Last data update: May 13, 2024. (Total: 46773 publications since 2009)
Records 1-30 (of 36 Records) |
Query Trace: Thacker L[original query] |
---|
Human exposures to Brucella canis from a pregnant dog during an international flight: Public health risks, diagnostic challenges and future considerations
Williams C , Swisher S , Miller N , Pinn-Woodcock T , Austin C , Hsiao SH , Arenas-Gamboa AM , Tiller R , Thacker T , Taetzsch S , Franklin-Guild R , Cutter L , Quance C , Hung CC , Maddox CW , Ernst M , Guarino C , Lanka S , Garcia-Gonzalez DG , Slager S , Sunavala Z , Brown C , Negron M , Pieracci EG . Zoonoses Public Health 2024 AIMS: This report documents the exposure of passengers and crew of a commercial international flight to the zoonotic pathogen Brucella canis after an infected dog aborted in the passenger cabin of the aircraft. This case demonstrates the challenges associated with brucellosis screening and the risks that airline personnel, airport employees and travellers face when animals with unrecognized zoonotic infections are transported. METHODS/RESULTS: The public health investigation of this case was conducted by the Centers for Disease Control, the Illinois Department of Health and the Illinois Department of Agriculture, in collaboration with a local veterinary clinic and several academic and federal diagnostic laboratories. It included an extensive diagnostic evaluation of the dam and aborted foetuses to confirm a diagnosis of canine brucellosis. Passengers, airline personnel and staff from the veterinary clinic where the dogs were treated underwent risk assessments, and clinic staff also received detailed guidance regarding infection prevention practices. CONCLUSIONS: Animal shelters and breeding programs are recommended to screen dogs routinely for brucellosis, but it is not unusual for domestic or imported animals to have unknown health histories, including the dog's brucellosis status, at the time of purchase, adoption, or re-homing. Testing recommendations and requirements vary by state, making it challenging for state public health and animal health agencies to monitor and respond appropriately. This case highlights the importance of Brucella spp. screening in sexually intact dogs prior to breeding, purchase, or domestic or international transportation of the dogs. The transportation of pregnant dogs may present a previously unrecognized public health threat in addition to contributing to unnecessary stress and health risks for pregnant animals. |
Association between SARS-CoV-2 infection and select symptoms and conditions 31 to 150 days after testing among children and adults
Zhang Y , Romieu-Hernandez A , Boehmer TK , Azziz-Baumgartner E , Carton TW , Gundlapalli AV , Fearrington J , Nagavedu K , Dea K , Moyneur E , Cowell LG , Kaushal R , Mayer KH , Puro J , Rasmussen SA , Thacker D , Weiner MG , Saydah S , Block JP . BMC Infect Dis 2024 24 (1) 181 BACKGROUND: An increasing number of studies have described new and persistent symptoms and conditions as potential post-acute sequelae of SARS-CoV-2 infection (PASC). However, it remains unclear whether certain symptoms or conditions occur more frequently among persons with SARS-CoV-2 infection compared with those never infected with SARS-CoV-2. We compared the occurrence of specific COVID-associated symptoms and conditions as potential PASC 31- to 150-day following a SARS-CoV-2 test among adults and children with positive and negative test results. METHODS: We conducted a retrospective cohort study using electronic health record (EHR) data from 43 PCORnet sites participating in a national COVID-19 surveillance program. This study included 3,091,580 adults (316,249 SARS-CoV-2 positive; 2,775,331 negative) and 675,643 children (62,131 positive; 613,512 negative) who had a SARS-CoV-2 laboratory test during March 1, 2020-May 31, 2021 documented in their EHR. We used logistic regression to calculate the odds of having a symptom and Cox models to calculate the risk of having a newly diagnosed condition associated with a SARS-CoV-2 positive test. RESULTS: After adjustment for baseline covariates, hospitalized adults and children with a positive test had increased odds of being diagnosed with ≥ 1 symptom (adults: adjusted odds ratio[aOR], 1.17[95% CI, 1.11-1.23]; children: aOR, 1.18[95% CI, 1.08-1.28]) or shortness of breath (adults: aOR, 1.50[95% CI, 1.38-1.63]; children: aOR, 1.40[95% CI, 1.15-1.70]) 31-150 days following a SARS-CoV-2 test compared with hospitalized individuals with a negative test. Hospitalized adults with a positive test also had increased odds of being diagnosed with ≥ 3 symptoms or fatigue compared with those testing negative. The risks of being newly diagnosed with type 1 or type 2 diabetes (adjusted hazard ratio[aHR], 1.25[95% CI, 1.17-1.33]), hematologic disorders (aHR, 1.19[95% CI, 1.11-1.28]), or respiratory disease (aHR, 1.44[95% CI, 1.30-1.60]) were higher among hospitalized adults with a positive test compared with those with a negative test. Non-hospitalized adults with a positive test also had higher odds or increased risk of being diagnosed with certain symptoms or conditions. CONCLUSIONS: Patients with SARS-CoV-2 infection, especially those who were hospitalized, were at higher risk of being diagnosed with certain symptoms and conditions after acute infection. |
Second nationwide tuberculosis outbreak caused by bone allografts containing live cells - United States, 2023
Wortham JM , Haddad MB , Stewart RJ , Annambhotla P , Basavaraju SV , Nabity SA , Griffin IS , McDonald E , Beshearse EM , Grossman MK , Schildknecht KR , Calvet HM , Keh CE , Percak JM , Coloma M , Shaw T , Davidson PJ , Smith SR , Dickson RP , Kaul DR , Gonzalez AR , Rai S , Rodriguez G , Morris S , Armitige LY , Stapleton J , Lacassagne M , Young LR , Ariail K , Behm H , Jordan HT , Spencer M , Nilsen DM , Denison BM , Burgos M , Leonard JM , Cortes E , Thacker TC , Lehman KA , Langer AJ , Cowan LS , Starks AM , LoBue PA . MMWR Morb Mortal Wkly Rep 2024 72 (5253) 1385-1389 During July 7-11, 2023, CDC received reports of two patients in different states with a tuberculosis (TB) diagnosis following spinal surgical procedures that used bone allografts containing live cells from the same deceased donor. An outbreak associated with a similar product manufactured by the same tissue establishment (i.e., manufacturer) occurred in 2021. Because of concern that these cases represented a second outbreak, CDC and the Food and Drug Administration worked with the tissue establishment to determine that this product was obtained from a donor different from the one implicated in the 2021 outbreak and learned that the bone allograft product was distributed to 13 health care facilities in seven states. Notifications to all seven states occurred on July 12. As of December 20, 2023, five of 36 surgical bone allograft recipients received laboratory-confirmed TB disease diagnoses; two patients died of TB. Whole-genome sequencing demonstrated close genetic relatedness between positive Mycobacterium tuberculosis cultures from surgical recipients and unused product. Although the bone product had tested negative by nucleic acid amplification testing before distribution, M. tuberculosis culture of unused product was not performed until after the outbreak was recognized. The public health response prevented up to 53 additional surgical procedures using allografts from that donor; additional measures to protect patients from tissue-transmitted M. tuberculosis are urgently needed. |
Association between hypertension and diabetes control and COVID-19 severity: National Patient-Centered Clinical Research Network, United States, March 2020 to February 2022
Jackson SL , Woodruff RC , Nagavedu K , Fearrington J , Rolka DB , Twentyman E , Carton TW , Puro J , Denson JL , Kappelman MD , Paranjape A , Thacker D , Weiner MG , Goodman AB , Lekiachvili A , Boehmer TK , Block JP . J Am Heart Assoc 2023 12 (21) e030240 Background Hypertension and diabetes are associated with increased COVID-19 severity. The association between level of control of these conditions and COVID-19 severity is less well understood. Methods and Results This retrospective cohort study identified adults with COVID-19, March 2020 to February 2022, in 43 US health systems in the National Patient-Centered Clinical Research Network. Hypertension control was categorized as blood pressure (BP) <130/80, 130 to 139/80 to 89, 140 to 159/90 to 99, or ≥160/100 mm Hg, and diabetes control as glycated hemoglobin <7%, 7% to <9%, ≥9%. Adjusted, pooled logistic regression assessed associations between hypertension and diabetes control and severe COVID-19 outcomes. Among 1 494 837 adults with COVID-19, 43% had hypertension and 12% had diabetes. Among patients with hypertension, the highest baseline BP was associated with greater odds of hospitalization (adjusted odds ratio [aOR], 1.30 [95% CI, 1.23-1.37] for BP ≥160/100 versus BP <130/80), critical care (aOR, 1.30 [95% CI, 1.21-1.40]), and mechanical ventilation (aOR, 1.32 [95% CI, 1.17-1.50]) but not mortality (aOR, 1.08 [95% CI, 0.98-1.12]). Among patients with diabetes, the highest glycated hemoglobin was associated with greater odds of hospitalization (aOR, 1.61 [95% CI, 1.47-1.76] for glycated hemoglobin ≥9% versus <7%), critical care (aOR, 1.42 [95% CI, 1.31-1.54]), mechanical ventilation (aOR, 1.12 [95% CI, 1.02-1.23]), and mortality (aOR, 1.18 [95% CI, 1.09-1.27]). Black and Hispanic adults were more likely than White adults to experience severe COVID-19 outcomes, independent of comorbidity score and control of hypertension or diabetes. Conclusions Among 1.5 million patients with COVID-19, higher BP and glycated hemoglobin were associated with more severe COVID-19 outcomes. Findings suggest that adults with poorest control of hypertension or diabetes might benefit from efforts to prevent and initiate early treatment of COVID-19. |
Incomplete tissue product tracing during an investigation of a tissue-derived tuberculosis outbreak
Marshall KE , Free RJ , Filardo TD , Schwartz NG , Hernandez-Romieu AC , Thacker TC , Lehman KA , Annambhotla P , Dupree PB , Glowicz JB , Scarpita AM , Brubaker SA , Czaja CA , Basavaraju SV . Am J Transplant 2023 24 (1) 115-122 In the United States, there is currently no system to track donated human tissue products to individual recipients. This posed a challenge during an investigation of a nationwide tuberculosis outbreak that occurred when bone allograft contaminated with Mycobacterium tuberculosis (Lot A) was implanted into 113 patients in 18 U.S. states, including two patients at one healthcare facility in Colorado. A third patient at the same facility developed spinal tuberculosis with an isolate genetically identical to the Lot A outbreak strain. However, healthcare records indicated this patient had received bone allograft from a different donor (Lot B). We investigated the source of this newly identified infection, including the possibilities of Lot B donor infection, product switch or contamination during manufacturing, product switch at the healthcare facility, person-to-person transmission, and laboratory error. Findings included gaps in tissue traceability at the healthcare facility, creating the possibility for a product switch at the point-of-care despite detailed tissue-tracking policies. Nationally, 6 (3.9%) of 155 Lot B units could not be traced to final disposition. This investigation highlights the critical need to improve tissue-tracking systems to ensure unbroken traceability, facilitating investigations of recipient adverse events and enabling timely public health responses to prevent morbidity and mortality. |
A Public Health Research Agenda for Managing Infodemics: Methods and Results of the First WHO Infodemiology Conference.
Calleja N , AbdAllah A , Abad N , Ahmed N , Albarracin D , Altieri E , Anoko JN , Arcos R , Azlan AA , Bayer J , Bechmann A , Bezbaruah S , Briand SC , Brooks I , Bucci LM , Burzo S , Czerniak C , De Domenico M , Dunn AG , Ecker UKH , Espinosa L , Francois C , Gradon K , Gruzd A , Gülgün BS , Haydarov R , Hurley C , Astuti SI , Ishizumi A , Johnson N , Johnson Restrepo D , Kajimoto M , Koyuncu A , Kulkarni S , Lamichhane J , Lewis R , Mahajan A , Mandil A , McAweeney E , Messer M , Moy W , Ndumbi Ngamala P , Nguyen T , Nunn M , Omer SB , Pagliari C , Patel P , Phuong L , Prybylski D , Rashidian A , Rempel E , Rubinelli S , Sacco P , Schneider A , Shu K , Smith M , Sufehmi H , Tangcharoensathien V , Terry R , Thacker N , Trewinnard T , Turner S , Tworek H , Uakkas S , Vraga E , Wardle C , Wasserman H , Wilhelm E , Würz A , Yau B , Zhou L , Purnat TD . JMIR Infodemiology 2021 1 (1) e30979 BACKGROUND: An infodemic is an overflow of information of varying quality that surges across digital and physical environments during an acute public health event. It leads to confusion, risk-taking, and behaviors that can harm health and lead to erosion of trust in health authorities and public health responses. Owing to the global scale and high stakes of the health emergency, responding to the infodemic related to the pandemic is particularly urgent. Building on diverse research disciplines and expanding the discipline of infodemiology, more evidence-based interventions are needed to design infodemic management interventions and tools and implement them by health emergency responders. OBJECTIVE: The World Health Organization organized the first global infodemiology conference, entirely online, during June and July 2020, with a follow-up process from August to October 2020, to review current multidisciplinary evidence, interventions, and practices that can be applied to the COVID-19 infodemic response. This resulted in the creation of a public health research agenda for managing infodemics. METHODS: As part of the conference, a structured expert judgment synthesis method was used to formulate a public health research agenda. A total of 110 participants represented diverse scientific disciplines from over 35 countries and global public health implementing partners. The conference used a laddered discussion sprint methodology by rotating participant teams, and a managed follow-up process was used to assemble a research agenda based on the discussion and structured expert feedback. This resulted in a five-workstream frame of the research agenda for infodemic management and 166 suggested research questions. The participants then ranked the questions for feasibility and expected public health impact. The expert consensus was summarized in a public health research agenda that included a list of priority research questions. RESULTS: The public health research agenda for infodemic management has five workstreams: (1) measuring and continuously monitoring the impact of infodemics during health emergencies; (2) detecting signals and understanding the spread and risk of infodemics; (3) responding and deploying interventions that mitigate and protect against infodemics and their harmful effects; (4) evaluating infodemic interventions and strengthening the resilience of individuals and communities to infodemics; and (5) promoting the development, adaptation, and application of interventions and toolkits for infodemic management. Each workstream identifies research questions and highlights 49 high priority research questions. CONCLUSIONS: Public health authorities need to develop, validate, implement, and adapt tools and interventions for managing infodemics in acute public health events in ways that are appropriate for their countries and contexts. Infodemiology provides a scientific foundation to make this possible. This research agenda proposes a structured framework for targeted investment for the scientific community, policy makers, implementing organizations, and other stakeholders to consider. |
COVID-19 outcomes stratified by control status of hypertension and diabetes: Preliminary findings from PCORnet, U.S
Jackson SL , Block JP , Rolka DB , Pavkov ME , Chevinsky JR , Lekiachvili A , Carton TW , Thacker D , Denson JL , Paranjape A , Kappelman MD , Boehmer TK , Twentyman E . AJPM Focus 2022 1 (1) 100012 INTRODUCTION: Hypertension and diabetes are associated with increased COVID-19 severity, yet less is known about COVID-19 outcomes across levels of disease control for these conditions. METHODS: All adults aged 20 years with COVID-19 between March 1, 2020 and March 15, 2021 in 42 healthcare systems in National Patient-Centered Clinical Research Network were identified. RESULTS: Among 656,049 adults with COVID-19, 41% had hypertension, and 13% had diabetes. Of patients with classifiable hypertension, 35% had blood pressure <130/80 mmHg, 40% had blood pressure of 130139/8089 mmHg, 21% had blood pressure of 140159/9099 mmHg, and 6% had blood pressure 160/100 mmHg. Severe COVID-19 outcomes were more prevalent among those with blood pressure of 160/100 than among those with blood pressure of 130-139/80-89, including hospitalization (23.7% [95% CI=23.0, 24.4] vs 11.7% [95% CI=11.5, 11.9]), receipt of critical care (5.5% [95% CI=5.0, 5.8] vs 2.4% [95% CI=2.3, 2.5]), receipt of mechanical ventilation (3.0% [95% CI=2.7, 3.3] vs 1.2% [95% CI=1.1, 1.3]), and 60-day mortality (4.6% [95% CI=4.2, 4.9] vs 1.8% [95% CI=1.7, 1.9]). Of patients with classifiable diabetes, 44% had HbA1c <7%, 35% had HbA1c 7% to <9%, and 21% had HbA1c 9%. Hospitalization prevalence was 31.3% (95% CI=30.7, 31.9) among those with HbA1c <7% vs 40.2% (95% CI=39.4, 41.1) among those with HbA1c 9%; other outcomes did not differ substantially by HbA1c. CONCLUSIONS: These findings highlight the importance of appropriate management of hypertension and diabetes, including during public health emergencies such as the COVID-19 pandemic. |
Report of the 2nd workshop of the International Collaboration on advanced vaccinology training.
Duclos P , MacDonald NE , Dochez C , Thacker N , Steffen CA , Nohynek H , Lambert PH , Wharton M . Vaccine 2022 40 (47) 6689-6699 At a workshop on 22-24 March 2022, leaders of 33 advanced vaccinology courses were invited to meet with partners to further the aims of the International Collaboration on Advanced Vaccinology Training (ICAVT) initiated in 2018 to assist courses in addressing challenges in priority areas and facilitate interactions and exchange of information. This included: an update to the landscape analysis of advanced vaccinology courses conducted in 2018, sharing experiences and good practices in the implementation of virtual training, reviewing the training needs of target audiences, informing courses of the principles, challenges, and added value of accreditation, discussing course evaluations and measurement of course impact, reviewing principles and support needed for quality cascade training, reviewing COVID-19 impact on training and identifying remaining related training needs, and identifying solutions to facilitate refresher courses and ways to facilitate networking of courses' alumni (particularly for virtual courses). The aims were to identify needs and impediments and implement necessary actions to facilitate sharing of information and resources between courses, to identify need for further developments of the e-Portal of the Collaboration (icavt.org) established to facilitate communication between the different courses and assist future course participants identify the most suitable course for them, and to discuss the formalization of the Collaboration. During the workshop, participants looked at several reports of surveys completed by courses and courses' alumni or partners. The COVID-19 pandemic impacted the delivery of some vaccinology courses leading to postponement, delivery online or hybrid training events. Lack of sustainable funding remained a major constraint for advanced vaccinology training and needs to be addressed. The Collaboration was consolidated with responsibilities and benefits for the members better defined. There was strong support for the Collaboration to continue with the organization of educational sessions at future workshops. The meeting re-enforced the view that there was much enthusiasm and commitment for the Global Collaboration and its core values. |
Nationwide tuberculosis outbreak in the USA linked to a bone graft product: an outbreak report.
Schwartz NG , Hernandez-Romieu AC , Annambhotla P , Filardo TD , Althomsons SP , Free RJ , Li R , Wyatt Wilson W , Deutsch-Feldman M , Drees M , Hanlin E , White K , Lehman KA , Thacker TC , Brubaker SA , Clark B , Basavaraju SV , Benowitz I , Burton Glowicz J , Cowan LS , Starks AM , Bamrah Morris S , LoBue P , Stewart RJ , Wortham JM , Haddad MB . Lancet Infect Dis 2022 22 (11) 1617-1625 BACKGROUND: Mycobacterium tuberculosis transmission through solid organ transplantation has been well described, but transmission through transplanted tissues is rare. We investigated a tuberculosis outbreak in the USA linked to a bone graft product containing live cells derived from a single deceased donor. METHODS: In this outbreak report, we describe the management and severity of the outbreak and identify opportunities to improve tissue transplant safety in the USA. During early June, 2021, the US Centers for Disease Control and Prevention (CDC) worked with state and local health departments and health-care facilities to locate and sequester unused units from the recalled lot and notify, evaluate, and treat all identified product recipients. Investigators from CDC and the US Food and Drug Administration (FDA) reviewed donor screening and tissue processing. Unused product units from the recalled and other donor lots were tested for the presence of M tuberculosis using real-time PCR (rt PCR) assays and culture. M tuberculosis isolates from unused product and recipients were compared using phylogenetic analysis. FINDINGS: The tissue donor (a man aged 80 years) had unrecognised risk factors, symptoms, and signs consistent with tuberculosis. Bone was procured from the deceased donor and processed into 154 units of bone allograft product containing live cells, which were distributed to 37 hospitals and ambulatory surgical centres in 20 US states between March 1 and April 2, 2021. From March 3 to June 1, 2021, 136 (88%) units were implanted into 113 recipients aged 24-87 years in 18 states (some individuals received multiple units). The remaining 18 units (12%) were located and sequestered. 87 (77%) of 113 identified product recipients had microbiological or imaging evidence of tuberculosis disease. Eight product recipients died 8-99 days after product implantation (three deaths were attributed to tuberculosis after recognition of the outbreak). All 105 living recipients started treatment for tuberculosis disease at a median of 69 days (IQR 56-81) after product implantation. M tuberculosis was detected in all eight sequestered unused units tested from the recalled donor lot, but not in lots from other donors. M tuberculosis isolates from unused product and recipients were more than 99·99% genetically identical. INTERPRETATION: Donor-derived transmission of M tuberculosis via bone allograft resulted in substantial morbidity and mortality. All prospective tissue and organ donors should be routinely assessed for tuberculosis risk factors and clinical findings. When these are present, laboratory testing for M tuberculosis should be strongly considered. FUNDING: None. |
How I came to write papers for clinicians in the late 1980s about improving the quality of reviews
Thacker SB . J R Soc Med 2022 115 (7) 273-275 I arrived at my interest in systematic reviews and meta-analysis through a circuitous route. In 1976, I joined the Epidemic Intelligence Service (EIS) Programme at the Communicable Disease Center (now Centers for Disease Control and Prevention). The EIS was established in 1951 by Alexander D Langmuir in response to concerns about the threat of biological weapons at the time of the Korean conflict.1 The Service is modelled along the lines of a clinical residency, with the ‘resident’ learning on the job in a mentored experience in applied epidemiology. EIS officers are known as ‘the disease detectives’ because they investigate epidemics of disease, the health effects of disasters, and trends over time of infectious disease, environmental health, chronic disease, violence, and unintentional injuries, as well as maternal and child health.2 I was assigned to the health department in Washington, DC, but spent my first few weeks with a team investigating the epidemic of Legionnaires Disease in Pennsylvania. Subsequently, I led investigations of diverse problems in hospitals, schools, restaurants, nursing homes, an institution for the mentally disabled and communities, including a study of the effects of a severe drought in Haiti. However, it was an investigation of a small cluster of febrile morbidity in a Washington, DC, hospital for women that led to my first systematic review and meta-analysis, although I had heard of neither of those terms at the time. |
Cardiac Complications After SARS-CoV-2 Infection and mRNA COVID-19 Vaccination - PCORnet, United States, January 2021-January 2022.
Block JP , Boehmer TK , Forrest CB , Carton TW , Lee GM , Ajani UA , Christakis DA , Cowell LG , Draper C , Ghildayal N , Harris AM , Kappelman MD , Ko JY , Mayer KH , Nagavedu K , Oster ME , Paranjape A , Puro J , Ritchey MD , Shay DK , Thacker D , Gundlapalli AV . MMWR Morb Mortal Wkly Rep 2022 71 (14) 517-523 Cardiac complications, particularly myocarditis and pericarditis, have been associated with SARS-CoV-2 (the virus that causes COVID-19) infection (1-3) and mRNA COVID-19 vaccination (2-5). Multisystem inflammatory syndrome (MIS) is a rare but serious complication of SARS-CoV-2 infection with frequent cardiac involvement (6). Using electronic health record (EHR) data from 40 U.S. health care systems during January 1, 2021-January 31, 2022, investigators calculated incidences of cardiac outcomes (myocarditis; myocarditis or pericarditis; and myocarditis, pericarditis, or MIS) among persons aged 5 years who had SARS-CoV-2 infection, stratified by sex (male or female) and age group (5-11, 12-17, 18-29, and 30 years). Incidences of myocarditis and myocarditis or pericarditis were calculated after first, second, unspecified, or any (first, second, or unspecified) dose of mRNA COVID-19 (BNT162b2 [Pfizer-BioNTech] or mRNA-1273 [Moderna]) vaccines, stratified by sex and age group. Risk ratios (RR) were calculated to compare risk for cardiac outcomes after SARS-CoV-2 infection to that after mRNA COVID-19 vaccination. The incidence of cardiac outcomes after mRNA COVID-19 vaccination was highest for males aged 12-17 years after the second vaccine dose; however, within this demographic group, the risk for cardiac outcomes was 1.8-5.6 times as high after SARS-CoV-2 infection than after the second vaccine dose. The risk for cardiac outcomes was likewise significantly higher after SARS-CoV-2 infection than after first, second, or unspecified dose of mRNA COVID-19 vaccination for all other groups by sex and age (RR 2.2-115.2). These findings support continued use of mRNA COVID-19 vaccines among all eligible persons aged 5 years. |
Notes from the Field: Brucella abortus RB51 infections associated with consumption of raw milk from Pennsylvania - 2017 and 2018
Gruber JF , Newman A , Egan C , Campbell C , Garafalo K , Wolfgang DR , Weltman A , Kline KE , Watkins SM , Robbe-Austerman S , Quance C , Thacker T , Kharod G , Negron ME , Schroeder B . MMWR Morb Mortal Wkly Rep 2020 69 (15) 482-483 In December 2018, the Pennsylvania Department of Agriculture (PDA) and Pennsylvania Department of Health (PADOH) were notified of a New York patient with brucellosis caused by infection with Brucella abortus RB51, the live attenuated vaccine strain of B. abortus used to prevent brucellosis in cattle (1). Brucellosis is a serious zoonotic infection caused by the bacteria Brucella spp. The most common sign is fever, followed by osteoarticular symptoms, sweating, and constitutional symptoms (2). Without proper treatment, infection can become chronic and potentially life-threatening (2). The patient had consumed raw (unpasteurized) milk from dairy A in Pennsylvania.* In July 2017, Texas health officials documented the first human case of domestically acquired RB51 infection associated with raw milk consumption from a Texas dairy (3). In October 2017, a second RB51 case associated with raw milk consumption was documented in New Jersey†; the milk source was not identified at the time. |
One Health and antimicrobial resistance, a United States perspective
Bright-Ponte SJ , Walters BK , Tate H , Durso LM , Whichard JM , Bjork KE , Shivley CB , Beaudoin AL , Cook KL , Thacker EL , Singh R , Gilbert JM . Rev Sci Tech 2019 38 (1) 173-184 Antimicrobial drugs are a precious resource, responsible for saving millions of lives since their discovery. Unfortunately, some antimicrobials are rapidly losing their effectiveness due to the development and spread of antimicrobial resistance (AMR), a multi-faceted and complex problem affecting humans, animals, plants and the environment. While AMR is a global problem, in this paper, the authors briefly highlight some ongoing efforts in the United States of America aimed at integrating a One Health approach into policies and programmes that address this important health threat. |
National Antimicrobial Resistance Monitoring System: Two Decades of Advancing Public Health Through Integrated Surveillance of Antimicrobial Resistance.
Karp BE , Tate H , Plumblee JR , Dessai U , Whichard JM , Thacker EL , Robertson Hale K , Wilson W , Friedman CR , Griffin PM , McDermott PF . Foodborne Pathog Dis 2017 14 (10) 545-557 Drug-resistant bacterial infections pose a serious and growing public health threat globally. In this review, we describe the role of the National Antimicrobial Resistance Monitoring System (NARMS) in providing data that help address the resistance problem and show how such a program can have broad positive impacts on public health. NARMS was formed two decades ago to help assess the consequences to human health arising from the use of antimicrobial drugs in food animal production in the United States. A collaboration among the Centers for Disease Control and Prevention, the U.S. Food and Drug Administration, the United States Department of Agriculture, and state and local health departments, NARMS uses an integrated "One Health" approach to monitor antimicrobial resistance in enteric bacteria from humans, retail meat, and food animals. NARMS has adapted to changing needs and threats by expanding surveillance catchment areas, examining new isolate sources, adding bacteria, adjusting sampling schemes, and modifying antimicrobial agents tested. NARMS data are not only essential for ensuring that antimicrobial drugs approved for food animals are used in ways that are safe for human health but they also help address broader food safety priorities. NARMS surveillance, applied research studies, and outbreak isolate testing provide data on the emergence of drug-resistant enteric bacteria; genetic mechanisms underlying resistance; movement of bacterial populations among humans, food, and food animals; and sources and outcomes of resistant and susceptible infections. These data can be used to guide and evaluate the impact of science-based policies, regulatory actions, antimicrobial stewardship initiatives, and other public health efforts aimed at preserving drug effectiveness, improving patient outcomes, and preventing infections. Many improvements have been made to NARMS over time and the program will continue to adapt to address emerging resistance threats, changes in clinical diagnostic practices, and new technologies, such as whole genome sequencing. |
Rationale for periodic reporting on the use of selected clinical preventive services to improve the health of infants, children, and adolescents - United States
Yeung LF , Shapira SK , Coates RJ , Shaw FE , Moore CA , Boyle CA , Thacker SB . MMWR Suppl 2014 63 (2) 3-13 This supplement is the second of a series of periodic reports from a CDC initiative to monitor and report on the use of a set of selected clinical preventive services in the U.S. population in the context of recent national initiatives to improve access to and use of such services. Increasing the use of these services can result in substantial reductions in the burden of illness, death, and disability and lower treatment costs. This supplement focuses on services to improve the health of U.S. infants, children, and adolescents. The majority of clinical preventive services for infants, children, and adolescents are provided by the health-care sector. Public health agencies play important roles in increasing the use of these services by identifying and implementing policies that are effective in increasing use of the services and by collaborating with stakeholders to conduct programs to improve use. Recent health-reform initiatives, including efforts to increase the accessibility and affordability of preventive services, fund community prevention programs, and improve the use of health information technologies, offer opportunities to improve use of preventive services. This supplement, which follows a previous report on adult services, provides baseline information on the use of a set of selected clinical preventive services to improve the health of infants, children, and adolescents before implementation of these recent initiatives and discusses opportunities to increase the use of such services. This information can help public health practitioners, in collaboration with other stakeholders that have key roles in improving infant, child, and adolescent health (e.g., parents or guardians and their employers, health plans, health professionals, schools, child care facilities, community groups, and voluntary associations), understand the potential benefits of the recommended services, address the problem of underuse, and identify opportunities to apply effective strategies to improve use and foster accountability among stakeholders. |
Public health surveillance in the United States: evolution and challenges
Thacker SB , Qualters JR , Lee LM . MMWR Suppl 2012 61 (3) 3-9 In its landmark 1988 report, a committee of the Institute of Medicine highlighted assessment as one of the three core functions of public health along with policy development and assurance. The committee recommended that every public health agency regularly and systematically collect, assemble, analyze, and make available information on the health of the community, including statistics on health status, community health needs, and epidemiologic and other studies of health problems. Public health surveillance, often called the cornerstone of public health practice, is an essential element of the assessment function. |
Rationale for periodic reporting on the use of adult clinical preventive services of public health priority--United States
Coates RJ , Yoon PW , Zaza S , Ogden L , Thacker SB . MMWR Suppl 2012 61 (2) 3-10 This supplement introduces a CDC initiative to monitor and report periodically on the use of a set of selected clinical preventive services in the U.S. adult population in the context of recent national initiatives to improve access to and use of such services. Increasing the use of these services has the potential to lead to substantial reductions in the burden of illness, death, and disability and to lower treatment costs. The majority of clinical preventive services are provided by the health-care sector, and public health agencies play important roles in helping to support increases in the use of these services (e.g., by identifying and implementing policies that are effective in increasing use of the services and by collaborating with stakeholders to conduct programs to improve use). Recent health reform initiatives, including efforts to increase the accessibility and affordability of preventive services, fund community prevention programs, and improve the use of health information technologies, offer opportunities to enhance use of preventive services. This supplement provides baseline information on a set of selected clinical preventive services before implementation of these recent reforms and discusses opportunities to increase the use of such services. This information can help public health practitioners collaborate with other stakeholders that have key roles to play in improving public health (e.g., employers, health plans, health professionals, and voluntary associations), understand the potential benefits of the recommended services, address the problem of underuse, and identify opportunities to apply effective strategies to improve use and foster accountability among stakeholders. |
Are we there yet? Seizing the moment to integrate medicine and public health
Scutchfield FD , Michener JL , Thacker SB . Am J Public Health 2012 102 Suppl 3 S312-6 Multiple promising but unsustainable attempts have been made to maintain programs integrating primary care and public health since the middle of the last century. During the 1960s, social justice movements expanded access to primary care and began to integrate primary care with public health concepts both to meet community needs for medical care and to begin to address the social determinants of health. Two decades later, the managed care movement offered opportunities for integration of primary care and public health as many employers and government payers attempted to control health costs and bring disease prevention strategies in line with payment mechanisms. Today, we again have the opportunity to align primary care with public health to improve the community's health. |
Comparison of attitudes about polio, polio immunization, and barriers to polio eradication between primary health center physicians and private pediatricians in India
Thacker N , Choudhury P , Gargano LM , Weiss PS , Pazol K , Bahl S , Jafari HS , Arora M , Dubey AP , Vashishtha VM , Agarwal R , Kumar A , Orenstein WA , Omer SB , Hughes JM . Int J Infect Dis 2012 16 (6) e417-23 OBJECTIVES: The objectives of this study were to compare attitudes and perceptions of primary health center (PHC) physicians and pediatricians in Uttar Pradesh and Bihar toward polio disease, immunization, and eradication, and to identify barriers to polio eradication. METHODS: PHC physicians from blocks with at least one confirmed polio case during January 2006 to June 2009 were selected for an in-person survey. Pediatricians were members of the Indian Academy of Pediatrics and were selected from a national directory of members for telephone or mail survey. RESULTS: A higher percentage of PHC physicians than pediatricians reported that an unvaccinated child was susceptible to polio (82.1% vs. 63.0%, p<0.0001) and that polio disease was severe in a child aged 1-5 years (77.7% vs. 62.2%, p<0.0001). PHC physicians and pediatricians expressed confidence in the protectiveness and safety of oral polio vaccine and cited parents' lack of awareness of the importance of polio eradication as an important barrier to eradication. Strengthening routine immunization efforts was reported as the leading intervention required to eradicate polio. CONCLUSIONS: PHC physicians and pediatricians support and have confidence in the success of polio eradication efforts. These findings will be useful for policy-makers involved in the planning of eradication strategies. Providers and parents need to maintain confidence in polio vaccination if polio is to be eradicated. |
The value of public health services and systems research
Arias I , Thacker SB , Monroe JA . Am J Prev Med 2012 42 S82-3 Systems research is not new; it routinely has been used in chemistry, biology, ecology, economics, and epidemiology for many years and has been applied toward understanding the public health system for nearly 2 decades. During that time, the CDC, other operating divisions within the DHHS, and several international organizations have been using systems research to advance the field of public health. The CDC has made major contributions through developing the National Public Health Performance Standards Program, the precursor to accreditation of health departments, and leading the establishment of the first national public health systems research agenda in 2006. The CDC also has funded nine Preparedness and Emergency Response Research Centers that are pursuing a multidisciplinary public health systems research approach to improving preparedness and response. Each of these research centers is yielding important results that are relevant to policy and practice. | Elsewhere in DHHS, systems research is being applied to other public health problems. For instance, the NIH is applying systems research to the complex issue of health literacy, a problem that affects people's access to care, skills in comprehending and acting on health information, and decision making about behavior change such as healthy eating and exercise. (obssr.od.nih.gov/scientific_areas/social_culture_factors_in_health/health_literacy/index.aspx). In June 2011, the Health Resources and Services Administration released a tool kit, based on systems thinking and systems analysis, for mapping state child health care.1 The Administration for Health Research and Quality is also using systems research and design to understand and improve the complex socio-technical system of healthcare delivery in the U.S. (www.ahrq.gov/qual/systemdesign.htm). |
Attitudes of pediatricians and primary health center physicians in India concerning routine immunization, barriers to vaccination, and missed opportunities to vaccinate
Gargano LM , Thacker N , Choudhury P , Weiss PS , Pazol K , Bahl S , Jafari HS , Arora M , Orenstein WA , Hughes JM , Omer SB . Pediatr Infect Dis J 2012 31 (2) e37-42 BACKGROUND: India has some of the lowest immunization rates in the world. The objective of this study was to determine the attitudes and practices of pediatricians and physicians working in primary health centers (PHCs) regarding routine immunization and identify correlates of missed opportunities to vaccinate children. We focused on Uttar Pradesh and Bihar, which has faced some of the greatest challenges to achieving high routine immunization coverage. METHODS: A sample of pediatricians from Uttar Pradesh and Bihar was selected from the national membership of the Indian Academy of Pediatrics to participate in either a phone or mail survey. For the sampling frame, the PHCs within selected blocks were enumerated to provide a list from which individuals could be randomly sampled. In all, 614 PHCs in Uttar Pradesh and 159 PHCs were selected for in-person surveys. RESULTS: The response rate for pediatricians was 47% (238/505) and 93% for PHC physicians (719/773). The greatest barrier to vaccinating children with routine immunizations, reported by both pediatricians (95.7%) and PHC physicians (95.1%), was parents' lack of awareness of their importance. Correlates of missing an opportunity to vaccinate for PHC physicians included holding other health care workers responsible for vaccination. PHC physicians were 50% to 70% less likely to vaccinate a child themselves if they thought another type of health care worker was responsible. CONCLUSIONS: Future interventions to increase vaccination coverage should address parental knowledge about the importance of vaccines. Understanding and addressing factors associated with missed opportunities to vaccinate may help improve vaccine coverage in Uttar Pradesh and Bihar. |
Epidemic assistance by the Centers for Disease Control and Prevention: role of the Epidemic Intelligence Service, 1946-2005
Thacker SB , Stroup DF , Sencer DJ . Am J Epidemiol 2011 174 S4-15 Since 1946, the Centers for Disease Control and Prevention has responded to urgent requests from US states, federal agencies, and international organizations through epidemic-assistance investigations (Epi-Aids). The authors describe the first 60 years of Epi-Aids, breadth of problems addressed, evolution of methodologies, scope of activities, and impact of investigations on population health. They reviewed Epi-Aid reports and EIS Bulletins, contacted current and former Epidemic Intelligence Service staff, and systematically searched the PubMed and Web of Science databases. They abstracted information on dates, location, staff involved, health problems, methods, and impacts of investigations according to a preplanned protocol. They assessed the methods presented as well as the quality of reports. During 1946-2005, a total of 4,484 investigations of health events were initiated by 2,815 Epidemic Intelligence Service officers. In the early years, the majority were in response to infectious agents, although environmental problems emerged. Investigations in subsequent years focused on occupational conditions, birth defects, reproductive health, tobacco use, cancer, violence, legal debate, and terrorism. These Epi-Aids heralded expansion of the agency's mission and presented new methods in statistics and epidemiology. Recommendations from Epi-Aids led to policy implementation, evaluation, or modification. Epi-Aids provide the Centers for Disease Control and Prevention with the agility to respond rapidly to public health crises. |
The cornerstone of public health practice: public health surveillance, 1961--2011
Lee LM , Thacker SB . MMWR Suppl 2011 60 (4) 15-21 The roots of modern public health surveillance took hold in 17th century Europe (1), but the seed for CDC's role as America's national agency for collecting, analyzing, interpreting, and using data to protect the public's health was firmly planted only in 1961, when the Morbidity and Mortality Weekly Report (MMWR) was transferred to what was then the Communicable Disease Center (CDC; now the Centers for Disease Control and Prevention) (2). The advent of MMWR at CDC marked the beginning of CDC's responsibility for aggregating and publishing data weekly on nationally notifiable diseases and publishing the data annually in MMWR's Summary of Notifiable Diseases, United States. |
Public health then and now: celebrating 50 years of MMWR at CDC. Introduction
Shaw FE , Kohl KS , Lee LM , Thacker SB . MMWR Suppl 2011 60 (4) 2-6 This supplement of MMWR celebrates the 50th anniversary of CDC's first publication of MMWR on January 13, 1961 (Figure 1). MMWR was not new in 1961, but it was new to CDC, an agency that itself had been founded only 15 years earlier, in 1946 (1). The longer history of MMWR traces back to July 13, 1878, when the first predecessor of MMWR, called simply The Bulletin of the Public Health, was inaugurated. The Bulletin was established in accordance with the first National Quarantine Act, passed by Congress 2 months earlier. The Act ordered the Surgeon General of the U.S. Marine-Hospital Service to begin publishing abstracted disease reports collected from U.S. consuls in foreign lands to alert U.S. quarantine officials about what diseases could be expected among passengers arriving on steamships (2,3). In the 83 years from 1878 to 1961, MMWR went through several incarnations. By 1952, the publication had its current name and was being published by the National Office of Vital Statistics, an agency within the U.S. Department of Health, Education and Welfare. In 1960, CDC's renowned chief of epidemiology, Alexander D. Langmuir, decided that MMWR should be transferred to CDC (then known as the Communicable Disease Center). After much discussion, and as Langmuir later said in an interview, "all sorts of pulling out teeth by the roots without anesthesia and all kinds of internal frictions," in 1960, MMWR was transferred to CDC (4). | | In 2009, as the 50th anniversary of MMWR loomed, the MMWR Editor (F.E.S.) began discussions with leaders at CDC and the MMWR Editorial Board about how best to commemorate this date. Members of the Board, editors, and friends of MMWR offered many good ideas. In the end, the most persuasive idea was to celebrate the 50th anniversary simply by doing what MMWR has done best for 5 decades at CDC: publish articles of high value to its readers. The title of the supplement is "Public Health Then and Now: Celebrating 50 Years of MMWR at CDC." The supplement's guest editors (F.E.S., K.S.K., L.M.L., S.B.T.) selected a cadre of expert authors who have long experience in their respective fields of public health---enough to enable them to look back over the past 50 years and trace the most important influences and developments. The guest editors asked the authors to answer three key questions. What was the state of the art in 1961? How did it develop through 50 years into its present form? What does the future hold? Thus, with few exceptions, the 16 articles that make up this supplement are not meant to be about MMWR but instead are meant to trace the development of key areas of public health through the 50-year era of MMWR at CDC. | | The authors took up the challenge admirably. The result is a diverse set of articles that portray public health in 1961 and forward in time to the present and beyond. The articles range from detailed historical review, to analyses of MMWR content, to the more whimsical. They are not meant to be exhaustive, nor can they treat their topics as thoroughly as would a longer text, but they do depict the main events, developments, and innovations that led public health to where it stands today. |
Evolution of epidemic investigations and field epidemiology during the MMWR era at CDC--1961-2011
Brachman PS , Thacker SB . MMWR Suppl 2011 60 (4) 22-6 Since 1946, CDC has provided rapid assistance to states, federal agencies, international organizations, and ministries of health, often through formal requests for epidemic-assistance investigations (Epi-Aids) (1). The Epi-Aid mechanism provides CDC with the agility to respond rapidly to serious and urgent public health crises. Epi-Aids operationalize the tenets of field epidemiology and are used to provide information, as quickly as possible, on which the processes of selecting and implementing interventions can be based to lessen or prevent illness, injury, or death (2,3). | | A total of 4,997 Epi-Aids have been conducted, of which 4,673 (94%) have occurred since 1960. Of the 556 international investigations, 551 (99%) have occurred since MMWR was transferred to CDC in 1960. Approximately 90% of these investigations have involved the approximately 3,000 Epidemic Intelligence Service officers (EISOs) who have trained at CDC since the program was initiated in 1951; however, only 218 EISOs came to CDC before MMWR arrived. EISOs assigned to state and local health departments conduct additional investigations within the states to which they are assigned. During the past 50 years, EISOs collectively have conducted approximately 5,000 state-based investigations without using the formal Epi-Aid request mechanism. |
Public health surveillance and knowing about health in the context of growing sources of health data
Lee LM , Thacker SB . Am J Prev Med 2011 41 (6) 636-40 The past decade has brought substantial changes in how data related to a community's health are collected, stored, and used to inform decisions about health interventions. Despite these changes, the purpose of public health surveillance has remained constant for more than a century. Public health surveillance is the ongoing, systematic collection, analysis, and interpretation of health-related data with the a priori purpose of preventing or controlling disease or injury, or of identifying unusual events of public health importance, followed by the dissemination and use of information for public health action. Surveillance is an important and necessary contributor to knowledge of a community's health. The public health system is responsible for ensuring that public health surveillance is conducted with appropriate practices and safeguards in order to maintain the public's trust. |
Using social media for research and public health surveillance
Eke PI . J Dent Res 2011 90 (9) 1045-6 The article in this issue of JDR by Heaivilin and colleagues with the title ‘Public Health Surveillance of Dental Pain via Twitter” (Heaivilin et al., 2011) introduces a potential new data source for dental surveillance and research, namely, publicly available information from the social network medium “Twitter”. The authors present a novel idea and approach in using publicly available Twitter data to assess dental pain experiences. Undoubtedly, monitoring episodes of dental pain, including the impact of the pain and actions taken to relieve pain, is a worthwhile objective for dental public health and has indeed been assessed in previous population-based surveys such as in the National Health and Nutrition Survey (NHANES) and National Health Interview Surveys (NHIS) (Beltrán-Aguilar et al., 2005; NIDCR/CDC DRC, 2011). This perspective provides a brief critical assessment of the use of Twitter for public health surveillance and research. | Public health surveillance is the ongoing systematic collection, analysis, and interpretation of health data from defined populations for use in planning, implementing, and evaluating public health programs (Thacker and Berkelman, 1988). The most important attributes of public health surveillance systems include simplicity, flexibility, and acceptability of the data collection instruments, as well as sensitivity, positive predictive value, representativeness, and timeliness of the data collected (Romaguera et al., 2000). It can be argued that tools such as Twitter do possess some of these attributes. Notably, Twitter data are available publically, and the data are relatively simple to access, extract, and analyze, as exemplified by the study by Heaivilin’s group (Heaivilin et al., 2011). Furthermore, tweets are reported in real time by millions of real persons from across several continents and are communicated via a variety of simple and easy-to-use formats, which are increasingly accessible in most populations. |
Legionella nagasakiensis sp. nov., isolated from water samples in Japan and Australia and from a patient with pneumonia in the United States
Yang PG , Benson RF , Ratcliff R , Brown EW , Steigerwalt AG , Thacker LW , Daneshvar M , Morey RE , Saito A , Fields BS . Int J Syst Evol Microbiol 2011 62 284-288 A novel Legionella species was identified based on 16S rRNA and mip (macrophage infectivity potentiator) gene sequencing analysis, cellular fatty acids, isoprenoid quinones, biochemical reactions, antigens, and quantitative DNA-DNA hybridization. The strain CDC-1796-JAP-E(T) was isolated from well water at the Nagassaki Municipal Medical Center, Japan. Two strains, CDC-3041-AUS-E and CDC-3558-AUS-E, were isolated from water samples during an outbreak of legionellosis in South Australia. The strain CDC-5427-OH-H was isolated from a 66-year-old female patient diagnosed with Legionnaires' disease in the U.S. The cells from these four strains were gram-negative, non-fluorescent, rod-shaped, and positive for alkaline phosphatase, esterase, leucine arylamidase, catalase, gelatinase, beta-lactamase, and tyrosine browning assay. Phylogenetic analysis of 16S rRNA and mip genes revealed that the four strains formed a distinct cluster within the genus Legionella. The bacteria contained branched-chain fatty acids and quinones that are typical of the genus Legionella. Slide agglutination tests demonstrated no cross-reaction with 52 previously described Legionellaceae. DNA hybridization studies indicated DNAs from the four strains were highly related (78-84%) but showed 29% relatedness to L. oakridgensis (ATCC 33761(T)) and less than 10% to other Legionella species tested. These characterizations suggest that the isolates represent a novel species, for which the name Legionella nagasakiensis sp. nov is proposed, for the type strain CDC-1796-JAP-E(T) (=ATCC BAA-1557(T)=JCM 15315(T)). |
An expanded public health role for birth defects surveillance
Correa A , Kirby RS . Birth Defects Res A Clin Mol Teratol 2010 88 (12) 1004-7 Through the early 20th century, the human uterus was thought to protect the developing fetus from maternal infections and environmental exposures. However, in the 1940s the first case reports of maternal rubella infection being linked to birth defects appeared in the literature, and, in the early 1960s, it was understood that maternal use of thalidomide caused an epidemic of limb deficiencies. These sentinel events led to the realization that maternal infections and other environmental factors could cause birth defects. This realization, in turn, led to the establishment of birth defects surveillance systems in the United States and other countries. | Public health surveillance is defined as the ongoing, systematic collection, analysis, interpretation, and dissemination of data regarding a health-related event for use in public health action to reduce morbidity and mortality and to improve health in the population (Thacker and Berkelman, 1992; CDC, 2001). Birth defects surveillance data have been used for public health action, program planning and evaluation, and formulating research hypotheses. Some examples of the types of public health action for which birth defects surveillance data have been used include the following: | Guiding action for issues of public health importance or concern. Birth defects surveillance data have been useful in evaluating community concerns about specific environmental exposures (e.g., water fluoridation, airport noise, air pollution) and birth defects (Erickson et al., 1976; Edmonds et al., 1979; Strickland et al., 2009), as well as for addressing concerns about clusters of birth defects possibly associated with less well-defined environmental factors (Calvert et al., 2007; Kucik et al., 2008). | Quantifying the burden of disease. Birth defects surveillance data have been useful in documenting the prevalence of major birth defects in the population (Correa et al., 2007; Rynn et al., 2008), the birth prevalence for specific defects such as Down syndrome, neural tube defects, and heart defects (Siffel et al., 2004; Canfield et al., 2006; Reller et al., 2008), as well as the prevalence of spina bifida and Down syndrome among children and adolescents (Shin et al., 2008; Shin et al., 2009). | Identifying populations at risk and/or health disparities. Birth defects surveillance data have been useful in identifying a higher prevalence of neural tube defects among Hispanics as compared to non-Hispanic whites in the United States (Kirby et al., 2000; Canfield et al., 2006). Similarly, linkages of birth defects surveillance data with vital status data have been useful in identifying race/ethnic disparities in survival for several defects (Dott et al., 2003; Rasmussen et al., 2006; Yang et al., 2006). Such studies have stimulated more research into possible determinants of such disparities in prevalence and survival. | Monitoring trends in the prevalence of birth defects. Birth defects surveillance data have been important in documenting decreasing trends in the prevalence of congenital rubella in relation to declining prevalence of maternal rubella infections (Cochi et al., 1989), trends in prevalence of selected birth defects before and after folic acid fortification (Canfield et al., 2005; Botto et al., 2006), and trends in the prevalence of gastroschisis (Williams et al., 2005; Loane et al., 2007), hypospadias (Carmichael et al., 2003; Dolk et al., 2004; Nassar et al., 2007), and congenital heart defects (Botto et al., 2001). | Evaluating outcomes among children with birth defects. Birth defects surveillance data have been useful in population-based evaluations of whether children with birth defects have an increased prevalence of developmental disorders (Decoufle et al., 2001; Yazdy et al., 2008) and the survival experience of children with birth defects (Nembhard et al., 2001; Wong and Paulozzi, 2001; Cleves et al., 2003; Rasmussen et al., 2006; Copeland and Kirby, 2007; Fixler et al., 2010). | Guiding the planning, implementation, and evaluation of programs to prevent birth defects and adverse exposures. Birth defects surveillance data on the prevalence of neural tube defects and in the variation of such prevalence by race/ethnic groups in the population have been instrumental in the development, implementation, and evaluation of policies for folic acid fortification for the prevention of neural tube defects (Canfield et al., 2005; Botto et al., 2006; Bower, 2006). | Serving as case registries for epidemiologic research. Several birth defects surveillance systems have served as cases registries for epidemiologic studies, including studies of possible associations of birth defects with paternal Vietnam Veteran status (Erickson et al., 1984), maternal vitamin supplement use (Mulinare et al., 1988), diabetes (Correa et al., 2008), obesity (Watkins et al., 2003; Waller et al., 2007; Gilboa et al., 2010), smoking (Honein et al., 2007; Malik et al., 2008), assisted reproductive technologies (Bower and Hansen, 2005; Reefhuis et al., 2009), and certain medications (Reefhuis et al., 2006; Caton et al., 2009; Alwan et al., 2010). |
In Snow's footsteps: commentary on shoe-leather and applied epidemiology
Koo D , Thacker SB . Am J Epidemiol 2010 172 (6) 737-9 The term shoe-leather epidemiology is often synonymous with field epidemiology or intervention epidemiology. All 3 terms imply investigations initiated in response to urgent public health problems and for which the investigative team does much of its work in the field (i.e., outside the office or laboratory). Alexander D. Langmuir is credited with articulating the concept of disease surveillance as it is applied to populations rather than individuals. He also founded the Epidemic Intelligence Service (EIS) Program in 1951, a 2-year training experience in applied epidemiology that places professionals in the field, domestically and internationally, in real-life situations. Today, 70-90 EIS officers are assigned each year to Centers for Disease Control and Prevention programs and to state and local health departments to meet the broad spectrum of challenges in chronic disease, injury prevention, violence, environmental health, occupational safety and health, and maternal and child health, as well as infectious diseases. Throughout their assignments, EIS officers are encouraged to strive for analytic rigor as well as public health consequence, which requires technical competence blended with good judgment and awareness of context. Effective applied epidemiologists must have skills beyond just epidemiology to improve a population's health; the field of applied epidemiology requires multiple team members, all having different but complementary skills, to be effective. |
- Page last reviewed:Feb 1, 2024
- Page last updated:May 13, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure