Last data update: Sep 16, 2024. (Total: 47680 publications since 2009)
Records 1-21 (of 21 Records) |
Query Trace: Whitehouse E [original query] |
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Person-centred care for older adults living with HIV in sub-Saharan Africa
Goldstein D , Kiplagat J , Taderera C , Whitehouse ER , Chimbetete C , Kimaiyo S , Urasa S , Paddick SM , Godfrey C . Lancet HIV 2024 More than a fifth of people living with HIV in the US President's Emergency Plan for AIDS Relief-supported programmes are older individuals, defined as aged 50 years and older, yet optimal person-centred models of care for older adults with HIV in sub-Saharan Africa, including screening and treatment for geriatric syndromes and common comorbidities associated with ageing, remain undefined. This Position Paper explores the disproportionate burden of comorbidities and geriatric syndromes faced by older adults with HIV, with a special focus on women. We seek to motivate global interest in improving quality of life for older people with HIV by presenting available research and identifying research gaps for common geriatric syndromes, including frailty and cognitive decline, and multimorbidity among older people with HIV in sub-Saharan Africa. We share two successful models of holistic care for older people with HIV that are ongoing in Zimbabwe and Kenya. Lastly, we provide policy, research, and implementation considerations to best serve this growing population. |
Surveillance for acute flaccid myelitis - United States, 2018-2022
Whitehouse ER , Lopez A , English R , Getachew H , Ng TFF , Emery B , Rogers S , Kidd S . MMWR Morb Mortal Wkly Rep 2024 73 (4) 70-76 Acute flaccid myelitis (AFM) is a serious neurologic condition primarily affecting children; AFM can cause acute respiratory failure and permanent paralysis. AFM is a rare but known complication of various viral infections, particularly those of enteroviruses (EVs). Increases in AFM cases during 2014, 2016, and 2018 were associated with EV-D68 infection. This report examines trends in confirmed AFM cases during 2018-2022 and patients' clinical and laboratory characteristics. The number of AFM cases was low during 2019-2022 (28-47 cases per year); the number of cases remained low in 2022 despite evidence of increased EV-D68 circulation in the United States. Compared with cases during the most recent peak year (2018), fewer cases during 2019-2021 had upper limb involvement, prodromal respiratory or febrile illness, or cerebrospinal fluid pleocytosis, and more were associated with lower limb involvement. It is unclear why EV-D68 circulation in 2022 was not associated with an increase in AFM cases or when the next increase in AFM cases will occur. Nonetheless, clinicians should continue to suspect AFM in any child with acute flaccid limb weakness, especially those with a recent respiratory or febrile illness. |
The impact of injury control research centers: Advancing the field of injury and violence prevention
Baker W , Skillman M , Rocha L , Bayne A , Whitehouse S , Murphy E , Papanikolaou M , Caples M , Choudhary E . J Saf Res 2023 Introduction: The Centers for Disease Control and Prevention's (CDC) National Center for Injury Prevention and Control (NCIPC) funds Injury Control Research Centers (ICRCs). These centers study injury and violence prevention through three core areas: (1) Research conducts cutting-edge, multidisciplinary research in the injury and violence prevention field; (2) Outreach translates injury and violence prevention research into action; and (3) Training educates and trains the next generation of injury and violence prevention professionals. We examined ICRC work from 2012 to 2019 to determine whether they fulfilled their goal of furthering injury and violence prevention research and practice. Methods: We created a database of core area accomplishments reported through annual and interim progress reports. These reports track core area accomplishments by injury and violence prevention topic area, publications, partnerships, and trainings. Results: From 2012 to 2019, ten ICRCs from two funding cycles received approximately $49 million. ICRCs reported 703 research, 1,432 outreach, and 660 training accomplishments. There were also 342 accomplishments contributing to a special tool or resource. These accomplishments focused on preventing traumatic brain injury, suicide, adverse childhood experiences, and transportation safety. ICRCs produced over 3,500 peer-reviewed publications. ICRCs reported over 3,600 accomplishments partnered with academic institutions, public health agencies, healthcare, and non-profit organizations. ICRCs created resources for audiences such as students, law enforcement, and policy makers. ICRCs trained 3,131 students and faculty. Practical Applications: ICRCs are the hubs of modern research and practice in the injury and violence prevention field. They successfully bring together stakeholders from disparate disciplines, perspectives, and agencies to join forces and tackle critical public health problems. Conclusion: ICRCs are an integral component of NCIPC's, CDC's and the Department of Health and Human Service's missions to protect and enhance the health of Americans. Research covered NCIPC research priorities over the funding period, furthering injury and violence prevention research and working as a foundation to practice and policy. Outreach and partnerships with an array of organizations put research into action. Trainings educated the new generation of injury and violence prevention professionals. © 2023 National Safety Council and Elsevier Ltd |
Reaching the First 90: Improving Inpatient Pediatric Provider-Initiated HIV Testing and Counseling Using a Quality Improvement Collaborative Strategy in Tanzania
Dougherty G , Panya M , Madevu-Matson C , Anyalechi GE , Clarke K , Fayorsey R , Kamonga M , Kimambo S , Lutkam D , Mugisha V , Mtiro H , Msuke S , Ramadhani A , Sipemba J , Urasa P , Rabkin M . J Assoc Nurses AIDS Care 2019 30 (6) 682-690 Although the United Republic of Tanzania has made remarkable progress in scaling up HIV services, substantial gaps in pediatric coverage remain (Joint United Nations Programme on HIV/AIDS, 2013). Tanzania is among the countries with the world's lowest pediatric antiretroviral therapy coverage (Joint United Nations Programme on HIV/AIDS, 2013), and the Ministry of Health (MOH), Community, Development, Gender, Elderly and Children has prioritized expanding access to HIV testing, care, and treatment for children (United Republic of Tanzania Ministry of Health and Social Welfare, 2012). | | Improving the identification of children living with HIV is a critical first step to expanding treatment coverage. In countries with generalized HIV epidemics, ill children presenting to health facilities have a higher HIV prevalence than the general pediatric population (Cohn, Whitehouse, Tuttle, Lueck, & Tran, 2016; Kankasa et al., 2009; Preidis, 2013; Wagner et al., 2015). Offering routine opt-out HIV testing to at-risk pediatric subpopulations (those presenting to health care with signs of illness or for admission, malnutrition, or tuberculosis treatment) is a high-yield identification strategy (Mutanga et al., 2012). Because these children and their caregivers are actively seeking health services and are easy to reach, they present a unique opportunity to identify those most in need of HIV care and to initiate treatment rapidly. |
Human rabies despite post-exposure prophylaxis: a systematic review of fatal breakthrough infections after zoonotic exposures
Whitehouse ER , Mandra A , Bonwitt J , Beasley EA , Taliano J , Rao AK . Lancet Infect Dis 2022 23 (5) e167-e174 Post-exposure prophylaxis (PEP) for rabies is widely administered and highly effective. Nevertheless, sporadic breakthrough infections (ie, rabies in people who have started PEP) have been reported. We conducted a systematic review of articles published between Jan 1, 1980 and June 1, 2022 to characterise breakthrough infections. After reviewing 3380 articles from across all continents, we identified 52 articles, which included a total of 122 breakthrough infections. We classified breakthrough infections on the basis of adherence to core practices (ie, wound cleaning and vaccine administration). Of 86 breakthrough infections with data, median time from exposure to symptom onset was 20 days (IQR 16-24). Most (89 [77%] of 115) participants received PEP within 2 days of an exposure. Severe wounds (defined as those involving multiple wound sites or bites to the head, face, or neck) were common (80 [69%] of 116 [with data]). Deviations from core practices were reported in 68 (56%) of 122 cases. Other possible causes for breakthrough infections included errors in the administration of rabies immunoglobulin, delays in seeking health care, and comorbidities or immunosuppression. Cold-chain integrity assessments and potency testing of PEP biologics were only rarely assessed (8 [7%] of 122 cases), neither of which were found to be a cause of breakthrough infections. Timely and appropriate administration of PEP is crucial to prevent rabies, and although people with high-risk exposures or immunosuppression can develop rabies despite adherence to core practices, this occurrence remains exceedingly rare. |
Evaluating Surveillance for and Estimating Administration of Rabies Postexposure Prophylaxis in the United States, 2012-2018
Whitehouse ER , Person MK , Brown CM , Slavinski S , Rao AK , Blanton JD . PLoS Negl Trop Dis 2021 15 (10) e0009878 BACKGROUND: An evaluation of postexposure prophylaxis (PEP) surveillance has not been conducted in over 10 years in the United States. An accurate assessment would be important to understand current rabies trends and inform public health preparedness and response to human rabies. METHODOLOGY/PRINCIPLE FINDINGS: To understand PEP surveillance, we sent a survey to public health leads for rabies in 50 U.S. states, Puerto Rico, Washington DC, Philadelphia, and New York City. Of leads from 54 jurisdictions, 39 (72%) responded to the survey; 12 reported having PEP-specific surveillance, five had animal bite surveillance that included data about PEP, four had animal bite surveillance without data about PEP, and 18 (46%) had neither. Although 12 jurisdictions provided data about PEP use, poor data quality and lack of national representativeness prevented use of this data to derive a national-level PEP estimate. We used national-level and state specific data from the Healthcare Cost & Utilization Project (HCUP) to estimate the number of people who received PEP based on emergency department (ED) visits. The estimated annual average of initial ED visits for PEP administration during 2012-2017 in the United States was 46,814 (SE: 1,697), costing upwards of 165 million USD. State-level ED data for initial visits for administration of PEP for rabies exposure using HCUP data was compared to state-level surveillance data from Maryland, Vermont, and Georgia between 2012-2017. In all states, state-level surveillance data was consistently lower than estimates of initial ED visits, suggesting even states with robust PEP surveillance may not adequately capture individuals who receive PEP. CONCLUSIONS: Our findings suggest that making PEP a nationally reportable condition may not be feasible. Other methods of tracking administration of PEP such as syndromic surveillance or identification of sentinel states should be considered to obtain an accurate assessment. |
Investigation of a Suspect SARS-CoV-2 and Influenza A Mixed Outbreak: Lessons Learned for Long-Term Care Facilities Nationwide.
Schrodt CA , Malenfant JH , Hunter JC , Slifka KJ , Campbell A , Stone N , Whitehouse ER , Wittry B , Christensen B , Barnes JR , Brammer L , Hemarajata P , Green NM , Civen R , Gounder PP , Rao AK . Clin Infect Dis 2021 73 S77-S80 A suspected outbreak of influenza A and SARS-CoV-2 at a long-term care facility in Los Angeles County was months later, determined to not involve influenza. To prevent inadvertent transmission of infections, facilities should use highly specific influenza diagnostics and follow CDC guidelines that specifically address infection control challenges. |
Clinical and epidemiologic findings from enhanced monkeypox surveillance in Tshuapa Province, Democratic Republic of the Congo during 2011-2015
Whitehouse ER , Bonwitt J , Hughes CM , Lushima RS , Likafi T , Nguete B , Kabamba J , Monroe B , Doty JB , Nakazawa Y , Damon I , Malekani J , Davidson W , Wilkins K , Li Y , Radford KW , Schmid DS , Pukuta E , Muyamuna E , Karhemere S , Tamfum JM , Okitolonda EW , McCollum AM , Reynolds MG . J Infect Dis 2021 223 (11) 1870-1878 BACKGROUND: Monkeypox is a poorly described emerging zoonosis endemic to Central and Western Africa. METHODS: Using surveillance data from Tshuapa Province, Democratic Republic of the Congo during 2011-2015, we evaluated differences in incidence, exposures, and clinical presentation of PCR-confirmed cases by sex and age. RESULTS: We report 1,057 confirmed cases. Average annual incidence was 14·1 per 100,000 (95% CI: 13·3-15·0). Incidence was higher in males (incidence rate ratio [IRR] males: females: 1·21, 95% CI 1·07-1·37), except among 20-29-year-old (IRR: 0·70, 95% CI: 0·51-0·95). Females aged 20-29 years also reported a high frequency of exposures (26·2%) to people with monkeypox-like symptoms. Highest incidence was among 10-19-year-old males, the cohort reporting the highest proportion of animal exposures (37·5%). Incidence was lower among those presumed to have received smallpox vaccination versus those presumed unvaccinated. No differences were observed by age group in lesion count or lesion severity score. CONCLUSIONS: Monkeypox incidence was twice that reported during 1980-1985, an increase possibly linked to declining immunity provided by smallpox vaccination. The high proportion of cases attributed to human exposures suggests changing exposure patterns. Cases were distributed across age and sex, suggesting frequent exposures that follow socio-cultural norms. |
Large outbreak of Guillain-Barr syndrome, Peru, 2019
Munayco CV , Gavilan RG , Ramirez G , Loayza M , Miraval ML , Whitehouse E , Gharpure R , Soares J , Soplopuco HV , Sejvar J . Emerg Infect Dis 2020 26 (11) 2778-2780 Outbreaks of Guillain-Barré syndrome (GBS) are uncommon. In May 2019, national surveillance in Peru detected an increase in GBS cases in excess of the expected incidence of 1.2 cases/100,000 population. Several clinical and epidemiologic findings call into question the suggested association between this GBS outbreak and Campylobacter. |
Exportation of Monkeypox virus from the African continent.
Mauldin MR , McCollum AM , Nakazawa YJ , Mandra A , Whitehouse ER , Davidson W , Zhao H , Gao J , Li Y , Doty J , Yinka-Ogunleye A , Akinpelu A , Aruna O , Naidoo D , Lewandowski K , Afrough B , Graham V , Aarons E , Hewson R , Vipond R , Dunning J , Chand M , Brown C , Cohen-Gihon I , Erez N , Shifman O , Israeli O , Sharon M , Schwartz E , Beth-Din A , Zvi A , Mak TM , Ng YK , Cui L , Lin RTP , Olson VA , Brooks T , Paran N , Ihekweazu C , Reynolds MG . J Infect Dis 2020 225 (8) 1367-1376 BACKGROUND: The largest West African monkeypox outbreak began September 2017, in Nigeria. Four individuals traveling from Nigeria to the UK (2), Israel, and Singapore became the first human monkeypox cases exported from Africa, and a related nosocomial transmission event in the UK became the first confirmed human-to-human monkeypox transmission event outside of Africa. METHODS: Epidemiological and molecular data for exported and Nigerian cases were analyzed jointly to better understand the exportations in the temporal and geographic context of the outbreak. RESULTS: Isolates from all travelers and a Bayelsa case shared a most recent common ancestor and traveled to Bayelsa, Delta, or Rivers states. Genetic variation for this cluster was lower than would be expected from a random sampling of genomes from this outbreak, but data did not support direct links between travelers. CONCLUSIONS: Monophyly of exportation cases and the Bayelsa sample, along with the intermediate levels of genetic variation suggest a small pool of related isolates is the likely source for the exported infections. This may be the result of the level of genetic variation present in monkeypox isolates circulating within the contiguous region of Bayelsa, Delta, and Rivers states, or another more restricted, yet unidentified source pool. |
Evaluation of online risk assessment to identify rabies exposures among health care workers - Utah, 2019
Whitehouse ER , Peterson D , McCaffrey K , Eichenbaum A , Gruninger R , Dascomb KK , Frame C , Wallace R , Bonwitt J . MMWR Morb Mortal Wkly Rep 2020 69 (29) 956-959 On November 7, 2018, the Utah Department of Health (UDOH) reported the first confirmed human rabies death in the state since 1944 (1). The case occurred in a person who had been treated over a period of 19 days at four health care facilities and an emergency medical transport service across three counties and two states. Human rabies is preventable through preexposure or postexposure vaccination but is invariably fatal upon symptom onset. Timely identification of persons who might have been exposed to rabies virus is therefore crucial to administer postexposure prophylaxis (PEP). Because of the large number of health care workers who had been involved in the patient's care, a standardized online risk assessment survey was developed by UDOH based on Advisory Committee on Immunization Practices recommendations (2). This online tool was evaluated for accuracy, acceptability, and administrative obligation by reviewing the results from the tool and conducting focus group discussions and a follow-up survey. Among 90 health care workers initially identified by the online risk assessment as being potentially exposed to infectious material, 74 were classified as exposed. All 74 health care workers received PEP following consultation with occupational health staff members, indicating a positive predictive value of the assessment tool of 82%. In a follow-up survey, 42 (76%) of the 55 respondents reported that they were satisfied with the assessment process. In focus group discussions, participants suggested that the survey could be improved by providing additional information about rabies exposures because many of them were unfamiliar with human-to-human rabies transmission. This evaluation highlighted the importance of adopting clear communication strategies, demonstrated the benefits of using an online risk assessment during a mass rabies exposure, and provided specific feedback for CDC to improve resources available for states and health care facilities after mass rabies exposures. |
Human rabies - Utah, 2018
Peterson D , Barbeau B , McCaffrey K , Gruninger R , Eason J , Burnett C , Dunn A , Dimond M , Harbour J , Rossi A , Lopansri B , Dascomb K , Scribellito T , Moosman T , Saw L , Jones C , Belenky M , Marsden L , Niezgoda M , Gigante CM , Condori RE , Ellison JA , Orciari LA , Yager P , Bonwitt J , Whitehouse ER , Wallace RM . MMWR Morb Mortal Wkly Rep 2020 69 (5) 121-124 On November 3, 2018, the Utah Department of Health (UDOH) was notified of a suspected human rabies case in a man aged 55 years. The patient's symptoms had begun 18 days earlier, and he was hospitalized for 15 days before rabies was suspected. As his symptoms worsened, he received supportive care, but he died on November 4. On November 7, a diagnosis of rabies was confirmed by CDC. This was the first documented rabies death in a Utah resident since 1944. This report summarizes the patient's clinical course and the subsequent public health investigation, which determined that the patient had handled several bats in the weeks preceding symptom onset. Public health agencies, in partnership with affected health care facilities, identified and assessed the risk to potentially exposed persons, facilitated receipt of postexposure prophylaxis (PEP), and provided education to health care providers and the community about the risk for rabies associated with bats. Human rabies is rare and almost always fatal. The findings from this investigation highlight the importance of early recognition of rabies, improved public awareness of rabies in bats, and the use of innovative tools after mass rabies exposure events to ensure rapid and recommended risk assessment and provision of PEP. |
Effectiveness and safety of extending intrauterine device duration: A systematic review
Ti AJ , Roe AH , Whitehouse KC , Smith RA , Gaffield ME , Curtis KM . Am J Obstet Gynecol 2020 223 (1) 24-35 e3 OBJECTIVE: To systematically review the literature to determine if extended use of intrauterine devices including the copper or levonorgestrel intrauterine device beyond approved durations is effective and safe for preventing pregnancy. DATA SOURCES: We searched PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and Global Index Medicus from inception through June 2019. STUDY ELIGIBILITY CRITERIA: We considered primary studies of women using the T380A Copper or currently available levonorgestrel intrauterine devices past their approved duration (extended use). The primary outcome was pregnancy. Safety outcomes included adverse events and side effects that led to discontinuation. STUDY APPRAISAL AND SYNTHESIS METHODS: We abstracted study data into evidence tables and assessed study quality as related to the risk of bias, precision, and external validity. For each intrauterine device type, we calculated a pooled pregnancy rate during the first two years of extended use using the Poisson inverse variance method. RESULTS: Of 4,068 studies identified by our search, four good to poor quality studies of the 52 mg levonorgestrel intrauterine device (approved for five years) with a total of 2098 women starting extended use, and two good to fair quality studies of the T380A copper intrauterine device (approved for 10 years) with 245 women starting extended use met inclusion criteria. For the levonorgestrel intrauterine device, the pooled pregnancy rate was 0.02 per 100 person-years (95% confidence interval 0.00-0.45) in year six, 0.03 per 100 person-years (95% confidence interval 0.00-0.71) in year 7, and 0.02 per 100 person-years (95% confidence interval 0.00-0.29) in years six and seven combined. During this same time, annual rates of adverse events or discontinuation due to side effects ranged from 0-3.7 per 100 participants. For the copper intrauterine device, the pooled pregnancy rate for years 11 and 12 was 0.0 per 100 person-years (95% confidence interval 0.0-0.8), and annual rates of adverse events and discontinuation due to side effects during extended use ranged from 0-4.6 per 100 participants. CONCLUSION: The available evidence suggests that rates of pregnancy, adverse events, and discontinuation due to side effects during the first two years of extended use of the 52 mg levonorgestrel intrauterine device and the T380A copper intrauterine device are low and comparable to rates during approved duration of use. Data were limited in quantity and quality, and may not be generalizable to all intrauterine device users. |
Novel treatment of a vaccinia virus infection from an occupational needlestick - San Diego, California, 2019
Whitehouse ER , Rao AK , Yu YC , Yu PA , Griffin M , Gorman S , Angel KA , McDonald EC , Manlutac AL , de Perio MA , McCollum AM , Davidson W , Wilkins K , Ortega E , Satheshkumar PS , Townsend MB , Isakari M , Petersen BW . MMWR Morb Mortal Wkly Rep 2019 68 (42) 943-946 Vaccinia virus (VACV) is an orthopoxvirus used in smallpox vaccines, as a vector for novel cancer treatments, and for experimental vaccine research (1). The Advisory Committee on Immunization Practices (ACIP) recommends smallpox vaccination for laboratory workers who handle replication-competent VACV (1). For bioterrorism preparedness, the U.S. government stockpiles tecovirimat, the first Food and Drug Administration-approved antiviral for treatment of smallpox (caused by variola virus and globally eradicated in 1980*(,dagger)) (2). Tecovirimat has activity against other orthopoxviruses and can be administered under a CDC investigational new drug protocol. CDC was notified about an unvaccinated laboratory worker with a needlestick exposure to VACV, who developed a lesion on her left index finger. CDC and partners performed laboratory confirmation, contacted the study sponsor to identify the VACV strain, and provided oversight for the first case of laboratory-acquired VACV treated with tecovirimat plus intravenous vaccinia immunoglobulin (VIGIV). This investigation highlights 1) the misconception among laboratory workers about the virulence of VACV strains; 2) the importance of providing laboratorians with pathogen information and postexposure procedures; and 3) that although tecovirimat can be used to treat VACV infections, its therapeutic benefit remains unclear. |
Vital Signs: Trends in Human rabies deaths and exposures - United States, 1938-2018
Pieracci EG , Pearson CM , Wallace RM , Blanton JD , Whitehouse ER , Ma X , Stauffer K , Chipman RB , Olson V . MMWR Morb Mortal Wkly Rep 2019 68 (23) 524-528 INTRODUCTION: Each year, rabies causes approximately 59,000 deaths worldwide, including approximately two deaths in the United States. Before 1960, dogs were a common reservoir of rabies in the United States; however, increasingly, species of wildlife (e.g., bats, raccoons) are the main reservoirs. This report characterizes human rabies deaths, summarizes trends in rabies mortality, and highlights current rabies risks in the United States. METHODS: Rabies trends in the United States during 1938-2018 were analyzed using national rabies surveillance data. Data from the Healthcare Cost and Utilization Project for 2006-2014 were used to estimate the number of postexposure prophylaxis (PEP) visits per 100,000 persons during 2017-2018. The Centers for Medicare & Medicaid Services' average sales price data were used to estimate PEP costs. RESULTS: From 1960 to 2018, a total of 125 human rabies cases were reported in the United States; 36 (28%) were attributed to dog bites during international travel. Among the 89 infections acquired in the United States, 62 (70%) were attributed to bats. In 2018, approximately 55,000 persons sought PEP after contact with a potentially rabid animal. CONCLUSIONS AND COMMENTS: In the United States, wildlife rabies, especially in bats, continues to pose a risk to humans. Travelers also might be exposed to canine rabies in countries where the disease is still present; increased awareness of rabies while traveling abroad is needed. Vaccinating pets, avoiding contact with wildlife, and seeking medical care if one is bitten or scratched by an animal are the most effective ways to prevent rabies. Understanding the need for timely administration of PEP to prevent death is critical. |
Evaluation of a nurse practitioner-physician task-sharing model for multidrug-resistant tuberculosis in South Africa
Farley JE , Ndjeka N , Kelly AM , Whitehouse E , Lachman S , Budhathoki C , Lowensen K , Bergren E , Mabuza H , Mlandu N , van der Walt M . PLoS One 2017 12 (8) e0182780 BACKGROUND: Treatment success rates for multidrug-resistant tuberculosis (MDR-TB) in South Africa remain close to 50%. Lack of access to timely, decentralized care is a contributing factor. We evaluated MDR-TB treatment outcomes from a clinical cohort with task-sharing between a clinical nurse practitioner (CNP) and a medical officer (MO). METHODS: We completed a retrospective evaluation of outcomes from a prospective, programmatically-based MDR-TB cohort who were enrolled and received care between 2012 and 2015 at a peri-urban hospital in KwaZulu-Natal, South Africa. Treatment was provided by either by a CNP or MO. FINDINGS: The cohort included 197 participants with a median age of 33 years, 51% female, and 74% co-infected with HIV. The CNP initiated 123 participants on treatment. Overall MDR-TB treatment success rate in this cohort was 57.9%, significantly higher than the South African national average of 45% in 2012 (p<0.0001) and similar to the provincal average of 60% (p = NS). There were no significant differences by provider type: treatment success was 61% for patients initiated by the CNP and 52.7% for those initiated by the MO. INTERPRETATION: Clinics that adopted a task sharing approach for MDR-TB demonstrated greater treatment success rates than the national average. Task-sharing between the CNP and MO did not adversely impact treatment outcome with similar success rates noted. Task-sharing is a feasible option for South Africa to support decentralization without compromising patient outcomes. Models that allow sharing of responsibility for MDR-TB may optimize the use of human resources and improve access to care. |
Development, updates, and future directions of the World Health Organization selected practice recommendations for contraceptive Use
Chen MJ , Kim CR , Whitehouse KC , Berry-Bibee E , Gaffield ME . Int J Gynaecol Obstet 2017 136 (2) 113-119 Correct and consistent use of contraception decreases the risk of unintended pregnancy; yet, outdated policies or practices can delay initiation or hinder continuation of contraceptive methods. To promote the quality of, and access to, family planning services, WHO created a series of evidence-based guidance documents for family planning, known as WHO’s Four Cornerstones of Family Planning Guidance (Fig. 1). The Medical eligibility criteria for contraceptive use (MEC), first published in 1996,1 provides guidance on the safety of various contraceptive methods in users with specific health conditions or characteristics (i.e. who can use a contraceptive method safely). The Selected practice recommendations for contraceptive use (SPR) is the second cornerstone,2 outlining how to safely and effectively use contraceptive methods. These two documents can serve as a reference for policymakers and program managers as they develop their own national family planning policies in the context of local needs, values, and resources. The two other cornerstone documents—the Decision making tool for family planning clients and providers3 and Family planning: a global handbook for providers4—provide guidance to healthcare providers for applying these recommendations in practice. |
Use of surveillance data to assess the impact of vaccination on circulating rotavirus strains
Leshem E , Parashar U . J Pediatric Infect Dis Soc 2015 4 (4) e90-2 Circulating rotavirus strains in a given location show natural secular variation with sometimes dramatic and rapid changes over successive rotavirus seasons [ 1 , 2 ]. This temporal variation makes it particularly challenging to determine whether any observed change in prevalent strains after implementation of rotavirus vaccination merely represents naturally occurring strain variation or instead the more concerning phenomenon of selection of strains against which vaccine effectiveness is lower (ie, selective pressure) [ 3 ]. In the current issue of the Journal of Pediatric Infectious Disease Society , Wylie et al [ 4 ] report the emergence during the 2012–2013 season of G12, a previously unusual rotavirus strain in the St. Louis area. The authors raise the question of whether this G12 emergence is related to the use of rotavirus vaccine implemented in 2006 in this population? | To address this question, it is important to first consider the evidence from prelicensure trials on strain-specific protection with rotavirus vaccines. The 2 rotavirus vaccines recommended by the Advisory Committee on Immunization Practices for use in US children differ in their composition: RotaTeq (RV5; RotaTeq, Merck and Co., Whitehouse Station, NJ) is a pentavalent (G1, G2, G3, G4, P[ 8 ]) human-bovine reassortant vaccine, whereas Rotarix (RV1; Rotarix, GSK Biologicals, Rixensart, Belgium) is a monovalent (G1P[ 8 ]) vaccine derived from a single attenuated human rotavirus strain [ 5 ]. In clinical trials, both vaccines protected against disease caused by a range of rotavirus strains that were homotypic (with both the G- and P-types included in vaccine), fully heterotypic (neither G- nor P-type included in vaccine), or partially heterotypic (only 1 of the G- or P-type included in vaccine). Although the point estimate of efficacy of RV1 was lower against fully heterotypic G2P[ 4 ] strains (41%; 95% confidence interval [CI], 79%–82%) compared with other strains (efficacy range, 87%–92%) in the pivotal prelicensure trial in Latin America, the number of G2P[ 4 ] cases was small, and thus firm conclusions could not be drawn [ 6 ]. Reassuringly, a later RV1 efficacy trial in Europe conducted during a period when G2P[ 4 ] strains were more prevalent showed good efficacy (85%; 95% CI, 24%–98%) against disease cause by this strain [ 7 ]. A subsequent trial of RV1 in Africa also reaffirmed that the vaccine provided good protection against a range of strains (G8, G9, G12) that are not included in the vaccine [ 8 ]. In addition, a recently published clinical trial of the Indian-made monovalent human-bovine (116E) rotavirus vaccine based on an unusual G9P[ 11 ] neonatal rotavirus strain showed good protection against a range of heterotypic strains [ 9 ]. The RV5 was also shown to be effective against heterotypic strains in clinical trials conducted in various settings [ 10 , 11 ]. Collectively, these data from various vaccine trials underscore the broad cross-protection seen with rotavirus vaccines and suggest that immunity to rotavirus is likely polygenic. |
Healthcare-Associated Transmission of Plasmodium falciparum in New York City.
Lee EH , Adams EH , Madison-Antenucci S , Lee L , Barnwell JW , Whitehouse J , Clement E , Bajwa W , Jones LE , Lutterloh E , Weiss D , Ackelsberg J . Infect Control Hosp Epidemiol 2015 37 (1) 1-3 A patient with no risk factors for malaria was hospitalized in New York City with Plasmodium falciparum infection. After investigating all potential sources of infection, we concluded the patient had been exposed to malaria while hospitalized less than 3 weeks earlier. Molecular genotyping implicated patient-to-patient transmission in a hospital setting. |
G2P[4]-RotaTeq Reassortant Rotavirus in Vaccinated Child, United States.
Roy S , Rungsrisuriyachai K , Esona MD , Boom JA , Sahni LC , Rench MA , Baker CJ , Wikswo ME , Payne DC , Parashar UD , Bowen MD . Emerg Infect Dis 2015 21 (11) 2103-4 Group A rotaviruses (RVAs) are a leading cause of acute gastroenteritis-associated deaths among children <5 years of age in developing countries (1). The genome of RVA consists of 11 double-stranded RNA segments that code for 11 or 12 viral proteins (VP1–VP4, VP6, VP7, nonstructural protein 1 [NSP1]–NSP5/6) (2). In 2008, the Rotavirus Classification Working Group established a system of extended classification that was based on the sequences of all 11 gene segments and used the notations Gx-P[x]-Ix-Rx-Cx-Mx-Ax-Nx-Tx-Ex-Hx for the genes VP7, VP4, VP6, VP1–VP3, NSP1–NSP5, respectively (3). Similar to other RNA viruses, RVAs show high genomic diversity, which is generated primarily through point mutations, reassortment, rearrangement, and recombination events. | In 2006 and 2008, two live-attenuated vaccines, RotaTeq (Merck, Whitehouse Station, NJ, USA) and Rotarix (GlaxoSmithKline, Rixensart, Belgium), respectively, were introduced in the United States (4). RotaTeq is a pentavalent human bovine reassortant vaccine that contains 4 G types (G1, G2, G3, and G4; VP7 gene) plus the P[8] VP4 type on a bovine WC3 (G6P[5]) backbone (5). In 2012, Bucardo et al. reported finding a vaccine-derived nonstructural protein 2 (NSP2) gene in 2 wild-type RVA strains with a G1P[8] genogroup 1 backbone (6). Each of these strains had been found during routine surveillance in Nicaragua, where RotaTeq was introduced in 2006, suggesting reassortment of the vaccine strain with circulating wild-type strains. The authors also examined alignments of the NSP2 gene and found no differences at functional domains between the vaccine-derived NSP2 and the circulating wild-type NSP2 (6). This finding could explain why a vaccine-derived NSP2 reassortant was viable. |
Sibling transmission of vaccine-derived rotavirus (RotaTeq) associated with rotavirus gastroenteritis
Payne DC , Edwards KM , Bowen MD , Keckley E , Peters J , Esona MD , Teel EN , Kent D , Parashar UD , Gentsch JR . Pediatrics 2010 125 (2) e438-41 Although rotavirus vaccines are known to be shed in stools, transmission of vaccine-derived virus to unvaccinated contacts resulting in symptomatic rotavirus gastroenteritis has not been reported to our knowledge. We document here the occurrence of vaccine-derived rotavirus (RotaTeq [Merck and Co, Whitehouse Station, NJ]) transmission from a vaccinated infant to an older, unvaccinated sibling, resulting in symptomatic rotavirus gastroenteritis that required emergency department care. Results of our investigation suggest that reassortment between vaccine component strains of genotypes P7[5]G1 and P1A[8]G6 occurred during replication either in the vaccinated infant or in the older sibling, raising the possibility that this reassortment may have increased the virulence of the vaccine-derived virus. Both children remain healthy 11 months after this event and are without underlying medical conditions. |
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