Seven patients developed respiratory symptoms within an 11-day span in December 2017 and were diagnosed with RSV; 6 patients (86%) were preterm and 1 had chronic lung disease. Three patients required additional respiratory support after symptom onset, and none died. Six of 7 patients were part of the same cluster based on > 99.99% nucleotide agreement with each other and 3 unique single-nucleotide polymorphisms were identified in viruses sequenced from those patients. The seventh patient was admitted from the community with respiratory symptoms and had a genetically distinct virus that was not related to the other 6. Implementation of enhanced infection control measures likely limited the spread. CONCLUSIONS: Using WGS, we found 2 distinct introductions of RSV into a NICU, highlighting the risk of healthcare-associated infections during RSV season. Early recognition and infection control measures likely limited spread, emphasizing the importance of considering RSV in the differential diagnosis of respiratory infections in healthcare settings. |
Notes from the Field: Respiratory syncytial virus infections in a neonatal intensive care unit - Louisiana, December 2017
Washington EJ , Rose EB , Langley GE , Hand JP , Benowitz I , Gerber SI , Salinas AL , Terry AL , Tonzel JL , Sokol TM , Smith AT , Richardson GJ . MMWR Morb Mortal Wkly Rep 2019 68 (1) 20-21 In December 2017, the Louisiana Department of Health was notified of seven cases of respiratory syncytial virus (RSV) infection in a five-unit (units A–E), 84-bed neonatal intensive care unit (NICU) that included 66 individual infant rooms. The first case occurred in an infant who had been discharged postpartum from the NICU 30 days earlier and was readmitted for respiratory distress (day 0), approximately 2 weeks after the peak in reported RSV cases in Louisiana (mid-November) (1). The other six infants had at least one respiratory symptom while in the NICU postpartum. Upon identification of the first case, the facility implemented contact precautions for symptomatic infants, and NICU staff members were asked to report any respiratory symptoms. Nasopharyngeal specimens were obtained from infants who had rhinorrhea, cough, or nasal congestion. Nasopharyngeal swabs were also obtained from asymptomatic infants in two of the three units where the seven identified patients resided. A case was defined as laboratory-confirmed RSV infection in an NICU patient during December 2017. After consultation with CDC, a team of Louisiana Department of Health epidemiologists visited the facility 3 days after notification to review medical charts, observe infection control procedures, interview NICU staff members, and determine measures to prevent further transmission. |
Severe respiratory illness outbreak associated with human coronavirus NL63 in a long-term care facility
Hand J , Rose EB , Salinas A , Lu X , Sakthivel SK , Schneider E , Watson JT . Emerg Infect Dis 2018 24 (10) 1964-1966 We describe an outbreak of severe respiratory illness associated with human coronavirus NL63 in a long-term care facility in Louisiana in November 2017. Six of 20 case-patients were hospitalized with pneumonia, and 3 of 20 died. Clinicians should consider human coronavirus NL63 for patients in similar settings with respiratory disease. |
Respiratory syncytial virus seasonality - United States, 2014-2017
Rose EB , Wheatley A , Langley G , Gerber S , Haynes A . MMWR Morb Mortal Wkly Rep 2018 67 (2) 71-76 Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infection in young children worldwide (1-3). In the United States, RSV infection results in >57,000 hospitalizations and 2 million outpatient visits each year among children aged <5 years (3). Recent studies have highlighted the importance of RSV in adults as well as children (4). CDC reported RSV seasonality nationally, by U.S. Department of Health and Human Services (HHS) regions* and for the state of Florida, using a new statistical method that analyzes polymerase chain reaction (PCR) laboratory detections reported to the National Respiratory and Enteric Virus Surveillance System (NREVSS) (https://www.cdc.gov/surveillance/nrevss/index.html). Nationally, across three RSV seasons, lasting from the week ending July 5, 2014 through July 1, 2017, the median RSV onset occurred at week 41 (mid-October), and lasted 31 weeks until week 18 (early May). The median national peak occurred at week 5 (early February). Using these new methods, RSV season circulation patterns differed from those reported from previous seasons (5). Health care providers and public health officials use RSV circulation data to guide diagnostic testing and to time the administration of RSV immunoprophylaxis for populations at high risk for severe respiratory illness (6). With several vaccines and other immunoprophlyaxis products in development, estimates of RSV circulation are also important to the design of clinical trials and future vaccine effectiveness studies. |
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