Last data update: May 13, 2024. (Total: 46773 publications since 2009)
Records 1-9 (of 9 Records) |
Query Trace: Varan A[original query] |
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Reply
Hofmeister MG , Edlin BR , Rosenberg ES , Rosenthal EM , Barker LK , Barranco MA , Hall EW , Mermin J , Ryerson AB . Hepatology 2019 70 (2) 759-760 We appreciate Dr. Spaulding and colleagues’ thoughtful commentary on our article. We used national data to provide the most accurate estimate possible of the prevalence of hepatitis C among adults in the United States, but our estimate was dependent on the quality and completeness of the available data. We corrected for the omission of several high-prevalence populations from the National Health and Nutrition Examination Survey (NHANES), but no nationally representative studies of these populations exist. Spaulding and her colleagues raise a number of reasons why our study may underestimate the true prevalence of hepatitis C among incarcerated persons, but unfortunately, no nationwide data exist to assess the magnitude of these potential biases. According to 2016 Bureau of Justice Statistics data, most people arrested are detained in jails for short periods of time(1); thus, most of the number of persons cited in Dr. Spaulding’s reply would be eligible for NHANES sampling. We could not further adjust estimates for potential nonresponse bias beyond those addressed through standard NHANES sample weights without risk of double-counting prevalent cases. | | Varan et al.(2) data were excluded because we decided a priori to include only articles published more recently than those included in the incarcerated prevalence analysis from the Edlin et al. 2015(3) national hepatitis C virus prevalence estimate. With respect to the differential treatment of North Carolina and South Carolina from Schoenbachler et al. (4) (“study 6”), South Carolina data were excluded because “Initially, the South Carolina program targeted detainees…who had obtained tattoos in non-professional or unregulated settings.” Although testing was eventually expanded to include other detainees, Shoenbachler et al. did not indicate at what point that transition occurred or whether the expansion applied to all four South Carolina jails in the study or just one.(4) We determined that the targeted risk-based screening employed met our “sampling higher-risk subpopulations selectively” exclusion criteria, and consequently only included North Carolina data from Schoenbachler et al. in our analysis. | | Incarcerated populations bear a large and disproportionate hepatitis C burden, and incarceration provides an important opportunity to identify cases, provide life-saving curative treatment, and prevent transmission. The Centers for Disease Control and Prevention (CDC) is looking to other systems to collect data for prevention planning and providing more support to traditional and nontraditional surveillance systems both within and outside correctional facilities. Regardless of the exact number, prevention, testing, care, and treatment of incarcerated persons with or at risk for hepatitis C is an important priority for CDC and the nation. |
Epidemiological surveillance of land borders in North and South America: a case study
Bruniera-Oliveira R , Horta MAP , Varan A , Montiel S , Carmo EH , Waterman SH , Verani JFS . Rev Inst Med Trop Sao Paulo 2017 59 e68 This study aims to analyze the different binational/multinational activities, programs, and structures taking place on the borders of Brazil and the U.S. between 2013 and 2015. A descriptive exploratory study of two border epidemiological surveillance (BES) systems has been performed. Two approaches were used to collect data: i) technical visits to the facilities involved with border surveillance and application of a questionnaire survey; ii) application of an online questionnaire survey. It was identified that, for both surveillance systems, more than 55% of the technicians had realized that the BES and its activities have high priority. Eighty percent of North American and 71% of Brazilian border jurisdictions reported an exchange of information between countries. Less than half of the jurisdictions reported that the necessary tools to carry out information exchange were available. Operational attributes of completeness, feedback, reciprocity, and quality of information were identified as weak or of low quality in both systems. Statements, guidelines, and protocols to develop surveillance activities are available at the U.S.-Mexico border area. The continuous systematic development of surveillance systems at these borders will create more effective actions and responses. |
Serological susceptibility to varicella among U.S. Immigration and Customs Enforcement detainees
Varan AK , Lederman ER , Stous SS , Elson D , Freiman JL , Marin M , Lopez AS , Stauffer WM , Joseph RH , Waterman SH . J Correct Health Care 2017 24 (1) 1078345817727287 U.S. Immigration and Customs Enforcement (ICE) is responsible for detaining unauthorized aliens during immigration proceedings. During 2014 to 2015, adult ICE detainees at a California facility were invited to complete a survey concerning self-reported varicella history and risk factors. Participants underwent serological testing for varicella-zoster virus (VZV) IgG; susceptible individuals were offered varicella vaccination. Among 400 detainees with available serology results, 48 (12%) were susceptible to varicella. Self-reported varicella history was negatively associated with susceptibility (adjusted odds ratio = 0.16; 95% confidence interval [0.07, 0.35]). Among 196 detainees reporting a positive history, 95% had VZV IgG levels suggestive of varicella immunity. Among 44 susceptible detainees offered vaccination, 86% accepted. Given relatively high varicella susceptibility, targeted screening and vaccination among ICE detainees lacking a positive history might reduce varicella transmission risks. |
Vaccination coverage disparities between foreign-born and U.S.-born children aged 19-35 months, United States, 2010-2012
Varan AK , Rodriguez-Lainz A , Hill HA , Elam-Evans LD , Yankey D , Li Q . J Immigr Minor Health 2016 19 (4) 779-789 Healthy People 2020 targets high vaccination coverage among children. Although reductions in coverage disparities by race/ethnicity have been described, data by nativity are limited. The National Immunization Survey is a random-digit-dialed telephone survey that estimates vaccination coverage among U.S. children aged 19-35 months. We assessed coverage among 52,441 children from pooled 2010-2012 data for individual vaccines and the combined 4:3:1:3*:3:1:4 series (which includes ≥4 doses of diphtheria, tetanus, and acellular pertussis vaccine/diphtheria and tetanus toxoids vaccine/diphtheria, tetanus toxoids, and pertussis vaccine, ≥3 doses of poliovirus vaccine, ≥1 dose of measles-containing vaccine, ≥3 or ≥4 doses of Haemophilus influenzae type b vaccine (depending on product type of vaccine; denoted as 3* in the series name), ≥3 doses of hepatitis B vaccine, ≥1 dose of varicella vaccine, and ≥4 doses of pneumococcal conjugate vaccine). Coverage estimates controlling for sociodemographic factors and multivariable logistic regression modeling for 4:3:1:3*:3:1:4 series completion are presented. Significantly lower coverage among foreign-born children was detected for DTaP, hepatitis A, hepatitis B, Hib, pneumococcal conjugate, and rotavirus vaccines, and for the combined series. Series completion disparities persisted after control for demographic, access-to-care, poverty, and language effects. Substantial and potentially widening disparities in vaccination coverage exist among foreign-born children. Improved immunization strategies targeting this population and continued vaccination coverage monitoring by nativity are needed. |
Risk factors for hospitalisation and associated costs among patients with hepatitis A associated with imported pomegranate arils, United States, 2013
Epson EE , Cronquist A , Lamba K , Kimura AC , Hassan R , Selvage D , McNeil CS , Varan AK , Silvaggio JL , Fan L , Tong X , Spradling PR . Public Health 2016 136 144-51 OBJECTIVES: To assess hospitalisation risk factors and economic effects associated with a multistate hepatitis A outbreak in 2013. STUDY DESIGN: Retrospective case series. METHODS: Eligible outbreak-related cases confirmed by September 1, 2013, were defined as acute hepatitis symptoms and positive IgM anti-hepatitis A during March 15-August 12 among patients who consumed the food vehicle or had the outbreak genotype. We reviewed medical records, comparing demographic and clinical characteristics among hospitalized and non-hospitalized patients; we used logistic regression analysis to identify factors associated with hospitalization. We interviewed patients regarding symptom duration and healthcare usage and estimated per-patient and total costs. Health departments reported outbreak-related personnel hours. RESULTS: Medical records were reviewed for 147/159 (92%) eligible patients; median age was 48 (range: 1-84) years, and 64 (44%) patients were hospitalized. Having any chronic medical condition was independently associated with hospitalisation (odds ratio, 3.80; 95% confidence interval, 1.68-8.62). Interviews were completed for 114 (72%) eligible patients; estimated per-patient cost of healthcare and productivity loss was $13,467 for hospitalized and $2138 for non-hospitalized patients and $1,304,648 for all 165 outbreak-related cases. State and local public health personnel expenditures included 82 h and $3221/outbreak-related case. CONCLUSIONS: Hospitalisations in this outbreak were associated with chronic medical conditions and resulted in substantial healthcare usage and lost productivity. These data can be used to inform future evaluation of expansion of hepatitis A vaccination recommendations to include adults with chronic medical conditions. |
Economic and social impact of Pertussis among adolescents in San Diego County
Varan AK , Harriman KH , Winter K , Thun MD , McDonald EC . J Adolesc Health 2016 58 (2) 241-4 PURPOSE: During recent pertussis epidemics, adolescents have experienced a large burden of disease. We assessed the impact of pertussis among San Diego adolescents and their households. METHODS: Parents of pertussis patients aged 13-17 years were surveyed about health care utilization, missed work and school, and other factors. Costs of medical visits, medication use, and lost wages were estimated. RESULTS: The parents of 53 (of 108 [49%]) eligible 2013 pertussis patients were interviewed; 51 (96%) of these patients previously received tetanus, diphtheria, and acellular pertussis vaccine. Medical visits included primary care (81%), urgent care (11%), and emergency department (9%); all patients received antibiotics. Forty-seven households (89%) received a post-exposure prophylaxis recommendation, and five (9%) reported ≥1 unpaid parental leave day. Thirty-eight patients (72%) missed ≥1 school day (mean = 5.4 days). Societal costs were estimated at $315.15 per household and $236,047.35 in San Diego during 2013-2014. CONCLUSIONS: Even among vaccinated adolescents, pertussis can result in considerable societal costs. |
Multinational disease surveillance programs: promoting global information exchange for infectious diseases
Varan AK , Bruniera-Oliveira R , Peter CR , Fonseca-Ford M , Waterman SH . Am J Trop Med Hyg 2015 93 (3) 668-71 Cross-border surveillance for emerging diseases such as Ebola and other infectious diseases requires effective international collaboration. We surveyed representatives from 12 multinational disease surveillance programs between January 2013 and April 2014. Our survey identified programmatic similarities despite variation in health priorities, geography, and socioeconomic context, providing a contemporary perspective on infectious disease surveillance networks. |
Notes from the field: fatal rat-bite fever in a child - San Diego County, California, 2013
Adam JK , Varan AK , Pong AL , McDonald EC . MMWR Morb Mortal Wkly Rep 2014 63 (50) 1210-1 In August 2013, the County of San Diego Health and Human Services Agency was notified of a fatal case of rat-bite fever (RBF) in a previously healthy male, aged 10 years, who owned pet rats. Two days before his death, the patient experienced rigors, fevers, vomiting, headaches, and leg pains. His physician noted a fever of 102.6 degrees F (39.2 masculineC), documented a normal examination, diagnosed viral gastroenteritis, and prescribed anti-nausea medication. During the next 24 hours, the patient experienced vomiting and persistent fever. He was confused and weak before collapsing at home. Paramedics reported the patient was unresponsive and had dilated pupils; resuscitation was initiated in the field and was continued for >1 hour after arrival at the emergency department but was unsuccessful. A complete blood count performed during resuscitation revealed anemia (hemoglobin 10.0 g/dL [normal = 13.5-18.0 g/dL], thrombocytopenia (platelets 40,000/microL [normal = 140,000-440,000/microL]), leukocytosis (white blood cells 17,900 cells/microL [normal = 4,000-10,500/microL]) with 16% band neutrophils; the patient also had evidence of disseminated intravascular coagulation. No rash or skin breakdown was noted. Lung, liver, and epiglottis tissue collected postmortem was positive for Streptobacillus moniliformis DNA by polymerase chain reaction. |
Fatal influenza outbreak aboard a sport fishing vessel in San Diego, California
Adam JK , Varan AK , Kao AS , McDonald EC , Waterman SH . Travel Med Infect Dis 2014 13 (1) 102-3 In January 2014, the Centers for Disease Control and Prevention (CDC) was notified about a death aboard a sport fishing vessel on a 16-day cruise off the Baja California peninsula. The male passenger, aged 70 years, had chronic obstructive pulmonary disease, coronary artery disease, was obese, and had not received the seasonal influenza vaccine. He had chills, productive cough, and dyspnea before his death on January 22, 2014. A second passenger, unrelated to the decedent, was medically evacuated on January 24, 2014, while at an international port due to respiratory illness. Upon return of the vessel to a U.S. port on January 27, 2014, federal and local public health officials assessed symptoms, offered influenza testing (rapid test and nasal swab for reverse transcription polymerase chain reaction [RT-PCR]) for all persons onboard, and planned for interviews to assess seasonal influenza vaccination beliefs. | Among 25 passengers (including the evacuee) and nine crew, all male adults, seven passengers (28%) and two crew (22%) met criteria for influenza-like illness (ILI), defined as subjective fever plus either cough or sore throat. Subjective fever could not be confirmed for the decedent via proxy interview; hence, he was not deemed to meet ILI criteria. Among persons with ILI, the median age was 52 years (range: 43–65 years). Illness onset dates among persons with ILI ranged from 13 to 23 January, 2014. The majority (78%) with ILI had not received the 2013–2014 influenza vaccine. The ILI attack rate was 26% among all passengers and crew, 28% among the unvaccinated, and 22% among the vaccinated. Twenty-seven passengers and crew (79%) onboard agreed to influenza testing, including seven of the nine persons with ILI. Among persons with ILI, specimens were collected a median of 12 days after illness onset (range: 5–15 days). All rapid tests were negative. Two (7.4%) passengers were positive for H1N1pdm09 virus by RT-PCR; neither met criteria for ILI. The evacuated passenger was hospitalized; convalescent serum was positive for influenza A H1N1pdm09 virus by hemagglutination inhibition assay. Additionally, the decedent had a post-mortem nasopharyngeal swab positive for H1N1pdm09 virus by RT-PCR; cause of death by autopsy report was acute viral influenza and bacterial bronchopneumonia. |
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