Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-22 (of 22 Records) |
Query Trace: Sharapov U[original query] |
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Rotavirus vaccine effectiveness and impact in Uzbekistan, the first country to introduce in central Asia.
Eraliev U , Latipov R , Tursunova D , Wasley A , Daniels D , Ismoilov U , Akramova M , Sultanova M , Yuldashova D , Barakaev B , Mutalova V , Tuychiev L , Musabaev E , Sharapov S , Pleshkov B , Videbaek D , Huseynov S , Safaeva K , Mijatovic-Rustempasic S , Bowen MD , Parashar UD , Cortese MM . Hum Vaccin Immunother 2020 17 (2) 1-7 Uzbekistan, the most populous country in central Asia, was the first in the region to introduce rotavirus vaccine into its national immunization program. Rotarix (GlaxoSmithKline Biologicals, RV1) was introduced in June 2014, with doses recommended at age 2 and 3 months. To evaluate vaccine impact, active surveillance for rotavirus diarrhea was reestablished in 2014 at 2 hospitals in Tashkent and Bukhara which had also performed surveillance during the pre-vaccine period 2005-2009. Children aged <5 y admitted with acute diarrhea had stool specimens collected and tested for rotavirus by enzyme immunoassay. Proportions testing rotavirus-positive in post-vaccine years were compared with the pre-vaccine period. Vaccine records were obtained and effectiveness of 2 RV1 doses vs 0 doses was estimated using rotavirus-case and test-negative design among children enrolled from Bukhara city. In 2015 and 2016, 8%-15% of infants and 10%-16% of children aged<5 y hospitalized with acute diarrhea at the sites tested rotavirus-positive, compared with 26% of infants and 27% of children aged<5 y in pre-vaccine period (reductions in proportion positive of 42%-68%, p <.001). Vaccine effectiveness of 2 RV1 doses vs 0 doses in protecting against hospitalization for rotavirus disease among those aged ≥6 months was 51% (95% CI 2-75) and is based on cases predominantly of genotype G2P[4]. Vaccine effectiveness point estimates tended to be higher against cases with higher illness severity (e.g., clinical severity based on modified Vesikari score ≥11). Our data demonstrate that the monovalent rotavirus vaccine is effective in reducing the likelihood of hospitalization for rotavirus disease in young children in Uzbekistan. |
Multistate outbreak of Escherichia coli O157:H7 infections associated with consumption of fresh spinach: United States, 2006
Sharapov UM , Wendel AM , Davis JP , Keene WE , Farrar J , Sodha S , Hyytia-Trees E , Leeper M , Gerner-Smidt P , Griffin PM , Braden C . J Food Prot 2016 79 (12) 2024-2030 During September to October, 2006, state and local health departments and the Centers for Disease Control and Prevention investigated a large, multistate outbreak of Escherichia coli O157:H7 infections. Case patients were interviewed regarding specific foods consumed and other possible exposures. E. coli O157:H7 strains isolated from human and food specimens were subtyped using pulsed-field gel electrophoresis and multiple-locus variable-number tandem repeat analyses (MLVA). Two hundred twenty-five cases (191 confirmed and 34 probable) were identified in 27 states; 116 (56%) case patients were hospitalized, 39 (19%) developed hemolytic uremic syndrome, and 5 (2%) died. Among 176 case patients from whom E. coli O157:H7 with the outbreak genotype (MLVA outbreak strain) was isolated and who provided details regarding spinach exposure, 161 (91%) reported fresh spinach consumption during the 10 days before illness began. Among 116 patients who provided spinach brand information, 106 (91%) consumed bagged brand A. E. coli O157:H7 strains were isolated from 13 bags of brand A spinach collected from patients' homes; isolates from 12 bags had the same MLVA pattern. Comprehensive epidemiologic and laboratory investigations associated this large multistate outbreak of E. coli O157:H7 infections with consumption of fresh bagged spinach. MLVA, as a supplement to pulsed-field gel electrophoresis genotyping of case patient isolates, was important to discern outbreak-related cases. This outbreak resulted in enhanced federal and industry guidance to improve the safety of leafy green vegetables and launched an independent collaborative approach to produce safety research in 2007. |
The World Health Organization measles programmatic risk assessment tool-pilot testing in India, 2014
Goel K , Naithani S , Bhatt D , Khera A , Sharapov UM , Kriss JL , Goodson JL , Laserson KF , Goel P , Kumar RM , Chauhan LS . Risk Anal 2016 37 (6) 1063-1071 Measles is a leading cause of child mortality, and reduction of child mortality is a key Millennium Development Goal. In 2014, the World Health Organization and the U.S. Centers for Disease Control and Prevention developed a measles programmatic risk assessment tool to support country measles elimination efforts. The tool was pilot tested in the State of Uttarakhand in August 2014 to assess its utility in India. The tool assessed measles risk for the 13 districts of Uttarakhand as a function of indicator scores in four categories: population immunity, surveillance quality, program delivery performance, and threat. The highest potential overall score was 100. Scores from each category were totaled to assign an overall risk score for each district. From this risk score, districts were categorized as low, medium, high, or very high risk. Of the 13 districts in Uttarakhand in 2014, the tool classified one district (Haridwar) as very high risk and three districts (Almora, Champawat, and Pauri Garhwal) as high risk. The measles risk in these four districts was largely due to low population immunity from high MCV1-MCV2 drop-out rates, low MCV1 and MCV2 coverage, and the lack of a supplementary immunization activity (SIA) within the past three years. This tool can be used to support measles elimination in India by identifying districts that might be at risk for measles outbreaks, and to guide risk mitigation efforts, including strengthening routine immunization services and implementing SIAs. |
Progress toward measles elimination - Nepal, 2007-2014
Khanal S , Sedai TR , Choudary GR , Giri JN , Bohara R , Pant R , Gautam M , Sharapov UM , Goodson JL , Alexander J , Dabbagh A , Strebel P , Perry RT , Bah S , Abeysinghe N , Thapa A . MMWR Morb Mortal Wkly Rep 2016 65 (8) 206-10 In 2013, the 66th session of the Regional Committee of the World Health Organization (WHO) South-East Asia Region (SEAR) established a goal to eliminate measles and to control rubella and congenital rubella syndrome (CRS)* in SEAR by 2020 (1,2). Current recommended measles elimination strategies in the region include 1) achieving and maintaining ≥95% coverage with 2 doses of measles-containing vaccine (MCV) in every district, delivered through the routine immunization program or through supplementary immunization activities (SIAs)(dagger); 2) developing and sustaining a sensitive and timely measles case-based surveillance system that meets minimum recommended performance indicators( section sign); 3) developing and maintaining an accredited measles laboratory network; and 4) achieving timely identification, investigation, and response to measles outbreaks. In 2013, Nepal, one of the 11 SEAR member states, adopted a goal for national measles elimination by 2019 (3). This report updates a previous report (4) and summarizes progress toward measles elimination in Nepal during 2007-2014. During 2007-2014, estimated coverage with the first MCV dose (MCV1) increased from 81% to 88%. Approximately 3.9 and 9.7 million children were vaccinated in SIAs conducted in 2008 and 2014, respectively (1). Reported suspected measles incidence declined by 13% during 2007-2014, from 54 to 47 cases per 1 million population. However, in 2014, 81% of districts did not meet the measles case-based surveillance performance indicator target of ≥2 discarded non-measles cases( paragraph sign) per 100,000 population per year. To achieve and maintain measles elimination, additional measures are needed to strengthen routine immunization services to increase coverage with MCV1 and a recently introduced second dose of MCV (MCV2**) to ≥95% in all districts, and to enhance sensitivity of measles case-based surveillance by adopting a more sensitive case definition, expanding case-based surveillance sites nationwide, and ensuring timely transport of specimens to the accredited national laboratory. |
Hepatitis a infections among food handlers in the United States, 1993–2011
Sharapov UM , Kentenyants K , Groeger J , Roberts H , Holmberg SD , Collier MG . Public Health Rep 2016 131 (1) 26-29 We reviewed news reports of hepatitis A virus (HAV)-infected food handlers in the United States from 1993 to 2011 using the LexisNexis® search engine. Using U.S. news reports, we identified 192 HAV-infected food handlers who worked while infectious; of these HAV-infected individuals, 34 (18%) transmitted HAV to restaurant patrons. News reports of HAV-infected food handlers declined from 1993 to 2011. This analysis suggests that universal childhood vaccination contributed to the decrease in reports of HAV-infected food handlers, but mandatory vaccination of this group is unlikely to be cost-effective. |
Measles outbreak associated with vaccine failure in adults - Federated States of Micronesia, February-August 2014
Breakwell L , Moturi E , Helgenberger L , Gopalani SV , Hales C , Lam E , Sharapov U , Larzelere M , Johnson E , Masao C , Setik E , Barrow L , Dolan S , Chen TH , Patel M , Rota P , Hickman C , Bellini W , Seward J , Wallace G , Papania M . MMWR Morb Mortal Wkly Rep 2015 64 (38) 1088-92 On May 15, 2014, CDC was notified of two laboratory-confirmed measles cases in the Federated States of Micronesia (FSM), after 20 years with no reported measles. FSM was assisted by the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), and CDC in investigating suspected cases, identify contacts, conduct analyses to guide outbreak vaccination response, and review vaccine cold chain practices. During February-August, three of FSM's four states reported measles cases: Kosrae (139 cases), Pohnpei (251), and Chuuk (3). Two thirds of cases occurred among adults aged >/=20 years; of these, 49% had received >/=2 doses of measles-containing vaccine (MCV). Apart from infants aged <12 months who were too young for routine vaccination, measles incidence was lower among children than adults. A review of current cold chain practices in Kosrae revealed minor weaknesses; however, an absence of historical cold chain maintenance records precluded an evaluation of earlier problems. Each state implemented vaccination campaigns targeting children as young as age 6 months through adults up to age 57 years. The preponderance of cases in this outbreak associated with vaccine failure in adults highlights the need for both thorough case investigation and epidemiologic analysis to guide outbreak response vaccination. Routine childhood vaccination coverage achieved in recent years limited the transmission of measles among children. Even in areas where transmission has not occurred for years, maintaining high 2-dose MCV coverage through routine and supplemental immunization is needed to prevent outbreaks resulting from increased measles susceptibility in the population. |
Progress toward measles elimination - South-East Asia region, 2003-2013
Thapa A , Khanal S , Sharapov U , Swezy V , Sedai T , Dabbagh A , Rota P , Goodson JL , McFarland J . MMWR Morb Mortal Wkly Rep 2015 64 (22) 613-7 In 2013, the 66th session of the Regional Committee of the World Health Organization (WHO) South-East Asia Region adopted the goal of measles elimination and rubella and congenital rubella syndrome control by 2020 after rigorous prior consultations. The recommended strategies include 1) achieving and maintaining ≥95% coverage with 2 doses of measles- and rubella-containing vaccine in every district through routine or supplementary immunization activities (SIAs); 2) developing and sustaining a sensitive and timely case-based measles surveillance system that meets recommended performance indicators; 3) developing and maintaining an accredited measles laboratory network; and 4) achieving timely identification, investigation, and response to measles outbreaks. This report updates previous reports and summarizes progress toward measles elimination in the South-East Asia Region during 2003-2013. Within the region, coverage with the first dose of a measles-containing vaccine (MCV1) increased from 67% to 78%; an estimated 286 million children (95% of the target population) were vaccinated in SIAs; measles incidence decreased 73%, from 59 to 16 cases per million population; and estimated measles deaths decreased 63%. To achieve measles elimination in the region, additional efforts are needed in countries with <95% 2-dose routine MCV coverage, particularly in India and Indonesia, to strengthen routine immunization services, conduct periodic high-quality SIAs, and strengthen measles case-based surveillance and laboratory diagnosis of measles. |
Patient awareness of need for hepatitis A vaccination (prophylaxis) before international travel
Liu SJ , Sharapov U , Klevens M . J Travel Med 2015 22 (3) 174-8 INTRODUCTION: Although hepatitis A virus (HAV) infection is preventable through vaccination, cases associated with international travel continue to occur. The purpose of this study was to examine the frequency of international travel and countries visited among persons infected with HAV and assess reasons why travelers had not received hepatitis A vaccine before traveling. METHODS: Using data from sentinel surveillance for HAV infection in seven US counties during 1996 to 2006, we examined the role of international travel in hepatitis A incidence and the reasons for patients not being vaccinated. RESULTS: Of 2,002 hepatitis A patients for whom travel history was available, 300 (15%) reported traveling outside of the United States. Compared to non-travelers, travelers were more likely to be female [odds ratio (OR) = 1.74 (95% confidence interval [95% CI], 1.35, 2.24)], aged 0 to 17 years [OR = 3.30 (1.83, 5.94)], Hispanic [OR = 3.69 (2.81, 4.86)], Asian [OR = 2.00 (1.06, 3.77)], and were less likely to be black non-Hispanic [OR = 0.30 (0.11, 0.82)]. The majority, 189 (61.6%), had traveled to Mexico. The most common reason for not getting pre-travel vaccination was "Didn't know I could [or should] get shots" [100/154 (65%)]. CONCLUSION: Low awareness of HAV vaccination was the predominant reason for not being protected before travel. Different modes of traveler education could improve prevention of hepatitis A. To highlight the risk of infection before traveling to endemic countries including Mexico, travel and consulate websites could list reminders of vaccine recommendations. |
Emerging epidemic of hepatitis C virus infections among young non-urban persons who inject drugs in the United States, 2006-2012
Suryaprasad AG , White JZ , Xu F , Eichler BA , Hamilton J , Patel A , Hamdounia SB , Church DR , Barton K , Fisher C , Macomber K , Stanley M , Guilfoyle SM , Sweet K , Liu S , Iqbal K , Tohme R , Sharapov U , Kupronis BA , Ward JW , Holmberg SD . Clin Infect Dis 2014 59 (10) 1411-9 BACKGROUND: Reports of acute hepatitis C in young persons in the United States have increased. We examined data from national surveillance and supplemental case follow-up at selected jurisdictions to describe the U.S. epidemiology of hepatitis C virus (HCV) infection among young persons (aged ≤30 years). METHODS: We examined trends in incidence of acute hepatitis C among young persons reported to CDC during 2006-2012 by state, county, and urbanicity. Socio-demographic and behavioral characteristics of HCV-infected young persons newly reported from 2011-2012 were analyzed from case interviews and provider follow-up at six jurisdictions. RESULTS: From 2006-2012, reported incidence of acute hepatitis C increased significantly in young persons-13% annually in non-urban counties (p=0.003) versus 5% annually in urban counties (p=0.028). Thirty (88%) of 34 reporting states observed higher incidence in 2012 than 2006, most noticeably in non-urban counties east of the Mississippi River. Of 1,202 newly reported HCV-infected young persons, 52% were female and 85% were white. In 635 interviews, 75% of respondents reported injection drug use. Of respondents reporting drug use, 75% had abused prescription opioids, with first use on average 2.0 years before heroin. CONCLUSION: These data indicate an emerging U.S. epidemic of HCV infection among young non-urban persons of predominantly white race. Reported incidence was higher in 2012 than 2006 in at least 30 states, with largest increases in non-urban counties east of the Mississippi River. Prescription opioid abuse at an early age was commonly reported and should be a focus for medical and public health intervention. |
Hepatitis B vaccine immunogenicity among adults vaccinated during an outbreak response in an assisted living facility-Virginia, 2010
Bender TJ , Sharapov U , Utah O , Xing J , Hu D , Rybczynska J , Drobeniuc J , Kamili S , Spradling PR , Moorman AC . Vaccine 2013 32 (7) 852-6 BACKGROUND: Failure to adhere to infection control guidelines, especially during assisted monitoring of blood glucose, has caused multiple hepatitis B outbreaks in assisted living facilities (ALFs). In conjunction with the response to such an outbreak at an ALF ("Facility X") where most residents had neuropsychiatric disorders, we evaluated seroprotection rates conferred by hepatitis B vaccine and assessed the influence of demographic factors on vaccine response. METHODS: Residents were screened for hepatitis B and C infection, and those susceptible were vaccinated against hepatitis A and hepatitis B with one dose of TWINRIX (GSK) given at 0, 1, and 7 months. Blood samples were collected 1-2 months after receipt of the third vaccine dose to test for antibody to hepatitis B surface antigen (anti-HBs). RESULTS: Of the 27 residents who had post-vaccination blood specimens collected, 22 (81%) achieved anti-HBs concentrations ≥10mIU/mL. Neither age nor neuropsychiatric comorbidity was significant determinants of seroprotection. Geometric mean concentration was lower among residents aged 60-74 years (74.3mIU/mL) than among residents aged 46-59 years (105.3mIU/mL) but highest among residents aged ≥75 years (122.5mIU/mL). The effect of diabetes on vaccination response could not be examined because 16/17 (94%) diabetic residents had HBV infection by the time of investigation. CONCLUSIONS: Adult vaccine recipients of all ages, even those over 60 years of age, demonstrated a robust capacity for achieving hepatitis B seroprotection in response to the combined hepatitis A/hepatitis B vaccine. The role for vaccination in interrupting HBV transmission during an outbreak remains unclear, but concerns about age-related response to hepatitis B vaccine may be insufficient to justify foregoing vaccination of susceptible residents of ALFs. |
Hepatitis E virus infection in a liver transplant recipient in the United States: a case report
Te HS , Drobeniuc J , Kamili S , Dong C , Hart J , Sharapov UM . Transplant Proc 2013 45 (2) 810-3 BACKGROUND: Chronic infection with hepatitis E virus (HEV) has recently been recognized in immunocompromised or immunosuppressed individuals. CASE REPORT: We report a case of concurrent HEV and human herpes virus-6 (HHV-6) infection, documented by serum HEV RNA and HHV-6 DNA, in an orthotopic liver transplant (OLT) recipient in the United States, where HEV genotype 3 infection, although prevalent, is considered to be self-limited and almost always asymptomatic. The coinfection was accompanied by elevated serum aminotransaminases, liver biopsies demonstrating chronic hepatitis, and the presence of HEV RNA in the tissue. After lowering of immunosuppressive therapy and 2 courses of valganciclovir, sequential clearance of the viruses and normalization of the serum aminotransaminases were observed. CONCLUSIONS: HEV infection can lead to chronic hepatitis in OLT recipients, and evaluation of this virus should be considered in immunosuppressed individuals with unexplained liver test abnormalities. |
Laboratory-based surveillance for hepatitis E virus infection, United States, 2005-2012
Drobeniuc J , Greene-Montfort T , Le NT , Mixson-Hayden TR , Ganova-Raeva L , Dong C , Novak RT , Sharapov UM , Tohme RA , Teshale E , Kamili S , Teo CG . Emerg Infect Dis 2013 19 (2) 218-22 To investigate characteristics of hepatitis E cases in the United States, we tested samples from persons seronegative for acute hepatitis A and B whose clinical specimens were referred to the Centers for Disease Control and Prevention during June 2005-March 2012 for hepatitis E virus (HEV) testing. We found that 26 (17%) of 154 persons tested had hepatitis E. Of these, 15 had not recently traveled abroad (nontravelers), and 11 had (travelers). Compared with travelers, nontravelers were older (median 61 vs. 32 years of age) and more likely to be anicteric (53% vs. 8%); the nontraveler group also had fewer persons of South Asian ethnicity (7% vs. 73%) and more solid-organ transplant recipients (47% vs. 0). HEV genotype 3 was characterized from 8 nontravelers and genotypes 1 or 4 from 4 travelers. Clinicians should consider HEV infection in the differential diagnosis of hepatitis, regardless of patient travel history. |
Transmission of hepatitis B virus from an orthopedic surgeon with a high viral load
Enfield KB , Sharapov U , Hall KK , Leiner J , Berg CL , Xia GL , Thompson ND , Ganova-Raeva L , Sifri CD . Clin Infect Dis 2013 56 (2) 218-24 BACKGROUND: During the evaluation of a needle-stick injury, an orthopedic surgeon was found to be unknowingly infected with hepatitis B virus (HBV) (viral load >17.9 million IU/mL). He had previously completed two 3-dose series of hepatitis B vaccine without achieving a protective level of surface antibody. We investigated whether any surgical patients had acquired HBV infection while under his care. METHODS: A retrospective cohort study of all patients who underwent surgery by the surgeon was conducted. Patients were notified of their potential exposure and need for testing, and samples with positive HBV loads underwent DNA sequencing. Characteristics of the surgical procedures for the cohort were evaluated. RESULTS: A total of 232 (70.7%) of potentially exposed patients consented to testing; 2 were found to have acute infection and 6 had possible transmission (evidence of past exposure without risk factors). Genome sequence analysis of HBV DNA from the infected surgeon and patients with acute infection revealed genetically related virus (>99.9% nucleotide identity). Only age was found to be statistically different between those with confirmed or possible HBV transmission and those who remained susceptible to HBV. CONCLUSIONS: We documented HBV transmission during orthopedic surgery to 2 patients from a surgeon with HBV. This investigation highlights the importance of evaluating individuals who do not respond to 2 series of HBV vaccination, the increased risk of HBV transmission from providers with high viral loads, and the need to evaluate the clinical practice of providers with HBV and implement appropriate procedure-based practice restrictions. |
Outbreak of hepatitis B virus infections associated with assisted monitoring of blood glucose in an assisted living facility - Virginia, 2010
Bender TJ , Wise ME , Utah O , Moorman AC , Sharapov U , Drobeniuc J , Khudyakov Y , Fricchione M , White-Comstock MB , Thompson ND , Patel PR . PLoS One 2012 7 (12) e50012 INTRODUCTION: In January 2010, the Virginia Department of Health received reports of 2 hepatitis B virus (HBV) infections (1 acute, 1 chronic) among residents of a single assisted living facility (ALF). Both infected residents had diabetes and received assisted monitoring of blood glucose (AMBG) at the facility. An investigation was initiated in response. OBJECTIVE: To determine the extent and mechanism of HBV transmission among ALF residents. DESIGN: Retrospective cohort study. SETTING: An ALF that primarily housed residents with neuropsychiatric disorders in 2 adjacent buildings in Virginia. PARTICIPANTS: Residents of the facility as of March 2010. MEASUREMENTS: HBV serologic testing, relevant medical history, and HBV genome sequences. Risk ratios (RR) and 95% confidence intervals (CIs) were used to identify risk factors for HBV infection. RESULTS: HBV serologic status was determined for 126 (91%) of 139 residents. Among 88 susceptible residents, 14 became acutely infected (attack rate, 16%), and 74 remained uninfected. Acute HBV infection developed among 12 (92%) of 13 residents who received AMBG, compared with 2 (3%) of 75 residents who did not (RR = 35; 95% CI, 8.7, 137). Identified infection control breaches during AMBG included shared use of fingerstick devices for multiple residents. HBV genome sequencing demonstrated 2 building-specific phylogenetic infection clusters, each having 99.8-100% sequence identity. LIMITATIONS: Transfer of residents out of the facility prior to our investigation might have contributed to an underestimate of cases. Resident interviews provided insufficient information to fully assess behavioral risk factors for HBV infection. CONCLUSIONS: Failure to adhere to safe practices during AMBG resulted in a large HBV outbreak. Protection of a growing and vulnerable ALF population requires improved training of staff and routine facility licensing inspections that scrutinize infection control practices. |
Integrated prevention services for HIV infection, viral hepatitis, sexually transmitted diseases, and tuberculosis for persons who use drugs illicitly: summary guidance from CDC and the U.S. Department of Health and Human Services
Belani H , Chorba T , Fletcher F , Hennessey K , Kroeger K , Lansky A , Leichliter J , Lentine D , Mital S , Needle R , O'Connor K , Oeltmann J , Pevzner E , Purcell D , Sabin M , Semaan S , Sharapov U , Smith B , Vogt T , Wynn BA . MMWR Recomm Rep 2012 61 1-40 This report summarizes current (as of 2011) guidelines or recommendations published by multiple agencies of the U.S. Department of Health and Human Services (DHHS) for prevention and control of human immunodeficiency virus (HIV) infection, viral hepatitis, sexually transmitted diseases (STDs), and tuberculosis (TB) for persons who use drugs illicitly. It also summarizes existing evidence of effectiveness for practices to support delivery of integrated prevention services. Implementing integrated services for prevention of HIV infection, viral hepatitis, STDs, and TB is intended to provide persons who use drugs illicitly with increased access to services, to improve timeliness of service delivery, and to increase effectiveness of efforts to prevent infectious diseases that share common risk factors, behaviors, and social determinants. This guidance is intended for use by decision makers (e.g., local and federal agencies and leaders and managers of prevention and treatment services), health-care providers, social service providers, and prevention and treatment support groups. Consolidated guidance can strengthen efforts of health-care providers and public health providers to prevent and treat infectious diseases and substance use and mental disorders, use resources efficiently, and improve health-care services and outcomes in persons who use drugs illicitly. An integrated approach to service delivery for persons who use drugs incorporates recommended science-based public health strategies, including 1) prevention and treatment of substance use and mental disorders; 2) outreach programs; 3) risk assessment for illicit use of drugs; 4) risk assessment for infectious diseases; 5) screening, diagnosis, and counseling for infectious diseases; 6) vaccination; 7) prevention of mother-to-child transmission of infectious diseases; 8) interventions for reduction of risk behaviors; 9) partner services and contact follow-up; 10) referrals and linkage to care; 11) medical treatment for infectious diseases; and 12) delivery of integrated prevention services. These strategies are science-based, public health strategies to prevent and treat infectious diseases, substance use disorders, and mental disorders. Treatment of infectious diseases and treatment of substance use and mental disorders contribute to prevention of transmission of infectious diseases. Integrating prevention services can increase access to and timeliness of prevention and treatment. |
Long-term immunogenicity of hepatitis A vaccine in Alaska 17 years after initial childhood series
Raczniak GA , Bulkow L , Bruce MG , Zanis C , Baum R , Snowball M , Byrd KK , Sharapov UM , Hennessy TW , McMahon BJ . J Infect Dis 2012 207 (3) 493-6 CDC recommends hepatitis A vaccination for all children at age 1 year and high risk adults. The vaccine is highly effective; however, protection duration is unknown. We report hepatitis A antibody concentrations 17 years after childhood immunization, demonstrating protective antibody levels remain and have stabilized over the past 7 years. |
Hepatitis B vaccination of susceptible elderly residents of long term care facilities during a hepatitis B outbreak
Williams RE , Sena AC , Moorman AC , Moore ZS , Sharapov UM , Drobenuic J , Hu DJ , Wood HW , Xing J , Spradling PR . Vaccine 2012 30 (21) 3147-50 Protection of older persons, particularly those with diabetes, against hepatitis B virus (HBV) infection is of growing concern because of increased reports of outbreaks among long-term care facility residents receiving assisted blood glucose monitoring. We evaluated hepatitis B vaccine immunogenicity among residents immunized in response to two such outbreaks in skilled nursing facilities during June 2009-July 2010. One hundred forty-eight (71%) of 209 residents were found to be susceptible to HBV infection. Of 105 patients who began a vaccination series with Twinrix((R)) (0-, 1-, 6-month dosing), 86 (82%) completed the series and postvaccination testing. Of these, most were elderly (median age 79.5 years; range 45-101), female (56%), and African-American (51%). Twenty-nine (34%) vaccinated residents had post-vaccination hepatitis B surface antibody levels ≥10mIU/ml. There were no significant differences in vaccine response by age, gender, race, diabetes status, body mass index, or current smoking status. Our findings indicate that a low proportion of skilled nursing facility residents achieved a seroprotective response after hepatitis B vaccination. |
Persistence of hepatitis A vaccine induced seropositivity in infants and young children by maternal antibody status: 10-year follow-up
Sharapov UM , Bulkow LR , Negus SE , Spradling PR , Homan C , Drobeniuc J , Bruce M , Kamili S , Hu DJ , McMahon BJ . Hepatology 2012 56 (2) 516-22 Persistence of seropositivity conferred by hepatitis A vaccine administered to children under 2 years of age is unknown and passively transferred maternal antibodies to hepatitis A virus (maternal anti-HAV) may lower the infant's immune response to the vaccine. Infants and young children (N=197) were randomized into three groups to receive a two dose hepatitis A vaccine (HAVRIX, GlaxoSmithKline; 720 EL.U. in 0.5 ml): group 1 at 6 and 12 months, group 2 at 12 and 18 months, and group 3 at 15 and 21 months of age; within each group infants were randomized by maternal anti-HAV status. Anti-HAV levels were measured at 1 and 6 months, and at 3, 5, 7 and 10 years after second dose of hepatitis A vaccination. Children in all groups had evidence of seroprotection (>10 mIU/mL) at 1 month after dose 2. At 10 years, all children retained seroprotective anti-HAV levels except for only 7% and 11% of children in group 1 born to anti-HAV negative and anti-HAV positive mothers, respectively and 4% of group 3 children born to anti-HAV negative mothers. At 10 years, children born to anti-HAV-negative mothers in Group 3 had highest geometric mean concentration (GMC) (97 mIU/mL, 95% CI: 71-133) and children born to anti-HAV-positive mothers in Group 1 had lowest GMC (29 mIU/mL, 95% CI: 20, 4052). Anti-HAV levels through 10 years of age correlated with initial peak anti-HAV levels (tested at 1 month after second dose). CONCLUSION: The seropositivity induced by hepatitis A vaccine given to children < 2 years of age persists for at least 10 years regardless of presence of maternal anti-HAV. (HEPATOLOGY 2012.). |
Evaluation of hepatitis B vaccine immunogenicity among older adults during an outbreak response in assisted living facilities
Tohme RA , Awosika-Olumo D , Nielsen C , Khuwaja S , Scott J , Xing J , Drobeniuc J , Hu DJ , Turner C , Wafeeg T , Sharapov U , Spradling PR . Vaccine 2011 29 (50) 9316-20 BACKGROUND: During the past decade, in the United States, an increasing number of hepatitis B outbreaks have been reported in assisted living facilities (ALFs) as a result of breaches in infection control practices. We evaluated the seroprotection rates conferred by hepatitis B vaccine among older adults during a response to an outbreak that occurred in multiple ALFs and assessed the influence of demographic and clinical factors on vaccine response. METHODS: Residents were screened for hepatitis B and C infection prior to vaccination and susceptible residents were vaccinated against hepatitis B with one dose of 20mcg Engerix-B (GSK) given at 0, 1, and 4 months. Blood samples were collected 80-90 days after the third vaccine dose to test for anti-HBs levels. RESULTS: Of the 48 residents who had post-vaccination blood specimens collected after the third vaccine dose, 16 (33.3%) achieved anti-HBs concentration ≥10mIU/mL. Age was a significant determinant of seroprotection with rates decreasing from 88% among persons aged ≤60 years to 12% among persons aged ≥90 years (p=0.001). Geometric mean concentrations were higher among non-diabetic than diabetic residents, however, the difference was not statistically significant (5.1 vs. 3.8mIU/mL, p=0.7). CONCLUSIONS: These findings highlight that hepatitis B vaccination is of limited effectiveness when administered to older adults. Improvements in infection control and vaccination at earlier ages might be necessary to prevent spread of infection in ALFs. |
Outbreak of acute hepatitis B virus infections associated with podiatric care at a psychiatric long-term care facility
Wise ME , Marquez P , Sharapov U , Hathaway S , Katz K , Tolan S , Beaton A , Drobeniuc J , Khudyakov Y , Hu DJ , Perz J , Thompson ND , Bancroft E . Am J Infect Control 2011 40 (1) 16-21 BACKGROUND: Effective measures exist to prevent health care-associated hepatitis B virus (HBV) transmission, yet outbreaks continue to occur. In 2008, the Los Angeles County Department of Public Health identified an outbreak of HBV infections among psychiatric long-term care facility residents. METHODS: Residents underwent HBV serologic testing and were classified as acutely infected, chronically infected, susceptible, or immune. Persons residing in the facility during 2008 were enrolled in a retrospective cohort study to identify risk factors for acute HBV infection. We assessed infection control practices at the facility. RESULTS: Nine of 81 residents (11%) enrolled in the cohort study had acute HBV infection. Five of 15 residents (33%) undergoing podiatric care on a single day subsequently developed acute infection (rate ratio, 4.33; 95% confidence interval, 1.18-15.92). Infection control observations of the consulting podiatrist revealed opportunities for cross-contamination of instruments with blood. Other potential health care and behavioral modes of transmission were identified as well. Residents were offered HBV vaccination, and infection control recommendations were implemented by the podiatrist and facility. CONCLUSIONS: Of the multiple potential transmission modes identified, exposure to HBV during podiatry was likely the dominant mode in this outbreak. Long-term care facilities should ensure compliance with infection control standards among staff and consulting health care providers. |
A diagnostic and public health quandary: acute viral hepatitis in a hospital cafeteria worker
Spradling PR , Selvage D , Drobeniuc J , Sharapov U , Stulberg D , Smelser C . J Clin Virol 2011 51 (4) 215-8 A 53-year-old female hospital-cafeteria-worker in New Mexico presented to a physician in January 2009 with a history of jaundice for one day and dark urine for one week. There was no history of travel or contact with any persons with known illness. She had a history of ongoing alcohol use at four drinks per day but denied ever injecting drugs. In 2005, she developed acute hepatitis B (seropositivity for hepatitis B surface antigen [HBsAg] documented) following sexual contact with a person known to have chronic hepatitis B. During this illness she tested negative for IgG antibody to hepatitis C virus (IgG anti-HCV) and later received one dose of hepatitis A vaccine. Blood testing done on January 27 was positive for: (1) IgM antibody to hepatitis A virus (IgM anti-HAV), (2) IgM antibody to hepatitis B core antigen (IgM anti-HBc), and (3) IgG anti-HCV; HBsAg tested negative. Aspartate aminotransferase (AST) activity was 1894 IU/L and alanine aminotransferase (ALT) activity was 992 IU/L. Based on her jaundice and the concern for occupational food-borne transmission, the physician advised the patient to refrain from her work in food service and reported the case to the New Mexico Department of Health (NMDOH). |
An outbreak of hepatitis A among primary and secondary contacts of an international adoptee
Pelletier AR , Mehta PJ , Burgess DR , Bondeson LM , Carson PJ , Rea VE , Sharapov UM , Hu DJ . Public Health Rep 2010 125 (5) 642-6 The Advisory Committee on Immunization Practices recommends that susceptible people traveling to developing countries receive hepatitis A vaccine or immune globulin prior to departure. Until 2009, the recommendations did not address non-traveling family members or other close contacts of international adoptees. We report an outbreak of hepatitis A in 2008 that occurred in Maine. Eight members of an extended family developed hepatitis A following the arrival of an asymptomatic infant from Ethiopia who was brought to the United States by an adoption agency. Two children in the family attended an elementary school where five additional cases of hepatitis A were subsequently identified. Only three (1%) of 208 students at the school had previously been immunized against hepatitis A. This outbreak highlights the need to immunize household members and other close contacts of families adopting children from countries where hepatitis A is endemic, as well as all children at one year of age. |
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