Volume 10, Issue 18, May 22, 2018

CDC Science Clips: Volume 10, Issue 18, May 22, 2018

Science Clips is produced weekly to enhance awareness of emerging scientific knowledge for the public health community. Each article features an Altmetric Attention scoreExternal to track social and mainstream media mentions!

  1. Top Articles of the Week

    Selected weekly by a senior CDC scientist from the standard sections listed below.

    The names of CDC authors are indicated in bold text.
    • Chronic Diseases and Conditions
      • Association between pediatric asthma care quality and morbidity and English language proficiency in OhioExternal
        Montgomery MP, Allen ED, Thomas O, Robinson BF, Clark D, Connelly A, Mott JA, Conrey E.
        J Asthma. 2018 May 8:1-24.

        OBJECTIVE: Limited English proficiency can be a barrier to asthma care and is associated with poor outcomes. This study examines whether pediatric patients in Ohio with limited English proficiency experience lower asthma care quality or higher morbidity. METHODS: We used electronic health records for asthma patients aged 2-17 years from a regional, urban, children’s hospital in Ohio during 2011-2015. Community-level demographics were included from U.S. Census data. By using chi-square and t-tests, patients with limited English proficiency and bilingual English-speaking patients were compared with English-only patients. Five asthma outcomes-two quality and three morbidity measures-were modeled using generalized estimating equations with a logit link function. RESULTS: The study included 15 352 (84%) English-only patients, 1744 (10%) patients with limited English proficiency, and 1147 (6%) bilingual patients. Recommended pulmonary function testing (quality measure) and multiple exacerbation visits (morbidity measure) did not differ by language group. Compared with English-only patients, bilingual patients had higher odds of ever having an exacerbation visit (morbidity measure) (adjusted odds ratio [aOR], 1.4; 95% confidence interval [CI], 1.2-1.6) but lower odds of admission to intensive care (morbidity measure) (aOR, 0.3; 95% CI, 0.2-0.7), while patients with limited English proficiency did not differ on either factor. Recommended follow-up after exacerbation (quality measure) was higher for limited English proficiency (aOR, 1.8; 95% CI, 1.4-2.3) and bilingual patients (aOR, 1.6; 95% CI, 1.3-2.1), compared with English-only patients. CONCLUSIONS: In this urban, pediatric population with reliable interpreter services, limited English proficiency was not associated with worse asthma care quality or morbidity.

    • Communicable Diseases
    • Disease Reservoirs and Vectors
      • Environmental panels as a proxy for nursing facility patients with methicillin-resistant Staphylococcus aure and vancomycin-resistant Enterococcus colonizationExternal
        Cassone M, Mantey J, Perri MB, Gibson K, Lansing B, McNamara S, Patel PK, Cheng VC, Walters MS, Stone ND, Zervos MJ, Mody L.
        Clin Infect Dis. 2018 May 2.

        Background: Most nursing facilities (NFs) lack methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) surveillance programs due to limited resources and high costs. We investigated the utility of environmental screening of high-touch surfaces in patient rooms as a way to circumvent these challenges. Methods: We compared MRSA and VRE culture data from high-touch surfaces in patients’ rooms (14450 samples from 6 NFs) and ranked each site’s performance in predicting patient colonization (7413 samples). The best-performing sites were included in a MRSA- and a VRE-specific panel that functioned as a proxy for patient colonization. Molecular typing was performed to confirm available concordant patient-environment pairs. Results: We identified and validated a MRSA panel that consisted of the bed controls, nurse call button, bed rail, and TV remote control. The VRE panel included the toilet seat, bed controls, bed rail, TV remote control, and top of the side table. Panel colonization data tracked patient colonization. Negative predictive values were 89%-92% for MRSA and 82%-84% for VRE. Molecular typing confirmed a strong clonal type relationship in available concordant patient-environment pairs (98% for MRSA, 91% for VRE), pointing to common epidemiological patterns for environmental and patient isolates. Conclusions: Environmental panels used as a proxy for patient colonization and incorporated into facility surveillance protocols can guide decolonization strategies, improve awareness of MRSA and VRE burden, and inform efforts to reduce transmission. Targeted environmental screening may be a viable surveillance strategy for MRSA and VRE detection in NFs.

    • Environmental Health
      • Environmental health program performance and its relationship with environment-related disease in FloridaExternal
        Gerding JA, DeLellis NO, Neri AJ, Dignam TA.
        Fla Public Health Rev. 2018 ;15:1-12.

        This study used a unique approach to examine Florida county health department environmental health (EH) program performance of the 10 Essential Environmental Public Health Services (EEPHS) and its relationship with environment-related disease, described by enteric disease rates. Correlation analysis tested the association between performance of each EEPHS and five different enteric disease rates, while multivariate regression analysis further examined the relationships while considering program organizational characteristics as potential confounders. Correlation analyses revealed cryptosporidiosis was associated with EEPHS 2 diagnose (Tb = .195, p = .027) and EEPHS 8 workforce (Tb = .234, p = .006), and salmonellosis with EEPHS 4 mobilize (Tb = .179, p = .042) and EEPHS 6 enforce (Tb = .201, p = .020). Multivariate regression results showed EEPHS 2 diagnose (p = .04) and EEPHS 4 mobilize (p = .00) had statistically significant associations with cryptosporidiosis and salmonellosis, respectively, and suggested that improved performance of these two EEPHS may have decreased disease incidence. EH programs may benefit from improving the performance of EEPHS to address the incidence of certain enteric diseases. Continued efforts to develop a robust understanding of EH program performance and its impact on environment-related disease could enhance EH services delivery and ability to improve health outcomes.

    • Global Health
      • Impact of enhanced health interventions for United States-bound refugees: Evaluating best practices in migration healthExternal
        Mitchell T, Lee D, Weinberg M, Phares C, James N, Amornpaisarnloet K, Aumpipat L, Cooley G, Davies A, Tin Shwe VD, Gajdadziev V, Gorbacheva O, Khwan-Niam C, Klosovsky A, Madilokkowit W, Martin D, Htun Myint NZ, Yen Nguyen TN, Nutman TB, O’Connell EM, Ortega L, Prayadsab S, Srimanee C, Supakunatom W, Vesessmith V, Stauffer WM.
        Am J Trop Med Hyg. 2018 Mar;98(3):920-928.

        With an unprecedented number of displaced persons worldwide, strategies for improving the health of migrating populations are critical. United States-bound refugees undergo a required overseas medical examination to identify inadmissible conditions (e.g., tuberculosis) 2-6 months before resettlement, but it is limited in scope and may miss important, preventable infectious, chronic, or nutritional causes of morbidity. We sought to evaluate the feasibility and health impact of diagnosis and management of such conditions before travel. We offered voluntary testing for intestinal parasites, anemia, and hepatitis B virus infection, to U.S.-bound refugees from three Thailand-Burma border camps. Treatment and preventive measures (e.g., anemia and parasite treatment, vaccination) were initiated before resettlement. United States refugee health partners received overseas results and provided post-arrival medical examination findings. During July 9, 2012 to November 29, 2013, 2,004 refugees aged 0.5-89 years enrolled. Among 463 participants screened for seven intestinal parasites overseas and after arrival, helminthic infections decreased from 67% to 12%. Among 118 with positive Strongyloides-specific antibody responses, the median fluorescent intensity decreased by an average of 81% after treatment. The prevalence of moderate-to-severe anemia (hemoglobin < 10 g/dL) was halved from 14% at baseline to 7% at departure (McNemar P = 0.001). All 191 (10%) hepatitis B-infected participants received counseling and evaluation; uninfected participants were offered vaccination. This evaluation demonstrates that targeted screening, treatment, and prevention services can be conducted during the migration process to improve the health of refugees before resettlement. With more than 250 million migrants globally, this model may offer insights into healthier migration strategies.

    • Laboratory Sciences
      • Recommendations for laboratory containment and management of gene drive systems in arthropodsExternal
        Benedict MQ, Burt A, Capurro ML, De Barro P, Handler AM, Hayes KR, Marshall JM, Tabachnick WJ, Adelman ZN.
        Vector Borne Zoonotic Dis. 2018 Jan;18(1):2-13.

        Versatile molecular tools for creating driving transgenes and other invasive genetic factors present regulatory, ethical, and environmental challenges that should be addressed to ensure their safe use. In this article, we discuss driving transgenes and invasive genetic factors that can potentially spread after their introduction into a small proportion of individuals in a population. The potential of invasive genetic factors to increase their number in natural populations presents challenges that require additional safety measures not provided by previous recommendations regarding accidental release of arthropods. In addition to providing physical containment, invasive genetic factors require greater attention to strain management, including their distribution and identity confirmation. In this study, we focus on insects containing such factors with recommendations for investigators who are creating them, institutional biosafety committees charged with ensuring safety, funding agencies providing support, those managing insectaries handling these materials who are responsible for containment, and other persons who will be receiving insects-transgenic or not-from these facilities. We give specific examples of efforts to modify mosquitoes for mosquito-borne disease control, but similar considerations are relevant to other arthropods that are important to human health, the environment, and agriculture.

      • Evaluation of modified two-tiered testing algorithms for Lyme disease laboratory diagnosis using well-characterized serum samplesExternal
        Pegalajar-Jurado A, Schriefer ME, Welch RJ, Couturier MR, MacKenzie T, Clark RJ, Ashton LV, Delorey MJ, Molins CR.
        J Clin Microbiol. 2018 May 9.

        Standard two-tiered testing (STTT) is the recommended algorithm for laboratory diagnosis of Lyme disease (LD). Several limitations are associated with STTT that include low sensitivity in the early stages of disease, as well as technical complexity and subjectivity associated with second-tier immunoblots; therefore, modified two-tiered testing (MTTT) algorithms that utilize two sequential first-tier tests and eliminate immunoblots have been evaluated. Recently, a novel MTTT that uses a VlsE chemiluminescence immunoassay followed by a C6 enzyme immunoassay has been proposed. The purpose of this study was to evaluate the performance of the VlsE/C6 MTTT using well-characterized serum samples. Serum samples from the CDC Lyme Serum Repository were tested using three MTTTs: VlsE/C6, whole cell sonicate (WCS)/C6 and WCS/VlsE, and three STTTs (immunoblots preceded by three different first-tier assays: VlsE, C6 and WCS). Significant differences were not observed between the MTTTs assessed; however, the VlsE/C6 MTTT resulted in the highest specificity (100%) when other diseases were tested and the lowest sensitivity (75%) for LD samples as compared to the other MTTTs evaluated. Significant differences were present between various MTTTs and STTTs evaluated. Specifically, all MTTTs resulted in higher sensitivities for all LD groups combined when compared to the STTTs and were significantly more accurate (i.e. higher proportion of correct classifications) for this group with the exception of the WCS/ViraStripe STTT. Additionally, when other diseases were tested, only the VlsE/C6 MTTT differed significantly from the WCS/ViraStripe STTT with the VlsE/C6 MTTT resulting in a 6.2% higher accuracy. Overall, the VlsE/C6 MTTT offers an additional laboratory testing algorithm for LD with equivalent or enhanced performance to the other MTTTs and STTTs evaluated in this study.

    • Nutritional Sciences
      • BACKGROUND & AIMS: Increasing evidence suggests that iron-containing multiple micronutrient may reduce the risk of pregnancy-induced hypertension including gestational hypertension or preeclampsia. We aimed to examine whether 30 mg iron plus folic acid or multiple micronutrients during pregnancy reduces the risk of pregnancy-induced hypertension. METHODS: We conducted a secondary data analysis by the dataset from a double-blind randomized controlled trial in China from 2006 to 2009 that was conducted to investigate the effects of multiple micronutrient supplements on adverse pregnancy outcomes when provided to pregnant women with no/mild anemia. We used logistic regression to estimate the adjusted odds ratio and 95% confidence interval and test for effect modification. RESULTS: The incidence of pregnancy-induced hypertension was 7.1% (423/5923), 6.3% (374/5933) and 6.3% (372/5914) among the pregnant women who took folic acid only, iron-folic acid and multiple micronutrient supplements, respectively. The adjusted odds ratios associated with iron-folic acid supplements and multiple micronutrient supplements for pregnancy-induced hypertension were both nearly 0.88 (95% confidence interval, 0.76-1.02), compared with folic acid supplements only. Among pregnant women aged 20-24 years, iron-folic acid (adjusted odds ratios: 0.81, 95% confidence interval: 0.67-0.96) or multiple micronutrient supplementation (adjusted odds ratios: 0.83, 95% confidence interval: 0.70-0.99) can significantly reduce the risk of pregnancy-induced hypertension compared to folic acid supplementation. CONCLUSIONS: Overall, there were no significant differences in pregnancy-induced hypertension across supplement groups. However, among pregnant women aged 20-24 years, iron-containing multiple micronutrient supplementation was associated with a reduced risk of pregnancy-induced hypertension compared with folic acid supplements only. TRIAL REGISTRATION: ClinicalTrials.gov NCT00133744.

    • Occupational Safety and Health
      • Law enforcement suicide: a reviewExternal
        Violanti JM, Owens SL, McCanlies E, Fekedulegn D, Andrew ME.
        Policing. 2018 .

        Purpose: The purpose of this paper is to provide a review of law enforcement suicide research from 1997 to 2016. Design/methodology/approach: The PRISMA systematic review methodology was implemented. A SCOPUS search identified a total of 97 documents. After applying all exclusion criteria, the results included a list of 44 articles in the review. Findings: Overall, studies investigating law enforcement suicide rates show conflicting results, with some studies showing lower suicide rates among law enforcement, some showing higher rates, and some showing no difference to comparison populations. Recurring research themes were lack of an appropriate comparison group, and small statistical power, particularly for minority and female officers. Stressors related to suicide among police included lack of organizational support, traumatic events, shift work, stigma associated with asking for help, or problems associated with fitting in with the police culture. Problems associated with domestic relationships and alcohol use were commonly mentioned as precursors to suicide or as correlates of suicidal ideation and were hypothesized to arise from stressful working conditions. Research limitations/implications: Some limitations in law enforcement suicide research include the lack of theory, under-reporting of suicides, and guarded survey responses from police officers. Future directions in police suicide research include investigating etiological factors such as past adverse life and family experiences, social-ecological variation in suicide, or differences in suicide rates within the law enforcement occupation. Practical implications: Police work, given chronic and traumatic stress, lack of support, danger, and close public scrutiny is a fertile occupation for increased suicide risk. Awareness of the scope of the problem and associated risk factors can help to initiate prevention programs. Originality/value: This paper provides a long-term review of literature regarding police suicidality, with suggestions for research and prevention.

    • Zoonotic and Vectorborne Diseases
      • Attenuation and efficacy of live-attenuated Rift Valley fever virus vaccine candidates in non-human primatesExternal
        Smith DR, Johnston SC, Piper A, Botto M, Donnelly G, Shamblin J, Albarino CG, Hensley LE, Schmaljohn C, Nichol ST, Bird BH.
        PLoS Negl Trop Dis. 2018 May 9;12(5):e0006474.

        Rift Valley fever virus (RVFV) is an important mosquito-borne veterinary and human pathogen that has caused large outbreaks of severe disease throughout Africa and the Arabian Peninsula. Currently, no licensed vaccine or therapeutics exists to treat this potentially deadly disease. The explosive nature of RVFV outbreaks and the severe consequences of its accidental or intentional introduction into RVFV-free areas provide the impetus for the development of novel vaccine candidates for use in both livestock and humans. Rationally designed vaccine candidates using reverse genetics have been used to develop deletion mutants of two known RVFV virulence factors, the NSs and NSm genes. These recombinant viruses were demonstrated to be protective and immunogenic in rats, mice, and sheep, without producing clinical illness in these animals. Here, we expand upon those findings and evaluate the single deletion mutant (DeltaNSs rRVFV) and double deletion mutant (DeltaNSs-DeltaNSm rRVFV) vaccine candidates in the common marmoset (Callithrix jacchus), a non-human primate (NHP) model resembling severe human RVF disease. We demonstrate that both the DeltaNSs and DeltaNSs-DeltaNSm rRVFV vaccine candidates were found to be safe and immunogenic in the current study. The vaccinated animals received a single dose of vaccine that led to the development of a robust antibody response. No vaccine-induced adverse reactions, signs of clinical illness or infectious virus were detected in the vaccinated marmosets. All vaccinated animals that were subsequently challenged with RVFV were protected against viremia and liver disease. In summary, our results provide the basis for further development of the DeltaNSs and DeltaNSs-DeltaNSm rRVFV as safe and effective human RVFV vaccines for this significant public health threat.

  2. CDC Authored Publications
    The names of CDC authors are indicated in bold text.
    Articles published in the past 6-8 weeks authored by CDC or ATSDR staff.
    • Chronic Diseases and Conditions
      1. Serum mercury concentration and the risk of ischemic stroke: The REasons for Geographic and Racial Differences in Stroke Trace Element StudyExternal
        Chen C, Xun P, McClure LA, Brockman J, MacDonald L, Cushman M, Cai J, Kamendulis L, Mackey J, He K.
        Environ Int. 2018 May 4;117:125-131.

        BACKGROUND: Although biologically plausible, epidemiological evidence linking exposure to methylmercury with increased risk of ischemic stroke is limited. The effects of methylmercury may be modified by selenium, which is an anti-oxidant that often co-exists with mercury in fish. OBJECTIVES: To examine the association between serum mercury levels with the incidence of ischemic stroke and to explore the possible effect modifications by serum selenium levels and demographic and geographic factors. METHODS: A case-cohort study was designed nested in the REasons for Geographic and Racial Differences in Stroke cohort, including 662 adjudicated incident cases of ischemic stroke and 2494 participants in a randomly selected sub-cohort. Serum mercury was measured using samples collected at recruitment. Multivariable-adjusted hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) were estimated using the Barlow-weighting method for the Cox proportional hazards regression model. RESULTS: No statistically significant association was observed between serum mercury concentration and the incidence of ischemic stroke (the highest vs. lowest quintile of mercury levels: HR=0.82; 95% CI=0.55-1.22; P for linear trend=0.42). Sex (P for interaction=0.06), but not serum selenium levels, modified the association; a more evident trend toward lower incidence of ischemic stroke with higher mercury levels was observed among women. CONCLUSION: This study does not support an association between mercury and the incidence of ischemic stroke within a population with low-to-moderate level of exposure. Further studies are needed to explore the possibility of mercury-induced ischemic stroke toxicity in other populations at higher exposure levels.

      2. Colorectal cancer screening in the United States: Trends from 2008 to 2015 and variation by health insurance coverageExternal
        de Moor JS, Cohen RA, Shapiro JA, Nadel MR, Sabatino SA, Robin Yabroff K, Fedewa S, Lee R, Paul Doria-Rose V, Altice C, Klabunde CN.
        Prev Med. 2018 May 2.

        Regular colorectal cancer (CRC) screening is recommended for reducing CRC incidence and mortality. This paper provides an updated analysis of CRC screening in the United States (US) and examines CRC screening by several features of health insurance coverage. Recommendation-consistent CRC screening was calculated for adults aged 50-75 in 2008, 2010, 2013 and 2015 using data from the National Health Interview Survey. CRC screening prevalence in 2015 was described overall and by sociodemographic subgroups. CRC screening by health insurance coverage was further examined using multivariable logistic regression, stratified by age (50-64years and 65-75years) and adjusted for age, race/ethnicity, sex, education, income, time in US, and comorbid conditions. Recommendation-consistent screening increased from 51.6% in 2008 to 58.3% in 2010 (p<0.001). Use plateaued from 2010 to 2013 but increased to 61.3% in 2015 (p<0.001). In 2015, adults aged 50-64years with traditional employer-sponsored private insurance were more likely to be screened (62.2%) than those with traditional private direct purchase plans (50.9%) and the uninsured (24.8%) (p<0.01, respectively). After multivariable adjustment, differences between traditional employer-sponsored private insurance and the uninsured remained statistically significant. Adults aged 65-75 with Medicare and private insurance were more likely to be screened (76.3%) than those with Medicare, no supplemental insurance (68.8%) or Medicare and Medicaid (65.2%) (p<0.001). After multivariable adjustment, the differences between Medicare and private insurance and Medicare no supplemental insurance remained statistically significant. CRC screening rates have increased over time, but certain segments of the population, especially the uninsured, continue to screen below recommended levels.

      3. AIMS: We hypothesized that height-corrected abdominal size (supine sagittal abdominal diameter/height ratio [SADHtR] or waist circumference/height ratio [WHtR]) would associate more strongly than body mass index (BMI, weight/height(2)) with levels of fasting insulin, triglycerides, and three derived biomarkers of insulin resistance. METHODS: Anthropometry, including SAD by caliper, was collected on 4398 adults in the 2011-2014 National Health and Nutrition Examination Survey. For comparison purposes, each adiposity indicator was scaled to its population-based, sex-specific, interquartile range (IQR). For each biomarker we created four outcome groups based on equal-sized populations with ascending values. Multivariable polytomous logistic regression modeled the relationships between the adiposity indicators and each biomarker. RESULTS: Highest-group insulin was associated with a one-IQR increment of BMI (RR 4.3 [95% CI 3.9-4.9]), but more strongly with a one-IQR increment of SADHtR (RR 5.7 [5.0-6.6]). For highest-group HOMA-IR the RR for BMI (4.2 [3.7-4.6]) was less than that of SADHtR (6.0 [5.1-7.0]). Similarly, RRs for BMI were smaller than those for SADHtR applying to highest-group triglycerides (RR 1.6 vs 2.1), triglycerides/HDL-cholesterol (RR 1.9 vs 2.4) and TyG index (RR 1.7 vs 2.2) (all p<.001). The RRs for WHtR were consistently between those for SADHtR and BMI. The top 25% of insulin resistance among US adults was estimated to lie above adiposity thresholds of 0.140 for SADHtR, 0.606 for WHtR, or 29.6kg/m(2) for BMI. CONCLUSIONS: Relative abdominal size rather than relative weight may better define adiposity associated with homeostatic insulin resistance. These population-based, cross-sectional findings could improve anthropometric prediction of cardiometabolic risk.

      4. Colorectal cancer screening: Preferences, past behavior, and future intentionsExternal
        Mansfield C, Ekwueme DU, Tangka FK, Brown DS, Smith JL, Guy GP, Li C, Hauber B.
        Patient. 2018 May 9.

        BACKGROUND: Screening rates for colorectal cancer are below the Healthy People 2020 goal. There are several colorectal cancer screening tests that differ in terms of accuracy, recommended frequency, and administration. In this article, we compare how a set of personal characteristics correlates with preferences for colorectal cancer screening test attributes, past colorectal cancer screening behavior, and future colorectal cancer screening intentions. METHODS: We conducted a discrete-choice experiment survey to assess relative preferences for attributes of colorectal cancer screening tests among adults aged 50-75 years in USA. We used a latent class logit model to identify classes of preferences and calculated willingness to pay for changes in test attributes. A set of personal characteristics were included in the latent class analysis and analyses of self-reported past screening behavior and self-assessed likelihood of future colorectal cancer screening. RESULTS: Latent class analysis identified three types of respondents. Class 1 valued test accuracy, class 2 valued removing polyps and avoiding discomfort, and class 3 valued cost. Having had a prior colonoscopy and a higher income were predictors of the likelihood of future screening and membership in classes 1 and 2. Health insurance and a self-reported higher risk of developing colorectal cancer were associated with prior screening and higher future screening intentions, but not class membership. CONCLUSION: We identified distinct classes of preferences focusing on different test features and personal characteristics associated with reported behavior and intentions. Healthcare providers should engage in a careful assessment of patient preferences when recommending colorectal cancer test options to encourage colorectal cancer screening uptake.

      5. Stroke and myocardial infarction are among the most common causes of mortality and disability in the world. The ischemic injury underlying these illnesses is complex, involving intricate interplays among many biological functions including energy metabolism, vascular regulation, hemodynamics, oxidative stress, inflammation, platelet activation, and tissue repair that take place in a context- and time-dependent manner. The current drug therapy of choice is to timely resupply the blood to the ischemic tissue; but reperfusion may introduce additional harm to the tissue through a process known as ischemia/reperfusion injury. As such, new drugs that would complement reperfusion by providing neural and cardiovascular protection and by targeting multiple abnormalities in ischemia are receiving increased attention. Scutellarin is an herbal flavonoid glucuronide with multiple pharmacological activities. Owing to its multiple beneficial effects, such as anti-oxidant, anti-inflammation, vascular relaxation, anti-platelet, anti-coagulation, and myocardial protection, scutellarin has been used clinically to treat stroke, myocardial infarction, and diabetic complications. Over the past three decades, clinical and pharmacological studies have accumulated a body of evidence that not only demonstrated these therapeutic effects, but also provided significant insights into the pharmacokinetic behavior, therapeutic profile, and mode of action of scutellarin in humans and animal models. Medicinal modification and new drug delivery methods have led to the development of new derivatives and formulations of scutellarin with improved bioavailability, efficacy, and safety. Here we review the current literature on scutellarin to provide a comprehensive understanding of the pharmacological activity, mechanism of action, toxicity, and therapeutic potential of scutellarin for the treatment of ischemia, diabetic complications, and other chronic diseases.

      6. Reply to Colon cancer survival in the US Department of Veterans Affairs by race and stage: 2001 through 2009External
        White A, Rim SH, Joseph DA, Johnson CJ, Coleman MP, Allemani C.
        Cancer. 2018 Apr 30.

        [No abstract]

    • Communicable Diseases
      1. Enterovirus and parechovirus surveillance – United States, 2014-2016External
        Abedi GR, Watson JT, Nix WA, Oberste MS, Gerber SI.
        MMWR Morb Mortal Wkly Rep. 2018 May 11;67(18):515-518.

        Infections caused by enteroviruses (EV) and parechoviruses (PeV), members of the Picornaviridae family, are associated with various clinical manifestations, including hand, foot, and mouth disease; respiratory illness; myocarditis; meningitis; and sepsis; and can result in death. The genus Enterovirus includes four species of enterovirus (A-D) known to infect humans, and the genus Parechovirus includes one species (A) that infects humans. These species are further divided into types, some of which are associated with specific clinical manifestations. During 2014-2016, a total of 2,967 U.S. cases of EV and PeV infections were reported to the National Enterovirus Surveillance System (NESS). The largest number of reports during that time (2,051) occurred in 2014, when a large nationwide outbreak of enterovirus D68 (EV-D68) occurred, accounting for 68% of cases reported to NESS that year (1). Reports to the National Respiratory and Enteric Virus Surveillance System (NREVSS) during 2014-2016 indicated that circulation of EV peaks annually in the summer and early fall. Because the predominant types of EV and PeV circulating from year to year tend to vary, tracking these trends requires consistent and complete reports from laboratories with the capacity to perform typing.

      2. In Taiwan, an outbreak of acute hepatitis A (AHA) infection has been identified since June 2015. Approximately half of the cases occurred in HIV-infected men who have sex with men (MSM). We used the Taiwan Centers for Disease Control (TCDC)-operated National Disease Surveillance Systems (NDSS) to identify the incidence of AHA during 2011-2016. Between June 2015 and December 2016, a total of 1,268 AHA cases were documented, and 601 cases (47.4%) were co-infected with HIV; the majority of whom were MSM (98.4%). Each AHA case was matched to two HIV-infected controls without AHA reported in the NDSS on age (+/- 5 years), risk factor of HIV infection, HIV diagnosis date (+/- 30 days) and county/city of residence at HIV diagnosis. Three hundred forty-three HIV/AHA cases were matched to 686 controls. In multivariable conditional logistic regression analysis, a previous gonorrhea (adjusted OR=1.77, 95% CI 1.16-2.70), and recent (aOR=6.77, 95% CI 4.34-10.55) or remote syphilis report (aOR=3.56, 95% CI 2.48-5.13) were independently associated with AHA. The epidemic persisted till December 2016, and the cases with a new diagnosis of HIV infection after AHA (28/301, 9.3%) increased after July 2016 (p=0.001). HIV/AHA cases were centralized in northern and central metropolitan areas and HIV-infected MSM with a recent history of sexually transmitted diseases in Taiwan. We recommend surveillance of associated behavioral and virologic characteristics and HAV counseling and testing for HIV-infected men. This article is protected by copyright. All rights reserved.

      3. HIV viral suppression, 37 states and the District of Columbia, 2014External
        Hess KL, Hall HI.
        J Community Health. 2018 Apr;43(2):338-347.

        Achieving viral suppression among HIV-positive persons is a critical component of HIV treatment and prevention, because it leads to improved health outcomes for the individual and reduced risk of HIV transmission. There is wide variation in viral suppression across jurisdictions, races/ethnicities, age groups, and transmission risk groups. This analysis uses HIV surveillance data to examine rates of viral suppression among people living with diagnosed HIV (PLWDH) in 38 jurisdictions with complete lab reporting. Among people who received a diagnosis in 2014, the percentage with viral suppression within 12 months of diagnosis and the average time to viral suppression was assessed. Overall, among PLWDH in 2014, 57.9% were virally suppressed, and, among people with HIV diagnosed in 2014, 68.2% were suppressed within 12 months of diagnosis with an average time to suppression of 6.9 months. All outcomes varied by jurisdiction, but most had similar patterns of disparities with a few exceptions. These data highlight the need for tailored interventions at the local level. In addition, jurisdictions with relatively low viral suppression among particular groups could adapt effective interventions from jurisdictions who have higher rates of suppression.

      4. Influenza-associated acute necrotizing encephalopathy in siblingsExternal
        Howard A, Uyeki TM, Fergie J.
        J Pediatric Infect Dis Soc. 2018 May 4.

        Encephalopathy is an important complication associated with influenza, most frequently observed in young children, with a wide range of severity. The most severe category of influenza-associated encephalopathy (IAE) is acute necrotizing encephalopathy (ANE), characterized by high frequency of neurologic sequelae and fatal outcomes. We report two young siblings who developed fever and seizures with altered mental status. Influenza A(H1N1)pdm09 virus infection was identified in upper respiratory tract specimens from both patients, and neuroimaging revealed bilateral inflammatory lesions, consistent with acute necrotizing encephalopathy. Neither child had received influenza vaccination. Both children progressed to critical illness and required invasive mechanical ventilation. In addition to critical care management, both patients received high-dose corticosteroids, mannitol, anticonvulsants, and antiviral treatment of influenza. The older child recovered fully and was discharged 2 weeks after illness onset, but the younger sibling developed severe brainstem edema and cerebellar tonsillar herniation, and died on illness day 11. Both children tested positive for Ran Binding Protein 2 (RANBP2) gene mutations. RANBP2 is a genetic polymorphism associated with recurrent episodes of necrotizing encephalitis with respiratory viral infections. Annual influenza vaccination is especially important for ANE survivors, with or without RANBP2 mutations, their household contacts, and caregivers. During influenza season, close monitoring of any child with a history of neurological complications associated with respiratory illness is indicated, with prompt initiation of antiviral treatment with onset of acute respiratory illness, and influenza testing performed by molecular assay.

      5. Progress toward polio eradication – worldwide, January 2016-March 2018External
        Khan F, Datta SD, Quddus A, Vertefeuille JF, Burns CC, Jorba J, Wassilak SG.
        MMWR Morb Mortal Wkly Rep. 2018 May 11;67(18):524-528.

        In 1988, when an estimated 350,000 cases of poliomyelitis occurred in 125 countries, the World Health Assembly resolved to eradicate polio globally. Transmission of wild poliovirus (WPV) continues uninterrupted in only three countries (Afghanistan, Nigeria, and Pakistan) (1), and among the three serotypes, WPV type 1 (WPV1) remains the only confirmed circulating type. This report describes global progress toward polio eradication during January 2016-March 2018, and updates previous reports (2). In 2017, 22 WPV1 cases were reported, a 41% decrease from the 37 WPV1 cases reported in 2016. As of April 24, 2018, eight WPV1 cases have been reported (seven in Afghanistan and one in Pakistan), compared with five cases during the same period in 2017. In Pakistan, continuing WPV1 transmission has been confirmed in multiple areas in 2018 by isolation from wastewater samples. In Nigeria, ongoing endemic WPV1 transmission was confirmed in 2016 (3); although WPV was not detected in 2017 or in 2018 to date, limitations in access for vaccination and surveillance in insurgent-held areas in northeastern Nigeria might permit continued undetected poliovirus transmission. Substantial progress toward polio eradication has continued in recent years; however, interruption of WPV transmission will require overcoming remaining challenges to reaching and vaccinating every missed child. Until poliovirus eradication is achieved, all countries must remain vigilant by maintaining high population immunity and sensitive poliovirus surveillance.

      6. Shifting the HIV paradigm from care to cure: Proceedings from the Caribbean Expert Summit in Barbados, August 2017External
        Landis RC, Abayomi EA, Bain B, Greene E, Janossy G, Joseph P, Kerrigan D, McCoy JP, Nunez CA, O’Gorman M, Pastoors A, Parekh B, Quimby K, Quinn TC, Robertson K, Thomas R, van Gorp E, Vermund SH, Wilson V.
        AIDS Res Hum Retroviruses. 2018 May 5.

        The CCAS EXPERT SUMMIT convened an array of international experts in Barbados on August 27-31 2017 under the theme “From Care to Cure – Shifting the HIV Paradigm”. The Caribbean Cytometry & Analytical Society (CCAS) partnered with the Joint United Nations Programme on HIV/AIDS (UNAIDS) to deliver a program that reviewed the advances in antiretroviral therapy and the public health benefits accruing from treatment as prevention. Particular emphasis was placed on re-examining stigma and discrimination through a critical appraisal of whether public health messaging and advocacy had kept pace with the advances in medicine. Persistent fear of HIV driving discriminatory behavior was widely reported in different regions and sectors, including the healthcare profession itself; continued fear of the disease was starkly misaligned with the successes of new medical treatments and progress towards the UNAIDS 90:90:90 targets. The summit therefore adopted the mantra “Test:Treat:Defeat” to help engage with the public in a spirit of optimism aimed at creating a more conducive environment for persons to be tested and treated; and thereby help reduce HIV disease and stigma at the individual and community levels.

      7. Long-term supportive housing is associated with decreased risk for new HIV diagnoses among a large cohort of homeless persons in New York CityExternal
        Lee CT, Winquist A, Wiewel EW, Braunstein S, Jordan HT, Gould LH, Gwynn RC, Lim S.
        AIDS Behav. 2018 May 8.

        It is unknown whether providing housing to persons experiencing homelessness decreases HIV risk. Housing, including access to preventive services and counseling, might provide a period of transition for persons with HIV risk factors. We assessed whether the new HIV diagnosis rate was associated with duration of supportive housing. We linked data from a cohort of 21,689 persons without a previous HIV diagnosis who applied to a supportive housing program in New York City (NYC) during 2007-2013 to the NYC HIV surveillance registry. We used time-dependent Cox modeling to compare new HIV diagnoses among recipients of supportive housing (defined a priori, for program evaluation purposes, as persons who spent > 7 days in supportive housing; n = 6447) and unplaced applicants (remainder of cohort), after balancing the groups on baseline characteristics with propensity score weights. Compared with unplaced applicants, persons who received >/= 3 continuous years of supportive housing had decreased risk for new HIV diagnosis (HR 0.10; CI 0.01-0.99). Risk of new HIV diagnosis decreased with longer duration placement in supportive housing. Supportive housing might aid in primary HIV prevention.

      8. Painful papules on the hand: A quizExternal
        Lee E, Patel T, Hale G, Zaki S, Fisher K.
        Acta Derm Venereol. 2018 Apr 27;98(5):542-543.

        [No abstract]

      9. Adolescent access to care and risk of early mother-to-child HIV transmissionExternal
        Ramraj T, Jackson D, Dinh TH, Olorunju S, Lombard C, Sherman G, Puren A, Ramokolo V, Noveve N, Singh Y, Magasana V, Bhardwaj S, Cheyip M, Mogashoa M, Pillay Y, Goga AE.
        J Adolesc Health. 2018 Apr;62(4):434-443.

        PURPOSE: Adolescent females aged 15-19 account for 62% of new HIV infections and give birth to 16 million infants annually. We quantify the risk of early mother-to-child transmission (MTCT) of HIV among adolescents enrolled in nationally representative MTCT surveillance studies in South Africa. METHODS: Data from 4,814 adolescent (</=19 years) and 25,453 adult (>/=20 years) mothers and their infants aged 4-8 weeks were analyzed. These data were gathered during three nationally representative, cross-sectional, facility-based surveys, conducted in 2010, 2011-2012, and 2012-2013. All infants were tested for HIV antibody (enzyme immunoassay), to determine HIV exposure. Enzyme immunoassay-positive infants or those born to self-reported HIV-positive mothers were tested for HIV infection (total nucleic acid polymerase chain reaction). Maternal HIV positivity was inferred from infant HIV antibody positivity. All analyses were weighted for sample realization and population live births. RESULTS: Adolescent mothers, compared with adult mothers, have almost three times less planned pregnancies 14.4% (95% confidence interval [CI]: 12.5-16.5) versus 43.9% (95% CI: 42.0-45.9) in 2010 and 15.2% (95% CI: 13.0-17.9) versus 42.8% (95% CI: 40.9-44.6) in 2012-2013 (p < .0001), less prevention of MTCT uptake (odds ratio [OR] in favor of adult mothers = 3.36, 95% CI: 2.95-3.83), and higher early MTCT (adjusted OR = 3.0, 95% CI: 1.1-8.0), respectively. Gestational age at first antenatal care booking was the only significant predictor of early MTCT among adolescents. CONCLUSIONS: Interventions that appeal to adolescents and initiate sexual and reproductive health care early should be tested in low- and middle-income settings to reduce differential service uptake and infant outcomes between adolescent and adult mothers.

      10. Infrequent testing of women for rectal chlamydia and gonorrhea in the United StatesExternal
        Tao G, Hoover KW, Nye MB, Peters PJ, Gift TL, Body BA.
        Clin Infect Dis. 2018 Feb 1;66(4):570-575.

        Background: Anal sex is a common sexual behavior among women that increases their risk of acquiring rectal infection with Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC). Methods: We estimated the frequency and positivity of rectal CT and GC tests for women aged 15-60 years performed by a large US commercial laboratory between November 2012 and September 2015. We also estimated the frequency and positivity of pharyngeal and genital specimens also performed on the same date. Among women with a positive CT or GC result, we estimated the frequency and positivity of recommended repeat testing within 12 months. Results: Of 5499 women who had rectal CT and GC tests, positivity was 10.8%. On the same date, approximately 80% also had genital CT tests, genital GC tests, and pharyngeal GC tests, while 40% had pharyngeal CT tests. Rectal CT or GC infection was associated with genital CT or GC infection, but 46.5% of rectal CT and GC infections would not have been identified with genital testing alone. Among women with a rectal CT or GC infection, only 20.0% had a recommended repeat rectal test. Of those who had a repeat test, 17.7% were positive. Conclusions: Testing women for rectal CT and GC was infrequent, but positive tests were often found in women with negative genital tests. Most women with positive rectal tests were not retested. Interventions are needed to increase extragenital CT and GC testing of at-risk women.

      11. The effects of the attributable fraction and the duration of symptoms on burden estimates of influenza-associated respiratory illnesses in a high HIV prevalence setting, South Africa, 2013-2015External
        Tempia S, Walaza S, Moyes J, Cohen AL, von Mollendorf C, McMorrow ML, Mhlanga S, Treurnicht FK, Venter M, Pretorius M, Hellferscee O, Wolter N, von Gottberg A, Nguweneza A, McAnerney JM, Dawood H, Variava E, Madhi SA, Cohen C.
        Influenza Other Respir Viruses. 2018 May;12(3):360-373.

        BACKGROUND: The attributable fraction of influenza virus detection to illness (INF-AF) and the duration of symptoms as a surveillance inclusion criterion could potentially have substantial effects on influenza disease burden estimates. METHODS: We estimated rates of influenza-associated influenza-like illness (ILI) and severe acute (SARI-10) or chronic (SCRI-10) respiratory illness (using a symptom duration cutoff of </=10 days) among HIV-infected and HIV-uninfected patients attending 3 hospitals and 2 affiliated clinics in South Africa during 2013-2015. We calculated the unadjusted and INF-AF-adjusted rates and relative risk (RR) due to HIV infection. Rates were expressed per 100 000 population. RESULTS: The estimated mean annual unadjusted rates of influenza-associated illness were 1467.7, 50.3, and 27.4 among patients with ILI, SARI-10, and SCRI-10, respectively. After adjusting for the INF-AF, the percent reduction in the estimated rates was 8.9% (rate: 1336.9), 11.0% (rate: 44.8), and 16.3% (rate: 22.9) among patients with ILI, SARI-10, and SCRI-10, respectively. HIV-infected compared to HIV-uninfected individuals experienced a 2.3 (95% CI: 2.2-2.4)-, 9.7 (95% CI: 8.0-11.8)-, and 10.0 (95% CI: 7.9-12.7)-fold increased risk of influenza-associated illness among patients with ILI, SARI-10, and SCRI-10, respectively. Overall 34% of the estimated influenza-associated hospitalizations had symptom duration of >10 days; 8% and 44% among individuals aged <5 and >/=5 years, respectively. CONCLUSION: The marginal differences between unadjusted and INF-AF-adjusted rates are unlikely to affect policies on prioritization of interventions. HIV-infected individuals experienced an increased risk of influenza-associated illness and may benefit more from annual influenza immunization. The use of a symptom duration cutoff of </=10 days may underestimate influenza-associated disease burden, especially in older individuals.

      12. High cryptococcal antigen titers in blood are predictive of subclinical cryptococcal meningitis among human immunodeficiency virus-infected patientsExternal
        Wake RM, Britz E, Sriruttan C, Rukasha I, Omar T, Spencer DC, Nel JS, Mashamaite S, Adelekan A, Chiller TM, Jarvis JN, Harrison TS, Govender NP.
        Clin Infect Dis. 2018 Feb 10;66(5):686-692.

        Background: High mortality rates among asymptomatic cryptococcal antigen (CrAg)-positive patients identified through CrAg screening, despite preemptive fluconazole treatment, may be due to undiagnosed cryptococcal meningitis. Methods: Symptoms were reviewed in CrAg-positive patients identified by screening 19233 individuals with human immunodeficiency virus infection and CD4 cell counts <100/microL at 17 clinics and 3 hospitals in Johannesburg from September 2012 until September 2015, and at 2 hospitals until June 2016. Cerebrospinal fluid samples from 90 of 254 asymptomatic patients (35%) and 78 of 173 (45%) with headache only were analyzed for cryptococcal meningitis, considered present if Cryptococcus was identified by means of India ink microscopy, culture, or CrAg test. CrAg titers were determined with stored blood samples from 62 of these patients. The associations between blood CrAg titer, concurrent cryptococcal meningitis, and mortality rate were assessed. Results: Cryptococcal meningitis was confirmed in 34% (95% confidence interval, 25%-43%; 31 of 90) of asymptomatic CrAg-positive patients and 90% (81%-96%; 70 of 78) with headache only. Blood CrAg titer was significantly associated with concurrent cryptococcal meningitis in asymptomatic patients (P < .001) and patients with headache only (P = .003). The optimal titer for predicting cryptococcal meningitis was >160 (sensitivity, 88.2%; specificity, 82.1%); the odds ratio for concurrent cryptococcal meningitis was 34.5 (95% confidence interval, 8.3-143.1; P < .001). Conclusions: About a third of asymptomatic CrAg-positive patients have concurrent cryptococcal meningitis. More effective clinical assessment strategies and antifungal regimens are required for CrAg-positive patients, including investigation for cryptococcal meningitis irrespective of symptoms. Where it is not possible to perform lumbar punctures in all CrAg-positive patients, blood CrAg titers should be used to target those most at risk of cryptococcal meningitis.

    • Disease Reservoirs and Vectors
      1. First report of Aedes albopictus (Diptera: Culicidae) in the Democratic Republic of CongoExternal
        Bobanga T, Moyo M, Vulu F, Irish SR.
        African Entomology. 2018 ;26(1):234-236.

        [No abstract]

    • Environmental Health
      1. Comparison of questionnaire-based estimation of pesticide residue intake from fruits and vegetables with urinary concentrations of pesticide biomarkersExternal
        Chiu YH, Williams PL, Minguez-Alarcon L, Gillman M, Sun Q, Ospina M, Calafat AM, Hauser R, Chavarro JE.
        J Expo Sci Environ Epidemiol. 2018 Jan;28(1):31-39.

        We developed a pesticide residue burden score (PRBS) based on a food frequency questionnaire and surveillance data on food pesticide residues to characterize dietary exposure over the past year. In the present study, we evaluated the association of the PRBS with urinary concentrations of pesticide biomarkers. Fruit and vegetable (FV) intake was classified as having high (PRBS>/=4) or low (PRBS<4) pesticide residues for 90 men from the EARTH study. Two urine samples per man were analyzed for seven biomarkers of organophosphate and pyrethroid insecticides, and the herbicide 2,4-dichlorophenoxyacetic acid. We used generalized estimating equations to analyze the association of the PRBS with urinary concentrations of pesticide biomarkers. Urinary concentrations of pesticide biomarkers were positively related to high pesticide FV intake but inversely related to low pesticide FV intake. The molar sum of urinary concentrations of pesticide biomarkers was 21% (95% confidence interval (CI): 2%, 44%) higher for each one serving/day increase in high pesticide FV intake, and 10% (95% CI: 1%, 18%) lower for each one serving/day increase in low pesticide FV intake. Furthermore, intake of high pesticide FVs positively related to most individual urinary biomarkers. Our findings support the usefulness of the PRBS approach to characterize dietary exposure to select pesticides.

      2. Identifying vulnerable periods of neurotoxicity to triclosan exposure in childrenExternal
        Jackson-Browne MS, Papandonatos GD, Chen A, Calafat AM, Yolton K, Lanphear BP, Braun JM.
        Environ Health Perspect. 2018 May 2;126(5):057001.

        BACKGROUND: Exposure to triclosan, an endocrine disrupting chemical, may affect thyroid hormone homeostasis and adversely affect neurodevelopment. OBJECTIVE: Using a longitudinal pregnancy and birth cohort, we investigated associations between triclosan exposures during different time windows, and cognitive test scores at 8 y of age in 198 children from the HOME Study. METHODS: We quantified triclosan in urine samples from mother-child pairs up to nine times between the second trimester of gestation and 8 y of age. The Wechsler Intelligence Scale for Children-IV [i.e., Full-Scale Intelligence Quotient (IQ)] assessment was administered to HOME Study children at 8 y of age. We estimated covariate-adjusted triclosan-IQ associations at each visit. We also tested whether associations between triclosan concentrations and cognitive test scores varied among exposure at different time periods. RESULTS: Full-Scale IQ was not significantly associated with urinary triclosan concentrations during gestation or childhood but was significantly associated with a 10-fold increase in maternal urinary triclosan concentration at delivery [-4.5 points (95% CI: -7.0, -2.0)]. Perceptual Reasoning Index (PRI) scores were significantly decreased in association with urinary triclosan concentrations at delivery and at 2 y of age. Associations between repeated triclosan concentrations and cognitive test scores significantly varied among exposure at different time periods for Full-Scale IQ, PRI, Verbal Comprehension Index, and Working Memory (triclosan-visit interaction p</=0.04). CONCLUSION: Urinary triclosan concentrations at delivery, but not during mid to late pregnancy and childhood, were associated with significantly lower children’s cognitive test scores at 8 y of age in this cohort of U.S. children. https://doi.org/10.1289/EHP2777.

      3. Variability and predictors of serum perfluoroalkyl substance concentrations during pregnancy and early childhoodExternal
        Kingsley SL, Eliot MN, Kelsey KT, Calafat AM, Ehrlich S, Lanphear BP, Chen A, Braun JM.
        Environ Res. 2018 May 4;165:247-257.

        Exposure to poly- and perfluoroalkyl substances (PFAS), ubiquitous and persistent environmental contaminants, could be associated with adverse health outcomes, but there are limited longitudinal data assessing patterns and predictors of exposure during childhood. We quantified concentrations of eight different PFAS in sera collected from women during pregnancy and children at delivery and ages 3 and 8 years in 367 mother-child pairs enrolled in a prospective cohort from 2003 to 2006. In general, median childhood PFAS concentrations increased from birth to age 3 and then decreased by age 8. Maternal serum PFAS concentrations during pregnancy were strongly correlated with cord serum concentrations (0.76<r<0.94), but were weakly correlated with childhood concentrations (0.12<r<0.30). Several sociodemographic factors were associated with maternal PFAS concentrations, including income, race, and parity. In children, serum PFAS concentrations were associated with maternal age at delivery, race, parity, and child age. Breastfeeding duration was positively associated with childhood PFAS concentrations at ages 3 and 8 years. In addition, stain repellant use was associated with higher perfluorooctanoic acid and perfluorohexane sulfonic acid concentrations at age 8 years. Serum PFAS concentrations are higher during early childhood, a potentially sensitive period of development, and were highest among breastfed children.

      4. Urinary cadmium threshold to prevent kidney disease developmentExternal
        Satarug S, Ruangyuttikarn W, Nishijo M, Ruiz P.
        Toxics. 2018 May 1;6(2).

        The frequently observed association between kidney toxicity and long-term cadmium (Cd) exposure has long been dismissed and deemed not to be of clinical relevance. However, Cd exposure has now been associated with increased risk of developing chronic kidney disease (CKD). We investigated the link that may exist between kidney Cd toxicity markers and clinical kidney function measure such as estimated glomerular filtration rates (eGFR). We analyzed data from 193 men to 202 women, aged 16&minus;87 years [mean age 48.8 years], who lived in a low- and high-Cd exposure areas in Thailand. The mean (range) urinary Cd level was 5.93 (0.05(-)57) &mu;g/g creatinine. The mean (range) for estimated GFR was 86.9 (19.6&minus;137.8) mL/min/1.73 m(2). Kidney pathology reflected by urinary &beta;2-microglobulin (&beta;2-MG) levels &ge; 300 &mu;g/g creatinine showed an association with 5.32-fold increase in prevalence odds of CKD (p = 0.001), while urinary Cd levels showed an association with a 2.98-fold greater odds of CKD prevalence (p = 0.037). In non-smoking women, Cd in the highest urinary Cd quartile was associated with 18.3 mL/min/1.73 m(2) lower eGFR value, compared to the lowest quartile (p < 0.001). Evidence for Cd-induced kidney pathology could thus be linked to GFR reduction, and CKD development in Cd-exposed people. These findings may help prioritize efforts to reassess Cd exposure and its impact on population health, given the rising prevalence of CKD globally.

    • Genetics and Genomics
      1. Precision medicine in action: The impact of ivacaftor on cystic fibrosis-related hospitalizationsExternal
        Feng LB, Grosse SD, Green RF, Fink AK, Sawicki GS.
        Health Aff (Millwood). 2018 May;37(5):773-779.

        Cystic fibrosis is a life-threatening genetic disease that causes severe damage to the lungs. Ivacaftor, the first drug that targeted the underlying defect of the disease caused by specific mutations, is a sterling example of the potential of precision medicine. Clinical trial and registry studies showed that ivacaftor improved outcomes and reduced hospitalizations. Our study used US administrative claims data to assess the real-world effectiveness of ivacaftor. Comparing twelve-month rates before and after starting the use of ivacaftor among people who initiated therapy during 2012-2015, we found that overall and cystic fibrosis-related inpatient admissions fell by 55 percent and 81 percent, respectively. There was a comparable reduction in inpatient spending. Ivacaftor appears to be effective for multiple mutations that cause the disease, as suggested by the fact that during the study period, ivacaftor’s use was extended to nine additional mutations in 2014. Examination of evidence from clinical trial, clinical care, and administrative data sources is important for understanding the real-world effectiveness of precision medicines such as ivacaftor.

      2. Motivation: Inferring population structure is important for both population genetics and genetic epidemiology. Principal components analysis (PCA) has been effective in ascertaining population structure with array genotype data but can be difficult to use with sequencing data, especially when low depth leads to uncertainty in called genotypes. Because PCA is sensitive to differences in variability, PCA using sequencing data can result in components that correspond to differences in sequencing quality (read depth and error rate), rather than differences in population structure. We demonstrate that even existing methods for PCA specifically designed for sequencing data can still yield biased conclusions when used with data having sequencing properties that are systematically different across different groups of samples (i.e. sequencing groups). This situation can arise in population genetics when combining sequencing data from different studies, or in genetic epidemiology when using historical controls such as samples from the 1000 Genomes Project. Results: To allow inference on population structure using PCA in these situations, we provide an approach that is based on using sequencing reads directly without calling genotypes. Our approach is to adjust the data from different sequencing groups to have the same read depth and error rate so that PCA does not generate spurious components representing sequencing quality. To accomplish this, we have developed a subsampling procedure to match the depth distributions in different sequencing groups, and a read-flipping procedure to match the error rates. We average over subsamples and read flips to minimize loss of information. We demonstrate the utility of our approach using two datasets from 1000 Genomes, and further evaluate it using simulation studies. Availability and implementation: TASER-PC software is publicly available at http://web1.sph.emory.edu/users/yhu30/software.html. Contact: yijuan.hu@emory.edu. Supplementary information: Supplementary data are available at Bioinformatics online.

      3. Delivery of cascade screening for hereditary conditions: A scoping review of the literatureExternal
        Roberts MC, Dotson WD, DeVore CS, Bednar EM, Bowen DJ, Ganiats TG, Green RF, Hurst GM, Philp AR, Ricker CN, Sturm AC, Trepanier AM, Williams JL, Zierhut HA, Wilemon KA, Hampel H.
        Health Aff (Millwood). 2018 May;37(5):801-808.

        Cascade screening is the process of contacting relatives of people who have been diagnosed with certain hereditary conditions. Its purpose is to identify, inform, and manage those who are also at risk. We conducted a scoping review to obtain a broad overview of cascade screening interventions, facilitators and barriers to their use, relevant policy considerations, and future research needs. We searched for relevant peer-reviewed literature in the period 1990-2017 and reviewed 122 studies. Finally, we described 45 statutes and regulations related to the use and release of genetic information across the fifty states. We sought standardized best practices for optimizing cascade screening across various geographic and policy contexts, but we found none. Studies in which trained providers contacted relatives directly, rather than through probands (index patients), showed greater cascade screening uptake; however, policies in some states might limit this approach. Major barriers to cascade screening delivery include suboptimal communication between the proband and family and geographic barriers to obtaining genetic services. Few US studies examined interventions for cascade screening or used rigorous study designs such as randomized controlled trials. Moving forward, there remains an urgent need to conduct rigorous intervention studies on cascade screening in diverse US populations, while accounting for state policy considerations.

    • Global Health
      1. Notes from the Field: Diarrhea and acute respiratory infection, oral cholera vaccination coverage, and care-seeking behaviors of Rohingya refugees – Cox’s Bazar, Bangladesh, October-November 2017External
        Summers A, Humphreys A, Leidman E, Van Mil LT, Wilkinson C, Narayan A, Miah ML, Cramer BG, Bilukha O.
        MMWR Morb Mortal Wkly Rep. 2018 May 11;67(18):533-535.

        [No abstract]

    • Immunity and Immunization
      1. BACKGROUND: In the United States, the Advisory Committee on Immunization Practices (ACIP) has recommended routine human papillomavirus (HPV) vaccination at age 11-12years since 2006 for girls and since 2011 for boys. ACIP also recommends vaccination through age 26 for females and through age 21 for males; males may be vaccinated through age 26. We describe vaccine uptake in adolescents and young adults using data from MarketScan Commercial Claims and Encounters. METHODS: We analyzed data on persons aged 11-26years on December 31, 2014 who were continuously enrolled in a MarketScan health plan from age 11 through year 2014, or from 2006 to 2014 if aged >/=11years in 2006 (916,513 females, 951,082 males). Individuals were grouped based on their age (years) in 2014: 11-12 (born 2002-03), 13-14 (2000-01), 15-16 (1998-99), 17-18 (1996-97), 19-21 (1993-95), and 22-26 (1988-1992). We calculated cumulative coverage with >/=1 HPV vaccine dose by sex, birth cohort, and calendar year. RESULTS: In females, the proportion initiating vaccination at age 11-12years was low in 2008 and 2010 (12.6% and 11.1%) and higher in 2012 (15.7%) and 2014 (19.5%); in males, initiation at age 11-12 was 0.9% in 2010, 8.3% in 2012, and 15.1% in 2014. In females who aged into vaccine eligibility, cumulative coverage by 2014 was higher in older cohorts (17-18: 53%; 15-16: 47%; 13-14: 39%; 11-12: 19.5%). For males, cumulative coverage by 2014 was similar in those aged 13-14, 15-16, and 17-18years (28.9%, 32.5%, 30.3%), and lower in those aged 11-12 (15.1%), 19-21 (18.4%), and 22-26years (4.5%). CONCLUSION: The proportion of males and females initiating vaccination at the recommended ages was low. Although more females than males were vaccinated in all cohorts, the male-female differences were smaller in younger than older cohorts. The trajectory of male vaccination uptake could signal higher acceptability in males.

      2. Impact of rotavirus vaccine on diarrheal hospitalization and outpatient consultations in the Philippines: First evidence from a middle-income Asian countryExternal
        Lopez AL, Raguindin PF, Esparagoza J, Fox K, Batmunkh N, Bonifacio J, Parashar UD, Tate JE, Ducusin MJ.
        Vaccine. 2018 May 2.

        BACKGROUND: Monovalent rotavirus (RV) vaccine was introduced in the Philippines in a phased manner beginning in 2012. To assess the impact of RV vaccine, we conducted a retrospective review of diarrheal admissions in two hospitals. METHODS: Records of physician-diagnosed diarrheal admissions were reviewed in D.O. Plaza Hospital (DOPH) from 2009 to 2016 in Agusan del Sur where RV vaccine was introduced in the immunization program; and in Cotabato Regional Medical Center (CRMC) from 2011 to 2016 in a region where the vaccine was not introduced. Reports from consultations in public health clinics in Agusan Del Sur and RV vaccine coverage were obtained. RESULTS: All-cause diarrheal admissions among children <5years old in DOPH declined from 2013 to 2016 following RV vaccine introduction in 2012. Using the 2009-2011 mean number of hospitalizations as baseline (X=1,141), the reductions were 28% (n=821), 56% (n=507), 63% (n=417) and 59% (n=466) in 2013, 2014, 2015 and 2016, respectively. In comparison, no substantial declines in diarrheal hospitalizations were seen in CRMC from 2011 to 2016. A declining trend was also seen in outpatient consultations in Agusan del Sur following RV vaccine introduction with declines of 27% (n=2,333), 33% (n=2,143), 45% (n=1,764) and 67% (n=1,059) in 2013, 2014, 2015 and 2016. From September 2012 to December 2016, the 1 and 2-dose RV vaccine coverage gradually increased from 5% and 4% in 2012 to 92% and 88% in 2015, but decreased in 2016 to 53% and 52%, respectively. DISCUSSION: RV vaccine introduction was associated with a substantial decline in diarrheal hospitalizations and outpatient consultations for diarrhea in Agusan del Sur, Philippines.

      3. [No abstract]

    • Injury and Violence
      1. Deaths from falls among persons aged >/=65 years – United States, 2007-2016External
        Burns E, Kakara R.
        MMWR Morb Mortal Wkly Rep. 2018 May 11;67(18):509-514.

        Deaths from unintentional injuries are the seventh leading cause of death among older adults (1), and falls account for the largest percentage of those deaths. Approximately one in four U.S. residents aged >/=65 years (older adults) report falling each year (2), and fall-related emergency department visits are estimated at approximately 3 million per year.* In 2016, a total of 29,668 U.S. residents aged >/=65 years died as the result of a fall (age-adjusted rate(dagger) = 61.6 per 100,000), compared with 18,334 deaths (47.0) in 2007. To evaluate this increase, CDC produced age-adjusted rates and trends for deaths from falls among persons aged >/=65 years, by selected characteristics (sex, age group, race/ethnicity, and urban/rural status) and state from 2007 to 2016. The rate of deaths from falls increased in the United States by an average of 3.0% per year during 2007-2016, and the rate increased in 30 states and the District of Columbia (DC) during that period. In eight states, the rate of deaths from falls increased for a portion of the study period. The rate increased in almost every demographic category included in the analysis, with the largest increase per year among persons aged >/=85 years. Health care providers should be aware that deaths from falls are increasing nationally among older adults but that falls are preventable. Falls and fall prevention should be discussed during annual wellness visits, when health care providers can assess fall risk, educate patients about falls, and select appropriate interventions.

      2. Adverse childhood experiences and HIV sexual risk-taking behaviors among young adults in MalawiExternal
        VanderEnde K, Chiang L, Mercy J, Shawa M, Hamela J, Maksud N, Gupta S, Wadonda-Kabondo N, Saul J, Gleckel J, Kress H, Hillis S.
        J Interpers Violence. 2018 Jun;33(11):1710-1730.

        Adverse childhood experiences (ACEs) exhibit a dose-response association with poor health outcomes in adulthood, including HIV. In this analysis, we explored the relationship between ACEs and HIV sexual risk-taking behaviors among young adults in Malawi. We analyzed responses from sexually active 19- to 24-year-old males and females ( n = 610) participating in the Malawi Violence Against Children Survey. We tested the association between respondents’ exposure to six ACEs (having experienced emotional, physical, or sexual violence; witnessing intimate partner violence or an attack in the community; one or both parents died) and infrequent condom use in the past year and multiple sexual partners in the past year. We used logistic regression to test the association between ACEs and these sexual risk-taking behaviors. A majority (82%) of respondents reported at least 1 ACE, and 29% reported 3+ ACEs. We found positive unadjusted associations between the number of ACEs (1-2 and 3+ vs. none) and both outcomes. In adjusted models, we found positive associations between the number of ACEs and infrequent condom use (adjusted odds ratio [aOR]: 2.7, 95% confidence interval [CI]: [1.0, 7.8]; aOR: 3.7, CI: [1.3, 11.1]). Among young adults in Malawi, exposure to ACEs is positively associated, in a dose-response fashion, with engaging in some sexual risk-taking behaviors. HIV prevention efforts in Malawi may benefit from prioritizing programs and policies aimed at preventing and responding to violence against children.

    • Laboratory Sciences
      1. Dosimetry of inhaled elongate mineral particles in the respiratory tract: The impact of shape factorExternal
        Asgharian B, Owen TP, Kuempel ED, Jarabek AM.
        Toxicol Appl Pharmacol. 2018 May 5.

        Inhalation exposure to some types of fibers (e.g., asbestos) is well known to be associated with respiratory diseases and conditions such as pleural plaques, fibrosis, asbestosis, lung cancer, and mesothelioma. In recent years, attention has expanded to other types of elongate mineral particles (EMPs) that may share similar geometry with asbestos fibers but which may differ in mineralogy. Inhalability, dimensions and orientation, and density are major determinants of the aerodynamic behavior for fibers and other EMPs; and the resultant internal dose is recognized as being the critical link between exposure and pathogenesis. Insufficient data are available to fully understand the role of specific physicochemical properties on the potential toxicity across various types of fiber materials. While additional information is required to assess the potential health hazards of EMPs, dosimetry models are currently available to estimate the initially deposited internal dose, which is an essential step in linking airborne exposures to potential health risks. Based on dosimetry model simulations, the inhalability and internal dose of EMPs were found to be greater than that of spherical particles having the same mass or volume. However, the complexity of the dependence of internal dose on EMPs dimensions prevented a straightforward formulation of the deposition-dimension (length or diameter) relationship. Because health outcome is generally related to internal dose, consideration of the factors that influence internal dose is important in assessing the potential health hazards of airborne EMPs.

      2. Characterization of rabies pDNA nanoparticulate vaccine in poloxamer 407 gelExternal
        Bansal A, Wu X, Olson V, D’Souza MJ.
        Int J Pharm. 2018 May 7.

        Plasmid DNA (pDNA) vaccines have the potential for protection against a wide range of diseases including rabies but are rapid in degradation and poor in uptake by antigen-presenting cells. To overcome the limitations, we fabricated a pDNA nanoparticulate vaccine. The negatively charged pDNA was adsorbed onto the surface of cationic PLGA (poly (d, l-lactide-co-glycolide))-chitosan nanoparticles and were used as a delivery vehicle. To create a hydrogel for sustainable vaccine release, we dispersed the pDNA nanoparticles in poloxamer 407 gel which is liquid at 4 degrees C and turns into soft gels at 37 degrees C, providing ease of administration and preventing burst release of pDNA. Complete immobilization of pDNA to cationic nanoparticles was achieved at a pDNA to nanoparticles ratio (P/N) of 1/50. Cellular uptake of nanoparticles was both time and concentration dependent and followed a saturation kinetics with Vmax of 11.389 microg/mL.hr and Km of 139.48 microg/mL. The in-vitro release studies showed the nanoparticulate vaccine has a sustained release for up to 24 days. In summary, pDNA PLGA-chitosan nanoparticles were non-cytotoxic, their buffering capacity and cell uptake were enhanced, and sustained the release of pDNA. We expect our pDNA vaccine’s potency will be greatly improved in the animal studies.

      3. Detection of TR34/L98H CYP51A mutation through passive surveillance for azole-resistant Aspergillus fumigatus in the United States from 2015 to 2017External
        Berkow EL, Nunnally NS, Bandea A, Kuykendall R, Beer K, Lockhart SR.
        Antimicrob Agents Chemother. 2018 May;62(5).

        The emergence of azole-resistant Aspergillus fumigatus has become a clinical problem in many parts of the world. Several amino acid mutations in the azole target protein Cyp51Ap contribute to this resistance, with the most concerning being the environmentally derived TR34/L98H and TR46/Y121F/T289A mutations. Here, we performed passive surveillance to assess a sample of the A. fumigatus population in the United States for the presence of these mutations. We found 1.4% of those isolates to exhibit elevated MIC via broth microdilution, and five of those isolates harbored the TR34/L98H mutation.

      4. Smartphones have evolved into powerful devices with computing capabilities that rival the power of personal computers. Any smartphone can now be turned into a sound-measuring device because of its built-in microphone. The ubiquity of these devices allows the noise measuring apps to expand the base of people being able to measure noise. Many sound measuring apps exist on the market for various mobile platforms, but only a fraction of these apps achieve sufficient accuracy for assessing noise levels, let alone be used as a replacement for professional sound level measuring instruments. In this paper, we present methods and results of calibrating our in-house developed NoiSee sound level meter app according to relevant ANSI (American National Standards Institute) and IEC (International Electrotechnical Commission) sound level meter standards. The results show that the sound level meter app and an external microphone can achieve compliance with most of the requirements for Class 2 of IEC 61672/ANSI S1.4-2014 standard.

      5. ICTV virus taxonomy profile: TogaviridaeExternal
        Chen R, Mukhopadhyay S, Merits A, Bolling B, Nasar F, Coffey LL, Powers A, Weaver SC, Ictv Report C.
        J Gen Virol. 2018 May 10.

        The Togaviridae is a family of small, enveloped viruses with single-stranded, positive-sense RNA genomes of 10-12 kb. Within the family, the genus Alphavirus includes a large number of diverse species, while the genus Rubivirus includes the single species Rubella virus. Most alphaviruses are mosquito-borne and are pathogenic in their vertebrate hosts. Many are important human and veterinary pathogens (e.g. chikungunya virus and eastern equine encephalitis virus). Rubella virus is transmitted by respiratory routes among humans. This is a summary of the International Committee on Taxonomy of Viruses (ICTV) Report on the taxonomy of the Togaviridae, which is available at www.ictv.global/report/togaviridae.

      6. Capillary electrophoresis analysis of affinity to assess carboxylation of multi-walled carbon nanotubesExternal
        Davis TA, Patberg SM, Sargent LM, Stefaniak AB, Holland LA.
        Analytica Chimica Acta. 2018 .

        Surface oxidation improves the dispersion of carbon nanotubes in aqueous solutions and plays a key role in the development of biosensors, electrochemical detectors and polymer composites. Accurate characterization of the carbon nanotube surface is important because the development of these nano-based applications depends on the degree of functionalization, in particular the amount of carboxylation. Affinity capillary electrophoresis is used to characterize the oxidation of multi-walled carbon nanotubes. A polytryptophan peptide that contains a single arginine residue (WRWWWW) serves as a receptor in affinity capillary electrophoresis to assess the degree of carboxylation. The formation of peptide-nanotube receptor-ligand complex was detected with a UV absorbance detector. Apparent dissociation constants (KD) are obtained by observing the migration shift of the WRWWWW peptide through background electrolyte at increasing concentrations of multi-walled carbon nanotubes. A 20% relative standard deviation in method reproducibility and repeatability is determined with triplicate analysis within a single sample preparation and across multiple sample preparations for a commercially available carbon nanotube. Affinity capillary electrophoresis is applied to assess differences in degree of carboxylation across two manufacturers and to analyze acid treated carbon nanotubes. The results of these studies are compared to X-ray photoelectron spectroscopy and zeta potential. Affinity capillary electrophoresis comparisons of carbon nanotube samples prepared by varying acid treatment time from 30 min to 3 h yielded significant differences in degree of carboxylation. X-ray photoelectron spectroscopy analysis was inconclusive due to potential acid contamination, while zeta potential showed no change based on surface charge. This work is significant to research involving carbon nanotube-based applications because it provides a new metric to rapidly characterize carbon nanotubes obtained from different vendors, or synthesized in laboratories using different procedures.

      7. CDK5 inhibition resolves PKA/cAMP-independent activation of CREB1 signaling in glioma stem cellsExternal
        Mukherjee S, Tucker-Burden C, Kaissi E, Newsam A, Duggireddy H, Chau M, Zhang C, Diwedi B, Rupji M, Seby S, Kowalski J, Kong J, Read R, Brat DJ.
        Cell Rep. 2018 May 8;23(6):1651-1664.

        Cancer stem cells promote neoplastic growth, in part by deregulating asymmetric cell division and enhancing self-renewal. To uncover mechanisms and potential therapeutic targets in glioma stem cell (GSC) self-renewal, we performed a genetic suppressor screen for kinases to reverse the tumor phenotype of our Drosophila brain tumor model and identified dCdk5 as a critical regulator. CDK5, the human ortholog of dCdk5 (79% identity), is aberrantly activated in GBMs and tightly aligned with both chromosome 7 gains and stem cell markers affecting tumor-propagation. Our investigation revealed that pharmaceutical inhibition of CDK5 prevents GSC self-renewal in vitro and in xenografted tumors, at least partially by suppressing CREB1 activation independently of PKA/cAMP. Finally, our TCGA GBM data analysis revealed that CDK5, stem cell, and asymmetric cell division markers segregate within non-mesenchymal patient clusters, which may indicate preferential dependence on CDK5 signaling and sensitivity to its inhibition in this group.

      8. Recent developments in molecular and chemical methods have enabled the analysis of fungal DNA and secondary metabolites, often produced during fungal growth, in environmental samples. We compared three fungal analytical methods by analyzing floor dust samples collected from an office building for fungi using viable culture, internal transcribed spacer (ITS) sequencing, and secondary metabolites using liquid chromatography-tandem mass spectrometry. Of the 32 metabolites identified, 29 had a potential link to fungi with levels ranging from 0.04 (minimum for alternariol monomethylether) to 5,700 ng/g (maximum for neoechinulin A). The number of fungal metabolites quantified per sample ranged from eight to sixteen (average=13/sample). We identified 216 fungal operational taxonomic units (OTUs) with the number per sample ranging from six to twenty-nine (average=18/sample). We identified 37 fungal species using culture and the number per sample ranged from two to thirteen (average=eight/sample). Agreement in identification between ITS sequencing and culturing was weak (kappa=-0.12-0.27). The number of cultured fungal species poorly correlated with OTUs, which did not correlate with the number of metabolites. These suggest that using multiple measurement methods may provide an improved understanding of fungal exposures in indoor environments and that secondary metabolites may be considered as an additional source of exposure. This article is protected by copyright. All rights reserved.

      9. Borrelia burgdorferi, the agent of Lyme borreliosis, can elude hosts’ innate and adaptive immunity as part of the course of infection. The ability of B. burgdorferi to invade or be internalized by host cells in vitro has been proposed as a mechanism for the pathogen to evade immune responses or antimicrobials. We have previously shown that B. burgdorferi can be internalized by human neuroglial cells. In this study we demonstrate that these cells take up B. burgdorferi via coiling phagocytosis mediated by the formin, Daam1, a process similarly described for human macrophages. Following coincubation with glial cells, B. burgdorferi was enwrapped by Daam1-enriched coiling pseudopods. Coiling of B. burgdorferi was significantly reduced when neuroglial cells were pretreated with anti-Daam1 antibody indicating the requirement for Daam1 for borrelial phagocytosis. Confocal microscopy showed Daam1 colocalizing to the B. burgdorferi surface suggesting interaction with borrelial membrane protein(s). Using the yeast 2-hybrid system for identifying protein-protein binding, we found that the B. burgdorferi surface lipoprotein, BBA66, bound the FH2 subunit domain of Daam1. Recombinant proteins were used to validate binding by ELISA, pull-down, and co-immunoprecipitation. Evidence for native Daam1 and BBA66 interaction was suggested by colocalization of the proteins in the course of borrelial capture by the Daam1-enriched pseudopodia. Additionally, we found a striking reduction in coiling for a BBA66-deficient mutant strain compared to BBA66-expressing strains. These results show that coiling phagocytosis is a mechanism for borrelial internalization by neuroglial cells mediated by Daam1.

    • Maternal and Child Health
      1. The design and implementation of the 2016 National Survey of Children’s HealthExternal
        Ghandour RM, Jones JR, Lebrun-Harris LA, Minnaert J, Blumberg SJ, Fields J, Bethell C, Kogan MD.
        Matern Child Health J. 2018 May 9.

        Introduction Since 2001, the Health Resources and Services Administration’s Maternal and Child Health Bureau (HRSA MCHB) has funded and directed the National Survey of Children’s Health (NSCH) and the National Survey of Children with Special Health Care Needs (NS-CSHCN), unique sources of national and state-level data on child health and health care. Between 2012 and 2015, HRSA MCHB redesigned the surveys, combining content into a single survey, and shifting from a periodic interviewer-assisted telephone survey to an annual self-administered web/paper-based survey utilizing an address-based sampling frame. Methods The U.S. Census Bureau fielded the redesigned NSCH using a random sample of addresses drawn from the Census Master Address File, supplemented with a unique administrative flag to identify households most likely to include children. Data were collected June 2016-February 2017 using a multi-mode design, encouraging web-based responses while allowing for paper mail-in responses. A parent/caregiver knowledgeable about the child’s health completed an age-appropriate questionnaire. Experiments on incentives, branding, and contact strategies were conducted. Results Data were released in September 2017. The final sample size was 50,212 children; the overall weighted response rate was 40.7%. Comparison of 2016 estimates to those from previous survey iterations are not appropriate due to sampling and mode changes. Discussion The NSCH remains an invaluable data source for key measures of child health and attendant health care system, family, and community factors. The redesigned survey extended the utility of this resource while seeking a balance between previous strengths and innovations now possible.

      2. Proportion of orofacial clefts attributable to recognized risk factorsExternal
        Raut JR, Simeone RM, Tinker SC, Canfield MA, Day RS, Agopian AJ.
        Cleft Palate Craniofac J. 2018 Jan 1:1055665618774019.

        OBJECTIVE: Estimate the population attributable fraction (PAF) for a set of recognized risk factors for orofacial clefts. DESIGN: We used data from the National Birth Defects Prevention Study. For recognized risk factors for which data were available, we estimated crude population attributable fractions (cPAFs) to account for potential confounding, average-adjusted population attributable fractions (aaPAFs). We assessed 11 modifiable and 3 nonmodifiable parental/maternal risk factors. The aaPAF for individual risk factors and the total aaPAF for the set of risk factors were calculated using a method described by Eide and Geffler. SETTING: Population-based case-control study in 10 US states. PARTICIPANTS: Two thousand seven hundred seventy-nine cases with isolated cleft lip with or without cleft palate (CL+/-P), 1310 cases with isolated cleft palate (CP), and 11 692 controls with estimated dates of delivery between October 1, 1997, and December 31, 2011. MAIN OUTCOME MEASURES: Crude population attributable fraction and aaPAF. RESULTS: The proportion of CL+/-P and CP cases attributable to the full set of examined risk factors was 50% and 43%, respectively. The modifiable factor with the largest aaPAF was smoking during the month before pregnancy or the first month of pregnancy (4.0% for CL+/-P and 3.4% for CP). Among nonmodifiable factors, the factor with the largest aaPAF for CL+/-P was male sex (27%) and for CP it was female sex (16%). CONCLUSIONS: Our results may inform research and prevention efforts. A large proportion of orofacial cleft risk is attributable to nonmodifiable factors; it is important to better understand the mechanisms involved for these factors.

    • Mining
      1. An FMM-FFT accelerated SIE simulator for analyzing EM wave propagation in mine environments loaded with conductorsExternal
        Yucel AC, Sheng W, Zhou C, Liu Y, Bagci H, Michielssen E.
        IEEE J Multiscale Multiphys Comput Tech. 2018 ;3:3-15.

        A fast and memory efficient three-dimensional full-wave simulator for analyzing electromagnetic (EM) wave propagation in electrically large and realistic mine tunnels/galleries loaded with conductors is proposed. The simulator relies on Muller and combined field surface integral equations (SIEs) to account for scattering from mine walls and conductors, respectively. During the iterative solution of the system of SIEs, the simulator uses a fast multipole method-fast Fourier transform (FMM-FFT) scheme to reduce CPU and memory requirements. The memory requirement is further reduced by compressing large data structures via singular value and Tucker decompositions. The efficiency, accuracy, and real-world applicability of the simulator are demonstrated through characterization of EM wave propagation in electrically large mine tunnels/galleries loaded with conducting cables and mine carts.

    • Occupational Safety and Health
      1. Respiratory symptoms in hospital cleaning staff exposed to a product containing hydrogen peroxide, peracetic acid, and acetic acidExternal
        Hawley B, Casey M, Virji MA, Cummings KJ, Johnson A, Cox-Ganser J.
        Ann Work Expo Health. 2018 May 4.

        [No abstract]

      2. Workers who operate mine haul trucks are exposed to whole-body vibration (WBV) on a routine basis. Researchers from the National Institute for Occupational Safety and Health (NIOSH) Pittsburgh Mining Research Division (PMRD) investigated WBV and hand-arm vibration (HAV) exposures for mine/quarry haul truck drivers in relation to the haul truck activities of dumping, loading, and traveling with and without a load. The findings show that WBV measures in weighted root-mean-square accelerations (aw) and vibration dose value (VDV), when compared to the ISO/ANSI and European Directive 2002/44/EC standards, were mostly below the Exposure Action Value (EAV) identified by the health guidance caution zone (HGCZ). Nevertheless, instances were recorded where the Exposure Limit Value (ELV) was exceeded by more than 500 to 600 percent for VDVx and awx, respectively. Researchers determined that these excessive levels occurred during the traveling empty activity, when the haul truck descended down grade into the pit loading area, sliding at times, on a wet and slippery road surface caused by rain and overwatering. WBV levels (not normalized to an 8-h shift) for the four haul truck activities showed mean awz levels for five of the seven drivers exceeding the ISO/ANSI EAV by 9-53 percent for the traveling empty activity. Mean awx and awz levels were generally higher for traveling empty and traveling loaded and lower for loading/dumping activities. HAV for measures taken on the steering wheel and shifter were all below the HGCZ which indicates that HAV is not an issue for these drivers/operators when handling steering and shifting control devices.

      3. OBJECTIVE: To examine dose-response relationships between internal uranium exposures and select outcomes among a cohort of uranium enrichment workers. METHODS: Cox regression was conducted to examine associations between selected health outcomes and cumulative internal uranium with consideration for external ionizing radiation, work-related medical X-rays and contaminant radionuclides technetium ((99) Tc) and plutonium ((239) Pu) as potential confounders. RESULTS: Elevated and monotonically increasing mortality risks were observed for kidney cancer, chronic renal diseases, and multiple myeloma, and the association with internal uranium absorbed organ dose was statistically significant for multiple myeloma. Adjustment for potential confounders had minimal impact on the risk estimates. CONCLUSION: Kidney cancer, chronic renal disease, and multiple myeloma mortality risks were elevated with increasing internal uranium absorbed organ dose. The findings add to evidence of an association between internal exposure to uranium and cancer. Future investigation includes a study of cancer incidence in this cohort.

    • Occupational Safety and Health – Mining
      1. BACKGROUND: Severe coal workers’ pneumoconiosis (CWP) is increasingly common, and sometimes requires lung transplantation. METHODS: Using Organ Procurement and Transplantation Network data, we updated the trend for CWP-related lung transplants, described CWP patients who have been waitlisted but not transplanted, and characterized the primary payer of medical costs for CWP-related and other occupational lung disease transplants. RESULTS: There have been at least 62 CWP-related lung transplants; 49 (79%) occurred in the last decade. The rate of these procedures has also increased. Twenty-seven patients were waitlisted but did not receive a transplant. Compared to other occupational lung diseases, transplants for CWP were more likely to be paid for by public insurance. CONCLUSIONS: The increase in the frequency and rate of lung transplantation for CWP is consistent with the rising prevalence of severe CWP among U.S. coal miners. Effective exposure controls and identification of early stage CWP remain essential for protecting these workers.

    • Parasitic Diseases
      1. Trichomonas vaginalis brain abscess in a neonateExternal
        Hamilton H, Pontiff KL, Bolton M, Bradbury RS, Mathison BA, Bishop H, De Almeida M, Ogden BW, Barnett E, Rastanis D, Klar AL, Uzodi AS.
        Clinical Infectious Diseases. 2018 ;66(4):604-607.

        We describe a case of cerebral trichomoniasis in a neonate in whom seizures and multiorgan failure developed during treatment for staphylococcal sepsis. Brain abscesses were identified with cranial sonography, and Trichomonas vaginalis was isolated from cerebrospinal fluid samples. The patient died despite metronidazole therapy.

      2. Effect of four rounds of annual school-wide mass praziquantel treatment for schistosoma mansoni control on schistosome-specific immune responsesExternal
        Ndombi EM, Abudho B, Kittur N, Carter JM, Korir H, Riner DK, Ochanda H, Lee YM, Secor WE, Karanja DM, Colley DG.
        Parasite Immunol. 2018 Mar 31:e12530.

        This study evaluated potential changes in antischistosome immune responses in children from schools that received 4 rounds of annual mass drug administration (MDA) of praziquantel (PZQ). In a repeated cross-sectional study design, 210 schistosome egg-positive children were recruited at baseline from schools in western Kenya (baseline group). Another 251 children of the same age range were recruited from the same schools and diagnosed with schistosome infection by microscopy (post-MDA group). In-vitro schistosome-specific cytokines and plasma antibody levels were measured by ELISA and compared between the 2 groups of children. Schistosome soluble egg antigen (SEA) and soluble worm antigen preparation (SWAP) stimulated higher IL-5 production by egg-negative children in the post-MDA group compared to the baseline group. Similarly, anti-SEA IgE levels were higher in egg-negative children in the post-MDA group compared to the baseline group. Anti-SEA and anti-SWAP IgG4 levels were lower in egg-negative children in the post-MDA group compared to baseline. This resulted in higher anti-SEA IgE/IgG4 ratios for children in the post-MDA group compared to baseline. These post-MDA immunological changes are compatible with the current paradigm that treatment shifts immune responses to higher antischistosome IgE:IgG4 ratios in parallel with a potential increase in resistance to reinfection.

      3. Risk factors for sporadic Giardia infection in the USA: a case-control study in Colorado and MinnesotaExternal
        Reses HE, Gargano JW, Liang JL, Cronquist A, Smith K, Collier SA, Roy SL, Vanden Eng J, Bogard A, Lee B, Hlavsa MC, Rosenberg ES, Fullerton KE, Beach MJ, Yoder JS.
        Epidemiol Infect. 2018 May 9:1-8.

        Giardia duodenalis is the most common intestinal parasite of humans in the USA, but the risk factors for sporadic (non-outbreak) giardiasis are not well described. The Centers for Disease Control and Prevention and the Colorado and Minnesota public health departments conducted a case-control study to assess risk factors for sporadic giardiasis in the USA. Cases (N = 199) were patients with non-outbreak-associated laboratory-confirmed Giardia infection in Colorado and Minnesota, and controls (N = 381) were matched by age and site. Identified risk factors included international travel (aOR = 13.9; 95% CI 4.9-39.8), drinking water from a river, lake, stream, or spring (aOR = 6.5; 95% CI 2.0-20.6), swimming in a natural body of water (aOR = 3.3; 95% CI 1.5-7.0), male-male sexual behaviour (aOR = 45.7; 95% CI 5.8-362.0), having contact with children in diapers (aOR = 1.6; 95% CI 1.01-2.6), taking antibiotics (aOR = 2.5; 95% CI 1.2-5.0) and having a chronic gastrointestinal condition (aOR = 1.8; 95% CI 1.1-3.0). Eating raw produce was inversely associated with infection (aOR = 0.2; 95% CI 0.1-0.7). Our results highlight the diversity of risk factors for sporadic giardiasis and the importance of non-international-travel-associated risk factors, particularly those involving person-to-person transmission. Prevention measures should focus on reducing risks associated with diaper handling, sexual contact, swimming in untreated water, and drinking untreated water.

    • Reproductive Health
      1. Effect of the depot medroxyprogesterone acetate injectable and levonorgestrel implant on HIV genital shedding: a randomized trialExternal
        Chinula L, Nelson JA, Wiener J, Tang JH, Hurst S, Tegha G, Msika A, Ellington S, Hosseinipour MC, Mataya R, Haddad LB, Kourtis AP.
        Contraception. 2018 May 7.

        OBJECTIVES: To assess the effect of the depot medroxyprogesterone acetate injectable (DMPA) and of the levonorgestrel (LNG)-implant on genital HIV shedding among women receiving antiretroviral therapy (ART). METHODS: We randomized HIV-infected Malawian women to either DMPA or LNG-implant from May 2014 to April 2015. HIV RNA was measured in cervicovaginal lavage (CVL) fluid and TearFlo Strips (TFS), and HIV DNA was measured in cells collected by CVL. We compared the frequency and magnitude of HIV genital shedding before and for 6months after initiation of contraception and between arms among women receiving ART. We also compared genital HIV RNA levels obtained by sample type (TFS versus CVL). RESULTS: We analyzed data for 68 HIV-infected women receiving ART; 33 randomized to DMPA and 35 randomized to the LNG-implant. Overall, HIV RNA was more often detectable and the quantity was higher on TFS, compared with CVL. HIV DNA was detected very rarely in CVL cell samples (4 of 360 samples). The frequency of genital shedding and the genital HIV quantity did not increase after contraceptive initiation with either DMPA or LNG-implant among women receiving ART. CONCLUSIONS: HIV-infected women receiving ART initiating contraception with either DMPA or LNG-implant did not have any increase in genital HIV shedding during the first 6months of contraceptive use. These findings are consistent with growing evidence that progestin contraception is not associated with increased HIV transmission risk from such women to their male partners. Consistent with other studies, genital HIV RNA detection was higher in TFS than in CVL fluid. IMPLICATIONS: In this randomized trial, neither DMPA nor the LNG-implant, two of the most commonly-used hormonal contraceptives among African women with HIV, was associated with increased genital HIV shedding in HIV-infected women receiving ART. These findings are reassuring and add to the currently limited information available for the highly effective contraceptive, LNG implant.

      2. Sexual and reproductive health care receipt among young males aged 15-24External
        Marcell AV, Gibbs SE, Pilgrim NA, Page KR, Arrington-Sanders R, Jennings JM, Loosier PS, Dittus PJ.
        J Adolesc Health. 2018 Apr;62(4):382-389.

        PURPOSE: This study aimed to describe young men’s sexual and reproductive health care (SRHC) receipt by sexual behavior and factors associated with greater SRHC receipt. METHODS: There were 427 male patients aged 15-24 who were recruited from 3 primary care and 2 sexually transmitted disease (STD) clinics in 1 urban city. Immediately after the visit, the survey assessed receipt of 18 recommended SRHC services across four domains: screening history (sexual health, STD/HIV test, family planning); laboratories (STDs/HIV); condom products (condoms/lubrication); and counseling (STD/HIV risk reduction, family planning, condoms); in addition, demographic, sexual behavior, and visit characteristics were examined. Multivariable Poisson regressions examined factors associated with each SRHC subdomain adjusting for participant clustering within clinics. RESULTS: Of the participants, 90% were non-Hispanic black, 61% were aged 20-24, 90% were sexually active, 71% had female partners (FPs), and 20% had male or male and female partners (M/MFPs). Among sexually active males, 1 in 10 received all services. Half or more were asked about sexual health and STD/HIV tests, tested for STDs/HIV, and were counseled on STD/HIV risk reduction and correct condom use. Fewer were asked about family planning (23%), were provided condom products (32%), and were counseled about family planning (35%). Overall and for each subdomain, never sexually active males reported fewer services than sexually active males. Factors consistently associated with greater SRHC receipt across subdomains included having M/MFPs versus FPs, routine versus non-STD-acute visit, time alone with provider without parent, and seen at STD versus primary care clinic. Males having FPs versus M/MFPs reported greater family planning counseling. CONCLUSIONS: Findings have implications for improving young men’s SRHC delivery beyond the narrow scope of STD/HIV care.

    • Substance Use and Abuse
      1. Access to syringe services programs – Kentucky, North Carolina, and West Virginia, 2013-2017External
        Bixler D, Corby-Lee G, Proescholdbell S, Ramirez T, Kilkenny ME, LaRocco M, Childs R, Brumage MR, Settle AD, Teshale EH, Asher A.
        MMWR Morb Mortal Wkly Rep. 2018 May 11;67(18):529-532.

        The Appalachian region of the United States is experiencing a large increase in hepatitis C virus (HCV) infections related to injection drug use (IDU) (1). Syringe services programs (SSPs) providing sufficient access to safe injection equipment can reduce hepatitis C transmission by 56%; combined SSPs and medication-assisted treatment can reduce transmission by 74% (2). However, access to SSPs has been limited in the United States, especially in rural areas and southern and midwestern states (3). This report describes the expansion of SSPs in Kentucky, North Carolina, and West Virginia during 2013-August 1, 2017. State-level data on the number of SSPs, client visits, and services offered were collected by each state through surveys of SSPs and aggregated in a standard format for this report. In 2013, one SSP operated in a free clinic in West Virginia, and SSPs were illegal in Kentucky and North Carolina; by August 2017, SSPs had been legalized in Kentucky and North Carolina, and 53 SSPs operated in the three states. In many cases, SSPs provide integrated services to address hepatitis and human immunodeficiency virus (HIV) infection, overdose, addiction, unintended pregnancy, neonatal abstinence syndrome, and other complications of IDU. Prioritizing development of SSPs with sufficient capacity, particularly in states with counties vulnerable to epidemics of hepatitis and HIV infection related to IDU, can expand access to care for populations at risk.

      2. Background: Many people with cancer continue smoking despite evidence that it negatively effects cancer treatment, worsens chemotherapy toxicity, and increases risk for a second cancer. Aims: We examined tobacco treatment services offered to cancer patients at hospitals providing oncology services, including National Cancer Institute (NCI)-Designated Cancer Centers (NDCCs). Methods: We examined survey data of 6,400 U.S. hospitals from 2008 to 2015 to determine the manner in which tobacco treatment/cessation program services were provided among NDCCs and non-NDCC hospitals providing oncology services (HPOs). Results: From 2008 to 2015, 784 responses from NDCCs and 18,281 responses from HPOs were received. NDCCs (86%) reported significantly higher tobacco treatment/cessation programs owned by the hospital compared to HPOs (68%) (p < 0.001). Among NDCCs, there was a significant increasing trend of tobacco treatment/cessation programs reported owned by the hospital, the health system, or other contractual mechanism from 2008 to 2015 (p = 0.03). Conclusions: More than 80% of oncology providing hospitals report providing tobacco cessation programs, with higher percentages reported in NDCCs. As hospitals implement smoking cessation programs, partnerships between hospitals and cancer coalitions could help bring tobacco cessation activities to communities they both serve, and link discharged patients to these cessation resources so they can continue quit attempts that they initialised while hospitalised.

      3. Tobacco cessation interventions and smoke-free policies in mental health and substance abuse treatment facilities – United States, 2016External
        Marynak K, VanFrank B, Tetlow S, Mahoney M, Phillips E, Jamal Mbbs A, Schecter A, Tipperman D, Babb S.
        MMWR Morb Mortal Wkly Rep. 2018 May 11;67(18):519-523.

        Persons with mental or substance use disorders or both are more than twice as likely to smoke cigarettes as persons without such disorders and are more likely to die from smoking-related illness than from their behavioral health conditions (1,2). However, many persons with behavioral health conditions want to and are able to quit smoking, although they might require more intensive treatment (2,3). Smoking cessation reduces smoking-related disease risk and could improve mental health and drug and alcohol recovery outcomes (1,3,4). To assess tobacco-related policies and practices in mental health and substance abuse treatment facilities (i.e., behavioral health treatment facilities) in the United States (including Puerto Rico), CDC and the Substance Abuse and Mental Health Services Administration (SAMHSA) analyzed data from the 2016 National Mental Health Services Survey (N-MHSS) and the 2016 National Survey of Substance Abuse Treatment Services (N-SSATS). In 2016, among mental health treatment facilities, 48.9% reported screening patients for tobacco use, 37.6% offered tobacco cessation counseling, 25.2% offered nicotine replacement therapy (NRT), 21.5% offered non-nicotine tobacco cessation medications, and 48.6% prohibited smoking in all indoor and outdoor locations (i.e., smoke-free campus). In 2016, among substance abuse treatment facilities, 64.0% reported screening patients for tobacco use, 47.4% offered tobacco cessation counseling, 26.2% offered NRT, 20.3% offered non-nicotine tobacco cessation medications, and 34.5% had smoke-free campuses. Full integration of tobacco cessation interventions into behavioral health treatment, coupled with implementation of tobacco-free campus policies in behavioral health treatment settings, could decrease tobacco use and tobacco-related disease and could improve behavioral health outcomes among persons with mental and substance use disorders (1-4).

      4. Chemical characterization of smokeless tobacco products from South Asia: Nicotine, unprotonated nicotine, tobacco-specific N-Nitrosamines, and flavor compoundsExternal
        Stanfill SB, Croucher RE, Gupta PC, Lisko JG, Lawler TS, Kuklenyik P, Dahiya M, Duncan B, Kimbrell JB, Peuchen EH, Watson CH.
        Food Chem Toxicol. 2018 May 7.

        [No abstract]

    • Zoonotic and Vectorborne Diseases
      1. Rift valley fever viral load correlates with the human inflammatory response and coagulation pathway abnormalities in humans with hemorrhagic manifestationsExternal
        de St Maurice A, Harmon J, Nyakarahuka L, Balinandi S, Tumusiime A, Kyondo J, Mulei S, Namutebi A, Knust B, Shoemaker T, Nichol ST, McElroy AK, Spiropoulou CF.
        PLoS Negl Trop Dis. 2018 May 4;12(5):e0006460.

        Rift Valley fever virus is an arbovirus that affects both livestock and humans throughout Africa and in the Middle East. Despite its endemicity throughout Africa, it is a rare event to identify an infected individual during the acute phase of the disease and an even rarer event to collect serial blood samples from the affected patient. Severely affected patients can present with hemorrhagic manifestations of disease. In this study we identified three Ugandan men with RVFV disease that was accompanied by hemorrhagic manifestations. Serial blood samples from these men were analyzed for a series of biomarkers specific for various aspects of human pathophysiology including inflammation, endothelial function and coagulopathy. There were significant differences between biomarker levels in controls and cases both early during the illness and after clearance of viremia. Positive correlation of viral load with markers of inflammation (IP-10, CRP, Eotaxin, MCP-2 and Granzyme B), markers of fibrinolysis (tPA and D-dimer), and markers of endothelial function (sICAM-1) were all noted. However, and perhaps most interesting given the fact that these individuals exhibited hemorrhagic manifestations of disease, was the finding of a negative correlation between viral load and P-selectin, ADAMTS13, and fibrinogen all of which are associated with coagulation pathways occurring on the endothelial surface.

      2. Scrub typhus diagnosis on acute specimens using serological and molecular assays – a 3-year prospective studyExternal
        Koralur M, Singh R, Varma M, Shenoy S, Acharya V, Kamath A, Stenos J, Athan E, Bairy I.
        Diagn Microbiol Infect Dis. 2018 Feb 24.

        Scrub typhus (ST) is an underdiagnosed acute febrile illness in the Asia Pacific region with recent reemergence. Clinical diagnosis is difficult, and laboratory confirmation is largely based on serological and molecular tests. However, Weil-Felix test still remains the only test available in much of the rural tropics where a disproportionate number of cases occur. Sensitive and affordable assays are important for broader use and accurate diagnosis. We evaluated the diagnostic capabilities of serological and molecular assays on single acute clinical samples. Out of 1036 cases, 319 were confirmed as ST, and the sensitivities of immunofluorescent assay (IFA), IgM enzyme-linked immunosorbent assay (ELISA), nested polymerase chain reaction (n-PCR) and WFT were 93.4%, 80.3%, 75.2%, and 54.2%, respectively. IgM ELISA + n-PCR combination demonstrated highest degree of agreement (kappa = .911) in the absence of IFA. Additionally, 16 cases were detected by n-PCR only. Our study emphasizes the diagnostic challenges in the developing world, importance of molecular tests, and best alternate assays in ST diagnosis.

      3. Meeting the urgent need for rabies education in HaitiExternal
        Osinubi MO, Fenelon N, Dyer JL, Franka R, Etheart M, Ali A, Birhane M, Phaimyr Jn Charles N, Destine A, Saleme N, Newman C, Crowdis K, Lutfy C, Rupprecht CE, Wallace RM, Johnson VR.
        Zoonoses Public Health. 2018 May 3.

        The highest rate of human rabies deaths reported in the Americas is in Haiti, and most of these deaths result from rabies virus infections that occur after individuals are bitten by infected dogs and do not receive rabies post-exposure prophylaxis. One barrier to rabies prevention in Haiti is a lack of knowledge about this disease among healthcare professionals and community members. During the past 4 years, The US Centers for Disease Control and Prevention has collaborated with public health officials and partners to develop, test and refine educational materials aimed at filling this need for rabies education. This report summarizes the use of feedback from knowledge, attitudes and practises surveys; key informant interviews; and focus groups to develop culturally appropriate rabies prevention materials for community members, health officials, clinicians, laboratory professionals, veterinary professionals, government officials and national and local district leaders about ways to prevent rabies. These formative research methods were critically important in ensuring that the materials would be culturally appropriate and would stand the greatest likelihood of motivating Haitians to protect themselves from rabies. Centers for Disease Control and Prevention is using lessons learned in Haiti to develop and test materials in other countries with high rates of canine rabies.

      4. Genotypes and subtypes of Cryptosporidium spp. in diarrheic lambs and goat kids in northern GreeceExternal
        Papanikolopoulou V, Baroudi D, Guo Y, Wang Y, Papadopoulos E, Lafi SQ, Abd El-Tawab MM, Diakou A, Giadinis ND, Feng Y, Xiao L.
        Parasitol Int. 2018 Apr 23;67(4):472-475.

        Inconsistent data exist on the distribution of zoonotic Cryptosporidium species and subtypes in sheep and goats in European countries, and few such data are available from Greece. In this study, 280 fecal specimens were collected from 132 diarrheic lambs and 148 diarrheic goat kids aged 4 to 15days on 15 farms in northern Greece, and examined for Cryptosporidium spp. using microscopy of Ziehl-Neelsen-stained fecal smears. Cryptosporidium spp. in 80 microscopy-positive fecal specimens (39 from lambs and 41 from goat kids) were genotyped by PCR-RFLP analysis of the small subunit rRNA gene and subtyped by sequence analysis the 60kDa glycoprotein gene. Among the 33 specimens successfully genotyped, C. parvum was found in 32 and C. xiaoi in one. Seven subtypes belonging to two subtype families (IIa and IId) were identified among the 29 C. parvum specimens successfully subtyped, including IIaA14G2R1 (1/29), IIaA15G2R1 (6/29), IIaA20G1R1 (7/29), IIdA14G2 (1/29), IIdA15G1 (9/29), IIdA16G1 (3/29), and IIdA23G1 (2/29). Lambs were more commonly infected with C. parvum IIa subtypes, whereas goat kids were more with IId subtypes. The results illustrate that C. parvum is prevalent in diarrheic lambs and goat kids in northern Greece and these animals could potentially play a role in epidemiology of human cryptosporidiosis.

      5. For those at risk for Zika virus infection, prevention requires an approach that includes individual, interpersonal, and community-level support for behavior change. In August 2016, the announcement of local Zika transmission in Florida provided an opportunity to determine whether Zika-related knowledge, attitudes, and behaviors might be affected differentially in Florida compared to the rest of the nation. From August 8-October 3, 2016, we conducted nationally representative weekly surveys (N = 12,236), oversampling Florida residents, measuring Zika virus news exposure, knowledge about transmission and prevention of the infection, and attitudes and behaviors toward prevention. We tested two classes of models: those focused on individual Zika risk perceptions (e.g., protection motivation theory) and one focused on community action beyond those directly at risk (social consensus model). Analyses assessed differences between Florida and the rest of the nation by survey week. Consistent with both models, Floridians demonstrated significantly higher levels of perceived susceptibility and knowledge, more positive attitudes toward Zika virus prevention, and higher likelihood of engaging in protective behavior than non-Floridians. Consistent with theories of individual risk perception, response was greater among respondents who saw themselves at risk of infection. However, consistent with the SCM, irrespective of personal risk, response was greater among Floridians. Nevertheless, more than half of the public took no direct action to prevent the spread of Zika. Communities at increased risk for a novel infection such as Zika may quickly acquire Zika-related knowledge, attitudes, and behavior, but large-scale community-wide response might be difficult without further community-level public education.

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CDC Science Clips Production Staff

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DISCLAIMER: Articles listed in the CDC Science Clips are selected by the Stephen B. Thacker CDC Library to provide current awareness of the public health literature. An article’s inclusion does not necessarily represent the views of the Centers for Disease Control and Prevention nor does it imply endorsement of the article’s methods or findings. CDC and DHHS assume no responsibility for the factual accuracy of the items presented. The selection, omission, or content of items does not imply any endorsement or other position taken by CDC or DHHS. Opinion, findings and conclusions expressed by the original authors of items included in the Clips, or persons quoted therein, are strictly their own and are in no way meant to represent the opinion or views of CDC or DHHS. References to publications, news sources, and non-CDC Websites are provided solely for informational purposes and do not imply endorsement by CDC or DHHS.

Page last reviewed: January 31, 2019