Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
Records 1-19 (of 19 Records) |
Query Trace: Stowell D[original query] |
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Estimated impacts of prescribed fires on air quality and premature deaths in Georgia and surrounding areas in the US, 2015-2020
Maji KJ , Li Z , Vaidyanathan A , Hu Y , Stowell JD , Milando C , Wellenius G , Kinney PL , Russell AG , Odman MT . Environ Sci Technol 2024 Smoke from wildfires poses a substantial threat to health in communities near and far. To mitigate the extent and potential damage of wildfires, prescribed burning techniques are commonly employed as land management tools; however, they introduce their own smoke-related risks. This study investigates the impact of prescribed fires on daily average PM(2.5) and maximum daily 8-h averaged O(3) (MDA8-O(3)) concentrations and estimates premature deaths associated with short-term exposure to prescribed fire PM(2.5) and MDA8-O(3) in Georgia and surrounding areas of the Southeastern US from 2015 to 2020. Our findings indicate that over the study domain, prescribed fire contributes to average daily PM(2.5) by 0.94 ± 1.45 μg/m(3) (mean ± standard deviation), accounting for 14.0% of year-round ambient PM(2.5). Higher average daily contributions were predicted during the extensive burning season (January-April): 1.43 ± 1.97 μg/m(3) (20.0% of ambient PM(2.5)). Additionally, prescribed burning is also responsible for an annual average increase of 0.36 ± 0.61 ppb in MDA8-O(3) (approximately 0.8% of ambient MDA8-O(3)) and 1.3% (0.62 ± 0.88 ppb) during the extensive burning season. We estimate that short-term exposure to prescribed fire PM(2.5) and MDA8-O(3) could have caused 2665 (95% confidence interval (CI): 2249-3080) and 233 (95% CI: 148-317) excess deaths, respectively. These results suggest that smoke from prescribed burns increases the mortality. However, refraining from such burns may escalate the risk of wildfires; therefore, the trade-offs between the health impacts of wildfires and prescribed fires, including morbidity, need to be taken into consideration in future studies. |
Strategies to strengthen COVID-19 vaccine uptake and improve vaccine equity in U.S. Territories and Freely Associated States during the first six months of vaccine rollout
Tippins A , Acevedo JC , Palomeque FS , Coy KC , Chadd P , Stowell D , Ademokun O , Apaisam C , Basilius M , Brostrom R , Collazo IOG , Encarnacion J , Gerena IC , Hancock T , Hunte-Ceasar T , Judicpa P , Leon-Guerrero M , Martinez M , Masunu Y , Pangelinan H , Parian E , Pedro D . Vaccine 2024 The eight U.S. territories and freely associated states (TFAS) have historically faced unique social and structural barriers in the implementation of vaccination programs due to geographic remoteness, a high prevalence of socioeconomic disparities, increasing prevalence of natural disasters, limited vaccine providers and clinics, difficulties with procurement and shipping, and difficulty tracking highly mobile populations. In the months leading up to emergency authorizations for the use of COVID-19 vaccines, the TFAS developed tailored vaccination strategies to ensure that key at-risk populations received timely vaccination, and successfully implemented these strategies during the first six months of the vaccine rollout. Subject matter experts supporting the Centers for Disease Control and Prevention's COVID-19 Response recognized the unique historical, geographic, social, and cultural dynamics for residents in the TFAS and worked with partners to prevent, detect, and respond to the pandemic in these jurisdictions. As a result of innovative partnerships and vaccine distribution strategies, vaccine equity was improved in the TFAS during the COVID-19 vaccine rollout. |
Public perceptions of Ebola vaccines and confidence in health services to treat Ebola, malaria, and tuberculosis: Findings from a cross-sectional household survey in Uganda, 2020
Koyuncu A , Carter RJ , Musaazi J , Namageyo-Funa A , Carter VM , Lamorde M , Prybylski D , Apondi R , Bakyaita T , Boore AL , Homsy J , Brown VR , Kigozi J , Nabaggala MS , Nakate V , Nkurunziza E , Stowell DF , Walwema R , Olowo A , Jalloh MF . PLOS Glob Public Health 2023 3 (12) e0001884 Uganda used Ebola vaccines as part of its preparedness and response during the 2018-2020 10th Ebola virus disease (EVD) outbreak in neighboring Democratic Republic of the Congo (DRC). We evaluated the public's perceptions of Ebola vaccines and compared their confidence in health services to treat Ebola versus malaria and tuberculosis as part of a survey on Ebola knowledge, attitudes, and practices (KAP) conducted in March 2020. A cross-sectional household survey was implemented in six districts in Uganda using multi-stage cluster sampling to randomly select participants. The districts were purposively selected from districts classified by the government as at high- or low-risk for an EVD outbreak. We describe perceptions of Ebola vaccines and confidence in health services to treat Ebola, tuberculosis, and malaria. Modified Poisson regression modeling was used to identify the demographic correlates of these outcomes. Among 3,485 respondents, 18% were aware of Ebola vaccines. Of those, 92% agreed that the vaccines were needed to prevent Ebola. Participants aged 15-24 years were 4% more likely to perceive such need compared to those 60 years and older (adjusted prevalence ratio [aPR] 1.04, 95% confidence interval [CI] 1.0-1.08). The perceived need was 5% lower among participants with at least some secondary education compared to uneducated participants (aPR 0.95; 0.92-0.99). Overall, 81% of those aware of the vaccines believed that everyone or most people in their community would get vaccinated if offered, and 94% said they would likely get vaccinated if offered. Confidence in health services to treat Ebola was lower compared to treating malaria or tuberculosis (55% versus 93% and 77%, respectively). However, participants from the EVD high-risk districts were 22% more likely to be confident in health services to treat Ebola compared to those in low-risk districts (aPR: 1.22; 95% CI: 1.08, 1.38). Our findings suggest that intent to take an Ebola vaccine during an outbreak was strong, but more work needs to be done to increase public awareness of these vaccines. The public's high confidence in health services to treat other health threats, such as malaria and tuberculosis, offer building blocks for strengthening their confidence in health services to treat EVD in the event of an outbreak. |
New York State, New York City, New Jersey, Puerto Rico, and the US Virgin Islands' Health Department experiences promoting health equity during the initial COVID-19 Omicron variant period, 2021-2022
Cox H , Gebru Y , Horter L , Palomeque FS , Myers K , Stowell D , Easterling T , de Noguera NS , Medina-Forrester A , Bravo J , Pérez S , Chaparro J , Ekpo LP , Cranford H , Santibañez S , Valencia D . Health Secur 2023 21 S25-S34 In this case study, we aim to understand how health departments in 5 US jurisdictions addressed health inequities and implemented strategies to reach populations disproportionately affected by COVID-19 during the initial Omicron variant period. We used qualitative methods to examine health department experiences during the initial Omicron surge, from November 2021 to April 2022, assessing successful interventions, barriers, and lessons learned from efforts to promote health equity. Our findings indicate that government leadership supported prioritizing health equity from the beginning of the pandemic, seeing it as a need and vital part of the response framework. All jurisdictions acknowledged the historical trauma and distrust of the government. Health departments found that collaborating and communicating with trusted community leaders helped mitigate public distrust. Having partnerships, resources, and infrastructure in place before the pandemic facilitated the establishment of equity-focused COVID-19 response activities. Finally, misinformation about COVID-19 was a challenge for all jurisdictions. Addressing the needs of diverse populations involves community-informed decisionmaking, diversity of thought, and delivery measures that are tailored to the community. It is imperative to expand efforts to reduce and eliminate health inequities to ensure that individuals and communities recover equitably from the effects of COVID-19. |
Building national health security through a rapid self-assessment and annual operational plan in Uganda, May to September 2021
Nabatanzi M , Bakiika H , Nabukenya I , Lamorde M , Bukirwa J , Achan MI , Babigumira PA , Nakiire L , Lubanga T , Mbabazi E , Taremwa RB , Mayinja H , Nakinsige A , Makanga DK , Muruta A , Okware S , Komakech I , Makumbi I , Wetaka MM , Kayiwa J , Ocom F , Ario AR , Nabatanzi S , Ojwang J , Boore A , Yemanaberhan R , Lee CT , Obuku E , Stowell D . Health Secur 2023 21 (2) 130-140 Uganda established a National Action Plan for Health Security in 2019, following a Joint External Evaluation (JEE) of International Health Regulations (2005) capacities in 2017. The action plan enhanced national health security awareness, but implementation efforts were affected by limited funding, excess of activities, and challenges related to monitoring and evaluation. To improve implementation, Uganda conducted a multisectoral health security self-assessment in 2021 using the second edition of the JEE tool and developed a 1-year operational plan. From 2017 to 2021, Uganda's composite ReadyScore improved by 20%, with improvement in 13 of the 19 technical areas. Indicator scores showing limited capacity declined from 30% to 20%, and indicators with no capacity declined from 10% to 2%. More indicators had developed (47% vs 40%), demonstrated (29% vs 20%), and sustained (2% vs 0%) capacities in 2021 compared with 2017. Using the self-assessment JEE scores, 72 specific activities from the International Health Regulations (2005) benchmarks tool were selected for inclusion in a 1-year operational plan (2021-2022). In contrast to the 264 broad activities in the 5-year national action plan, the operational plan prioritized a small number of activities to enable sectors to focus limited resources on implementation. While certain capacities improved before and during implementation of the action plan, countries may benefit from using short-term operational planning to develop realistic and actionable health security plans to improve health security capacities. |
Evaluation of community perceptions and prevention practices related to ebola virus as part of outbreak preparedness in Uganda, 2020
Musaazi J , Namageyo-Funa A , Carter VM , Carter RJ , Lamorde M , Apondi R , Bakyaita T , Boore AL , Brown VR , Homsy J , Kigozi J , Koyuncu A , Nabaggala MS , Nakate V , Nkurunziza E , Stowell DF , Walwema R , Olowo A , Jalloh MF . Glob Health Sci Pract 2022 10 (3) Introduction: During the 2018–2020 Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo, risk communication and community engagement (RCCE) were prioritized in geographic areas in Uganda considered at high risk of introduction of EVD. To inform EVD preparedness in Uganda, we evaluated community perceptions and prevention practices related to EVD in 6 districts in Uganda. Methods: In March 2020, we conducted a population-based survey in 6 purposively selected districts in Uganda using multistage cluster sampling. We examined differences between districts classified as high- versus low risk for EVD in terms of their message exposure from RCCE; risk perception; and EVD knowledge, attitudes, and prevention practices. Results: A total of 3,485 respondents were interviewed (91% response rate). EVD message exposure was more common in the high- versus low-risk districts. EVD risk perceptions were low overall but greater in the high- versus low-risk districts. Comprehensive knowledge was significantly greater in the high- versus low-risk districts (adjusted prevalence ratio [aPR] 1.61, 95% confidence interval [CI]=1.35, 1.93). Respondents’ engagement in all 3 EVD prevention practices (frequent handwashing with soap, avoiding physical contact with suspected Ebola patients, and avoiding burials involving contact with a corpse) was very low (4%). However, respondents with comprehensive knowledge were more likely to engage in all 3 EVD prevention practices compared to respondents without comprehensive knowledge (aPR 1.87, 95% CI=1.08, 3.25). Conclusion: Our findings suggest that while RCCE efforts as part of EVD outbreak preparedness may have contributed to higher EVD knowledge in the targeted high-risk districts, uptake of prevention behaviors was similarly low across districts. In a non-outbreak setting, implementing targeted RCCE strategies may not be sufficient to motivate people to adopt protective behaviors in the absence of a high threshold of perceived threat such as in an active outbreak. © Musaazi et al. |
How can we strengthen the Joint External Evaluation
Stowell D , Garfield R . BMJ Glob Health 2021 6 (5) The COVID-19 pandemic raises fundamental questions about the appropriateness of the International Health Regulations and the effectiveness of the Joint External Evaluation (JEE) for strengthening global health security. | In the wake of COVID-19, revision of JEE tool should be based on an understanding of the purpose, use and limitations of the measurement tool. | Successfully strengthening the tool will necessitate countries to take action on the results of the assessment as well as addressing certain strategic, technical and operational considerations in the next edition of the tool. |
Notes from the Field: COVID-19 Case Investigation and Contact Tracing Program - Spirit Lake Tribe, North Dakota, September-November 2020.
Matthias J , Charboneau T , Schaffer C , Rusten J , Whitmer S , de la Paz J , Dykstra J , Pathmanathan I , Stowell D . MMWR Morb Mortal Wkly Rep 2021 70 (14) 533-534 In late September 2020, the incidence of confirmed COVID-19* in North Dakota began increasing rapidly, from approximately 300 new cases per day to approximately 2,260 cases on November 13, 2020 (1). On October 20, the North Dakota Department of Health reported that contact tracing notification efforts were delayed. Because of the delay, COVID-19 patients were asked to notify their own contacts about potential exposure and encourage them to seek testing for SARS-CoV-2, the virus that causes COVID-19 (2). The Spirit Lake sovereign nation in east central North Dakota is home to approximately 7,500 members of the Spirit Lake Tribe. In response to increasing incidence of COVID-19 on the Spirit Lake Reservation, CDC assisted the Spirit Lake Tribe in building a tribally managed program for comprehensive COVID-19 case investigations, case notification, contact tracing, contact testing, and contact management to ensure timely implementation of these critical epidemic control measures. |
COVID-19 intra-action reviews: potential for a sustained response plan.
Greiner AL , Nguyen L , Shamout M , Krishnan S , Stowell D . Lancet Glob Health 2021 9 (5) e594 We echo Landry Ndriko Mayigane and colleagues’ call (December, 2020)1 for countries to plan and conduct intra-action reviews regularly throughout the COVID-19 response. An intra-action review is a country-led process that reviews past response actions to identify crucial gaps and optimise response plans going forward. WHO guidance for conducting a country COVID-19 intra-action review includes more than 300 discussion questions that can be adapted to a country’s context.2 | | However, given that 26 of 33 countries that have already completed an intra-action review are experiencing ongoing SARS-CoV-2 transmission at the time of writing,3 the retrospective intra-action review process does not sufficiently address ongoing and protracted response planning. Within this context, we advocate for the inclusion of a prospective response examination in the intra-action review process—ie, examining how to sustain response measures to ensure resiliency and plan effectively for the future. |
Uganda's experience in Ebola virus disease outbreak preparedness, 2018-2019
Aceng JR , Ario AR , Muruta AN , Makumbi I , Nanyunja M , Komakech I , Bakainaga AN , Talisuna AO , Mwesigye C , Mpairwe AM , Tusiime JB , Lali WZ , Katushabe E , Ocom F , Kaggwa M , Bongomin B , Kasule H , Mwoga JN , Sensasi B , Mwebembezi E , Katureebe C , Sentumbwe O , Nalwadda R , Mbaka P , Fatunmbi BS , Nakiire L , Lamorde M , Walwema R , Kambugu A , Nanyondo J , Okware S , Ahabwe PB , Nabukenya I , Kayiwa J , Wetaka MM , Kyazze S , Kwesiga B , Kadobera D , Bulage L , Nanziri C , Monje F , Aliddeki DM , Ntono V , Gonahasa D , Nabatanzi S , Nsereko G , Nakinsige A , Mabumba E , Lubwama B , Sekamatte M , Kibuule M , Muwanguzi D , Amone J , Upenytho GD , Driwale A , Seru M , Sebisubi F , Akello H , Kabanda R , Mutengeki DK , Bakyaita T , Serwanjja VN , Okwi R , Okiria J , Ainebyoona E , Opar BT , Mimbe D , Kyabaggu D , Ayebazibwe C , Sentumbwe J , Mwanja M , Ndumu DB , Bwogi J , Balinandi S , Nyakarahuka L , Tumusiime A , Kyondo J , Mulei S , Lutwama J , Kaleebu P , Kagirita A , Nabadda S , Oumo P , Lukwago R , Kasozi J , Masylukov O , Kyobe HB , Berdaga V , Lwanga M , Opio JC , Matseketse D , Eyul J , Oteba MO , Bukirwa H , Bulya N , Masiira B , Kihembo C , Ohuabunwo C , Antara SN , Owembabazi W , Okot PB , Okwera J , Amoros I , Kajja V , Mukunda BS , Sorela I , Adams G , Shoemaker T , Klena JD , Taboy CH , Ward SE , Merrill RD , Carter RJ , Harris JR , Banage F , Nsibambi T , Ojwang J , Kasule JN , Stowell DF , Brown VR , Zhu BP , Homsy J , Nelson LJ , Tusiime PK , Olaro C , Mwebesa HG , Woldemariam YT . Global Health 2020 16 (1) 24 BACKGROUND: Since the declaration of the 10th Ebola Virus Disease (EVD) outbreak in DRC on 1st Aug 2018, several neighboring countries have been developing and implementing preparedness efforts to prevent EVD cross-border transmission to enable timely detection, investigation, and response in the event of a confirmed EVD outbreak in the country. We describe Uganda's experience in EVD preparedness. RESULTS: On 4 August 2018, the Uganda Ministry of Health (MoH) activated the Public Health Emergency Operations Centre (PHEOC) and the National Task Force (NTF) for public health emergencies to plan, guide, and coordinate EVD preparedness in the country. The NTF selected an Incident Management Team (IMT), constituting a National Rapid Response Team (NRRT) that supported activation of the District Task Forces (DTFs) and District Rapid Response Teams (DRRTs) that jointly assessed levels of preparedness in 30 designated high-risk districts representing category 1 (20 districts) and category 2 (10 districts). The MoH, with technical guidance from the World Health Organisation (WHO), led EVD preparedness activities and worked together with other ministries and partner organisations to enhance community-based surveillance systems, develop and disseminate risk communication messages, engage communities, reinforce EVD screening and infection prevention measures at Points of Entry (PoEs) and in high-risk health facilities, construct and equip EVD isolation and treatment units, and establish coordination and procurement mechanisms. CONCLUSION: As of 31 May 2019, there was no confirmed case of EVD as Uganda has continued to make significant and verifiable progress in EVD preparedness. There is a need to sustain these efforts, not only in EVD preparedness but also across the entire spectrum of a multi-hazard framework. These efforts strengthen country capacity and compel the country to avail resources for preparedness and management of incidents at the source while effectively cutting costs of using a "fire-fighting" approach during public health emergencies. |
CMV on surfaces in homes with young children: results of PCR and viral culture testing
Amin MM , Stowell JD , Hendley W , Garcia P , Schmid DS , Cannon MJ , Dollard SC . BMC Infect Dis 2018 18 (1) 391 BACKGROUND: Caring for young children is a known risk factor for cytomegalovirus (CMV) infection mainly through exposure to their saliva and urine. In a previous study, 36 CMV-seropositive children 2 mo. to 4 years old were categorized as CMV shedders (n = 23) or non-shedders (n = 13) based on detection of CMV DNA in their saliva and urine. The current study evaluated the presence of CMV on surfaces in homes of the children. METHODS: Study staff made 4 visits to homes of the 36 enrolled children over 100 days. Saliva was collected by swabbing the mouth and urine was collected on filter paper inserted into diapers. In addition, five surface specimens were collected: three in contact with children's saliva (spoon, child's cheek, washcloth) and two in contact with children's urine (diaper changing table, mother's hand). Samples were tested by PCR and viral culture to quantify the presence of CMV DNA and viable virus. RESULTS: A total of 654 surface samples from 36 homes were tested; 136 were CMV DNA positive, 122 of which (90%) were in homes of the children shedding CMV (p < 0.001). Saliva-associated samples were more often CMV positive with higher viral loads than urine-associated samples. The higher the CMV viral load of the child in the home, the more home surfaces that were PCR positive (p = 0.01) and viral culture positive (p = 0.05). CONCLUSIONS: The main source for CMV on surfaces in homes was saliva from the child in the home. Higher CMV viral loads shed by children correlated with more viable virus on surfaces which could potentially contribute to viral transmission. |
Using theory-based messages to motivate U.S. pregnant women to prevent cytomegalovirus infection: results from formative research
Levis DM , Hillard CL , Price SM , Reed-Gross E , Bonilla E , Amin M , Stowell JD , Clark R , Johnson D , Mask K , Carpentieri C , Cannon MJ . BMC Womens Health 2017 17 (1) 131 BACKGROUND: An estimated 1 in 150 infants is born each year with congenital cytomegalovirus (CMV); nearly 1 in 750 suffers permanent disabilities. Congenital CMV is the result of a pregnant woman becoming infected with CMV. Educating pregnant women about CMV is currently the best approach to prevention. Limited research is available on how to effectively communicate with women about CMV. We conducted formative research on fear appeals theory-based messages about CMV and prevention with U.S. women. Fear appeal theories suggest that message recipients will take action if they feel fear. METHODS: First, we conducted in-depth interviews (N = 32) with women who had young children who tested positive for CMV. Second, we conducted eight focus groups (N = 70) in two phases and two cities (Phase 2: Atlanta, GA; Phase 3: San Diego, CA) with pregnant women and non-pregnant women who had young children. Few participants knew about CMV before the focus groups. Participants reviewed and gave feedback on messages created around fear appeals theory-based communication concepts. The following concepts were tested in one or more of the three phases of research: CMV is severe, CMV is common, CMV is preventable, CMV preventive strategies are similar to other behavior changes women make during pregnancy, CMV preventive strategies can be incorporated in moderation to reduce exposure, and CMV is severe but preventable. RESULTS: Participants recommended communicating that CMV is common by using prevalence ratios (e.g., 1 in 150) or comparing CMV to other well-known disabilities. To convey the severity of CMV, participants preferred stories about CMV along with prevention strategies. Participants also welcomed prevention strategies when it included a message about risk reduction. In general, participants said messages were motivating, even if they felt that it could be difficult to make certain behavior changes. CONCLUSIONS: Findings from this research can contribute to future efforts to educate pregnant women about CMV, especially regarding use of fear appeals-based messages. Pregnant women may face certain challenges to practicing prevention strategies but, overall, are motivated make changes to increase their chances of having a healthy baby. |
Antibody effector functions mediated by Fcγ-receptors are compromised during persistent viral infection
Wieland A , Shashidharamurthy R , Kamphorst AO , Han JH , Aubert RD , Choudhury BP , Stowell SR , Lee J , Punkosdy GA , Shlomchik MJ , Selvaraj P , Ahmed R . Immunity 2015 42 (2) 367-78 T cell dysfunction is well documented during chronic viral infections but little is known about functional abnormalities in humoral immunity. Here we report that mice persistently infected with lymphocytic choriomeningitis virus (LCMV) exhibit a severe defect in Fcgamma-receptor (FcgammaR)-mediated antibody effector functions. Using transgenic mice expressing human CD20, we found that chronic LCMV infection impaired the depletion of B cells with rituximab, an anti-CD20 antibody widely used for the treatment of B cell lymphomas. In addition, FcgammaR-dependent activation of dendritic cells by agonistic anti-CD40 antibody was compromised in chronically infected mice. These defects were due to viral antigen-antibody complexes and not the chronic infection per se, because FcgammaR-mediated effector functions were normal in persistently infected mice that lacked LCMV-specific antibodies. Our findings have implications for the therapeutic use of antibodies and suggest that high levels of pre-existing immune complexes could limit the effectiveness of antibody therapy in humans. |
Cytomegalovirus viral and antibody correlates in young children
Dollard SC , Keyserling H , Radford K , Amin MM , Stowell J , Winter J , Schmid DS , Cannon MJ , Hyde TB . BMC Res Notes 2014 7 776 BACKGROUND: Young, healthy children shedding cytomegalovirus (CMV) in urine and saliva appear to be the leading source of CMV in primary infection of pregnant women. FINDINGS: We screened 48 children 6 months - 5 years old for CMV IgG and measured levels of CMV IgG, IgM and IgG avidity antibodies, frequency of CMV shedding, and viral loads in blood, urine, and saliva. Thirteen of the 48 children (27%) were CMV IgG positive, among whom 3 were also CMV IgM positive with evidence of recent primary infection. Nine of the 13 seropositive children (69%) were shedding 102-105 copies/ml of CMV DNA in one or more bodily fluid. Among seropositive children, low IgG antibody titer (1:20-1:80) was associated with the absence of shedding (p = 0.014), and enrollment in daycare was associated with the presence of CMV shedding (p = 0.037). CONCLUSIONS: CMV antibody profiles correlated with CMV shedding. The presence of CMV IgM more often represents primary infection in children than in adults. Correlating antibodies with primary infection and viral shedding in healthy children adds to the understanding of CMV infection in children that can inform the prevention of CMV transmission to pregnant women. |
Repeated measures study of weekly and daily cytomegalovirus shedding patterns in saliva and urine of healthy cytomegalovirus-seropositive children
Cannon MJ , Stowell JD , Clark R , Dollard PR , Johnson D , Mask K , Stover C , Wu K , Amin M , Hendley W , Guo J , Schmid DS , Dollard SC . BMC Infect Dis 2014 14 (569) 569 BACKGROUND: To better understand potential transmission risks from contact with the body fluids of children, we monitored the presence and amount of CMV shedding over time in healthy CMV-seropositive children. METHODS: Through screening we identified 36 children from the Atlanta, Georgia area who were CMV-seropositive, including 23 who were shedding CMV at the time of screening. Each child received 12 weekly in-home visits at which field workers collected saliva and urine. During the final two weeks, parents also collected saliva and urine daily. RESULTS: Prevalence of shedding was highly correlated with initial shedding status: children shedding at the screening visit had CMV DNA in 84% of follow-up saliva specimens (455/543) and 28% of follow-up urine specimens (151/539); those not shedding at the screening visit had CMV DNA in 16% of follow-up saliva specimens (47/303) and 5% of follow-up urine specimens (16/305). Among positive specimens we found median viral loads of 82,900 copies/mL in saliva and 34,730 copies/mL in urine (P=0.01), while the viral load for the 75th percentile was nearly 1.5 million copies/mL for saliva compared to 86,800 copies/mL for urine. Younger age was significantly associated with higher viral loads, especially for saliva (P<0.001). Shedding prevalence and viral loads were relatively stable over time. All children who were shedding at the screening visit were still shedding at least some days during weeks 11 and 12, and median and mean viral loads did not change substantially over time. CONCLUSIONS: Healthy CMV-seropositive children can shed CMV for months at high, relatively stable levels. These data suggest that behavioral prevention messages need to address transmission via both saliva and urine, but also need to be informed by the potentially higher risks posed by saliva and by exposures to younger children. |
Cross-sectional study of cytomegalovirus shedding and immunological markers among seropositive children and their mothers
Stowell JD , Mask K , Amin M , Clark R , Levis D , Hendley W , Lanzieri TM , Dollard SC , Cannon MJ . BMC Infect Dis 2014 14 (568) 568 BACKGROUND: Congenital cytomegalovirus (CMV) is the leading infectious cause of birth defects in the United States. To better understand factors that may influence CMV transmission risk, we compared viral and immunological factors in healthy children and their mothers. METHODS: We screened for CMV IgG antibodies in a convenience sample of 161 children aged 0-47 months from the Atlanta, Georgia metropolitan area, along with 32 mothers of children who screened CMV-seropositive. We assessed CMV shedding via PCR using saliva collected with oral swabs (children and mothers) and urine collected from diapers using filter paper inserts (children only). RESULTS: CMV IgG was present in 31% (50/161) of the children. Half (25/50) of seropositive children were shedding in at least one fluid. The proportion of seropositive children who shed in saliva was 100% (8/8) among the 4-12 month-olds, 64% (9/14) among 13-24 month-olds, and 40% (6/15) among 25-47 month-olds (P for trend=0.003). Seropositive mothers had a lower proportion of saliva shedding (21% [6/29]) than children (P<0.001). Among children who were shedding CMV, viral loads in saliva were significantly higher in younger children (P<0.001); on average, the saliva viral load of infants (i.e., <12 months) was approximately 300 times that of two year-olds (i.e., 24-35 months). Median CMV viral loads were similar in children's saliva and urine but were 10-50 times higher (P<0.001) than the median viral load of the mothers' saliva. However, very high viral loads (> one million copies/mL) were only found in children's saliva (31% of those shedding); children's urine and mothers' saliva specimens all had fewer than 100,000 copies/mL. Low IgG avidity, a marker of primary infection, was associated with younger age (p=0.03), higher viral loads in saliva (p=0.02), and lower antibody titers (p=0.005). CONCLUSIONS: Young CMV seropositive children, especially those less than one year-old may present high-risk CMV exposures to pregnant women, especially via saliva, though further research is needed to see if this finding can be generalized across racial or other demographic strata. |
Cytomegalovirus survival and transferability and the effectiveness of common hand-washing agents against cytomegalovirus on live human hands
Stowell JD , Forlin-Passoni D , Radford K , Bate SL , Dollard SC , Bialek SR , Cannon MJ , Schmid DS . Appl Environ Microbiol 2014 80 (2) 455-61 Congenital cytomegalovirus (CMV) transmission can occur when women acquire CMV while pregnant. Infection control guidelines may reduce risk for transmission. We studied the duration of CMV survival after application of bacteria to the hands and after transfer from the hands to surfaces and the effectiveness of cleansing with water, regular and antibacterial soaps, sanitizer, and diaper wipes. Experiments used CMV AD169 in saliva at initial titers of 1 x 10(5) infectious particles/ml. Samples from hands or surfaces (points between 0 and 15 min) were placed in culture and observed for at least 2 weeks. Samples were also tested using CMV real-time PCR. After application of bacteria to the hands, viable CMV was recovered from 17/20 swabs at 0 min, 18/20 swabs at 1 min, 5/20 swabs at 5 min, and 4/20 swabs at 15 min. After transfer, duration of survival was at least 15 min on plastic (1/2 swabs), 5 min on crackers and glass (3/4 swabs), and 1 min or less on metal and cloth (3/4 swabs); no viable virus was collected from wood, rubber, or hands. After cleansing, no viable virus was recovered using water (0/22), plain soap (0/20), antibacterial soap (0/20), or sanitizer (0/22). Viable CMV was recovered from 4/20 hands 10 min after diaper wipe cleansing. CMV remains viable on hands for sufficient times to allow transmission. CMV may be transferred to surfaces with reduced viability. Hand-cleansing methods were effective at eliminating viable CMV from hands. |
Cytomegalovirus survival on common environmental surfaces: opportunities for viral transmission
Stowell JD , Forlin-Passoni D , Din E , Radford K , Brown D , White A , Bate SL , Dollard SC , Bialek SR , Cannon MJ , Schmid DS . J Infect Dis 2012 205 (2) 211-4 Congenital cytomegalovirus (CMV) affects approximately 1 of 150 births and is a leading cause of hearing loss and intellectual disability. It has been suggested that transmission may occur via contaminated surfaces. CMV AD169 in filtered human saliva, applied to environmental surfaces, was recovered at various time points. Samples were evaluated by culture and real-time polymerase chain reaction. CMV was found viable on metal and wood to 1 hour, glass and plastic to 3 hours, and rubber, cloth, and cracker to 6 hours. CMV was cultured from 83 of 90 wet and 5 of 40 dry surfaces. CMV was more likely to be isolated from wet, highly absorbent surfaces at earlier time points. |
Congenital cytomegalovirus: an update
Stowell JD , Forlin-Passoni DF , Cannon MJ . Contemp Pediatr 2010 27 (5) 38-51 Cytomegalovirus (CMV) is the most commong source of congential infection in newborns and is a leading cause of hearing loss and intellectual disability in the United Sates. As a result of its substantial disease burden, congential CMV is associated with an estimated $1 billion to $2 billion in direct ecnomic costs each year. However, there has been limited progress in developing interventions to prevent or treat CMV infection. Researchers across disciplines are striving to better understand the epidemiology of congenital CMV, improve diagnostic tools, develop new treatments, and explore interventions for preventing infection and improving outcomes for infected infants. |
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