Last data update: Sep 23, 2024. (Total: 47723 publications since 2009)
Records 1-30 (of 1040 Records) |
Query Trace: Thomas I [original query] |
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Early, robust mucosal secretory IgA but not IgG response to SARS-CoV-2 spike in oral fluid is associated with faster viral clearance and COVID-19 symptom resolution
Pisanic N , Antar AAR , Hetrich MK , Demko ZO , Zhang X , Spicer K , Kruczynski KL , Detrick B , Clarke W , Knoll MD , Thomas DL , Dawood FS , Veguilla V , Karron RA , Manabe YC , Heaney CD . J Infect Dis 2024 BACKGROUND: High priority efforts are underway to support the development of novel mucosal COVID-19 vaccines, such as the US Government's Project NextGen and the Center for Epidemic Preparedness Innovations' goal to respond to the next pandemic with a new vaccine in 100 days. However, there is limited consensus about the complementary role of mucosal immunity in disease progression and how to evaluate immunogenicity of mucosal vaccines. This study investigated the role of oral mucosal antibody responses in viral clearance and COVID-19 symptom duration. METHODS: Participants with PCR-confirmed SARS-CoV-2 infection provided oral fluid for testing with SARS-CoV-2 antibody multiplex assays, nasal swabs for RT-PCR and symptom information at up to eight follow-ups from April 2020 to February 2022. RESULTS: High and moderate oral fluid anti-spike (S) secretory IgA (SIgA) post infection was associated with significantly faster viral clearance and symptom resolution across age groups with effect sizes equivalent to having COVID-19 vaccine immunity at the time of infection. Those with high and moderate anti-S SIgA cleared the virus 14 days (95% CI: 10-18) and recovered 9-10 days (95% CI: 6-14) earlier. Delayed and higher anti-S IgG was associated with significantly longer time to clearance and recovery. Experiencing symptoms longer than four weeks was associated with lower anti-RBD SIgA 15-30 days after infection onset (p<0.001). CONCLUSION: Robust mucosal SIgA early post infection appears to support faster clearance of SARS-CoV-2 and recovery from COVID-19 symptoms. This research underscores the importance of harmonizing mucosal immune response assays to evaluate new mucosal vaccines. |
Respiratory Viral Infections from 2015 to 2022 in the HIVE Cohort of American Households: Incidence, illness characteristics, and seasonality
Monto AS , Foster-Tucker JE , Callear AP , Leis AM , Godonou ET , Smith M , Truscon R , Johnson E , Thomas LJ , Thompson MS , Fry AM , Flannery B , Malosh RE , Petrie JG , Lauring AS , Martin ET . J Infect Dis 2024 BACKGROUND: Viral respiratory illnesses are the most common acute illnesses experienced and generally follow a predicted pattern over time. The SARS-CoV-2 pandemic interrupted that pattern. METHODS: The HIVE (Household Influenza Vaccine Evaluation) study was established in 2010 to follow a cohort of Southeast Michigan households over time. Initially focused on influenza, surveillance was expanded to include other major respiratory pathogens, and, starting in 2015, the population was followed year-round. Symptoms of acute illness were reported, and respiratory specimens were collected and tested to identify viral infections. Based on the known population being followed, virus-specific incidence was calculated. RESULTS: From 2015 to 2022, 1755 participants were followed in HIVE for 7785 person-years with 7833 illnesses documented. Before the pandemic, rhinovirus (RV) and common cold human coronaviruses (HCoVs) were the viruses most frequently identified, and incidence decreased with increasing age. Type A influenza was next but with comparable incidence by age. Parainfluenza and respiratory syncytial viruses were less frequent overall, followed by human metapneumoviruses. Incidence was highest in young children, but infections were frequently documented in all age groups. Seasonality followed patterns established decades ago. The SARS-CoV-2 pandemic disrupted these patterns, except for RV and, to a lesser extent, HCoVs. In the first two years of the pandemic, RV incidence far exceeded that of SARS-CoV-2. CONCLUSION: Longitudinal cohort studies are important in comparing the incidence, seasonality, and characteristics of different respiratory viral infections. Studies documented the differential effect of the pandemic on the incidence of respiratory viruses in addition to SARS-CoV-2. |
Timing of influenza antiviral therapy and risk of death in adults hospitalized with influenza-associated pneumonia, FluSurv-NET, 2012-2019
Tenforde MW , Noah KP , O'Halloran AC , Kirley PD , Hoover C , Alden NB , Armistead I , Meek J , Yousey-Hindes K , Openo KP , Witt LS , Monroe ML , Ryan PA , Falkowski A , Reeg L , Lynfield R , McMahon M , Hancock EB , Hoffman MR , McGuire S , Spina NL , Felsen CB , Gaitan MA , Lung K , Shiltz E , Thomas A , Schaffner W , Talbot HK , Crossland MT , Price A , Masalovich S , Adams K , Holstein R , Sundaresan D , Uyeki TM , Reed C , Bozio CH , Garg S . Clin Infect Dis 2024 BACKGROUND: Pneumonia is common in adults hospitalized with laboratory-confirmed influenza, but the association between timeliness of influenza antiviral treatment and severe clinical outcomes in patients with influenza-associated pneumonia is not well characterized. METHODS: We included adults aged ≥18 years hospitalized with laboratory-confirmed influenza and a discharge diagnosis of pneumonia over 7 influenza seasons (2012-2019) sampled from a multi-state population-based surveillance network. We evaluated 3 treatment groups based on timing of influenza antiviral initiation relative to admission date (day 0, day 1, days 2-5). Baseline characteristics and clinical outcomes were compared across groups using unweighted counts and weighted percentages accounting for the complex survey design. Logistic regression models were generated to evaluate the association between delayed treatment and 30-day all-cause mortality. RESULTS: 26,233 adults were sampled in the analysis. Median age was 71 years and most (92.2%) had ≥1 non-immunocompromising condition. Overall, 60.9% started antiviral treatment on day 0, 29.5% on day 1, and 9.7% on days 2-5 (median 2 days). Baseline characteristics were similar across groups. Thirty-day mortality occurred in 7.5%, 8.5%, and 10.2% of patients who started treatment on day 0, day 1, and days 2-5, respectively. Compared to those treated on day 0, adjusted OR for death was 1.14 (95%CI: 1.01-1.27) in those starting treatment on day 1 and 1.40 (95%CI: 1.17-1.66) in those starting on days 2-5. DISCUSSION: Delayed initiation of antiviral treatment in patients hospitalized with influenza-associated pneumonia was associated with higher risk of death, highlighting the importance of timely initiation of antiviral treatment at admission. |
Evaluation of the Laboratory Response Network and testing access during the first 10 weeks of the mpox response, United States, May 17-July 31, 2022
Thomas KL , Aden TA , Blevins PA , Raziano AJ , Wolford T , Honein MA , Villanueva JM . Public Health Rep 2024 333549241269497 OBJECTIVES: The Laboratory Response Network (LRN) consists of US and international laboratories that respond to public health emergencies, such as biothreats. We used a qualitative approach to assess the successes and challenges of the LRN during the initial 10 weeks of the 2022 mpox outbreak (May 17-July 31, 2022). METHODS: We conducted 9 unstructured interviews, which included 3 interviews with subject matter experts from the Centers for Disease Control and Prevention (CDC) and 6 interviews with state and local public health laboratories and epidemiologists and Association of Public Health Laboratories (APHL) staff. We asked guiding questions on investments in preparedness, successes, and challenges during the initial mpox response and asked for suggestions to improve future LRN responses to infectious disease outbreaks. We also reviewed data from 2 contemporaneous APHL surveys conducted in June and July 2022 in 84 LRN public health laboratories. RESULTS: Notable successes included availability of an assay that had received clearance from the US Food and Drug Administration (FDA) for testing orthopoxviruses (non-variola Orthopoxvirus [NVO] assay) and a trained workforce; strong relationships among FDA, CDC, and the LRN; and strong communications between LRN laboratories and CDC. Challenges included variability among LRN laboratories in self-reported testing capacity, barriers to accessing the NVO assay for health care providers, and gaps in LRN function during surges of testing needs. CONCLUSIONS: The LRN system plays an essential role in the response to emerging infectious disease outbreaks in the United States. Lessons learned from the LRN's initial response to the mpox outbreak can help guide improvements to better position the LRN for future responses, including continued engagement with health care providers, commercial laboratories, and laboratories in health care settings. |
Molecular mimicry in multisystem inflammatory syndrome in children
Bodansky A , Mettelman RC , Sabatino JJ Jr , Vazquez SE , Chou J , Novak T , Moffitt KL , Miller HS , Kung AF , Rackaityte E , Zamecnik CR , Rajan JV , Kortbawi H , Mandel-Brehm C , Mitchell A , Wang CY , Saxena A , Zorn K , Yu DJL , Pogorelyy MV , Awad W , Kirk AM , Asaki J , Pluvinage JV , Wilson MR , Zambrano LD , Campbell AP , Thomas PG , Randolph AG , Anderson MS , DeRisi JL . Nature 2024 Multisystem inflammatory syndrome in children (MIS-C) is a severe, post-infectious sequela of SARS-CoV-2 infection(1,2), yet the pathophysiological mechanism connecting the infection to the broad inflammatory syndrome remains unknown. Here we leveraged a large set of samples from patients with MIS-C to identify a distinct set of host proteins targeted by patient autoantibodies including a particular autoreactive epitope within SNX8, a protein involved in regulating an antiviral pathway associated with MIS-C pathogenesis. In parallel, we also probed antibody responses from patients with MIS-C to the complete SARS-CoV-2 proteome and found enriched reactivity against a distinct domain of the SARS-CoV-2 nucleocapsid protein. The immunogenic regions of the viral nucleocapsid and host SNX8 proteins bear remarkable sequence similarity. Consequently, we found that many children with anti-SNX8 autoantibodies also have cross-reactive T cells engaging both the SNX8 and the SARS-CoV-2 nucleocapsid protein epitopes. Together, these findings suggest that patients with MIS-C develop a characteristic immune response to the SARS-CoV-2 nucleocapsid protein that is associated with cross-reactivity to the self-protein SNX8, demonstrating a mechanistic link between the infection and the inflammatory syndrome, with implications for better understanding a range of post-infectious autoinflammatory diseases. |
Notes from the field: Illnesses after administration of presumed counterfeit botulinum toxin in nonmedical settings - Tennessee and New York City, March 2024
Thomas CM , McElroy R , Yackley J , Fill MA , Goonewardene D , Mackley C , Roth E , Ackelsberg J , Slavinski S , Habrun C , Hodge B , Rush C , Brown CM , Waltenburg MA , Bertling LH , McGorty M , Johnson R , Schaffner W , Jones TF , Dunn JR . MMWR Morb Mortal Wkly Rep 2024 73 (27) 609-611 |
Unmet needs for ancillary services by provider type among people with diagnosed human immunodeficiency virus
Thomas C , Yuan X , Taussig JA , Tie Y , Dasgupta S , Riedel DJ , Weiser J . Open Forum Infect Dis 2024 11 (7) ofae284 BACKGROUND: Unmet needs for ancillary services are substantial among people with human immunodeficiency virus (PWH), and provider type could influence the prevalence of unmet needs for these services. METHODS: Data from a national probability sample of PWH were analyzed from the Centers for Disease Control and Prevention's Medical Monitoring Project. We analyzed 2019 data on people who had ≥1 encounter with a human immunodeficiency virus (HIV) care provider (N = 3413) and their care facilities. We assessed the proportion of needs that were unmet for individual ancillary services, overall and by HIV care provider type, including infectious disease (ID) physicians, non-ID physicians, nurse practitioners, and physician assistants. We calculated prevalence differences (PDs) with predicted marginal means to assess differences between groups. RESULTS: An estimated 98.2% of patients reported ≥1 need for an ancillary service, and of those 46% had ≥1 unmet need. Compared with patients of ID physicians, needs for many ancillary services were higher among patients of other provider types. However, even after adjustment, patients of non-ID physicians had lower unmet needs for dental care (adjusted PD, -5.6 [95% confidence interval {CI}, -9.9 to -1.3]), and patients of nurse practitioners had lower unmet needs for HIV case management services (adjusted PD, -5.4 [95% CI, -9.4 to -1.4]), compared with patients of ID physicians. CONCLUSIONS: Although needs were greater among patients of providers other than ID physicians, many of these needs may be met by existing support systems at HIV care facilities. However, additional resources may be needed to address unmet needs for dental care and HIV case management among patients of ID physicians. |
The development of social determinants of health outcome measures: The role of multisector partnerships and community validation
Hacker K , Thomas C , Sheridan J , Glasgow L . J Public Health Manag Pract 2024 PURPOSE: To develop a set of social determinants of health (SDOH) measurements. PROBLEM: Despite burgeoning interest in addressing both SDOH and health-related social needs, the evidence on what works is limited due in part to the lack of standardized measures for evaluation. METHODS: In 2020, the Centers for Disease Control and Prevention (CDC) National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) identified 5 SDOH domains related to chronic disease for future programmatic work. These included built environment, community connections to clinical care, tobacco-free policies, social connectedness, and food and nutrition security. Subsequently, NCCDPHP launched an effort to develop a set of SDOH measures for evaluating funded programs in these domains. The approach involved a literature scan and a rating process based on 5 criteria relevant to NCCDPHP's SDOH priorities. A complementary community review by 13 multisector community partnerships (MCPs) applied a real-world public health practice lens to measure development. MCPs' ratings were analyzed to create summary scores for each measure, and open-ended feedback was synthesized using rapid qualitative analysis. RESULTS: The internal workgroup identified 59 measures from the initial 200 measures. Feedback from the MCPs identified issues of relevancy and burden of measures. Their high scores narrowed the 59 measures to 22 covering all 5 domains. In response, CDC is honing the original measures review criteria to include community perspectives. CONCLUSION: Public health measures development is often an academic pursuit. Engaging MCPs lends real-world credibility to the development of common SDOH measures. |
Birth outcomes related to prenatal Zika, Dengue, and other flavivirus infections in the Zika en Embarazadas y Niños prospective cohort study in Colombia
Tannis A , Newton S , Rico A , Gonzalez M , Benavides M , Ricaldi JN , Rodriguez H , Zambrano LD , Daza M , Godfred-Cato S , Thomas JD , Acosta J , Maniatis P , Daniels JB , Burkel V , Ailes EC , Valencia D , Gilboa SM , Jamieson DJ , Mercado M , Villanueva JM , Honein MA , Ospina ML , Tong VT . Am J Trop Med Hyg 2024 Zika virus (ZIKV) infection in pregnancy is associated with severe abnormalities of the brain and eye and other adverse outcomes. Zika en Embarazadas y Niños was a prospective cohort study conducted in multiple Colombian cities that enrolled pregnant women in their first trimester. Specimens collected from pregnant women (n = 1,519) during February 2017-September 2018 and their infants (n = 1,080) during June 2017-March 2019 were tested for prenatal ZIKV infection by nucleic acid amplification tests or IgM antibody testing. Zika virus infection in pregnancy was present in 3.2% of pregnant women (incidence rate [IR] per 1,000 person-months = 5.9, 95% CI: 4.3-7.8). Presumptive ZIKV infection was present in 0.8% of infants (IR = 1.6, 95% CI: 0.7-2.9). Five percent of infants with prenatal ZIKV exposure or infection presented with Zika-associated abnormalities; 4.7% were small for gestational age. Understanding the risk of ZIKV infection during pregnancy and associated adverse outcomes can help inform counseling efforts. |
Proceedings of the dengue endgame summit: Imagining a world with dengue control
Wegman AD , Kalimuddin S , Marques ETA , Adams LE , Rothman AL , Gromowski GD , Wang TT , Weiskopf D , Hibberd ML , Alex Perkins T , Christofferson RC , Gunale B , Kulkarni PS , Rosas A , Macareo L , Yacoub S , Eong Ooi E , Paz-Bailey G , Thomas SJ , Waickman AT . Vaccine 2024 The first dengue "endgame" summit was held in Syracuse, NY over August 9 and 10, 2023. Organized and hosted by the Institute for Global Health and Translational Sciences at SUNY Upstate Medical University, the gathering brought together researchers, clinicians, drug and vaccine developers, government officials, and other key stakeholders in the dengue field for a highly collaborative and discussion-oriented event. The objective of the gathering was to discuss the current state of dengue around the world, what dengue "control" might look like, and what a potential roadmap might look like to achieve functional dengue control. Over the course of 7 sessions, speakers with a diverse array of expertise highlighted both current and historic challenges associated with dengue control, the state of dengue countermeasure development and deployment, as well as fundamental virologic, immunologic, and medical barriers to achieving dengue control. While sustained eradication of dengue was considered challenging, attendees were optimistic that significant reduction in the burden of dengue can be achieved by integration of vector control with effective application of therapeutics and vaccines. |
Shared vision for improving outcomes for serious fungal diseases: Report of a patient, caregiver, and clinician summit
Purdie R , Tushla LA , Ferretti J , Castro GK , Watson R , Davis T , Raborg B , Mazi PB , Stroman A , Thomas Jones C , Walsh TJ , Chiller TM , Pappas PG , Meyer J , Spec A . Open Forum Infect Dis 2024 11 (6) ofae226 BACKGROUND: Recently, increasing focus on patient input into research and healthcare improvements has fostered expanded patient-centered advocacy efforts. This first pan-fungal disease summit, part of the MYCology Advocacy, Research, & Education effort, brought together patients, caregivers, and mycology experts to better document patient experiences with invasive fungal disease (IFD) and establish priorities for mycology education, advocacy, and research. METHODS: Patients who had suffered from IFD, their caregivers, clinicians, industry representatives, government officials, and patient advocacy professionals were invited. Patients and caregivers shared their stories and struggles with IFD. Breakout sessions separated mycology experts from patients and caregivers for further discussions to identify commonalities and perceived gaps and to formulate recommendations. The 2 groups then reconvened to develop consensus recommendations. RESULTS: IFD patients and their caregivers shared experiences reflecting the typically lengthy prediagnosis, acute treatment, long-term treatment, and posttreatment recovery stages of IFD. They reported substantial physical, psychological, and financial burdens associated with the IFD experience, particularly related to delayed diagnoses. They reaffirmed a need for coordinated patient-centered education, peer support, and advocacy to document the burden of serious fungal infections. Mycology experts discussed strategies to address gaps in the mycology field, such as insufficient training, inadequate workforce support, and a need to partner more with patient groups. CONCLUSIONS: A summit involving patients with IFD, family caregivers, and mycology experts identified a substantial nonclinical burden of disease associated with IFD. Patients and mycology experts prioritized several goals for education, advocacy, and research to raise awareness of IFD and improve outcomes. |
Shiga toxin-producing Escherichia coli O157:H7 outbreak associated with school field trips at a farm animal exhibit-Tennessee, September-October 2023
Thomas CM , Foster A , Boop S , Kirschke D , Mooney H , Reid I , May AS , Mullins H , Garman KN , Golwalkar M , Marr JH , Orejuela K , Ripley D , Rasnic R , Terrell E , Durso LM , Schaffner W , Jones TF , Fill MA , Dunn JR . Zoonoses Public Health 2024 AIMS: In October 2023, the Tennessee Department of Health identified an outbreak of Shiga toxin-producing Escherichia coli (STEC) O157:H7 infections among elementary school students who attended school field trips to the same farm animal exhibit. Our aim was to determine STEC source and prevent additional illnesses by initiating epidemiologic, laboratory and environmental investigations. METHODS AND RESULTS: We identified cases using laboratory-based surveillance and by surveying caregivers of children who attended the exhibit. Probable cases were defined as illness with abdominal cramps or diarrhoea after attendance; confirmed cases were laboratory-confirmed STEC infection in an attendee or household contact. A site visit was conducted, and event organizers were interviewed. Human stool, animal faeces and environmental samples were tested for STEC O157:H7 by real-time polymerase chain reaction (PCR), culture and whole-genome sequencing (WGS). Approximately 2300 elementary school students attended the animal exhibit during 2 days. Field trip activities included contact with different farm animal species, drinking pasteurized milk outside animal enclosures and eating lunch in a separate building onsite. We received survey responses from 399 caregivers for 443 (19%) animal exhibit attendees. We identified 9 confirmed and 55 probable cases with illness onset dates during 26 September to 12 October. Seven children aged 1-7 years were hospitalized. Four children aged 1-6 years experienced haemolytic uraemic syndrome; none died. Laboratory testing identified STEC O157:H7 by culture from eight human stool samples with 0-1 allele difference by WGS. Three environmental samples had Shiga toxin (stx 2) genes detected by PCR, but no STEC isolates were recovered by culture. CONCLUSIONS: This is the largest reported STEC O157:H7 outbreak associated with an animal exhibit in Tennessee. We identified opportunities for educating school staff, event organizers and families about zoonotic disease risks associated with animal contact and published prevention measures. |
Molecular and epidemiological investigation of fluconazole-resistant Candida parapsilosis-Georgia, United States, 2021
Misas E , Witt LS , Farley MM , Thomas S , Jenkins EN , Gade L , Peterson JG , Mesa Restrepo A , Fridkin S , Lockhart SR , Chow NA , Lyman M . Open Forum Infect Dis 2024 11 (6) ofae264 BACKGROUND: Reports of fluconazole-resistant Candida parapsilosis bloodstream infections are increasing. We describe a cluster of fluconazole-resistant C parapsilosis bloodstream infections identified in 2021 on routine surveillance by the Georgia Emerging Infections Program in conjunction with the Centers for Disease Control and Prevention. METHODS: Whole-genome sequencing was used to analyze C parapsilosis bloodstream infections isolates. Epidemiological data were obtained from medical records. A social network analysis was conducted using Georgia Hospital Discharge Data. RESULTS: Twenty fluconazole-resistant isolates were identified in 2021, representing the largest proportion (34%) of fluconazole-resistant C parapsilosis bloodstream infections identified in Georgia since surveillance began in 2008. All resistant isolates were closely genetically related and contained the Y132F mutation in the ERG11 gene. Patients with fluconazole-resistant isolates were more likely to have resided at long-term acute care hospitals compared with patients with susceptible isolates (P = .01). There was a trend toward increased mechanical ventilation and prior azole use in patients with fluconazole-resistant isolates. Social network analysis revealed that patients with fluconazole-resistant isolates interfaced with a distinct set of healthcare facilities centered around 2 long-term acute care hospitals compared with patients with susceptible isolates. CONCLUSIONS: Whole-genome sequencing results showing that fluconazole-resistant C parapsilosis isolates from Georgia surveillance demonstrated low genetic diversity compared with susceptible isolates and their association with a facility network centered around 2 long-term acute care hospitals suggests clonal spread of fluconazole-resistant C parapsilosis. Further studies are needed to better understand the sudden emergence and transmission of fluconazole-resistant C parapsilosis. |
"I could not find the strength to resist the pressure of the medical staff, to refuse to give commercial milk formula": a qualitative study on effects of the war on Ukrainian women's infant feeding
Iellamo A , Wong CM , Bilukha O , Smith JP , Ververs M , Gribble K , Walczak B , Wesolowska A , Al Samman S , O'Brien M , Brown AN , Stillman T , Thomas B . Front Nutr 2024 11 1225940 INTRODUCTION: During emergencies, breastfeeding protects infants by providing essential nutrients, food security, comfort, and protection and is a priority lifesaving intervention. On February 24, 2022, the war in Ukraine escalated, creating a humanitarian catastrophe. The war has resulted in death, injuries, and mass internal displacement of over 5 million people. A further 8.2 million people have taken refuge in neighboring countries, including Poland. Among those impacted are infants and young children and their mothers. We conducted a study to explore the infant feeding challenges and needs of Ukrainian women affected by the war. METHODS: We conducted a qualitative descriptive study involving in-depth interviews (IDIs) with 75 war-affected Ukrainian mothers who had at least one infant aged less than 12 months at the time of the interview. Eligible mothers were either (1) living as Ukrainian refugees in Poland, having crossed the border from Ukraine on or after February 24, 2022, when the war started (n = 30) or (2) living in Ukraine as internally displaced persons or as residents in the community (n = 45). All interviews were audio-recorded (either transcribed or had responses summarized as expanded notes) and analyzed using qualitative thematic analysis using a two-step rapid analysis process. RESULTS: Participants in Ukraine who wanted to initiate breastfeeding right after birth faced opposition from healthcare workers at maternity hospitals. Ukrainian refugees who gave birth in Poland faced language barriers when seeking breastfeeding support. Half of the participants in Ukraine received commercial milk formula (CMF) donations even if they said they did not need them. Most respondents stated that breastfeeding information and support were urgently needed. CONCLUSION: Our data suggests that healthcare workers in Ukrainian maternity hospitals require additional training and motivation on delivering breastfeeding support. In addition, lactation consultants in maternity ward are needed in Ukraine, and interpretation support is needed for refugees to overcome language barriers. There is a need to control the indiscriminate donations of commercial milk formula and to ensure that complementary foods and commercial milk formula are available to those that need it. This study confirms the need for actions to ensure infant and young child feeding (IYCF) support is provided during emergencies. |
Predictors of PrEP retention and attrition in an urban publicly funded safety-net specialty clinic
Drezner K , Coleman M , Visconti A , Thomas C , Beverley J , Harold RE , Furness BW . AIDS Behav 2024 Pre-exposure prophylaxis (PrEP) is an effective tool for human immunodeficiency virus (HIV) prevention. The purpose of this study is to identify correlates of PrEP retention using patient data from an urban, publicly funded safety-net clinic in Washington, DC. Cox proportional hazards regression, logistical regression, and survival curves were used to assess the association of age, gender, race/ethnicity, insurance, number of partners, and sexually transmitted infection (STI) diagnosis at PrEP initiation with time on PrEP. From August 2016-December 2020, 1,126 people were prescribed PrEP - patients were mostly Black (44.8%) or Latinx (30.4%) and identified as cisgender men (84.6%). Half had no insurance (49.1%), with the remaining patients reporting private (28.9%) or public (21.5%) insurance. Age at PrEP prescription ranged from 15 to 66 with 80% being 20 to 39 years. For the 87.7% (n = 987) of patients who discontinued PrEP, mean PrEP time was 158 days and median was 28 days. The highest rates of discontinuation were observed within the first month with 44.3% discontinuing by day 30, 52.3% by 3 months, and 73.2% by 1 year. Cisgender women, transgender persons, and those younger than 30 years were more likely to discontinue PrEP. Latinx and patients with less than 3 male partners in the last 90 days were less likely to discontinue PrEP. We demonstrated a high level of PrEP uptake among populations disproportionally affected by HIV. Future analyses are needed to examine ways of reducing barriers to PrEP initiation and improving PrEP adherence. |
Linking exposure to per- and polyfluoroalkyl substances (PFAS) in house dust and biomonitoring data in eight impacted communities
Minucci JM , DeLuca NM , Durant JT , Goodwin B , Kowalski P , Scruton K , Thomas K , Cohen Hubal EA . Environ Int 2024 188 108756 Per- and polyfluoroalkyl substances (PFAS) are widely used in industry and have been linked to various adverse health effects. Communities adjacent to sites where PFAS are manufactured, stored, or used may be at elevated risk. In these impacted communities, significant exposure often occurs through contaminated drinking water, yet less is known about the role of other pathways such as residential exposure through house dust. We analyzed a paired serum and house dust dataset from the Agency for Toxic Substances and Disease Registry's PFAS Exposure Assessments, which sampled eight United States communities with a history of drinking water contamination due to aqueous film forming foam (AFFF) use at nearby military bases. We found that serum PFAS levels of residents were significantly positively associated with the dust PFAS levels in their homes, for three of seven PFAS analyzed, when accounting for site and participant age. We also found that increased dust PFAS levels were associated with a shift in the relative abundance of PFAS in serum towards those chemicals not strongly linked to AFFF contamination, which may suggest household sources. Additionally, we analyzed participant responses to exposure questionnaires to identify factors associated with dust PFAS levels. Dust PFAS levels for some analytes were significantly elevated in households where participants were older and had lived at the home longer, cleaned less frequently, used stain resistant products, and had carpeted living rooms. Our results suggest that residential exposure to PFAS via dust or other indoor pathways may contribute to overall exposure and body burden, even in communities impacted by AFFF contamination of drinking water, and the magnitude of this exposure may also be influenced by demographic, behavioral, and housing factors. |
Vital signs: Drowning death rates, self-reported swimming skill, swimming lesson participation, and recreational water exposure - United States, 2019-2023
Clemens T , Moreland B , Mack KA , Thomas K , Bergen G , Lee R . MMWR Morb Mortal Wkly Rep 2024 73 (20) 467-473 INTRODUCTION: Drowning is the cause of approximately 4,000 U.S. deaths each year and disproportionately affects some age, racial, and ethnic groups. Infrastructure disruptions during the COVID-19 pandemic, including limited access to supervised swimming settings, might have affected drowning rates and risk. Data on factors that contribute to drowning risk are limited. To assess the potential impact of the pandemic on drowning death rates, pre- and post-COVID-19 pandemic rates were compared. METHODS: National Vital Statistics System data were used to compare unintentional drowning death rates in 2019 (pre-COVID-19 pandemic onset) with those in 2020, 2021, and 2022 (post-pandemic onset) by age, sex, and race and ethnicity. National probability-based online panel survey (National Center for Health Statistics Rapid Surveys System) data from October-November 2023 were used to describe adults' self-reported swimming skill, swimming lesson participation, and exposure to recreational water. RESULTS: Unintentional drowning death rates were significantly higher during 2020, 2021, and 2022 compared with those in 2019. In all years, rates were highest among children aged 1-4 years; significant increases occurred in most age groups. The highest drowning rates were among non-Hispanic American Indian or Alaska Native and non-Hispanic Black or African American persons. Approximately one half (54.7%) of U.S. adults reported never having taken a swimming lesson. Swimming skill and swimming lesson participation differed by age, sex, and race and ethnicity. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Recent increases in drowning rates, including those among populations already at high risk, have increased the urgency of implementing prevention strategies. Basic swimming and water safety skills training can reduce the risk for drowning. Addressing social and structural barriers that limit access to this training might reduce drowning deaths and inequities. The U.S. National Water Safety Action Plan provides recommendations and tools for communities and organizations to enhance basic swimming and water safety skills training. |
Characteristics of healthcare personnel with SARS-CoV-2 infection: 10 emerging infections program sites in the United States, April 2020-December 2021
Chea N , Eure T , Alkis Ramirez R , Zlotorzynska M , Blazek GT , Nadle J , Lee J , Czaja CA , Johnston H , Barter D , Kellogg M , Emanuel C , Meek J , Brackney M , Carswell S , Thomas S , Fridkin SK , Wilson LE , Perlmutter R , Marceaux-Galli K , Fell A , Lovett S , Lim S , Lynfield R , Shrum Davis S , Phipps EC , Sievers M , Dumyati G , Myers C , Hurley C , Licherdell E , Pierce R , Ocampo VLS , Hall EW , Wilson C , Adre C , Kirtz E , Markus TM , Billings K , Plumb ID , Abedi GR , James-Gist J , Magill SS , Grigg CT . Infect Control Hosp Epidemiol 2024 1-9 BACKGROUND: Understanding characteristics of healthcare personnel (HCP) with SARS-CoV-2 infection supports the development and prioritization of interventions to protect this important workforce. We report detailed characteristics of HCP who tested positive for SARS-CoV-2 from April 20, 2020 through December 31, 2021. METHODS: CDC collaborated with Emerging Infections Program sites in 10 states to interview HCP with SARS-CoV-2 infection (case-HCP) about their demographics, underlying medical conditions, healthcare roles, exposures, personal protective equipment (PPE) use, and COVID-19 vaccination status. We grouped case-HCP by healthcare role. To describe residential social vulnerability, we merged geocoded HCP residential addresses with CDC/ATSDR Social Vulnerability Index (SVI) values at the census tract level. We defined highest and lowest SVI quartiles as high and low social vulnerability, respectively. RESULTS: Our analysis included 7,531 case-HCP. Most case-HCP with roles as certified nursing assistant (CNA) (444, 61.3%), medical assistant (252, 65.3%), or home healthcare worker (HHW) (225, 59.5%) reported their race and ethnicity as either non-Hispanic Black or Hispanic. More than one third of HHWs (166, 45.2%), CNAs (283, 41.7%), and medical assistants (138, 37.9%) reported a residential address in the high social vulnerability category. The proportion of case-HCP who reported using recommended PPE at all times when caring for patients with COVID-19 was lowest among HHWs compared with other roles. CONCLUSIONS: To mitigate SARS-CoV-2 infection risk in healthcare settings, infection prevention, and control interventions should be specific to HCP roles and educational backgrounds. Additional interventions are needed to address high social vulnerability among HHWs, CNAs, and medical assistants. |
Informing digital programs for lupus self-management education: A systematic scoping review
Carpenter K , Gilman S , French M , Shakur Y , Dunlop-Thomas C , Cullerton L , Drenkard C , Barbour KE , Lim SS . Arthritis Care Res (Hoboken) 2024 OBJECTIVE: We describe the characteristics, content, and effectiveness of digital self-management (SM) education programs for lupus and other chronic conditions to identify gaps and inform the improvement of future programs in lupus. METHODS: Three bibliographic databases were searched for articles published between May 2012 and April 2022. The search was cast to capture the breadth of digital SM education programs in the following conditions: lupus, epilepsy, fibromyalgia, multiple sclerosis, sickle cell anemia, Sjogren's syndrome, psoriatic arthritis, and rheumatoid arthritis. Title and abstract screening, as well as full-text review, was conducted by two independent reviewers. Data extraction was first completed by one author charting all studies and then, a second time, by four members of the research team charting collaboratively. RESULTS: Of the 1,969 articles identified through the search, 14 met inclusion criteria. Two additional articles were included following bibliography review. The 16 articles represented 12 unique digital SM education programs. Programs covered five conditions: epilepsy (n=3), fibromyalgia (n=2), multiple sclerosis (n=4), lupus (n=1), and rheumatoid arthritis (n=2). Most programs were asynchronous and internet-based (n=9) with a prescribed sequence of content (n=8). Peer, technical, or specialist support was offered in seven programs. Most programs demonstrated statistically significant improvement of symptoms in the intervention group (n=8). CONCLUSION: This scoping review summarizes the current landscape for digital SM education programs in lupus and similar conditions. In lupus, further investigation will fill in the gaps around digital SM education needs, user experience and evaluation of outcomes. |
Outbreak of postpartum group a Streptococcus infections on a labor and delivery unit
Haden M , Liscynesky C , Colburn N , Smyer J , Malcolm K , Gonsenhauser I , Rood KM , Schneider P , Hardgrow M , Pancholi P , Thomas K , Cygnor A , Aluko O , Koch E , Tucker N , Mowery J , Brandt E , Cibulskas K , Mohr M , Nanduri S , Chochua S , Day SR . Infect Control Hosp Epidemiol 2024 1-3 A healthcare-associated group A Streptococcus outbreak involving six patients, four healthcare workers, and one household contact occurred in the labor and delivery unit of an academic medical center. Isolates were highly related by whole genome sequencing. Infection prevention measures, healthcare worker screening, and chemoprophylaxis of those colonized halted further transmission. |
Effectiveness of 13-valent pneumococcal conjugate vaccine for prevention of invasive pneumococcal disease among children in the United States between 2010 and 2019: An indirect cohort study
Andrejko KL , Gierke R , Rowlands JV , Rosen JB , Thomas A , Landis ZQ , Rosales M , Petit S , Schaffner W , Holtzman C , Barnes M , Farley MM , Harrison LH , McGee L , Chochua S , Verani JR , Cohen AL , Pilishvili T , Kobayashi M . Vaccine 2024 BACKGROUND: A U.S. case-control study (2010-2014) demonstrated vaccine effectiveness (VE) for ≥ 1 dose of the thirteen-valent pneumococcal conjugate vaccine (PCV13) against vaccine-type (VT) invasive pneumococcal disease (IPD) at 86 %; however, it lacked statistical power to examine VE by number of doses and against individual serotypes. METHODS: We used the indirect cohort method to estimate PCV13 VE against VT-IPD among children aged < 5 years in the United States from May 1, 2010 through December 31, 2019 using cases from CDC's Active Bacterial Core surveillance, including cases enrolled in a matched case-control study (2010-2014). Cases and controls were defined as individuals with VT-IPD and non-PCV13-type-IPD (NVT-IPD), respectively. We estimated absolute VE using the adjusted odds ratio of prior PCV13 receipt (1-aOR x 100 %). RESULTS: Among 1,161 IPD cases, 223 (19.2 %) were VT cases and 938 (80.8 %) were NVT controls. Of those, 108 cases (48.4 %; 108/223) and 600 controls (64.0 %; 600/938) had received > 3 PCV13 doses; 23 cases (17.6 %) and 15 controls (2.4 %) had received no PCV doses. VE ≥ 3 PCV13 doses against VT-IPD was 90.2 % (95 % Confidence Interval75.4-96.1 %), respectively. Among the most commonly circulating VT-IPD serotypes, VE of ≥ 3 PCV13 doses was 86.8 % (73.7-93.3 %), 50.2 % (28.4-80.5 %), and 93.8 % (69.8-98.8 %) against serotypes 19A, 3, and 19F, respectively. CONCLUSIONS: At least three doses of PCV13 continue to be effective in preventing VT-IPD among children aged < 5 years in the US. PCV13 was protective against serotypes 19A and 19F IPD; protection against serotype 3 IPD did not reach statistical significance. |
Exposure to emissions generated by 3-dimensional printing with polycarbonate: effects on peripheral vascular function, cardiac vascular morphology and expression of markers of oxidative stress in male rat cardiac tissue
Krajnak K , Farcas M , Richardson D , Hammer MA , Waugh S , McKinney W , Knepp A , Jackson M , Burns D , LeBouf R , Matheson J , Thomas T , Qian Y . J Toxicol Environ Health A 2024 1-19 Three-dimensional (3D) printing with polycarbonate (PC) plastic occurs in manufacturing settings, homes, and schools. Emissions generated during printing with PC stock and bisphenol-A (BPA), an endocrine disrupter in PC, may induce adverse health effects. Inhalation of 3D printer emissions, and changes in endocrine function may lead to cardiovascular dysfunction. The goal of this study was to determine whether there were any changes in markers of peripheral or cardiovascular dysfunction in animals exposed to PC-emissions. Male Sprague Dawley rats were exposed to PC-emissions generated by 3D printing for 1, 4, 8, 15 or 30 d. Exposure induced a reduction in the expression of the antioxidant catalase (Cat) and endothelial nitric oxide synthase (eNos). Endothelin and hypoxia-induced factor 1α transcripts increased after 30 d. Alterations in transcription were associated with elevations in immunostaining for estrogen and androgen receptors, nitrotyrosine, and vascular endothelial growth factor in cardiac arteries of PC-emission exposed animals. There was also a reduction eNOS immunostaining in cardiac arteries from rats exposed to PC-emissions. Histological analyses of heart sections revealed that exposure to PC-emissions resulted in vasoconstriction of cardiac arteries and thickening of the vascular smooth muscle wall, suggesting there was a prolonged vasoconstriction. These findings are consistent with studies showing that inhalation 3D-printer emissions affect cardiovascular function. Although BPA levels in animals were relatively low, exposure-induced changes in immunostaining for estrogen and androgen receptors in cardiac arteries suggest that changes in the action of steroid hormones may have contributed to the alterations in morphology and markers of cardiac function. |
Differences in pertussis incidence by race and ethnicity in the United States, 2010-2017
Patel JC , Cole M , Rubis AB , Burzalff K , Cruz V , Edge K , Kudish K , Liko J , Pena S , Thomas ES , Skoff TH , McNamara LA . Open Forum Infect Dis 2024 11 (4) ofae177 BACKGROUND: An increased pertussis burden has been demonstrated among Hispanic or Latino and American Indian or Alaska Native (AI/AN) infants. However, data on potential disparities among other age and racial groups are limited. METHODS: We analyzed pertussis cases reported through Enhanced Pertussis Surveillance from 2010 to 2017. Pertussis and severe pertussis incidence were calculated by race (White, Black or African American, AI/AN, and Asian or Pacific Islanders), ethnicity (Hispanic or Latino and non-Hispanic or non-Latino), and age. RESULTS: Compared with White persons, overall incidence was lower among Black or African American (incidence rate ratio [IRR], .57; 95% confidence interval [CI], .53-.61), AI/AN (IRR, 0.65; 95% CI, .58-.72), and Asian or Pacific Islander persons (IRR, 0.39; 95% CI, .35-.43). Overall incidence of pertussis was higher (1.5-fold; 95% CI, 1.37-1.60) among Hispanic or Latino compared with non-Hispanic or non-Latino adults, potentially related to household size or lower pertussis vaccine uptake among adult Hispanic or Latino cases. Severe pertussis incidence was similar among Black or African American and AI/AN persons compared with White persons. Among infants, severe pertussis incidence was 1.4-fold higher (95% CI, 1.03-1.82) among Black or African American infants than among White infants, and 2.1-fold higher (95% CI, 1.67-2.57) among Hispanic or Latino infants than non-Hispanic or non-Latino infants. CONCLUSIONS: The contrast between lower reported incidence but similar or higher severe pertussis incidence among Black or African American and AI/AN persons compared with White persons warrants further investigation and may reflect underdiagnosis or underreporting of mild disease. |
Respiratory syncytial virus hospitalizations associated with social vulnerability by census tract: An opportunity for intervention?
Thomas CM , Raman R , Schaffner W , Markus TM , Ndi D , Fill MA , Dunn JR , Talbot HK . Open Forum Infect Dis 2024 11 (5) ofae184 BACKGROUND: Respiratory syncytial virus (RSV) can cause hospitalization in young children and older adults. With vaccines and monoclonal antibody prophylaxis increasingly available, identifying social factors associated with severe illnesses can guide mitigation efforts. METHODS: Using data collected by the RSV Hospitalization Surveillance Network from 2016 to 2023, we identified RSV hospitalizations in Tennessee. We linked hospitalization information (eg, patient demographic characteristics and outcome) with population-level variables (eg, social vulnerability and health care insurance coverage) from publicly available data sets using census tract of residence. Hospitalization incidence was calculated and stratified by period (2016-2020 and 2020-2023). We modeled social vulnerability effect on hospitalization incidence using Poisson regression. RESULTS: Among 2687 RSV hospitalizations, there were 677 (25.2%) intensive care unit admissions and 38 (1.4%) deaths. The highest RSV hospitalization incidences occurred among children aged <5 years and adults aged ≥65 years: 272.8 per 100 000 person-years (95% CI, 258.6-287.0) and 60.6 (95% CI, 56.0-65.2), respectively. Having public health insurance was associated with higher hospitalization incidence as compared with not having public insurance: 60.5 per 100 000 person-years (95% CI, 57.6-63.4) vs 14.3 (95% CI, 13.4-15.2). Higher hospitalization incidence was associated with residing in a census tract in the most socially vulnerable quartile vs the least vulnerable quartile after adjusting for age, sex, and period (incidence rate ratio, 1.4; 95% CI, 1.3-1.6). CONCLUSIONS: RSV hospitalization was associated with living in more socially vulnerable census tracts. Population measures of social vulnerability might help guide mitigation strategies, including vaccine and monoclonal antibody promotion and provision to reduce RSV hospitalization. |
Preventable premature deaths from the five leading causes of death in nonmetropolitan and metropolitan counties, United States, 2010-2022
García MC , Rossen LM , Matthews K , Guy G , Trivers KF , Thomas CC , Schieb L , Iademarco MF . MMWR Surveill Summ 2024 73 (2) 1-11 PROBLEM/CONDITION: A 2019 report quantified the higher percentage of potentially excess (preventable) deaths in U.S. nonmetropolitan areas compared with metropolitan areas during 2010-2017. In that report, CDC compared national, regional, and state estimates of preventable premature deaths from the five leading causes of death in nonmetropolitan and metropolitan counties during 2010-2017. This report provides estimates of preventable premature deaths for additional years (2010-2022). PERIOD COVERED: 2010-2022. DESCRIPTION OF SYSTEM: Mortality data for U.S. residents from the National Vital Statistics System were used to calculate preventable premature deaths from the five leading causes of death among persons aged <80 years. CDC's National Center for Health Statistics urban-rural classification scheme for counties was used to categorize the deaths according to the urban-rural county classification level of the decedent's county of residence (1: large central metropolitan [most urban], 2: large fringe metropolitan, 3: medium metropolitan, 4: small metropolitan, 5: micropolitan, and 6: noncore [most rural]). Preventable premature deaths were defined as deaths among persons aged <80 years that exceeded the number expected if the death rates for each cause in all states were equivalent to those in the benchmark states (i.e., the three states with the lowest rates). Preventable premature deaths were calculated separately for the six urban-rural county categories nationally, the 10 U.S. Department of Health and Human Services public health regions, and the 50 states and the District of Columbia. RESULTS: During 2010-2022, the percentage of preventable premature deaths among persons aged <80 years in the United States increased for unintentional injury (e.g., unintentional poisoning including drug overdose, unintentional motor vehicle traffic crash, unintentional drowning, and unintentional fall) and stroke, decreased for cancer and chronic lower respiratory disease (CLRD), and remained stable for heart disease. The percentages of preventable premature deaths from the five leading causes of death were higher in rural counties in all years during 2010-2022. When assessed by the six urban-rural county classifications, percentages of preventable premature deaths in the most rural counties (noncore) were consistently higher than in the most urban counties (large central metropolitan and fringe metropolitan) for the five leading causes of death during the study period.During 2010-2022, preventable premature deaths from heart disease increased most in noncore (+9.5%) and micropolitan counties (+9.1%) and decreased most in large central metropolitan counties (-10.2%). Preventable premature deaths from cancer decreased in all county categories, with the largest decreases in large central metropolitan and large fringe metropolitan counties (-100.0%; benchmark achieved in both county categories in 2019). In all county categories, preventable premature deaths from unintentional injury increased, with the largest increases occurring in large central metropolitan (+147.5%) and large fringe metropolitan (+97.5%) counties. Preventable premature deaths from CLRD decreased most in large central metropolitan counties where the benchmark was achieved in 2019 and increased slightly in noncore counties (+0.8%). In all county categories, preventable premature deaths from stroke decreased from 2010 to 2013, remained constant from 2013 to 2019, and then increased in 2020 at the start of the COVID-19 pandemic. Percentages of preventable premature deaths varied across states by urban-rural county classification during 2010-2022. INTERPRETATION: During 2010-2022, nonmetropolitan counties had higher percentages of preventable premature deaths from the five leading causes of death than did metropolitan counties nationwide, across public health regions, and in most states. The gap between the most rural and most urban counties for preventable premature deaths increased during 2010-2022 for four causes of death (cancer, heart disease, CLRD, and stroke) and decreased for unintentional injury. Urban and suburban counties (large central metropolitan, large fringe metropolitan, medium metropolitan, and small metropolitan) experienced increases in preventable premature deaths from unintentional injury during 2010-2022, leading to a narrower gap between the already high (approximately 69% in 2022) percentage of preventable premature deaths in noncore and micropolitan counties. Sharp increases in preventable premature deaths from unintentional injury, heart disease, and stroke were observed in 2020, whereas preventable premature deaths from CLRD and cancer continued to decline. CLRD deaths decreased during 2017-2020 but increased in 2022. An increase in the percentage of preventable premature deaths for multiple leading causes of death was observed in 2020 and was likely associated with COVID-19-related conditions that contributed to increased mortality from heart disease and stroke. PUBLIC HEALTH ACTION: Routine tracking of preventable premature deaths based on urban-rural county classification might enable public health departments to identify and monitor geographic disparities in health outcomes. These disparities might be related to different levels of access to health care, social determinants of health, and other risk factors. Identifying areas with a high prevalence of potentially preventable mortality might be informative for interventions. |
Implications of measles inclusion by commercial syndromic polymerase chain reaction panels - United States, May 2022-April 2023
Thomas CM , Hartley A , Schmitz A , Reid HD , Sullivan S , Huebner E , Robinson M , Mathis A , Fill MA , Levinson KJ , Jones TF , Schaffner W , Newhouse CN , Dunn JR . MMWR Morb Mortal Wkly Rep 2024 73 (12) 260-264 Syndromic polymerase chain reaction (PCR) panels are used to test for pathogens that can cause rash illnesses, including measles. Rash illnesses have infectious and noninfectious causes, and approximately 5% of persons experience a rash 7-10 days after receipt of a measles, mumps, and rubella (MMR) vaccine. MMR vaccine includes live attenuated measles virus, which is detectable by PCR tests. No evidence exists of person-to-person transmission of measles vaccine virus, and illness does not typically result among immunocompetent persons. During September 2022-January 2023, the Tennessee Department of Health received two reports of measles detected by syndromic PCR panels. Both reports involved children (aged 1 and 6 years) without known risk factors for measles, who were evaluated for rash that occurred 11-13 days after routine MMR vaccination. After public health responses in Tennessee determined that both PCR panels had detected measles vaccine virus, six state health departments collaborated to assess the frequency and characteristics of persons receiving a positive measles PCR panel test result in the United States. Information was retrospectively collected from a commercial laboratory testing for measles in syndromic multiplex PCR panels. During May 2022-April 2023, among 1,548 syndromic PCR panels, 17 (1.1%) returned positive test results for measles virus. Among 14 persons who received a positive test result and for whom vaccination and case investigation information were available, all had received MMR vaccine a median of 12 days before specimen collection, and none had known risk factors for acquiring measles. All positive PCR results were attributed to detection of measles vaccine virus. Increased awareness among health care providers about potential measles detection by PCR after vaccination is needed. Any detection of measles virus by syndromic PCR testing should be immediately reported to public health agencies, which can use measles vaccination history and assessment of risk factors to determine the appropriate public health response. If a person recently received MMR vaccine and has no risk factors for acquiring measles, additional public health response is likely unnecessary. |
Correction and Republication: Symptoms of Depression, Anxiety, Post-Traumatic Stress Disorder, and Suicidal Ideation Among State, Tribal, Local, and Territorial Public Health Workers During the COVID-19 Pandemic - United States, March-April 2021
Bryant-Genevier J , Rao CY , Lopes-Cardozo B , Kone A , Rose C , Thomas I , Orquiola D , Lynfield R , Shah D , Freeman L , Becker S , Williams A , Gould DW , Tiesman H , Lloyd G , Hill L , Byrkit R . MMWR Morb Mortal Wkly Rep 12/28/2021 70 (48) 1679 On July 2, 2021, MMWR published “Symptoms of Depression, Anxiety, Post-Traumatic Stress Disorder, and Suicidal Ideation Among State, Tribal, Local, and Territorial Public Health Workers During the COVID-19 Pandemic — United States, March–April 2021” (1). On October 12, 2021, the authors informed MMWR that some data were inaccurate because 420 incomplete participant responses were incorrectly assigned scores for depression. This error resulted in a change in overall depression prevalence from 32.0% to 30.8%, and other similar changes in stratified prevalences of depression, prevalence ratios of depression, and the overall proportion of respondents who reported at least one mental health condition. The authors have corrected the MMWR report by excluding the 420 records from the depression analysis and confirmed that the interpretation and the conclusions of the original report were not affected by these corrections. MMWR has republished the report (2), which includes the original report with clearly marked corrections in supplementary materials. |
Estimating causes of death where there is no medical certification: evolution and state of the art of verbal autopsy
Chandramohan D , Fottrell E , Leitao J , Nichols E , Clark SJ , Alsokhn C , Cobos Munoz D , AbouZahr C , Di Pasquale A , Mswia R , Choi E , Baiden F , Thomas J , Lyatuu I , Li Z , Larbi-Debrah P , Chu Y , Cheburet S , Sankoh O , Mohamed Badr A , Fat DM , Setel P , Jakob R , de Savigny D . Glob Health Action 12/28/2021 14 1982486 Over the past 70 years, significant advances have been made in determining the causes of death in populations not served by official medical certification of cause at the time of death using a technique known as Verbal Autopsy (VA). VA involves an interview of the family or caregivers of the deceased after a suitable bereavement interval about the circumstances, signs and symptoms of the deceased in the period leading to death. The VA interview data are then interpreted by physicians or, more recently, computer algorithms, to assign a probable cause of death. VA was originally developed and applied in field research settings. This paper traces the evolution of VA methods with special emphasis on the World Health Organization's (WHO)'s efforts to standardize VA instruments and methods for expanded use in routine health information and vital statistics systems in low- and middle-income countries (LMICs). These advances in VA methods are culminating this year with the release of the 2022 WHO Standard Verbal Autopsy (VA) Toolkit. This paper highlights the many contributions the late Professor Peter Byass made to the current VA standards and methods, most notably, the development of InterVA, the most commonly used automated computer algorithm for interpreting data collected in the WHO standard instruments, and the capacity building in low- and middle-income countries (LMICs) that he promoted. This paper also provides an overview of the methods used to improve the current WHO VA standards, a catalogue of the changes and improvements in the instruments, and a mapping of current applications of the WHO VA standard approach in LMICs. It also provides access to tools and guidance needed for VA implementation in Civil Registration and Vital Statistics Systems at scale. |
Prevention of zoonotic spillover: From relying on response to reducing the risk at source
Wanda M , Thomas CM , Wiku BA , Salama A , Casey BB , Pépé B , Salome AB , Natalia C , Natalia CB , Dominique FC , Abhishek C , Janice RCZ , Andrew AC , Osman D , Nitish D , Baptiste D , Elmoubasher F , George FG , David TSH , Margaret K , Marion PGK , Catherine M , John SM , Serge M , Vyacheslav S , Zhou L , Giraudoux P . PLoS Pathog 2023 19 (10) e1011504 |
American Indian and Alaska Native violence prevention efforts: a systematic review, 1980 to 2018
Rollman JE , Thomas M , Mercer Kollar LM , Ports KA , Clelland C , Satter DE , David-Ferdon C . Inj Epidemiol 2024 8 72 BACKGROUND: Violence is a serious public health concern disproportionately experienced by American Indian and Alaska Native (AIAN) people. While the burden and impact of violence may be explained by the presence of risk factors among this group, AIAN communities benefit from unique protective factors and universal strategies which may be tailored with tribal adaptations. We sought to identify and explore violence prevention strategies specific to AIAN populations. METHODS: A review was conducted to systematically identify violence prevention programs, policies, and practices implemented in AIAN communities. We searched nine electronic databases and relevant gray literature released between January 1980 and June 2018. We included intervention-focused records targeting at least one violence topic area (child abuse/neglect, elder abuse, intimate partner violence, sexual violence, youth violence, and suicide) in a majority (> 50%) AIAN population. RESULTS: A total of 5220 non-duplicate records were screened, yielding 318 full-text records. After applying exclusion criteria, 57 records describing 60 program, policy, or practice implementations of 43 unique interventions were identified. All six violence types were represented, although more than half (58%; n = 25/43) focused on suicide prevention. Among suicide prevention programs, the most common strategies were identifying and supporting people at risk (80%; n = 20), teaching coping and problem-solving skills (56%; n = 14), and promoting connectedness (48%; n = 12). Two-thirds of the implementations (67%; n = 40/60) were in fully (100%) AIAN communities. Programs were implemented across many settings, though schools were the most common (35%, n = 21/60) setting. Of the 60 total implementations, a majority (80%; n = 48) were new approaches developed by and for AIAN communities, while the remainder were AIAN adaptations of programs previously created for non-AIAN populations. Most implementations (60%; n = 36/60) provided some evaluation data although less than half (45%; n = 27/60) reported evaluation results. CONCLUSIONS: This review identified many violence prevention strategies specific to AIAN populations. While programs developed in one tribe may not be completely generalizable to others, shared tribal risk and protective factors suggest programs could be successful across diverse communities. Findings indicate there is a need to develop and evaluate violence prevention programs, policies and practices for AIAN populations. |
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